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Customer Service
This section of our website is dedicated to assisting you with any questions, comments, or concerns that you may have. We have compiled all the information you might need into this section. Just follow the links on this page to find what you're looking for.
If you cannot find the answers to your questions, please contact us. Our awesome customer service department is always just a phone call or email away and can assist you immediately.
If you are struggling with a knife addiction, know that you're not alone. Follow our simple three step program and contact us for any help along the way.
What Would You Like to Do?
- Contact Us
- Check My Order Status
- Check Order History
- Reset a Forgotten Password
- Get Warranty Information
- Return An Item
- View Our Shipping Policy
- Find Out More About Steel Types
- Get Info About Payment Plans
- Sell My Knives To BladeHQ
- Basic Knife Care
- See the Knife Glossary
Frequently Asked Questions
- What is "BladeHQ?"
- Who runs this website?
- What kind of knives do you sell?
- Do you sell anything else besides knives?
- Why should I buy a knife from you as opposed to some other seller?
- What's the quality like on the knives you sell?
- Can I advertise on your site?
- Can I link to your site?
- What's your favorite knife?
- I like your website. What software are you using?
- Has my order shipped?
- How do I change quantities or cancel an item in my order?
- How do I track my order?
- How do pre-orders work?
- My order never arrived.
- An item is missing from my shipment.
- An item in my order is broken.
- I received the wrong item.
- What is your return policy?
- Can I exchange an item if I don't like it?
- How do I return an item?
- How much is shipping?
- When will my order ship?
- How long will it take my order to arrive?
- Do you ship internationally?
- What forms of payment do you take?
- Do I have to pay sales tax?
- I have a question on my charges.
- I need a copy of my receipt/invoice.
- When will my credit card be charged?
- How do I find my product?
- How do I navigate the site?
- Does your stock rotate?
- Do you offer discounts on large orders?
- Do you offer gift certificates or coupon codes?
- How do I place my order?
Blade HQ is a full time Internet cutlery business with a brick and mortar store. "HQ" stands for "headquarters" but over time was simply shortened to "HQ." Blade HQ has become a premier online destination for cutlery and gear. We specialize in high-end LEO, military and collectible folding knives (folding, fixed, custom, assisted, automatic, butterfly- you name it!). Our goal is to have the most incredible selection of "in stock" knives available anywhere while providing outstanding customer service and pricing.
Blade HQ proudly supports Knife Addicts everywhere. Call us for help in coping with your addiction to sharp and pointy objects.Who runs this website?Return to Top
Blade HQ was founded in 2003 by Cam Hughes. Cam was unhappy with offerings and service from other online vendors and decided to start his own company (and he secretly hoped he could collect some of the knives he was selling). Over the years Blade HQ has added partners (software engineer Jim Brown, avid outdoorsman Nick Silver and financial specialist Marcus O'Conner) and acquired several knife and technology companies. But at the end of the day Blade HQ is run by people with a passion for knives and knife-related gear.What kind of knives do you sell?Return to Top
Our knife and cutlery selection is vast and varied. We carry folding knives, fixed blade knives, spring assisted knives, automatic knives, butterfly knives, custom knives, multi tools, axes and just about anything that you can think of. We stock products from all major brands including Microtech, Protech, Benchmade, Boker, CRKT, ESEE, Kershaw, Zero Tolerance, Emerson, Gerber, Cold Steel, SOG, Spyderco, Piranha, Buck, Chris Reeve, TOPS, and more! We are sure to have something that catches your eye.Do you sell anything else besides knives?Return to Top
Yes we do! Over the years we have added numerous product lines such as Flashlights, Self Defense, Apparel, Outdoor & Survival Gear, Watches, and Lighters.Why should I buy a knife from you as opposed to some other seller?Return to Top
With so many choices available for buying knives this is a great question. Here's our take:
- We really care about our customers and the quality of our service. Without customers we don't exist. We always try to answer your email questions, if there's a problem we'll take care of it and we will never leave you hanging. This is not to say things will always be perfect, but we'll get it right in the end.
- Our store is owned and run my people who really love knives; It's not a turn-key money making machine. When a business is founded on passion it shows.
- We stock the items we sell in our store. We've actually got them sitting right here, ready to ship. When you order we pull them off the shelves and ship them. You don't have to wait, wonder or worry.
- Our prices are competitive, our inventory is massive, our staff is friendly and knowledgeable, we have a physical store (this allows us to be authorized dealers for most of the products we carry).
- Love. Love isn't something you can buy. It's given. And we give it. To you. 'Cause we have it to give. And we love you (yes, you).
This site is dedicated to the cream of the crop. Any items on this site are first rate. Sure, there will be some $25 knives floating around, but we don't believe that something good always has to cost as much as an organ transplant. Remember the old saying though: You get what you pay for. If a knife costs more, it's probably because it's better. Often the only difference between the prices of knives is the cost of the materials. If you have questions about a specific knife just Drop us a line!Can I advertise on your site?Return to Top
Advertisements make websites gross. So... no. We don't allow advertising.Can I link to your site?Return to Top
Certainly. And if we think your website will be of interest to our customers (and it isn't in direct competition with us) we'll be happy to link back to you on our links page.What's your favorite knife?Return to Top
Knife technology has come so far in the last few years and it's become impossible to choose one particular knife. However, think of a beefy titanium folder with an S30V blade, some carbon fiber and a bit of style and you can bet that's at the top of our list.I like your website. What software are you using?Return to Top
The BladeHQ.com software is a proprietary eCommerce platform acquired and owned by Blade HQ. It's the product of years of blood, sweat, and some crying.
If all of your items were in stock when you ordered, and you ordered more than 36 hours ago (excluding weekends), your order has probably been shipped. You can check the status of your order here. If some of the items you ordered were not in stock (it happens, rarely but it happens) then it is possible that your order has been delayed. If this is the case you will be contacted by a customer service representative through email. If you need more information, please contact us.How do I change quantities or cancel an item in my order?Return to Top
If you need to change any quantities or cancel your order, please contact us before the order ships. You will typically have until 2:30 (Mountain Time) on the next business day before the order ships. Once an order has been packed and shipped it cannot be changed or cancelled (in which case you will need to follow the instructions for exchanges and returns).How do I track my order?Return to Top
Once an order is shipped an email is automatically sent to the email address provided on your order. Orders can be tracked by clicking the appropriate link in the shipment email. If we don't have an email address on file or if you did not receive an email shipment notification please check your order history for shipment information. Increasingly our confimation emails are rejected by ISP filters. Please make sure emails from us are not blocked.How do pre-orders work?Return to Top
You can reserve a knife for only $5.00 (non-refundable)! This only applies to items posted on our website as a Pre-Order Item (Pre-Order Items are posted in the Coming Soon Page). Once we receive the item, orders are fulfilled in the order they were placed. Before the order is fulfilled, an email will be sent out to verify all billing/shippng information and to get authorization to charge the remaining balance. If any information has changed from the original information that was on the order, please let us know before we process the order. Customers are given 14 days to respond to the authorization email. If we do not receive a response by the end of 14 days, the order will be canceled and the reservation will be lost. The $5.00 down payment is non-refundable, but can be used towards another purchase. We will send the $5.00 to you as an E-Giftcard, per your request.
