Chronology of Ancient Mesopotamian Kings of Sumeria

Mesopotamia, the Land Between Two Rivers, was located in present-day Iraq and Syria  and was home to one of the most ancient civilizations: the Sumerians. Between the Tigris and Euphrates rivers, Sumerian cities such as Ur, Uruk, and Lagash provide some of the earliest evidence of human societies, along with the laws, writing, and agriculture that made them function. Sumeria in southern Mesopotamia was countered by Akkad (as well as Babylonia and Assyria) in the north. Rival dynasties would shift the center of power from one city to another over thousands of years; the Akkadian ruler Sargon united the two societies during his reign (2334-2279 B.C.) The fall of Babylon to the Persians in 539 B.C. saw the end of indigenous rule in Mesopotamia, and the land was marked by further conquests by Alexander the Great, the Romans, and before coming under Muslim rule in the 7th Century. This list of ancient Mesopotamian kings comes from John E. Morby. Notes based on Marc Van De Mieroops. Sumerian Timelines First Dynasty of Ur c. 2563-2387 B.C. 2563-2524... Mesannepadda 2523-2484... Aannepadda 2483-2448... Meskiagnunna 2447-2423... Elulu 2422-2387... Balulu Dynasty of Lagash c. 2494-2342 B.C. 2494-2465... Ur-Nanshe 2464-2455... Akurgal 2454-2425... Ennatum 2424-2405... Enannatum I 2402-2375... Entemena 2374-2365... Enannatum II 2364-2359... Enentarzi 2358-2352... Lugal-anda 2351-2342... Uru-inim-gina Dynasty of Uruk c. 2340-2316 B.C. 2340-2316... Lugal-zaggesi Dynasty of Akkad c. 2334-2154 B.C. 2334-2279... Sargon 2278-2270... Rimush 2269-2255... Manishtushu 2254-2218... Naram-Suen 2217-2193... Shar-kali-sharri 2192-2190... anarchy 2189-2169... Dudu 2168-2154... Shu-Turul Third Dynasty of Ur c. 2112-2004 B.C. 2112-2095... Ur-Nammu 2094-2047... Shulgi 2046-2038... Amar-Suena 2037-2029... Shu-Suen 2028-2004... Ibbi-Suen (The last king of Ur. One of his generals, Ishbi-Erra, established a dynasty in Isin.) Dynasty of Isin c. 2017-1794 B.C. 2017-1985... Ishbi-Erra 1984-1975... Shu-ilishu 1974-1954... Iddin-Dagan 1953-1935... Ishme-Dagan 1934-1924... Lipit-Ishtar 1923-1896... Ur-Ninurta 1895-1875... Bur-Sin 1874-1870... Lipit-Enlil 1869-1863... Erra-imitti 1862-1839... Enlil-bani 1838-1836... Zambiya 1835-1832... Iter-pisha 1831-1828... Ur-dukuga 1827-1817... Sin-magir 1816-1794... Damiq-ilishu Dynasty of Larsa c. 2026-1763 B.C. 2026-2006... Naplanum 2005-1978... Emisum 1977-1943... Samium 1942-1934... Zabaya 1933-1907... Gunnunum 1906-1896... Abi-sare 1895-1867... Sumu-el 1866-1851... Nur-Adad 1850-1844... Sin-iddinam 1843-1842... Sin-eribam 1841-1837... Sin-iqisham 1836... Silli-Adad 1835-1823... Warad-Sin 1822-1763... Rim-Sin (probably an Elamite. He defeated a coalition from Uruk, Isin, and Babylon and destroyed Uruk in 1800.)

APM Policy Enforcers - 897 Words

. On the other hand, APM policy enforces users to get access to a certain resource. APM needs to be available at each layer of the cloud network. This APM policy is more critical because any incorrect setup of the policy can damage the entire access control system. AR is a monitoring and reporting tool which can keep track of information of all policies and credentials by which cloud administrators can prevent and identify access violations, measure risk coverage, and enforce segregation of duties. Different types of reports can be implemented in AR, based on security guidelines and within the scope of AIM. AR is one of the most vital parts of AAM, as all of the security polices fully depend on this tool (SIG, 2012). However, another important security aspect of the cloud computing is SQL injection attacks (SQLIA) which needs to be improved. According to the cloud hosting company Firehost, SQLIA have increased from 18% to 20% from the first quarter to the second quarter of 20 13. Computer hackers try to insert malicious codes to get unauthorized access to database systems which will eventually give access to steal the contents of the databases. The cloud network should implement and improve on parameterized SQL queries, input validation, and stored procedures which will secure the system from exploiting the database. To retrieve, alter, or insert any data from the database system, SQL queries are required. SQL queries should separate the logic from data which

Womens suffrage movement Free Essays

Womens suffrage movement BY raider2014 Victoria Woodhull- The first woman to declare herself as a candidate for president, Woodhull announced her run on April 2, 1870, by sending a notice to the New York Herald. This was an absolutely astounding thing to do: women only recently received the right to vote in the two relatively obscure territories of Wyoming and Utah, and it would be another fifty years before the ratification of the 19th Amendment that assured the ballot to all American women. Moreover, she took this step without contacting any leading uffragists, who by then had been well organized for more than two decades. We will write a custom essay sample on Womens suffrage movement or any similar topic only for you Order Now Susan B. Anthony and others were stunned by the action of this controversial woman, whose â€Å"open marriage† was the talk of New York City. The next presidential election was two years away, and Woodhull used this time to bring attention to women’s issues, including the right to vote. Undaunted by the fact that women could not vote and that she was not yet old enough to legally become president, Woodhull traveled the country campaigning. Her speeches not only advocated the vote, but also birth ontrol, â€Å"free love,† and other positions that were a century ahead of her time. Many listeners were surprised to find themselves more sympathetic than they had expected: her beauty, soft voice, and reasoned arguments took the edge off of such shocking statements as her belief that marriage was â€Å"legalized prostitution. † Woodhull and her sister, Tennie C. , were in Jail, however, when the 1872 presidential election occurred. Because they wanted to draw attention to the era’s hypocrisy on sexual matters, their newspaper published the facts about an adulterous affair between the nationally popular Rev. Henry Ward Beecher and a leader of the women’s movement, Elizabeth Tilton. It was true, but not politically correct, and the sisters were indicted for both libel and obscenity. The charges eventually were dropped, but the scandal was enough to end Woodhull’s presidential aspirations, as she spent election day in Jail. Belva Lockwood- Belva Ann Bennett McNall Lockwood was a self-made woman who adopted bold positions in support of equal opportunity for women. She lived her life fighting to ensure that women had the same opportunities as their male counterparts, both by xample and in her law practice. Lockwood was set to graduate from law school in 1873, but was notified that she would not receive her degree. She appealed to President Ulysses S. Grant and he intervened on her behalf. Later she refused to take no for an answer again when she lobbied Congress for the right to argue in front of the federal courts and helped get the bill passed in 1879. She also Joined the National Women’s Suffrage Association (NWSA) lecture circuit, which made her money and gave her recognition. She would upset the NWSA, though, with her decision to un as a presidential candidate for the National Equal Rights Party in 1884. Susan B. Anthony and others felt that Lockwood’s decision was self-serving and distracting from their greater mission, but she saw it as a way to bring attention to women as genuine citizens. Although always a fringe group, the party had its strongest support in Calitornia, where San Franciscan Marie tta Stowe served as the vice- presidential nominee. The party’s platform was not Just limited to feminism: it included positions on foreign affairs, civil service reform, and other issues, including n innovative proposal for federalization of family law. The Lockwood/Stowe ticket won Just over 4,000 votes in six states, but Lockwood was not discouraged and ran again in 1888. â€Å"Women should not merely talk about what needed to be done†, she said, â€Å"but should do it†. Margaret Chase Smith- Margaret Chase Smith served 32 years in Congress and was the first woman elected to both the House and Senate. Although a champion for women’s issues, she was always clear about being seen as a U. S. Senator and not a woman Senator. In 1964, she became the first credible female candidate for president. Unlike her predecessors, she had legislative experience. A liberal Republican closely associated with her native state of Maine, Margaret Madeline Chase was born to a blue-collar Skowhegan family in 1897. Her entry into politics began when her employer suggested that she be added to the Skowhegan Town Committee. She still was carrying out traditional wifely duties, however, as this helped husband, Clyde Smith, be elected the U. S. House in 1936. She moved to Washington and served as his aide, doing research on pending bills and assisting with speeches. When Clyde died in 940, Margaret won the special election to succeed him, and three months later, Maine voters elected her to the first of four full House terms. Smith moved up to the Senate in 1948, defeating both Maine’s current governor and a former governor. Her 1960 re-election was a milestone for women, as it was the first time that two women were nominated for a U. S. Senate seat: Smith easily defeated Democratic nominee Lucia Cormier. Nationally respected by 1964, Smith ran for president. Most states did not yet conduct primaries, but she ran credibly in those that did, and won the votes f 27 delegates at the Republican National Convention that nominated the more conservative Barry Goldwater. At 66, ageism Joined sexism as a factor in her loss. She was not credited for her greater experience; instead pundits speculated about whether Senator Smith was menopausal. Her point that â€Å"l haven’t seen the age played up in the case of the men candidates† was in vain. Patsy Takemoto Mink- Patsy Takemoto Mink was the first woman of color to serve in the United States Congress, but it was the work that she did there that should be remembered. Mink epresented many groups that, prior to her election, had been absent from national politics, working tirelessly to serve women, minorities and the poor. She brought attention to issues that others ignored. Takemoto learned first-hand that she could not take citizenship and the promise of the U. S. Constitution for granted: her family was put under surveillance after the attacks on Pearl Harbor, and her father was taken from their home for interrogation. Like most Hawaiians of Japanese descent, the Takemotos were not sent to an internment camp, but the awareness that most ainland Japanese Americans were incarcerated was an important factor in Patsy’s development. She graduated from law school in 1951, however no Chicago law firms wou d hire her, which sne initially thought was due to her ethnicity, but her gender and married status were also negative factors. Instead of allowing herself to be defeated, she and her husband moved to Hawaii. She opened her own law practice, becoming the first female Japanese-American lawyer in Hawaii. Active in the territorys Democratic Party, she also was a founder of the Young Democrats of America. This led to her election to the Territorial House of Representatives in 1956 and to the Hawaii Senate in 1958. How to cite Womens suffrage movement, Papers

