In 1856, German pathologist Rudolf Virchow postulated the interplay of three processes resulting in venous thrombosis, now known as Virchow’s triad: a decreased blood flow rate (venous stasis), increased tendency to clot (hypercoagulability), and changes to the blood vessel wall. DVT formation typically begins inside the valves of the calf veins, where the blood is relatively oxygen deprived, which activates certain biochemical pathways. Several medical conditions increase the risk for DVT, including cancer, trauma, and antiphospholipid syndrome. Other risk factors include older age, surgery, immobilization (as with bed rest, orthopedic casts, and sitting on long flights), combined oral contraceptives, pregnancy, the postnatal period, and genetic factors. Those genetic factors include deficiencies with antithrombin, protein C, and protein S, the mutation of factor V Leiden, and the property of having a non-O blood type.

Individuals suspected of having DVT may be assessed using a clinical prediction rule such as the Wells score. A D-dimer test may also be used to assist with excluding the diagnosis (because of its high sensitivity) or to signal a need for further testing. Diagnosis is most commonly done with ultrasound of the suspected veins.

Prevention options for at-risk individuals include early and frequent walking, calf exercises, anticoagulants, aspirin, graduated compression stockings, and intermittent pneumatic compression. Anticoagulation is the standard treatment; typical medications include low-molecular-weight heparin or a vitamin K antagonist. Wearing graduated compression stockings appears to reduce the risk of post-thrombotic syndrome. The rate of DVTs increases from childhood to old age; in adulthood, about one in 1000 adults is affected per year.

Physical methods for prevention of deep vein thrombosis (DVT)—including intermittent
pneumatic compression (IPC)—have documented efficacy in surgical patients. As recently as
2010, however, a Cochrane review found insufficient evidence to recommend IPC in stroke
patients, calling for larger randomized trials to assess potential risks and benefits in this
population.1 One such study is CLOTS 3, the results from which were presented at the European
Stroke Conference (ESC) in May 2013 and published simultaneously in The Lancet.2

Although venous thromboembolism (VTE) is a common complication of hospitalized medical
and surgical patients, VTE prevention measures are persistently underutilized, especially in
medical patients, in whom the risk-benefit ratio is less certain.2,3 In the UK alone, there are an
estimated 80,000 stroke patients at risk for DVT because they are immobilized. Among these,
10% will experience DVT and 1.5% will have a pulmonary embolus within the first month after
a stroke.4 Hence, the clinical and economic costs of not treating VTE in at-risk patients are
considerable.

Here’s a brief review of the history of the Clots in Legs Or sTockings after Stroke study: CLOTS
1 failed to show a benefit for thigh-length graduated compression stockings (GCS) in stroke
patients.5 CLOTS 2, which compared thigh-length to calf-length GCS, also failed to find any
benefit for GCS and was halted before enrollment was completed to avoid exposing study
subjects to the discomfort and risk of thigh-length GCS.6 IPC, which includes sleeves that are
inflated one leg at a time to compress the legs at intervals and stimulate venous flow, is thought
to lessen the risk of DVT both by reducing stasis and stimulating release of fibrinolytic factors.2

CLOTS 3 was a large randomized, controlled, multicenter trial that enrolled immobile patients
(N=2876) admitted following stroke.2 Within 3 days of hospitalization, patients were randomly
assigned not to receive IPC or to receive open-label IPC for a minimum of 30 days, or until
restoration of mobility, discharge, or death. The primary outcome was asymptomatic DVT
discovered in the proximal veins by compression duplex ultrasound at 7 to 10 days and 25 to 30
days, or symptomatic DVT in the proximal veins confirmed on imaging within 30 days of
enrollment.

IPC resulted in an absolute risk reduction of 3.6% (95% confidence interval [CI] 1.4 to 4.8). A
somewhat unexpected finding was a nonsignificant reduction in mortality in the IPC group (11%
versus 13%; P=.057). Benefit was found across all patient subgroups, including both
hemorrhagic and ischemic stroke patients. On the negative side, the IPC-treated group had an
increased risk of skin breaks (3% versus 1%, P=.002) and there was a minimal nonsignificant
increase in the risk of falls with injury (33 versus 24, 2% in each group, P=.221).2

“At last we have a simple, safe, and affordable treatment that reduces the risk of DVT and even
appears to reduce the risk of dying after a stroke,” commented Professor Martin Dennis of the
University of Edinburgh, who presented the study at ESC on behalf of the CLOTS Trials
Collaboration.7

This favorable risk-benefit profile is especially encouraging since issues surrounding the use of
anticoagulant prophylaxis include bleeding risk and uncertain benefit in medical patients.2
Despite a long list of potential study limitations—from the nonblinded nature of the trial to the
method of detecting symptomatic DVT to the lack of IPC adherence—the results of CLOTS 3
appear both valid and generalizable to stroke populations and perhaps to other medical patients
as well.2,3

“Finding a way of preventing blood clots from developing in the legs after stroke has been a huge
challenge, with all the research up until now failing to identify a safe and effective treatment to
this common and dangerous complication,” said Professor Tony Rudd, chair of the
Intercollegiate Stroke Working Party at the UK Royal College of Physicians in London. “This
study is a major breakthrough, showing how a simple and safe treatment can save lives. It is one
of the most important research studies to emerge from the field of stroke in recent years.”7
References:

Naccarato M, Chiodo Grandi F, Dennis M, et al. Physical methods for preventing deep vein
thrombosis in stroke. Cochrane Database Syst Rev. 2010 Aug 4;(8):CD001922.
CLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration. Effectiveness of
intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who
have had a stroke (CLOTS 3): a multicentre randomised controlled trial. Lancet.
2013;382:516-524.
Stevens SM, Woller SC. Intermittent pneumatic compression in patients with stroke. Lancet.
2013;382:484-486.
Dennis M, Sandercock P, Reid J, et al; CLOTS Trials Collaboration. Does intermittent
pneumatic compression reduce the risk of post stroke deep vein thrombosis? The CLOTS 3 trial:
study protocol for a randomized controlled trial. Trials. 2012;13:26.
CLOTS Trials Collaboration. Effectiveness of thigh-length graduated compression stockings to
reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised
controlled trial. Lancet. 2009;373:1958-1965.
CLOTS Trials Collaboration. Thigh-length versus below-knee stockings for deep venous
thrombosis prophylaxis after stroke: a randomized trial. Ann Intern Med. 2010;153:553-562.
Hope for stroke patients [press release]. The University of Edinburgh College of Medicine and
Veterinary Medicine. June 3, 2013.
http://www.ed.ac.uk/schools-departments/medicine-vet-medicine/news-events/all-news/hopefors
trokepatients310513. Accessed September 3, 2013.

Antidepressant use nearly doubles the risk of hip fracture among community-dwelling persons with Alzheimer’s disease, according to a new study from the University of Eastern Finland. The increased risk was highest at the beginning of antidepressant use and remained elevated even 4 years later. The findings were published in the International Journal of Geriatric Psychiatry.

For each person with Alzheimer’s disease, two controls without the disease were matched by age and sex. Antidepressant use was associated with two times higher risk of hip fracture among controls. However, the relative number of hip fractures was higher among persons with Alzheimer’s disease compared to controls.

The increased risk was associated with all of the most frequently used antidepressant groups, which were selective serotonin reuptake inhibitors (SSRI drugs), mirtazapine and selective noradrenaline reuptake inhibitors (SNRI drugs). The association between antidepressant use and the increased risk of hip fracture persisted even after adjusting the results for use of other medication increasing the risk of fall, osteoporosis, socioeconomic status, history of psychiatric diseases, and chronic diseases increasing the risk of fall or fracture.

Antidepressants are used not only for the treatment of depression, but also for the treatment of chronic pain and behavioral and psychological symptoms of dementia, including insomnia, anxiety and agitation. If antidepressant use is necessary, researchers recommend that the medication and its necessity be monitored regularly. In addition, other risk factors for falling should be carefully considered during the antidepressant treatment.

The study was based on the register-based MEDALZ cohort comprising data on all community-dwelling persons diagnosed with Alzheimer’s disease in Finland between 2005-2011, and their matched controls. The study population included 50,491 persons with and 100,982 persons without the disease. The follow-up was 4 years from the date of Alzheimer’s disease diagnosis or a corresponding date for controls. The mean age of the study population was 80 years.

Over 1800 consecutive inpatients were enrolled in this randomized prospective clinical study. A total of 902 patients were managed with chemoprophylaxis alone and 901 patients received chemoprophylaxis augmented with [VenaFlow] intermittent pneumatic compression (IPC). All patients were Dopplered for evidence of symptomatic and nonsymptomatic deep vein thrombosis (DVT) at discharge. In the chemoprophylaxis-only group, fifteen patients (1.7%) were diagnosed with a DVT; three thromboses were symptomatic. In the IPC group, four patients (0.4%) were diagnosed with DVT; one thrombosis was symptomatic. The difference was significant. In addition, patients who wore the IPC device more than six hours per day had no deep vein thromboses. The results demonstrate that the multimodal approach of using a rapid inflation intermittent pneumatic compression device as an adjunct to low-molecular-weight heparin is significantly more effective in preventing DVTs than using low-molecular-weight heparin alone.

Exercise does not increase the chance that lymphedema will develop in patients who are at risk for lymphedema. In the past, these patients were advised to avoid exercising the affected limb. Studies have now shown that slow, carefully controlled exercise is safe and may even help keep lymphedema from developing. Studies have also shown that, in breast-cancer survivors, upper-body exercise does not increase the risk that lymphedema will develop. Some studies with breast cancer survivors show that upper-body exercise is safe in women who have lymphedema or who are at risk for lymphedema. Weight-lifting that is slowly increased may keep lymphedema from getting worse. Exercise should start at a very low level, increase slowly over time, and be overseen by the lymphedema therapist. If exercise is stopped for a week or longer, it should be started again at a low level and increased slowly. If symptoms (such as swelling or heaviness in the limb) change or increase for a week or longer, talk with the lymphedema therapist. It is likely that exercising at a low level and slowly increasing it again over time is better for the affected limb than stopping the exercise completely.

by Joyce Frieden
News Editor, MedPage Today

CHICAGO — A proposal by the Centers for Medicare & Medicaid Services (CMS) to change the way Medicare pays for drugs under the Part B program would hurt physician practices, the American Medical Association said at its annual meeting here.
“This is a patient care issue and an access issue,” said Heather Smith, MD, an ob/gyn in Bronx, N.Y., who spoke on behalf of the American Congress of Obstetricians and Gynecologists. “This will impact care of our patients, especially those with ovarian cancer.”

The AMA House of Delegates passed a resolution Wednesday asking that CMS withdraw its proposal and, if that doesn’t happen, that the AMA lobby Congress block the proposal’s implementation. The proposal, if put into place, “would significantly undermine the ability of physician practices to meet the significant administrative and financial burdens associated with the rapidly evolving healthcare environment,” according to the resolution.
The CMS plan would replace the current Medicare reimbursement — the average sales price of the drug plus a 6% add-on fee to cover costs — with a rate of the average sales price plus 2.5%, plus a flat fee of $16.80 per drug per day. The flat fee would be adjusted at the beginning of each year.

For full story go to: http://www.medpagetoday.com/MeetingCoverage/AMA/58630

Abstract

Objective: To compare the long-term efficacy of pneumatic compression and low-level laser therapies in the management of postmastectomy lymphoedema.

Design: Randomized controlled trial.

Setting: Department of Physical Medicine and Rehabilitation of Cukurova University, Turkey.

Subjects: Forty-seven patients with postmastectomy lymphoedema were enrolled in the study.

Interventions: Patients were randomly allocated to pneumatic compression (group I, n=24) and low-level laser (group II, n=23) groups. Group I received 2 hours of compression therapy and group II received 20 minutes of laser therapy for four weeks. All patients were advised to perform daily limb exercises.

Main measures: Demographic features, difference between sum of the circumferences of affected and unaffected limbs (▵C), pain with visual analogue scale and grip strength were recorded.

Results: Mean age of the patients was 48.3 (10.4) years. ▵C decreased significantly at one, three and six months within both groups, and the decrease was still significant at month 12 only in group II (P = 0.004). Improvement of group II was greater than that of group I post treatment (P = 0.04) and at month 12 after 12 months (P = 0.02). Pain was significantly reduced in group I only at posttreatment evaluation, whereas in group II it was significant post treatment and at follow-up visits. No significant difference was detected in pain scores between the two groups. Grip strength was improved in both groups, but the differences between groups were not significant.

Conclusions: Patients in both groups improved after the interventions. Group II had better long-term results than group I. Low-level laser might be a useful modality in the treatment of postmastectomy lymphoedema.

Excerpted from an article by Lee Ann Griffen in the Florida Health Care Association’s newsletter
“Pulse”.

“Competent residents engaging in consensual sexual activity is not a cause for undue concern in
assisted living, especially considering many residents have their own rooms which they call
home. CMS’ interpretation of Home and Community-Based Characteristics for assisted living
clients who receive Medicaid services takes this further, providing individuals the right to have
visitors of their choosing at any time.

Assisted living communities may specialize in accommodating residents who have cognitive
impairments. It’s important to recognize that cognitive impairments do not necessarily make a
person ineligible for sexual activity. However, administrators and professional staff must try to
differentiate between intimacy and abuse. There is no one-size-fits-all approach to sexuality and
dementia.

A clinical assessment must occur in order to determine consent. Guidance may be found at
www.nih.gov/ ; search Intimacy and Sexuality. It should be noted that a person’s right to make
choices is not invalidated solely because the staff does not agree. Staff should be educated on
distinguishing between their own values and the values of the residents.

Dementia training, open dining halls put bullying at bay in senior living

By Robin Hocevar

Elements in a Comprehensive Effort
As long-term care facilities begin to plan their respiratory protection programs, they should keep
in mind several essential components to remain compliant, effectively mitigate risk and protect
patients and staff:

Qualified administrator
This individual should be intimately familiar with OSHA regulations and understand the
potential infectious hazards an organization may face. He or she should also be aware of the
necessary personal protective equipment (PPE) that will adequately safeguard staff. Typically
this is an N-95 respirator-a device that prevents the spread of target sized particulate matter 95%
of the time.

A written plan
Underpinning a dynamic program is a detailed document that describes how the organization
shields staff from respiratory hazards and complies with OSHA regulations. This document
should describe any PPE needed, as well as the required environmental controls, such as proper
ventilation. To assist organizations in crafting a written plan, OSHA provides in-depth resources
that outline necessary components. In particular, the agency’s small entity respiratory program
compliance guide is quite helpful, including a sample plan for reference.

A workplace analysis
To ensure a respiratory protection program mitigates the correct hazards, long-term care
organizations should conduct a workplace analysis to see what risks are, or may be, present.
Organizations should take this assessment seriously as it is the only way to guarantee the
selection of optimal respirators and PPE. The program administrator may want to consult
external resources when conducting this assessment, such as CDC modules about specific
airborne diseases.

The July/August issue of Senior Living Executive magazine talks to senior living leaders about how they are connecting the dots between current dementia research and the delivery of memory care services in cover story “Connecting the Dots for Dementia Care.”  For example, Juliet Klinger, senior director of dementia care and programs at Brookdale, says the company focuses on “concepts that have research as their foundation,” pointing to Brookdale’s Crossings program, which combines physical exercise, nutrition, socialization, and other fundamentals to a new level by combining different types of exercise using different muscles and requires participants to engage their bodies and their minds.  Senior Resource Group offers The Club, a program seeking to delay the onset of full dementia for those with mild cognitive impairment by creating a “comfort zone” for residents who might otherwise feel swallowed up in a bigger crowd. This approach falls in line with a host of research findings generated from universities and other institutions.

The policy, released on June 25, represents the second time in two months that OSHA has warned those in the healthcare industry of its intent to increase enforcement. In April, OSHA issued revised guidelines for preventing workplace violence against workers in the healthcare and social service fields. The agency states that it is responding to “some of the highest rates of injury and illness” for these workplaces when compared with industries tracked nationwide. This includes “57,680 work-related injuries and illnesses” in U.S. hospitals, a rate “almost twice as high as the rate for private industry as a whole,” according to OSHA.

Five Specific Hazards

The new enforcement policy promises that OSHA will monitor closely compliance with health and safety rules relating to:

• Safe patient handling,
• Workplace violence,
• Bloodborne pathogens,
• Tuberculosis, and
• Slips, trips, and falls.

OSHA states that it is also interested in:

• Exposure to multi-drug resistant organisms (MDROs), such as Methicillin-resistant Staphylococcus aureus (MRSA), and
• Exposures to hazardous chemicals, such as sanitizers, disinfectants, anesthetic gases, and hazardous drugs.

Even if an inspection begins for an unrelated reason, OSHA now will take the opportunity to examine a facility’s compliance in each of these areas. It anticipates seeking access to employee medical records and interviewing employees to confirm what it finds in injury and illness records. Since these hazards are common in the industry and the policy, in essence, broadens the scope of each healthcare facility inspection and lengthier, broader, and more exacting inspections are likely to result — with the possibility that more citations and proposed penalties will be issued to employers in the healthcare industry.

For more go to the web site of the Jackson Lewis law firm.

Meanwhile, a new report from employment website Career Building shows that the long-term
care sector is likely to see job growth over the next five years. Home health care services are
expected to grow from 1.3 million jobs in 2014 to 1.7 million in 2019. The dovetails with new
Labor Department numbers showing job gains in the health care arenaLink Icon, with 408,000
jobs added in health care over the past year.

Preventive measures include:

●Hand-washing. Health care workers should practice good hand hygiene before and after treating
each person in their care. In the event of a C. difficile outbreak, using soap and warm water is a
better choice for hand hygiene, because alcohol-based hand sanitizers do not effectively destroy
C. difficile spores. Visitors also should wash their hands with soap and warm water before and
after leaving the room or using the bathroom.

●Contact precautions. People who are hospitalized with C. difficile have a private room or share
a room with someone who has the same illness. Hospital staff and visitors wear disposable
gloves and gowns while in the room.

●Thorough cleaning. In any setting, all surfaces should be carefully disinfected with a product
that contains chlorine bleach. C. difficile spores can survive routine cleaning products that don’t
contain bleach.

●Avoid unnecessary use of antibiotics. Antibiotics are sometimes prescribed for viral illnesses
that aren’t helped by these drugs. Take a wait-and-see attitude with simple ailments. If you do
need an antibiotic, ask your doctor to prescribe one that has a narrow range and that you take for
the shortest time possible.

“One of the most frequent questions I hear from homeowners relates to what to choose for tiling in their kitchen (and other rooms) and how they can make it look totally pulled together and not a mish-mash of tiles,” says Dean Dupre, owner of Champion Tile & Marble . “The thing with tiles is sometimes a mish-mash isn’t a mish-mash and the resulting design is eye-catching and very appealing. That’s the beauty of tiles.”

When in doubt about how to proceed with tile installation, sit down and figure out the project on a piece of paper. It acts as the roadmap to the finished product. Want a design in different colors? Plan it out and mark which areas are to be certain hues. Know in advance where everything is going to go, and use the predrawn pattern to place tiles in the chosen location.

“Even though tiles look good anywhere you put them, make certain to visualize the finished project,” adds Dupre. “Go to the store and choose tile samples and bring them home. Do a dry run of your design. The more you do in advance of tiling, the better the outcome.”

Finding the right tile is typically about what the homeowner likes and finds appealing. However, before just choosing tiles based on looks, research differences between various tiles on the market. There is a wide range of tile options available, including porcelain, cork, ceramic, vinyl, glass and quarry. Pick tile according to best fit for the chosen room and surface. Flooring tiles are usually bamboo, cork and vinyl, while counters and backsplashes may be ceramic, porcelain or quarry. Glass is usually reserved for backsplashes and walls.

“It’s important to also decide before you go tile shopping just what your budget is going to be and absolutely stick to it,” Dupre points out. “Search for reasonably priced products and stay within your limits. You may always upgrade later. Don’t buy a tile based on looks alone. You might get a shock at the cash register.”

Tile choices should also be based on the lifestyle of the householders. If the family has several children and numerous pets, tiles that are durable and easily maintained are in order. If the tiles meant for the kitchen, choose tiles that are not prone to break, chip or crack. While trying to choose the right tile for the right location may be confusing at first, one only has to keep in mind that choosing tiles is closely tied to a family’s lifestyle.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

“Backsplashes didn’t used to be as popular as they are now, but these days, most kitchens have them,” says the owner of Clearwater’s Champion Tile and Marble, Dean Dupre. “And they have, over time, become a way to add a touch of personality to the room. Most people also use them to make a personal statement with color, pattern and design,”

Backsplashes not only keep water off the walls, but also catch food splatters. This is important when it comes to materials that stain easily, such as oil, wine and tomato-based products. Without the protection of a backsplash, walls can easily get permanent stains. For backsplash installation, choose materials that are easy to maintain and wipe clean.

“Although the first inclination is to install a backsplash that matches the flooring, you might want to reconsider that option,” Dupre adds. “Easily installed backsplashes, ones that are lively, exciting and relatively inexpensive, as well as easy to keep clean, are those made from tile.” Try to avoid choosing a granite backsplash as they retain stains and are difficult to clean unless a specific solution is used. This applies even if the granite is sealed. Granite must be resealed every few years.

Tiles have the added advantage of being highly versatile and visually appealing. An owner can also lay out and install them in a design pattern of his or her creation and are relatively inexpensive.

When choosing what material to use for a kitchen backsplash, keep in mind how often various pots and pans may spatter, splash and ding it, and plan accordingly to install something durable. Durability does not have to mean dull, uninteresting and so-so looking tiles that do not add to a kitchen’s ambience, but can now mean exciting colors and patterns, all of which are definitely affordable.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

Laminate flooring is extremely popular with homeowners for a variety of reasons, including price point, easy installation and superior durability, not to mention ease of cleaning, especially with kids and pets. And laminate flooring is better designed than it used to be, so it might be the answer for a busy hub of a home.

These days, laminate is so chic that one may mistakenly assume it is really hardwood. Given the quality of most laminates nowadays, the two materials are almost identical twins when seen side-by-side. However, that natural hardwood look that laminate boasts is really only a paper layer sealed under a hard-as-nails protective film. Under the paper and protective coating is a backing board with the product glued and pressed into place. The coating makes laminate flooring so popular, easy to clean and durable.

Laminates today are so dense, thanks to the backing board, that they are resistant to punctures, cuts and scraping. The coating repels stains and blocks liquids from seeping under the boards, provided correct installation. Move furniture, drop stuff off the counters, wear spike heels or let the family dog pack run loose and the laminate still looks great.