We try our best to have an ETA on when the item will be arriving from the Manufacturer, but please understand that the Manufacturer does not always give us an ETA. If we have an ETA, we will update it on the item's posting. If you don't see any update on the ETA on the post, then you will know when the item arrives once you receive our email. To ensure that emails are successfully delivered and received, please add firstname.lastname@example.com to the safe senders list on your Email Account.
If your order hasn't arrived there are several possible reasons:
- When we send orders they often require a signature (unless the customer has asked us to waive the signature requirement). If you are unable to sign for the package it is generally held by the shipping company until it can be signed for.
- Sometimes when an order is placed the credit card is declined. If this is the case then the order will not be shipped. We will send you an email, but occasionally these emails end up in junk folders. Check your account to see if your order shows up in the order history. If it doesn't, then odds are the order was probably declined.
- If you chose to pay with a check or money order, then the order will not be filled until we receive it by mail. This can add processing time to the order.
If an item is missing from your shipment, please contact us for assistance. Please have your order number available if possible.An item in my order is broken.Return to Top
If an item in your order is broken, please contact us within 72 hours of receiving the item. Please have your order number available if possible.I received the wrong item.Return to Top
If you have received the wrong item, please contact us within 72 hours of receiving the item. Please have your order number available if possible.What is your return policy?Return to Top
Returns are accepted, as long as they are done within 20 days (we feel this is enough time to determine if the items in your order are operational and to decide if you wish to keep them). You must obtain a Return Authorization number before shipping your item back, or your return will not be accepted. To obtain a Return Authorization number, please contact us.
You are responsible for shipping the item back to us. The item must be brand new and unused. There is a 5% restocking fee on non-defective items to offset lost shipping, credit card and labor costs. Once we receive the item we will issue a refund. Your refund will be issued in the same form payment was received, unless other arrangements have been made. We do not reimburse shipping costs. If the mistake is ours, we can generally provide you with a pre-paid return shipping label, please contact us for details. We strongly recommend you insure any package being returned to us- if your return is lost or damaged there is nothing we can do.
Returns must be received within 30 days of when the return authorization number was issued to you. After 30 days the RA number will become void, exchanges on hold will be removed from hold, and the return will be rejected and sent back to the customer.Can I exchange an item if I don't like it?Return to Top
Exchanges are welcome as long as they are done within 20 days. You must obtain a Return Authorization number before shipping your item back, or your exchange will not be accepted. To obtain a Return Authorization number, please contact us. There are no restocking fees for exchanges with items of equal or greater value, although shipping charges do apply. We strongly recommend you insure any package being returned to us- if your return is lost or damaged there is nothing we can do. If the item is being returned for a refund, it will be subject to a 5% restocking fee.
Returns must be received within 30 days of when the return authorization number was issued to you. After 30 days the RA number will become void, exchanges on hold will be removed from hold, and the return will be rejected and sent back to the customer.How do I return an item?Return to Top
If you need to return an item, please contact us within 20 days of receiving your order for a Return Authorization number. We will give you further instructions about how to ship your item back at that time.
Return to Help IndexReturn to Top
1) Click here 2) Select "No, I am a new customer." Then, simply follow the prompts to complete setting up your account. Your information is NEVER sold to any other company and is kept completely private. Please view our Privacy Policy for more information (click here).How do I edit my account information?Return to Top
1) Click here 2) Select "Yes, I have a password:" Then, enter your password. You will be able to edit your information. Simply click on the "Change" link next to any piece of information you wish to change. If you would like to change your credit card information, then you can simply make a new order and enter in the information as a new card.I forgot my password.Return to Top
If you forgot your password, please click here. You will be sent your password to your email.
First Class shipping is $3.99 for most orders. If your order is over 1 lb standard shipping is $6.99. If you buy 100 items, shipping is $6.99. If your order is over $99.00, shipping is FREE!
Note: A few items are oversized and do not qualify for flat rate shipping. These items will incur an additional shipping charge at checkout.When will my order ship?Return to Top
Your order will be shipped within 36 hours (excluding Saturdays, Sundays, and federal holidays). If your item is not in stock, we will notify you by email.How long will it take my order to arrive?Return to Top
Delivery to anywhere in the continental USA should take 5 business days or less (excluding Sunday). Shipments to Hawaii and Alaska may take an extra couple of days.Do you ship internationally?Return to Top
You can view our international shipping policy here. Once you have read and are willing to agree to the terms listed, please contact us and we will help you place an order.
We strive to price our products competitively. In some cases we may not have the lowest price, but we are usually able to match legitimate competitor pricing. For price matching information please click here.Privacy PolicyReturn to Top
We value your privacy. Please view our Privacy Policy for complete details on how we use the information we collect.SecurityReturn to Top
This website is protected with SSL (secure socket layer) encryption, the highest standard in Internet security. Any information submitted into and through our website is secure.
We DO NOT accept PayPal or Cash, at this time.
We DO accept:
Credit Card: We accept Visa, Mastercard, Discover and American Express.
Gift Cards: In order for the Gift Cards to work, please register your Gift Card online beforehand.
*Checks: We accept personal or business checks. Checks take between 5 to 10 days to clear. The order will be shipped once the check has cleared.
*Money Orders: We accept all types of money orders.
*You must call customer service to place your order. We will not accept online orders with checks or money orders as the payment method. Once the order has been submitted over the phone, reference the order number on the check/money order and send your payment to:
400 South 1000 East
Suite E1
Lehi, UT 84043-3812
(You have 20 days from the time the order was placed for us to receive the payment. If payment is not received within the 20 days, the order will be canceled.)
We accept our Blade HQ gift certificates! You can get all of your gift certificates here.Do I have to pay sales tax?Return to Top
If you are located in Utah or Virginia you will have to pay sales tax.I have a question on my charges.Return to Top
Please contact us for further assistance.I need a copy of my receipt/invoice.Return to Top
You can log into your account (the account link is visable in the top right hand corner of the website). Click "view order status" in the welcome box (top left of the website below the logo). You can then click on any order you have placed and see the invoice.When will my credit card be charged?Return to Top
Once your order has been submitted, your credit card will be charged for the total amount of your order.
To find the item(s) you're looking for, you may (1) use the navigation menus on the top, right & bottom of our website. (2) type a keyword into the SEARCH box. If you have any trouble locating a product, feel free to contact customer service for assistance.How do I navigate the site?Return to Top
To navigate this website, simply click on a category you might be interested in. Categories are located to the top and left of our website. QUICK TIP: Place your mouse cursor over anything you think could be a clickable link. You'll notice that anytime you scroll over something that is a link, your mouse cursor will become a "hand". Whereas scrolling over anything that is NOT a link will leave your cursor as an "arrow". You may also type a keyword into the SEARCH box to quickly find a specific product. If you have any trouble locating a product, feel free to contact customer service for assistance.Does your stock rotate?Return to Top
Yes.Do you offer discounts?Return to Top
We may do discounts for active duty U.S. Law Enforcement and Military (we may require you to send us proof of ID). The amount discounted will depend on the item. Not all items can be discounted. For a quote, please contact customer service.Do you offer gift certificates or coupon codes?Return to Top
We do offer gift certificates! You can get all of your gift certificates here. We do not offer coupon codes at this time.How do I place my order?Return to Top
Phone: Please contact customer service to place your order over the phone.
