Tag Archives: abuse

Expansion of Law Enforcement Post-9/11

Prior to 1993, federal law enforcement agencies, specifically the Federal Bureau of Investigation (FBI), felt more than adequate in investigating and preventing terrorism on U.S. soil (Smith & Hung, 2010). On September 11, 2001, as has been done on numerous emergent occassions, the U.S. government all but suspended Article III, Sec. 2 and Amendments II, IV, V, VI, IX, X, XIII, XIV of the U.S. Constitution in the name of protecting liberty; a premise I find sadly ironic.

According to an article by Abramson and Godoy (2006), the passage of the USA PATRIOT Act (2001) promotes intelligence sharing among the intelligence community, utilization of technological tools to combat tech-savvy terrorists, allows easier access to the business records of suspected terror supporters, allows search warrants to be affected without undermining other concomitant investigations, and allows wiretaps to be dynamic in order to follow the target suspect more easily. Detractors of the USA PATRIOT Act, however, argue that these measures undermine certain liberties that Americans are right to enjoy. These detractors warn of information cataloging that could lead to massive data stores of private information of regular citizens, unwarranted investigations, searches, and seizures of casual contacts of someone under investigation, and general use of “sneak and peek” warrants for the investigation of petty crimes.

One particular part of the USA PATRIOT Act, the usage of letters of national security that demand secrecy of government involvement from the recipient, was struck down by a federal judge based on Constitutional freedom of speech issues (Liptak, 2007). This is no surprise. Passing 357 to 66 in the House of Representatives and 98 to 1 in the Senate just six weeks after 9/11 and with little debate, this knee-jerk legislation was destined for failure, at least where public relations is concerned (Weigel, 2005).

The USA PATRIOT Act (2001) grants immeasurable power to law enforcement to investigate and prevent terrorism, this is a good thing; however, most of the provisions seem to fail whenever exercised against a U.S. citizen or lawful resident (Weigel, 2005). We need to rethink our approach to terrorism and ask the question of ourselves: is our safety worth every ounce of our liberty?


Abramson, L. & Godoy, M. (2006, February). The Patriot Act: Key controversies. Retrieved from http://www.npr.org/news/specials/patriotact/patriotactprovisions.html

Liptak, A. (2007, September 7). Judge voids F.B.I. tool granted by Patriot Act. The New York Times, pp. A18. Retrieved from http://www.nytimes.com

Smith, C. S. & Hung, L. (2010). The Patriot Act: issues and controversies. Springfield, IL: Thomas Books.

USA PATRIOT Act. P. L. 107-56 Stat. 115 Stat. 272. (2001).

Weigel, D. (2005, November). When patriots dissent. Reason, 37(6). Retrieved from http://www.reason.com/news/show/33167.html

Long-term care versus acute care

This discussion, again, allows me to ponder some musings of my colleagues and consider them in scholarly reflection. As a paramedic, I frequently respond to skilled nursing facilities (SNFs) to care for patients with minimal medical complaints or exacerbations of chronic conditions. The comments are always the same: What is the point of having nurses here if they cannot care for their patients? As I have never had an acceptable answer to this quandary, I will use this opportunity to explore the usefulness of SNFs based on measured outcomes. I will also compare the abilities of acute care facilities (ACFs) with those of SNFs to weigh the appropriateness of relying on ACFs to care for SNF patients.

The leading number of long-term care facilities are elderly SNFs, and as such, the elderly are the major demographic cared for in SNFs, yet there is a shortage, even within SNFs, of health care providers skilled in geriatric care (Cohen, 2002; Gaugler, Duval, Anderson, & Kane, 2007; Shi & Singh, 2011b). As Gaugler, Duval, Anderson, and Kane (2007) describe, the mere admission of an elderly patient into an SNF is associated with poor outcomes, “questionable quality of care, early mortality for many residents, and psychological or emotional upheaval for caregiving families” (p. 14). As long-term care also includes varying degrees of home care, family care, and limited residential care (e.g. assisted living centers), an international effort has been underway to help determine ways of identifying and limiting SNF admissions in order to limit potential negative outcomes and maintain patients’ self-efficacy and quality of life (Kennedy et al., 2007).

