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Ever feel like there’s not enough time in the day to get everything done? Do you start feeling overwhelmed as soon you think about everything on your plate?

If you’re an entrepreneur, you probably know this feeling well. You’re running on all cylinders trying to build your business. You have a long to-do list that seems to grow longer every day. You just don’t have enough hours in the day.

Feeling overwhelmed can result in negative emotions such as anxiety, worry or irritability. And it can increase your stress levels, which could lead to even more serious issues with your mental or physical health.

While you can’t addmore hours to your day, there are a number of strategies you can use to help you stop feeling overwhelmed.

1. Take a Deep Breath

When you’re overwhelmed or feeling stressed, it can be hard to think clearly.

And when you’re not focused and thinking clearly, you’re more likely to make a bad decision or struggle to get things done.

The first and most important step when you’re feeling stressed, is to relax.

In the 1970s, Herbert Benson, a Harvard Medical School physician developed a technique called the relaxation response. This is a state of deep rest that helps to change your response to stress e.g. reduced heart rate, blood pressure, rate of breathing and muscle tension

You can you use a number of techniques to induce the relaxation response, including mindfulness, tai chi, yoga, deep breathing etc.

Deep breathing, which is also known as diaphragmatic breathing, is a simple but powerful technique for dealing with stress. Here’s a short 3 minute video that will teach you this technique:

You can practice diaphragmatic breathing lying down, sitting or even standing up. Once you’re comfortable with this technique, you can do it anywhere.

One reason you might be overwhelmed is that your brain feels overloaded with information. You might be mentally juggling a long list of tasks or you may have negative thoughts spinning around in your head.

One of the best ways to clear your mind is to write things down.

If you’re feeling overwhelmed because your head is filled with all the things you need to get done, then try this simple exercise.

Get a piece of paper and spend 10 minutes making a list of everything that you need to get done. Don't try to evaluate or organize every task, you can do that later. For now, just get those tasks out of your head and onto paper.

Connecting Individuals, Disabilites, Communities
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IMPORTANT CHANGES TO SOUTH PARK DATES

BECAUSE OF RECENT FLOODING, THE GRANT LODGE, SOUTH PARK, IS NOT AVAILABLE FOR PACC EVENTS SCHEDULED THERE ON 7/11, 7/12, 07/17, 07/26, 08/23 AND 08/29.

THE EVENTS SCHEDULED FOR THOSE DAYS WILL BE HELD, INSTEAD, AT THE DIANA PAVILION AT SOUTH PARK.

PAR Mail 2018-032 | February 16, 2018

House Vote on HR 620 Seen as Weakening Disability Rights

Disability Rights

The legislation now goes to the Senate for vote. Click to ask your senators to oppose HR 620 through Access Living’s call to action information page

Yesterday, in a nearly party line vote, the House of Representatives passed onto the Senate, H.R. 620, the American Disabilities Act (ADA) Education and Reform Act of 2017. The American Disabilities Act was passed in 1990 to prevent employment discrimination against those with disabilities. At that time, the passage of the ADA was heralded as the bi-partisan crown achievement of President George H.W. Bush’s Administration, with strong support by then-Senators Orin Hatch, Bob Dole, Tom Harkin, Ted Kennedy and House sponsor Representative Tony Coehlo.

The House-passed bill H.R. 620 includes a new provision limiting individuals from pursuing litigation against business owners unless they are given written notice and fail to respond with improvements or to make substantial progress after six months. The bill passed 225-192.

Disability and civil rights groups strongly opposed the bill asserting that its passage would weaken the rights of people with disabilities. Vanita Gupta, President and CEO of The Leadership Conference on Civil and Human Rights and a former head of the U.S. Department of Justice Civil Rights Division, called yesterday’s vote “shameful.”

Others, including Robyn Powell, a former Civil Rights attorney with the National Council on Disability, called upon Congress to look at lawyers believed to be seeking frivolous lawsuits, rather than restricting the rights of people with disabilities.

The bill’s narrow passage in the House may signal a tough road ahead in the Senate, where Senators will need 60 votes to overcome an expected filibuster on the bill, should it reach the Senate floor.

House Leadership plans to vote on H.R. 620. This legislation would eliminate the need for businesses to meet accessibility requirements until a complaint is filed against them . Since the Americans with Disabilities Act (ADA) was established twenty-seven years ago, people with disabilities still are fighting to gain access to businesses and other entities that offer services to the public. This bill would add many additional burdens for people with disabilities to access a business by requiring them to file a complaint, specifically explain how they violated the law, and address how this is a permanent or temporary fix. H.R. 620 takes away the civil rights of people with disabilities instead of providing more inclusion into our communities.