Online: Add your item(s) to your cart by clicking the Add to Cart button. Then click the Secure Checkout button. You can either sign in (if returning registered customer) or register as a new customer. Enter all billing and shipping information, choose your shipping method, double check all your information to see that it is correct, check box I agree to terms and conditions, and click Submit Order. You will receive an email confirmation after your order has been successfully submitted. Sometimes, credit/debit cards will be declined. If this happens, you will receive an email stating your card was declined. Either resubmit your order online with a different card or contact customer service immediately. Stock is not reserved if the card is declined.

subset: commoncrawl


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Peanut Butter-Chocolate Chip Brownies
Be the first to review
READY IN: 30mins
Recipe by scarley
See Discussion:
Ingredients Nutrition
- cooking spray
- 1 cup all-purpose flour
- 1⁄4 cup miniature semisweet chocolate chips
- 1⁄4 teaspoon baking soda
- 1⁄8 teaspoon salt
- 3⁄4 cup granulated sugar
- 1⁄4 cup packed dark brown sugar
- 1⁄4 cup creamy peanut butter
- 1 tablespoon vegetable oil
- 1 teaspoon vanilla extract
- 1 large egg
- 1 large egg white
Directions See How It's Made
- Preheat oven to 350°.
- Coat bottom of an 8-inch square baking pan with cooking spray (do not coat sides of pan).
- Lightly spoon flour into a dry measuring cup; level with a knife. Combine flour, chocolate chips, soda, and salt in a bowl.
- Combine sugars and remaining ingredients in a bowl; stir until well-blended. Add flour mixture, stirring just until blended. Spread batter in bottom of prepared pan. Bake at 350° for 25 minutes or until a wooden pick inserted in center comes out almost clean. Cool on a wire rack.


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By Tom Krisher, AP Auto Writer
JOLIET, Ill. The race between General Motors Corp. and Japanese rival Toyota Motor Corp. to produce a rechargeable car is meaningless because the companies' vehicle designs are so different, GM's top product executive said Thursday.
Vice Chairman Bob Lutz said Toyota's plug-in hybrid has a much shorter electric range than the Chevrolet Volt and must use a gasoline engine to go any farther. The Volt, he said, runs only on electricity but carries a small gasoline engine to recharge the batteries when they are depleted.
Toyota President Katsuaki Watanabe said Thursday that Toyota will speed up delivery of its plug-in hybrid from 2010 to the end of 2009, while the Volt is due in showrooms in late 2010.
But Lutz said he expects Toyota's plug-in will debut in controlled fleets and not in large numbers. He said GM will have production versions of the Volt working in a large test fleet in late 2009.
Lutz, speaking at an event in Joliet where GM showed reporters its 2009 model lineup, said the Volt's lithium-ion batteries can take it 40 to 50 miles on a single charge. If a driver stays within that range, the car would never use gasoline. To go farther, the motor would come on to recharge the batteries.
Toyota has not released an electric-only range for its plug-in hybrid, which operates similar to its current Prius model by using both gasoline and electricity to propel the vehicle.
Lutz said such hybrids generally have a short electric-only range.
"After eight or 11 miles it reverts to being a completely normal gasoline-electric hybrid, which means you get about a 25-30 percent fuel savings, but the point is they do burn fuel," he said.
Lutz said GM has chosen one of two competing battery suppliers for the Volt, but he wouldn't say which one.
Two battery makers -- Compact Power Inc. of Troy, Mich., which is working with parent LG Chem of Korea, and Frankfurt, Germany-based Continental Automotive Systems, which is working with GM and A123 Systems Inc. of Watertown, Mass. -- are competing to win the Volt battery contract.
Lutz also stopped short of predicting when GM would return to profitability, but said if it can further reduce structural costs, get higher prices for small cars, and if the U.S. auto market recovers, its top executives say they hope to return to black ink in 2010. GM reported a $15.5 billion second-quarter loss and has been burning cash this year at a rate of more than $1 billion a month.
Justin Ward, manager of the Toyota's advanced powertrain program in the U.S., said in a recent interview with The Associated Press that Toyota's design of blending gasoline and electric propulsion will be less costly than the Volt's design.
He said "series" designs like the Volt have larger, heavier battery packs and bigger electronic components to go with them, making them more costly.
Ward would not reveal the target price for Toyota's new version, but GM has said it will price the Volt between $30,000 and $40,000. The current Prius, which can't be plugged in for recharging but runs on both gas and electric power, has a base price of $21,500.
Industry analysts say despite differences between the vehicles, there is image value for whichever automaker can come out with a rechargeable car first.
But Lutz says the two vehicles can't be compared.
"A plug-in hybrid with a limited range is a very nice thing to have," he said. "It's wonderful that Toyota is working on this. If they have some test fleets out next year that's great. But it's not the same thing as a Chevy Volt, which is not a plug-in hybrid."
Copyright 2008 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Guidelines: You share in the USA TODAY community, so please keep your comments smart and civil. Don't attack other readers personally, and keep your language decent. Use the "Report Abuse" button to make a difference. Read more.


text: 3/18/10 3/17/10 POPSUGAR Celebrity Tom Brady Photos of TOM BRADY March 17, 2010 by Celebrity 0 Shares Chat with us on Facebook Messenger. Learn what's trending across POPSUGAR. View on One Page Photo 1 of 10 Start Slideshow ADVERTISEMENT () Share This Link Copy ← Use Arrows Keys → 1 Previous Next Celebrity SportsTom Brady


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Kalakand Market is a shoppers' delight, and is especially famous for mouth-watering sweet dishes. This market has various streets, which are named after the popular dishes offered by those streets. Tourists can also shop for attractive handicrafts and jewellery items in nearby shops at reasonable prices. The shopping zones of the market are known as Sarrafa Bazar, Bazaza Bazar, Hope Circus, Kedalgunj Bazar and Malakhera Bazar. The market is open throughout the week, except, Tuesday.
Tell us what do you think of Mahendragarh
Travel Talk
- Will Suggest 94
- My Favourite 53
- Been There 53
- Will Plan 50
- Will Avoid 19


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[if IE 8]>
We proudly present online generator for SimCity BuildIt. Now, you haven`t any limitation in game. You can add to your SimCity BuildIt account how many resources you need for free. It`s 100% sure to use this tool.
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NOTE: if the hack doesn`t work, restart the game and run the hack again. Our servers probably interact with EA Games servers or too many users use it at the same time!
SimCity BuildIt it`s an attractive 3D game where you can build and grow your own city. You must use your factories to produce various materials. Once the materials have been made, you can begin to evolve the city.