However, if the family pet is older, laminate flooring can be dangerous, as older dogs are often unsteady on their feet due to arthritis. If they come inside with wet paws, laminate floor offers no grip and the canine in question can frequently end up doing four-footed splits and face plants. For a dog with arthritis or other hip and joint issues, this is excruciatingly painful and may also result in further injuries, such as pulled and torn ligaments, or strains and sprains.

If upgrade plans include laminate flooring in a residence with older dogs, consider using rug runners or other kinds of rugs that provide them with safer footing. Although older dogs can handle walking on dry laminate, it is still an exercise in caution for them, as older canines do not always have the same sense of balance that they had when younger. For them, walking on laminate becomes like skating on ice. Wet laminate is also very dangerous for older humans who may find themselves flat on the floor if they hit an errant wet or greasy spot.

Deciding what kind of flooring is best for a home upgrade needs to include all members of a family, even the pets.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

For those that love hardwood, but can not bring themselves to use it in high traffic areas in the home, there is some good news. Try oak hardwood. It is one of the most durable options out there and not only does it add a classy touch to any home, it does double duty as a tough surface for the kids, pets and constant company.

Hardwood is supremely popular for many reasons, but some species of hardwood have a fatal flaw – they do not do well in homes with pets and kids. However, that does not have to rule out hardwood if that happens to be a long held dream, not when oak hardwood is an available choice for classy, yet durable, floor. It is also good for increasing the resale value of a home.

Oak has won a spot in consumers hearts thanks to its classic elegant, yet understated quality of being the best kid on the block when it comes to adding a touch of fancy, charm and warmth to any home. It comes in engineered hardwood and solid hardwood forms. The choice, usually based on budget, is up to the consumer. One very appealing bonus is that the number of species of oak on the market allows for a wide variety of colors and looks.

Red oak has a hardness rating of 1,290. Red is hugely appealing to many homeowners for its unique gloss, shine and coloring, ranging from pink to red tones. Its classy grain patterns are also very exciting and do well in any room, as an accent or laid from wall-to-wall. In short, red oak is a workhorse of sorts and performs like a pro anywhere YOU want it.

White oak is the hardest oak, with a Janka hardness scale rating of 1,360. Just think of the serious style that floors would have with white and red oak as compliments to one another. Contrast white oak with the red and a home’s wow-factor shoots through the roof. While oak has a finer grain and a more defined pattern, it may be stained to any chosen color, or left to make a statement about simplicity. It’s up to the homeowner what to choose when it comes to oak flooring, but the choices are stunning and add lasting beauty to any home.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

Many older Americans may remember vinyl flooring, the kind mom and pop had in the kitchen or the grandparents swore by for ease of care. The black and white, red and white or yellow and black checkered patterns or the plain Jane flooring that yelled “It’s the 60s and this is grooving.” The good news is that although vinyl is back, it is definitely not the same flooring grandma and grandpa had.
Technology has brought some remarkable advances,some of these have been in flooring, vinyl in particular. Rather than down-the-street café or diner flooring, the new offerings are luxury vinyl, more resilient and flashier than the flooring of years past.

While gran or mom had to wax the floors? No more. The latest in chic vinyl flooring has a no-wax surface. In order to clean up, just wipe it with a wet mop, and voila. This vinyl is also scratch and stain resistant and applying a specific coating material in heavy wear and tear areas spiffs it up nicely. Check with the manufacturer for the right flooring formulation.

Unlike old vinyl which did not hold up for very long, the new vinyl flooring is four-layered, making the flooring highly wear resistant and providing a much longer life span. Layer one is the top, also referred to as the wear layer.

Beneath that is the printed pattern layer, then an optional cushioning layer, which makes the floor even easier to walk on, and the base. Flooring like this has the pattern just on the printed layer, as opposed to inlaid vinyl flooring where the pattern is imprinted on every layer. Inlaid flooring does not have a wear layer and is more expensive.

Along with all the maintenance aspects of the new vinyl floors, there are aesthetic options including wood, marble, tile, brick and stone and in any color imaginable. Even if the budget is a bit tight, with the wide variety of textures, patterns and colors, this choice of flooring is a homeowner’s dream.

Today, there is a wide range of styles and colors to choose from that are uniquely suited to just about any room in any house. Stuck on a particular color for the kitchen? Want a certain kind or look or pattern? Well, vinyl is now printed using a process called rotogravue that rolls the design on the second layer of the flooring. It involves using a rotary press and photoengraved plates, meaning that it can imprint just about any design desired.

No matter what look a house is aspiring to, it is available with today’s vinyl flooring choices. If renovators just do the research before buying, the home renovation project will go well.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

Flooring choices for environmentally conscious homeowners were once very limited. Today, however, the sky is the limit, or rather, the imagination is. Just about any type of green flooring conceivable, from bamboo to rubber to concrete, is readily available. A home can be a modern showcase of flooring that neither harms Mother Earth nor costs an arm and a leg.

But is concrete actually an indoor flooring option? Oddly enough, yes, concrete is becoming a very appealing choice because of its range of colors and the ability to customize, by stamping patterns into it or even using a circular saw. Color is not a limitation, as paints, stains, and dyes can create a whole spectrum of desired shades and hues for any given room in the house. But the major selling point is its durability. Even the relentless traffic of kids, pets and visitors can’t wear down a concrete floor.

If concrete is too bold an option, bamboo or even cork flooring are wonderful alternatives. They are not easily shredded and are far more resilient that people realize. For instance, bamboo is actually used as an alternative to hardwood and according to flooring experts, it is actually studier than hardwood. It appeals to homeowners who want their flooring to be both biodegradable and recyclable. Plus, bamboo has a renewal story that cheers that hearts of most green conscious people. It is rapidly renewable in its natural environment and, although light colored, it may be dyed or stained. Its ease of installation makes it a big hit with the DIY crowd.

Cork flooring, meanwhile, has an enviable reputation for being biodegradable, renewable and recyclable, also coming in a huge range of colors and sizes. No matter what the project, there is a suitable cork option. Installation is a snap and the finished product is appealing for several reasons: it acts as a natural thermal insulator, reducing heating costs, and is a comfortable surface to stand on.

Believe it or not, anyone can use eco-conscious tiles to create a floor of their choice. For instance, a creative renovator can lay cork and bamboo in a variety of ways. Experimentation is one of the best motivators for a unique floor design, so try using tiles creatively, mixing and matching, using thin and thick to contrast and using various colors.

This is not to say it is impossible to go wildly overboard with tile choices, but trying different approaches can make rooms come alive. Drawing out a pattern before actually laying the tiles can help avoid regrets once everything is glued in place. A tasteful, creative approach can make eco-conscious flooring into a beautiful part of the home.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

“It’s true, marble in the kitchen is one of the most attractive, elegant stones you could possibly use to upgrade your personal cooking space,” says Dean Dupre, owner of Champion Marble & Tile in Clearwater, Fla. “Kitchen countertops in particular are spectacular done in white marble.”

Marble is a much sought after stone for a number of reasons, but its main attraction is the uniqueness of the erratic veining that provides an inner elegance that homeowners love. Marble feels like an old friend, yet still holds the power to become a new acquaintance when it comes to improving the home’s interior. The Greeks and Romans used it to good effect and of their creations still standing today, all look breathtakingly beautiful. There is no reason the modern design eye should see it as just a stone for the fireplace hearth or mantel.

Installing marble in any room provides a showcase for this mysterious stone to show off its inner light in a softly reflective manner. Honed marble almost glows in the dark and has an eerie, yet elegant look. “I have heard many of my customers say that marble almost seems to have a life of its own,” Dupre adds.

Trending kitchen upgrades tend to include marble as a backsplash, a countertop or both. The ambience is incredible when smartly paired to compliment wood graining in the cabinets and/or flooring. For that incredibly crisp and authoritative appeal, white Danby, Carrara or Calacatta marble fit the bill. It is considered to be high-fashion and versatile enough to appeal to both modernists and traditionalists.

Although marble holds incredible appeal, it should be noted that it does require more maintenance than other stones, due to its softness. Extra care must be taken to avoid staining and scratching the surface. “If you want marble in the kitchen, choose a harder stone,” advises Dupre. “In general, darker colors are harder and the lighter marbles are softer. If you want a more durable white marble, choose the Danby white, sourced from Vermont. However, you still need to take care not to stain and scratch it.”

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

Self-reclaimed wood is not always ready to be nailed down either. Most of it comes with nicks, gouges, staples, nails, glue, screws and all the other things that originally went into making it what is once was. It takes time to clean these boards up and make them look passable enough to be used in a home as reclaimed flooring. The only way to get wood that looks good as new is to buy it from an outlet that has already done the work needed to make it acceptable for use for flooring.

Aside from reclaimed flooring, solid wood flooring, the old standby, is still a great option when upgrading. It is not laminated and is ready to be laid down right away. While somewhat expensive, much of it comes at a price that is competitive with reclaimed wood.

Engineered wood is another option, but consumers should keep in mind that it is layered plywood backing with a chosen top layer of wood, hence the lower price tag. It’s durable flooring and would suit those with a tight budget.

In general, solid wood flooring may range in price from $4 to $9 per square foot, with a higher price usually indicating a higher quality wood. Engineered flooring may range from $7 to $15 per square foot. No one should let the price of flooring be a bar to their dreams though, because even if doing a whole room in the wood of choice is out of the budget, there are certainly ways to get creative and use it just in key areas or as an accent.

Anyone on the hunt for wood flooring should sharpen a pencil and do some fancy calculating. Exercising a bit of imagination in using the chosen wood can easily yield stunning results.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

“People think that to upgrade their home they need to redo the bathroom, tear apart the kitchen, replace flooring and other such major projects,” says Dean Dupre, owner of Champion Marble & Tile in Clearwater, Fla. “Truth is choosing the right tiles to spiff up a room works wonders instead of spending a lot of money you may not have.”

Water resistance is usually an issue for homeowners, particularly in the bath and laundry room areas – two locations that tend to get makeovers when it comes time to sell. Porcelain ceramic tiles handle moisture with aplomb and reduce the chances of slipping and falling. Other types of stone tiles do not handle water well and tend to pool moisture in a thin layer, making secure traction difficult.

One of the best ways to upgrade a home’s flooring into a higher selling price range is porcelain ceramic tiles. They are well-known for their durability and even have the ability to handle more wear-and-tear than either granite or marble tiles while keeping their aesthetic appeal intact.
“Porcelain tiles are made to handle heat and do not burn, so they’re perfect for the kitchen,” adds Dupre. “This tough flooring can even handle having a hot pot dropped on it and not melt or scorch. It may chip a bit if it hits the right way, but it doesn’t burn.”

If choosing ceramic tiles for the kitchen floor, be aware there are various grades or groups of hardness and each grade is suitable for a variety of different things. Group 0 tiles are not fit to be used for flooring and are typically used as wall tiles. Group 1 tiles can only be used in light traffic areas. Group 2 tiles are not for kitchen use or for any areas with high traffic. Group 3 tiles are not for commercial use, but are suited to residential and light use applications. Group 4 tiles handle regular traffic well and Group 5 tiles are specifically for heavy duty traffic, where anything goes.

“Know the area you want to upgrade, do the research and get the right type of tiles for the job,” advises Dupre. “If you get the wrong tiling, you’ll have wasted your time and money.”

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

“It’s a rare occurrence when a health insurance lead converts from a lead without any contact from an agent,” says Clelland Green, RHU, CEO of benepath.net. “It has happened, but not often. Leads are just that, leads, an indication of someone interested in buying insurance. If there is no follow up by the agent receiving the lead, it dies and so does the potential for a sale,”

Even if an insurance agent has solid gold health insurance leads, they must be worked. The agent receiving the lead is the prime catalyst in persuading a lead to convert and buy a policy. The interesting fact about generated leads is that even great ones become aged after 48 hours and may lose interest without a call from an agent, the key factor in moving them from initial motivation to a sale.

Part of running an insurance agency is also the amount of training each agent undergoes to be able to sell their product to others. Selling insurance is not easy in a highly competitive market. Training assists an agent in overcoming objections, providing reasonable alternatives, recognizing when “no” means “not right now, but maybe later,” and keeping in touch with a prospective client in a manner that educates instead of aggravates.

“It is important to recognize that even the most qualified lead sent to you is not going to turn into a paying client without work,” adds Green. “Proper training shows you how to do that work and excel at it. Before buying leads, take the time to educate yourself about what type of leads you want and how you are going to handle them.”
One thing to consider is the distinction between real-time leads and aged leads. If an agent is not going to work a lead within the 48 hour time frame when it is still considered to be live, consider aged leads instead. Otherwise, real-time leads can be an effective way of pursuing actively interested parties.

“There are a number of things to consider before buying leads, but the number one goal is to aim for leads that can build a solid foundation for your business,” says Green. “If you are not sure what you are doing, start slow, invest in leads carefully and ask a lot of questions. The more time you spend training and investing smart marketing dollars, the better your business becomes.”

Learn more at Benepath.net

But if you have both carpet and animals, for example, you may need to step back and take a look at your options. There are many practical reasons to choose tiling instead of carpeting.

If you don’t like cleaning carpets on a regular basis, then tiles would definitely be an improvement. Carpets retain vestiages of just about everything dropped on them, from a present from the dog to a glass of red wine. Professional stain cleaning can be prohibitively expensive. Tiles make cleaning up accidents much easier and less stressful.

Those who love tile have an artistic side that revels in the lovely mosiac patterns they make possible. They have choices one cannot find with carpeting. Homeowners get to create their own designs, choose the type of tile to suit each room, mix-and-match their choices and, perhaps, spend a lot less on tiles.

The choice of tiles is truly stunning in colors, surfaces, glazing and patterns. Even if the exact right color does not seem to exist for a home, tile can be painted to match. Carpet does not offer the same flexibility; buyers can’t change the color without replacing the entire surface, and options are far more limited.

Of course, there are also plenty of reasons to love carpeting. It all comes down to personal preference. Just make sure to choose a floor that truly suits your lifestyle.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

The actual installation is easy. The tough part is the preparation: smoothing and cleaning, tearing out old fixtures or features, making decisions, scheduling and gathering supplies. If you intend to install anything new in a home, always protect the flooring before beginning work.
Without protection, the floors might unintentionally become the next renovation project.

Any home construction project, large or small, can destroy home flooring if not handled properly. The damage is an extra, unnecessary cost to incur, and there is no sense in destroying one part of a home while enhancing another.

The best methods of protection vary from surface to surface and from location to location. Find solutions that keep surfaces clean and safe while allowing work to proceed above them.

It is easy to spill on or damage carpeting, leaving stains, rips, texture damage or frayed edges. Use carpet protection film to protect soft flooring. On acrylic carpet, use adhesive film, which will not move around or leave bare gaps, and which removes easily. Wool rugs need a non-adhesive film.

The film can also offer protection from workers walking in and out with supplies, dirty feel and equipment. Who needs dry grouting or sawdust ground into an unprotected floor?

Hardwood floors need a heavier layer of protection to compensate for their vulnerability. Wet wall jobs, like tiling in a living room, require waterproof plastic film or a multiple surface shield, which is handy for just about any surface. In addition, installers will need several reusable, padded rubber mats for a docking spot for tools and other equipment.

In two-story structures, simple craft paper can be used to cover stairs. The solution is portable and inexpensive, and it can easily be collected when the stairs are in use (and the project is on pause).

Think ahead, and the completed project will look even better than expected.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

Concrete is gaining a real following with eco-conscious homeowners who want something a little different. The material lasts for more than a lifetime and is chic, impressive and unusual — not to mention environmentally friendly. Concrete can be more than just the gray stuff you find in sidewalks. It comes in a variety of colors with a choice of patterns and designs.

As such, it is finding a niche in the residential sector.

The advantages of this type of flooring are numerous, but the most obvious one is durability. This type of flooring will not require replacement any time soon. Those with kids and animals are especially likely to benefit from its toughness.

Concrete flooring also adds value to a home on resale. Before investing in hardwood, laminate or tiling, research concrete floors. Easy to clean and maintain, with no seams and a smooth finish, versatility is its middle name. Installation is fast, and cracking and heaving are rare.

However, concrete is harder underfoot than softer wood flooring is. If desired, one can certainly use carpeting to give polish to certain areas or install a foam-backed runner to give the surface some spring. These finishes also add desirable warmth, as concrete will feel cold during the winter months. On the other hand, some prefer concrete flooring precisely for its cooling ability in warmer climates like Florida’s.

Pouring concrete needs to be done correctly. If errors are made, moisture finds its way under the surface and can mar the top of the flooring, creating the possibility of chips and cracks in variable temperatures. One needs to ensure the material is handled in just the right manner to ensure a level floor when the concrete hardens.

Concrete is a viable and worthy alternative flooring, and the price is extremely attractive as well.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

Tiling is not as easy as it looks. House, home and hearth need professional installation and finishing to look stunning. Those wishing to install tiling themselves should strive for a professional understanding. Read and study proper techniques. A poorly done job becomes a massive expense very quickly, especially if flawed grouting and sealing are involved. Installers can run out of tile because a job was not measured properly or tiles broke, then be unable to find a matching unit for replacements. Mistakes damage durability and jump out at the eye.

Experience in placing and fitting tiling is a major advantage. Start with a draft map design laying out the precise desired result. A reference keeps installers on track.

Rethinking the idea of tiling a bathroom or kitchen independently? It never hurts to ask a professional flooring expert for assistance. Many are happy to answer questions, and all are happy to step in and complete the work. The extra expense also buys confidence: the homeowner will know for a fact that the tiling will withstand just about anything.

Tiling is an investment in a home that makes it look the very best it can. A professional flooring contractor’s services are among the best investments to further that goal.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

Radiant heating is omni-directional, moving in all directions and heating indirectly. Installers need to understand how the system works when installing different kinds of hardwood in a home.

The installation of this heating requires sinking tubing into concrete or tucking tubes underneath plywood sub-flooring. Homeowners need to be aware that radiant heating causes hardwood to dry out. If a person wants to have both hardwood and radiant heat, bamboo flooring will be the best option. Bamboo weathers heat well and is not troubled by variable humidity. If choosing bamboo, be sure to find high-quality, older bamboo and evaluate its maintenance needs before you purchase.

In installation, make sure to use glue, not nails. With nails, installers run the risk of rupturing the embedded heating coils. Floating bamboo, which is durable and stable, is the best choice to partner with radiant heating.

Take care to not install hardwood right on top of heating coils. You need a barrier between the floor and the heat source. The recommended thickness for a plywood barrier is two thirds of an inch. The wood is not just a barrier. It also supports the floor planks, offering more stability.

Once installed, the floor will need at least three days to adapt to heating cycles and shifts in humidity. Ideally, heat the floor slowly and keep the heat at a steady temperature below 80 degrees Fahrenheit.

Bamboo makes impressive flooring and withstands radiant heating very well. It may be the perfect solution for an eco-conscious homeowner.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

By the time it is installed, bamboo no longer resembles the stalks of the tropical, green, grassy plant from which it comes. Though its fast growth is one of its most prominent qualities, flooring bamboo is not harvested every year. It takes up to five years to harvest a crop that is not only practical, adaptable and elegant, but also environmentally friendly.

After upgrading flooring to bamboo, homeowners may find that the value of their home is higher on resale. Although bamboo is regarded as a grass, its durability is legendary. It repeatedly outperforms traditional hardwood flooring. Bamboo is fire-retardant, requires very little maintenance and resists insects and mildew well. The fact that bamboo is made of organic material often appeals to those who suffer from allergies.

As with any material, bamboo has its drawbacks. Most of bamboo’s relate to weight and foot traffic.

Bamboo is firm, durable, resilient and charming. Better still, the material naturally resists moisture and staining. It is easy to install, and it can be laid in a number of ways to showcase its stunning patterns – woven, horizontal and vertical. Bamboo’s gold-blonde coloration enhances any pattern when installed.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

Ask for a quote and an estimate of how long the project is expected to take. Professional tilers should be able to estimate the number of tiles needed and the amount of labor that will be involved. They will be able to source the right kind of tiles and grouting for you, including extra materials to protect themselves from delays from cracked or broken tiles.

There’s also nothing wrong with doing it yourself. Tiling on your own can be a lot of fun. Make sure you study the techniques you’ll need to make the job looks good when it’s done. Many DIYers, for example, forget about adding in a number of extra tiles to take care of the smaller pieces needed for the corners of a room and awkward spots that require handcutting.

Usually, it makes more sense to hire a tiling expert unless you enjoy the actual assembly process. Whichever you choose, your floor will look beautiful with a little planning.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

Wood-look tiles, as you might imagine, mimic natural wood, but they also contribute the strength of tiling to your floors. Sturdy and durable, these tiles are moisture-resistant and can withstand high heat. They are easier to clean than conventional wooden floors, and they require little upkeep and no polishing.

Typically composed of porcelain and/or ceramic, the tiles mime natural woodgrain surprisingly well. Plus, wood-look tiles are far easier to install and maintain. Tiled surfaces will not shrink or swell with changes in heat or humidity, and each tile is much easier to replace when damaged than strips of hardwood.

Indoors or out, wood-look tiles can withstand water, heavy traffic and frequent sun exposure. They are particularly cost-effective in their maintenance; once wood-look tiles are down, they require very little upkeep and continued funds.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

When new trends hit the market, you tend to see a lot of homeowners rushing out to try the latest fad. Right now, the hottest trending new idea is to tile walls. According to a number of real estate agents, properties with elegantly tiled walls are selling very well. And why not? The tiling slabs add a whole new dimension to a home or office and the good news is that they can withstand pretty much anything.

The ability to stand up to whatever is thrown at it is the hallmark of a sturdy wall slab. Homeowners should consider this when tiling walls of areas such as the kitchen, laundry room area and bathroom. Tiled walls definitely create a unique look, and with the wide variety of colors, tones, patterns and shades on the market, there is a whole lot of latitude in creating just what you want. Hands down, tiling a wall beats painting it, when you consider that the minute paint comes into contact with the moisture that touches it on a daily basis, it begins the long, slow process of disintegration.

For those creative souls that love to design a room around a theme or hand-paint their own slabs, this newest way to make a room stand out is most welcome. Additionally, tiling walls is a much cheaper alternative than some other options out there. For instance, if you want to save some serious money, consider using ceramic wall tiles. They’re not only cost-effective, but they’re also attractively durable and they are not hard to keep looking good. It helps that they are also water-resistant.

If your budget is more generous, then you might gravitate to slate, granite, marble, quartz or travertine. The choice is yours for each room. For instance, try granite in the kitchen, marble in the bathroom and travertine for the study. The sky’s the limit when it comes to installing tiling on your walls. This is one trend that will definitely increase the resale value of your home.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

Many DIY homeowners feel they can install their own flooring, and many do a fine job. However, when it comes to hardwood, there are a few extra things to be aware of; buckling and cupping are two of them. A warping process transforms wood flooring after prolonged exposure to humidity and moisture. The wood absorbs the moisture, retaining it until it dries. When it does dry, the floor warps, and it doesn’t matter if your floor is older or brand-new.