Misunderstood free essay sample

Everyone has his or her own struggles to deal with, which is why I don’t really like to talk about mine. However, the struggles I had did indeed help shape me as an individual. When I was younger, I was very quiet and reserved—exactly the opposite of how I am now. Due to this trait, I guess some people just saw me as an easy target. My mother grew up in Taiwan, and she immigrated to America to make something better out of her life. Because she was a native Mandarin Chinese speaker, that’s how she and I would communicate in the early years of my life, so I was effectively bilingual. I never saw this as a big deal until one of my six-year-old classmates came up to me and asked me why I was such a freak. He told me I was ugly and didn’t belong here with normal people, and that I should go back to the pig’s hole of a country where I came from. We will write a custom essay sample on Misunderstood or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Those are some pretty prejudiced things for a six year old to say to someone, especially since I’m only half ethnic. I was born in America, so how was I any less American? I wasn’t. I didn’t see it that way, though. I thought being half Chinese made me inferior to everyone else—that I was ugly, unimportant, and abnormal. I pretty much grew up with the mentality of being ugly, unimportant, and abnormal, all thanks to one individual. This â€Å"personal struggle† really taught me how much words mean. It doesn’t matter if your words seem unimportant—everything said by every single person is important, and they all have an impact on someone. Words are so powerful, and it’s so unfair to underestimate that.

Barilla Spa Case Report Essay Example

Barilla Spa Case Report Essay This system is entirely different from the existing setup and is being opposed by both the distributors and Barilla’s Sales and Marketing Department. Barilla SpA, an Italian pasta manufacturer, is experiencing amplified levels of inefficiencies and rising costs due to variability in demand from its distributors. In order to bring things back in order and to improve its margins. I have studied the reasons for this opposition by several facts and have suggested recommendations. I suggest that in order to condense the Bullwhip effect being experienced by Barilla, their supply chain would have to be centralized. I have given my rationale for the JITD system to work and have suggested recommendations to resolve all existing issues. I think that a centralized supply chain with Barilla controlling the orders will result in better margins for all the partners. I also believe that by following my recommendations, Barilla will succeed in influencing its distributors and Sales personnel to work together and implement the JITD program. This will not only result in better performance in terms of time and money but also promote trust and good relations among all the partners in the supply chain. Issues with Impact Analysis Issues: Bar-code system will be linked to the supply chain system which will be an added cost to the entire implementation Reduced operational costs and higher profit margins once JITD is implemented The cost of implementing JITD would be very expensive at all the plant locations and distributors warehouses Distributors may not agree to the idea of having a vendor-managed inventory The lack of resources and competencies to gain sustainable competitive advantages We will write a custom essay sample on Barilla Spa Case Report specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Barilla Spa Case Report specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Barilla Spa Case Report specifically for you FOR ONLY $16.38 $13.9/page Hire Writer It is anticipated that it would take a lot of time and effort before the implementation of the JITD system to the supply chain would be successful Impacts: For the manufacturer: Increased supply chain visibility Reduced manufacturing costs Increase Distributor’s dependence on Barilla Improvement in manufacturing planning using objective data Reduced inventory levels Better Relationship with Distributors For the distributors: Reduced Inventory holding costs Additional service without any extra cost Improved fill rates to Retail stores 4 Environmental and Root Cause Analysis The decisions at the moment are not advancing the company’s overall operational success; this includes excess inventory, poor forecasting methods, higher manufacturing costs, and higher transportation costs. Also judging by the discussion of the manager from the largest distributor that summed up during a conversation saying â€Å"Managing stock is my job† also the sales and marketing personnel felt as if their responsibilities would be diminished if such a program were put in place. The distributors don’t want to share their data with Barilla. The lack of communication between the departments and the supply chain is harming the success of Barilla SpA. The new (JITD) system needs to be addressed in a manner that all departments can understand the importance of implementing such a program and how it will benefit the overall success of the supply chain. Overcoming Resistance at Barilla SpA Before trying to convince the distributors, one has to convince everyone at Barilla that the JITD system will be a success. If everyone within the company is convinced and they provide a single front to the distributors, Barilla has a better chance of convincing the distributors. Some of the steps that Barilla will have to take in this situation are: * Convince and use the Upper Level Management: if they are convinced of its feasibility, they will offer full support in trying to convince the Sales department. It will make a lot of difference if the Upper management talks to the Sales people than if just their Logistics department talks to them. * Involve the Sales Department in all stages: To make the Sales people feel important and wanted, Barilla should involve them in all stages of the JITD proposal. They should be made to feel that they would have lots to do even after the system comes into effect. * New Compensation System: The Sales department should be informed that they would still be rewarded for good performance, except that in this case it was the performance of the entire company as a whole and not just they individually. The new system would award a percentage of Barilla’s profits to the employees as a bonus. They should be shown that the reduction in costs due to the JITD system would ensure greater margins for Barilla that would then be passed on to the employees. Convincing Barilla’s Distributors Barilla has to convince them that the plan will work and not only benefit Barilla but also the distributors participating in it. Some recommendations to convince the distributors are: * Show them the money: This is as always the foremost issue on any business enterprises mind. If an enterprise can be convinced that it will make more money, it will be ready to change its current practices. The distributors should be shown that the costs of the system would reduce so much that everyone in the supply chain would save considerable amounts of money. * Address Trust Issues: This is a major issue between Barilla and its distributors and to solve this Barilla should work out some confidence building measures which would prove to the distributors that Barilla was worth trusting and that they were making the right decision. Some of the steps that could be taken to increase trust are: * Barilla should have a transparent policy and should not hide any of its plans from the distributors. * Instead of sending the Logistics personnel to talk to the distributors, Barilla should send the Upper Management. This would make the distributors feel important and would help in convincing them better. * Barilla should make compromises in its business in order to help its distributors. * Barilla should initiate joint decision-making and planning with its distributors to show them that it cared for each one of them and wanted them to be involved in the process. Alternatives/Options Brando Vitali, Barilla’s previous director of Logistics, had proposed a Just-In-Time Distribution (JITD) system to counter this demand variation. This system required the distributors to share their sales data with Barilla, who would then forecast and deliver appropriate amounts of products to the distributors at the right time in order to effectively meet demand. This was a major change from the current and more traditional supply-chain setup where the distributors were not sharing any data and could place orders at will. Vitali’s proposal came under severe criticism from not only the distributors but also Barilla’s own Sales and Marketing department for an array of reasons. Under the proposed JITD system, decisionmaking authority for determining shipments from Barilla to a distributor would transfer from the distributor to Barilla. Having a centralized supply chain with Barilla controlling the orders will result in better margins for all the partners. Specifically, rather than simply filling orders specified by the distributor, Barilla would monitor the flow of its product through the distributor’s warehouse, and then decide what to ship to the distributor and when to ship it. The JITD system proposed something very new and unheard of. It entailed disclosure of sales data by the distributors to Barilla who would then forecast for the entire supply chain and provide products in the right quantity and at the right time to meet demand. It has many benefits both to the manufacturer and the distributors: Other Recommendations Other recommendations that I believe will help to reduce demand uncertainty and eventually improve overall supply chain performance. They are: * JITD in Exports: Barilla has a 22% market share in Europe and this share is expected to rise as the growth in the export market increases by 20-25% each year. Barilla could try and implement the JITD 6 system with its distributors, both current and future, outside Italy. If implemented and successful, this idea would result in savings for Barilla in its export supply chain. * Reduce SKUs: Currently, Barilla’s dry products are offered in 800 different SKUs. This large amount leads to a lot of complexity in the order process, distribution as well as inventory and thus increases costs and variability. Recommendation After implementing the JITD system Barilla can look forward to a much more efficient and profitable future. As a result of implementing these recommendations concerning the JITD system: their demand would become more steady, easier to produce, and transport, as well as their operating costs will be reduce and these savings would result in better margins and the cycle times would decrease allowing the cash flow to become even throughout the supply chain. Implementation Plan and Monitor/Control The implementation of the new (JITD) system will allow for better operational