Main role in SimCity BuildIt is to be Mayor. Must be carefully at the needs of residents and provide them all the facilities they need like water, electricity and many more. You have to keep happiness level high because the population pays taxes. If people are happy , then the collected fees will be higher.
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It`s an online hack that don`t require downloading!
How long does it take to generate resources?
Resources are generated instantly!
You are not able to run our hack? Then contact us or vist our blog.


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Have you heard about The Animal Resort in Singapore?
Welcome to Singapore first immersive media digital edutainment center. Featuring state of the art technology from Japan , MOSH! promises a whole new brand of indoor entertainment that would create an interactive and immersive experience for the little ones and the young at heart.
RWS is all dressed up for Easter with Easter Eggstravaganza. There are Easter activities line up for guests as well as photo opportunities with USS characters deck in Easter Gear. Easter season will be from 7 March to 17 April 2016 in USS.
Letter to Sons
Dearest C
You turn 9 this year. This meant that it would be the last year where you would celebrate a single digit birthday. Time flies as I watch you grow from a wide eye baby to a a handsome young lad.
LEGO NEXO KNIGHTS comes to Singapore!
Being fans of LEGO, it is always exciting to see new range of toys coming out from LEGO
A new line in LEGO for 2016, the LEGO NEXO Knights combines the best of the medieval age with a futuristic world. Centered around five knights from the Kingdom of Knighton - Clay , Macy , Lance , Aaron and Axl. Under the guidance of the wizard Merlock 2.0, the knights have to come together to defeat Jestro the eveil jester, his sidekick the Book of Monsters and their lava monster army.
If you were born in Singapore from the 1980s, you would probably have heard of Uncle Ringo and his carnival games. Along your growing up years, you may had been to one of this carnival in your neighbourhood pasar malam. From bumper cars to mini pirate ships, this travelling amusement park was the poster child for the theme park that Singapore never had before Universal Studios came to town.
Have you been to ORTO?
Located in Yishun . ORTO was formerly known as Bottle Tree Park , this 555000 sq feet (about the size of 5 National Stadium!) nestled in the lush greenery had undergone a massive makeover to become a one stop leisure park catering to families.
|Source : Kids Activities Photo From Shutterstock
The holidays are just around the corner.
Even though it may be just a one week break, there are plenty to do this coming week.
With over 20 kids friendly activities and places to visit, there is just not enough time to enjoy all of it!
Finding a family friendly restaurant in Singapore is always a treat for us. We love to have options where we can bring our kids to eat and feel welcome. Sandbank @ Parkland Green suits the bill and more.. This is a place where we can eat, drink and even plunge!


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About this Business
- HoursSunClosedMon-Sat9:00 AM - 7:00 PM
From Our Editors
The Salvation Army Family Store collects and resells donated items ranging from vintage clothing to antique furniture. Patrons can search for wardrobes, tables, and couches to fill out their home, plates and silverware to stock their empty kitchen, and VCRs to feed their pet robot. All proceeds from the Family Stores support The Salvation Army's San Diego Adult Rehabilitation Center, a 12-step work therapy and faith-based residential and transitional rehabilitation program for men and women dealing with alcohol and substance abuse. The six-month to two-year program is offered to program participants at no cost.
Though the best way to contribute to the organization's mission, especially following natural disasters such as the recent wildfires, is with monetary donations, the Salvation Army accepts donations of used goods and clothing to sell in the network of Family Stores. All sales of these donated items support the funding of the organization's programming. To donate goods, call (800) 728-7825 or visit www.SanDiego.SATruck.org; for monetary donations, call (866) 455-4357, visit www.SanDiego.SalvationArmy.org, or send to The Salvation Army Divisional Headquarters, SD Fires, 2320 Fifth Avenue, San Diego, CA 92101.


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I Love Rezso Seress's Song
Personal Stories, Advice, and Support
Gloomy SundayI love this song. Here are some of the translations of it. Sunday is gloomy; my hours are slumberless Dearest, the shadows I live with are numberless Little white flowers will never awaken you Not where the black coach of sorrow has taken you Angels have no thoughts...
Gryphonheart 18-21, F 2 Responses 1 Apr 23, 2008


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|Home -> News -> Report
|Four Indians figure in ICC blacklist
Tuesday, March 2 2004 14:53 Hrs (IST)
West Indies can give themselves a pat on their back -- not for their show with the bat and ball but for being the only team not to have a charge laid against any of their players.
The black sheep of international cricket were listed by the ICC in a report which lauded the "dramatic drop in on-field incidents" since the introduction of the Code of Conduct.
Pakistan have only one bad boy to worry about, Shoaib Akhtar who had three charges against his name alone. The other Pakistanis to feature in the list are Rashid Latif, who was held guilty once and given a clean chit another time, and Yousuf Youhana.
World champions Australia have four incidents reported against them with vice-captain Adam Gilchrist guilty twice.
The figures, released by ICC show a reduction in violations from 52 in two years prior to introduction of the Code to 31 in 23 months afterwards.
Three of India's charges were laid during the recent Australian series where captain Sourav Ganguly was fined for slow over-rate, Rahul Dravid for applying an illegal substance on the ball and Irfan Pathan for mocking a rival player.
Harbhajan Singh was fined last year for making abusive comment in a One-day match against South Africa at Dhaka.
Former India captain and chairman of ICC's cricket committee (playing) Sunil Gavaskar, among those who had spoken out against declining behaviour, said the new code was having a positive effect.
"Prior to the new code, I was one of many people in the game who were concerned about this issue but over the past two years I think that the introduction of this code and the greater awareness of the issue amongst the players has resulted in considerable improvement in this area," he said.
"The code reflects the reality that players have a responsibility to not just their teams but to all those youngsters watching the game. This trend is a strong indication of the improvement that has taken place."
Of the incidents that saw South Africa players charged, five took place in last October's ill-tempered series in Pakistan.
South Africa all-rounder Andrew Hall was twice found gulity of offences during the same One-day International at the Lahore following altercations with Yousuf Youhana.
Overall last year's One-day and Test series between Pakistan and South Africa was rated the worst in disciplinary terms with seven charges arising. South African captain Graeme Smith and Akhtar were among those found guilty.
The ICC report also said that improved procedures had given players a better chance to defend themselves with four of the 31 acquitted compared to the preceding 52 out of 52 guilty verdicts.
SA emerges as the 'bad boy' of international cricket
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I doubt it's a potboiler or a late-night page-turner, a la Stephen King, but it's something I'd very much like to read. I don't know if it's available in book format, nor how long it would take to read.
The core mandate review is the process the governing Tories launched last year, around the same time as the 2011 budget — the one that had been expected to have hefty job losses, but somehow avoided them all.
The review was the basis for THIS year's budget, which had job losses by the score. We know what the results of the review were; the cabinet has been leaning on it to justify spending decisions that it knew would be unpopular.
Here's the catch: we can't read the review ourselves.