As surprising as it may seem, many homes have high levels of humidity and moisture. Humidity inside or outside the home can damage floors. Outside factors are outdoor climate, heat and humidity; so living in a rain forest is not good for hardwood floors. Inside moisture is generated in the bathroom, kitchen and laundry rooms. And for those of you who have lived through ruptured water lines and burst water heaters, you know how much damage that can do to the inside of your house. It helps to catch that kind of situation early, but that does not always happen.

If you’re going to lay hardwood floors, you want to make sure they are protected from absorbing moisture. After all, hardwood flooring is a significant investment. Make sure to seal the floor properly by glazing it and using a transparent sealant or waterproofing stain.

However, before the real work is done, always lay the planks on waterproofed and insulated layering. This gives the underside of the boards the protection they need from moisture. Now is not the time to cut corners, because this floor needs to last a long time. If you don’t install it the right way the first time, chances are you’ll be taking it up again due to water damage causing buckling. It is quite rare to have hardwood cup and buckle as a result of being defective. In nine cases out of ten, warping is related to improper installation and a poor job applying sealant, which allows moisture to work its way under the wood.

Take the time to research carefully how to install hardwood floors the right way. When in doubt, consider reaching out to an experienced flooring expert who is able to advise you on your project or do it for you. Ultimately, you want your home to look great. Make sure you do it up with class and attention to detail.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

Ceramic tiles offer beauty, flexibility, texture, color and value. Moreover, ceramic is exceptionally durable. Tiles have survived the test of time for centuries. Some have been recovered in sound condition from ancient Egyptian and Roman ruins. Your home will hardly need to become an ancient ruin for its tile to be appreciated. Ceramic enhances its beauty now and into the future.

Ceramic tiles have at least one feature that makes them unique — ceramic refuses to harbor germs, making it an ideal and popular surface for kitchens and bathrooms. The smooth surface is also easy to keep clean. Just make sure that the ceramic tiles you purchase all come from the same lot, which will ensure that they are uniform.

Additionally, make sure to choose the correct hardness for the job at hand. Ceramic tiles range in hardness from zero to five. If you want to tile a wall, then the best choices are tiles rated zero through two. For in-home floor use, go with a three-rated tile, and if you want tiles for a commercial application, a ranking of four or five would be suitable. Backsplashes, walls, floors and countertops all benefit from ceramic, as it is easy to maintain, very versatile, highly durable and reasonably priced.

Porcelain is considered a subtype of ceramic, and its clean look makes it a good alternative. Porcelain is the tile of choice for truly high-traffic areas, especially in industrial and commercial settings. The tiling you find in airports is almost always porcelain. Your personal tastes will determine whether you like that look for your home, but its extreme durability may not even be the driving factor in your choice. Usually, homeowners choose ceramic tiles due to their unlimited versatility.

Another alternative may be natural stone tiling, which is often considered to be an agglomerate/aggregate tile: it is a mixture of marble and other rocks held together by epoxy. Stone tiling comes in a variety of engaging colors and designs. If you choose to install it yourself, be sure to measure twice and cut once. Since stone tiling is man-made, measuring and cutting work needs to be very precise.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

Without a doubt, the kitchen is the heart of the home. Just about everything — from cooking to entertainment to homework — happens in its friendly atmosphere. People come. People go. People pass through and spend time. It’s always a room with stories to tell, and over time, the floor begins to show signs of its wear. So when a family upgrades their kitchen space, they want to make sure to find something durable, attractive, easy to maintain and within their budget.

Today, many Americans are choosing stone and tiling for this high-traffic room. Tile and stone are well-known to stand up to the demands of children and pets.

Nothing performs better than stone for resistance; it does not scratch as other flooring, like laminate or hardwood, would. Stone lends itself to a natural look, and it gives a room an interesting, warm ambiance. Slate, sandstone and limestone are most popular. While these choices do need to be treated to maintain their elegance, they are tough and sturdy.

If budget is a concern, you may opt to use porcelain tiles that look like stone. It takes some sleight of hand, but the solution is very appealing to the eye when all is said and done. Tile is also smoother underfoot than stone would be. Porcelain tiles come in multitudinous patterns, designs and colors, and they can even be ordered with a metallic finish. With an eye to quiet design, metallic-finish tiles energize a kitchen in an understated, elegant way. The right choice of tile will also withstand a virtual army’s worth of tromping.

Concrete flooring is a third, newer trend. Popping up on floors across the nation, concrete holds heat well and is one of the toughest floor materials on the market. These surfaces are nothing like the sidewalk material you may be picturing. Concrete can be acid-stained, colored, polished or honed. In many cases, the final result looks like another substance entirely. With coloring, you can choose between various shades of yellow, gray, white, red and even green. And concrete can even be used for countertops.

Your kitchen can be the inviting, central hub that you want it to be. Think about your choices and how they fit your budget before investing in any surface.

Sally Odell - Rifkin & Fox-Isicoff, PA is an immigration lawyer in Miami with immigration law offices in Orlando and Miami Florida. To learn more, visit http://www.rifkinfox.com/.

While both sides make strong points, studies still show that email marketing can have a powerful effect as a direct marketing tactic. The key lies in quality. Stong emails boost communication and reaches a wide range of current and potential clients. Tackle the challenge yourself, or, if you prefer, get in touch with an experienced search engine optimization (SEO) company to find out how its teams can help you leverage your website to get more conversions.

Online, people today tend to have short attention spans. Email has become a daily part of life, so it can be difficult to stand out in a person’s inbox. You want people to open your email and read it. So, create subject lines that capture attention and compel readers to open your email to discover its contents.
Never hesitate to tell your recipients why they should open your email. Offer useful incentives relating to insurance products, like news on beneficial changes in the industry or tips on dealing with new developments in your speciality areas.

Treat your subjects lines like titles. They need to appeal to readers enough to make them open and read your message. Before sending any insurance news out by email, experiment with subject lines. Ask for outside opinions. If your initial choices fall flat, try again or discuss your direct email marketing needs with an experienced SEO company. SEO and email marketing work together, so do not discount their connections.

Creating a subject line that sells someone on opening an email is a bit like creating keywords for a website. The intention is the same: encourage people to take an action and convert. All types of marketing are related, so your agency’s more familiar tactics can help you to write content for a new form.

Subject lines need to be short and to the point. Use 50 characters or fewer. Avoid making exciting promises you can’t keep. Stay away from three toxic terms that make people hit the delete key most often: “reminder,” “help,” and “percent off.”

If you need help finding a strategy to build your agency’s reach, contact an SEO company that knows how to market insurance agencies.

Ready to Quote is an insurance marketing company focusing on search engine marketing and <a href="http://www.readytoquote.com“>insurance websites. Learn more at http://www.readytoquote.com/ or call 1.800.504.8593

But before you begin to shop for replacement materials, pull up a corner and check the surface underneath the carpet. If you find underlying hardwood flooring, it may change your plans. Instead of laying new flooring, you might opt to bring that dusty, scratched hardwood back to its former glory.

You probably bought your home thinking you won’t be moving again anytime soon, but life often holds surprises. An illness, transfer, divorce or job loss could change your plans. So, if you find hardwood under your carpets, work to save it. Hardwood is extremely popular with homebuyers, and it tends to raise the asking price for and value of your home. If you still want to include some carpeting after wood renovations, you can add area rugs for a cozy, lived-in feeling.

Are you uncertain that you have the time and budget to rip up the carpets immediately? If so, consider keeping the current carpets, provided that you can clean them well enough to restore most of their original softness and beauty. There may be more life left in those rugs than you would expect. Consider giving them a second chance and a thorough, professional cleaning. They may offer you several more years to save for a major flooring upgrade.

You may have carpeting all through your house, but chances are that the flooring is different in the bathroom, kitchen and laundry areas. Here, you could consider a “mini” flooring renovation and opt to use natural stones and/or tiles. Tile and stone are smart choices for areas in the house that see high traffic and deal with spills and stains on a regular basis. Stone and tile, provided they are properly sealed, remain durable, beautiful and elegant for years to come. Additionally, the rainbow of colors available makes it a joy to brighten your new home to your tastes.

Flooring is a very personal choice. It may be tempting to choose an “unusual” surface to express a distinct style, but always keep your resale value in mind. An off-the-wall montage of tiles in the living room and an electric-neon-tiled kitchen certainly make a statement, but they also reduce the number of people who will be interested in buying your home later. While resale value should not completely constrict your flooring or tiling choices, it is best to find compromises with an eye to the future.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

Pinterest is no longer just for pictures of potential wedding favors and stunning landscapes. Now, it has evolved into an even more interesting platform with the newest addition to its lineup: Article Pins. Article Pins are a bit longer than normal Pins, and they offer a user an article link, story description, author and headline.

The change is happening gradually, so your insurance agency still has a chance to plan strategies for marketing and outreach on Pinterest before most users begin Pinning articles on a regular basis.

Before the revamp, if a user Pinned an article, other users would see a picture relating to that article and a link to it. This format left articles fairly unattractive amongst other Pins, and it was difficult to determine the relevance of any given piece.

If you want people to Pin your insurance articles and blogs under the new format, always attach a picture. Learn how to summarize your article accurately in its opening sentence.

You might be wondering about the potential insurance audience on the site. Just about every American online should want to read about insurance, because, one way or another, they each need a product you sell (whether now or in the near future). Pinterest may be exceptionally effective if you sell health insurance and Medicare/Medigap policies. But other types of insurance policies are gaining their own attention as people realize their need for the protection that insurance can offer.

Through Pinterest, you have a chance to create highly visual, narrative marketing. A wealth of images apply to your agency; surf online for pictures of people recovering in hospitals, using crutches, reading pill bottles or standing in front of a tornado-struck house. Pictures are definitely worth a thousand words. However, be sure only to attach images that follow Creative Commons guidelines or images for which you have purchased the rights.

Choose your article topic (say, home insurance or health insurance), write from the heart, keep it short and crisp, find a picture to match your content and Pin it to your company’s board.

Can’t write to save your life? Don’t know the right focus to choose? Clueless about SEO and social media? There are options for you, too. Contact an experienced search engine optimization (SEO) company with a background in the insurance industry. They will know exactly what to do, so you will be able to build your business without worrying about website maintenance and the other chores of social media.

Ready to Quote is an insurance marketing company focusing on search engine marketing and <a href="http://www.readytoquote.com“>insurance websites. Learn more at http://www.readytoquote.com/ or call 1.800.504.8593

There are a vast number of flooring options on the market today. So many, in fact, that it can be confusing to consider every choice. Would ceramic look good in the kitchen? Would marble work in the bathroom? What about hardwood flooring? They are all valid questions, and the simplest solution is to choose something that instinctively appeals to you. Find something you love on sight. After all, you will be living with your choice for a long time.

You may find yourself falling in love with a hardwood surface. Many people love how elegant hardwood flooring looks. It offers beauty, durability and class. Hardwood adds inviting warmth to the atmosphere and works to pull a room together in a very visceral, visual manner. If you have an open floor plan, hardwood may be the perfect choice. It is versatile and warm on the feet. It can be refinished without too much effort and, should you ever choose to sell your home, its resale value will bring your investment back to you.

Just be aware that hardwood does contract and expand in response to the level of humidity in the air, so it’s not a good choice for bathrooms, laundry rooms or the kitchen unless it is properly sealed. If you do choose hardwood for a high-humidity location, expect to reseal the floor every six years or so.

Not sure you want the work of sanding, refurbishing or sealing? You might want to consider engineered wood flooring. These surfaces are hardwood, but they come in layers. Their cross-grain construction makes them even stronger and more durable than solid pieces of wood on their own. Engineered wood flooring offers more structural integrity: it does not gap, buckle or warp. Engineered wood is perfect for the kitchen, and it can be laid directly on concrete without a subfloor if you are finishing your basement.

You might also consider bamboo flooring, especially if you are environmentally conscious. It does cost more than hardwood, but it is even tougher. It offers an excellent walking surface, and it acts to muffle sound. Bamboo is an excellent choice for high humidity locations, but it must be sealed. Be aware that if you plan to revamp your own floors, it can be tricky to cut bamboo. You may particularly wish to hire a professional installer for this job to avoid losing material to waste.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

A blog can establish an agent as an expert who knows products well and can help others make smart policy choices. The insurance industry is filled with jargon, but with the translations of a good agent, it does not have to be so. Agents who blog have a knack for taking complicated riders, policies and clauses and turning them into plain English for customers. It’s good marketing, and visitors appreciate it.

A blog is also excellent material for search engine optimization (SEO). All search engines thrive on original content, so if an agent blog frequently and creatively, the content will appeal to engines and rank higher in results. Content does not need to be endless, but frequent, original, fresh posts make a difference. An onsite blog allows an agent to offer visitors precise information in the areas that directly affect them. For instance, a medical insurance professional can discuss how Medicare works, or what Medigap insurance is, as he or she links visitors to the coverage they seek.

Blogs have grown out of forums and message boards, and it is now even simpler to post and to be noticed. Add something new often, and visitors will beat a path to the door over time. Dismiss “instant” success stories. Instead, build your blog carefully and steadily to seek out steady traffic that converts.

Should an agent allow people to comment on posts? While the idea is appealing, it works better in theory than in practice. Moderating comments for spam and inappropriate content can consume an undue amount of time and effort. Instead, provide readers with the information to call or contact the agency online with questions and comments.

How does an agent prevent a blog from becoming a static entity on an insurance website? Use Real Simple Syndication (RSS). Most blogs offer an RSS feed that syndicates your blog entries into other forums, search engines and blogs.

It the process sounds overwhelming (and it can be for a new user), look into hiring an insurance-industry-savvy SEO company that knows what is needed to make an insurance website a huge success. The marketing investment is well spent for the potential for new customers it will provide.

Ready to Quote is an insurance marketing company focusing on search engine marketing and <a href="http://www.readytoquote.com“>insurance websites. Learn more at http://www.readytoquote.com/ or call 1.800.504.8593

It used to be that vinyl flooring didn’t wear well and just had a “cheaper” look, even when it was newly laid. The product has definitely changed, and today’s Americans may not be aware of the new benefits (no matter how they felt about Granny’s white-and-red checked kitchen floors).

You can still find that checked vinyl flooring, and now it is considered to offer a clean, retro look. However, the vinyl that composes it is now resilient and durable, able to withstand applesauce, Kraft dinners, soup, dog bones and even wine. Be careful how you install the flooring, and it will last for years. Vinyl can now be installed with no-slip sheets, which enhances its safety and makes it even easier to clean.

Vinyl is also water-resistant, making mopping easy. Spills are not an issue if wiped up promptly because the material’s virtual seamlessness will prevent leaking underneath it. No mold, dirt, bacteria or other pathogens will slip beneath your floor, making vinyl a safe, healthy choice for homes with children. Vinyl flooring offers a huge variety of colors, patterns and textures. Modern vinyl has been known to fool a discerning eye with intelligent mimicry of other types of flooring. Smooth? Yes. Rougher and more rustic? Yes. A pebbled surface? You can find that too.

Vinyl flooring is extremely economical, and it will serve those with a strict budget well. You can save even more if you lay it yourself. Just pay attention to the directions for proper installation. There are smart buys on the market for those who appreciate the versatility of contemporary vinyl. The option is well worth exploration.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

Don’t buy anything to upgrade your floors on impulse. Take the time to study each room you want to enhance. What do you want it to look like when you are done? Is your home styled in a modern, western, contemporary or chic way? Do you want carpet, hardwood, laminate, rubber or bamboo? Decide before you visit any flooring stores. The concrete decisions will help you stick to your budget and beautify your home.

Let’s say you want carpet in the master bedroom, just to add some warmth for your feet during the winter months. Finding precisely what you want can be challenging (not to mention expensive), but it is possible. There are a number of options to check out for less expensive carpeting. Your local carpet store might hold a treasure trove of discounted carpeting, and sometimes you get lucky and find a sale piece at a 75 percent discount. Not a bad deal, even though the carpet may be discontinued. Search out precut carpeting that was returned. If you can snag a large piece (larger than the area you want to carpet), you’ve got new, high-quality carpeting for pennies on the dollar. Explore carpet remnant stores, estate and yard sales. You’ll know you’ve succeeded when you find a piece you like within the budget range you set.

What about hardwood and laminate? Typically, laminate is a lot less expensive than hardwood, but don’t eliminate the option automatically. Companies that sell discounted hardwood flooring do exist. If you have your heart set on hardwood, start with a wholesale flooring outfit. You may find the prices are about 50 percent lower than retail prices, though be aware that you may be required to meet a minimum to order. And if the budget just won’t tolerate hardwood, even at a discount, compare discount laminate flooring, which typically costs only two-thirds what hardwood does. Plus, it’s easy to install without nailing the material down. It all depends on the look you have planned. If you love the hardwood of maple, red or white oak or hickory, try reworking the budget. You will live with the new flooring for many years to come, so perhaps a splurge is worth the durability after all.

With so many discount flooring options, you are likely to find what you need quickly. It is absolutely worth your time to explore the available alternatives to save money and and maintain quality.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

You may already know a great deal about Google seach engine results for web searches. But Google also offers additional, specific (and lesser-known) search engines. Have you heard of Google Blog Search? This service does just what it says it does: it searches for and through blogs just as Google Shopping offers results and price comparisons on items for sale.

Truth be told, not all insurance agents and brokers blog, and they really should begin. Blogging expands your online reach in a significant way. But of those agents and brokers who already blog, not all realize that they could be using Google to better promote their writing.

So, if you already blog on your insurance website, it is a smart marketing manuever to submit your blog to Goolge Blog Search. It’s not difficult to do. You just need to find your feed URL. Your URL will look something like this:
nameofyourwebsite.com/com/blog.

At the bottom of your website, you should see a link that says, “ATOM, XML or RSS.” Click on one of them. Then, visit Google Blog Search at blogsearch.google.com/ping to add your blog’s feed.

The process cannot be completed overnight, so check back in a week to ensure that your blog has been added.

For an even smarter boost, click the option that provides “automatic pinging” when you submit your URL. The option is applicable to WordPress platforms and to several others. Every time you add something new to your blog, Google updates your listing, which is surprisingly important. No one will read an out-of-date blog; an old blog can even work against you, making it appear that you take little interest in your marketing or that you have abandoned the endeavor.

Most importantly, remember that relatively frequent entries keep your readers interested in what you have to say. Google’s algorithms love fresh content. Accordingly, your insurance website will rank better in results if you blog actively, post fresh articles and send out regular news releases.

Don’t know how to blog? Don’t have time to do it? Think your writing is atrocious? You’re not alone. Many insurance agents and brokers have enough work trying to run a business without keeping track of a website. A search engine optimization (SEO) company may be your answer. Such a company will run your marketing plan for you and bring out your best features to help visitors become customers.

Ideally, find an SEO company that has serious experience selling insurance and a full understanding of the market. Such a winning partner can guide you to the higher rankings and increased conversions you need to make your business grow.

Ready to Quote is an insurance marketing company focusing on search engine marketing and <a href="http://www.readytoquote.com“>insurance websites. Learn more at http://www.readytoquote.com/ or call 1.800.504.8593

The recent changes to gmail’s look, which include a variety of things, like new tabbing, has created a great deal of consternation. People have been logging in to find a whole new filtering system in place. Nice. Or is it? The system now sorts your email into three categories, promotions, social and primary, with the option to add forums and updates.

Supposedly, this lets users scan their inbox to see what’s there and deal with it when they can. In some respects, this is good, as you would, ideally, see those emails you need to deal with immediately, while other ones can wait for later. Call it a time saver if you will. Or is it?

Seems, according to a recent survey, that about a month after the new filter system went into effect, there was a drop of up to a full percentage point in open rates, a warning signal, but likely to be expected. People don’t like dealing with new things that have been forced on them. What will the long-term affects be? No one knows, until later.

Insurance agencies that track email marketing campaigns already know that customers filter their emails. They also know that not everyone reads everything in their inbox. Instead, they strive to avoid filters by offering something the recipient wants to read. Supposedly, those already reading your email marketing efforts will still find and read what you have sent. But, will they? And there in lies the dilemma.

The uproar centers around marketers feeling Google is cheating them out of readers after they worked hard to get them in the first place. It’s true, marketing insurance in an online newsletter can be tough and if you have an established mailing list that is fairly active, this change may clip your wings. They feel if it is not delivered to your primary inbox, that once delivered in another tab, people won’t read the messages, using the system as a spam filter instead.

It’s up in the air for insurance marketers, but one thing to keep in mind is instead of instantly reacting negatively to the change, take the time to assess it first. It may not affect your insurance marketing plans the way you think it may. Monitor the situation before making any changes and remember that people still want to read quality content (yes, content is still king) that is relevant to them and that users can move items from one tab to another.

Since users may move items from one tab to another, they are also asked if they wish to keep getting emails from the same person in the new location. You may not have an issue to worry about. If all else fails, talk to a qualified search engine optimization company with insurance experience. They know the ropes.

Ready to Quote is an insurance marketing company focusing on search engine marketing and <a href="http://www.readytoquote.com“>insurance websites. Learn more at http://www.readytoquote.com/ or call 1.800.504.8593

Do you know what you need to do if the algorithms keep changing? You already know that affects how you market your insurance website, but dealing with it is another can of worms you may not be prepared to handle. Although many agents and brokers mutter faint curses under their breath when the rules keep changing, it is done to make sure the Internet has good, interesting, fresh and relevant copy. But, yes, it does mess up your insurance marketing. It’s frustrating.

You’re not alone. There are hundreds of other insurance companies that groan loudly when yet another algorithm change is trotted out. There have been so many of them lately that if you are riding herd on your agency search engine optimization (SEO) program, now may be the time to consult with an SEO specialist with particular expertise in insurance marketing. There just aren’t enough hours in the day to do it all.

The latest changes —- think Penguin —- have made insurance agents jittery about their rankings and how the changes affect their marketing plans for the foreseeable future. No sense getting uptight. Sit back and wait to see what shakes. Take the time to determine if the changes would upset your marketing plans. They may not, so rushing in to fix something that isn’t possibly broken may make things worse. Analyze the changes before taking action. If you are not sure how to do that, hire it out to a good SEO company. It’s a smart business move, worth every penny.

Focus intently on your news releases and ensure they are top quality, interesting, relevant and offer solid links to your website. Make sure what you write about is interesting to people. Sure, not all of it may be barn-burning material, but try to put out information, in plain English, that people need to know. Write about things of interest. Things that help potential customers make a decision to buy and things that are newsworthy.

