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    <title>Community Geriatric Care Management</title>
    
    
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    <id>tag:typepad.com,2003:weblog-1797050</id>
    <updated>2010-11-07T11:24:12-08:00</updated>
    
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        <title>Care Means Compassion, Confirmation and Community</title>
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        <id>tag:typepad.com,2003:post-6a00d8341d911d53ef0133f5a8aca2970b</id>
        <published>2010-11-07T11:24:12-08:00</published>
        <updated>2010-11-07T11:24:12-08:00</updated>
        <summary>by Roy Herndon Smith, PhD Three sources of stress among disabled people and those who care for them are: Impoverishment caused by the costs of providing adequate care Isolation caused by the loss or weakening of ties to family members, friends and communities Devaluation caused by others’ treatment of impoverished and isolated disabled people and those who care for them primarily as clients with needs, rather than as valuable persons Care with disabled people that effectively addresses these sources of suffering requires the practice of: Compassion (or empathy) with disabled people. For instance, compassion is the recognition that terror of...</summary>
        <author>
            <name>royherndonsmith</name>
        </author>
        <category scheme="http://www.sixapart.com/ns/types#category" term="It Takes A Community" />
        
        
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<p><em>by Roy Herndon Smith, PhD</em></p>
<p>Three sources of stress among disabled people and those who care for them are:</p>
<p><em>Impoverishment</em> caused by the costs of providing adequate care</p>
<p><em>Isolation</em> caused by the loss or weakening of ties to family members, friends and communities</p>
<p><em>Devaluation </em>caused by others’ treatment of impoverished and isolated disabled people and those who care for them primarily as clients with needs, rather than as valuable persons</p>
<p> </p>
<p><em>Care</em> with disabled people that effectively addresses these sources of suffering requires the practice of:</p>
<p><em>Compassion</em><strong> </strong>(or empathy) with disabled people.  For instance, compassion is the recognition that terror of losing control over one’s mind lies behind the rage that sometimes accompanies dementia.</p>
<p><em>Confirmation</em><strong> </strong>of their value, knowledge, skills, and care.  For example, effective care with people suffering with dementia requires ongoing valuing of their</p>
<blockquote>
<div>
<p>lives      through evoking their memories and listening to their stories</p>
</div>
<div>
<p>wisdom      through conversations in which one asks for and receives their insights</p>
</div>
<div>
<p>skills      through setting up situations in which they can practice their abilities      and teach others what they know</p>
</div>
<div>
<p>care      through affirming their consideration and compassion for others</p>
</div>
</blockquote>
<p><em>Community</em><strong> </strong>through maintaining and strengthening long-term bonds of mutual compassion, confirmation and help.  For instance, effective care with people with dementia requires maintaining and strengthening their ongoing interactions with family members, friends, neighbors and community members whom they care for, value, enjoy and help and who care for, value, enjoy and help them. </p>
<p><strong> </strong></p></div>
</content>



    </entry>
    <entry>
        <title>Myths and Facts about Medicaid, Surplus Income and Pooled Income Trusts</title>
        <link rel="alternate" type="text/html" href="http://www.communitygeriatriccare.com/2010/09/myths-and-facts-about-medicaid-surplus-income-and-pooled-income-trusts.html" />
        <link rel="replies" type="text/html" href="http://www.communitygeriatriccare.com/2010/09/myths-and-facts-about-medicaid-surplus-income-and-pooled-income-trusts.html" thr:count="0" />
        <id>tag:typepad.com,2003:post-6a00d8341d911d53ef0133f499ef2e970b</id>
        <published>2010-09-26T11:08:38-07:00</published>
        <updated>2010-09-26T11:32:35-07:00</updated>
        <summary>Myth: “I have too much income to get Medicaid.” Fact: If you are a US citizen or a documented and qualified immigrant, you can get Medicaid even if you have income over the Medicaid limit. Myth: “I have to pay all my income over the Medicaid limit to get Medicaid.” Fact: If you join a Pooled Income Trust and deposit your surplus income (income over the Medicaid limit) into the trust each month, you will not have to pay the surplus income to Medicaid, and Medicaid will pay for all the services it usually covers. Myth: “I will lose control...</summary>
        <author>
            <name>royherndonsmith</name>
        </author>
        <category scheme="http://www.sixapart.com/ns/types#category" term="Medicaid--If You Need It, You Can Get It" />
        
        
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Myth: “I have too much income to get Medicaid.”  Fact:  <span style="text-decoration:underline;">If you are a US citizen or a documented and qualified immigrant, you can get Medicaid even if you have income over the Medicaid limit.</span>
</p><p>
Myth: “I have to pay all my income over the Medicaid limit to get Medicaid.”  Fact:  <span style="text-decoration:underline;">If you join a Pooled Income Trust and deposit your surplus income (income over the Medicaid limit) into the trust each month, you will not have to pay the surplus income to Medicaid, and Medicaid will pay for all the services it usually covers.</span> 
</p><p>
Myth:  “I will lose control over the money I put into a Pooled Income Trust.”  Fact:  <span style="text-decoration:underline;">Joining a Pooled Income Trust is how you can keep control over your surplus money, rather than having to pay it to Medicaid.  You can use the money you deposit into the trust each month to pay your bills.</span>  
</p><p>
Myth:  “I need a lawyer to apply for Medicaid and to join a Pooled Income Trust.”  Fact:  <span style="text-decoration:underline;">You do not need a lawyer to apply for Medicaid or to join a Pooled Income Trust.  A social worker or private geriatric care manager can help you.  Private geriatric care managers charge much less than do lawyers for helping with Medicaid applications and Pooled Income Trusts. </span>
</p><p>
Myth:  "There is only one Pooled Income Trust, the NYSARC Trust."  Fact: <span style="text-decoration:underline;">There are different Pooled Income Trusts.  You can choose the trust that best fits your needs.</span>   
</p><p>
  
</p></div>
</content>



    </entry>
    <entry>
        <title>One-Stop Medicaid Home Care</title>
        <link rel="alternate" type="text/html" href="http://www.communitygeriatriccare.com/2010/07/one-stop-medicaid-home-care.html" />
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        <id>tag:typepad.com,2003:post-6a00d8341d911d53ef0133f2976c7f970b</id>
        <published>2010-07-27T05:28:03-07:00</published>
        <updated>2010-07-27T05:39:39-07:00</updated>
        <summary>Get home care paid for by Medicaid Even if your income and assets are over the Medicaid limits Call or email Roy Herndon Smith, PhD 917-685-2687 communitygeriactriccare@gmail.com Our fees are highly competitive On a case-by-case basis, we charge reduced fees and provide pro-bono services We do not charge for arranging for Medicaid pending or regular Medicaid home care Our staff · Provides expert consultations for older people and family members about maintaining the quality of their lives when they become frail · Prepares, submits, and ensures approval of applications for Medicaid · Assists in joining Pooled Income Trusts and in...</summary>
        <author>
            <name>royherndonsmith</name>
        </author>
        <category scheme="http://www.sixapart.com/ns/types#category" term="Home Care and How to Pay for It" />
        
        
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<strong>Get home care paid for by Medicaid</strong><span style="font-family:Arial;">
<br /></span><span style="font-size:9pt;">Even if your income and assets are over the Medicaid limits
<br /></span><span style="font-family:Arial;"><strong>Call or email Roy Herndon Smith, PhD</strong></span><span style="font-family:Arial;font-size:13pt;">
<br /></span><span style="font-family:Arial;">917-685-2687</span>
<br /><span style="font-family:Arial;"><a href="mailto:communitygeriactriccare@gmail.com">communitygeriactriccare@gmail.com</a></span>
</p><ul>
<li><span style="font-family:Arial;font-size:9pt;">Our fees are highly competitive</span></li>
<li><span style="font-family:Arial;font-size:9pt;">On a case-by-case basis, we charge reduced fees and provide pro-bono services</span></li>
<li><span style="font-family:Arial;font-size:9pt;">We do not charge for arranging for Medicaid pending or regular Medicaid home care</span></li>
</ul><p style="text-align:center;">
<span style="font-family:Arial;font-size:9pt;">
<br /></span><span style="font-family:Arial;font-size:9pt;"><strong>Our staff</strong></span>
</p><p>
<span style="font-family:Times;font-size:9pt;">·        </span><span style="font-family:Arial;font-size:9pt;">Provides expert consultations for older people and family members about maintaining the quality of their lives when they become frail
<br /></span><span style="font-family:Times;font-size:9pt;">·        </span><span style="font-family:Arial;font-size:9pt;">Prepares, submits, and ensures approval of applications for Medicaid
<br /></span><span style="font-family:Times;font-size:9pt;">·        </span><span style="font-family:Arial;font-size:9pt;">Assists in joining Pooled Income Trusts and in getting the Pooled Income Trusts approved by Medicaid
<br /></span><span style="font-family:Times;font-size:9pt;">·        </span><span style="font-family:Arial;font-size:9pt;">Arranges for Medicaid pending and regular Medicaid home care
<br /></span><span style="font-family:Times;font-size:9pt;">·        </span><span style="font-family:Arial;font-size:9pt;">Provides presentations and workshops on home care, Medicaid, and Pooled Income Trusts
<br /></span>
</p></div>
</content>



    </entry>
    <entry>
        <title>IMPORTANT INFORMATION ABOUT POWER OF ATTORNEY IN NEW YORK STATE</title>
        <link rel="alternate" type="text/html" href="http://www.communitygeriatriccare.com/2009/09/important-information-about-power-of-attorney-in-new-york-state.html" />
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        <id>tag:typepad.com,2003:post-6a00d8341d911d53ef0120a5a6148a970b</id>
        <published>2009-09-28T15:21:17-07:00</published>
        <updated>2009-09-28T15:21:17-07:00</updated>
        <summary>1. If you have a Durable Power of Attorney, fill out a new form as soon as possible and write in “Power to create and fund trusts," if you have not already assigned this power in your existing form. If you do not assign this power, your power of attorney will likely not be able to establish a pooled income trust or an asset trust if you are incapacitated and need to create such a trust in order to get Medicaid benefits. 2. When filling out a new Power of Attorney form, use the new New York Statutory Short Form...</summary>
        <author>
            <name>royherndonsmith</name>
        </author>
        <category scheme="http://www.sixapart.com/ns/types#category" term="Legal Planning" />
        