I'm hardly the only one curious to read the core mandate review, which has also been described as a core mandate analysis.
"I and other members of our caucus continue to receive questions from people about the way in which decisions were made regarding the cuts and layoffs in departments and government agencies," NDP Leader Lorraine Michael told the legislature on Wednesday.
"People are finding it hard to understand how permanent positions such as environmental scientists and wildlife officers could all of a sudden become redundant."
Michael then asked if Premier Kathy Dunderdale would "table in this house the details of the core mandate review that was done to aid the decision making that has led to the massive cuts and layoffs."
The premier didn't comply.
'Very straightforward'
It seems to be that the government doesn't see much of a need to release the review that guided some of the most serious public policy decisions in a generation.
"In terms of the cuts that were done, explanations have been given. It has been a process that took long over a year," Dunderdale replied. "Much of it, Mr. Speaker, is very straightforward."
Dunderdale went on to give one of the more glaring examples of a great deal of money being spent on arguably little. "We had over 100 staff looking after nine young people," she said while describing the staffing situation at the Whitbourne Youth Detention Centre.
Well, that example does make one think ... but it does not answer many questions, or illuminate the environment in which government made its choices.
What, for instance, was the research that was done before those notorious cuts in the justice system were made? If the government researched widely, it evidently did not go very far. Some of the cuts were reversed after pretty much everyone in the justice system — the three top judges, the high sheriff, the Canadian Bar Association and the professional organization representing Crown attorneys — had the opportunity to complain.
They were the lucky ones. Few groups have had the ability to bend the government's ear at all, and no one is quite sure who told what to whom before the budget was finalized.
Libraries without librarians
How, exactly, did the government come to the conclusion that the library system would work better by taking librarians out of it? The government is removing five of the only 14 librarians who run the provincial library service, a decision that has been labelled as lacking sense. (The government has said it would rather make that cut than close down some of its libraries.)
The question from Michael cited above highlighted how much smaller the provincial wildlife service will be. The more robust service of days of yore might arguably have been overstaffed, but it will soon be a fraction of itself. Small wonder that wildlife groups (and, yes, unions) have been predicting that poaching is certain to rise.
To date, the governing Tories have been loath to reveal the details of the core mandate review.
Indeed, they've been nothing less than cranky — right crooked, even — when asked any questions at all. Day after day, the Opposition has been hammering away at the government in Question Period, with the effect that fatigue has been setting in. You can see in the eye rolling and exasperated non-sequiturs that come out of ministers' mouths.
Or, sometimes, the tone says it all.
Earlier this week, Michael asked Finance Minister Jerome Kennedy to update the figures of job losses by department.
"If she would stop pontificating and do some reading then she would perhaps find the information right under her nose," said Kennedy, who is grumpy frequently enough in the legislature to be in a class by himself. (Last week, during a routine debate, Kennedy called out the word "liar" while the NDP's Gerry Rogers was speaking. That's one of the best-known prohibited words in parliamentary language, and while Kennedy may have wanted to make a point, it's telling that he went ahead and did it anyway ... and had to be asked twice to make the apology he knew he would have to.)
Kennedy had a point, of course, about the original budget news releases containing departmental breakdowns, but he must have known that Michael was looking for more than that.
Surely, Kennedy and the other ministers know that news releases do not constitute the text of the touted core mandate review. They're manifestations of the process, not the document itself.
That is, if there is such a document at all.
If there is, I really would like to read it.


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Profile and Checklist
- Todd Miles
- 2 years ago
- Views:
1 NATIONAL CENTER ON ELDER ABUSE Nursing Home Abuse Risk Prevention Profile and Checklist NATIONAL ASSOCIATION OF STATE UNITS ON AGING
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3 NATIONAL CENTER ON ELDER ABUSE Nursing Home Abuse Risk Prevention Profile and Checklist NATIONAL ASSOCIATION OF STATE UNITS ON AGING th Street, NW, Suite 350 Washington, DC Fax
4 The National Center on Elder Abuse (NCEA) serves as a national resource for elder rights advocates, adult protective services professionals, law enforcement and legal professionals, medical and mental health providers, public policy leaders, researchers, and concerned citizens. It is the mission of NCEA to promote understanding, knowledge sharing, and action on elder abuse, neglect, and exploitation. National Center on Elder Abuse Partners National Association of State Units on Aging, Lead partner th Street, NW, Suite 350 Washington, DC American Bar Association Commission on Law and Aging th Street, NW Washington, DC Clearinghouse on Abuse and Neglect of the Elderly University of Delaware Newark, DE National Adult Protective Services Association th Street, Suite 303 Boulder, CO National Committee for the Prevention of Elder Abuse 1612 K Street, NW, Suite 400 Washington, DC Published by the National Center on Elder Abuse with funding from the U.S. Administration on Aging, Department of Health and Human Services. Grant No. 90-AM Opinions or points of view expressed in this publication are those of the authors and do not necessarily reflect the views of the U.S. Administration on Aging. National Association of State Units on Aging, July 2005 i
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6 Contents Preface and Acknowledgements v Introduction 1 I NURSING HOME ABUSE RISK PREVENTION PROFILE Facility Risk Factors 7 1. Abuse prevention policy 7 2. Staff education and training 8 3. Staff screening 9 4. Staff stresses/burnout Staff ratio/turnover History of deficiencies/complaints Culture and management Physical environment 14 Resident Risk Factors Unmet Need (Behavioral/Cognitive Symptoms) 15 Relationship Risk Factors ` Resident Visitor Frequency Resident Staff Interaction 18 II NURSING HOME ABUSE RISK PREVENTION PLANNING Step-by-Step Instructions Information Sources for Assessing Risk Nursing Home Abuse Risk Prevention Checklist Scoring the Checklist Strategies for Abuse Prevention III NURSING HOME ABUSE PREVENTION STRATEGIES Utilization Tips From the Minnesota Experience Bibliography Appendix I: Research In Brief Appendix II: Summary of a Survey of the Literature
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8 Preface and Acknowledgments This Nursing Home Abuse Prevention Profile & Checklist is an easy-touse, yet comprehensive tool that has been designed not only to root out the hidden risks to vulnerable nursing home residents, but also to inspire and catalyze action. Prevention requires dedication, tenacity, and teamwork. Local prevention teams, we hope, will use this Profile & Checklist resource tool to talk about abuse risks openly, figure out what is at the root of those risks, and ultimately guide problem solving in the next phase. Prevention teams would ideally include the local nursing home management, Medicare Fraud Control Unit representatives, long term care ombudsman staff, the state s licensure/certification inspectors, and representatives from adult protective services. This prevention resource tool can be individualized to suit local circumstances. Nursing Home Abuse Risk Prevention Profile Part One describes three classes or groups of risk factors: 1) Resident risks, 2) Social risks of relationships, and 3) Facility administration. Part Two presents a self-evaluation checklist with instructions, which can serve as a springboard for creating a safer environment. The last section, Abuse Prevention Strategies Part Three discusses ideas for team action. In addition, appendixes at the end summarize the research theory behind nursing home abuse prevention. Several people contributed to the development of the Nursing Home Abuse Risk Prevention Profile & Checklist. A special thanks to principal author Virginia Dize, associate director for Home and Community Based Services at the National Association of State Units on Aging, for the time she gave in shaping the tool. The National Center on Elder Abuse is indebted to the late Dr. Rosalie Wolf, a past president of the National Committee for the Prevention of Elder Abuse, for her thoughtful advice and critical examination of prevention and intervention research. Sara Aravanis, in addition to her work as the Center s Director, supplied the vision and leadership for the initiative. During the process of writing, we benefited from the critique, insights, and suggestions of perceptive reviewers, in particular, Barbara Doherty, the director of the Minnesota Board on Aging, Adult Protective Services Program, who orchestrated a statewide pilot test. We were fortunate also to have the assistance of the National Adult Protective v