Butler’s Tourism Lifecycle Model Essay Essay Example

Butler’s Tourism Lifecycle Model Essay Essay Example Butler’s Tourism Lifecycle Model Essay Paper Butler’s Tourism Lifecycle Model Essay Paper Butler developed a theoretical account which shows how any tourer resort may turn. A resort may get down off from being a little. low key. finish. He suggests that all resorts go through the same kind of procedure. The seven phases of tourer development A graph of Butler’s resort life rhythm theoretical account 1. Exploration – a little figure of tourers visit the country. The country is good and few tourer installations exist. 2. Involvement – local people start to supply some installations for tourers. There starts to go a recognized tourer season. 3. Development – the host state starts to develop and publicize the country. The country becomes recognised as a tourer finish. 4. Consolidation – the country continues to pull tourers. The growing in tourer Numberss may non be a fast as earlier. Some tensenesss develop between the host and the tourers. 5. Stagnation – the installations for the tourers may worsen as they become old and run down. The Numberss of tourers may worsen excessively. 6. Rejuvenation – investing and modernization may happen which leads to betterments and visitant Numberss may increase once more. 7. Decline – if the resort is non rejuvenated ( present 6 ) so it will travel into diminution. Peoples lose their occupations re lated to touristry. The image of the country suffers. The Butler theoretical account is a generalization. and so non all resorts will follow this procedure. Application of Butler’s Tourism Lifecycle Model to Calafell A ; Sitges. Spain ( MEDC ) Sitges and Calafell are about equal-sized colonies lying to the south West of Barcelona. Both rely on touristry as a major beginning of income and employment and the survey aims to compare the comparative success of touristry. in its assorted signifiers. by using the Butler Model. 1. SITGES Sitges – a brief history Sitges is a town of about 25. 000 people and is located about 30 kilometers south of Barcelona. Originally occupied by the Romans on a defensive promontory looking out to sea. Sitges’ port was used to merchandise merchandises from the Penedes part and other topographic points from the Roman Mediterranean. Despite its direct contact with the sea. the town had more peasant husbandmans than fishermen. with vineries being the chief economic activity. In the eighteenth century Catalonia obtained permission to merchandise straight with the West Indian Spanish settlements and by 1833 more than 27 % of the Catalans trading with Cuba were Sitgetans. The lucks made were invested in the purchase or fix of the town’s old houses. Sitges. although located near to Barcelona. was still difficult to entree at the clip. but began to develop as a summer resort for taking the Waterss. Equally early as 1879. there are records demoing that baths were already being used as medicative therapy and watering place partisans straight became beach partisans. However. it was non until 1881. with the reaching of the railroad line from Barcelona. that touristry in Sitges truly began to develop. With the reaching of Santiago Rusinol in 1891 – one of the designers of Modernism – Sitges became the cultural Centre of the modernists. In 1909. Sitges was visited by Charles Deering. a North American millionaire who converted a street in the historic nucleus into a castle. the Palau Maricel. This castle and Rusinol’s abode helped launch Sitges to tourist celebrity. In 1918. the Terramar garden metropolis and the Passeig Maritim or Esplanade were constructed. Atraccion de Forasteros ( Tourist Attraction Company ) was created in 1928 and the Tourist Information Office in 1934. From so on. Sitges would go a European touristry standard compositor. Aerial position of Sitges’ historic nucleusThe Butler Model applied to Sitges1. Sitges Discovery Sitges was discovered early by people from the metropolis of Barcelona. It subsequently began to pull many creative persons and intellectuals such as Rusinol. Many affluent Catalans besides built 2nd places in Sitges to get away a much polluted Barcelona. Much of the early wealth of Sitges was based on trade with the West Indies and Cuba in peculiar. The houses on the southern portion of the Esplanade reflect this Cuban influence. 2. Sitges Growth and Development The local tourer industry remained in topographic point until the developments of the 1960’s when touristry from abroad first began to filtrate into the town. The development of the bundle vacation whereby riders booked flights. transportations and adjustment all in one engagement made topographic points such as Sitges accessible to people from Northern Europe. Furthermore. the usage of jet aircraft made such sensed heroic poems journeys now possible in under half of a twenty-four hours. Sitges responded to these developments with the building of big hotels such as the Terramar and Calipolis on the sea forepart. Other smaller hotels were besides built. frequently in converted Cubanesque houses. Restaurants. stores and bars besides opened to provide for the demands of the increased figure of tourers who visited in the chief season widening from mid-May until the terminal of September. 3. Sitges Success Sitges is now a major tourer resort. perceived as high position and providing for more flush visitants. It has a broad scope of 36 hotels and 12 pensions. numbering 2. 540 suites. It is popular with the homosexual community. many of whom vacation in Sitges during the summer season. This has added to the success of the town and is further reflected in the scope of high position stores and eating houses found at that place. There are over 150 apparels stores and 175 bars and eating houses. four times more than expected in a town the size of Sitges. Sitges has besides attracted many migrators non merely to work in the tourer industry but besides others to populate in the town. These include affluent people from elsewhere in Spain. every bit good as others from around the universe. The migrators comprise of 63 % from Europe and 30 % from Latin America. Many of the Europeans are populating for good in Sitges while others ain 2nd places in the town. Proximity to Barcelona airdrome and the coming of low-priced air hoses such as Easyjet and Ryanair have been an added encouragement to Sitges in pulling people on short interruptions. Today big Numberss of the tourers are independent travelers. doing all of their ain vacation agreements via the cyberspace instead than utilizing a High Street travel bureau. This has been particularly of import since the economic downswing as the bulk of visitants are here for short interruptions merely. 4 Sitges Stagnation Tourism trends alteration. Many of the early tourers to Sitges now looked for cheaper options to topographic points they may hold visited before or go tired of. New resorts opened as the Mediterranean states of Greece. Turkey. Cyprus and others developed their tourer potency and more established resorts such as Sitges saw a autumn in their traditional client base. This stage saw holiday companies such as Thompson remove Sitges from their vacation booklets. 5 Sitges Decline or Rejuvenation The autumn in the traditional tourer base has led Sitges to seek to develop more sustainable schemes. Many environmental betterments are in advancement and the resort has been rebranded as an all-year finish. To this terminal the calendar of events that Sitges offers extends good beyond the traditional vacation season. The extension of the season has been promoted with the production of a DVD with the subject ‘Sitges the art of living’ . This entreaties to high income professional groups to do Sitges a lasting base for multiple short interruptions in the Mediterranean Sun. Sitges has capitalised on its propinquity to Barcelona to go one of the chief finishs for Business and Conference touristry in Catalonia. Its specialized hotels in this sector include the Dolce Sitges. with over 30 meeting suites and the Melia Sitges. with a conference hall siting more than 1. 300 delegates and 16 meeting suites. Furthermore. the Sitges Council is shiping on a undertaking called ‘QUALIA Sitges’ to heighten touristry by working what is called the ‘creative economy’ . This refers to the development of activities associating to creativeness. art and civilization which will congratulate Sitges’ tourer based economic system. It aims to construct upon the earlier function o f Sitges as a Centre of art and civilization based upon the plants of the creative person Rusinol in the late nineteenth and early twentieth centuries. It aims to promote and advance cultural and artistic tradition with new engineering. The undertaking is a long term program covering the following 10 old ages and will see the development of a province of the art campus with a school of music and dance. a University of the Performing Arts and a Design Centre. These installations will convey in to Sitges up to 2. 000 pupils a twelvemonth every bit good as a farther 2000 occupations including academic staff and other professionals working in the QUALIA installation. It has been estimated that each pupil will pass about 750ˆ per month in Sitges of which 150ˆ will be on tourer and leisure installations. Added to this are the household and friends of the pupils coming to see them who are expected to add a farther 25. 000 guest darks in Sitges and the usage of the town’s tourer installations. Therefore. Sitges can be seen as traveling frontward in its programs to stay a major leisure finish by diversifying to guarantee long term sustainability. 2. CALAFELL Calafell – a brief history Calafell has a population of about 25. 000 people and lies 50 kilometer South of Barcelona. It owes its beginnings to a palace and occupied a defensive site on an inland hill. The name Calafell means ‘small castle’ and the earliest mention to it dates from 999AD. For old ages the economic system of Calafell was devoted to agriculture and angling. Like Sitges. the reaching in the late 1880’s of the railroad from Barcelona led to a alteration in its economic lucks. Calafell became more accessible and the development of 2nd places around the railroad Stationss flourished with the 1947 Garden City undertaking known as the Quadra de Segur. At first people lived there merely during vacation periods. but now the bulk of the population are lasting occupants. It was non until the 1960’s that touristry began to develop strongly in Calafell. particularly along the 5km of uninterrupted beach where legion flat edifices and hotels were constructed. With the approval of consecutive metropolis councils. a immense speculative roar in the 1970’s led to an eternal row of 6-storey flats confronting the sea. Later ordinances prevented inordinate perpendicular growing whilst inland the prohibition of edifice over two and a half floors led to more green infinite and a lower population denseness. Today. the town of Calafell is delimited into three really distinguishable countries. To the North. narrow streets surround the palace and the old church. To the South. and disconnected from the historic nucleus. the former seafront fishing small town has been converted into tourist country. And to the E is Segur de Calafell. a former Garden City of 2nd places developed on farming area environing the railroad station. | Calafell palace: the historic nucleus of Calafell is disconnected from the seafront beach resort| |Calafell seafront: 6-storey flats confronting the sea| The Butler Model applied to Calafell 1. Discovery Calafell. like Sitges. benefited from the gap of the railroad line but because of its greater distance from Barcelona. there was really slow development until a immense speculative roar in the 1970’s. Developers constructed hotels and flats to take advantage of the resort’s greatest plus – its long and broad beach. 2. Growth and Development The building of the promenade and the completion of the sea forepart flats and hotels attracted households from Madrid and northern Spain. peculiarly in the summer months. New concerns opened to provide for the demands of these people. 3. Success The 5 kilometers stretch of coastline consisting the beach resort of Calafell became to the full occupied during the high seasons of the 1970’s and 1980’s. However. Calafell neer attracted the bundle circuit operators in the manner that Sitges has done and the scope of hotels is really limited. 4. Problem – Stagnation The bad roar of the 1970’s and 1980’s resulted in the devastation of about all of Calafell’s original seafront. The fishing bungalows were replaced by an eternal row of 6-storey flats confronting the sea. As a consequence. the seafront lacks character and appeal and with the economic crisis and competition from other resorts in Spain and overseas. the figure of hotel suites has decreased by 17 % in the last decennary ( from 1. 690 in 1996 to 1402 in 2006 ) . The immigrant population now represents 20 % of the entire population of Calafell. holding grown quickly in recent old ages. However. Calafell has non attracted big Numberss of affluent people from elsewhere in Spain and Europe in the manner Sitges has. Alternatively. about 50 % of the immigrants are from North Africa. subsiding in the country of Segur de Calafell. Calafell therefore seems to be in stagnancy or diminution manner. Calafell: merely one bungalow from the original seafront remains today 5. Decline or Rejuvenation Like Sitges. the autumn in the traditional tourer base has led Calafell to seek to develop more sustainable schemes. Many environmental betterments are in advancement and the resort has been rebranded as an all-year finish. However. touristry in Calafell has taken a instead different way to Sitges. The family-orientated nature of the resort has been promoted. with Calafell gaining the ‘Family Holiday Destination certificate’ from the Catalan authorities in 2007. This recognised the family-oriented adjustment. eating houses and a scope of leisure activities provided. Calafell has a Children’s Club in the summer months and. like Sitges. has a tourer train running along the sea forepart and a 2nd associating the beach country with the historic nucleus inland. Calafell has helped open up the tendency for more active vacation chases and in 2008 became the first resort in Spain to offer Nordic walking. This. together with trekking and mountain biking are provided free of charge. with certified ushers. However. despite following the motto ‘Calafell tot l’any’ ( ‘Calafell. all year’ ) . the resort has struggled to widen the tourer season every bit efficaciously as Sitges. Calafell’s 2009 Municipal Urban Plan ( POUM ) seeks to halt the uncontrolled urban growing of the town. protect the natural and historical heritage and maintain and heighten the touristry that forms its economic base. Calafell needs to widen its touristry offer and new economic activities need to be attracted to diversify its economic system if it is to avoid going a dormitory town for Barcelona. It can hence be seen that both Sitges and Calafell cater for tourers but are two really different towns. The propinquity of Barcelona has enabled Sitges to turn much more quickly and diversify its touristry more efficaciously than Calafell with the consequence that the two towns have developed and evolved in different ways.