        
<content type="xhtml" xml:lang="en-US" xml:base="http://www.communitygeriatriccare.com/">
<div xmlns="http://www.w3.org/1999/xhtml"><span style="font-family:monospace;">1.  If you have a Durable Power of Attorney, fill out a new form as soon as possible and write in “</span><span style="font-family:monospace;">Power to create and fund trusts</span><span style="font-family:monospace;">," if you have not already assigned this power in your existing form.  If you do not assign this power, your power of attorney will likely not be able to establish a pooled income trust or an asset trust if you are incapacitated and need to create such a trust in order to get Medicaid benefits. 
<br />
<br />2.  When filling out a new Power of Attorney form, use the new New York Statutory Short Form Power of Attorney, issued on July 28, 2009.  Power of Attorney forms signed after September 1, 2009, must be this new form in order to be valid and recognized (form and addendums attached).
<br /> 
<br /></span>
<p>
<span style="font-family:monospace;">For help in filling out a new Power of Attorney form, see an elder law attorney, a geriatric care manager or social worker or case manager with an agency that serves the elderly and their family members.
<br />
<br /></span><span style="font-family:monospace;text-decoration:underline;">Elder law attorneys, geriatric care managers, social workers and case managers</span><span style="font-family:monospace;">: It is urgent that you advise your elderly clients who have not yet filled out Power of Attorney forms to do so, to use the new form, and to write in the “power to create and fund trusts” in the new form if this power is not explicitly listed on their existing power of attorney forms.  
<br /></span>
</p><p>
<a href="http://www.royherndonsmith.com/new-york-statutory-major-gifts-rider-form.pdf" onclick="window.open('http://www.royherndonsmith.com/new-york-statutory-major-gifts-rider-form.pdf','popup','width=612,height=792,scrollbars=no,resizable=yes,toolbar=no,directories=no,location=no,menubar=no,status=yes,left=0,top=0');return false"><img src="http://www.royherndonsmith.com/.a/6a00d8341d911d53ef0120a5a6147b970b-pi" height="100" width="77" border="1" hspace="4" vspace="4" alt="New-York-Statutory-Major-Gifts-Rider-Form" /></a>
</p><p>
<a href="http://www.royherndonsmith.com/new-york-statutory-short-form-power-of-attroney.pdf" onclick="window.open('http://www.royherndonsmith.com/new-york-statutory-short-form-power-of-attroney.pdf','popup','width=612,height=792,scrollbars=no,resizable=yes,toolbar=no,directories=no,location=no,menubar=no,status=yes,left=0,top=0');return false"><img src="http://www.royherndonsmith.com/.a/6a00d8341d911d53ef0120a5fcb71d970c-pi" height="100" width="77" border="1" hspace="4" vspace="4" alt="New-York-Statutory-Short-Form-Power-Of-Attroney" /></a>
</p><p>
<a href="http://www.royherndonsmith.com/new-york-suggested-modifications-to-major-gifts-rider-form.pdf" onclick="window.open('http://www.royherndonsmith.com/new-york-suggested-modifications-to-major-gifts-rider-form.pdf','popup','width=612,height=792,scrollbars=no,resizable=yes,toolbar=no,directories=no,location=no,menubar=no,status=yes,left=0,top=0');return false"><img src="http://www.royherndonsmith.com/.a/6a00d8341d911d53ef0120a5a61487970b-pi" height="100" width="77" border="1" hspace="4" vspace="4" alt="New-York-Suggested-Modifications-To-Major-Gifts-Rider-Form" /></a>
</p><p>
<a href="http://www.royherndonsmith.com/new-york-suggested-modifications-to-statutory-short-form-power-of-attorney.pdf" onclick="window.open('http://www.royherndonsmith.com/new-york-suggested-modifications-to-statutory-short-form-power-of-attorney.pdf','popup','width=612,height=792,scrollbars=no,resizable=yes,toolbar=no,directories=no,location=no,menubar=no,status=yes,left=0,top=0');return false"><img src="http://www.royherndonsmith.com/.a/6a00d8341d911d53ef0120a5fcb716970c-pi" height="100" width="77" border="1" hspace="4" vspace="4" alt="New-York-Suggested-Modifications-To-Statutory-Short-Form-Power-Of-Attorney" /></a>
<br /><span style="font-family:monospace;">
<br /></span>
</p><p style="font-family:monospace;">
  
</p></div>
</content>



    </entry>
    <entry>
        <title>Meditation</title>
        <link rel="alternate" type="text/html" href="http://www.communitygeriatriccare.com/2009/07/meditation.html" />
        <link rel="replies" type="text/html" href="http://www.communitygeriatriccare.com/2009/07/meditation.html" thr:count="0" />
        <id>tag:typepad.com,2003:post-6a00d8341d911d53ef011572029f0c970b</id>
        <published>2009-07-14T05:02:05-07:00</published>
        <updated>2009-07-14T05:22:32-07:00</updated>
        <summary>by Roy Herndon Smith In this series of pieces, I write about what I have learned from almost forty years of practicing meditation. Meditation has been very helpful to me and I think it might be helpful to you. I will, at the end of each piece, suggest an exercise that you can do to learn more about meditation. The exercises build on one another. However, each also exists on its own. If you find a particular exercise helps you more than the others, stick with it and come back to it. If an exercise doesn’t appear to help you,...</summary>
        <author>
            <name>royherndonsmith</name>
        </author>
        <category scheme="http://www.sixapart.com/ns/types#category" term="Meditation" />
        