SNFs and ACFs are similar in that they both house patients, have nursing staff, are demographed by the number of beds housed, and, typically, have some sort of medical team responsible for the patients’ overall care. ACFs are numerous in type and offering. General hospitals, specialty hospitals, free-standing emergency clinics, and tertiary care centers are just some of the ACFs available to treat illness and injury (Shi & Singh, 2011a). ACFs tend to focus treatment on acute manifestations of illness and injury, while SNFs (and other long-term care facilities) focus on continuing care for chronic maladies (Shi & Singh, 2011a, 2011b; Singh, 2011). While ACFs rely on outcome measures to improve the care that is offered, such as that in stroke, it appears that SNFs and other long-term care facilities operate on a more traditional sense without regard to their effect on patient outcomes (Ahmed & Ekundayo, 2009; Díez-Tejedor & Fuentes, 2001; Kennedy et al., 2007; Martin & Ancoli-Isreal, 2008).

As I contemplate my original question in light of the available literature, I find that the elderly should only be institutionalized as a last resort (e.g. lay-led self-care, home health care, independant or assited living), training in geriatric care needs to be improved within SNFs, and outcome measures need to be further developed and assessed to fully understand the impact of long-term care on the elderly population (Ahmed & Ekundayo, 2009; Cohen, 2002, Gaugler et al., 2007; Kennedy et al., 2007, Martin & Ancoli-Israel, 2008). Until these three issues are rectified, SNFs will need to rely on ACFs to safely, effectively, and efficiently care for their patients.


Ahmed, A. & Ekundayo, O. J. (2009). Cardiovascular disease care in the nursing home: The need for better evidence for outcomes of care and better quality for processes of care. Journal of the American Medical Director’s Association, 10(1), 1-3. doi:10.1016/j.jamda.2008.08.019

Cohen, J. J., Gabriel, B. A., & Terrell, C. (2002). The case for diversity in the health care workforce. Health Affairs, 21(5), 90-102. doi:10.1377/hlthaff.21.5.90

Díez-Tejedor, E. & Fuentes, B. (2001). Acute care in stroke: Do stroke units make the difference? Cerebrovascular Diseases, 11(Suppl. 1), 31-39. doi:10.1159/000049123

Gaugler, J. E., Duval, S., Anderson, K. A., & Kane, R. L. (2007). Predicting nursing home admission in the U.S: a meta-analysis. BMC Geriatrics, 7(1), 13-26. doi:10.1186/1471-2318-7-13

Kennedy, A., Reeves, D., Bower, P., Lee, V., Middleton, E., Richardson, G., … Rogers, A. (2007). The effectiveness and cost effectiveness of a national lay‐led self care support programme for patients with long‐term conditions: a pragmatic randomised controlled trial. Journal of Epidemiology and Community Health, 61(3), 254–261. doi:10.1136/jech.2006.053538.

Martin, J. L. & Ancoli-Israel, S. (2008). Sleep disturbances in long-term care. Clinical Geriatric Medicine, 24(1), 39–vi. doi:10.1016/j.cger.2007.08.001.

Shi, L. & Singh, D. A. (2011a). Inpatient facilities and services. Current issues in healthcare policy and practice (pp. 1-44). Sudbury, MA: Jones & Bartlett.

Shi, L. & Singh, D. A. (2011b). The future of health services delivery. Current issues in healthcare policy and practice (pp. 123-156). Sudbury, MA: Jones & Bartlett.

Singh, D. A. (2011). Overview of long-term care. Current issues in healthcare policy and practice (pp. 123-156). Sudbury, MA: Jones & Bartlett.