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Introduction

The purpose of this White Paper is to provide a context for approaching the challenge of evaluating the capacity for consent for sexual activity by persons with dementia residing in long term care (LTC) facilities. This area of LTC practice is still poorly understood and inadequately researched. A 2013 survey found that only 26% of 91 Kansas nursing homes had a policy on sexuality. Also in 2013, a survey of 175 AMDA medical directors found that only 13% said their facilities provide staff training addressing sexual behavior in the facility. Only 23% were certain their facility had a policy on intimacy and sexual behavior. Only 20% said their facility had a policy addressing capacity for sexual consent. The most helpful resources preferred by respondents would be a staff training manual (71%), samples of documents and forms related to sexual consent capacity and sexual behavior (63%), creation of specific policies regarding sexual behavior (57%), multimedia educational resources (56%), and online continuing education offerings (52%).

Consensus around standard of care on this issue is limited at best. There are limitations in knowing how to determine sexual consent capacity in dementia. In addition, there is irreducible ethical diversity within our society, particularly in the area of sexual values. Given the lack of a widely accepted standard to identify capacity for sexual consent, this paper is primarily descriptive of a current overview of the topic. The conclusions reached are necessarily modest, but intended to motivate further progress.

This paper begins with a brief statement of the contrasting but complementary rights at play in this dilemma. These rights point to the need for clarity on what constitutes capacity for sexual consent in dementia. Second, the perspective of the American Psychological Association and American Bar Association is reviewed from their joint work on a monograph devoted to formal assessment of older adults with diminished capacity, including capacity for sexual consent. The third section reviews the research literature on perspectives of other disciplines involved more directly in the care of older adults with dementia and sexual expression. Fourth, the literature on family perspectives is sampled. Fifth, examples of proposals for LTC policy formation are examined. Sixth, three sample cases are discussed, followed by concluding remarks. The focus of this paper is on ethical, clinical and administrative aspects of this issue. Legal standards vary from state to state and should be consulted for particular LTC settings before policies are enacted.

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In matters of sexual behavior by LTC residents with dementia, three fundamental rights are in focus. First, in America, all persons who have reached the age of consent (varying by state from 16-18 years) have the right to consensual sexual activity, and are presumed to have the capacity to consent, absent evidence to the contrary. Thus, as an implication of respect for persons, resident autonomy, and privacy, LTC residents have a right to appropriate accommodation for consensual sexual relationships. Second, all persons have the right to not have unconsented-to sexual aggression directed at them. If one assumes a definition of sexual abuse that includes nonconsensual physical contact of a sexual nature, not necessarily involving intercourse, most sexual abuse of older adults probably occurs in nursing homes and involves resident-to-resident sexual aggression (RRSA). LTC facilities have been found liable as third parties in cases involving RRSA leading to abuse, and are expected to take steps to mitigate the risk of unwanted RRSA that may lead to abuse.

Given the significant prevalence of dementia in the LTC population, the importance of a process to determine capacity for sexual consent of an older adult with dementia in LTC is clear. These realities point to a third right, the right to an authentic process by which LTC professionals evaluate capacity for consent by individuals with dementia in LTC engaging in sexual activity.

For the purposes of this paper, capacity for decision-making will be considered a clinical determination. The term “competency” has historically been used to refer to a legal determination by a court of global functioning in making personal decisions across a wide range of domains. “Capacity” can refer to specific functions; thus, a clinician may determine an individual has the capacity to perform simple daily activities such as selection of menu items, but lacks the capacity to consent to a major medical procedure. Capacity thresholds for varying degrees of intimacy activities likewise may vary.

2. FORMAL ASSESSMENT OF OLDER ADULTS WITH DIMINISHED CAPACITY FOR CONSENT

The American Bar Association (ABA) and the American Psychological Association (APA) have co-published a resource for psychologists entitled “Assessment of Older Adults with Diminished Capacity.” This perspective provides an overview of a formal approach to capacity evaluation. The following is a synopsis of excerpts from this resource on the general issue of consent, and sexual consent particularly.