        
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<span style="color:#082740;font-size:11pt;"><em>by Roy Herndon Smith</em></span><span style="color:#082740;font-size:16pt;">
<br />
<br /></span><span style="color:#082740;font-size:11pt;">In this series of pieces, I write about what I have learned from almost forty years of practicing meditation.  Meditation has been very helpful to me and I think it might be helpful to you.  I will, at the end of each piece, suggest an exercise that you can do to learn more about meditation.
<br /></span>
</p><p>
<span style="color:#082740;font-size:11pt;">
<br />The exercises build on one another.   However, each also exists on its own.  If you find a particular exercise helps you more than the others, stick with it and come back to it.  If an exercise doesn’t appear to help you, then move on.  Pick and choose what is helpful.</span>
</p><p style="text-align:center;">
<span style="color:#05213c;font-size:11pt;"><strong>1</strong></span><span style="color:#05213c;font-size:11pt;">
<br /></span>
</p><p style="text-indent:36pt;">
<span style="font-size:11pt;">
<br /></span><span style="color:#05213c;font-size:11pt;">
<br />
<br />My definition of meditation is paying attention to what is happening.  Meditation then is the practice of being aware.  Anytime we become aware of what is happening around and in us, we are meditating.
<br />
<br /></span><span style="color:#05213c;font-size:11pt;"><strong>Exercise 1:  </strong></span><span style="color:#05213c;font-size:11pt;"><em>Right now, as you read these words, pay attention to what is happening.  If you continue to read, stay aware of reading, of seeing the words unfold on the page and inside your mind.  If you find yourself listening to sounds, pay attention to listening, to the textures of the sounds.  If tension or another physical sensation enters your mind, pay attention to exactly how it feels.  If you become aware that you have not been paying attention, that your mind has drifted off, pay attention to being conscious; what is your mind like when you are conscious?
<br />
<br />You can do this exercise any time throughout the day.  Anytime you think of it and feel like it, pay attention for a moment or two to what you are doing, feeling, or thinking or to what you are seeing, hearing, touching, smelling, or tasting.
<br /></em></span><span style="color:#05213c;font-size:11pt;">
<br />
<br /></span>
</p><p style="text-align:center;">
<span style="font-size:11pt;">
<br /></span><span style="color:#05213c;font-size:11pt;">
<br /></span><span style="color:#05213c;font-size:11pt;"><strong>
<br />
<br />2</strong></span><span style="color:#05213c;font-size:11pt;">
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</p><p style="text-indent:36pt;">
<span style="font-size:11pt;">
<br /></span><span style="color:#05213c;font-size:11pt;">
<br />
<br />We don’t know what is happening without being aware of it.  To attend to what is happening is to attend to how we are aware—to how we know reality.
<br />
<br />Mediation is thus an exploration of consciousness.  Neither you nor I can explore consciousness from someplace outside of it, but only from inside our own awareness.  Meditation is not something someone else can do for us.  It is what we know directly, for ourselves.  Because meditation is the practice of being conscious and each of us knows what it is to be conscious, each of us also knows what meditation is.
<br />
<br /></span><span style="color:#05213c;font-size:11pt;"><strong>Exercise 2: </strong></span><span style="color:#05213c;font-size:11pt;"><em> Ask yourself: What do you know about your own consciousness?  What are the qualities of your mind when you are conscious?  Pay attention to whatever comes into your mind when you ask these questions—any thoughts, fantasies, feelings, bodily sensations, sounds, images, smells, and tastes.  Notice how your consciousness changes as you focus on being aware of it.
<br />
<br />Again, you can do this exercise anytime and any place.  As you go through your day, when you remember to do so, notice how you are aware of what is happening.
<br />
<br /></em></span>
</p><p style="text-align:center;">
<span style="font-size:11pt;">
<br /></span><span style="color:#05213c;font-size:11pt;">
<br /></span><span style="color:#05213c;font-size:11pt;"><strong>
<br />3</strong></span><span style="color:#05213c;font-size:11pt;">
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</p><p style="text-indent:36pt;">
<span style="font-size:11pt;">
<br /></span><span style="color:#05213c;font-size:11pt;">
<br />
<br />Teachers and writers about meditation sometimes describe consciousness as like an open, clear, and still space without limits.
<br />
<br /></span><span style="color:#05213c;font-size:11pt;"><strong>Exercise 3:  </strong></span><span style="color:#05213c;font-size:11pt;"><em>When you finish reading this paragraph, stop reading and thinking.   Be physically, emotionally, and mentally still.  Focus on this stillness.  Now, stop.
<br />
<br />Practice stopping your mind and attending to the stillness throughout the day.
<br />
<br /></em></span>
</p><p style="text-align:center;">
<span style="font-size:11pt;">
<br /></span><span style="color:#05213c;font-size:11pt;">
<br /></span><span style="color:#05213c;font-size:11pt;"><strong>
<br />
<br />4</strong></span><span style="color:#05213c;font-size:11pt;"><em>
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<br /></span>
</p><p style="text-indent:36pt;">
<span style="font-size:11pt;">
<br /></span><span style="color:#05213c;font-size:11pt;">
<br /></span><span style="font-family:Arial;color:#05213c;font-size:11pt;">We tend to think of meditation as a way to get something we don’t have now.  We are tense, we strive to relax.  We are suffering, we strive not to suffer.  We don’t think we know what consciousness is, we strive to know what consciousness is.  We feel cut off from the beauty of reality, we strive not to be cut off.  We feel that we do not love, we strive to love.
<br />
<br />Experienced teachers of meditation will often say something like, “Yes, meditation is a way of getting something you feel you don’t have.  But you can only get this something by not trying to get it, by not striving.”
<br />
<br />An insight lies behind such paradoxical statements.  To strive for something is to have an image and therefore some experience and knowledge of what we are striving for.  To strive for relaxation, the healing of suffering, and an understanding of consciousness, beauty, and love is to have an image and thus an experience, even if only a very fleeting experience, of relaxation, healing, consciousness, beauty, and love.
<br />
<br />In meditation, then, we can come to know that what we are striving for exists in our minds side by side with what we seek to leave behind—tension, misery, ignorance, alienation, hatred, and indifference.
<br />
<br />Meditation is thus a way of opening ourselves to what is all around and in us, but often seems to be lost to us—relaxation, healing, beauty, knowledge, faith, joy, and love.
<br />
<br /></span><span style="font-family:Arial;color:#05213c;font-size:11pt;"><strong>Exercise 4:  </strong></span><span style="font-family:Arial;color:#05213c;font-size:11pt;"><em>Focus on what you desire to achieve through meditation.  What do you already know about this goal?  How do you experience it?  What emotional and bodily feelings come with the goal?  What images, sounds, smells, and tastes come with it?  What thoughts?
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<br />As you go through your day, notice when you are experiencing what you are striving for.  What is going on around and inside of you that accompanies your experience of what you are striving for? Notice how your experience of what you are striving for changes.  What you are striving for may intensify or fade away.  Notice the circumstances, sensations, feelings, and thoughts that accompany these changes.
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<br />If you have different reasons to meditate and are wondering where to begin, you might start with the most mundane goal, relaxation, and then move on to the others.  Here are specific questions about relaxation:
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<br />What do you know about relaxation?  What is relaxation?  How do you experience it?  What emotional and bodily sensations let you know that you are relaxed?  What images, sounds, smells, and tastes come with relaxation? When you relax, what are you thinking and feeling and what are you not thinking and feeling?</em></span><span style="font-family:Arial;color:#05213c;font-size:11pt;">
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<br /></span><span style="font-family:Arial;color:#05213c;font-size:11pt;"><em>As you go about your day, notice when you are relaxed or, at least, less tense.  Notice what is happening around you.  Notice what happened just before you relaxed.  As you focus, notice any changes in your feelings, sensations, and thinking?  Are you becoming more or less relaxed?  If more, then identify the sensations, feelings, and thoughts that come with being more relaxed.  If less, then notice the changing sensations, feelings, and thoughts that accompany moving out of relaxation.</em></span><span style="font-family:Arial;color:#05213c;font-size:11pt;">
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<br />The psychologist Daniel Stern observes, in </span><span style="font-family:Arial;color:#05213c;font-size:11pt;"><em>The Present Moment, </em></span><span style="font-family:Arial;color:#05213c;font-size:11pt;">that,</span><span style="font-family:Arial;color:#05213c;font-size:11pt;"><em> </em></span><span style="font-family:Arial;color:#05213c;font-size:11pt;">in everyday waking life, we are conscious of being conscious in “present moments” that last from between one and ten seconds.  Between these moments, we sense and respond to what is happening, but we </span><span style="color:#05213c;font-size:11pt;">are caught up in thoughts, feelings, sensations, and actions, without being aware of thinking, feeling, sensing, or acting.
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<br /></span><span style="color:#05213c;font-size:11pt;"><strong>Exercise 5:  </strong></span><span style="color:#05213c;font-size:11pt;"><em>Right now, as you read this, focus on your reading.  Notice the rhythm of your reading.  In my case, when I do this, I notice that, for a short period of time, I keep in mind a certain number of words, then there is a slight break, and I switch to the next set of words, and the previous set of words moves into the background of my awareness; I have to look back at them to bring them into present consciousness again.
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<br />As you go through your day, repeat this exercise while you are doing different activities.  Notice the rhythms of your consciousness in these different activities.  Notice the lengths of present moments during which you are aware of what is happening.  Notice the breaks during which you are not aware of what is happening.  Notice the lengths of these breaks, whether they are relatively short or long.
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<br />Building up the ability to concentrate—to extend the present moments during which one is conscious of being conscious—can be very helpful in achieving the goals of meditation.
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<br /></span><span style="font-family:Arial;color:#05213c;font-size:11pt;"><strong>Exercise 6:</strong></span><span style="font-family:Arial;color:#05213c;font-size:11pt;"><em>  Find a place where you can sit quietly and uninterrupted for at least five minutes once or twice or more times a day.
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<br />Find a comfortable sitting position that keeps your back straight.  If you know of a cross-legged position (for instance, that you have learned in a yoga class), try that.  Otherwise, or if a cross-legged position is not comfortable, sit in a straight-backed chair with your feet flat on the floor and your back as straight as possible.  Put your hands in your lap, one under the other, or on your knees.  Look slightly down so that your neck is straight.  Either keep your eyes closed or, if you wish, open and unfocused, whichever cuts off distractions the most (most people choose eyes closed). Once you have chosen a certain sitting position, a certain placement of the hands, and whether to keep your eyes closed or open, stick with these choices for a whole session. As you start a new session, feel free to experiment with how you sit, place your hands, or keeping your eyes open or closed.  But, after five or six sessions, stick with one set of choices.
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<br />Take a minute to settle into a position.  Check that your back and neck are straight.  Then be still.  Focus your attention on your breathing—either the sensation of your breath coming into and flowing out of your nostrils or on of the rise and fall of your diaphragm.  Again choose one of these foci for each session and, after a few sessions, settle on one and stick with it. 
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<br />Keep your mind concentrated on the breathing.  When you become aware that your mind has been wandering, bring it back to the breath.  Focus on the sensations of breathing and on how you are breathing.  If sensations other than those associated with breathing—usually sounds or visual or physical sensations—enter your awareness, note them, but keep the focus on breathing.  If you become aware of feelings or thoughts, note them, but keep the focus on breathing.
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<br />Do this exercise for at least five minutes and up to half and hour or longer.
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<br />During the day, when you remember and have even just a moment or two, focus on your breathing.
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<br />Most people, especially when beginning meditation, find it difficult to maintain a focus on the breath or anything else for longer than the usual length of a present moment—one to ten seconds.  During the natural breaks between these moments, the mind sometimes gets lost as it moves from one sensation, feeling, or thought to another.  Or it goes blank and, later, you come back to awareness as if awakening from a sleep.  Or you realize that a sensation or feeling or line of thought has wholly captured you and submerged your awareness of your awareness.
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<br />These difficulties—restlessness, captivation, and blanking out—are expressions of the way the mind naturally works.
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<br />Even when wholly focused, the mind is in continual movement from sensation to sensation, feeling to feeling, thought to thought.
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<br />The mind continually works on different levels. Usually one level is foremost in the mind and others remain in the background.  The classic example is </span><span style="color:#05213c;font-size:11pt;">riding a bike.  When one is learning to ride a bike, one is acutely conscious of the bike and of wobbling and sometimes falling.  Once one knows how to ride, riding slips into the background of consciousness.  One observes what is going on around one—the route one is taking, possible obstacles, the feel of the air.  One only focuses one’s attention on the bike and how one is riding it when one needs to or wants to.  Riding the bike becomes automatic, which is good because automatic responses are, most of the time, quicker and more accurate than those directed by intentional consciousness.
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<br />Often, when one is riding a bike along a familiar route or doing something else that is familiar, a feeling or line of thought or set of images or some physical sensations captures the mind.  Later, one realizes that, without being aware of it, one’s mind was wholly caught up in these thoughts, images, feelings, or sensations.  It is like what happens at the end of a movie when one realizes that one was only aware of what was happening in the movie and had wholly forgotten everything else.
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<br />Sometimes, when riding a bike or doing something familiar, one’s mind seemingly goes blank.  One comes to, sometimes with a bit of a start, and realizes that, for a time, while one was awake, one was not aware of what one was doing; one was on automatic pilot.
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<br />The mind that is restless, becomes captivated, or blanks out is usually not wholly unconscious, even of its own sensing, feeling, and thinking.  When the mind returns to awareness of itself, one can often, through concentration, extend self-awareness into times in which one was not originally self-aware.
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<br /></span><span style="color:#05213c;font-size:11pt;"><strong>Exercise 7:  </strong></span><span style="color:#05213c;font-size:11pt;"><em>Set aside fifteen minutes to half an hour to meditate.  Settle into your meditation position and focus you mind on your breathing—the sensation of the flow of air in and out of your nostrils or of the rise and fall of your diaphragm.  Concentrate closely on the changes in the sensations as you breathe in, the pause between breathing in and breathing out, as you breathe out, and the pause between breaths.  Count your breaths by thinking to yourself: “In one, one, one, one … (as long as you are breathing in), pause, out one, one, one … (as long as you are breathing out), pause, in two, two, two, two… pause, out two, two, two...” Count up to ten breaths, then start over.  If and when you become aware that your mind has wandered and that you have lost track of counting your breaths, start counting your breaths again, starting at “one.”
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<br />After you have counted your breaths for a number of rounds—say about ten rounds of ten breaths each, stop counting, but keep your mind focused on your breathing.  Notice any changes in the qualities of your consciousness and of what you are aware of.  If your find that your mind has wandered, notice the change in the qualities of your mind and what you are aware of as you move from wandering to focusing on the breath.  If your mind is wandering a lot, start counting your breaths again.
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<br />Keep doing this exercise for between fifteen minutes and half an hour.  Try doing it during one session each day for a week or more.  Notice any changes in the qualities of your awareness and what you are aware of as you practice this exercise regularly.
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<br />At other times during the day, when you remember and have a moment or two, focus on counting your breaths.  Notice any changes in the qualities of your awareness and what you are aware of.
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<br />From now on, you can use this exercise to build up the ability of the mind to concentrate.   
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<br />The previous exercises introduced three ways of dealing with difficulties in or obstacles to staying aware of what is happening.
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<br />The first is concentration.  Focusing awareness on one point, object, or activity, such as breathing, helps to extend consciousness beyond the usual lengths of present moments.
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<br />The second is noting.  Mentally noting what is happening, including the restlessness, blanking out, or captivation of the mind, and then returning to a focus of awareness—for instance, the breath—extends the periods of self-awareness so that they include moments of time when the mind is restless, blanking out, or being captivated.
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<br />The third is studying.  One expands the ability to stay aware through the restlessness, blanking out, or captivation of the mind by focusing on or studying these shifts from state to state.
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<br /></span><span style="color:#05213c;font-size:11pt;"><strong>Exercise 8:  </strong></span><span style="color:#05213c;font-size:11pt;"><em>Plan for a half hour of meditation.  Begin by counting your breaths for about ten rounds of ten breaths each.  Then stop counting the breaths, but continue to note the inflow and the outflow of the breaths by thinking, “Breathing in (as the breath comes in), breathing out (as the breath goes out).”  If other sensations, feelings, and thoughts come to mind, mentally note them with words that describe your activities.  For instance, if a thought enters your mind, think “thinking.”  If you hear a sound, think “listening.”  If you feel an emotion, for instance, sadness, think, “feeling,” “feeling sad,” or just “sad.”  If you have a physical sensation, for instance, of tension or relaxation or pain, think “tensing,” “relaxing,” or “hurting.” 
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<br />When you become aware that you have lost track of what is happening—because your mind has wandered, because a certain line of sensations, feelings, or thoughts captured your mind, because you blanked out, or for any other reason—focus closely on the details of your memory of what happened.  Note, either with or without words, the qualities of your experience as you maintain this focus.  For instance, if your mind wandered, notice the sensations, feelings, and thoughts that accompany focusing on wandering.
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<br />You may find, as you are focusing on the memory of the difficulty, that your mind begins to do it again.  Keep focusing as long as you can on the sensations, feelings, and thoughts that arise as you begin to lose track of what is happening.  For instance, if your mind begins to wander, keep focusing on the sensations, feelings, and thoughts that accompany wandering.
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<br />When you realize that you lost track of what is happening, begin the exercise over again.
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<br />Repeat this exercise once or more times a day for a number of days.
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<br />It is easy to mistake certain techniques or skills or exercises for meditation itself.  Thus people and some teachers will say something like: “If your mind is wandering, you are not meditating.”  “If your mind is not still, you are not meditating.”  “If your mind is not concentrated, you are not meditating.”  “If you fall asleep, you are not meditating.”
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<br />Remember, meditation is simply being aware of what is happening.
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<br />The only mistake you can make in meditating is to think that you are not meditating, and even that is not really a mistake, but just a thought that you are aware of.  If you think you are not meditating, you are aware of what you are doing and you are meditating.
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<br />If you are aware of reading these words, you are meditating.  If you are aware of hearing the sounds that surround you, you are meditating.  If you are aware of breathing, you are meditating.
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<br />There is no wrong way to meditate.  If you were not aware of what was happening, if you got caught up in reading and you didn’t know you were reading, if a line of thought captured your mind and you forgot that you were thinking, if you became sleepy and your forgot that you were dreaming, if your mind went blank—if any of these happened, you were not meditating when they were happening, but as soon as you become aware that you were not aware, then you are meditating.
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<br />Not meditating is always something that happened, in the past, or will happen, in the future.  If you are aware of what happened, then you are aware of remembering, remembering is what is happening; you are meditating on remembering.  If you are aware of what will happen, then you are aware of imagining what will happen, you are meditating on imagining.
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<br />Meditating is like waking up after a sleep or a dream. There is no right or wrong way to be awake or to dream or to be asleep.  You are simply awake or not awake, dreaming or not dreaming, sleeping or not sleeping.
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<br /></span><span style="color:#05213c;font-size:11pt;"><strong>Exercise 9:  </strong></span><span style="color:#05213c;font-size:11pt;"><em>Sit down for a half-hour meditation session.  Settle into you position.  Then notice when you are aware of what is happening.  Don’t try to do or not to do, to think or not to think, to perceive or not to perceive, or to feel or not to feel anything.  Just notice when you notice what you are doing or not doing, thinking or not thinking, feeling or not feeling, perceiving or not perceiving.
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<br />You may start, without really intending to, to do one of the previous meditation exercises.  That’s fine.  Just notice that you are doing the exercise.  For instance, you may notice that you are focusing on your breathing.  When you stop focusing on your breathing, notice that too.
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<br />Your mind may wander, you may get caught up in thoughts, feelings, or sensations, you may fall into a dream, you may blank out, you may fall asleep.  That’s fine.  When you come back to being aware of what is happening, notice that you were not aware and that now you are aware.
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<br />You may find yourself making judgments about yourself.  Either negative judgments, such as, “Oh, I shouldn’t have fallen asleep!”  Or, “I can’t meditate because my mind is all over the place.”  Or, “I’m too tense, I need to calm down.”  Or, “How can I meditate when I can’t even sit still.”   Or, “I’m really angry.  I shouldn’t be angry.”
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<br />Or positive judgments like, “Wow, I stayed concentrated for forty whole breaths!  I’m really getting the hang of this meditation business.”  Or, “My mind is really calm.  This meditation stuff is easy.”  Or, “I’m really relaxed.  I feel so at peace.  How wonderful.”  Or, “I’m really feeling loving toward everyone.  How good.”
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<br />Or you may find yourself making positive or negative judgments about someone else.
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<br />If you make judgments, that’s fine.  Just notice what you are doing.  Notice that you are judging.
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<br />Although it will help in the beginning, you don’t need to sit for half an hour to do this exercise.  Anytime during the day, when you notice that you are aware of what is happening, recognize, for however long you are aware of what you are doing, thinking, feeling, or perceiving, that you are meditating.  It doesn’t matter what you are doing, thinking, feeling, or perceiving.  If you are aware of what is happening, you are meditating.
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<br /></strong></span><span style="color:#05213c;font-size:11pt;">Meditation is being aware that we are aware.  Most of the time, even when we are meditating and thus even when we are aware that we are aware, we don’t differentiate being conscious from the changing states, foci, and contents of which we are aware.  Knowing ourselves as conscious beings requires focusing in on being conscious.
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<br />While we are awake, we are conscious.  Being aware of consciousness is like being aware of the air we breathe in and out.  The air is always there and, most of the time, we are not aware of if.  Even if we attend to the air, it is difficult to be aware of it just as air.  We are aware of air moving—for instance, as we breathe in and out—or of the coolness or warmth of the air or of smells it carries, but we don’t usually focus on the air itself.
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<br />Similarly, most of the time when we meditate, we are aware of being aware of sensations, feelings, and thoughts.  We are aware of changes from one state of consciousness to another.  For instance, one who wakes up is often aware: first, of awakening from sleep, sometimes into a dreamlike state in which the focus is on body sensations, feelings, and thoughts; then, of external sensations—sounds, light, the feel of the sheets; then, of the intention to get up and of thoughts about what one needs to do; then, as one comes fully awake (sometimes only after a cup of coffee), of what one is doing right now, of what one is going to do next and of planning out the day.  But we are usually not aware of the awareness that is continuous while we are awake.
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<br /></span><span style="color:#05213c;font-size:11pt;"><strong>Exercise 10:  </strong></span><span style="color:#05213c;font-size:11pt;"><em>Sit down for a meditation session.  Focus on your breathing without counting your breaths or intentionally naming your breathing in and breathing out.  Quietly attend to the sensations of breathing for a few breaths.
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<br />Do not intentionally name what you are doing or what is happening. With a quiet mind, focus on the pauses between breathing in and breathing out and between breathing out and breathing in.  Don’t try to control your breathing.  Don’t intentionally hold your breath.  Just focus on these pauses in which your body and the air are still.
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<br />Without intentionally naming what is happening, attend to the qualities of your experience during these pauses, to the stillness itself.
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<br />Notice that the stillness remains as you resume breathing in or breathing out.  Keep focused on this stillness as you breathe in and out.  Let your awareness of your breathing shift into the background.
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<br />When you become aware of anything else—your breathing, thoughts, feelings, sensations, that your mind has wandered—bring your focus back to this stillness.  Notice that, like the air you breathe in and out, it continues while everything else is going on.  When you are aware, no matter how filled your mind is with everything else, there is also this stillness, or openness, or space.
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<br />Once you have a clear sense of this stillness or openness or sense of space, begin a meditation session by focusing directly on it.  Keep coming back to it when your mind goes to something else.  Let everything else stay in the background of your awareness.  Keep the stillness in the foreground.
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<br />Use this stillness as the focus for a number of meditation sessions.  Notice the changes in your awareness as you do so.
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<br />As with the other exercises, you can do this one at any time.  When you remember to throughout the day, focus for however long you can on this stillness (or openness or sense of space) that is there whenever you are aware.
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<br />Awareness of the continuity of consciousness opens the mind, making it like a wide space in which all that we are aware of appears.  Within this space, we can explore what is happening and learn more about it.
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<br /></span><span style="color:#05213c;font-size:11pt;"><strong>Exercise 11:  </strong></span><span style="color:#05213c;font-size:11pt;"><em>Pick a time when you can meditate for half an hour or more.  Settle into your meditation position.  Focus on the stillness of awareness, allowing all else that is happening to appear and pass away.  When you become aware that you have lost track of what is happening, focus again on the stillness.  If you are having difficulty coming back to the stillness, focus on your breathing and then on the pauses between breathing in and breathing out and between breathing out and breathing in, then on the stillness itself.
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<br />When your awareness of the stillness is relatively steady, meaning that you can come back to it with some ease after your mind has wandered, focus on your breathing.  Let your awareness of the stillness shift to the background.  You may experience a movement back and forth between your breathing and the stillness.  Or your may experience your breathing as in the front of your mind, with the stillness above or behind or around it.  Or you may experience the stillness and the breathing as wholly fused with each other.  Or you may experience something else.  Attend to what you are experiencing.
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<br />As your mind begins to focus on something other than the breathing or the stillness, allow whatever you are becoming aware of to move into the center or foreground, with the stillness around, behind, or in it.  You may find that you are shifting back and forth between this new focus, your breathing, and the stillness.  Or you may experience the stillness as a space in which the new focus and the breathing appear.  Or you may experience all three as three aspects of one event.  Or you may experience something different.  Attend to what you are experiencing.
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<br />When you realize that you have lost track of what is happening, begin the exercise again.  Focus on the stillness.  Or, if that is difficult, on your breathing and then the pauses in your breathing and then the stillness.  Then on what comes into your mind, with the stillness in the background.
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<br />You may find that one focus remains in the center of your awareness or that you keep coming back to it.  It may be a physical sensation, a line of thought, or a feeling.  You may find that, after losing track of what is happening, that this focus immediately moves into the center of your awareness.  If so, allow this focus to remain in the center, while keeping awareness of the stillness in the background.  Attend to the changes in it and in your awareness as you focus on it.
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<br />You may discover that you got lost in this focus so that you were longer aware of being aware.  When you become aware that this has happened, keep your awareness on what is happening.  If what you were focusing on and got lost in is still at the center of your awareness, allow it to be there.  Keep focusing on it, while also being aware of the stillness in the background.
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<br />Again, at any time, if you have difficulty maintaining your awareness, start the exercise over.  Focus on the stillness or, if that is difficult, first on your breathing, then on the pauses in your breathing, and then on the stillness; then focus on whatever comes up, and allow awareness of the stillness to remain in the background.
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<br />After you have practiced this exercise during a sitting session, you can do a quick version of it anytime during the day.  When you remember and have a moment, focus on whatever is in the foreground of your mind, but also be aware of the stillness in the background.
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<br />While doing the above exercises, especially the last one, you may find that what you focus on fills your mind without extinguishing your awareness.  Rather than being aware of what you are focusing on from the outside, you are aware from the inside.  Rather than your awareness being a space in which everything appears and passes away, your awareness dissolves—without being lost, rather it intensifies—into the vivid and particular reality of what you are aware of.
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<br />Such dissolutions of the boundary between being aware and what we are aware of happen in everyday life.   Often we remember these moments as times when we were fully alive.  They happen when we fall in love and when we are doing something we love.  In such moments, the other—what we are aware of, for instance, a storm, a painting, a piece of music, a rock, a tree, a lover, a friend, a cat, a poem, or the stillness of awareness—becomes the world, or rather the atmosphere in which the rest of the world appears.  We are aware of our moving and thinking and feeling and sensing, of the clarity of consciousness, but there is no barrier between this awareness of the particular ways we are aware and the other we are aware of; the two are different and necessary elements of the single event.
<br />
<br />Some such moments are a source of profound insights into reality—for instance, about consciousness, others, our own nature, love, and the causes and healing of suffering.  These insights come in the form of events that grasp and change us as whole thinking, feeling, and acting beings—as unions of bodies, emotions, and thoughts.
<br />
<br />In the long run, however, the more important of these moments are the smaller, more subtle and more frequent ones that carry with them the repeated and eventually everyday realization that who we are—all our thinking, sensing, acting, feeling, imagining, doing—continually participates in everything we know, sense, meet, act upon, feel, and imagine.  The Jewish religious thinker and philosopher Martin Buber said that we truly exist in our meetings with others.  The Buddhist teacher Thich Nhat Hahn says, “We interbeing are.”  We are ever changing meetings.  We are relational movements.  We and everything continually cocreate ourselves, each other, and everything else.
<br />
<br />When we attend to what is happening, we identify these moments or meetings and their effects on us.  This attending opens us to these moments and their effects; we become attuned to them.  We realize that they are always happening.  They’re the way reality and consciousness exist.  We just aren’t always aware that they are always happening.
<br />
<br /></span><span style="color:#05213c;font-size:11pt;"><strong>Exercise 12:  </strong></span><span style="color:#05213c;font-size:11pt;"><em>Do the beginning of exercise 11.  Settle into your position for a session.  Focus on your breathing, then on the stillness between the breaths, then on the stillness itself.  Then, when something comes into focus—a perception, say a sound, a physical sensation, a feeling, or a line of thought—rather than simply focusing on it and observing it, enter into the middle of it with your awareness.  Allow what you are focusing on to surround and fill your awareness.  Concentrate fully on the particular and changing sensations, feelings, and thoughts. 
<br />
<br />Doing this is likely to be easier with a perception, physical sensation, or feeling than it is with a line of thinking; so you might try it with one of the former foci, rather than a line of thinking, first.
<br />
<br />You may find, as you do this exercise, that you get caught up in the focus and lose awareness of what is happening.  Again, that’s to be expected.  When you become aware that you lost track of what was happening, start over wherever it is easiest to do so.  If you can, immediately feel with your awareness into the inside of a focus.  If you are having difficulty concentrating, go through part or the whole of the beginning of this exercise again and come back to entering into a focus.
<br />
<br />Again, once you have done this exercise during a sitting session, you can do a shorter version of it anytime throughout the day.  Anytime you remember and choose to, reach with your awareness into whatever you are aware of.  Concentrate on the details of what you are aware of from the inside of it.  Allow the other to surround and fill your awareness.
<br /></em></span>
</p></div>
</content>