Research Paper - Health Care Reform Assignment Example | Topics and Well Written Essays - 500 words

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Amazon Research Paper Example | Topics and Well Written Essays - 3250 words

Amazon - Research Paper Example Since its inception, the company has witnessed significant growth to become a member of Fortune 100 Company in the US. It specialises in selling a variety of goods and services online. 1.1 Mission and strategy of Amazon According to its official website, the company’s mission is: â€Å"to be Earth’s most customer-centric company, where customers can find and discover anything they might want to buy online, and endeavors to offer its customers the lowest possible prices.† The company uses the strategy of selling a variety of products online and it targets customers from all corners of the globe. 1.2 Products or services of the organization Amazon.com offers millions of unique new, refurbished, and used items in categories such as books; movies; music & games; digital downloads; electronics & computers; home & garden; toys; kids & baby; grocery; apparel; shoes & jewelry; health & beauty; sports & outdoor; and tools, auto & industrial (Amazon, 2013). The company has also incorporated thousands of sellers and software developers which use its trademark across the globe. 1.3 SWOT analysis â€Å"A SWOT analysis is used to identify internal strengths and weaknesses of a business and external opportunities and threats facing it,† (Strydom J. p 31). This section outlines these environmental factors facing Amazon. Organization’s internal strengths and weaknesses Strengths Regarded as the world’s best online retailer of various products Technological innovation has driven the growth of Amazon.com to offer a wide range of products to the customers conveniently and at lower prices. It operates international retail websites, and worldwide network designed to fulfil the needs of the customers across the globe Amazon is comprised of teams that work across the world on behalf the customers and it provides 24/7 support to the consumers. Weaknesses The company is mainly present in developed parts of the world where some developing countri es are not fully covered The payment methods used by Amazon are not compatible with other countries’ banking sectors Organization’s external environmental factors Opportunities The company has opportunities to partner with different retailers which will help it to increase the revenue it generates. New information and communication technology is continuing to develop hence the company is poised for continual growth. Threats Online retailing is now characterised by competition since a wide range of organizations have also adopted this strategy which is very convenient. 1.4 Staffing in terms of employee categories Amazon is an equal opportunity employer and it is committed to staff a diverse workforce on the basis of a barrier-free employment process. The company employs about 88  400 people around the world and it has offices fulfilment centers, customer service centers, data centers, and software development centers around the globe (Amazon, 2013). The company is gui ded by the provisions of Section 503 of the Rehabilitation Act of 1973, the Vietnam Era Veterans'

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Recruitment and Selection - Research Paper Example In this reflective report, I will examine how the discernment of the theories for interviewing contributes to the success of an interview. This will also serve as a gauge of my understanding of the concepts studied. This exercise started with the modifying the original job description provided. The original job description was edited to give the recruiting company a more defined identity and to inject the personality of the management. This is an important step in "attracting" the right kind of people to answer the job posting. According to Ben Schneider's Attraction-Selection-Attrition Framework, the personality of the organization is the sum total of the personalities of its employees, thus "people are attracted to an organization on the basis of their interests and personality" as mentioned in the Recruitment and Selection Module of Hull University (5). After the modification of the job description, I created a person specification for what I think is the "ideal person" for the job. For the job person specification, I used Fraser's Five-Fold Grading System, referencing the Recruitment and Selection Module of Black's Academy (2). It is in creating the person specification that I understood th e significance of Schneider's theory of "like-attracts-like". The conceptualization of the interview plan and the formulation of the interview questions followed... For the interview questions, I used a combination of questions based on Behavior Description Interviewing, Situation Interviewing and interjected some technical questions as well (Interview Techniques, University of Alberta, 1-3). I chose to use a combination of these questions to check if the person meets the person specification that I created. Reflective Report Looking back on the interview exercise, I think that it went quite well. I remember being confident during the interview and I was also able to put the interviewee or applicant at ease. Personally, I think the preparation step is very important for two reasons; one is that it enabled the applicant to open up and, two, as the interviewer, I was also able to observe the body language of the applicant without the nervousness. This may have worked because of the amount of preparation that I spent creating and revising my interview plant based on the WASP framework from the Online Business Learning Archive. The predominantly open-ended questions that I used gave the applicant an opportunity to share his experiences in detail which in turn helped me see beyond the CV of the applicant. This exercise helped me see the applicant as a person and imagine how he would fit in my organization. During the interview, although I did plan and succeed in making the applicant at ease, I may have over-emphasized my welcome. As my assessor commented, my statement that "we need you, rather than you need us" may have placed my applicant to mindset of having already secured the job. I think this may also have "weakened" my role as the representative of the employer or company. In the interest of having all of my questions answered, I may have hurried the interview and potentially caused the

