Assisting with the Care of a Loved One – What does Care Mean?

It is not uncommon to have to assist aging loved ones with their care from time to time. Our loved ones are “family,” and we want them to be healthy, safe, and comfortable. Moving into the role of the caregiver may be sudden or unexpected. With elders, it generally begins as part-time caregiving responsibility but can progress to a time-consuming activity, eventually becoming an overwhelming role. Over time, the caregiver may develop feelings of resentment and compassion fatigue, which in turn leads to guilt and shame for both parties. 

Many variables go into assisting with care. Honest and clear communication with the loved one can often clarify needs and expectations, which will decrease disagreements and arguments. For example, what does “care” really mean to the loved one? Do they want/need simple reminders concerning medication? Can they make their own appointments and drive themselves? Do they need housekeeping assistance? How about help with bathing and grooming? Conversations around these subjects may be awkward. The loved one may be in denial about needing assistance or be ashamed to ask for help. The caregiver may not realize how much help is needed or may overstep boundaries. The concept of “care” should be congruent between the loved one and the care provider. Otherwise, untoward issues may arise. 

Quality of life is a suggested area of the initial discussion. What does the quality of life mean to the loved one? Do they have preferred activities that bring them immense joy? What would create misery in their daily life if they were unable to participate? It is a critical area of discussion because the quality of life is tied directly to the loved one’s goals. Missing out on this crucial conversation before a caregiving arrangement is made can build a wall between the loved one and the caregiver and cause bad feelings.  

A good place to start in terms of a conversation with a loved one needing care is exploring what their daily goals are and what “care” means to them. Most people will agree that the goal of care is to assist another person in living as independently as possible. Harder conversations include where the care takes place, who provides the care, and the frequency. 

Exploring daily and monthly routines is essential when determining caregiving needs. Is the living environment clean and safe? Are finances managed adequately? When do meal preparation/eating, dressing, bathing, toileting occur? How easily are the activities of daily living accomplished independently? How are groceries and medications obtained? Are treatments for specific health conditions required? Answers to these questions provide a general understanding of the loved one’s needs. 

Respecting the rights and the autonomy of the loved one is key to building a solid foundation for care. Controlling, rigid, and dictating behaviors on the part of the caregiver can be demoralizing for the loved one.  

Taking on the role of caregiver for a loved one can be both rewarding and anxiety-inducing. The likelihood of a successful partnership is based on honest and clear communication regarding expectations. Ask them about their goals, what “care” means to them, things that enhance their quality of life, and what their daily routines look like. To reiterate, consider the rights and autonomy of your loved one when providing care. Remember you are not alone!  

Key Document Management System Features

R&G LCMS

The paperless office is here to stay, with many businesses, large and small, making the move to online storage. Document management systems come in various forms. Some are simple online filing systems, others are complex with features such as access control, audit trails, encryption, and data backup. The type of information a business maintains is a driver for the type of security needed as a safeguard. For example, law firms often need a system associated with case files that safeguard client personal health care information. A small business many need a billing document management system.  

A robust document management system should offer multiple layers of protection. For example, access controls allow individuals permission to access data. Two examples are personal identification numbers and passwords. Some passwords are specialized and require special characters. The more complex the password, the less likely a hack will occur. Audit trails are another means of protection which provide a history of who viewed certain data and when. It allows for the tracking of a source of a breach. Lastly, encryption provides a way to share files securely as well as limits the viewing of certain documents.  

A good document management system also has a data backup feature. This occurs when data is replicated to an additional system such as the cloud. Theft, data loss, or a natural disaster are just a few reasons to incorporate redundancy into the system as data redundancy is essential for speedy and seamless recovery. If there is no built-in redundancy, the opportunity for recovery of files may be forever lost. The key to redundancy is to balance the redundancy so that data remains as clean and up to date as possible.  

Document collaboration is a more sophisticated feature of an online system. This feature allows for mark up, versioning, searchability, e-signature and customized security. While overkill for some businesses, the features are essential for others.  