And one last super valuable tip: if you don’t do social networking, you need to get on that bandwagon pronto. Why? You need to get on that bandwagon because, believe it or not, it makes a big difference in promoting your agency and in attaining a good SEO ranking. So, aim for the best and use Google+ and Facebook. In the alternative, hire an SEO company that specializes in helping to rank insurance websites.

Ready to Quote is an insurance marketing company focusing on search engine marketing and <a href="http://www.readytoquote.com“>insurance websites. Learn more at http://www.readytoquote.com/ or call 1.800.504.8593

These days it’s hot to trick out your décor or stage your home for a quick sale. Staging can make a huge difference in how fast a home sells, not to mention it may even increase the price some. The latest trend in staging is using reclaimed wood for just about everything, from floors to accessories. Called re-purposing, it’s catching on fast because it is eco-friendly and means hacking down fewer trees. People love the idea of using reclaimed wood for flooring and, of all things, furniture and home interior accessories with a twist.

Just be certain, if you want to have reclaimed wood in your home, that it is indeed “reclaimed.” As with many other things in this world today, there are even scam artists out to make buck off fake reclaimed flooring. Check your prospective purchase carefully to see if it is correctly labelled, meaning it should be certified as being from a reputable organization such as the Rainforest Alliance. When in doubt, don’t buy if it does not feel right for you.

You should also be aware that depending on where the reclaimed lumber came from there may be chemicals or toxins in the wood. Or, it may have been treated and prepared for reuse by the manufacturer. Reclaimed wood may have paints, insecticides, unknown chemicals, preservatives or adhesives and even lead in it. You don’t want to live with that in your home if you have inhalant allergies. Always make sure you find out where the wood came from and what is in it.

Don’t want to pay the price for reclaimed wood because of the labor and processing involved in obtaining it? You could DIY, particularly if you already have some experience in doing that kind of work. One thing’s for sure, you’ll likely fall in love with reclaimed flooring because the quality and durability is bar none the best.

Did you know that reclaimed woods can be even more durable than original, virgin wood, that has never been used before? That’s due to the fact that it comes from old-growth trees, not the younger ones. Some of the best reclaimed wood is from barns, a fact those with a love of the Western look find appealing. There’s just something about the rustic, old-fashion look that goes well with antiques, and staging designs that use reclaimed flooring or furniture, are noted for being colourful and eye-catching. That’s what versatility is all about.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

Did that get your attention? Did you know that even if you spend lots of dollars on getting the perfect insurance website, paying for great blogs and tons of highly useful articles with relevant content, that the content is not yours to keep?

You may never have needed to know that, unless you choose to move your insurance website to another service provider. If you make that decision, you may just be told you have no rights to what you paid for.

You want to market your insurance agency effectively, and to do that you want to know where you stand, how to improve and what is needed to move forward. In doing that, you may decide you need a new website, and assume that the content is transferable. Legally, you are not entitled to the contents. Take a look at your service agreement.

If it does not say your search engine optimization company, content provider and/or website designer specifically transfers rights to your insurance company, then they own the content. Even if you technically own the content, since you paid for it, legally, that is another can of worms.

Companies that have you locked in really retain no particular advantage other than it makes things hard for you to transfer your insurance website to another provider. There isn’t much you can do about it, but you can most definitely learn from that situation and not make the same mistake again.

For your new insurance website, make sure to have your contract spell out in great detail that your insurance company owns full rights to the content of the website, design, and whatever content management system is being used. Insist that there will be no close out fees/transfer fees if you have completed a contract term. Make certain you own your own domain name and have all the relevant information needed to access it and have all your licensed picture rights transferred to your insurance company at no addition cost.

Controlling your own insurance website content is the smart thing to do.

Ready to Quote is an insurance marketing company focusing on search engine marketing and <a href="http://www.readytoquote.com“>insurance websites. Learn more at http://www.readytoquote.com/ or call 1.800.504.8593

Resin flooring is not made of that sticky stuff which comes out of trees. Resin flooring is a relatively new player in the home flooring upgrade arena, and perfect for someone who wants a different look in their office. It has the quiet ability to add a little something special to any room it is installed in. It’s an interesting alternative to the usual upgrade choices of marble, tiling, ceramic tile, carpet and various wood flooring options.

New does not always mean better, or even that people will agree it is a choice worth considering. However, with resin flooring, it is slowly coming into its own and making a name for itself. One thing is for sure, it is not boring flooring. It is robust, durable, interesting and does the job in any location in which it is placed. While those characteristics may sound bland, they are anything but. Resin can be functional in even the most elegant of locations and settings; that is part of its enormous consumer appeal.

What are its benefits, besides beauty? Did you know resin floors are stronger than concrete? Concrete, especially in locations where there is high, heavy traffic, crumbles and breaks. Not so with resin. It holds up to anything put on it, whether it is a heavy stainless steel fridge, or a tractor, or a classical sculpture of a bronze mountain lion, or a washing machine. “Versatility” is the keyword when it comes to resin flooring.

Contrary to popular opinion, this type of flooring is not dull. It has a nice shine that catches the eye and stays appealing over the years. Yes, you do pay more for this kind of flooring. However, since it is a one-time upgrade, because it will almost outlast your house, it is worth the investment, plus it may well increase the sale price of your home. Another bonus!

If you’re thinking resin is dark and dreary, not so. You can get any color you like, including yellow, blue and red. If you have a retro or pop culture-like kitchen, you’ll love resin flooring. This kind of flooring is not ranked well for a D-I-Y project; you’ll want to call a professional flooring contractor on this one. After all, you want it to look good. Don’t take the chance on tackling a project like this on your own.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

If you don’t, you are not alone. There are so many changes in what you need to do to get ranked well and stay there, that you almost need to be a search engine optimization (SEO) specialist to be on top of it all. If you run your own agency, there is not enough time to do that.

Recent changes, thanks to Google’s Penguin updates, have made insurance agencies very concerned about their rankings and what they are supposed to do for future marketing efforts.
While it is scary to try and figure out what to do next, it’s best just to sit tight and approach things calmly. First, analyze just how much the latest changes impact on your marketing plans. It is entirely possible that there are not many changes to be made. If you do not know how to analyze the changes and what they mean, search for and hire an established SEO company with experience in the insurance industry.

What really affects your insurance website is what you do in terms of press releases. The news release is not, contrary to what some think, dead. Now, since the latest changes, you get to spend time focusing on quality content without stuffing it with keywords. Yes, content is still the most important thing you need to provide. Keep the rest of the information, such as your agency name, and provide relevant links to your insurance website. Write about things that interest those looking for insurance, newsworthy topics that capture people’s attention.

Not into social networking? You need to be. Being involved in social networking does payoff in terms of SEO, and that is the whole point of being online —- to promote your insurance agency and get good SEO rankings. Your best social choices? Facebook and Google+. Make no mistake, Google is watching social interactions, and if your insurance agency is a part of that scene, keep up the good work.

You might hear the term “content marketing.” It’s the latest in thing to do. However, it is not new. Google has always placed a high value on active blogs and web pages that are updated often. Really the only thing you need to consider when writing insurance articles (and if you can’t write, hire it out) is what you focus on and how it should be distributed. For distribution, just frequently add fresh content to blogs and your insurance website and remember to stick with it diligently. Remember to use a wide variety of text linking to different pages on your website, not just the home page.

Ready to Quote is an insurance marketing company focusing on search engine marketing and <a href="http://www.readytoquote.com“>insurance websites. Learn more at http://www.readytoquote.com/ or call 1.800.504.8593

When you want to upgrade your living space, your first consideration is to keep an eye on what adds value for a potential sale. Choosing the perfect floor and wall tile can really make a huge difference in the marketability of your home. Hands down, tile is the best choice for interior upgrades in the bathroom(s) and kitchen, but you want it to be just perfect.

If you have not tried Crema Marfil marble, this may be something you should check out. Crema Marfil is well-worth having in your home and a good option for those who love the sense of beauty it brings to every room. It is elegant, soothing, and adds a touch of class to any location.

This particular tile is noted for its range of attractive patterns, color tones and interesting and arresting presence once installed. It is versatile and may be laid for flooring or used on walls. Put it into any room, and the whole atmosphere changes to an appealingly charismatic place to hang out.

Most homeowners find this marble choice appealing thanks to the wide variation of tiles sizes, making it a natural choice for those handy do-it-yourselfers, who pride themselves on a difficult job well done. The interesting trick with Crema Marfil is that depending on what size tiles you choose the look of a room or hallway changes dramatically. For instance, bigger tiles create the appearance of greater length and width. If using a combo of short and long tiles, the resulting mosaic effect is dynamic and stunning.

Another hugely popular bonus with this marble is its elegant finish. It is perfectly serene, clean, easy to maintain and soothing to look at. It’s not often you get a tile that is this versatile and universally admired by many. And, if you are a stickler for durable flooring, but don’t think this would do the trick, think again. It is durable, beautiful, fashionable and highly useful. What more could you ask for in terms of superior flooring?

Still not convinced? Take your time and do research on the various options on the market today. There are hundreds of options that may appeal to you and even offer you colors you never though you would see put to use for wall or flooring jobs. That’s the fund part of shopping for tiles when you are looking to do an upgrade project. The tough part is choosing just one among all the tiles that are reasonably priced.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

Luckily, most of the newest marketing methods all meld together —- mostly. You might just be able to use banner ads, provided you use them on the right kinds of sites. For example, using them on a large, extremely active, national mega-site is a potential waste of money, especially if you do business in a smaller way, and work locally. On the other hand, you can target the right people and choose the sites to match, with the help of an experienced SEO company —- one with a track record in the insurance market.

Is a banner ad appropriate for your insurance website? Are people even clicking on them anymore? The answer to those two questions are, “It may be appropriate for your marketing strategy, but you need to have that evaluated,” and “Yes, people do still click.” The main thing you need to know is who is clicking and what demographic they fall into and then figure out if that is your target market.

For instance, a recent marketing study shows those age 55 and older are more than likely to click on banners. In fact, just about 50 percent of the clicks come from this age range. However, 58 percent fall into the 15-to-24 age range. Is that your market? If you answer yes, then banner ads may work for you.

Just remember that people click for as many reasons as they choose not to click, so you need to target the placement of your marketing banner very carefully. Choosing sites on your own can be a major pain. Instead, partner with an experienced SEO company that understands the insurance market. You then have an understanding ally who can help shape your insurance marketing plan.

Ready to Quote is an insurance marketing company focusing on search engine marketing and <a href="http://www.readytoquote.com“>insurance websites. Learn more at http://www.readytoquote.com/ or call 1.800.504.8593

While it may be time to do something to upgrade the older, and perhaps unattractive, flooring in your home, today’s homeowners are far more environmentally conscious than ever before. It is imperative for an eco-focused consumer to choose flooring products which are sustainable.

Thankfully, designers, architects, interior decorators and home builders have been working on practical ways to work with sustainable materials, things that are environmentally friendly, both now and in the future. What does “sustainable” mean and why should you care?

Sustainable materials are those which carefully and consciously maintain balance in all of our natural resources, whether it is water or wood. If we do not have balance or maintain a necessary balance, it has an enormous affect on our lives. We must be willing to work with products that can replace themselves. This is vitally important with virtually everything we use today.

What are the choices in terms of flooring for those who want to go green and are serious about it? You can upgrade your flooring with sustainable options, materials that are easy-to-find and a snap to install. For instance, bamboo flooring is a good sustainable choice. Bamboo is water-resistant, hard as nails and has an innate anti-bacterial agent. If you want to install it like hardwood flooring, you can, or you can cut it into smaller planks during installation.

This next sustainable recommendation may raise some eyebrows: recycled leather. Where does recycled leather come from? The leather used to make car seats. The seats are ground up, and the resulting mixture is glued, using natural glue and fillers. The end result is tiles that you can install in any room. They look natural and are richly textured.

If your goal is to have aesthetically-pleasing and environmentally-sustainable flooring, think outside of the box and find out what other interesting options you could apply to your floors to make them look unique, yet classic.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

If you do the math, that means 33 percent of Americans, on average, use social media as their primary search method. What does that mean for your insurance website? It means that you need to be more visible in the social sense, particularly if you want to market to the younger demographic. Marketing methods are rapidly changing and you need to keep up with them if you expect to grow your business.

While you may not need to be in a great hurry to plunge into the social media stream, it’s a marketing niche that has the potential to greatly impact how you do business in the near future. Pay attention to the age range you want to embrace, what products you market and who is likely to buy them. It’s certainly not like trying to find out when the next hot movie is going to hit town or which hair salon is the trendiest, but there is food for thought in how to properly market an insurance website and products using social media.

Social media, without any doubts, is ideally suited to building bridges with prospects and colleagues —- the very same prospects and colleagues who may refer business your way. Having a strong social presence is not a deterrent, as the younger grow older and into your market demographics.

Love the idea of social media to market your insurance agency, but dislike the thought of setting up an account and trying to learn how to use it, when to use it and how to optimize it? Now is the time to find the right search engine optimization (SEO) company, with a background in marketing insurance, and partner with them, to get a leg up on the latest in marketing strategies that impact on your agency in a positive way. The world is your oyster. Time to start making plans to grab that media pearl.

Ready to Quote is an insurance marketing company focusing on search engine marketing and <a href="http://www.readytoquote.com“>insurance websites. Learn more at http://www.readytoquote.com/ or call 1.800.504.8593

It’s a no-brainer that hardwood floors, or hardwood lookalikes, sell houses. Hands down, people love the look of hardwood and this type of flooring is one of the better investments you could make to increase the resale value of your home. Would you be surprised to find out that hardwood may even add up to 6 percent to the value of your sale price? Worth considering, right?

If you already have wood flooring in your home, that is half the battle. Keep those floors in tiptop shape and you likely have a quick sale on your hands. If you do not have wood floors, maybe it’s time to dust off the budget, take a good, hard look at your existing floors, decide which rooms need to be done and start some serious shopping. You do not need to put hardwood floors in every room, unless that is something you want to do and can afford it.

Many people simply start with hardwood floor upgrades their bedroom, but you may wish to begin in the kitchen or living room. If you have carpeting right now, you need to decide if you want to keep it or take it out. If you replace the old carpet with new carpet, stick to neutral colors if your goal is to sell your home. If you want hardwood flooring to capture the eye of a potential buyer, then spend time looking for the right kind of hardwood that suits your style and is simpatico with where you live. For instance, if you live in Florida, you might want to gravitate to tiling in the main living areas.

If you prefer hardwood, then check out the latest trending flooring, handscaped hardwood. Handscaped hardwood excites buyers with the country charm it lends a room and the aura of authenticity it brings. Some call it “vintage planking;” wait until you see how many different finishes and breathtaking woods are available to choose from. And the bonus? Handscaped hardwood blends well with every other kind of flooring on the market.

Do you prefer the wooden planks narrow, or wide? These days, wider planks are leading in the popularity polls, because that is they way they used to be when older factories and warehouses were turned into stores and living spaces. This type of flooring is a nod to history, but it works very well with today’s more modern interiors.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

Even when the urge to get really creative with flooring and tiling choices may be strong, it is best to picture what your choices may look like down the road, or to someone who was interested in buying your home. Red, black and yellow tiling may be a powerful conversation starter when people use your bathroom, but not everyone wants that kind of ambiance. Plus, even though you may like the colors when you buy and install them, you may not like them so much a few years later when color trends and tastes change.

While there is nothing wrong with red in a bathroom, or any room for that matter, you may want to use it carefully, more as an accent than a predominant color. Bold and exciting might be the order of the day, but remember, you have to live with it long-term, unless you plan to rip out the tiles in a few years and do it over.

Limiting what you do in terms of too much color is not as great a disadvantage as it may seem. This is because you have other choices to complement what you want to achieve for an overall look and feeling. For instance, consider glass mosaic tiles or even pebble tiles for that “something different” kind of look. If you tile you walls in a memorable and unique way, it will stand the test of time, even if you have standard flooring, provided it does not need to be upgraded as well.

Another different approach is to use complementary inlay tiles on the wall or floor. Inlays can do wonders for a room and act to give it a unique focal point. You may use an inlay to highlight a feature in the room, sharpen up the edges of the tiling around the room or showcase a stunning feature in your bathroom or kitchen. It’s all up to you what you choose.

Consider mixing various tile mediums for another different look. An example would be using natural stone with pebble tiles or using odd-size mosaic tiles to create a work of art on the floor or wall. It’s exciting when you get right down to the final choices you have before your begin your project. If you aren’t sure what to choose, how durable a choice may be or what would suit your lifestyle, drop in to your local Tampa flooring contractor and take a look at the various jobs they have done. You will know instantly what would work in your home.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

The time has come for a more conversational approach, meaning plain English in words everyone understands, even if a concept may be difficult. Insurance companies need to pay attention to this latest trend, as Google is the driving force behind it, and when Google does something, you know it’s going to drive your marketing efforts.

What’s the latest? Casual verbal conversation searches. That is like asking a search engine where the nearest movie theatre is, what times the shows are, what the address is and where is the best parking near the theatre. The near future holds an interesting experience for everyone and that includes insurance agents who want to market their websites in a competitive manner. It’s the best way to stay ahead of the pack when it comes to proper search engine optimization protocol.

Casual verbal conversation searches are just like your neighbor asking you across the back fence where he can get a good set of reasonably priced tires for his 1979 Mustang. It’s people-talk, not search engine speak —- the stilted string of words used to search for something a person needs. This will have a huge impact on how people search for insurance of any kind. Instead of trying to plug in awkward terms to find out about final expense insurance or about Medicare supplements, the person doing the search can just ask something like: “Show me what I need to supplement my Medicare policy.”

The idea of a search engine responding to human-speak enquiries is exciting, but it will not happen overnight. Nonetheless, Google’s reasoning is sound. People want to communicate online the same way they talk. You only have to read a few Twitter or Facebook posts to know that. If you want to stay ahead of your competitors in the insurance marketplace, then make sure you hire a search engine optimization company that not only understands the insurance industry, but practices what it preaches. You find a company that does that, and you are set to meet the future.

Just think about how your customers may find you in the future. Imagine them Googling that they need better drug coverage, a homeowners’ policy that offers replacement, not assessed value, a car insurance policy that covers three teen drivers, and so forth. It’s a brave new world out there for insurance companies who market online. Get into the mainstream of the latest trends now, before you find your website losing traffic.

A conversational approach to searching will change key phrase research and ultimately, how an insurance website (or any website) is optimized. Make sure you work with a search engine optimization company with extensive experience in the insurance industry. Then get ready to ride the wave of success.

Ready to Quote is an insurance marketing company focusing on search engine marketing and <a href="http://www.readytoquote.com“>insurance websites. Learn more at http://www.readytoquote.com/ or call 1.800.504.8593

Your website might be the best-looking insurance website you have ever seen, but if your content is filled with industry insider jargon, things shared between others in the same profession, you’re in trouble. While the shorthand may be necessary in some instances, it is best to keep it to a bare minimum. People who want to buy insurance do not want to ready insurance lingo and not understand what it means. They want to get the point of what each policy offers, quickly, do some price comparisons, make a decision and buy something. If you confuse them upfront, you lose them — a bad thing for your business.

Industry-speak is confusing to people who do not have a reason to use various acronyms as a common part of their daily conversations. If you have an insurance website, you must tailor your content in such a way that is it understandable to everyone. Yes, you still need to adhere to search engine optimization (SEO) best practices, but that does not mean you need to eradicate all mentions of acronyms. What it does mean is you need to always aim your content at your potential customers, as that is the ideal insurance marketing guideline to convert traffic to your website.

Even though you may think that using jargon makes you look informed and knowledgeable, it only serves to drive people away, because they want the concept of insurance explained to them in plain English. You run the risk of coming across as a stuffed shirt, bursting at the seams to show people how smart you are. Visitors to your insurance website want to know you as a person, how your customer service is, whether you have a product that will suit them and if your prices are reasonable. The plain, down-to-earth kind of concerns you would have when you go searching to hire an SEO company to enhance your website and boost it in Google’s rankings.

A good SEO firm will tell you all these things and point out why being an approachable, likeable, plain speaking insurance agent with a social media, user friendly website does well in search engine rankings. And isn’t that what wanting better rankings is about —- reaching the people you want to market to?

Ready to Quote is an insurance marketing company focusing on search engine marketing and <a href="http://www.readytoquote.com“>insurance websites. Learn more at http://www.readytoquote.com/ or call 1.800.504.8593

Home is where the flooring is, and home is the one place you find peace and tranquility. For some, looking at floors that have seen their day, first placed years ago, can take away from the enjoyment of owning a home. Flooring is far more important than many people realize. In fact, it is one of the first things a potential buyer will look at when you have your house on the market.

Homes are not just about flooring alone. They are a reflection of the people living there. Accordingly, you want the best-looking possible decor. You want compatible colors and/or wallpaper throughout the house, perhaps matching the furniture and the ambiance you wish to create. Think what the overall effect would be if the flooring was retro 1930s and the decor was 21st century.

Flooring sets the tone of each room in your home. If you want to change flooring in each room, you have the freedom of creativity to do so. Consider hardwood for the living and dining room, marble for the bathroom, rubber flooring for the kids play area and ceramic for the kitchen. It all depends on what kind of mood you want for each room. Decide what works for your imagination, figure out a budget, shop online and in person and stop by your local Tampa flooring contractor to see what they recommend. It’s time well spent.

Lighter-colored flooring makes a room look larger, while darker planking or other floor coverings, shrinks the room. If you have high-traffic areas to worry about with the kids and pets, then stick with a flooring that is not only durable, but does not show too much dirt. As an alternative, you could always opt to use runners to protect the floor or carpet.

The choices on the market in terms of flooring are so diverse, even if you are a dedicated go-green kind of person, there are flooring choices just for you such as reclaimed barn wood or bamboo. If you plan to do something different, just do the research first before investing your money in a floor choice you might not like once it is installed. You may even decide that since flooring comes in far more colors than it used to, to opt for colored flooring instead of carpets. The nice thing about shopping for floors for your home is the wide variety of choices.

And, if you are worried that wood may make a room look smaller, you’ll be happy to know that it actually makes it look bigger. This is due to the way the wood is cut, but also a result of how it is laid in longer lines across a floor. If you want the visual effect of a larger room, try wood flooring, as it widens and lengthens a room.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

by Patty Cisco
Summer is the time for action! Unfortunately for senior care and living organizations, summer
typically represents sluggish census and occupancy results. The sales reps and marketing
directors who work in the trenches can certainly make a list of all the reasons why this occurs.
While there may be validity to some of those reasons, they also can be the excuse that creates a
barrier to productive activity. Taking a proactive approach to your marketing strategies and sales
tactics now will not only reap results in the summer months, but you’ll be surprised by what your
third and fourth quarters will yield.