Experiences of Adult Offspring Making Care Decisions

Experiences of Adult Offspring Making Care Decisions In normal aging, decline in mental skills is modest with no consequential decrease in ability to care for oneself. Normally, older adults are able to maintain activities of daily living (ADLs) such as bathing, dressing, transferring, and toileting, and instrumental activities of daily living (IADLs), which include shopping, cooking, housekeeping, laundry, and handling money (Schaie, 1989). Nevertheless, one in 10 persons over 65 and nearly half of those over 85 have Alzheimers disease, a form of dementia (The Alzheimers Association, 1999) and, thus, have problems with IADLs, ADLs or both, and need assistance with care decisions. Often these decisions are left to adult offspring who are ill prepared to cope with role changes and parent-caring responsibilities (Archbold, 1980; Brody, Johnsen, Fulcomer Lang, 1983; Brody, Kleban, Johnsen, Hoffman Schoonover, 1987; Cantor 1883; Stoller, 1982). What is the experience of these adult children as they negotiate their way through the their own internal voices, their family of origin and the healthcare system? Have we been asking the right questions when we assume that all is reduced to family obligation and responsibility? This project was designed to elicit and understand the experience of those adult offspring who are making care decisions for a mentally impaired parent. Chapter I includes background and significance of the project, the philosophical framework in which the project question is poised, the project question, and definition of terms. Background and Significance of the Project Although almost half (47%) of persons 85 and older will have mental impairment (Schaie, 1989), many elderly do not make plans for dealing with possible changes in mental status. As elderly â€Å"age in place†, it is frequently left to family members to decide about care and living arrangements. For most family members these care decisions about the care of elderly parent are difficult at best (Pfeiffer, 1995), and the number of people involved in making these decisions will increase as life expectancy increases and the population of the United States continues to age. Life expectancy is the average number of years people born in a given year are expected to live based on a set of age-specific death rates. At the beginning of the 20th century, life expectancy at birth was 47.3 years. Today, at the beginning of the 21st century, the average life expectancy has increased dramatically at birth to nearly 77 years. In addition, life expectancy for every age group has also increased during the past century. â€Å"Based on todays age-specific death rates, individuals aged 65 years can be expected to live an average of 18 more years, for a total of 83 years. Those aged 75 years can be expected to live an average of 11 more years, for a total of 86 years† (http://www.health.gov/healthypeople/Document/HTML/Volume1/goal.htm, August 14, 2000). Persons older than 65 now comprise 12.7% of the population of the United States (Statistical Abstract of the United States, 1999, http://www.census.gov/statab/www/states/md.txt, August 14, 2000). By the year 2020, 20% of the population will be older than 65 years (US Bureau of the Census, 1996). The largest percentage of growth is in elders 85 and over, a group at high risk for mental disorders such as Alzheimers disease. Almost 19 million Americans report they have a family member with Alzheimers, and 37 million know someone with the disease (The Alzheimers Association, 1999). Since 7 out of 10 people with Alzheimers live at home, lost productivity of caregivers is estimated to cost American businesses $26 billion a year plus $7 billion annually related to costs for health and long-term care (The Alzheimers Association, 1999). Other estimates put the cost of informal caregiving at $18 billion. In a project of 7, 443 of elders seventy and over taken from a national representative sur vey, the cost of informal care for mild dementia at $3,630 per person with double the cost for moderate dementia relatives and almost five times the cost for severe dementia (Langa, Chernew, Kabeto, Herzog, Ofstedal, Willis, Wallace, Much, Straus Fendrick, 2001). It is not surprising that the public is starting to ask for help with this complex issue. Previous research sought to identify predictors of placement decisions by family caregivers with dementia (Colerick George, 1986) when care options were few and rational mental models of decision making were thought to be superior to the human mind. At the turn of the 21st century, however, the healthcare environment offers multiple models of care for mentally impaired patients (Abraham, Onega, Chalifoux Maies, 1994). Decision making needs to be informed by the context of continuity of care, which now ranges from home and home-like environments to part time respite or adult day care to long term care services in nursing homes. Indeed, â€Å"patients and families are often surprised if not shocked about the actual services they may receive from various community-based or institutionalized services† (Abraham, Onega, Chalifoux Maies, 1994, p.165). In addition to the increasing complexity of choices, rational mental models of decision-making are in question and giving way to a more naturalistic project of how real world decisions are being made (Sloan, 1996). Rational standards, in which it is assumed people merely choose among options, do not take into consideration most contextual factors that impact on decision-making in real-world situations (Beach Lipshitz, 1993; Cohen, 1993). There is a stark contrast between the assumptions of rational decision-making and naturalistic decision-making. In the naturalistic decision making paradigm, problems are seen as ill structured rather than artificial and well structured. Solutions to these problems are made in uncertain, dynamic environments rather than static, simulated situations. Goals are shifting, ill defined or competing rather than clear and stable. There are action/feedback loops to decision-making process not one-shot decisions. Time stress is a factor and stakes are high i nstead of the presumed luxury of leisurely deliberation and absence of true consequences for the decision-maker (Orasanu Connolly, 1993; Zsambok, 1997). Research on the experience of making care decisions for mentally impaired parents needs to take into account the way decisions are made in the real world and the numerous opportunities for care assistance that are available today. The majority of middle aged, and even young-old Americans, will be faced with making decisions about care for a mentally impaired parent at a time in life when they are dealing with their own transitional issues, as well as those of the generations before and after them. Given the resulting emotional and financial cost, it would be wise to develop health policy about mentally impaired elder citizens and their offspring based on an understanding of the experience of making decisions about the care of a mentally impaired parent. Understanding what these care decisions mean to the increasing number of persons who must make care decisions for mentally impaired parents would lay the foundation for addressing issues in getting adequate assistance for these famili es. It would also help to provide a framework for policy decisions about the fragmented care system for the mentally impaired elderly, and decrease the cost to society in lost productivity. Clearly, the experience of making these decisions needs to be reexamined. Since the definition of naturalistic decision-making is â€Å"the way people use their experience to make decisions in the field setting† (Zsambok, 1997), it is incumbent upon the researcher to go into the field. Qualitative methodologies, which involve fieldwork can help build knowledge of the enormously complex and profound issue of making care decisions for mentally impaired family members. CHAPTER III METHODS Methods Design of the project Personal Reflections Part of the process in analyzing data during a qualitative project is the use of field notes. I have to admit that the process of recording field notes after each visit was a tiresome one for me. I choose to incorporate my thoughts and feelings about the phenomenon at hand, the relationships with my respondents, and the data, in the form of tape recorded field notes immediately after each visit, which were later transcribed. I have never considered myself disciplined enough to be a consistent and in-depth journaler but do consider myself a very reflective person. I guess what happens to me is once I start to put down thoughts and feelings into a very personal form, I dont know when or if I can stop. I also wanted to keep some of my personal issues private and did not initially understand who might be reading these notes. In addition, the interviews were so intense and so moving that I thought I would never forget one word, one thought, one emotion, or one observation that I had experienced before, during and after the encounter with each respondent. Well I guess it easy to imagine that, indeed, I have forgotten some of my reactions. I have been impressed and surprised by how valuable reading my field notes were during this project. When I was growing up, I was exposed to several close relatives who either had dementia or a type of mental illness where they were experienced delusions. My own grandfather experienced delusions and hallucinations when I was about 11 and was hospitalized in a mental institution for some time. I do remember some of his erratic behavior, he stayed right next door to our house, which enabled us to visit him anytime, so I had experienced being around a relative with mental conditions. I was surprised to learn that many of the respondents who had taken a mentally impaired parent into their home stated that they did not feel particularly close or even liked their parent while growing up or in subsequent adulthood. On the other hand, many family that their parents had had hard times during their lifetimes and wanted to make this part of their lives easier. Indeed, many family the parent had become part of the nuclear family and took them everywhere with them. I couldnt help but wonder, how ever, that the parents dementia might make things somewhat easier for these adult children regarding painful memories. One of the difficulties I encountered during this project was role change. I was the listener, the interpreter, and the one becoming vicariously part of their experiences. It was hard not to intrude and offer some input and advice when I family it was being solicited or challenge assumptions when needed. I was surprised and shocked about how deeply this affected me. Another challenge was the feelings I had to deal with after each interview. It was difficult sort out at first what my feelings were versus what I had ‘empathized during the interview and hadnt let go of. After many interviews I family tired, very tired and fatigued, sometimes depressed, sometimes overwhelmed and some times angry. On the other hand, some interviews energized me and where I had gone to the interview very tired after a busy day at work, I drove home feeling great until my real fatigue actually caught up with me. One helpful strategy was to have one of my committee members review some of my field notes. I learned from that feedback to pay attention to my feelings and use them to inform myself about how that particular respondent interacted with the world. Although there were many personal issues that came up during interviews which held personal meanings for me and from which I had to distance my own reactions from the respondents, there were also professional issues which got to me. When the ‘system, be it healthcare, political or whatever let these informants down, I took it personally. It made me very angry that in our very rich, very evolved society we do not offer supports and safety nets for those who are dealing with such difficult and challenging isse4s such as making care decisions for a mentally impaired parent. I am hoping my anger will drive me to work on legislative issues and to continue research in this area. CHAPTER IV RESULTS The five themes and nineteen categories (see Table 1) presented in this chapter emerged from sixty-seven codes rendered from the raw data. Raw data consisted of nineteen transcripts from interviews with twenty-two adult offspring who self-identified as primary decision-makers for mentally impaired parents. Findings collapsed into five main themes: Level of Contact ; Interpersonal Conflict; Personal Sharing; Providng Assistance; and Giving Gratitude. These themes suggest that, indeed, adult offspring in this project did go through a reiterative decision-making process when making care decisions for a mentally impaired parent. At various times during the course of numerous decision-making processes, adult offspring struggled to find that Level of Contact internally, as reality set in that parents were no longer able to make effective and safe care decisions. There was the need to Interpersonal Conflicty as they contemplate where they, as adult children, fit into this picture and what r esponsibilities they will accept while negotiating with other siblings. Other phases of the decision-making process involve: Personal Sharing as they stepped up to the plate and made and implemented decisions; inevitably having to alter course as circumstances and levels of energy changed (Providng Assistance); and Self Sufficiency where they reinforced their decisions by being thankful that their situation (or perception of their situation) was more tolerable than others in similar circumstances. Nineteen sub-themes or categories flowed from the five themes. Level of Contact consisted of Defining Condition, Safety Concerns, and Role-Reversion. Interpersonal Conflict involved a Conscious Choice, Strained Family Relationships, Sharing the Load and Sole Responsibility. A Thread of Memory on the part of the parent sustains adult offspring in the Personal Sharing stage of the decision-making process. In this stage, the adult offspring would be Guessing Needs of the parent, Getting Information, looking at Finances, and Expressing Goals. Caregiver Wear and Tear, Time Constraints, and Problems with Care triggered a Providng Assistance phase. Adult offspring would respond to these stressors by Dealing with It and Becoming Assertive with the parent. Finally adult offspring would use mental coping strategies to confirm their decisions and the accompanying hardships by Comparing with Others and turning to Spirituality (Self Sufficiency). Theme I. Level of Contact Category 1. Defining Condition All but three of the interviews contained a category of Defining Condition of the parent. Adult offspring went through a process where they had to let go of their past preconceptions of parents capabilities and put their own words to the startling fact that the parent needed help with care decision making. Sometimes this became much clearer after the parent was in the household a number of years. One respondent who had taken his mother in before the onset of dementia was able to describe her condition after several years of living with her. She used to get on the bus and run around