    </entry>
    <entry>
        <title>If You Need Medicaid, You Can Get It</title>
        <link rel="alternate" type="text/html" href="http://www.communitygeriatriccare.com/2009/04/if-you-need-medicaid-you-can-get-it.html" />
        <link rel="replies" type="text/html" href="http://www.communitygeriatriccare.com/2009/04/if-you-need-medicaid-you-can-get-it.html" thr:count="0" />
        <id>tag:typepad.com,2003:post-66056601</id>
        <published>2009-04-27T03:00:33-07:00</published>
        <updated>2009-07-15T04:00:15-07:00</updated>
        <summary>by Roy Herndon Smith If you are a U.S. citizen or long-term resident alien, are 65 or over and need Medicaid to pay for home care or other medical expenses while you are living at home or in an assisted living facility, you can get it, no matter what your income and assets are. (If you need Medicaid to pay for nursing home care, you can also get it. See the post, "Medicaid to Pay for Nursing Home Care.") (Medicaid is also available to people under 65. Consult http://www.health.state.ny.us/health_care/medicaid/index.htm#qualify.) If you have income above the Medicaid limit, you can still...</summary>
        <author>
            <name>royherndonsmith</name>
        </author>
        <category scheme="http://www.sixapart.com/ns/types#category" term="Home Care and How to Pay for It" />
        <category scheme="http://www.sixapart.com/ns/types#category" term="Medicaid--If You Need It, You Can Get It" />
        