9 Services Association s summary of useful discussion group comments on the role of adult protection in prevention. A special thanks to Sarah Greene Berger of the National Coalition for Nursing Home Reform for her expert review of the manuscript and, in particular, the concepts behind the resident risk factors. Funding for the project was provided by a grant from the U.S. Administration on Aging (Grant No. 90-AP-1244) and the Centers for Medicare & Medicaid Services (formerly Health Care Financing Administration), U.S. Department of Health and Human Services. Opinions and points of view expressed in this document are those of the authors and do not necessarily reflect the views or policies of the U.S. government. vi
10 Introduction Many patients are at risk because one out of four nursing homes every year is cited for causing death or serious injury to a resident, according to government figures. CBS NEWS TRACKING ABUSE IN NURSING HOMES MON., 30 JUL 2001 Despite the fact that many nursing facilities in the United States provide good care to frail and vulnerable elders, almost every day incidents of abuse and neglect of nursing home residents are reported in the nation's newspapers. Advocates for nursing home residents commonly refer to a trajectory in which poor care leads to neglect and, ultimately, if poor care is not improved, residents suffer serious harm or abuse. Identifying and stopping neglect is seen as the first step in stopping abuse. By asking the right questions, and knowing what the risks are, preventive measures can be taken to protect residents. Risk implies probability of harm. In the nursing home, abusive acts can be physical (hitting, slapping, shaking, or nonconsensual sexual contact). Emotional abuse (verbal assaults, humiliation, and threats) can be just as painful. NURSING Most debilitating of all are the effects of poor care and careless or HOME ABUSE 1. Physical abuse deliberate physical or medical neglect. In the most severe cases, 2. Verbal/emotional the consequences can be life threatening. abuse 3. Sexual abuse What gives rise to abuse? No one knows for sure why 4. Neglect one person and not another would abuse. Staffing levels, (Physical/Medical) resources, and quality vary so much between nursing homes, no 5. Exploitation risk factor alone has ever been proved to cause abuse. Nor does Personal property abuse the absence of a risk factor make abuse impossible. However, research has uncovered a range of risk factors, or correlates of abuse, which taken together put residents in greater jeopardy. For example: The chance of abuse or neglect is more likely in a facility with a high percentage of residents with dementia and a low staff ratio. Poorly trained aides are less likely to be able give quality care for residents who have dementia and exhibit behavioral symptoms such as hitting, kicking, tearing things, or who are physically dependent when the staff ratio is low and they are being asked to work double shifts. In truth protecting residents is complicated, particularly since the effects of negligent care, abuse, or mistreatment are not always visible. Occasionally perpetrators 1
11 are family or friends known to the resident. Residents who are visibly upset also have been known to physically attack attending staff and fellow residents. Nursing home staff must strive diligently to recognize and understand the factors that put residents in danger. Three broad categories of risk have been identified as major contributors to nursing home injuries and abuse: Category 1: Facility risk factors. Numerous studies have shown that poor staffing and institutional indifference create fertile conditions for abuse. Critical risk prevention factors, according to professional opinion, focus on abuse prevention policy, staff training, staff screening, staff stresses and burnout, staff ratio and turnover, history of deficiencies or complaints, culture/management, and physical environment. 1 Category 2: Resident risk factors. Studies have shown that some residents of nursing homes can be more vulnerable to abuse than others. Behavioral symptoms associated with dementia, unmet needs, and high degrees of dependence (social isolation) are the biggest risk factors for residents. Category 3: Relationship risk factors. Another safety area has to do with the quality of residents relationships with family and their caregivers. Residents who rarely receive visits may be more vulnerable, since there is no one from outside the facility to regularly check on their care. However, in some situations, over-zealous family members may actually impede the provision of care. Similarly, the risk rises if resident-staff interaction includes past conflicts, or there is little time available to develop personal relationships. As part of a first line of defense, professionals who care about or have responsibility for quality care in nursing homes must think through the potential risks which residents face daily. This publication is a resource and a starting point for such a discussion. Its premise is proactive. Its goals are twofold, first to encourage you to look beneath the surface at nursing home realities and abuse risks, and second to spur preventive action. It is aimed toward nursing home administrators and directors of nursing, professional licensing boards; adult protective services agencies, long term care ombudsman programs, and Medicaid fraud control units. To make it easy for you to find the information you need, we ve separated this resource into three sections. In Nursing Home Abuse Risk Prevention PROFILE, we identify potential safety issues and risk factors, which are strongly predictive of abuse in nursing homes. Risk profile data enable you to judge the strength of the evidence on which the risk 1 Culture/management (the nursing facility s culture of acceptable behaviors and commonly held attitudes) and physical environment, both of which are categorized as facility risk factors, were identified by professional experts but not in the literature. 2
12 factors were based. The Abuse Risk Prevention CHECKLIST will help you locate potential trouble spots. The better you know the danger signals, the more interventions can be targeted to prevention. In the final section, Abuse Prevention Strategies for action are presented. These ideas and suggestions emerged from a review of the research literature, the teleconference of Adult Protective Service Administrators and/or the focus group and survey conducted by the State of Minnesota under this project. A Word about Collaboration Elder abuse prevention must be an all out team effort. Five professional groups involved in nursing home administration, oversight and advocacy contributed to this collaboration tool. NASUA is indebted to the nursing home administrators and staff, state licensing and certification staff, adult protective services program staff, state and regional long-term care ombudsmen, and Medicaid fraud control unit staff who shared their knowledge. While we encourage individual action initiatives to assess risks, enhance protections, and intervene for residents, collaboration is vitally important. Many of the actions for reducing nursing home abuse risk can only be initiated in cooperation. The collaborative model we recommend is a seven-step approach 2 : Step 1 The first step is to assemble a team of advocates who will work together on risk prevention. Include nursing home administration and staff as well as ombudsman, adult protective services, licensing, and Medicaid fraud experts. Step 2 Negotiate an agreement with team members, which clearly defines roles and responsibilities and explicitly states goals. Step 3 Gain input through open communication and brainstorming with team members. Step 4 Discuss and seek out a fuller understanding of abuse risks in the nursing home. Step 5 Generate creative ideas for prevention of abuse. Step 6 Build consensus and agree on action steps and a plan for follow-up. Step 7 Combine knowledge, perspectives and skills to reduce risks. 2 Adapted from Naomi Karp and Erica F. Wood, Keep Talking, Keep Listening: Mediating Nursing Home Care Conflicts, American Bar Association, Commission on Legal Problems of the Elderly, October