1. Focus on quality, not quantity, in your sales calls. Analyze your referral list over a two-year
period. Categorize your referral sources as follows: A (represents top 15% of your referral
sources that make up 65% of your referrals); B (represents 20% of your referral sources that
make up 20% of your referrals; C (represents 65% of your remaining referrals sources that make
up 15% of your referrals; D (no referrals received but relationship worth maintaining). Compare
this referral analysis to current sales call activity. How much time are you spending on
non-referral related external sales calls?

2. Evaluate your marketing strategies. Compare how much time you spend on fun-oriented
marketing activities vs. educational activities and media buys vs. relationship-oriented. Your
time is precious and limited. Stop doing what’s not working and focus on target audience
activity.

3. Scrub lead lists. The cheapest leads are those you have. Set aside the time to review your lead
list and make a follow up. Contact is key to turning leads. Also, don’t forget to update your email
database list.

4. Break down barriers with education. If you or other decision makers in your organization
aren’t sure where to start with establishing a sales culture (people, systems and processes), or
haven’t engaged in an interactive website or have yet to initiate a social media strategy then
maybe it’s time to start strategizing. Plan to attend The Discovery to Sustainable Census
Workshop. Click here for more information on the Workshop.

5. Engage in a Just Ask Campaign. Yes, that’s right, it’s ok to ask for. Engage your staff, current
and past families, residents and network associates in a fun campaign designed to send prospects
of interest your way.

6. Stop all marketing activities for 30 days and just engage in a Summer Blitz! It’s a fun break
from the routine and creates a lot of buzz.

7. Engage in an online interactive campaign that focuses on one core service line. This strategy is
beneficial for special offerings, discounts, new services etc.

Senior care and living organizations can no longer stay in the comfort zone of past marketing
strategies and sales tactics. It’s time for a paradigm shift if you want to drive sustainable census
and occupancy. Starting a proactive action plan now for the summer months will pay in census
benefits later.

 
Bullying In Workplace Brings Devastation to the Company In The Long Run

Bullying in workplace is one of the types of abuse a particular employee or a group of employees
are subjected to at a workplace. It has many forms and comes in the form of verbal, physical or
emotional abuse. This is found in almost all the places like schools, churches and workplaces.
This can happen in many ways face to face, or in your absence, or online or with your friends and
relatives or even with strangers. Bullying is said to take place when a person is repeatedly
exposed over a period of time to any form of negative action from one or more of other persons
and he or she has difficulty in defending himself or herself from these actions.

Bullying in workplace is very common and it cannot be remedied by avoidance as in other cases
of bullying. Most of the times the workplace bullying makes the life of the person targeted more
difficult and unhappy and leads to constant mental strain. This has a very bad effect on his
morale and his productivity suffers much. Due to this, a hostile work environment develops that
leads to deterioration in the work values of the employees. But as per an estimate of the
Workplace Bullying Institute more than one third of the employees are subject to one form or
other of the bullying in workplace during some point of their work life.

The Bullying in a workplace can occur in many ways and some of them include:

Unjustified hypercritical judgment
Unnecessary or unfounded blame
Undue segregation
Isolation
Indifferent treatment from co-workers
Unnecessary yelling and humiliation in front of co-workers
Disproportionate monitoring of the work
Unnecessary verbal or written warnings etc
Vague or untrue claims of poor or underperformance

The bad effects of bulling in workplace

When there is bullying in workplace the employees who are subject to bullying are suffer more in
terms of physical and mental effects. They have very high stress levels, and suffer from extreme
bitterness in their attitude. They usually suffer from depression, and usually do not have any
motivation to excel in their jobs and exhibit greater levels of hostility towards other employees.
Due to the constant depression and stress they suffer from many physical illnesses like digestive
problems, sleeping disorders like insomnia and usually have high blood pressure.

Those in the management must always be aware of the fact that bullying in workplace is not the
right way of running their business as a company with bullying becomes dysfunctional and
inefficient. You can see that the absenteeism and low productivity are the norms of any working
day and due to this the company suffers very strong negative growth factors in the long run. An
employee who is subject to bullying in workplace becomes totally against any form of innovation
at his workplace and he never expresses or develops his own ideas for the betterment of the
company.

Due to the hostile and unfavorable work environment even quality employees who are not bullied
also feel it necessary to leave the company at their earliest opportunities. When the bullying in
workplace is known to outside world new employees do not opt to come into the company for
fear of being bullied while working for the company.

Compression Therapy Reduces Blood Clots in Stoke Patients, Study Finds

New research shows that inexpensive leg compression devices help prevent fatal blood clots in
stroke patients. The thigh-length sleeves promote blood flow by periodically filling with air and
gently squeezing the legs. Vascular PRN, based in Tampa, Fla., is a leading national distributor
of intermittent pneumatic compression (IPC) therapy equipment. Greg Grambor, the company’s
president, commented on the study.

“Compression therapy has been around for over 20 years,” Grambor said. “Many doctors have
already come to rely on this equipment for safe, effective, and affordable prevention of deep vein
thrombosis. I’m glad this new research was done, and I hope it will help convince more doctors to
give it a try.”

Deep vein thrombosis (DVT) is the formation of a blood clot inside a vein deep within the body.
It is common in stroke patients and immobile patients and can also occur in healthy people on
long flights where movement is restricted. When a clot detaches, it can then become lodged in
the arteries of the lungs, causing a potentially life-threatening pulmonary embolism.

The study involved nearly 3,000 stroke patients at over 100 hospitals across the United Kingdom.
Results showed 8.5 percent of patients treated with compression devices developed blood clots,
versus 12.1 percent of patients who received alternative treatments.

“Many patients at risk of DVT are prescribed blood thinning drugs,” Grambor added. “But these
drugs increase the risk of bleeding, which is quite dangerous for stroke patients as it may lead to
bleeding in the brain.”

So far, no study has conclusively shown that blood thinners increase the survival rate of stroke
patients. Doctors at the European Stroke Conference, held in London on May 31, 2013, discussed
the study’s findings. Professor Martin Dennis of the University of Edinburgh said that the UK’s
guidelines for treatment of stroke should be revised to recommend IPC treatment for all patients
at high risk of DVT. Currently, they only recommend it in cases where blood thinners are
unsuccessful or too risky.

Each year, some 15 million people worldwide suffer a stroke. One third of strokes are fatal and
another third result in permanent disability.

Vascular PRN may be reached at 800-886-4331.

by Patty Cisco
Summer is the time for action! Unfortunately for senior care and living organizations, summer
typically represents sluggish census and occupancy results. The sales reps and marketing
directors who work in the trenches can certainly make a list of all the reasons why this occurs.
While there may be validity to some of those reasons, they also can be the excuse that creates a
barrier to productive activity. Taking a proactive approach to your marketing strategies and sales
tactics now will not only reap results in the summer months, but you’ll be surprised by what your
third and fourth quarters will yield.

1. Focus on quality, not quantity, in your sales calls. Analyze your referral list over a two-year
period. Categorize your referral sources as follows: A (represents top 15% of your referral
sources that make up 65% of your referrals); B (represents 20% of your referral sources that
make up 20% of your referrals; C (represents 65% of your remaining referrals sources that make
up 15% of your referrals; D (no referrals received but relationship worth maintaining). Compare
this referral analysis to current sales call activity. How much time are you spending on
non-referral related external sales calls?

2. Evaluate your marketing strategies. Compare how much time you spend on fun-oriented
marketing activities vs. educational activities and media buys vs. relationship-oriented. Your
time is precious and limited. Stop doing what’s not working and focus on target audience
activity.

3. Scrub lead lists. The cheapest leads are those you have. Set aside the time to review your lead
list and make a follow up. Contact is key to turning leads. Also, don’t forget to update your email
database list.

4. Break down barriers with education. If you or other decision makers in your organization
aren’t sure where to start with establishing a sales culture (people, systems and processes), or
haven’t engaged in an interactive website or have yet to initiate a social media strategy then
maybe it’s time to start strategizing. Plan to attend The Discovery to Sustainable Census
Workshop. Click here for more information on the Workshop.

5. Engage in a Just Ask Campaign. Yes, that’s right, it’s ok to ask for. Engage your staff, current
and past families, residents and network associates in a fun campaign designed to send prospects
of interest your way.

6. Stop all marketing activities for 30 days and just engage in a Summer Blitz! It’s a fun break
from the routine and creates a lot of buzz.

7. Engage in an online interactive campaign that focuses on one core service line. This strategy is
beneficial for special offerings, discounts, new services etc.

Senior care and living organizations can no longer stay in the comfort zone of past marketing
strategies and sales tactics. It’s time for a paradigm shift if you want to drive sustainable census
and occupancy. Starting a proactive action plan now for the summer months will pay in census
benefits later.

 
Bullying In Workplace Brings Devastation to the Company In The Long Run

Bullying in workplace is one of the types of abuse a particular employee or a group of employees
are subjected to at a workplace. It has many forms and comes in the form of verbal, physical or
emotional abuse. This is found in almost all the places like schools, churches and workplaces.
This can happen in many ways face to face, or in your absence, or online or with your friends and
relatives or even with strangers. Bullying is said to take place when a person is repeatedly
exposed over a period of time to any form of negative action from one or more of other persons
and he or she has difficulty in defending himself or herself from these actions.

Bullying in workplace is very common and it cannot be remedied by avoidance as in other cases
of bullying. Most of the times the workplace bullying makes the life of the person targeted more
difficult and unhappy and leads to constant mental strain. This has a very bad effect on his
morale and his productivity suffers much. Due to this, a hostile work environment develops that
leads to deterioration in the work values of the employees. But as per an estimate of the
Workplace Bullying Institute more than one third of the employees are subject to one form or
other of the bullying in workplace during some point of their work life.

The Bullying in a workplace can occur in many ways and some of them include:

Unjustified hypercritical judgment
Unnecessary or unfounded blame
Undue segregation
Isolation
Indifferent treatment from co-workers
Unnecessary yelling and humiliation in front of co-workers
Disproportionate monitoring of the work
Unnecessary verbal or written warnings etc
Vague or untrue claims of poor or underperformance

The bad effects of bulling in workplace

When there is bullying in workplace the employees who are subject to bullying are suffer more in
terms of physical and mental effects. They have very high stress levels, and suffer from extreme
bitterness in their attitude. They usually suffer from depression, and usually do not have any
motivation to excel in their jobs and exhibit greater levels of hostility towards other employees.
Due to the constant depression and stress they suffer from many physical illnesses like digestive
problems, sleeping disorders like insomnia and usually have high blood pressure.

Those in the management must always be aware of the fact that bullying in workplace is not the
right way of running their business as a company with bullying becomes dysfunctional and
inefficient. You can see that the absenteeism and low productivity are the norms of any working
day and due to this the company suffers very strong negative growth factors in the long run. An
employee who is subject to bullying in workplace becomes totally against any form of innovation
at his workplace and he never expresses or develops his own ideas for the betterment of the
company.

Due to the hostile and unfavorable work environment even quality employees who are not bullied
also feel it necessary to leave the company at their earliest opportunities. When the bullying in
workplace is known to outside world new employees do not opt to come into the company for
fear of being bullied while working for the company.

Compression Therapy Reduces Blood Clots in Stoke Patients, Study Finds

New research shows that inexpensive leg compression devices help prevent fatal blood clots in
stroke patients. The thigh-length sleeves promote blood flow by periodically filling with air and
gently squeezing the legs. Vascular PRN, based in Tampa, Fla., is a leading national distributor
of intermittent pneumatic compression (IPC) therapy equipment. Greg Grambor, the company’s
president, commented on the study.

“Compression therapy has been around for over 20 years,” Grambor said. “Many doctors have
already come to rely on this equipment for safe, effective, and affordable prevention of deep vein
thrombosis. I’m glad this new research was done, and I hope it will help convince more doctors to
give it a try.”

Deep vein thrombosis (DVT) is the formation of a blood clot inside a vein deep within the body.
It is common in stroke patients and immobile patients and can also occur in healthy people on
long flights where movement is restricted. When a clot detaches, it can then become lodged in
the arteries of the lungs, causing a potentially life-threatening pulmonary embolism.

The study involved nearly 3,000 stroke patients at over 100 hospitals across the United Kingdom.
Results showed 8.5 percent of patients treated with compression devices developed blood clots,
versus 12.1 percent of patients who received alternative treatments.

“Many patients at risk of DVT are prescribed blood thinning drugs,” Grambor added. “But these
drugs increase the risk of bleeding, which is quite dangerous for stroke patients as it may lead to
bleeding in the brain.”

So far, no study has conclusively shown that blood thinners increase the survival rate of stroke
patients. Doctors at the European Stroke Conference, held in London on May 31, 2013, discussed
the study’s findings. Professor Martin Dennis of the University of Edinburgh said that the UK’s
guidelines for treatment of stroke should be revised to recommend IPC treatment for all patients
at high risk of DVT. Currently, they only recommend it in cases where blood thinners are
unsuccessful or too risky.

Each year, some 15 million people worldwide suffer a stroke. One third of strokes are fatal and
another third result in permanent disability.

Vascular PRN may be reached at 800-886-4331.

If you really want to add some punch and pizzazz to your home, think about using marble in the kitchen, the bathrooms, the laundry room or wherever you think it would look good. Marble does it all, including countertops. Ever noticed in those fancy home magazines the kinds of marble used for kitchen countertops? Quite elegant and super easy to have done in your own home.

Why not get stone countertops in the room you spend most of your time in cooking? The look of marble can rejuvenate any room in your home and give everyone who sees it a feeling of timeless beauty. You just need to decide what color of marble you want, what would look best in the rooms you want to redo and how to compliment the rest of the room when the marble is installed.

Even though most associate marble with bathrooms, it is making its way into other locations in the home, like fireplaces, vanities, kitchen countertops, laundry rooms and tiling in other locations. It has a clean look; a polished presence and gives each room a quiet, yet classy finish. Just keep in mind that if you do choose marble for the kitchen countertop, that you need to treat it with respect and care to maintain its elegance.

Yes, marble does break and chip as a result of kitchen accidents, and some people, if they spend a lot of time in the kitchen, would prefer something less prone to marring, like granite. It’s tough and not as prone to stain, like marble. It just depends on what kind of look you want in the kitchen. Some like the idea of a slightly worn and chipped marble counter because it adds an old world vintage look to the room. It’s sort of like distressed clothing on the market today. People love the retro look.

It’s certainly a personal decision as to what you want for a new look. Keep in mind that marble tends to look better the more it ages and acquires character and it is water resistant, which means you do not have to worry about getting it wet when washing dishes. Just make sure it is sealed properly and don’t cut corners doing it, either. The sealing will need to be done more than once.

In the final analysis, marble is the look of now and the future. You just need to treat it with respect to keep it looking its very best.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

Remember one thing though —- headlines do not need to be long, long sentences. In fact, shoot for less than eight words. If you can’t make it eight words, then try another heading. Why is this so important? The longer the heading, the higher the likelihood that search engines split it with an ellipsis, which looks really ridiculous to begin with and causes confusion for the engines. Spilt titles are difficult for a search engine to categorize properly, meaning this lowers your chances of getting a higher ranking.

Also, there is a myth about website titles. It says you should rely on using meta-tags to give your keywords that extra bit of oomph. Do not rely on just your meta-tags to trumpet your keywords. Be careful what you choose for a title because the title can affect your website more than you realize. So, ideally, you would want to list specific keywords first then add in others, the ones with a broader scope. You lead with your best keywords in the title, because search engines give them the most importance. Put another way, specific keywords used in a title often override any meta-tags you have.

One bit of good news when it comes to insurance marketing and creating and choosing titles to use online is that Google can handle up to 70 characters and not split the title. So long as the title does not go over 70 characters, the whole thing is displayed. This isn’t to suggest that longer titles are good, as shorter ones tend to be more effective and capture people’s attention.

If you want your insurance website to start acting like it is a force to be reckoned with, hire the right search engine optimization (SEO) company that also offers clean, clear and crisp website design, highly effective and ethical SEO techniques and top notch professionalism. It’s the best investment your insurance agency will ever make.

Ready to Quote is an insurance marketing company focusing on search engine marketing and <a href="http://www.readytoquote.com“>insurance websites. Learn more at http://www.readytoquote.com/ or call 1.800.504.8593

There is a famous myth in the search engine optimization (SEO) industry, or rather, people have the following impression about search engine optimization results —- that the minute they get their website optimized, it will shoot to number one spot on the first page of Google’s search engine results. Nothing could be further from the truth, unless you hire a company that uses black hat methods that only return short spurt rankings, which typically only last about a week, if that. Not to mention the fact that with the latest tweaking in algorithms, such sites would be dead in the water.

It is true that an active and tailored SEO plan for your insurance marketing does return great benefits for your company. It can drive traffic to your site, make social networks sit up and notice you, get your insurance agency’s name in the news and likely pull you on to the first page of Google. This does not happen in 24 or even 48 hours. SEO plans are well built, consistent, persistent and return results over time. You need patience to see those results and to watch them grow steadily. Bonus? The bonus is that building a slow and steady increase in page ranking with a quality SEO plan keeps your agency in a good spot for a long time.

It’s all about steady, refined, relevant websites and content that appeals to your about-to-be-customers. You want to build your results over time and make sure they stay right up where you want them. This is important for new insurance websites. For older sites with a history on the web, the process is a bit different, but nonetheless, still dramatic if you have lost ranking. For instance, if your website has been around for about five or more years, and is now in the back pages of Google, your site content can be properly optimized according to the newer web requirements. Add in a number of credible links and you will see almost immediate results.

Remember, Google’s algorithm, even with all the recent tweaking, is focused on quality. That makes sense when you consider that in order to stay profitable, Google needs a large audience searching the Internet. People do not appreciate spammy sites, or garbage content. Google knows this and strives to weed out the “rest” of the herd that needs culling, leaving in the “best” results for users. Google rules will get even stricter over time. It’s important to have a company that knows what it’s doing to not only design your insurance website, but keep a sharp eye on content and build you a better SEO plan to grow your online business.

You’ve maybe tried other companies and discovered you did not get what you wanted and needed to boost your site ranking. Try the company who has over a quarter of a century of insurance business under their belt. They’ll get you results.

Ready to Quote is an insurance marketing company focusing on search engine marketing and <a href="http://www.readytoquote.com“>insurance websites. Learn more at http://www.readytoquote.com/ or call 1.800.504.8593

You spend so much time in the kitchen that you want it to look good. Maybe you even entertain in there, or the kids love it and the all congregate there after school. Whatever the reason you want a new look for your kitchen, there are a whole slew of options out there. It won’t take long to find precisely what you need to make the heart of the home look spectacular. Just remember, you want it to be durable, classy and look like a million bucks.

For heavy traffic, stone or tile is just about the perfect solution. Stone would be your first choice if you want a natural look in your home. Start with the kitchen and then work your way through the rest of the house. It’s a bit like eating popcorn —- once you start upgrading flooring, love how it looks and endures, you want more. You might want to consider slate, limestone or even sandstone. These are the current trending natural floorings and you can choose a rougher look or one that is slightly more polished.

Not into stone? Then you may like the smooth, glossy and sleek finish of porcelain. Although, if you do have kids and they drop things a lot, this might not be a good option for you. However, if your kids are older and don’t drop glasses anymore, porcelain could be a crowd pleaser. And here’s another tip: you can use porcelain tiles to make the floor look like stone, but spend fewer bucks on the deal. While they are smoother than stone, they have a wider variety of patterns, designs and colors. Coming into its own these days is metallic finish tiles. Quite eye-catching indeed.

If porcelain or stone don’t appeal to you, you could always think about concrete flooring. While that may sound really odd, and more like something one would find in a mall, concrete flooring is being installed in many newer homes. This is because it holds heat well and if you’re worried about longevity, this stuff lasts for decades.

Don’t think for a minute that it just lays there and looks like concrete, the stuff outside we use for sidewalks. It can be tricked out in ways you would not believe, like acid stained, polished, colored or honed. And believe it or not, it can be used for countertops, as well.

You could also select woods such as oak, bamboo or laminates, or go modern with glass and resin. No matter what look you want, you will find it out there.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

By Jordan Rau
Kaiser Health News
More than 2,000 hospitals — including some nationally recognized ones — will be penalized by
the government starting in October because many of their patients are readmitted soon after
discharge, new records show.

Together, these hospitals will forfeit more than $280 million in Medicare funds over the next
year as the government begins a wide-ranging push to start paying health care providers based on
the quality of care they provide.

With nearly one in five Medicare patients returning to the hospital within a month of discharge,
the government considers readmissions a prime symptom of an overly expensive and
uncoordinated health system. Hospitals have had little financial incentive to ensure patients get
the care they need once they leave, and in fact they benefit financially when patients don’t
recover and return for more treatment.

Nearly 2 million Medicare beneficiaries are readmitted within 30 days of release each year,
costing Medicare $17.5 billion in additional hospital bills. The national average readmission rate
has remained steady at around 19 percent for several years, even as many hospitals have worked
harder to lower theirs.

The penalties, authorized by the 2010 health care law, are part of a multipronged effort by
Medicare to use its financial muscle to force improvements in hospital quality. In a few months,
hospitals also will be penalized or rewarded based on how well they adhere to basic standards of
care and how patients rated their experiences. Overall, Medicare has decided to penalize 71
percent of the hospitals whose readmission rates it evaluated, the records show.

The penalties will fall heaviest on hospitals in New Jersey, New York, the District of Columbia,
Arkansas, Kentucky, Mississippi, Illinois and Massachusetts, a Kaiser Health News analysis of
the records shows. Hospitals that treat the most low-income patients will be hit particularly hard.

A total of 307 hospitals nationally will lose the maximum amount allowed under the health care
law: 1 percent of their base Medicare reimbursements. Several of those are top-ranked
institutions, including Hackensack University Medical Center in New Jersey, North Shore
University Hospital in Manhasset, N.Y. and Beth Israel Deaconess Medical Center in Boston, a
teaching hospital of Harvard Medical School.

“A lot of places have put in a lot of work and not seen improvement,” said Dr. Kenneth Sands,
senior vice president for quality at Beth Israel. “It is not completely understood what goes into an
institution having a high readmission rate and what goes into improving” it.

Sands noted that Beth Israel, like several other hospitals with high readmission rates, also has
unusually low mortality rates for its patients, which he says may reflect that the hospital does a
good job at swiftly getting ailing patients back and preventing deaths.

Penalties Will Increase Next Year

The maximum penalty will increase after this year, to 2 percent of regular payments starting in
October 2013 and then to 3 percent the following year. This year, the $280 million in penalties
comprise about 0.3 percent of the total amount hospitals are paid by Medicare.