and all that stuff. When she took that fall she developed this what I call this old persons syndrome. She became so deathly afraid of falling again that her movements became choppier and choppier and tighter and tighter and the tighter they got the more prone she was to kind of losing her balance a little bit and then she would get scared more. She has physically gone down hill a lot since then. Mentally, well mentally shes gone down a lot too. Dementia, as I understand, is about a ten-year disease and she is probably three to four years into it. She probably had some symptoms of dementia four years ago, but it has gotten significantly worse since then. I think it has been four years. Although this respondent was able to clearly acknowledge symptoms of dementia, he still had difficulty accurately defining which symptoms were pertinent to the dementia and to the type of dementia involved. I said well my mother doesnt have Alzheimers, my mother has dementia. She said oh it is the same thing. I said well no its not, it is a significantly different thing. Alzheimers is a variation of dementia, dementia is a much broader category. If my mother has Alzheimers it wouldnt be safe to leave her alone because Alzheimers, as I understand it, is a spatial disorientation to where they can feel they are not where they need to be and they need to go where they want to go. Now they may be right there, but they dont feel it and so they go. My mother doesnt have Alzheimers. She plants, she is right where she wants to be and she knows it. But she does have dementia, that mental sense of connection to what just happened. And the gal said well we treat them both the same. Well how can you do that, they are both two separate issues and for one you should do this and for the other you should do that. Its frustrating. This adult son as he was trying to define the condition to himself, limited his conception to physical components of Alzheimers however inaccurately. How he defined his mothers condition to himself influenced what decisions he made and implemented in the Personal Sharing stage. Indeed, he had recently undergone an investigation by the Department of Aging (from which he was cleared of all charges) for leaving his mother alone and for cleanliness issues. Another respondent described how she was able to put words to the deteriorating condition of her mother. This respondent was a registered nurse with her masters degree and chose to define the condition through objective tests and outside opinions. No, she was not. She was totally independent and totally well until about the age of 82. So, that is getting to be close to five years now, she is 86. Then she began to get lost driving and not to be able to do what you and I would do if we were lost to stop and find out where we were, draw a map and follow it home, she couldnt do it anymore. At that point I took her toI had a wonderful physician who was a geriatric specialist and she got us in touch with some psychological testing services and we went through a battery of those and came up with the fact that what she should for her level of functioning prior to that date, she was losing an awful lot of executive ability. You probably know better than I exactly what that encompassed. So that is the point at which somebody had said to me she truly has some dementia developing, it is not just normal forgetfulness, it is dementia. Then I began to intervene with things like finances and make sure that she got to doctors. You know, just gradually taking on more and more responsibility. Note how this daughter accurately describes and defines her mothers condition, relying on her own observations and objective tests, a method of assessment which she probably is familiar with through her professional nursing career. Once the diagnosis was established, she got on with Personal Sharing phase by examining finances and making and keeping doctors appointments. This was an only child, born of parents who were also only children of which only the mother was living. These circumstances necessitated that the daughter did not have the luxury of dealing with siblings and determining her place in all of these decisions for her mentally impaired mother. Another adult daughter defined her mothers condition by the things she was still able to observe and how she functioned. Yeah. She is so observant. On the way home from [the daycare facility] the other day she said you know I am just intrigued by the cloud formations. She said I look up and I see all these configurations in the cloud. Coming down 29 she said have you ever thought about the laying of asphalt on that road, that is such a steep hill. How did they lay all that asphalt without it trickling down hill? So I mean shes not out of it. And every Sunday morning I dont know what triggers it she wakes up at six oclock and says is it time to go to mass. The other mornings of the week she will say what day is today. But somehow Sunday she knows it is Sunday. She will say now what time is it. Be sure to fast long enough to go to communion. She is a big help to me with her hands. She folds all the laundry. She cleans up all the plates and Sunday afternoon she took the fern and gave it a haircut all afternoon, it took quite a while to do it. She cuts up the salad, she makes fruit salads, she will wash ve getables, she will wash beans, anything she can do with her hands. Focusing on the positive might impact on this respondents ability to acknowledge continuous regression and might negatively influence the Personal Sharing phase when the inevitable physical decline begins and nursing home care must be considered. I mean if the time comes when she can no longer go to the Center or she is so feeble I would then have to make the choices to whether I was going to have somebody come in during the day to care for her and then I would be the caregiver until I got home from school until the next morning or put her in assisted living. I doubt that she will ever need nursing care, although one never knows. I mean nursing home care. She would be more likely to go into an assisted living. And as to where I would take her I dont know. Two other respondents defined their mothers and mothers-in-law mental impairment by attributing it to being taken advantage of by a preacher. Respondent: I truly believe that the religious aspect of this deteriorating her rather than helped her. Ive had extensive kinds of confrontations on her about she and God. This man always prayed with her and just a week ago did she say I believe in God. I think this man was her avenue and had her believing she was an avenue to God. Wife: And shes been in church all of her life and taught Sunday school. Respondent: I think it was a brainwash. I think this lady right now could still be playing the piano and doing everything she wanted to do if she hadnt of gotten too involved with him. Interviewer: So you think some of her thinking difficulties have to do with being involved with the church. Respondent: I know so. Three years, two years or more before this happened she always raised money for the preacher. She was the league chairman. She was going to give him this appreciation and I told her I was not taking her back there for her to take a bunch of money a thousand dollars or so out of the bank to give to some preacher. She said if you dont take me Ill catch the bus. It took her fourteen hours to go to West Virginia. It almost killed her. They continued talking about their journey to define in their own words what was happening to their parent despite what others were telling them. Wife: Then the people told us that she had gotten to the point where she was not bathing, had weird stuff on her hands, dirty, nasty stinking and he was steadily draining her and the neighbors and the church people had been telling us this and of course we didnt believe it not as strong a woman as momma was. But, they said she was even begging in the church for money for him and she would call us here and people kept sending bank statements to them that checks were bouncing. And he found out because he asked about a savings account and she said what savings account and we know that his father left her plenty of money. She doesnt have a dime except for money that she gets Respondent: And we have a beautiful house like this in West Virginia and we have borrowed on it. We go there and live four weeks out of the year. Two months out of the year we are there, we just came back. But, yeah I really think that this man really deteriorated her mind. Any time something would go wrong for himI hadnt paid attention to it. She would tell Wife that she called the preacher and he prayed with her and things were okay. I think that can happen to an old person and its called brainwash. Brainwash is a strange thing. The respondents kept coming back to the fact that their mother was taken advantage of by a preacher but incorrectly attribute this as a cause of her mental impairment rather than a consequence of it. On the other hand, they were able to seek out a doctors opinion and had some understanding of dementia. And I started questioning him about her and he said why dont I just get the chart and discuss it with you. I said because I am going to be taking her away from here and she can not get over here to see you properly. She has to pay somebody for everything that they do. So, he started out with dementia and I said what is dementia. I said is that Alzheimers what is it. He said a form of it. He said she will do well for a good while and I cant tell you how long, but he said she will start deteriorating and this will take over and it will appear to be almost like Alzheimers. He said she always has some deficiencies here in the spine at the base and that is going to be crippling and she would be wheelchair bound. He said other than that there was some enlargement of the heart which is normal for this age, 95 or 96. That is how we found out. There was always no problem everything is all right. Because we never went to see her business because she took care of everything. But when we found i t out that is when we made the decision. She had always said she would come and live in her room at the right time and the room was fixed, it was all ready Of course she has been unhappy many, many times in the beginning when we brought her here. She always wanted to send money back to the preachers wife, which she used to always buy her clothes all the time and making commitment always for that group. I guess people like who they like. I think they took advantage of her, I know so. This man was also an only child and it is evident that he moved into the Personal Sharing phase with the support of his wife while short-circuiting the Interpersonal Conflict stage due to his clear place in the family and no siblings with whom to negotiate. Category 2. Safety Concerns As adult children moved through the Level of Contact phase, they inevitably encountered issues about the safety of the parents behavior. They were often still unsure about whether these safety concerns were real since many times at the beginning of the course of the mental impairment, they were being told of these behaviors by others and not directly observing them for themselves. Thus presented quite a dilemma. The adult offspring were still struggling with defining the parents condition and not believing that the parent they knew could no longer be counted on to behave in an appropriate and safe manner. Looking back on being told of his mothers erratic behavior about finances and being drained of her life savings by a local preacher, one adult son remarked: Well it really was at a point that something I should have addressed ten years ago when I was told by distance relatives and friends and classmates there in the town that he was doing this. I just came to grips to where I just didnt believe it and you all told me and I didnt do anything about it. You all were right. I should have called this guy on the carpet way back. Hey man what are you doing. As I tell Wife Im not sure that would have been right either because then it is hearsay. This respondent was much more comfortable intervening in the situation once he had concrete evidence of the unsafe manner in which his mother was handling her finances and ability to live on her income. What happens is I have fact. I have the canceled checks. I know things that hes done. I have people that have seen him take her to the stores where she can cash checks and wait on the money, all of that. Safety Concerns whether they were about finances, getting lost in familiar surroundings, leaving appliances on such as stoves, falling or being unable to perform routine activities of daily living particularly eating regularly were effective at helping the adult offspring to move through the Level of Contact phase only when they were real to the adult son or daughter. The implications of seeing a formerly competent parent falter at taking care of themselves in an appropriate and safe manner seemed to be almost impossible until unsafe behaviors were personally observed. One adult daughter put it this way: Um, so it went on like that and then, what really brought it to a head was one morning I knew she needed milk. She could get her cereal but for some reason that was the thin that she really wanted so thats what she did, um, and I thought, well Ill drop the milk by and shell have milk for her cereal and then Ill come by at lunchtime and see, you know, see whats going on. So ordinarily, my mother slept very well and slept a little bit later in the morning, so I thought, well, you know, I let myself in and put the milk in the refrigerator and then thought, well, Ill just take a little peek, maybe shes awake, and I went around the corner and my mother, yeah she was awake but she was also on the floor surrounded by her covers, didnt know how shed gotten there, didnt know who she was, didnt know who I was at first, but she was so upset and you know, didnt have any idea how long shed been there, so I got her back up on the bed. She didnt hurt anything, cause the bed was low and she just sor t of slipped off of it. I think she used to take a medication. Sometimes it would make her a little sleepy, you know and she used to get up in the middle of the night to go to the bathroom and I think that maybe when she went back she may have missed the bed for some reason. I dont know how she did it, but she was OK, so I called my husband, I called my job and I called the doctorfrom then on it just seemed that things just went very quickly Another adult daughter talked about the time she realized that it was no longer safe for her mother to live alone. What happened one day, my mother stayed with them, they had a house and what happened was my mom she went to the dentist and they gave her some anesthesia and I think it just made her more confused and she was lost, we couldnt find her. She had left the house about ten oclock that morning and everybody was wondering where is mother, where is mother and we couldnt find her. So I think around like ten oclock or something like that we called the police and eventually we found her. She was over in the old neighborhood where she used to live prior to staying with them. So, I just took her at my house and I kept her like six months because