        
<content type="xhtml" xml:lang="en-US" xml:base="http://www.communitygeriatriccare.com/">
<div xmlns="http://www.w3.org/1999/xhtml"><p>
<span style="color:#001834;font-size:11pt;"><em>by Roy Herndon Smith
<br /></em></span><span style="color:#001834;font-size:11pt;">
<br /></span>
</p><p>
<span style="color:#001834;font-size:11pt;text-decoration:underline;">If you are a U.S. citizen or long-term resident alien, are 65 or over and need Medicaid to pay for home care or other medical expenses while you are living at home or in an assisted living facility, you can get it, no matter what your income and assets are.</span><span style="color:#001834;font-size:11pt;">  (If you need Medicaid to pay for nursing home care, you can also get it.  See the post, "Medicaid to Pay for Nursing Home Care.") (</span><span style="color:#000a2b;font-size:11pt;">Medicaid is also available to people under 65.  Consult </span><span style="font-size:11pt;"><a href="http://www.health.state.ny.us/health_care/medicaid/index.htm#qualify">http://www.health.state.ny.us/health_care/medicaid/index.htm#qualify</a></span><span style="color:#000a2b;font-size:11pt;">.)</span>
</p><p>
<span style="color:#001834;font-size:11pt;">If you have income above the Medicaid limit, you can still apply for Medicaid and have it pay for all your home care if you join a pooled income trust.  You will be able to use the surplus income to pay for living expenses.</span>
</p><p>
<span style="color:#001834;font-size:11pt;">
<br />We at Community Geriatric Care Management can, for a fee, help you fill out a Medicaid application and join a pooled income trust. Or you can follow the instructions in the following posts and fill out a Medicaid application and join a pooled income trust yourself:</span>
</p><p>
<span style="color:#001834;font-size:11pt;">
<br />1.	How to Apply for Medicaid Home Care
<br />2.	Have Income Above the Medicaid Limit? Join a Pooled Income Trust</span>
</p><p>
<span style="color:#001834;font-size:11pt;">
<br />If you have assets above the Medicaid limit, you can still get Medicaid.  See the post “Have Assets Above the Medicaid Limit?  You Can Still Get Medicaid.” We can also refer you to other agencies and eldercare attorneys who can help you get Medicaid even if you have significant assets.</span>
</p><p>
<span style="color:#001834;font-size:11pt;">
<br />Community Geriatric Care Management also offers workshops to congregations and groups about how to fill out Medicaid applications and join a pooled income trust.</span>
</p><p>
<span style="color:#001834;font-size:11pt;">
<br />If we receive a complete Medicaid application, with all the necessary documentation, and, if necessary, joined a pooled income trust and/or brought your assets down to the asset limit, and if we determine that Medicaid is likely to approve the application, we can arrange for you to receive Medicaid paid-for home care within two weeks (usually less).  Once Medicaid is approved (usually within two months after the submission of the application), you will continue to receive Medicaid paid-for home care from, if you wish, the same home care agency with which you started.  You will not have to change aides once Medicaid is approved.</span>
</p></div>
</content>