According to Medicare records, 1,910 hospitals will receive penalties less than 1 percent; the
total number of hospitals receiving penalties is 2,217. Massachusetts General Hospital in Boston,
which U.S. News last month ranked as the best hospital in the country, will lose 0.53 percent of
its Medicare payments because of its readmission rates, the records show. The smallest penalties
are one hundredth of a percent, which 49 hospitals will receive.

Dr. Eric Coleman, a national expert on readmissions at the University of Colorado School of
Medicine, said the looming penalties have captured the attention of many hospital executives.
“I’m not sure penalties alone are going to move the needle, but they have raised awareness and
moved many hospitals to action,” Coleman said.

The penalties have been intensely debated. Studies have found that African-Americans are more
likely to be readmitted than other patients, leading some experts to be concerned that hospitals
that treat many blacks will end up being unfairly punished.

Hospitals have been complaining that Medicare is applying the rule more stringently than
Congress intended by holding them accountable for returning patients no matter the reason they
come back.

Hospitals That Serve Poor Are Hit Harder Than Others

Some safety-net hospitals that treat large numbers of low-income patients tend to have higher
readmission rates, which the hospitals attribute to the lack of access to doctors and medication
these patients often experience after discharge. The analysis of the penalties shows that 80
percent of the hospitals that have a lot of low-income patients will lose Medicare funds in the
fiscal year starting in October. Sixty-seven percent of the hospitals treating few poor patients are
going to be penalized, the analysis shows.

“It’s our mission, it’s good, it’s what we want to do, but to be penalized because we care for
those folks doesn’t seem right,” said Dr. John Lynch, chief medical officer at Barnes-Jewish
Hospital in St. Louis, which is receiving the maximum penalty.

“We have worked on this for over four years,” Lynch said, but those efforts have not substantially
reduced the hospital’s readmissions. He said Barnes-Jewish has tried sending nurses to patients’
homes within a week of discharge to check up on them, and also scheduled appointments with a
doctor at a clinic, but half the patients never showed. This spring, the hospital established a team
of nurses, social workers and a pharmacist to monitor patients for 60 days after discharge.

“Some of the hospitals that are going to pay penalties are not going to be able to afford these
types of interventions,” said Lynch, who estimated the penalty would cost Barnes-Jewish $1
million.

Atul Grover, chief public policy officer for the Association of American Medical Colleges, called
Medicare’s new penalties “a total disregard for underserved patients and the hospitals that care
for them.” Blair Childs, an executive at the Premier healthcare alliance of hospitals, said: “It’s
really ironic that you penalize the hospitals that need the funds to manage a particularly difficult
population.”

Medicare disagreed, writing that “many safety-net providers and teaching hospitals do as well or
better on the measures than hospitals without substantial numbers of patients of low
socioeconomic status.” Safety-net hospitals that are not being penalized include the University of
Mississippi Medical Center in Jackson and Denver Health Medical Center in Colorado, the
records show.

Bill Kramer, an executive with the Pacific Business Group on Health, a California-based
coalition of employers, said the penalties provide “an appropriate financial incentive for hospitals
to do the right thing in terms of preventing avoidable readmissions.”

The government’s penalties are based on the frequency that Medicare heart failure, heart attack
and pneumonia patients were readmitted within 30 days between July 2008 and June 2011.
Medicare took into account the sickness of the patients when calculating whether the rates were
higher than those of the average hospital, but not their racial or socio-economic background.

The penalty will be deducted from reimbursements each time a hospital submits a claim starting
Oct. 1. As an example, if a hospital received the maximum penalty of 1 percent and it submitted
a claim for $20,000 for a stay, Medicare would reimburse it $19,800.

The Centers for Medicare & Medicaid Services has been trying to help hospitals and community
organizations by giving grants to help them coordinate patients’ care after they’re discharged.
Leaders at many hospitals say they are devoting increased attention to readmissions in concert
with other changes created by the health law.

Sally Boemer, senior vice president of finance at Mass General, said she expected readmissions
will drop as the hospital develops new methods of arranging and paying for care that emphasize
prevention. Readmissions “is a big focus of ours right now,” she said.

Gundersen Lutheran Health System in La Crosse, Wis., and Intermountain Medical Center in
Murray, Utah, were among 887 hospitals where Medicare determined the readmission rates were
acceptable. Those hospitals will not lose any money, nor will another 346 hospitals that had too
few cases for Medicare to evaluate. On average, the readmissions penalties were lightest on
hospitals in Utah, South Dakota, Vermont, Wyoming and Oregon, the analysis shows. Idaho was
the only state where Medicare did not penalize any hospital.

Even some hospitals that won’t be penalized are struggling to get a handle on readmissions.
Michael Baumann, chief quality officer at the University of Mississippi Medical Center, said
in-house doctors had made headway against heart failure readmissions by calling patients at
home shortly after discharge. “It’s a fairly simple approach, but it’s very labor intensive,” he said.

The problems afflicting many of the center’s patients—including obesity and poverty that makes
it hard to afford medications—make it more challenging. “It’s a tough group to prevent
readmissions with,” he said.

Compression Therapy Reduces Blood Clots in Stoke Patients, Study Finds

New research shows that inexpensive leg compression devices help prevent fatal blood clots in stroke patients.

The thigh-length sleeves promote blood flow by periodically filling with air and gently squeezing the legs. Vascular PRN, based in Tampa, Fla., is a leading national distributor of intermittent pneumatic compression (IPC) therapy equipment. Greg Grambor, the company’s president, commented on the study.  “Compression therapy has been around for over 20 years,” Grambor said. “Many doctors have already come to rely on this equipment for safe, effective, and affordable prevention of deep vein thrombosis. I’m glad this new research was done, and I hope it will help convince more doctors to give it a try.”  Deep vein thrombosis (DVT) is the formation of a blood clot inside a vein deep within the body. It is common in stroke patients and immobile patients and can also occur in healthy people on long flights where movement is restricted. When a clot detaches, it can then become lodged in the arteries of the lungs, causing a potentially life-threatening pulmonary embolism.

The study involved nearly 3,000 stroke patients at over 100 hospitals across the United Kingdom. Results showed 8.5 percent of patients treated with compression devices developed blood clots, versus 12.1 percent of patients who received alternative treatments.  “Many patients at risk of DVT are prescribed blood thinning drugs,” Grambor added. “But these drugs increase the risk of bleeding, which is quite dangerous for stroke patients as it may lead to bleeding in the brain.”

So far, no study has conclusively shown that blood thinners increase the survival rate of stroke patients. Doctors at the European Stroke Conference, held in London on May 31, 2013, discussed the study’s findings. Professor Martin Dennis of the University of Edinburgh said that the UK’s guidelines for treatment of stroke should be revised to recommend IPC treatment for all patients at high risk of DVT. Currently, they only recommend it in cases where blood thinners are unsuccessful or too risky.

Each year, some 15 million people worldwide suffer a stroke. One third of strokes are fatal and another third result in permanent disability.

By Jordan Rau
Kaiser Health News
More than 2,000 hospitals — including some nationally recognized ones — will be penalized by
the government starting in October because many of their patients are readmitted soon after
discharge, new records show.

Together, these hospitals will forfeit more than $280 million in Medicare funds over the next
year as the government begins a wide-ranging push to start paying health care providers based on
the quality of care they provide.

With nearly one in five Medicare patients returning to the hospital within a month of discharge,
the government considers readmissions a prime symptom of an overly expensive and
uncoordinated health system. Hospitals have had little financial incentive to ensure patients get
the care they need once they leave, and in fact they benefit financially when patients don’t
recover and return for more treatment.

Nearly 2 million Medicare beneficiaries are readmitted within 30 days of release each year,
costing Medicare $17.5 billion in additional hospital bills. The national average readmission rate
has remained steady at around 19 percent for several years, even as many hospitals have worked
harder to lower theirs.

The penalties, authorized by the 2010 health care law, are part of a multipronged effort by
Medicare to use its financial muscle to force improvements in hospital quality. In a few months,
hospitals also will be penalized or rewarded based on how well they adhere to basic standards of
care and how patients rated their experiences. Overall, Medicare has decided to penalize 71
percent of the hospitals whose readmission rates it evaluated, the records show.

The penalties will fall heaviest on hospitals in New Jersey, New York, the District of Columbia,
Arkansas, Kentucky, Mississippi, Illinois and Massachusetts, a Kaiser Health News analysis of
the records shows. Hospitals that treat the most low-income patients will be hit particularly hard.

A total of 307 hospitals nationally will lose the maximum amount allowed under the health care
law: 1 percent of their base Medicare reimbursements. Several of those are top-ranked
institutions, including Hackensack University Medical Center in New Jersey, North Shore
University Hospital in Manhasset, N.Y. and Beth Israel Deaconess Medical Center in Boston, a
teaching hospital of Harvard Medical School.

“A lot of places have put in a lot of work and not seen improvement,” said Dr. Kenneth Sands,
senior vice president for quality at Beth Israel. “It is not completely understood what goes into an
institution having a high readmission rate and what goes into improving” it.

Sands noted that Beth Israel, like several other hospitals with high readmission rates, also has
unusually low mortality rates for its patients, which he says may reflect that the hospital does a
good job at swiftly getting ailing patients back and preventing deaths.

Penalties Will Increase Next Year

The maximum penalty will increase after this year, to 2 percent of regular payments starting in
October 2013 and then to 3 percent the following year. This year, the $280 million in penalties
comprise about 0.3 percent of the total amount hospitals are paid by Medicare.

According to Medicare records, 1,910 hospitals will receive penalties less than 1 percent; the
total number of hospitals receiving penalties is 2,217. Massachusetts General Hospital in Boston,
which U.S. News last month ranked as the best hospital in the country, will lose 0.53 percent of
its Medicare payments because of its readmission rates, the records show. The smallest penalties
are one hundredth of a percent, which 49 hospitals will receive.

Dr. Eric Coleman, a national expert on readmissions at the University of Colorado School of
Medicine, said the looming penalties have captured the attention of many hospital executives.
“I’m not sure penalties alone are going to move the needle, but they have raised awareness and
moved many hospitals to action,” Coleman said.

The penalties have been intensely debated. Studies have found that African-Americans are more
likely to be readmitted than other patients, leading some experts to be concerned that hospitals
that treat many blacks will end up being unfairly punished.

Hospitals have been complaining that Medicare is applying the rule more stringently than
Congress intended by holding them accountable for returning patients no matter the reason they
come back.

Hospitals That Serve Poor Are Hit Harder Than Others

Some safety-net hospitals that treat large numbers of low-income patients tend to have higher
readmission rates, which the hospitals attribute to the lack of access to doctors and medication
these patients often experience after discharge. The analysis of the penalties shows that 80
percent of the hospitals that have a lot of low-income patients will lose Medicare funds in the
fiscal year starting in October. Sixty-seven percent of the hospitals treating few poor patients are
going to be penalized, the analysis shows.

“It’s our mission, it’s good, it’s what we want to do, but to be penalized because we care for
those folks doesn’t seem right,” said Dr. John Lynch, chief medical officer at Barnes-Jewish
Hospital in St. Louis, which is receiving the maximum penalty.

“We have worked on this for over four years,” Lynch said, but those efforts have not substantially
reduced the hospital’s readmissions. He said Barnes-Jewish has tried sending nurses to patients’
homes within a week of discharge to check up on them, and also scheduled appointments with a
doctor at a clinic, but half the patients never showed. This spring, the hospital established a team
of nurses, social workers and a pharmacist to monitor patients for 60 days after discharge.

“Some of the hospitals that are going to pay penalties are not going to be able to afford these
types of interventions,” said Lynch, who estimated the penalty would cost Barnes-Jewish $1
million.

Atul Grover, chief public policy officer for the Association of American Medical Colleges, called
Medicare’s new penalties “a total disregard for underserved patients and the hospitals that care
for them.” Blair Childs, an executive at the Premier healthcare alliance of hospitals, said: “It’s
really ironic that you penalize the hospitals that need the funds to manage a particularly difficult
population.”

Medicare disagreed, writing that “many safety-net providers and teaching hospitals do as well or
better on the measures than hospitals without substantial numbers of patients of low
socioeconomic status.” Safety-net hospitals that are not being penalized include the University of
Mississippi Medical Center in Jackson and Denver Health Medical Center in Colorado, the
records show.

Bill Kramer, an executive with the Pacific Business Group on Health, a California-based
coalition of employers, said the penalties provide “an appropriate financial incentive for hospitals
to do the right thing in terms of preventing avoidable readmissions.”

The government’s penalties are based on the frequency that Medicare heart failure, heart attack
and pneumonia patients were readmitted within 30 days between July 2008 and June 2011.
Medicare took into account the sickness of the patients when calculating whether the rates were
higher than those of the average hospital, but not their racial or socio-economic background.

The penalty will be deducted from reimbursements each time a hospital submits a claim starting
Oct. 1. As an example, if a hospital received the maximum penalty of 1 percent and it submitted
a claim for $20,000 for a stay, Medicare would reimburse it $19,800.

The Centers for Medicare & Medicaid Services has been trying to help hospitals and community
organizations by giving grants to help them coordinate patients’ care after they’re discharged.
Leaders at many hospitals say they are devoting increased attention to readmissions in concert
with other changes created by the health law.

Sally Boemer, senior vice president of finance at Mass General, said she expected readmissions
will drop as the hospital develops new methods of arranging and paying for care that emphasize
prevention. Readmissions “is a big focus of ours right now,” she said.

Gundersen Lutheran Health System in La Crosse, Wis., and Intermountain Medical Center in
Murray, Utah, were among 887 hospitals where Medicare determined the readmission rates were
acceptable. Those hospitals will not lose any money, nor will another 346 hospitals that had too
few cases for Medicare to evaluate. On average, the readmissions penalties were lightest on
hospitals in Utah, South Dakota, Vermont, Wyoming and Oregon, the analysis shows. Idaho was
the only state where Medicare did not penalize any hospital.

Even some hospitals that won’t be penalized are struggling to get a handle on readmissions.
Michael Baumann, chief quality officer at the University of Mississippi Medical Center, said
in-house doctors had made headway against heart failure readmissions by calling patients at
home shortly after discharge. “It’s a fairly simple approach, but it’s very labor intensive,” he said.

The problems afflicting many of the center’s patients—including obesity and poverty that makes
it hard to afford medications—make it more challenging. “It’s a tough group to prevent
readmissions with,” he said.

Compression Therapy Reduces Blood Clots in Stoke Patients, Study Finds

New research shows that inexpensive leg compression devices help prevent fatal blood clots in stroke patients.

The thigh-length sleeves promote blood flow by periodically filling with air and gently squeezing the legs. Vascular PRN, based in Tampa, Fla., is a leading national distributor of intermittent pneumatic compression (IPC) therapy equipment. Greg Grambor, the company’s president, commented on the study.  “Compression therapy has been around for over 20 years,” Grambor said. “Many doctors have already come to rely on this equipment for safe, effective, and affordable prevention of deep vein thrombosis. I’m glad this new research was done, and I hope it will help convince more doctors to give it a try.”  Deep vein thrombosis (DVT) is the formation of a blood clot inside a vein deep within the body. It is common in stroke patients and immobile patients and can also occur in healthy people on long flights where movement is restricted. When a clot detaches, it can then become lodged in the arteries of the lungs, causing a potentially life-threatening pulmonary embolism.

The study involved nearly 3,000 stroke patients at over 100 hospitals across the United Kingdom. Results showed 8.5 percent of patients treated with compression devices developed blood clots, versus 12.1 percent of patients who received alternative treatments.  “Many patients at risk of DVT are prescribed blood thinning drugs,” Grambor added. “But these drugs increase the risk of bleeding, which is quite dangerous for stroke patients as it may lead to bleeding in the brain.”

So far, no study has conclusively shown that blood thinners increase the survival rate of stroke patients. Doctors at the European Stroke Conference, held in London on May 31, 2013, discussed the study’s findings. Professor Martin Dennis of the University of Edinburgh said that the UK’s guidelines for treatment of stroke should be revised to recommend IPC treatment for all patients at high risk of DVT. Currently, they only recommend it in cases where blood thinners are unsuccessful or too risky.

Each year, some 15 million people worldwide suffer a stroke. One third of strokes are fatal and another third result in permanent disability.

Many people when asked about whether they would consider vinyl plank flooring, get a deer in the headlights look and mumble something about vinyl being kind of ugly and they want something that looks good in their home.

You’re in for a real surprise, because luxury vinyl plank flooring has elegance, functionality and lots of style. This happens to be due to the fact that being in style is hot and flooring manufacturers know a good thing when they see it. Today’s vinyl plank flooring looks great and even more realistic in mimicking other flooring choices that are more expensive.

In fact, choosing vinyl plank over hardwood or laminate is actually a good idea, largely due to the fact that it is far more durable and tougher than either of those two choices. Its ability to withstand spills and scratches is phenomenal.
Just keep in mind when you start shopping around for this flooring, that not all flooring, and this applies to every choice you ultimately make, is created equal. For instance, check the backing system, how it is constructed, does it have a commercial or residential warranty, come with a mold inhibitor and is it certified hypo-allergenic?

You will also want to check whether or not your potential choice is water proof or water resistant, as that makes a huge difference as to where you have it installed. Find out how thick it is, as the thicker, the better, for some locations. There are so many options to choose and no matter what you do choose, you will find the pricing quite reasonable.

There aren’t too many flooring options on the market these days that can boast of a starting price of $.99/sq.ft. Certainly there are more expensive choices, but if you have budget issues, the least expensive flooring choice still looks good.

You just need to take your time choosing what works for you, as you would with selecting more expensive flooring. You will want to check that what you are being quoted does match up with your product choice. For example check the thickness and layering to ensure you are getting what you want, and make certain that when you compare various options of the same flooring, that you are comparing the same kind of product within the flooring range. It’s pretty easy to shop, but just take your time and you will end up with a good deal for something that really looks great in your home.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

People buy things from your insurance website because they feel they know you, appreciate your experience, your education, credentials, your style of writing and explaining insurance policies or they like your smile. Whatever the reason people do buy insurance from you, you can be certain it was not your logo or the pictures of the inside of your office. People like dealing with people. It’s the personal touch that makes a difference.

In short, you do not want your insurance website to end up being a buffer or barrier between you and your potential customers. You want it to be an extension of who you are. This is even more important if you have more than one insurance agent on staff. Each person that deals with the public needs to be known. You want everyone in the office to be a part of your online presence.

If you want to score large in the insurance industry, you make sure people know who you are personally. Your hobbies, the organizations you belong to, why you chose to sell Medicare supplements or car insurance or term life insurance or health insurance. You want them to see you doing the things you love, even if that is riding a horse in back country trails. The real you is what you want to convey to potential customers.

In sharing a part of who you are with those who visit your insurance website, you have opened the door to more personal contact; heightened the potential for visitors to stay and get to know you and buy something. By showing people who you are, the real you, you have a cutting edge advantage over your competition, because you become more personable, approachable and someone people want to know better. The advantages to this strategy? You likely sell more insurance. It does not get any better than that.

Ready to Quote is an insurance marketing company focusing on search engine marketing and <a href="http://www.readytoquote.com“>insurance websites. Learn more at http://www.readytoquote.com/ or call 1.800.504.8593

You spend hundreds of hours making sure you get people to your website. You want the business and you have good products to offer. You have a really professional and clean site that is easy to navigate and had relevant content. So far, so good. What about links? Having relevant and quality links helps you get high quality traffic. In fact, you may even see an increase in traffic to your URL.

So, what happens when visitors land on your insurance website? Do your visitors stay on your site? Are they reading your content, articles and news items? Are they contacting you or just scanning a page or two and then leaving? In short, are they being engaged enough to stay on your site?

Keeping visitors happy offers you two benefits. The longer someone stays on your site, the higher the chances they will buy something — or convert from a surfer to a buyer. If people needing insurance find the information they want on your site, their opinion of that site goes up and you are likely to get a phone call or contact email. It’s a simple equation really; have good content that speaks to people and they will remember you and recommend you. Good content is so very crucial these days, even more so in light of Google’s constantly changing algorithms.

While you might be able to tell how high a bounce rate you have for your website, the information does not tell you how people react to your web pages. Did they read the whole page? Just scroll down? Just read certain content? Leave your site by clicking on a link you provided? This is information you need to know to tweak your insurance website.

How in the world do you keep track of that kind of information? First, you need a search engine optimization company that knows what it’s doing, one with overwhelmingly outstanding hands-on experience in the insurance industry. They have the information you need, the skills to help you get your insurance marketing kicked into high drive and the time to explain things like Google Analytics, to help you track your traffic. It doesn’t get any better than that.

In the final analysis, successful insurance websites keep their traffic on the site long enough for the surfer to call them, fill out a form or sign up for a newsletter, etc. More ways to track your traffic. It’s your business and your success. Do your website up the right way the first time.

Ready to Quote is an insurance marketing company focusing on search engine marketing and <a href="http://www.readytoquote.com“>insurance websites. Learn more at http://www.readytoquote.com/ or call 1.800.504.8593

Protective flooring is also referred to as safety flooring, and its main distinctive feature is its flexibility to work in multiple environments. If you have young children, you know that any flooring that is hard-wearing, non-slip, virtually stain resistant and thrives on heavy traffic is a winner.

Although you tend to find flooring like this in factories, warehouses, hospitals, nurseries and so forth, the simple fact is this type of flooring is go to go no matter where you want to put it. It has a stellar record when it comes to safety by preventing falls or slipping, and what could be better than that with young toddlers?

Safety flooring does well in the kitchen and even the bathroom, but don’t let the name fool you into thinking it’s ugly and utilitarian. Sure, it is handy, does yeoman’s duty and can handle just about anything thrown at it. Putting it down in a kitchen would be a smart choice.

When considering safety flooring, take an inventory of what it is you need before buying anything. For instance, rubber vinyl flooring goes well in rooms designated as children’s play areas. On the other hand, you would want a non-slip surface in a kitchen or bathroom. If in doubt, ask your local Tampa flooring contractor what would best in your home.

People used to think that safety flooring was only something you hid behind a closed door. While that was true once, it is not now. It comes in beautiful colors and designs, and you can even choose what kind of finish appeals to you. Safety flooring is coming into its own and if you take a good look around the next time you are out, you’ll notice it in open areas frequented by the public.

Imagine being able to choose safety flooring that looks like wood, right down to the finish. It even offers quality acoustic abilities to reduce the happy sounds of children at play.