I Experiences of Adult Offspring Making Care Decisions Experiences of Adult Offspring Making Care Decisions In normal aging, decline in mental skills is modest with no consequential decrease in ability to care for oneself. Normally, older adults are able to maintain activities of daily living (ADLs) such as bathing, dressing, transferring, and toileting, and instrumental activities of daily living (IADLs), which include shopping, cooking, housekeeping, laundry, and handling money (Schaie, 1989). Nevertheless, one in 10 persons over 65 and nearly half of those over 85 have Alzheimers disease, a form of dementia (The Alzheimers Association, 1999) and, thus, have problems with IADLs, ADLs or both, and need assistance with care decisions. Often these decisions are left to adult offspring who are ill prepared to cope with role changes and parent-caring responsibilities (Archbold, 1980; Brody, Johnsen, Fulcomer Lang, 1983; Brody, Kleban, Johnsen, Hoffman Schoonover, 1987; Cantor 1883; Stoller, 1982). What is the experience of these adult children as they negotiate their way through the their own internal voices, their family of origin and the healthcare system? Have we been asking the right questions when we assume that all is reduced to family obligation and responsibility? This project was designed to elicit and understand the experience of those adult offspring who are making care decisions for a mentally impaired parent. Chapter I includes background and significance of the project, the philosophical framework in which the project question is poised, the project question, and definition of terms. Background and Significance of the Project Although almost half (47%) of persons 85 and older will have mental impairment (Schaie, 1989), many elderly do not make plans for dealing with possible changes in mental status. As elderly â€Å"age in place†, it is frequently left to family members to decide about care and living arrangements. For most family members these care decisions about the care of elderly parent are difficult at best (Pfeiffer, 1995), and the number of people involved in making these decisions will increase as life expectancy increases and the population of the United States continues to age. Life expectancy is the average number of years people born in a given year are expected to live based on a set of age-specific death rates. At the beginning of the 20th century, life expectancy at birth was 47.3 years. Today, at the beginning of the 21st century, the average life expectancy has increased dramatically at birth to nearly 77 years. In addition, life expectancy for every age group has also increased during the past century. â€Å"Based on todays age-specific death rates, individuals aged 65 years can be expected to live an average of 18 more years, for a total of 83 years. Those aged 75 years can be expected to live an average of 11 more years, for a total of 86 years† (http://www.health.gov/healthypeople/Document/HTML/Volume1/goal.htm, August 14, 2000). Persons older than 65 now comprise 12.7% of the population of the United States (Statistical Abstract of the United States, 1999, http://www.census.gov/statab/www/states/md.txt, August 14, 2000). By the year 2020, 20% of the population will be older than 65 years (US Bureau of the Census, 1996). The largest percentage of growth is in elders 85 and over, a group at high risk for mental disorders such as Alzheimers disease. Almost 19 million Americans report they have a family member with Alzheimers, and 37 million know someone with the disease (The Alzheimers Association, 1999). Since 7 out of 10 people with Alzheimers live at home, lost productivity of caregivers is estimated to cost American businesses $26 billion a year plus $7 billion annually related to costs for health and long-term care (The Alzheimers Association, 1999). Other estimates put the cost of informal caregiving at $18 billion. In a project of 7, 443 of elders seventy and over taken from a national representative sur vey, the cost of informal care for mild dementia at $3,630 per person with double the cost for moderate dementia relatives and almost five times the cost for severe dementia (Langa, Chernew, Kabeto, Herzog, Ofstedal, Willis, Wallace, Much, Straus Fendrick, 2001). It is not surprising that the public is starting to ask for help with this complex issue. Previous research sought to identify predictors of placement decisions by family caregivers with dementia (Colerick George, 1986) when care options were few and rational mental models of decision making were thought to be superior to the human mind. At the turn of the 21st century, however, the healthcare environment offers multiple models of care for mentally impaired patients (Abraham, Onega, Chalifoux Maies, 1994). Decision making needs to be informed by the context of continuity of care, which now ranges from home and home-like environments to part time respite or adult day care to long term care services in nursing homes. Indeed, â€Å"patients and families are often surprised if not shocked about the actual services they may receive from various community-based or institutionalized services† (Abraham, Onega, Chalifoux Maies, 1994, p.165). In addition to the increasing complexity of choices, rational mental models of decision-making are in question and giving way to a more naturalistic project of how real world decisions are being made (Sloan, 1996). Rational standards, in which it is assumed people merely choose among options, do not take into consideration most contextual factors that impact on decision-making in real-world situations (Beach Lipshitz, 1993; Cohen, 1993). There is a stark contrast between the assumptions of rational decision-making and naturalistic decision-making. In the naturalistic decision making paradigm, problems are seen as ill structured rather than artificial and well structured. Solutions to these problems are made in uncertain, dynamic environments rather than static, simulated situations. Goals are shifting, ill defined or competing rather than clear and stable. There are action/feedback loops to decision-making process not one-shot decisions. Time stress is a factor and stakes are high i nstead of the presumed luxury of leisurely deliberation and absence of true consequences for the decision-maker (Orasanu Connolly, 1993; Zsambok, 1997). Research on the experience of making care decisions for mentally impaired parents needs to take into account the way decisions are made in the real world and the numerous opportunities for care assistance that are available today. The majority of middle aged, and even young-old Americans, will be faced with making decisions about care for a mentally impaired parent at a time in life when they are dealing with their own transitional issues, as well as those of the generations before and after them. Given the resulting emotional and financial cost, it would be wise to develop health policy about mentally impaired elder citizens and their offspring based on an understanding of the experience of making decisions about the care of a mentally impaired parent. Understanding what these care decisions mean to the increasing number of persons who must make care decisions for mentally impaired parents would lay the foundation for addressing issues in getting adequate assistance for these famili es. It would also help to provide a framework for policy decisions about the fragmented care system for the mentally impaired elderly, and decrease the cost to society in lost productivity. Clearly, the experience of making these decisions needs to be reexamined. Since the definition of naturalistic decision-making is â€Å"the way people use their experience to make decisions in the field setting† (Zsambok, 1997), it is incumbent upon the researcher to go into the field. Qualitative methodologies, which involve fieldwork can help build knowledge of the enormously complex and profound issue of making care decisions for mentally impaired family members. CHAPTER III METHODS Methods Design of the project Personal Reflections Part of the process in analyzing data during a qualitative project is the use of field notes. I have to admit that the process of recording field notes after each visit was a tiresome one for me. I choose to incorporate my thoughts and feelings about the phenomenon at hand, the relationships with my respondents, and the data, in the form of tape recorded field notes immediately after each visit, which were later transcribed. I have never considered myself disciplined enough to be a consistent and in-depth journaler but do consider myself a very reflective person. I guess what happens to me is once I start to put down thoughts and feelings into a very personal form, I dont know when or if I can stop. I also wanted to keep some of my personal issues private and did not initially understand who might be reading these notes. In addition, the interviews were so intense and so moving that I thought I would never forget one word, one thought, one emotion, or one observation that I had experienced before, during and after the encounter with each respondent. Well I guess it easy to imagine that, indeed, I have forgotten some of my reactions. I have been impressed and surprised by how valuable reading my field notes were during this project. When I was growing up, I was exposed to several close relatives who either had dementia or a type of mental illness where they were experienced delusions. My own grandfather experienced delusions and hallucinations when I was about 11 and was hospitalized in a mental institution for some time. I do remember some of his erratic behavior, he stayed right next door to our house, which enabled us to visit him anytime, so I had experienced being around a relative with mental conditions. I was surprised to learn that many of the respondents who had taken a mentally impaired parent into their home stated that they did not feel particularly close or even liked their parent while growing up or in subsequent adulthood. On the other hand, many family that their parents had had hard times during their lifetimes and wanted to make this part of their lives easier. Indeed, many family the parent had become part of the nuclear family and took them everywhere with them. I couldnt help but wonder, how ever, that the parents dementia might make things somewhat easier for these adult children regarding painful memories. One of the difficulties I encountered during this project was role change. I was the listener, the interpreter, and the one becoming vicariously part of their experiences. It was hard not to intrude and offer some input and advice when I family it was being solicited or challenge assumptions when needed. I was surprised and shocked about how deeply this affected me. Another challenge was the feelings I had to deal with after each interview. It was difficult sort out at first what my feelings were versus what I had ‘empathized during the interview and hadnt let go of. After many interviews I family tired, very tired and fatigued, sometimes depressed, sometimes overwhelmed and some times angry. On the other hand, some interviews energized me and where I had gone to the interview very tired after a busy day at work, I drove home feeling great until my real fatigue actually caught up with me. One helpful strategy was to have one of my committee members review some of my field notes. I learned from that feedback to pay attention to my feelings and use them to inform myself about how that particular respondent interacted with the world. Although there were many personal issues that came up during interviews which held personal meanings for me and from which I had to distance my own reactions from the respondents, there were also professional issues which got to me. When the ‘system, be it healthcare, political or whatever let these informants down, I took it personally. It made me very angry that in our very rich, very evolved society we do not offer supports and safety nets for those who are dealing with such difficult and challenging isse4s such as making care decisions for a mentally impaired parent. I am hoping my anger will drive me to work on legislative issues and to continue research in this area. CHAPTER IV RESULTS The five themes and nineteen categories (see Table 1) presented in this chapter emerged from sixty-seven codes rendered from the raw data. Raw data consisted of nineteen transcripts from interviews with twenty-two adult offspring who self-identified as primary decision-makers for mentally impaired parents. Findings collapsed into five main themes: Level of Contact ; Interpersonal Conflict; Personal Sharing; Providng Assistance; and Giving Gratitude. These themes suggest that, indeed, adult offspring in this project did go through a reiterative decision-making process when making care decisions for a mentally impaired parent. At various times during the course of numerous decision-making processes, adult offspring struggled to find that Level of Contact internally, as reality set in that parents were no longer able to make effective and safe care decisions. There was the need to Interpersonal Conflicty as they contemplate where they, as adult children, fit into this picture and what r esponsibilities they will accept while negotiating with other siblings. Other phases of the decision-making process involve: Personal Sharing as they stepped up to the plate and made and implemented decisions; inevitably having to alter course as circumstances and levels of energy changed (Providng Assistance); and Self Sufficiency where they reinforced their decisions by being thankful that their situation (or perception of their situation) was more tolerable than others in similar circumstances. Nineteen sub-themes or categories flowed from the five themes. Level of Contact consisted of Defining Condition, Safety Concerns, and Role-Reversion. Interpersonal Conflict involved a Conscious Choice, Strained Family Relationships, Sharing the Load and Sole Responsibility. A Thread of Memory on the part of the parent sustains adult offspring in the Personal Sharing stage of the decision-making process. In this stage, the adult offspring would be Guessing Needs of the parent, Getting Information, looking at Finances, and Expressing Goals. Caregiver Wear and Tear, Time Constraints, and Problems with Care triggered a Providng Assistance phase. Adult offspring would respond to these stressors by Dealing with It and Becoming Assertive with the parent. Finally adult offspring would use mental coping strategies to confirm their decisions and the accompanying hardships by Comparing with Others and turning to Spirituality (Self Sufficiency). Theme I. Level of Contact Category 1. Defining Condition All but three of the interviews contained a category of Defining Condition of the parent. Adult offspring went through a process where they had to let go of their past preconceptions of parents capabilities and put their own words to the startling fact that the parent needed help with care decision making. Sometimes this became much clearer after the parent was in the household a number of years. One respondent who had taken his mother in before the onset of dementia was able to describe her condition after several years of living with her. She used to get on the bus and run around