    </entry>
    <entry>
        <title>Community Organizing and the Need for Home Care</title>
        <link rel="alternate" type="text/html" href="http://www.communitygeriatriccare.com/2009/03/community-organizing-and-the-need-for-home-care.html" />
        <link rel="replies" type="text/html" href="http://www.communitygeriatriccare.com/2009/03/community-organizing-and-the-need-for-home-care.html" thr:count="0" />
        <id>tag:typepad.com,2003:post-63612265</id>
        <published>2009-03-03T17:40:22-08:00</published>
        <updated>2009-03-05T09:13:55-08:00</updated>
        <summary>by Roy Herndon Smith Frail elderly people and those who care for them cry out for affordable home care. Because of their poverty, often the only way to pay for sufficient home care is to get Medicaid. But even those who can privately pay for home care or who get it through Medicaid often still suffer from isolation and devaluation. Sometimes, the home care worker is a frail elderly person’s only regular social contact. Here is a proposal for community organizing with the frail elderly, their family members and friends, and their community. In this proposal, I use a Naturally...</summary>
        <author>
            <name>royherndonsmith</name>
        </author>
        <category scheme="http://www.sixapart.com/ns/types#category" term="Home Care and How to Pay for It" />
        <category scheme="http://www.sixapart.com/ns/types#category" term="It Takes A Community" />
        <category scheme="http://www.sixapart.com/ns/types#category" term="Medicaid--If You Need It, You Can Get It" />
        
        
<content type="xhtml" xml:lang="en-US" xml:base="http://www.communitygeriatriccare.com/">
<div xmlns="http://www.w3.org/1999/xhtml"><p><span style="font-size: 10pt;"><em>by </em></span><span style="font-size: 10pt;"><strong><em>Roy Herndon Smith</em></strong></span><span style="font-size: 10pt;"><em>
<br /></em></span><span style="font-size: 10pt;">
<br />Frail elderly people and those who care for them cry out for affordable home care.  Because of their poverty, often the only way to pay for sufficient home care is to get Medicaid.  But even those who can privately pay for home care or who get it through Medicaid often still suffer from isolation and devaluation.  Sometimes, the home care worker is a frail elderly person’s only regular social contact.  
<br />
<br />Here is a proposal for community organizing with the frail elderly, their family members and friends, and their community.  In this proposal, I use a Naturally Occurring Retirement Community (NORC) as an example of a community.  The social work staff of the NORC would carry out the initial steps of the plan.</span>
</p><p style="font-size: 10pt;">
1.  Identify and hold a meeting with those residents of the NORC who are concerned about the need for home care.  Be sure that this meeting includes at least one frail elderly person and at least one person who is currently caring for a frail elderly person, as well as others who make have more time to do community work.  Introduce the following plan to them.  Invite them to question and modify the plan.  Ask them if they would be willing to take oversight responsibility for implementing the plan.
</p><p style="font-size: 10pt;">
2.  Work with this group to set up weekly community gatherings that focus on the abilities of those who are frail and those who are helping them.  Plan for the gatherings to be celebratory and social events, as well as times people can meet and trade abilities and resources.  Invite all community members to participate in the gatherings.  As much as possible, include the frail in the events.
</p><p style="font-size: 10pt;">
3.  Use the gatherings to disseminate information and recruit people with skills to do needed tasks.  For instance, perhaps a homebound retired social worker can become a resident expert on Medicaid and pooled income trusts and can help people fill out these documents.  Perhaps a retired lawyer or legal aide can help people with Power of Attorneys, Health Care Proxies, and Living Wills.  Provide access fot these community workers to the information and resources they need to do the tasks.  For instance, provide educational workshops on Medicaid and pooled income trusts.
</p><p style="font-size: 10pt;">
4.  Map the NORC.  Identify people who might have time and abilities related to personal home care, housekeeping, escort, shopping, escort and companionship.  Also ask what their needs are.  Identify the frail and homebound residents and their abilities, interests and needs.  Where possible, facilitate links between the two groups.
</p><p style="font-size: 10pt;">
5.  Identify those in and around the NORC who need paid home care.  Identify those in and around the NORC who might have the time and abilities to be home care aides and who need or want a job.  Contract with a home care agency to train and employ those who are able and willing to become aides.  As much as possible, have these resident aides be the ones for the resident frail people.  Submit Medicaid applications through the agency that trains and employs the resident aides.  
</p><p style="font-size: 10pt;">
6.  Set up congregate home care where possible.  Bring two or three frail people together and have one aide provide for their care.
</p></div>
</content>



    </entry>
    <entry>
        <title>Community Organizing With the Frail Elderly and Those Who Care for Them</title>
        <link rel="alternate" type="text/html" href="http://www.communitygeriatriccare.com/2009/03/community-organizing-with-the-frail-elderly-and-those-who-care-for-them.html" />
        <link rel="replies" type="text/html" href="http://www.communitygeriatriccare.com/2009/03/community-organizing-with-the-frail-elderly-and-those-who-care-for-them.html" thr:count="0" />
        <id>tag:typepad.com,2003:post-63611621</id>
        <published>2009-03-03T17:24:56-08:00</published>
        <updated>2009-03-03T17:24:56-08:00</updated>
        <summary>by Roy Herndon Smith The source of the suffering of frail and homebound people and those family members, friends, neighbors and professionals who care for them is weak communities and the resulting poverty, isolation and devaluation. In communities, interactions are mutual. People sustain, care, lament enjoy, struggle, play, learn and work with each other. Communities become weak when more and more interactions become one-way. People become frozen in primarily active or passive positions. They do to and for each other, rather than with each other. People suffer the ravages of poverty, isolation and devaluation in either position. Devaluation occurs as...</summary>
        <author>
            <name>royherndonsmith</name>
        </author>
        <category scheme="http://www.sixapart.com/ns/types#category" term="It Takes A Community" />
        