Whether you choose to install it at home or work, you’ll find you will be pleased with this hard-working, smart-looking and versatile flooring. It’s definitely a long-term solution for a reasonable price if you want to upgrade existing flooring.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

by Elizabeth Rosto Sitko
Culture change is driving most of the innovations we’re seeing in long-term care dining today.
Rather than cookie cutter meals, residents and their families are looking for updated dining
programs that allow for more choices on a daily basis. “Families want to ensure that their loved
ones are eating first and foremost, but also that they want to eat and enjoy what they are eating,”
said Jeremy T. Manners, CDM, CFPP, FMP, culinary and nutrition director, West Haven Manor,
a 257-bed skilled and personal care facility in Apollo, Pa. Residents who are happy and healthy
will ultimately have better outcomes. If you’re looking for new ways to innovate your dining
program, here’s a glance at some of the latest trends in the long-term care dining landscape.

Honoring Resident Requests
Most people don’t like to eat the same things over and over, so be sure to update your menus
frequently with new items. “Residents easily get bored with the same items all the time, so by
changing it up frequently and adding new items or recipes, they get refreshed,” Manners said.
West Haven Manor’s dining department is seeing a lot more requests for items such as tacos,
pizza and Chinese food, he added. Buena Vida CCRC, a 240-bed facility with a 30-bed assisted
living facility in Brooklyn, N.Y, has a large Hispanic population. So residents are always asking
for Spanish dishes, according to Evelyn Conner, CDM, CFPP, director of food and nutrition
services.

“We have added arroz con pollo, yucca four different ways weekly, white sweet potatoes and
sancocho soup [a nourishing stew popular throughout the Latin World]. Every month we have
menu planning meetings with the residents, which allow them to sample different food items,”
she explained. Recently, they sampled chana masala, an Indian dish of chickpeas with onions,
tomatoes and spice. “These meetings allow the residents to agree on items that they would like to
have added to the menus and enhances their evolvement in their care. I’m constantly looking for
Spanish entrees to add to the menus in order to increase the resident satisfaction with their dining
experience,” Conner said.

‘Round the Clock Service
West Haven Manor added a 24-hour menu and a third shift team member to create a 24-hour
foodservice program. The facility has seen an increase in non-traditional residents, middle aged
residents coming in for rehab after knee or hip surgery, and even younger residents in their 20s
and 30s coming for IV therapy. “Many of these residents lead different lifestyles while at home,
up late at night for example, and while in our care, we don’t expect them to just change their
usual habits. Many of these residents are taking advantage of an empty lounge to play Wii, others
are simply utilizing the WiFi from their room to surf the internet,” Manners said. “At home these
folks would be snacking on something more likely than not, so again, why make them change all
of their habits just because they are temporarily residing in a nursing home?” This service has
been very successful since they started the 24-hour meal program in January of 2012, Manners
said. To balance offering many options but not letting food go to waste, many of the items on the
24-hour menu are quick options that can be kept on hand and are easily prepared. After working
with their foodservice distributor, they selected a pre-cooked burger, pre-grilled chicken breast,
along with other choices like individual slices of stuffed crust pizza. These items are all quickly
prepared in a microwave or countertop pizza oven, Manners explained.

Buffet Stations
With the addition of a buffet table to the main dining room, Manners said, West Haven Manor
can offer a variety of options at meal times based on a par level system-that is, a stocking
quantity is established for each item based on average usage and a target number of days’ supply.
Many of the items already available on the late night menu can be offered here as well with the
addition of special items or seasonal items from time to time.
A Healthcare Team Without Doctors……Really???

by Dr. Steven Fuller
There are 624,434 U.S. physicians (AHRQ, 2010), but only 0.6% of them would ever consider
entering an Assisted Living Community (ALC) to provide on-site care. There are more than
36,000 ALCs in the US caring for over 1 million fragile older adults (ALFA 2011), but you are
literally more likely to be struck by lightning than to ever see a doctor walk through the doors of
any of these communities!

The first ALC began in 1981 to care for the Founder’s mother who was in her early 60s (The
History of Assisted Living, www.assistedlivinghistory.com). These Communities were
originally promoted to provide a supportive, primarily non-medical living environment to bridge
the gap between independent living and the nursing home. But the landscape for ALCs has
dramatically changed since their inception.

The average age of an ALC resident is now 87 years (Harris-Wallace et al, 2011, Seniors
Housing & Care Journal). Thirty-seven percent of residents receive assistance with 3 or more
activities of daily living (NCAL 2012), greater than half of the residents have 2 or more chronic
medical conditions and are taking multiple medications having a variety of potential side effects,
and 42% have at least some degree of memory impairment or dementia (NCAL 2012).

ALCs are no longer predominantly non-medical communities. They have high acuity residents,
and this will only intensify in the future due to a very competitive market as well as resident
expectations to age in place and experience the progression of chronic medical conditions in one
setting that provides ongoing care and monitoring.

In other words, times have changed. But the problem is…our thinking hasn’t! Our thinking is
stuck back in the 1980s and hasn’t kept pace with the changing demands and expectations
residents impose on ALCs. The healthcare team that provides medical oversight of residents in
ALCs is led either by non-medically trained administrators or by nurses with additional support
from aides and assistants. But there is a glaring omission: WHERE ARE THE DOCTORS???

Just as in the 1980s, we keep hauling our residents off-site all over town to a variety of doctor’s
offices just to get their basic primary care needs met. But this isn’t the 1980s any longer! These
residents are 20 years older, much more fragile on average, and all these off-site trips are
incredibly stressful not only on the residents but also their families as well as the ALCs and their
employees. We can and must do better!

It is no longer appropriate to be thinking as we did in the 1980s and have predominantly off-site
physician care. And it is no longer acceptable to have the supervisory medical team not include a
fully engaged physician who provides on-site care.

ALCs and physicians MUST come together and meet the demand of caring for high acuity
patients in the community setting. The direction of modern healthcare delivery is TOWARD
THE COMMUNITY to proactively keep people as healthy as possible at home and AWAY
FROM HIGH COST INSTITUTIONS that only care for patients reactively after they become ill.
This reversal in the direction of healthcare delivery falls right in the laps of ALCs, and the
pressure to care for higher acuity residents will therefore only increase. This also means that
on-site care by physicians offered to ALL residents should no longer be a luxury but MUST be a
REALITY.

There are a few innovative healthcare models now available that encourage ALCs and physicians
to each put “skin in the game” and come together as PARTNERS
(http://housecalls-llc.com/articles/physicians-must-partner-with-retirement-communities-and-her
es-why). To meet the new demands that confront this partnership is surprisingly easy and not
intimidating and can happen overnight. The biggest obstacle is in our thinking: WE MUST
THINK DIFFERENTLY
(http://housecalls-llc.com/articles/think-the-same-stay-the-same-think-differently-and-thrive/).

If we think differently…if we bring physicians and ALCs together as partners, we will discover
that EVERYBODY WINS!

Compression Therapy Equipment Available From Vascular PRN Treats Diabetic Ulcers

Vascular PRN offers compression therapy devices that help promote blood flow to prevent and
heal diabetic ulcers.

Ulcers on the legs and feet are a major complication of diabetes. They occur in 15% of all
diabetes patients. Without prompt and effective treatment, they can leave doctors no alternative
but partial leg amputation. Diabetic ulcers precede 84% of all lower leg amputations.

“Our compression therapy equipment gently compresses the leg to increase the flow of oxygen-
rich blood,” said Greg Grambor, president of Vascular PRN. “Compression therapy is effective,
inexpensive, and completely non-invasive.”

The direct cause of diabetic ulcers is the subject of debate within the medical community, but it
is widely agreed that insufficient blood flow is a dominant contributor to the condition.
Treatments for diabetic ulcers other than compression therapy include topical and internal drugs
and surgery, each of which has a number of potential complications.

Grambor also pointed out the use of compression therapy as a preventive measure.

“Compression therapy is a good option even after a diabetic leg ulcer has healed because it helps
prevent recurrences of the wounds,” Grambor said. “Studies have shown that up to half of all
diabetic ulcers recur within five years of healing.”

The U.S. Centers for Disease Control and Prevention last year released its Diabetes Report Card
2012, the result of a survey of diabetes patients nationwide. That survey showed that just over
two thirds of diabetic adults in the U.S. received their recommended annual foot exam in 2009-
10.

“Patients themselves take an active role in preventing these wounds as well through a regimen of
self-examination and proper cleaning of the feet. When doctors combine compression therapy
with patient education, the ongoing prevention of diabetic foot ulcers can be very manageable for
patients,” added Grambor.

Based in Tampa, Florida, Vascular PRN is a leading national distributor of compression therapy
equipment, serving nursing homes, hospitals, surgery centers and other institutions in all 50
states.

by Elizabeth Rosto Sitko
Culture change is driving most of the innovations we’re seeing in long-term care dining today.
Rather than cookie cutter meals, residents and their families are looking for updated dining
programs that allow for more choices on a daily basis. “Families want to ensure that their loved
ones are eating first and foremost, but also that they want to eat and enjoy what they are eating,”
said Jeremy T. Manners, CDM, CFPP, FMP, culinary and nutrition director, West Haven Manor,
a 257-bed skilled and personal care facility in Apollo, Pa. Residents who are happy and healthy
will ultimately have better outcomes. If you’re looking for new ways to innovate your dining
program, here’s a glance at some of the latest trends in the long-term care dining landscape.

Honoring Resident Requests
Most people don’t like to eat the same things over and over, so be sure to update your menus
frequently with new items. “Residents easily get bored with the same items all the time, so by
changing it up frequently and adding new items or recipes, they get refreshed,” Manners said.
West Haven Manor’s dining department is seeing a lot more requests for items such as tacos,
pizza and Chinese food, he added. Buena Vida CCRC, a 240-bed facility with a 30-bed assisted
living facility in Brooklyn, N.Y, has a large Hispanic population. So residents are always asking
for Spanish dishes, according to Evelyn Conner, CDM, CFPP, director of food and nutrition
services.

“We have added arroz con pollo, yucca four different ways weekly, white sweet potatoes and
sancocho soup [a nourishing stew popular throughout the Latin World]. Every month we have
menu planning meetings with the residents, which allow them to sample different food items,”
she explained. Recently, they sampled chana masala, an Indian dish of chickpeas with onions,
tomatoes and spice. “These meetings allow the residents to agree on items that they would like to
have added to the menus and enhances their evolvement in their care. I’m constantly looking for
Spanish entrees to add to the menus in order to increase the resident satisfaction with their dining
experience,” Conner said.

‘Round the Clock Service
West Haven Manor added a 24-hour menu and a third shift team member to create a 24-hour
foodservice program. The facility has seen an increase in non-traditional residents, middle aged
residents coming in for rehab after knee or hip surgery, and even younger residents in their 20s
and 30s coming for IV therapy. “Many of these residents lead different lifestyles while at home,
up late at night for example, and while in our care, we don’t expect them to just change their
usual habits. Many of these residents are taking advantage of an empty lounge to play Wii, others
are simply utilizing the WiFi from their room to surf the internet,” Manners said. “At home these
folks would be snacking on something more likely than not, so again, why make them change all
of their habits just because they are temporarily residing in a nursing home?” This service has
been very successful since they started the 24-hour meal program in January of 2012, Manners
said. To balance offering many options but not letting food go to waste, many of the items on the
24-hour menu are quick options that can be kept on hand and are easily prepared. After working
with their foodservice distributor, they selected a pre-cooked burger, pre-grilled chicken breast,
along with other choices like individual slices of stuffed crust pizza. These items are all quickly
prepared in a microwave or countertop pizza oven, Manners explained.

Buffet Stations
With the addition of a buffet table to the main dining room, Manners said, West Haven Manor
can offer a variety of options at meal times based on a par level system-that is, a stocking
quantity is established for each item based on average usage and a target number of days’ supply.
Many of the items already available on the late night menu can be offered here as well with the
addition of special items or seasonal items from time to time.
A Healthcare Team Without Doctors……Really???

by Dr. Steven Fuller
There are 624,434 U.S. physicians (AHRQ, 2010), but only 0.6% of them would ever consider
entering an Assisted Living Community (ALC) to provide on-site care. There are more than
36,000 ALCs in the US caring for over 1 million fragile older adults (ALFA 2011), but you are
literally more likely to be struck by lightning than to ever see a doctor walk through the doors of
any of these communities!

The first ALC began in 1981 to care for the Founder’s mother who was in her early 60s (The
History of Assisted Living, www.assistedlivinghistory.com). These Communities were
originally promoted to provide a supportive, primarily non-medical living environment to bridge
the gap between independent living and the nursing home. But the landscape for ALCs has
dramatically changed since their inception.

The average age of an ALC resident is now 87 years (Harris-Wallace et al, 2011, Seniors
Housing & Care Journal). Thirty-seven percent of residents receive assistance with 3 or more
activities of daily living (NCAL 2012), greater than half of the residents have 2 or more chronic
medical conditions and are taking multiple medications having a variety of potential side effects,
and 42% have at least some degree of memory impairment or dementia (NCAL 2012).

ALCs are no longer predominantly non-medical communities. They have high acuity residents,
and this will only intensify in the future due to a very competitive market as well as resident
expectations to age in place and experience the progression of chronic medical conditions in one
setting that provides ongoing care and monitoring.

In other words, times have changed. But the problem is…our thinking hasn’t! Our thinking is
stuck back in the 1980s and hasn’t kept pace with the changing demands and expectations
residents impose on ALCs. The healthcare team that provides medical oversight of residents in
ALCs is led either by non-medically trained administrators or by nurses with additional support
from aides and assistants. But there is a glaring omission: WHERE ARE THE DOCTORS???

Just as in the 1980s, we keep hauling our residents off-site all over town to a variety of doctor’s
offices just to get their basic primary care needs met. But this isn’t the 1980s any longer! These
residents are 20 years older, much more fragile on average, and all these off-site trips are
incredibly stressful not only on the residents but also their families as well as the ALCs and their
employees. We can and must do better!

It is no longer appropriate to be thinking as we did in the 1980s and have predominantly off-site
physician care. And it is no longer acceptable to have the supervisory medical team not include a
fully engaged physician who provides on-site care.

ALCs and physicians MUST come together and meet the demand of caring for high acuity
patients in the community setting. The direction of modern healthcare delivery is TOWARD
THE COMMUNITY to proactively keep people as healthy as possible at home and AWAY
FROM HIGH COST INSTITUTIONS that only care for patients reactively after they become ill.
This reversal in the direction of healthcare delivery falls right in the laps of ALCs, and the
pressure to care for higher acuity residents will therefore only increase. This also means that
on-site care by physicians offered to ALL residents should no longer be a luxury but MUST be a
REALITY.

There are a few innovative healthcare models now available that encourage ALCs and physicians
to each put “skin in the game” and come together as PARTNERS
(http://housecalls-llc.com/articles/physicians-must-partner-with-retirement-communities-and-her
es-why). To meet the new demands that confront this partnership is surprisingly easy and not
intimidating and can happen overnight. The biggest obstacle is in our thinking: WE MUST
THINK DIFFERENTLY
(http://housecalls-llc.com/articles/think-the-same-stay-the-same-think-differently-and-thrive/).

If we think differently…if we bring physicians and ALCs together as partners, we will discover
that EVERYBODY WINS!

Compression Therapy Equipment Available From Vascular PRN Treats Diabetic Ulcers

Vascular PRN offers compression therapy devices that help promote blood flow to prevent and
heal diabetic ulcers.

Ulcers on the legs and feet are a major complication of diabetes. They occur in 15% of all
diabetes patients. Without prompt and effective treatment, they can leave doctors no alternative
but partial leg amputation. Diabetic ulcers precede 84% of all lower leg amputations.

“Our compression therapy equipment gently compresses the leg to increase the flow of oxygen-
rich blood,” said Greg Grambor, president of Vascular PRN. “Compression therapy is effective,
inexpensive, and completely non-invasive.”

The direct cause of diabetic ulcers is the subject of debate within the medical community, but it
is widely agreed that insufficient blood flow is a dominant contributor to the condition.
Treatments for diabetic ulcers other than compression therapy include topical and internal drugs
and surgery, each of which has a number of potential complications.

Grambor also pointed out the use of compression therapy as a preventive measure.

“Compression therapy is a good option even after a diabetic leg ulcer has healed because it helps
prevent recurrences of the wounds,” Grambor said. “Studies have shown that up to half of all
diabetic ulcers recur within five years of healing.”

The U.S. Centers for Disease Control and Prevention last year released its Diabetes Report Card
2012, the result of a survey of diabetes patients nationwide. That survey showed that just over
two thirds of diabetic adults in the U.S. received their recommended annual foot exam in 2009-
10.

“Patients themselves take an active role in preventing these wounds as well through a regimen of
self-examination and proper cleaning of the feet. When doctors combine compression therapy
with patient education, the ongoing prevention of diabetic foot ulcers can be very manageable for
patients,” added Grambor.

Based in Tampa, Florida, Vascular PRN is a leading national distributor of compression therapy
equipment, serving nursing homes, hospitals, surgery centers and other institutions in all 50
states.

First and foremost, your insurance marketing must be people-friendly, or “user-friendly” for those online. It must be simple, terms must be easily explained, it must be easy to read and easy to follow. While some might think that “easy” and “insurance” do not belong in the same sentence, this is a bit of a fallacy. Sure, there is technical jargon and legal jargon, but if your insurance marketing plan is what it needs to be, you have addressed those issues with aplomb. So, let’s say you have an insurance website that is really nicely laid out, easy to navigate, colorful without being the cousin to a neon sign, and offers a quote function. You’re ready to go and get traffic, or are you?

While having bells and whistles on your website, including the latest Facebook, Twitter, Google + or Pinterest connections, that does not, in and of itself, drive traffic to your website. Even the best website on the Internet must not only be properly optimized, but offer visitors relevant information that they are looking for when trying to find insurance. So while optimization is the tip of the iceberg, the underlying foundation for the site is information. As Google crawls your website, determining your site ranking, they use text content to get an appropriate rank.

These days, you are not the only insurance website online and thus, in the crush of competition for customers, you want to stand out. You already know more people shop online now, for insurance and other things, more than ever before. Knowing that, you must think strategically and position your agency as an online resource.

Simply put, should someone be looking for pertinent information to answer questions about their insurance needs, and you have that information on your site, the visitor is more likely to ask you for a quote. So, having online quoting is a bonus. Garnering a new customer begins with a properly optimized website, online quoting and offering relevant information. It doesn’t hurt to have first class insurance web design either.

It is also vitally important that the information you offer is clearly presented and thoroughly explained. No one likes to go to a website, read something and find it confusing. This drives people away. This does not mean you have to go into great detail about everything you know or sell.

It means that the policies most commonly bought from you should be clearly explained in a manner that most people will understand. If a potential buyer is comfortable with your explanation of what they are looking for, they will likely be comfortable buying a policy from you. Giving valuable information and answering questions also positions you as an expert in your field. Bonus.

Want to get the best of service anywhere to improve your website ranking? Find a search engine optimization company with serious experience in the insurance industry. They know what you need.

Ready to Quote is an insurance marketing company focusing on search engine marketing and <a href="http://www.readytoquote.com“>insurance websites. Learn more at http://www.readytoquote.com/ or call 1.800.504.8593

Exclusive Medicare supplement leads are worth every penny you spend on them. They are a critical part of your business as well, since America is aging, and you have a growing, captive market. However, you do not want to waste time trying to find your own leads or deal with a fly-by-night lead generation company who might skirt some legal and ethical issues. Gone are the days of trying to beat out every other agent within a 50 mile radius to sell Medicare supplements —- unless you like doing business that way.

Before you invest in exclusive Medicare supplement leads, there are some questions you need to ask the company you are planning on dealing with. Were the leads checked against the “No Not Call” list? Do they come in the territories you want? Do they come as set appointments? Are they pre-screened and qualified, so you know you are not wasting your time? Those are just some of the things you might want to ask; you can custom order exclusive Medicare care supplement needs, based on what you want. Won’t it be nice to talk to leads that need and want your products and are qualified to buy them?

With exclusive Medicare supplement leads, you do not share with any other agent. You have genuine exclusivity to serve your potential customer to the best of your ability. Leads that come pre-screened and pre-qualified increase not only your productivity, but enhance your financial bottom line. No more wasting time on dead end calls. Just sit down, open your email, check your leads, pick up the phone and call your prospective customers to discuss what they would like and answer questions. It doesn’t get any better than that.

To begin with, you might want to do just one geographic territory, so you don’t feel overwhelmed, but remember, you have the choice to take as many leads as you want, or keep it to a small handful a day so you have time to work them all. In short, you get to arrange times and appointments and contacts according to times that best suit you. It’s a smart way to do business and one that will expand your agency’s financial bottom line.

Clelland Green is with Benepath.net, a leader in providing Medicare leads. Benepath provides agents with exclusive leads in just a few mouse clicks. To click here to visit http://www.benepath.net.

Focusing on green products for the home is still going strong, and many people are giving serious thought to what kind of flooring to have in their homes. It’s about protecting our habitat and environment, protecting the earth and our forests. One alternative flooring that is piquing people’s interest is reclaimed rubber. Talk about cost effective flooring. It is even less expensive than natural rubber. While you may think it sounds too different and while you might not be able to visualize what your home would look like with reclaimed rubber floors, check it out online. The look is quite appealing.

While gyms, spas and fitness centers might come to mind, reclaimed rubber has a role to play in your home. You can’t beat it for maintenance. Imagine a floor that is completely stain-resistant and will not scratch up, not even if you have pets and busy kids. This kind of flooring lasts for years and years and years. If you have a need for safe flooring in your home for children or older or disabled adults, reclaimed rubber flooring may be just the thing for you.

As you might expect, reclaimed rubber flooring is made from cast off automobile tires. After processing, it ends up as rolls of flooring and as tiles. It is environmentally friendly in terms of a green flooring option. Recycled rubber also uses less energy, as opposed to creating new rubber, a process that requires an enormous amount of energy, which often gets wasted during its creation. Starting from scratch is not always a great idea. It is also more expensive than reclaimed rubber and if you are on a budget, reclaimed rubber is a great fit for you.

It might take some work to adjust your perception of rubber flooring as something you would only find in commercial buildings. Think “outside of the box” and you’ll see that rubber would be beneficial for many areas in your home —- the laundry room, playrooms, the garage, pantry or even a bathroom. The best use of this type of flooring is in a kid’s playroom. It cuts the noise level and prevents them from slipping and falling. Also, if you have pets, a rubber floor is a breeze to keep clean.

One further point in favor of using reclaimed rubber is that, contrary to what you may think, it is not pitch black, unless that is what you want. It comes in different colors, formats, thicknesses and designs, just like any other type of flooring. Why not give it some thought? It might be the right thing to do if you have concerns about preserving the planet.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

Take a long, hard look at your insurance website. Do you like what you see? Does your staff like it? Do your customers like it? How does it compare to your nearest competition? These are hard questions to answer, as a website is a personal thing and as it was developed, there were parts of you that went into making it what it is today. However, you need to stand back and regard it from the point of view of a visitor to your site. It might not be as wonderful as you think it is. It’s time for some serious introspection about your insurance marketing goals.