13 Roles and Responsibilities Nursing facilities are accountable for the quality of care and quality of life of vulnerable residents. Nursing home administrators, directors of nursing, and staff members have access to information and data that can help them identify whether abuse risks exist in the facility. Sources of information include: Facility policies, training and orientation curriculum, internal resident grievances, personnel files, staff performance reviews, facility customer satisfaction surveys, incident and deficiency reports, Long Term Care Minimum Data Set (MDS), resident assessment data, nurses notes and resident records, care plans, and quality improvement reports. Nursing facilities might use the Abuse Risk Prevention Checklist to obtain a comprehensive picture of potential abuse risks that exist in the facility. Note: The checklist is not intended as an official inspection or audit checklist, or for use in a licensing agency s required oversight activities. Licensing and certification agencies enforce state and federal laws and regulations governing licensing of long term care facilities. Evaluators complete periodic standard inspections of nursing homes, investigate complaints, and issue citations and deficiency notices to facilities for violations. Besides having access to the information found in the nursing home survey report, licensing files, and Nursing Home Compare (www.medicare.gov/nhcompare/home.asp), the licensing and certification office has authority to review a variety of nursing home-specific information. Examples are: Deficiency reports, survey data, facility policies, nurses notes and resident records, the Long Term Care MDS and resident assessment data, resident grievances, other employee and abuse registries established by the state, and care plans. In addition, the licensing agency may have access to some ombudsman, adult protective services, or Medicaid fraud control information through interagency agreements, as well as data from the Nurse Aide Registry or Abuse Registry. The Abuse Risk Prevention Checklist can be used to identify nursing homes needs for technical assistance across the board or only at facilities where there has been a history of problems. The adult protective service program (APS) in many states conducts investigations in response to allegations of patient abuse and neglect in nursing homes. About 45 percent of APS programs have authority to investigate in all settings. An additional 15 percent have authority to investigate in institutions. APS workers have access to their own complaint files and the registries. Under state law they may access: Police reports, nurses notes and residents records, medical reports, MDS and resident assessments, care plans, and other facility records needed in an abuse investigation. 4
14 APS should be able to review the latest nursing home inspection report at the nursing home and may access Nursing Home Compare data online. In addition, APS may have interagency agreements with the ombudsman program, licensing and certification, and Medicaid fraud control unit, providing them access to these information sources. The Abuse Risk Prevention Checklist can help APS workers to clue into potential problem areas in a nursing home when they verify an abuse complaint or advise interventions. The Abuse Risk Prevention Profile can serve as a stand-alone resource for training APS front line staff about elder abuse. The long term care (LTC) ombudsman program investigates and resolves complaints made by or on behalf of nursing home residents concerning their health and welfare, safety, and rights. The ombudsman program also maintains a regular presence in facilities by making regular visits to monitor residents care and provide information and education on long-term care services and conditions in nursing homes. In addition to the information contained in their files, ombudsmen have access to: Nurses notes and residents records, the MDS and resident assessments, care plans (all of which may be accessed with the resident's permission or with permission of a court ordered guardian) and other facility data pertinent to complaint investigations. Ombudsman programs may have agreements with licensing and certification, APS, and the Medicaid fraud control unit which permit sharing of some data. The Abuse Risk Prevention Checklist could be used by ombudsman programs to identify facilities that present a higher risk of abuse. Ombudsmen might then target such facilities for inservice training or a more frequent schedule of volunteer visits. The Medicaid fraud control unit is empowered to investigate Medicaid fraud and patient abuse in facilities that receive Medicaid payments. Medicaid fraud investigators have access to: Medicaid complaint and investigative files, law enforcement records, as well as a number of information sources maintained by the nursing home, including residents records. Investigators also have access to the nursing home survey report, Nursing Home Compare data, and may be able to access information from the Nurse Aide Registry. If there is an interagency agreement with licensing and certification, the ombudsman program or adult protective services, the unit may also have access to some of the information maintained by those programs. The Abuse Risk Prevention Checklist could help expedite technical assistance. The checklist might also be used to train new Medicaid fraud investigators about the problems of nursing home abuse. 5
15 A Note About Sources Risk projections and intervention strategies identified in this Profile & Checklist come from three primary sources: A literature survey conducted by world-renowned expert and older victims advocate, Rosalie S. Wolf, Ph.D., former president of the National Committee for the Prevention of Elder Abuse. A National Association of Adult Protective Service Administrators' focus group convened to obtain expert consensus about the adult protective service role in the prevention of nursing home abuse. A focus group facilitated by the Minnesota Board on Aging to identify safety issues and risk factors related to abuse in long term care settings. 6
16 Nursing Home Abuse Risk Prevention Profile I. Facility Risk Factors Risk Factor #1: Abuse prevention policy. Studies show abuse is more likely to occur and to go unreported in nursing homes that have no abuse prevention policy. Employees must be able to recognize the signs and symptoms of abuse and believe that they can report allegations to management without suffering negative consequences themselves. An abuse prevention policy is a public statement that a facility is committed to open communication and to a facility-wide culture that recognizes and supports the dignity of residents. Procedures for hiring and training staff should be an integral part of abuse prevention policy (see Risk Factor # 5: Staff training and Risk Factor #6: Staff screening). An abuse prevention policy should include the following elements, at a minimum: information on how to recognize abuse; detailed procedures for reporting abuse allegations and assurance in facility policy that staff will not be punished for reporting; staff training requirements to ensure safety and prevent abuse; and appropriate and prompt steps by management to stop the abuse, investigate, and report abuse to appropriate agencies when it occurs. RISK PROFILE DATA A method of selecting and training staff that puts particular emphasis on witnessing and reporting abuse is necessary for preventing abuse. (Payne and Cikovic, 1995) Source: B. K. Payne and R. Cikovic, Journal of Elder Abuse and Neglect, 1995 Risk Factor #2: Staff education and training. To assure resident safety, staff training is crucial. Training should be frequent, not a one-shot intervention, and trainers must be well educated and provide consistent information. Besides improving competence and knowledge, training also offers a vehicle for building self-esteem, which also may help to reduce stress and burnout. Research demonstrates that training can also prepare staff to respond appropriately to difficult situations, such as dealing with physically combative residents, which have the potential to trigger abuse. As well, 7