        
<content type="xhtml" xml:lang="en-US" xml:base="http://www.communitygeriatriccare.com/">
<div xmlns="http://www.w3.org/1999/xhtml"><span style="color:#001555;font-size:10pt;"><em>by </em></span><span style="color:#001555;font-size:10pt;"><strong><em>Roy Herndon Smith</em></strong></span><span style="color:#001555;font-size:10pt;">
<br />
<br />The source of the suffering of frail and homebound people and those family members, friends, neighbors and professionals who care for them is weak communities and the resulting poverty, isolation and devaluation.  
<br />
<br />In communities, interactions are mutual.  People sustain, care, lament enjoy, struggle, play, learn and work with each other. 
<br />
<br />Communities become weak when more and more interactions become one-way.  People become frozen in primarily active or passive positions.  They do to and for each other, rather than with each other.  People suffer the ravages of poverty, isolation and devaluation in either position.  </span>
<p>
<span style="color:#001255;font-size:10pt;">Devaluation occurs as people value themselves and others only for their possessions—what they have and what they make.  Isolation and poverty follow.  For instance, the frail elderly, no matter how active and engaged they once were, find that others do not value them because they are no longer productive.  They become passive objects that others take care of and help.  People don’t see them as being able to care for or help others.  Because others see them primarily as empty vessels into which they pour time, energy and resources, these others tend to neglect them.  The frail elderly thus often become isolated.  And, unless they have large amounts of money and often even if they do, isolation results in impoverishment; too often, they do not have enough food, their clothes wear out, their homes become cluttered and dangerous and their health deteriorates. 
<br />
<br />But these ills also afflict those stuck in the active position.  For instance, those who care for the frail elderly—family members, friends, home care aides, social workers and health care workers—learn two lessons.  First, their value lies only in paid jobs.  People who have to give up paid work to care for their frail spouses, partners, parents, children or friends face impoverishment, isolation and devaluation along with those they care for.  For instance, in Manhattan, many such people live with and spend all or almost all of their time and resources on the one they care for.   Second, even if they are paid for their work, as are home care and social workers, they get paid poorly, precisely because they are taking care of people society does not value.  They thus constantly face the threat that, with illness or the loss of a job, they will slip into poverty and the resulting devaluation and isolation.  
<br />
<br />A community-organizing model addresses poverty, isolation and devaluation by addressing their cause, weak communities.
<br />
<br />
<br /></span><span style="color:#001255;font-size:10pt;"><strong>Community Organizing Principles</strong></span><span style="color:#001255;font-size:10pt;">
<br />
<br /></span>
</p><p style="color:#001255;font-size:10pt;">
1.  Community: We only live and thrive in communities in which we sustain each other. We alleviate suffering by strengthening our communities, by pulling people together to share their abilities and to address their needs and suffering.  
</p><p style="color:#001255;font-size:10pt;">
Thus, for instance, when addressing the suffering of the frail elderly and those who care for them, begin by mapping the communities in which these people dwell, by locating where the frail elderly and those who care for them are and where the community resources—the stores, banks, community centers, religious communities, agencies, informal gathering places—are.
</p><p style="color:#001255;font-size:10pt;">
2. Mutuality: All of us, including those of us who are professionals have needs, and all of us, including the frailest elderly person, have resources—abilities, time and material goods.  It’s only by sharing our resources to meet our needs that we can alleviate suffering.  We work together, in mutuality.  
</p><p style="color:#001255;font-size:10pt;">
The second step in community organizing is to map these resources and needs.  Begin with resources.  Who has what abilities, time and material resources?  Where does this person with this resource live or work and is he or she mobile or not?  Then look at needs.  Who has what needs and where does he or she live or work?  Remember, as you do this, that each person has both resources and needs.  Finally, link people with needs up with people who have the complementary resources.  For instance, a homebound retired English teacher and a teenage immigrant who is struggling with English might be able to help each other out. 
</p><p style="color:#001255;font-size:10pt;">
3.  Sustainability:  Maintain, strengthen and build sustainable, long-term patterns of interaction.  In a crisis, turn first to people and resources that are already in the community and will be in the community no matter what.  Avoid, when possible, creating dependency on programs and resources that can (and often are) vulnerable to being withdrawn at any time.  Focus, when possible, on maintaining, strengthening and building intergenerational, interfamilial, intergroup and interclass ties.  Such ties tend to be sustainable.  Focus on maintaining, strengthening and building long-term multi-dimensional friendships and associations.  For instance, the immigrant teenager and the retired English teacher have such a sustainable association, build on companionship and learning.
</p><p style="color:#001255;font-size:10pt;">
4.  Responsibility:  Responsibility for the maintenance, strengthening and building up of the community lies with the community.  For service agencies and professionals, this principle requires a relinquishment of responsibility.  The focus of an outside professional is to facilitate the community taking responsibility for addressing the suffering of its members.  This principle has a significant implication for how to name or think of those who actively participate in community work.  They are not “volunteers” “supervised” by “professionals.”  Rather, they are “citizens,” members of the community who are taking responsibility for maintaining, strengthening and building up their community.  Thus, the responsibility for coordinating communal activities should rest with community members organized into committees and the like.
</p><p style="color:#001255;font-size:10pt;">
 
</p><p>
<span style="color:#001255;font-size:10pt;">5.  Openness:  A community thrives when it is open to the full participation of anyone.  A member is someone who is willing to participate.  If someone seeks to participate in the community, the focus should be on how best to facilitate that participation, not on whether or not that person should participate.  Similarly, openness applies to information and skills, which should be shared openly and not restricted to certain people who are deemed “qualified” to use the information and skills.</span><span style="color:#001255;font-size:9pt;">
<br /></span>
</p></div>
</content>



    </entry>
    <entry>
        <title>Home Care and How to Pay for It</title>
        <link rel="alternate" type="text/html" href="http://www.communitygeriatriccare.com/2009/02/home-care-and-how-to-pay-for-it.html" />
        <link rel="replies" type="text/html" href="http://www.communitygeriatriccare.com/2009/02/home-care-and-how-to-pay-for-it.html" thr:count="0" />
        <id>tag:typepad.com,2003:post-63411917</id>
        <published>2009-02-27T01:08:52-08:00</published>
        <updated>2009-02-27T01:39:06-08:00</updated>
        <summary>by Roy Herndon Smith Home Care Two kinds of aides are available to help people in their homes who have difficulties with the day-to-day activities of living: Home health aides help those who have skilled nursing needs, such as physical therapy, occupational therapy, wound care and instruction and assistance in taking medications. Visiting nurses or therapists provide the skilled nursing care, while home health aides provide skilled day-to-day care. Personal care aides help those who do not have skilled nursing needs, but do have difficulty with personal care or maintaining their homes. Both home health aides and personal care aides...</summary>
        <author>
            <name>royherndonsmith</name>
        </author>
        <category scheme="http://www.sixapart.com/ns/types#category" term="Home Care and How to Pay for It" />
        
        
<content type="html" xml:lang="en-US" xml:base="http://www.communitygeriatriccare.com/">
&lt;div xmlns="http://www.w3.org/1999/xhtml"&gt;&lt;span style="color:#000721;font-size:10pt;"&gt;&lt;em&gt;by &lt;/em&gt;&lt;/span&gt;&lt;span style="color:#000721;font-size:10pt;"&gt;&lt;strong&gt;&lt;em&gt;Roy Herndon Smith&lt;/em&gt;&lt;/strong&gt;&lt;/span&gt;&lt;span style="color:#000721;font-size:10pt;"&gt;
&lt;br /&gt;
&lt;br /&gt;&lt;/span&gt;&lt;span style="color:#000721;font-size:10pt;"&gt;&lt;strong&gt;Home Care&lt;/strong&gt;&lt;/span&gt;&lt;span style="color:#000721;font-size:10pt;"&gt;
&lt;br /&gt;
&lt;br /&gt;Two kinds of aides are available to help people in their homes who have difficulties with the day-to-day activities of living:
&lt;br /&gt;
&lt;br /&gt;Home health aides help those who have skilled nursing needs, such as physical therapy, occupational therapy, wound care and instruction and assistance in taking medications.  Visiting nurses or therapists provide the skilled nursing care, while home health aides provide skilled day-to-day care.
&lt;br /&gt;
&lt;br /&gt;Personal care aides help those who do not have skilled nursing needs, but do have difficulty with personal care or maintaining their homes.
&lt;br /&gt;&lt;/span&gt;
&lt;p&gt;
&lt;span style="color:#000723;font-size:10pt;"&gt;Both home health aides and personal care aides can help with:&lt;/span&gt;&lt;span style="color:#000723;"&gt;
&lt;br /&gt;&lt;/span&gt;
&lt;/p&gt;&lt;p style="text-indent:20pt;"&gt;
&lt;span style="color:#000723;font-size:10pt;"&gt;
&lt;br /&gt;• day-to-day tasks, such as walking, dressing, bathing, maintaining personal hygiene, transferring from a bed to a wheel chair, eating and escort to doctors’ appointments and other events&lt;/span&gt;&lt;span style="color:#000723;"&gt;
&lt;br /&gt;&lt;/span&gt;
&lt;/p&gt;&lt;p style="text-indent:20pt;"&gt;
&lt;span style="color:#000723;font-size:10pt;"&gt;
&lt;br /&gt;• and house-keeping tasks, such as light cleaning, laundry, shopping and preparing meals&lt;/span&gt;&lt;span style="color:#000723;"&gt;
&lt;br /&gt;&lt;/span&gt;
&lt;/p&gt;&lt;p&gt;
&lt;span style="color:#000723;font-size:10pt;"&gt;
&lt;br /&gt;In most cases, home care aides work a minimum of 4 hours a day (although some agencies do provide aides that work 2 to 3 hours a day).  Visiting aides can work up to 12 hours a day.  Live-in aides provide 24-hour-a-day care.  They can work 1 to 7 days a week.
&lt;br /&gt;
&lt;br /&gt;
&lt;br /&gt;&lt;/span&gt;&lt;span style="color:#000723;font-size:10pt;"&gt;&lt;strong&gt;How to Pay for It&lt;/strong&gt;&lt;/span&gt;&lt;span style="color:#000723;font-size:10pt;"&gt;
&lt;br /&gt;
&lt;br /&gt;Home care costs between $8 and $25 and hour.  There are four ways of paying for it:
&lt;br /&gt;&lt;/span&gt;
&lt;/p&gt;&lt;p style="color:#000723;"&gt;

&lt;/p&gt;&lt;p style="color:#000723;"&gt;

&lt;/p&gt;&lt;p&gt;
&lt;span style="color:#000723;font-size:10pt;"&gt;1. Private pay: either through a home care agency or by finding and hiring independent aides.  It often costs less to hire independent aides, but finding, replacing and supervising them can be difficult.  Some people hire private geriatric care managers to do these tasks.  For information about geriatric care managers, click on the category on this blog How a Private Geriatric Care Manager Can Help You.  People usually use a home care agency that provides and supervises trained and certified aides.  For information about and a listing of home care agencies, go to: &lt;/span&gt;&lt;span style="font-size:10pt;"&gt;&lt;a href="http://www.nyshcp.org/content.aspx?id=56&amp;linkidentifier=id&amp;itemid=56"&gt;http://www.nyshcp.org/content.aspx?id=56&amp;#38;linkidentifier=id&amp;#38;itemid=56&lt;/a&gt;&lt;/span&gt;&lt;span style="color:#000723;font-size:10pt;"&gt;.
&lt;br /&gt;
&lt;br /&gt;2. Medicare, some private insurance and long-term care insurance will pay for limited amounts of home health care for someone with a skilled nursing need.  Long-term care insurance will also pay for limited amounts of personal home care.  A referral from a doctor for homecare is necessary for insurance to pay for home care.  For information about Medicare go to &lt;/span&gt;&lt;span style="font-size:10pt;"&gt;&lt;a href="http://www.nyc.gov/portal/site/nycgov/menuitem.c066bd98b2125fe6a62fa24601c789a0"&gt;http://www.nyc.gov/portal/site/nycgov/menuitem.c066bd98b2125fe6a62fa24601c789a0&lt;/a&gt;&lt;/span&gt;&lt;span style="color:#000723;font-size:10pt;"&gt;, &lt;/span&gt;&lt;span style="font-size:10pt;"&gt;&lt;a href="http://www.medicarerights.org"&gt;http://www.medicarerights.org&lt;/a&gt;&lt;/span&gt;&lt;span style="color:#000723;font-size:10pt;"&gt; or &lt;/span&gt;&lt;span style="font-size:10pt;"&gt;&lt;a href="http://www.ins.state.ny.us/caremain.htm"&gt;http://www.ins.state.ny.us/caremain.htm&lt;/a&gt;&lt;/span&gt;&lt;span style="color:#000723;font-size:10pt;"&gt;.
&lt;br /&gt;&lt;/span&gt;
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&lt;/p&gt;&lt;p style="color:#000723;"&gt;