Customer support is essential for any document management system. A standard method for contacting the developer should be known and responses should come quickly when there are questions. A client portal with a help button is a common feature for many systems.  

R&G offers clients a Legal Case Tracking System as a secure means of online case storage information. The Legal Case Management System (LCMS) is an integral part of workflow management at R&G. LCMS is a state-of-the-art database providing anytime-anywhere access to case details, retrieved medical records, and completed work products. 

There are no additional fees associated with access. All of R&G’s medical legal consulting or document management clients can: 

  • Track case deadlines and status of records in real time 
  • Access medical records and completed work products 
  • Data is safe and private! LCMS uses BOTH redundant storage (to protect your data in real-time) AND frequent backups (to protect data in case of disaster) 

If you need assistance with a case, please call R&G Medical Legal Solutions at 1-888-486-2245. 

Medical Abbreviations

The use of medical abbreviations has been used since the development of medicine and is a longstanding practice. They are thought to save time and space when writing medical records. Additionally, they are cost effective and can be customized. While many healthcare facilities have gone to electronic records, the practice of handwritten records still exists, thus the continuance of handwritten medical abbreviations.  

Paper records are prone to errors. Illegible writing causes confusion and at times, a delay in care due to a need for follow up with the author for clarification; especially when it comes to medication orders and dispensing. Many abbreviations may have more than one meaning and the staff interpreting the record may not be familiar with the abbreviation being used.  

In 2005 The Joint Commission, an enterprise that accredits and certifies healthcare organizations, adopted a list that is forbidden to be used by Joint Commission accredited facilities. Below is the list along with an explanation of the potential problem.  

*DO NOT USE POTENTIAL PROBLEM USE INSTEAD  
U, u Mistaken for “0” (zero), the number “4” (four) or cc Write “unit” 
IU (international unit) Mistaken for IV (intravenous) or the number ten (10) Write “International Unit” 
Q.D., QD, q.d., qd (daily)   Mistaken for each other  Write ‘daily” 
Q.O. D., QOD, q.o.d., qod Period after the Q mistaken for “I” and the “O” mistaken for “I” Write “every other day” 
Trailing zero (X.o mg) (Applies to medication orders) Decimal point is missed  Write X mg Write 0.X mg 
MS     MSO4 and MgSo4 Can mean Morphine Sulfate or Magnesium Sulfate   Confused for one another  Write “morphine sulfate” Write “magnesium sulfate” 

 2020 The Joint Commission Fact Sheet 

*List does not apply to preprogrammed health information technology systems.  

The Joint Commission has made a recommendation to not sure the symbols for “greater than” or “less than” as they may be interpreted for the letter L or the number 7. The symbol for at (@) is discouraged because it may be misinterpreted as the number 2. Instead, providers should write out the words, “greater than”, “less than” or “at” as they appropriately apply in the chart.  

Misinterpretation of abbreviations may result in patient harm to include death. R&G nurses are skilled at reading handwritten records and recognized when a contributing error has occurred. If you are an attorney and need help with your case, please contact R&G at 1-888-486-2245. 

R&G LNC Services

Legal Nurse Consultant -AALNC

R&G provides services to firms of all sizes.  Services are performed by US-based registered nurses who possess both clinical nursing experience and specialized legal training. Effective partnerships between R&G and clients are facilitated through the use of Project Managers who ensure timely delivery of work products. 

Though not required, clients and Project Managers use R&G’s proprietary, secure, legal case management system with a built in DICOM viewer, to monitor project progress in real time, with the ability to access finished work products, anytime, anywhere.  All work products are customizable to meet the needs of the clients.

We use US-based Legal Nurse Analysts working in a secure virtual environment. We also offer our clients Virtual Legal Nurse Associates. R&G will match a highly experienced and appropriately specialized LNC to your case.  The nurse can work either on a short term or long term basis.  Client’s have direct access to their assigned nurse in order to facilitate communication.