2.1 General Considerations Concerning Evaluation of Capacity to Consent (ABA/APA)

Capacity may be defined as an individual’s physical or mental ability relative to a specific task, e.g., executing a will, consenting to medical treatment, or sexual consent. Unless they have been adjudicated as lacking capacity, all individuals are presumed to have capacity for personal decisions, and with it the right to make what others may consider bad decisions. Neither advanced age nor the presence of cognitive impairment in themselves are sufficient to declare incapacity to decide or to consent.

What formerly was referred to as competency is now more commonly referred to as legal capacity. This should be distinguished from clinical capacity, which is a determination by a clinician as to the presence or absence of an individual’s capacity to make a decision or consent to a specific activity. Incapacity is a legal status determined by a court that an individual lacks sufficient ability to make personal or financial decisions for her or himself.

There is no single test for determining capacity to consent. The ABA/APA Handbook posits a complex framework for approaching capacity determinations, depicted as a balancing scale encompassing several categories of evidence. The foundation of the scale is the legal standard for the particular function. The balancing point is clinical judgment, which weighs the several factors which are part of the assessment.

On one side of the balance are more standardized, objective, or structured measures. These include:

On the other side of the balance are more subjective or hypothetical factors, including

Current decisions which are consistent with longstanding values may indicate capacity. However, it is recognized that values may change over time without indicating a loss of capacity. Clinicians must be aware of an individual’s values and base a capacity determination on the individual’s values, not on the clinician’s values.

This conceptual framework considers multiple aspects of the situation involving a person with diminished capacity to determine if sufficient capacity exists for the task in question. It should be noted that the APA/ABA Handbook does not emphasize the role of formal tests for capacity over and above an analysis of the broader perspective. “One difference between capacity assessment and most neuropsychological assessment is this focus on functioning, and the inclusion of some method to assess the specific capacity in question using direct assessment.” (ABA/APA, p.26).

The concept of undue influence is also part of capacity assessment. Undue influence is a legal term used to refer to the intentional use of social influence, deception and manipulation by one person to exert control over the decisions of another person. Power and role are sometimes used to exploit the trust, dependency or fear of the individual who is the object of undue influence. The presence of undue influence does not equate to incapacity, but it may hinder or negate the ability of the victim to exercise their capacity for a voluntary choice, free from coercion or manipulation.

functional assessment

Witnesses were asked to comment on the use of science at the state level for managing fisheries and preventing overfishing. Mr. Chris Blankenship (Commissioner, Alabama Department of Conservation and Natural Resources), Mr. Chris Macaluso (Director; Center for Marine Fisheries, Theodore Roosevelt Conservation Partnership), and Mr. Mike Merrifield (Fish Section Chairman, Southeastern Fisheries Association) praised the management of state and recreational fisheries and articulated anglers’ trust for state level management. There was bipartisan support for encouraging federal-state research efforts.

Ranking Member Huffman called out the partisan nature of the reauthorization process and asked instead for bipartisan “mutually agreed upon priorities” and an end to “poison pill provisions” that would undermine environmental legislation such as the Marine Mammal Protection Act , the National Marine Sanctuaries Act , and the Endangered Species Act .

The current use of outdated stock assessments to set annual catch limits was broadly disliked by many panelists and Republicans and was acknowledged by NOAA and Democrats as a problem that could be fixed. Some struggled with the agency’s perspective of having the “best science available” and proposed that NOAA use alternative (more real-time) data sources from states or universities as a solution. How these data would be collected and which would be used has yet to be determined, but both parties agreed that state-federal cooperation would be advantageous.

Quotable

“NOAA Fisheries stands ready to work with the Congress to craft a reauthorization bill that addresses current fishery management challenges and ensures the nation’s fisheries are able to meet the needs of both current and future generations.” – Mr. Chris Oliver (Assistant Administrator, NOAA Fisheries)

“We have been able to craft a fisheries management strategy that is flexible and based in sound science. The MSA is unique among natural resource laws in that best practices are crafted by fishermen and other stakeholders to deal with specific region challenges.” – Representative Nanette Barragán (CA-44)

“What we are dealing with is a one-size-fits-all, and it is not very adaptive, in my opinion.” – Representative Jody Hice (GA-10).

“The truth of the matter is there are plenty of fish out there…we just need to get our science right, and I think the bills that are being considered by this committee will get us there.” – Representative Bradley Byrne (AL-1)

Next Steps

Chairman Emeritus Young committed to progressing forward, declaring, “We’re going to try to get some things moving by October or November of this year.”

Find Out More

Watch the full hearing

Witness Testimonies:

Related coverage from the Consortium for Ocean Leadership

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