17 it can provide them with conflict resolution and other coping skills, and increase staff empathy and competence. Experts recommend the following topics in training: Communication skills and anger management How to respond appropriately to the different cultural and ethnic issues likely to be encountered in the nursing facility How to care for residents with dementia, mental illness or behavioral symptoms Facility policies and procedures, particularly policies for reporting abuse How to recognize abuse, neglect, and exploitation RISK PROFILE DATA 11,331 complaints reported in 32 states during 1998 were examined by the U.S. Office of Inspector General, Department of Health and Human Services. Analysis revealed that the primary abusers were aides and orderlies. A major cause of abuse was that staff lacked training to handle stressful situations. What s more, the study found that the majority of state oversight agencies and advocates perceived abuse as a serious growing problem, while nursing home administrators and industry representatives viewed abuse and neglect as minor. Recommended abuse prevention strategy: Staff education. (Saveman, et al., 1999) Curriculum content for abuse prevention: Understanding resident abuse; identification and recognition of types of abuse; possible causes of abuse; cultural and ethnic perspectives and implications for staff-resident dynamics; resident abuse of staff; legal and ethical issues regarding reporting; intervention strategies for abuse prevention. (Hudson, 1990) Staff training should emphasize witnessing and reporting abuse. (Payne and Cikovic, 1995) Adult Protective Service Administrators note that staff training on behavior management (how to handle combative residents or wanderers) is not adequate. Attending staff typically are not trained to handle heavy care residents. Training also does not address reporting requirements. (National Center on Elder Abuse, 2000) 8
18 Training recommended in creative problem solving, conflict resolution, and staff supervision. (Goodridge, Johnson and Thomson, 1996) Training recommended in techniques for dealing with difficult situations/stressful conditions and to increase coping skills, self-esteem, conflict resolution, and stress management. (Braun, et al., 1997) Training recommended in the care of aggressive patients. (Shaw, 1998) Sources: U.S. Department of Health and Human Services, Office of the Inspector General s Survey, 1998; B. Saveman, et al., Journal of Elder Abuse and Neglect, B. Hudson, Journal of Elder Abuse and Neglect, B. K. Payne and R. Cikovic, Journal of Elder Abuse and Neglect, National Center on Elder Abuse, Adult Protective Service Role in Prevention, D. M. Goodridge, et al, Journal of Elder Abuse and Neglect, K. L. Braun, et al., Journal of Elder Abuse and Neglect, M. Shaw, Journal of Elder Abuse and Neglect, Risk Factor #3: Staff screening. When low staff ratios and high turnover drive facilities to fill vacancies in a hurry, skills may be less than optimum necessary. Preemployment screening including checking references and conducting criminal background checks is essential to ensure that applicants who are not suited to care for vulnerable elders are not hired. People who would be inappropriate are people who lack empathy, who have no real interest in the welfare of the residents for whom they care, who are disrespectful or controlling, who have known substance abuse, domestic violence or criminal histories. An important strategy for preventing abuse is asking questions to learn the job applicant s: feelings about caring for elders; how they might react to an abusive situation; their work ethic; how they handle anger and stress; and history of alcohol or substance abuse. RISK PROFILE DATA The stress of work leads to inappropriate behavior management (implies the need for staff screening). (Pillemer and Moore, 1990) Test for job suitability at the time of employment. (Saveman, et al., 1999) 9
19 Screen potential staff using a role play or other technique to identify feelings about caring for elders, reaction to abusive situations, work ethic, anger and stress management, history of substance abuse. (Shaw, 1998) Sources: K. Pillemer and D.W. Moore, Journal of Elder Abuse and Neglect, B. Saveman, Journal of Elder Abuse and Neglect, M. Shaw, Journal of Elder Abuse and Neglect, Risk Factor #4: Staff stresses/burnout. The research tells us that stress and burnout take on special emergency in light of what is known about physical and psychological abuse. Hostility directed toward residents may stem from stressful working conditions. For staff, low wages, too much work for too few people, inflexible, work schedules, a perceived lack of supervisory support, poor REDUCING communication between management and employees are pressure THE RISK points. Invariably, stress becomes the breeding ground for abuse. Promoting respect and self-esteem is an This is not to say that attending staff are never abused essential component themselves. At times they are subjected to physical and verbal of any stress assaults by the residents for whom they care, and past abuse of reduction program. staff by a resident is likely to increase the chances that staff will improvise approaches to hands-on care. Often the staff s stress is amplified by grief over the loss of a resident. Negative emotions can undermine care. Adding to this are personal problems ranging from alcohol or drug addictions, to being abused (outside the job), to poverty. Nursing home caregivers are exposed to countless stressful situations daily. To combat stress, experts advise that facilities adopt the following preventive strategies: Increase wages. Develop a career ladder for direct service staff. Include nurse aides as members of the care team. Encourage registered and licensed professional nurses to help with handson care, especially when nurse aides are struggling to complete tasks. Improve communication between management and employees and departments. provide strong leadership that stresses human kindness The experts believe one of the best tools for lowering stress is to keep the nursing home well staffed. The strategy makes it less likely that staff will have to work double shifts. Another thing it can do is to reduce heavy reliance on outside contract workers. 10
20 RISK PROFILE DATA The level of staff burnout is a predictor of physical and psychological abuse. The stress of work may lead to inappropriate behavior management. (Pillemer and Moore, 1990) The level of staff burnout in nursing homes matched those of other health care workers. Nursing assistants could expect to be physically assaulted nine times per month and psychologically abused eleven times. A slight correlation was found between burnout and conflict. (Goodridge, Johnson, and Thomson, 1996) Inadequate staff supervision, poor communication among staff regarding changes in residents' needs, and unclear expectations for staff are among the factors leading to increased incidence of abuse and neglect, according to Adult Protective Services Administrators. (National Center on Elder Abuse, 2000) Senior staff absences, lack of interest, preoccupied with events in their own lives, in the position for very long time were found to contribute to staff stress. (Clough, 1999) Recommendations for reducing staff stress: enhance communication and collaboration between direct and administrative staff; better salaries; build selfesteem; respect and understanding for staff and their family needs (e.g., health benefits, sick time, child care, job stress support programs, DV, substance abuse); a program of rewards and upward mobility. (Shaw, 1998) To address staff stress, provide support to help staff deal with abusive situations, facilitate teamwork, and provide systematic supervision. (Saveman, et al., 1999) Elevate nurse aide status and implement a reward system. (Braun, et al., 1997) Sources: K. Pillemer and D.W. Moore, Journal of Elder Abuse and Neglect, D. M. Goodridge, et al, Journal of Elder Abuse and Neglect, National Center on Elder Abuse, Adult Protective Service Role in Prevention, R. Clough, Journal of Elder Abuse and Neglect, M. Shaw, Journal of Elder Abuse and Neglect, B. Saveman, Journal of Elder Abuse and Neglect, K. L. Braun, et al., Journal of Elder Abuse and Neglect,
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text:
Yoshette is a Yoshi that appears in Super Mario Gravity Loss. Her tongue is blue unlike Yoshi's tongue which is pink.
Yoshette lived in Dinosaur Land many years ago until a fierce storm swept through Dinosaur Land and every other dinosaur died except Yoshette. Yoshette leaves Dinosaur land. Many years later she comes back to Dinosaur Land. All that is left is a family of Koopas. The Koopas adopt Yoshette. Yoshette grows up and leaves Dinosaur Land. She travels to an Island of paradise. Later an ice block washes up on the shore. Yoshette breaks the block of ice and out comes Mark.