Give us a call today to discuss your case needs!

Phone: 1-888-486-2245

Email: rngrfp@rngmedical.com

Your Trusted Legal Solutions, On Time, On Target, On Task

Hit by Ransomware? Check out these tools to see if any of them can help you.

Ransomware stock image

If you’ve been hit by ransomware, check out the tools found here to see if any will unlock your files. There are over 121 ransomware decryption tools and it’s growing every day.

Another couple website that we like to check for virus/ransomware removal tools is bleepingcomputer.com and majorgeeks.com

Here’s a recent article covering The No More Ransom website listed above.

“The project, founded by Europol, the National High Tech Crime Unit of the Netherlands’ police, Europol’s European Cybercrime Centre, Kaspersky, and McAfee, launched five years ago and has grown to involve 170 partners across law enforcement, cybersecurity companies, academia, and others. 

The No More Ransom portal now offers 121 free ransomware decryption tools which can decrypt 151 ransomware families. They’ve helped more than six million ransomware victims recover their encrypted files for free – all without the need to give into the demands of cyber extortionists. 

Available in 37 languages, ransomware victims around the world have used the portal to help against ransomware attacks. The website’s ‘Crypto Sheriff‘ allows users to upload encrypted files to help identify which form of ransomware they’ve fallen victim to, then directs them to a free decryption tool if one is available.”  

Ethics Training Resource for Attorneys

Ethics word art

Ethics provides the foundation for acceptable standards of conduct and behavior.  It is a framework for determining right from wrong.  Given the nature of the sensitivity legal work, it is imperative for attorneys to be able to identify and avoid conflicts. 

Ethics training has been shown to have a positive impact. According to an April 2019 paper by Frank Fagen, EDHEC Business School, an increase of one hour of ethics training reduces the number of attorney ethical misconduct by 10.506%.

Completing training is now easier than ever due to the online environment and training is now readily offered in an asynchronous fashion.  Face to face offerings, outside of Zoom types of meetings, have all but ceased but should soon resume to some degree as Covid restrictions have eased.  

Pricing is always a consideration. Some ethics offerings are free, while some are available for a small fee.  Some websites offer education for “free” however, there are charges to belong to the site.  

Finding online education can be cumbersome. Subscriptions to sites that offer a catalog of opportunities are often an efficient way to obtain ethics training as well as a plethora alternative subject matter.

Knowing state ethics requirements for CLEs can influence a subscription membership.  The Mario Legal Academy has a synopsis of state-by-state requirements.  https://marinolegalcle.com/state_rule/rule-1/.  Lorman also lists state by state requirements.  https://www.lorman.com/Minimum-CLE-Hours-by-State.

Multiple competing priorities provide challenges in obtaining training. Below are 3 sites for consideration to fulfil requirements. Non attorney legal support staff may also find these resources helpful.  

Lawline:  Getting your CLEs through Lawline is easy but you must be a member.  As of 22 June 2021, $199 buys a 1-year unlimited CLE opportunity. Ethical Challenges Facing Attorneys Today is rated at 4.9 out of 5 stars. https://www.lawline.com/cle/courses

Practicing Law Institute: Paralegal and attorney continuing education is available at this site.  An offering on Ethics for Corporate Lawyers is now available. https://www.pli.edu/

2Civility: This is a site that lists other free CLEs.  The Buck Stops Here: Ethics and Professionalism for In-House Counsel is featured as a free offering. https://www.2civility.org/attorney-programs-cle/free-online-cle-resources/

LawShelf:  This site has a beginner level course titled Basics of Legal Ethics. It is directed towards attorneys but appropriate for non-attorney support staff.  https://lawshelf.com/videocoursescontentview/basics-legal-ethics/

In sum, there is no shortage of ethics training on the internet for legal professionals. However, knowing state requirements will influence which offerings are a best fit.