&lt;/p&gt;&lt;p&gt;
&lt;span style="color:#000723;font-size:10pt;"&gt;3. Various government-funded and privately funded programs sometimes provide limited amounts of home care at no or reduced cost.  Federally funded caregiver programs will sometimes pay for limited amounts of home care; see &lt;/span&gt;&lt;span style="font-size:10pt;"&gt;&lt;a href="http://www.nyc.gov/html/caregiver"&gt;http://www.nyc.gov/html/caregiver&lt;/a&gt;&lt;/span&gt;&lt;span style="color:#000723;font-size:10pt;"&gt; for the caregiver program that serves your area.  The Alzheimer’s Foundation website lists programs that provide limited amounts of free or low-cost home care to qualified people or their caregivers; go to &lt;/span&gt;&lt;span style="font-size:10pt;"&gt;&lt;a href="http://www.alznyc.org/resourcedb"&gt;http://www.alznyc.org/resourcedb&lt;/a&gt;&lt;/span&gt;&lt;span style="color:#000723;font-size:10pt;"&gt; and click on Respite Services or telephone them at their 24-hour helpline: 800.272.3900.  New York State, through the New York City Department for the Aging, will sometimes arrange to pay part of the costs of home care, based on an applicant’s income and expenses; for information, go to &lt;/span&gt;&lt;span style="font-size:10pt;"&gt;&lt;a href="http://www.nyc.gov/html/dfta/html/home/home.shtml"&gt;http://www.nyc.gov/html/dfta/html/home/home.shtml&lt;/a&gt;&lt;/span&gt;&lt;span style="color:#000723;font-size:10pt;"&gt; and pick “home care” under the services for your zip code or borough.
&lt;br /&gt;&lt;/span&gt;
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&lt;/p&gt;&lt;p&gt;
&lt;span style="color:#000723;font-size:10pt;"&gt;4. Medicaid will pay for up to 24 hours of home care 7 days a week for those who need it, but cannot afford it.  &lt;/span&gt;&lt;span style="color:#000723;font-size:10pt;text-decoration:underline;"&gt;Someone who truly needs Medicaid can get it, no matter how large their income or assets.&lt;/span&gt;&lt;span style="color:#000723;font-size:10pt;"&gt;  For information about Medicaid and how to apply for it, click on the category on this blog: Medicaid—If You Need It, You Can Get It.&lt;/span&gt;&lt;span style="color:#000723;"&gt;
&lt;br /&gt;&lt;/span&gt;
&lt;/p&gt;&lt;/div&gt;
</content>



    </entry>
    <entry>
        <title>It Takes A Community</title>
        <link rel="alternate" type="text/html" href="http://www.communitygeriatriccare.com/2009/02/it-takes-a-community.html" />
        <link rel="replies" type="text/html" href="http://www.communitygeriatriccare.com/2009/02/it-takes-a-community.html" thr:count="0" />
        <id>tag:typepad.com,2003:post-63221373</id>
        <published>2009-02-23T04:29:43-08:00</published>
        <updated>2009-02-24T07:14:50-08:00</updated>
        <summary>by Roy Herndon Smith We live and thrive only in communities—families, neighborhoods, religious and other associations—in which we care for, value and enjoy each other. The cutting off of frail people from communities weakens not only them, but also the rest of us, as we lose their skills, insights, wisdom, and the joy of their company. A strong and healthy society, in which individuals thrive, requires the identification, maintenance, strengthening and building of communities that include, support and value the participation of all members, including those who are frail. We live in interaction with others. As children we learn how...</summary>
        <author>
            <name>royherndonsmith</name>
        </author>
        <category scheme="http://www.sixapart.com/ns/types#category" term="It Takes A Community" />
        
        
<content type="xhtml" xml:lang="en-US" xml:base="http://www.communitygeriatriccare.com/">
<div xmlns="http://www.w3.org/1999/xhtml"><span style="color:#000c3b;font-size:10pt;"><em>by </em></span><span style="color:#000c3b;font-size:10pt;"><strong><em>Roy Herndon Smith</em></strong></span><span style="color:#030412;font-size:11pt;">
<br />
<br /></span><span style="color:#030412;font-size:10pt;">We live and thrive only in communities—families, neighborhoods, religious and other associations—in which we care for, value and enjoy each other.  The cutting off of frail people from communities weakens not only them, but also the rest of us, as we lose their skills, insights, wisdom, and the joy of their company.  A strong and healthy society, in which individuals thrive, requires the identification, maintenance, strengthening and building of communities that include, support and value the participation of all members, including those who are frail.
<br /></span>
<span style="color:#000413;font-size:10pt;">We live in interaction with others.  As children we learn how to live from and with others.  And if, as adults, we find that we are alone, what we learned with others sustains us.  In the movie The Castaway, the sole survivor of a plane crash washes up on the shore of a desert island. He survives because he remembers what he has learned with others—how to start a fire, how to make rope, how to spear fish.</span>
<br /><span style="color:#000413;font-size:10pt;">
<br />But we do not live by the practice of survival skills alone.  After four years alone on the island, the castaway is desperate for interaction with others.  He clings to life by holding imagined conversations with a volleyball, “Wilson,” and remembering those he loves.  We live through and in the conversations we have with others or through the memory of these interactions.</span>
<br /><span style="color:#000413;font-size:10pt;">
<br />The greatest suffering a community can inflict on a member is to cast him or her out, thus cutting the person off from:
<br />•	the networks of people that provide him or her with food, shelter, clothing, protection and healing
<br />•	the social interactions that make life meaningful
<br />•	the confirmation of his or her value that sustains his or her self.</span>
<br /><span style="color:#000413;font-size:10pt;">
<br />Frail elderly people constitute one of the groups in our society that suffer most from the impoverishment, isolation and devaluation that result from being cast out of communities.</span>
<br /><span style="color:#000413;font-size:10pt;">
<br />Frail people are often unable to work.  They often live on fixed incomes.  Often, even if they had good jobs when they were not frail, their income from social security and retirement accounts is barely or not enough to cover their basic needs.  Medicare and other insurance often do not cover all their medical expenses, especially if they suffer from chronic, disabling illnesses.</span>
<br /><span style="color:#000413;font-size:10pt;">
<br />Isolation afflicts many of the frail elderly, especially if they are also homebound.  Retirement often separates them from day-to-day contact with others.  Spouses, partners and friends are often ill or have died.  Family members have often moved away.  Their frailty often prevents them from participating in associations—religious communities, neighborhood, interest and vocational groups, service and political organizations.</span>
<br /><span style="color:#000413;font-size:10pt;">
<br />Frail older people, even if they are not poor or isolated, often face devaluation, especially if they live in institutions.  Usually this devaluation is unintentional.  Health care and social service workers, as well as overwhelmed adult children, often focus almost entirely on frail people’s needs, not on their wisdom, skills, and strengths.  Too often, frail older people find no confirmation of the value of their participation in their communities.</span>
<br /><span style="color:#000413;font-size:10pt;">
<br />Impoverishment, isolation and devaluation too often result in frail elderly people concluding that their lives are over, that they exist only as burdens on those they love, and that death is the only escape from a life that has become desperate, lonely and empty.</span>
<br /><span style="color:#000413;font-size:10pt;">
<br />A compassionate response to frail people begins with the realization that the desperation, despair and bitterness that afflict many of them are not primarily signs of individual mental illness, but are effects of impoverishment, isolation and devaluation that, in turn, are effects of weak communities.  And weak communities afflict all of us.  When we are healthy and strong, we can sometimes deny our own suffering that results from the breaking up of the communities that sustain us; we can claim to be wholly autonomous, independent and self-reliant.  But, as we tell ourselves in movies and television shows, even the seemingly most omnipotent superhero needs and relies on networks of friends, neighbors and others—communities—to sustain his life; and weakening these communities threatens his life.  When we unintentionally cast frail people out of the communities that sustain them, we weaken the communities that sustain all of us.  When we impoverish, isolate and devalue them, we impoverish, isolate and devalue ourselves.  That is the basic fact of life.  We are communal beings.  We live, suffer and thrive together.</span>
<br /><span style="color:#000413;font-size:10pt;">
<br />The current economic crisis makes this fact abundantly clear.  What we as a society have been doing to frail people we are now doing to tens of millions of the rest of us.  All but a very few of us face the threats of impoverishment, isolation and devaluation that result from our systematic breaking up of the communities that sustain us.</span>
<br /><span style="color:#000413;font-size:10pt;">
<br />A compassionate response to the weakening of communities that threatens all of us builds on the recognition that each of us needs the participation, skills, knowledge and wisdom of the rest of us if we are going to survive and thrive.  The impoverishment, isolation and devaluation of the frail result in the rest of us losing their participation, skills, knowledge and wisdom.  And we cannot afford this loss.  We need the wisdom of elderly homebound people if we are going to survive and thrive.  We need their participation in making the ongoing decisions about how all of us are going live.</span>
<br /><span style="color:#000413;font-size:10pt;">
<br />We are communal beings. What strengthens one of us strengthens all of us.  What weakens one of us weakens all of us. Strong and healthy societies and the strong and healthy communities that constitute them support, include and value everyone, including the frail, because such support, inclusion and valuing are necessary for everyone to live and thrive.</span>
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