and all that stuff. When she took that fall she developed this what I call this old persons syndrome. She became so deathly afraid of falling again that her movements became choppier and choppier and tighter and tighter and the tighter they got the more prone she was to kind of losing her balance a little bit and then she would get scared more. She has physically gone down hill a lot since then. Mentally, well mentally shes gone down a lot too. Dementia, as I understand, is about a ten-year disease and she is probably three to four years into it. She probably had some symptoms of dementia four years ago, but it has gotten significantly worse since then. I think it has been four years. Although this respondent was able to clearly acknowledge symptoms of dementia, he still had difficulty accurately defining which symptoms were pertinent to the dementia and to the type of dementia involved. I said well my mother doesnt have Alzheimers, my mother has dementia. She said oh it is the same thing. I said well no its not, it is a significantly different thing. Alzheimers is a variation of dementia, dementia is a much broader category. If my mother has Alzheimers it wouldnt be safe to leave her alone because Alzheimers, as I understand it, is a spatial disorientation to where they can feel they are not where they need to be and they need to go where they want to go. Now they may be right there, but they dont feel it and so they go. My mother doesnt have Alzheimers. She plants, she is right where she wants to be and she knows it. But she does have dementia, that mental sense of connection to what just happened. And the gal said well we treat them both the same. Well how can you do that, they are both two separate issues and for one you should do this and for the other you should do that. Its frustrating. This adult son as he was trying to define the condition to himself, limited his conception to physical components of Alzheimers however inaccurately. How he defined his mothers condition to himself influenced what decisions he made and implemented in the Personal Sharing stage. Indeed, he had recently undergone an investigation by the Department of Aging (from which he was cleared of all charges) for leaving his mother alone and for cleanliness issues. Another respondent described how she was able to put words to the deteriorating condition of her mother. This respondent was a registered nurse with her masters degree and chose to define the condition through objective tests and outside opinions. No, she was not. She was totally independent and totally well until about the age of 82. So, that is getting to be close to five years now, she is 86. Then she began to get lost driving and not to be able to do what you and I would do if we were lost to stop and find out where we were, draw a map and follow it home, she couldnt do it anymore. At that point I took her toI had a wonderful physician who was a geriatric specialist and she got us in touch with some psychological testing services and we went through a battery of those and came up with the fact that what she should for her level of functioning prior to that date, she was losing an awful lot of executive ability. You probably know better than I exactly what that encompassed. So that is the point at which somebody had said to me she truly has some dementia developing, it is not just normal forgetfulness, it is dementia. Then I began to intervene with things like finances and make sure that she got to doctors. You know, just gradually taking on more and more responsibility. Note how this daughter accurately describes and defines her mothers condition, relying on her own observations and objective tests, a method of assessment which she probably is familiar with through her professional nursing career. Once the diagnosis was established, she got on with Personal Sharing phase by examining finances and making and keeping doctors appointments. This was an only child, born of parents who were also only children of which only the mother was living. These circumstances necessitated that the daughter did not have the luxury of dealing with siblings and determining her place in all of these decisions for her mentally impaired mother. Another adult daughter defined her mothers condition by the things she was still able to observe and how she functioned. Yeah. She is so observant. On the way home from [the daycare facility] the other day she said you know I am just intrigued by the cloud formations. She said I look up and I see all these configurations in the cloud. Coming down 29 she said have you ever thought about the laying of asphalt on that road, that is such a steep hill. How did they lay all that asphalt without it trickling down hill? So I mean shes not out of it. And every Sunday morning I dont know what triggers it she wakes up at six oclock and says is it time to go to mass. The other mornings of the week she will say what day is today. But somehow Sunday she knows it is Sunday. She will say now what time is it. Be sure to fast long enough to go to communion. She is a big help to me with her hands. She folds all the laundry. She cleans up all the plates and Sunday afternoon she took the fern and gave it a haircut all afternoon, it took quite a while to do it. She cuts up the salad, she makes fruit salads, she will wash ve getables, she will wash beans, anything she can do with her hands. Focusing on the positive might impact on this respondents ability to acknowledge continuous regression and might negatively influence the Personal Sharing phase when the inevitable physical decline begins and nursing home care must be considered. I mean if the time comes when she can no longer go to the Center or she is so feeble I would then have to make the choices to whether I was going to have somebody come in during the day to care for her and then I would be the caregiver until I got home from school until the next morning or put her in assisted living. I doubt that she will ever need nursing care, although one never knows. I mean nursing home care. She would be more likely to go into an assisted living. And as to where I would take her I dont know. Two other respondents defined their mothers and mothers-in-law mental impairment by attributing it to being taken advantage of by a preacher. Respondent: I truly believe that the religious aspect of this deteriorating her rather than helped her. Ive had extensive kinds of confrontations on her about she and God. This man always prayed with her and just a week ago did she say I believe in God. I think this man was her avenue and had her believing she was an avenue to God. Wife: And shes been in church all of her life and taught Sunday school. Respondent: I think it was a brainwash. I think this lady right now could still be playing the piano and doing everything she wanted to do if she hadnt of gotten too involved with him. Interviewer: So you think some of her thinking difficulties have to do with being involved with the church. Respondent: I know so. Three years, two years or more before this happened she always raised money for the preacher. She was the league chairman. She was going to give him this appreciation and I told her I was not taking her back there for her to take a bunch of money a thousand dollars or so out of the bank to give to some preacher. She said if you dont take me Ill catch the bus. It took her fourteen hours to go to West Virginia. It almost killed her. They continued talking about their journey to define in their own words what was happening to their parent despite what others were telling them. Wife: Then the people told us that she had gotten to the point where she was not bathing, had weird stuff on her hands, dirty, nasty stinking and he was steadily draining her and the neighbors and the church people had been telling us this and of course we didnt believe it not as strong a woman as momma was. But, they said she was even begging in the church for money for him and she would call us here and people kept sending bank statements to them that checks were bouncing. And he found out because he asked about a savings account and she said what savings account and we know that his father left her plenty of money. She doesnt have a dime except for money that she gets Respondent: And we have a beautiful house like this in West Virginia and we have borrowed on it. We go there and live four weeks out of the year. Two months out of the year we are there, we just came back. But, yeah I really think that this man really deteriorated her mind. Any time something would go wrong for himI hadnt paid attention to it. She would tell Wife that she called the preacher and he prayed with her and things were okay. I think that can happen to an old person and its called brainwash. Brainwash is a strange thing. The respondents kept coming back to the fact that their mother was taken advantage of by a preacher but incorrectly attribute this as a cause of her mental impairment rather than a consequence of it. On the other hand, they were able to seek out a doctors opinion and had some understanding of dementia. And I started questioning him about her and he said why dont I just get the chart and discuss it with you. I said because I am going to be taking her away from here and she can not get over here to see you properly. She has to pay somebody for everything that they do. So, he started out with dementia and I said what is dementia. I said is that Alzheimers what is it. He said a form of it. He said she will do well for a good while and I cant tell you how long, but he said she will start deteriorating and this will take over and it will appear to be almost like Alzheimers. He said she always has some deficiencies here in the spine at the base and that is going to be crippling and she would be wheelchair bound. He said other than that there was some enlargement of the heart which is normal for this age, 95 or 96. That is how we found out. There was always no problem everything is all right. Because we never went to see her business because she took care of everything. But when we found i t out that is when we made the decision. She had always said she would come and live in her room at the right time and the room was fixed, it was all ready Of course she has been unhappy many, many times in the beginning when we brought her here. She always wanted to send money back to the preachers wife, which she used to always buy her clothes all the time and making commitment always for that group. I guess people like who they like. I think they took advantage of her, I know so. This man was also an only child and it is evident that he moved into the Personal Sharing phase with the support of his wife while short-circuiting the Interpersonal Conflict stage due to his clear place in the family and no siblings with whom to negotiate. Category 2. Safety Concerns As adult children moved through the Level of Contact phase, they inevitably encountered issues about the safety of the parents behavior. They were often still unsure about whether these safety concerns were real since many times at the beginning of the course of the mental impairment, they were being told of these behaviors by others and not directly observing them for themselves. Thus presented quite a dilemma. The adult offspring were still struggling with defining the parents condition and not believing that the parent they knew could no longer be counted on to behave in an appropriate and safe manner. Looking back on being told of his mothers erratic behavior about finances and being drained of her life savings by a local preacher, one adult son remarked: Well it really was at a point that something I should have addressed ten years ago when I was told by distance relatives and friends and classmates there in the town that he was doing this. I just came to grips to where I just didnt believe it and you all told me and I didnt do anything about it. You all were right. I should have called this guy on the carpet way back. Hey man what are you doing. As I tell Wife Im not sure that would have been right either because then it is hearsay. This respondent was much more comfortable intervening in the situation once he had concrete evidence of the unsafe manner in which his mother was handling her finances and ability to live on her income. What happens is I have fact. I have the canceled checks. I know things that hes done. I have people that have seen him take her to the stores where she can cash checks and wait on the money, all of that. Safety Concerns whether they were about finances, getting lost in familiar surroundings, leaving appliances on such as stoves, falling or being unable to perform routine activities of daily living particularly eating regularly were effective at helping the adult offspring to move through the Level of Contact phase only when they were real to the adult son or daughter. The implications of seeing a formerly competent parent falter at taking care of themselves in an appropriate and safe manner seemed to be almost impossible until unsafe behaviors were personally observed. One adult daughter put it this way: Um, so it went on like that and then, what really brought it to a head was one morning I knew she needed milk. She could get her cereal but for some reason that was the thin that she really wanted so thats what she did, um, and I thought, well Ill drop the milk by and shell have milk for her cereal and then Ill come by at lunchtime and see, you know, see whats going on. So ordinarily, my mother slept very well and slept a little bit later in the morning, so I thought, well, you know, I let myself in and put the milk in the refrigerator and then thought, well, Ill just take a little peek, maybe shes awake, and I went around the corner and my mother, yeah she was awake but she was also on the floor surrounded by her covers, didnt know how shed gotten there, didnt know who she was, didnt know who I was at first, but she was so upset and you know, didnt have any idea how long shed been there, so I got her back up on the bed. She didnt hurt anything, cause the bed was low and she just sor t of slipped off of it. I think she used to take a medication. Sometimes it would make her a little sleepy, you know and she used to get up in the middle of the night to go to the bathroom and I think that maybe when she went back she may have missed the bed for some reason. I dont know how she did it, but she was OK, so I called my husband, I called my job and I called the doctorfrom then on it just seemed that things just went very quickly Another adult daughter talked about the time she realized that it was no longer safe for her mother to live alone. What happened one day, my mother stayed with them, they had a house and what happened was my mom she went to the dentist and they gave her some anesthesia and I think it just made her more confused and she was lost, we couldnt find her. She had left the house about ten oclock that morning and everybody was wondering where is mother, where is mother and we couldnt find her. So I think around like ten oclock or something like that we called the police and eventually we found her. She was over in the old neighborhood where she used to live prior to staying with them. So, I just took her at my house and I kept her like six months because I