Outsourcing Record Retrieval Pays Off

RNG Medical Records

Medical records play a key role in a variety of legal cases and insurance claims. Retrieving medical records when putting together a case has always been a laborious task, with requests typically taking up to a month to complete. It can get costly too, not just because you usually must pay for each record, but also because it can take multiple working hours to prepare and submit requests, as well as track progress. You need all the time you can get to put together a compelling case, but if a lot of that time is being spent on retrieving important documents, then it will not take long before the costs start piling up and delays become a part of the process. 

Consider the following breakdown of this best-case scenario of retrieving records and billing statements:

In House Record Retrieval

Processing Paperwork for Request15 minutes
Faxing or Mailing Paperwork20 minutes
Follow Up with the Provider (3 follow-ups at 10 minutes per follow up)30 minutes
Paying & Tracking the Invoice15 minutes
Reviewing & Scanning Records30 minutes
Total1 hour 50 minutes
Legal Assistant US Avg: $18.34/hour$34.84
Taxes, Equipment, Operating, Insurance, Benefits: 30%$10.45
Total$45.29

This is a best-case scenario of how the entire process plays out and the actual time your staff spends on getting records from the provider. Mind you, this is the best-case scenario. What happens if the request is lost by the provider? Documents are incorrect? The provider takes 10 phone calls before they will send the records. Let us look at additional tasks and issues that arise that can take up hours:

Tasks Requiring Additional Time

Re-submitting a Request10 minutes$3.00
Resending Paperwork10 minutes$3.00
Each Additional Follow Up10 minutes$3.00
Receive Wrong Records
Reach Back Out to Get Corrected
30 minutes$7.80
Affidavit (filling out, quality checking, etc.)30 minutes$7.80
Setting Up Courier Service30 minutes$7.80
Coordinating Courier Service (average 3 visits to provider)60 minutes$15.60

If you must re-submit the request, have 6 extra follow-up calls, and must reach back out to get an affidavit corrected you have just added $48 of expenses for a total of approximately $93.29 for just one request.

By using R&G Medical Legal Solutions, all tasks having to do with managing the retrieval process fall on R&G. The only tasks needed to be done by the firm are submitting the request and providing us with any necessary documents. It is as easy as that!

On top of a budget-friendly process, we have a secure Online Legal Case Management Database System (LCMS) providing anytime-anywhere access to case details, retrieved medical records, and completed work products.  R&Gs secure, online picture archiving and communication system (PACs) allows clients and/or their Expert Witnesses to view radiology images in one location, online, in lieu of pdf/jpeg copies. Digital Imaging and Communications in Medicine (DICOM) features such as video imaging and panning and digital measuring tools are included in the viewer. There are no additional fees associated with access. 

All of R&G’s medical-legal consulting or document management clients can:

  • Track case deadlines and status of records in real-time
  • Access medical records and completed work products
  • Data is safe and private!  LCMS uses BOTH redundant storage (to protect your data in real-time) AND frequent backups (to protect data in case of disaster)

Please call us at 623-566-3333 to get a free quote today. We can’t wait to hear from you!

Medical Cannabis

Medical Cannabis

Medical cannabis remains a controversial topic throughout the United States as many states are repealing associated restrictions. Both recreational and medicinal cannabis is now available in a handful of states.  Despite the growing research supporting cannabis as a pain management and rehabilitation tool, the federal government continues to classify cannabis as a Schedule 1 drug. This makes cannabis federally illegal, as well as limits medical studies that would better explore the benefits. 

Cannabis and cannabis derivatives are used to treat the symptoms of many ailments and illnesses, such as cancer, PTSD, AIDS, epilepsy, and more.  According to a 2017 study published in Cancer Chemotherapy and Pharmacology, pharmaceutical cannabis can decrease nausea caused by chemotherapy and almost eliminate vomiting. Cannabis has also been found to relieve the spasticity of the muscles that is sometimes associated with multiple sclerosis and can help treat appetite loss and “wasting” associated with conditions such as HIV/AIDS and certain types of cancers. One chemical compound of the cannabis plant, Cannabidiol (CBD), has been used to treat and reduce seizures in people with epilepsy (specifically Lennox-Gastaut syndrome and Dravet syndrome). Cannabis is used to treat chronic pain, and in some cases may be used instead of opioids for pain management. (Opioids are highly addictive and are typically not recommended for long-term use in treating chronic pain.)  Cannabis may also be beneficial in symptom management of some mental health conditions, such as PTSD.

While there are many benefits to using cannabis, there is still much we do not know about this plant and its long-term usage. For example, studies have shown that frequent use may seriously affect short-term memory, as well as impair cognitive ability. While there are many ways to ingest cannabis, smoking anything can seriously damage your lung tissue. Immediate side effects of cannabis use may include paranoia, elevated heart rate, anxiety, and impaired motor function.  Long-term effects may include mood swings, lung infections, panic attacks, and memory loss.  Signs of impairment may include red eyes, delayed reaction time, poor hand-eye coordination, lack of concentration, and decreased perception of time and distance.

Cannabis has been implicated in a high percentage of automobile crashes and workplace accidents. A review of the medical record and summary of care often provides insight into the extent and timing of cannabis use in relation to a mishap.  R&G is here to help with reviews of cases involving cannabis.  Please call 623-566-3333 or 1-888-486-2245 for more information about case reviews. 

Virtual Nurse Associate

Virtual Nurse Associate

What is a virtual nurse associate?  
A virtual associate is an independent contract worker who works remotely in support of clients nationally. Typical tasks include administrative, technical, and business support services. Legal Nurse Consultants are well suited to work in a similar capacity serving law firms who may need assistance on a regular or per diem basis. This allows firms to scale staffing to their immediate needs and “right-size” when/if workflow subsides.  

What does a virtual office assistant do?  
Virtual nurse associates do many things including records analysis, case summaries, chronologies, identifying missing records and/or gaps in care, as well as identifying experts. A virtual nurse can do almost anything an in-house nurse can do. A virtual nurse associate can easily maintain office hours consistent with their clients or work in an asynchronous fashion, whichever benefits the client the most.   

Skills Set of a Virtual Nurse Associate  

Working virtually can be a challenge and is not a good fit for everyone.   Some people find working remotely to be isolating and stressful and prefer to work in an office environment.  Nurses are adaptable and are well suited to virtual work.  Characteristics of most nurses include:  

  • Self-starter 
  • Ability to set and see goals through fruition. 
  • Able to manage multiple competing priorities. 
  • Problem-solving skills.  
  • Excellent oral and written communication skills  

Benefits of Working with a Virtual Nurse Associate  

Communication virtually with a nurse associate need not be a challenge. The nurse can adapt their online hours to match that of the client. Should short notice taskings arise the nurse is available, just as an in-house nurse would be.  

Working with a virtual nurse associate is cost-effective in that they can be used as much or as little as needed. No doubt this model increases profits for firms. For example, the nurse could be used for a working surge before trial. If a client needs to “right-size,” no-layoff will occur as the nurse is an independent contractor without any benefits typical of an employee. The Virtual Nurse Associate does not require other benefits from their clients such as sick time, paid time off, vacation time, health insurance, or retirement benefits.  

A virtual nurse is an excellent fit for a firm who is searching for their “best fit” but needs assistance in the interim. If a less experienced nurse is hired, a virtual nurse could also serve as a mentor to the new nurse. Should the new nurse turn out not to be the best fit, the virtual nurse continues to service the firm seamlessly.  

R&G Medical Legal Solutions, LLC has a virtual nurse program, and no job is too big or too small. R&G nurses have a wide variety of backgrounds to include medical-surgical, emergency department, critical care, and long-term care, just to name a few. This allows firms to take a variety of cases knowing R&G can match the virtual nurse to the background of the case. Please contact Pamela Showers, COO at 623-566-3333 for rates and any questions.