First things first. Leads are the lifeblood of an insurance agency. No leads, no customers. No customers, no income. Your website needs to garner leads that will convert. That does not just mean having your contact information on the site. It means a lot more, like a good search engine optimization (SEO) campaign, one that draws traffic to your website. Once you have the traffic, you can get leads and from those leads, you can do quotes. While it sounds simple, you may be surprised to know that we hear from a number of insurance agencies wondering why their websites just do not bring in the traffic they need to grow their business.

While they may have a nice site, it may be old, out-of-date, built on a different platform, not properly optimized, or it does not load quickly, or have social media or even an instant quoting function. Yesterday’s websites are losing ground, if not vanishing entirely. In order to have an up-to-the-minute insurance website, you want to get as many targeted visitors as possible. Targeting your visitors begins with the right kind of SEO campaign, a revamped or new insurance website and a steady, controlled marketing strategy aimed at your target audience. For instance, if you specialize in selling Medicare supplements to seniors, you likely are not interested in students in college. Focusing your campaign is critical to your website’s success.

Back to the quoting function for a second: It’s crucial to have a quote request form readily accessible on every page of your website, not just the home page. For instance, instead of just having a Medicare supplement information page and a Medicare supplement quote page, ensure that there is a short contact form on the Medicare supplement page, which offers a visitor to your site the choice of filling out a detailed Medicare supplement request on the quote page. Of course, by offering quotes online, you must have secure pages for the collection of private information. All this is part and parcel of effective insurance website design.

If you want the traffic to grow your business, find an SEO partner with serious experience in the insurance industry. They know their stuff and it looks good on you.

Ready to Quote is an insurance marketing company focusing on search engine marketing and <a href="http://www.readytoquote.com“>insurance websites. Learn more at http://www.readytoquote.com/ or call 1.800.504.8593

One thing you may wish to consider when upgrading your flooring is what type of covering you want. For instance, do you prefer a soft covering, hard or wooden flooring or chemical flooring? Choosing something that suits your lifestyle might sound easy, but with the various options available, sometimes the choices are overwhelming. Start with the basics by considering whether or not you want carpets to cover your existing flooring. Do you have kids and/or pets? Would carpet work with your busy lifestyle? What kind of carpet would best address your needs? And what type of budget do you want to work with? Will you do-it-yourself or have someone install it? Then of course, there are various colors and textures to decide on as well.

Let’s say carpeting is not for you. What about hard flooring? In this category of floor choices you would find terracotta, ceramic and porcelain. Its material designed to withstand pressure. The bonus with hard flooring is that it is colorful, versatile, easy to clean, reasonably priced, easy to find and easy to install, provided you follow the instructions. For example, ceramic flooring can be a nice whimsical touch in a kitchen and liven it up considerably. Think resale value if you choose to sell your home.

If you don’t care for hard flooring, then wood may be a good choice for you. For instance, the marketplace has a full range of wooden laminates that come in various designs and colors. These days, many laminates very closely resemble hardwood, but are considerably less expensive than the real thing. The only issue you may have with laminate flooring is if you choose a very inexpensive one. They are typically hard to keep clean.

Why not consider chemical flooring? Simply put, this is polyester, epoxy or latex applied to an existing floor to provide a seamless covering. One of the more popular choices today is an epoxy coat that keeps the flooring from degrading and creates a strong surface, resistant to acid. This may be perfect for a high traffic area recreation room, a laundry room or workshop area. Check it out. It may offer you an alternative to the traditional types of flooring.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

Look at it this way. If you were surfing on the Internet and you landed on a website that appealed to you and you wanted to buy something, but had a question, and could not find out how to contact the site owners, what would you do? If you’re like the vast majority of people on the Net these days, you go away and don’t come back. That just cost the website owner money. Additionally, if the one disgruntled surfer tells others about their experience, it will mean at least five other people will not visit your site either.

It can’t be emphasized enough that you need to be clear as a bell about how people may contact you to ask questions. More so in the insurance industry, because there will always be questions about policies and pricing and so forth. If you don’t have the information front and center on your site, and people have to hunt for it, consider them gone.

The fact is that an average website visitor will take a peek at about three of your web pages. If you have an interesting and up-to-date blog, they may stay longer. But, if the first page they land on is the home page, then the second page must, by necessity be your contact form(s). There are some proponents of having contact information on every web page on your site. While that might be necessary in some cases, this is something to discuss with a search engine optimization company with experience in marketing insurance. They know what you need, even before you know what you need.

Often the best answer to having contact information on all pages is to have a short contact form, similar to the longer one. That means that no matter what page a surfer lands on, they know they can get a hold of you by clicking on the shortcut form, filling it out and waiting for you to reply. “Contact us” buttons are not as effective as you may think, as many people don’t use them, preferring to fill out a form instead.

Ready to Quote is an insurance marketing company, ReadytoQuote.com. ReadytoQuote.com specializes in marketing insurance websites online. Learn more at ReadytoQuote.com.

If you hired the right search engine optimization company, one that understand the insurance biz inside out, this service would be performed for you every month. However, you could do it yourself just as easily by using a free tool (free is a good word when you want to save money) called the Ping-O-Matic. It is user friendly and you only have to spend about two minutes a month to check out what’s going on with your blog statistics.

Just head on over to www.pingomatic.com, owned by WordPress Foundation, and sign up. Be sure to remember to check mark all relevant blog search engines you send your feed to. When you’ve done that, just click on the “send pings” button and you will get a status page in short order. It’s kind of fun to watch what happens a day or so after you have updated your insurance website blog.

Pinging, as unassuming as it is, is a vital component in keeping those blog search engines up-to-the-minute with your new information, which in turn drives new traffic to your site. Relevant new content is always food for the engines. If you happen to have an insurance website built on WordPress, you can add a plugin that automatically gets your blog pinged every time you post. How easy is that?

Ready to Quote is an insurance marketing company, ReadytoQuote.com. ReadytoQuote.com specializes in marketing insurance websites online. Learn more at ReadytoQuote.com.

Homeowners with hardwood flooring just love it. They couldn’t be happier. However, even though they love it, they notice early signs of warping and gapping. This has to do with variable moisture levels in your home. Your floors are also affected by what you bring inside with you when you come in. Although it is difficult to keep all the sticks, leaves and small stones outside, making sure you have an area rug right by the door will help protect your floors.

Since it tends to be drier outside during the winter, this also affects your indoor temperatures. It is warmer inside to stave off the cold. Over time, the hardwood dries out and the boards shift, leaving small gaps in the flooring. Dry, cold winters mean a lower moisture level, and when you remove moisture from wood, it shrinks. You know that horrid squeak you have in the middle of the living room floor that makes everyone jump in the middle of the night when the dog walks over it? Thank dry hardwood flooring for that, and take steps to increase the humidity level inside your home.

One way to increase the relative humidity in your home is to use a humidifier. However, before you invest in one and keep it running all the time, ask a flooring contractor what the level should be, ideally, for the climate you live in. For instance, if you live in northeastern U.S. area, you get really harsh winters, and a humidifier may be the answer to help keep your hardwood flooring from shrinking. Think stand-alone units or one that may be attached to your furnace.

Again, mats make all the difference in the world when making sure your hardwood floor stays as clean and debris free as possible. They also help absorb rain, slush and other gunk, like runny mud. Better to have it on the carpet that you can wash, than on your hardwood floor. A mat also keeps small stones embedded and off the floor, avoiding scratches and abrasions.

Although all of this might sound like a lot of work to keep a floor looking nice, it is well worth it. A home with hardwood flooring that is in good shape and has been well-kept, brings a better price on the market.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

You know from running an insurance agency that many people do not understand insurance, what it does for them, what it includes and excludes and really, why they need it. They may understand it protects their health to a certain extent, but they do not think they can afford it. The truth of the matter is they cannot afford to not have insurance. That is where you and your insurance website come in. Insurance marketing involves customer’s education.

However, to educate your customers and potential customers, you need to draw them to your website and be able to convert them to policy buyers. To draw in visitors and give them what they want, ideally you should have an active/interactive blog, a site map, a frequently asked questions section and fresh articles and news releases every month. You, of course, also need relevant keywords and keyword phrases in order to properly optimize your insurance website. And, one thing you really need is an instant quoting function, as this, more than anything, will give potential conversions instant service; information on what it would cost for a policy.

The bottom line here is that people are far more likely to call an agency that gave them the information they wanted to know right away, rather than call an agency that made them hunt for answers and was not forthcoming about other information they needed. If you offer surfers a wealth of up-to-date relevant information that affects them, they will remember your site and come back, and likely buy a policy from you.

It’s not just about a nicely designed website, or one that is easy to navigate, although those are considerations for being online and presenting a dynamic presence. It is about the information you offer that makes a difference to people when they land on your site. You know you cannot offer everything online, but you can offer new things on a frequent basis. In the process, you educate your existing customers and potential buyers.

And here is another up-to-the-minute tip about utilizing your blog. Have your staff hop on and post items as well. For instance, post questions that come up while talking to customers and what the answer is. It’s a nice human touch that people appreciate. A blog is your immediate vehicle to get across a story, a new piece of information, a special on certain policies or to post customer stories and testimonials. It’s all good promotion in an interesting and engaging way. Why not hop onboard and get your insurance website up to speed to meet the online demands of today’s Internet.

Ready to Quote is an insurance marketing company, ReadytoQuote.com. ReadytoQuote.com specializes in marketing insurance websites online. Learn more at ReadytoQuote.com.

Many Americans have misconceptions about term life insurance, and in fact, about life insurance in general. They think getting it is a jinx, and might mean they will die earlier, that it is too expensive, that it is only for a limited time, and that they have no control over the contents or dispersal. None of these myths are true, but they are heard so often, people think they are the real deal.

Here is the truth. You, the buyer, may decide on a plan that suits your specific needs and then set a specific time on when and how much you want to pay for premiums. In short, you dictate what your want and ultimately purchase, not the agent. You just need to remember that a term policy is for life coverage only and you may buy terms for up to 30 years. If the insured dies, the policy pays out to the beneficiary the face value.

Where do you start your search for the right kind of term insurance; insurance that you are happy with and at ease with, knowing it will do what you wish it to do on your death? The best place to start a search is online, as this gives you enough choices to compare the various policies available. Can this be a confusing process?

It can be, as inevitably there will be terminology that is baffling and not as clear as you would like it to be. Just pick up the phone and call the agent. Cut directly to the chase. Tell them what you want, how you would like to achieve your goal(s) and let the agent make recommendations based on their intimate knowledge of the products they carry.

You will get a good sense of what is out there by comparing the details of what you find. The best policies will offer you solutions that are affordable and let you revise things as needed. Keep in mind that not all term life polices do offer those features, and if you want them, you should ask for them specifically. You also want to ask what renewable means when it comes to term life insurance policies.

Interestingly, so many people are so intently focused on the buying details that they forget to re-evaluate and update their policies every few years. Let’s face it. Life changes for everyone, and there is no sense in having a policy that suited your needs 20 years ago when your whole lifestyle is completely different now. For instance, you may now have adult children and a second wife and the beneficiary on the policy is still your first wife. These things need to change.

Clelland Green is with Benepath.com, a leader in providing health insurance quotes. Benepath provides individuals, families, and businesses with affordable health insurance quotes in just a few mouse clicks. To learn more, visit http://www.benepath.com.

Senate Bill 1770, sponsored by Sen. David Simmons, R-Altamonte Springs, is a large insurance reform effort, containing many changes that the insurance industry has long advocated for. However, critics say that if the bill becomes law, property insurance policy holders will see their rates go up. The bill targets the government-run Citizens, but may also cause rate increases.

Sen. Simmons said that the bill would reduce the high level of risk the state faces in the event of a major hurricane and would also reduce reliance on state-run insurance. Some Senators from coastal areas said that the bill would result in unmanageable rate increases for homeowners’ insurance. Consumer advocates criticized the lawmaking process, saying that public comment had been limited.

The bill would make the following changes in current law:

The rates charged by Citizens would be required to be actuarially sound, to not compete with private insurers and to carry an appropriate risk load. These measures could cause rate increases for customers of Citizens, who currently have a cap of 10 percent for increases in their rates.

When insurance companies purchase reinsurance to cover a potential hurricane, they would be permitted to charge higher rates. This means that customers of Citizens may be charged an additional 3 percent per year, though the assessment they would face after a major hurricane would also be lower.

Some of Citizens’ $6 billion surplus could be lent to private companies that would take over some of its policies, a move that would reduce the insurer’s resources and could result in higher rates for Citizens customers that remain.

For new policyholders at Citizens, as well as existing policies for second homes and homes worth more than $300,000, Citizens will be required to charge rates higher than those charged by the top 20 private
insurers.

When it comes time for renewal, Citizens policyholders will lose their coverage if a private insurance company offers a policy that can be up to 15 percent pricier than Citizens.

The bill has cleared the Banking and Insurance Committee and the Government Operations subcommittee. It must clear the Appropriations Committee before it faces a full floor vote in the Senate. If the bill passes both the Senate and the House, it will go to Gov. Rick Scott for his signature.

Learn more about Florida home insurance by visiting FloridaInsurance.com.

It’s never a good idea to cut corners too much when it comes to buying Tampa flooring tile for you home upgrade. This isn’t to say it may not be a steal of a deal, but when it comes right down to it, it won’t last as long as you want and you’ll be replacing it sooner than later. That means you haven’t really saved any money at all, just delayed the re-install a few years and then you need to put more cash out to fix or upgrade the floor again.

Another thing many do when it comes to selecting tile for their next home renovation project is choose discontinued tiles. Those typically come in at a really nice price, and are often high caliber, high quality tiles that will last longer and look good. However, check the bargain bin, because you will also find every day, not so wonderful tiles in the mixture as well. If you get lucky and find discounted marble, granite or limestone tiles, you’ve hit pay dirt and your budget will love you.

Certainly buying discontinued, quality tiles is a smart way to go, but be aware there are a couple of things you should know before buying them. The first thing is discontinued actually means no more tile like the one you are planning to buy will come on the market any time soon. So, what you see is what you get, and what you get will be all that you can get.

If the tiles are neutral enough to go anywhere and look good for years, this isn’t a drawback if you take care of them. However, if the discounted tiles are an interesting, brash shade of red or perhaps green, you might want to rethink buying them, unless you don’t mind replacing them in a few years when you tire of the color or a new color trend hits the market.

You may also get lucky on a hunt to try and match existing tiles in your home; the ideal solution to do the flooring in that laundry room extension you have been planning for years. The bonus here is that what you find should match flooring already down, making the job that much easier.

Or, you might only need a few replacement tiles to take care of the flooring you have right now. It might not be damaged now, but you can’t predict if it will be blemish free in the years to come. Pick up extra tiles for the “what if” things that happen in the life of your flooring.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.

Older adults have sexual needs, which have often been minimized by the rest of the population. Furthermore, older adults that live in nursing home environments also have sexual needs that often are left unaddressed. Although addressing the topic has often been a sticky subject, a British nursing home has recently made the news by addressing the sexual needs of their elderly in a less than commonly accepted therapeutic modality.  They have used prostitutes! Chaseley nursing home in Eastbourne, England has allegedly been using prostitutes to come into the facility to address the sexual needs of their older adult clientele.  The Times of London writes that those that have these special sexual encounters meet with the prostitute in a special designated room of the facility that is often identified by a hanging “red sock” on the door to in form everyone that the room is currently being used for the sexual therapeutic intervention.  A former manager for the nursing care center says that the nursing home’s use of prostitutes, which supposedly are acquired through a “third party contact,” helps to serve the sexual needs of the elderly. According to the staff member, not only is this serving a therapeutic need of the individual, but once their sexual needs are satisfied, it helps to address the needs of the institutional environment as well, by preventing residents from touching or groping other residents due to unsatisfied sexual needs.
A note from the editor of this blog: Prostitution is a legal business activity in England. The only place in the USA where prostitution is legal is the state of Nevada. If your facility is not in Nevada, proceed with caution!

Emeritus Gets Clobbered – Is it fair?
by Steve Moran

It was painful to read the news reports about the Emeritus guilty verdict.  After reading the first article about the case a few weeks ago, I assumed Emeritus was going to get dinged on this one,but it was unclear how bad it would be.  I first wrote about it in this article:  Case Study – “Suit:Facility let woman ‘waste away’”.  According to the story in the March 6, Sacramento Bee Story,the jury found Emeritus to be guilty, finding that “that an employee, officer, director or a managing agent acted with recklessness, malice, oppression and fraud.”  The family was given an initial award of more than $4,000,000 which will likely be reduced to around $250,000 because of statutory pain and suffering limits.  Then on Friday the jury awarded an additional $23 million in punitive damages. In the damage story, it came out that Emeritus had made a pretrial settlement offer of $3.5 million suggesting that from the very beginning they were expecting to get hurt.

What it Means

Emeritus is not known as a company that scrimps on resident care.  In fact the Emeritus people I know have a huge commitment to providing quality care and services to their resident.  It seems pretty clear this was an isolated problem at one community, with one resident  . . . something that happened 5 years ago.  Don’t get me wrong, I do think it was probably not unreasonable that Emeritus pay something.

That being said . . .
To take one single incident and use it to imply “recklessness, malice, oppression and fraud” is a huge stretch.  This is particularly true because in Emeritus is a good company and runs good senior communities. It is particularly frustrating that the Sacramento Bee was essentially a shill for the plaintiff attorneys.  They ran at least 3 stories that were heavily slanted against Emeritus. Most egregious is it appears that the article on closing arguments only covered the plantiff’s side and not the Emeritus defense. That is not reporting. To be honest, it appears there were some real problems with this particular situation:

●Several people have wondered if this woman should have ever been admitted.  It is a good question, but without seeing the specific facts, it seems to me that it was a reasonable, better quality of life for the resident, decision.

●It sounds like this woman was frail and was probably assisted with bathing, so the fact that the decubitus ulcers were not caught, documented, reported and addressed earlier is problematic.

●This has to be the worst nightmare for operators, because assuming there was a problem, it could very well come down to one or two staff members who didn’t do the things should have done.

●It seems unlikely that whatever happened had a substantial impact on the resident’s longevity which makes the $23 million look ridiculous.

●There seem to be several “facts” that proved Emeritus provided substandard care, that even if true, don’t seem to have substantive relevance to the case.  The one that really caught my eye was the allegation that on at least one occasion, there was no dedicated night shift memory care staff member (or at least no record of it).  This seems to be mostly emotional smoke without fire;surely not an ideal thing, but the implication that somehow this caused the community to miss the skin problems makes no sense

●I feel particularly bad for all the hardworking dedicated Emeritus team members who work hard each day providing great care for their seniors that have now been tainted.

●It suggests it is now open season, at least in California, for assisted living providers.  Again something that will make it harder to provide great care for seniors.
In truth, this week and in the weeks to follow, the fine providers of assisted living, includingthose who work for Emeritus will continue to provide quality compassionate care to seniors in the state of California.  This case and the on-going threat of litigation will force senior communities to be more careful, to expend more time and energy on protecting themselves from predatory attorneys.  This in turn means higher costs.
Union contracts drive 5 Connecticut nursing homes into bankruptcy.
By Bill McMorris

The Washington Free Beacon

Lucrative union contracts have driven five Connecticut nursing homes at the center of a labor dispute into bankruptcy. HealthBridge Management has entered five of its nursing homes into Chapter 11 bankruptcy to escape labor contracts that left the company losing $1.3 million each month, according to senior vice president of labor relations Lisa Crutchfield.  “The centers have a bright future if they can operate under labor agreements that reflect today’s financial realities, but the fact is the centers will not survive unless we have relief from the crushing burden of unsustainable labor costs, especially the spiraling costs of pension and health care obligations,” Crutchfield said in a press release.  The nursing homes’ costs have soared after negotiating lush contracts with the politically powerful Service Employees International Union Local 1199 NE in 2004, according to the company. The company spent nearly 50 percent more on employee benefits than the average Connecticut nursing home.  “There is no getting around the fact that SEIU District 1199 labor agreements are the leading reason for nursing home closures in Connecticut. That’s bad for patients, employees, physicians and the communities they serve,”Ms. Crutchfield said. “In our case, the union’s collective bargaining agreements hobble the centers with labor costs that are well above state averages and which are simply unsustainable.”  The nursing homes are asking a New Jersey bankruptcy court to amend the contracts since the union has not accepted concessions on pay and benefits. “This bankruptcy filing is the latest in along string of actions by HealthBridge aimed at avoiding their legal obligations to more than 600 hardworking nursing home caregivers across Connecticut and at chipping away at the quality of care for patients—a cynical evasion of responsibility to Connecticut working families and their communities,” District 1199 president David Pickus said.  HealthBridge was left with few options after the embattled National Labor Relations Board ordered the company to rehire 600 striking union members despite allegations that the workers endangered patients during a July walkout. The Connecticut State Police are investigating whether union members mixed up patient medical records and identification documents during the strike.
Lorraine Mulligan, a veteran nurse, pleaded with the NLRB to keep the accused union members away from patients. “The nature and severity of the … incidents … put the safety, health, and well-being of the residents of those facilities in immediate jeopardy,” she said in a legal brief filed by HealthBridge. “A court order requiring the reinstatement of any of them or additionally those who had knowledge of sabotage and failed to act would expose the residents to immediate danger and put them at risk of suffering serious harm or death.”  HealthBridge and Care One,another nursing home company, are suing the union on charges of racketeering and extortion in connection to the walkout and other instances of alleged vandalism. The bankruptcy declaration will put that suit on hold for the time being, according to a source familiar with the case. The company claims it is just the latest victim of financial giveaways to the union. SEIU 1199represents 19,000 workers in Connecticut and has contracts in place at nearly 30 percent of state nursing homes. Nearly 70 percent of state nursing home bankruptcies have emerged in centers with SEIU contracts in place, according to HealthBridge.

Conquering C. difficile in LTC
by Pamela Tabar, Senior Editor, Long Term

Living Clostridium difficile (C. diff.) leads to 14,000 deaths per year in the United States, and the numbers are on the rise. The illness often plagues those who have received antibiotics,exacerbated by the fact that C. diff itself is resistant to antibiotic treatments. A single infected patient costs an average of $35,000 to treat, according to the newly updated Guide to Preventing Clostridium difficile Infections released yesterday. The virulent microbe and the challenges it poses across healthcare settings is the topic of a two-day educational conference this week hosted by the Association for Professionals in Infection Control and Epidemiology (APIC).  C. diff outbreaks can be especially difficult to contain and eradicate within long-term and post-acutecare settings, said Phenelle Segal, RN, CIC, president of Infection Control Consulting Services, Delray Beach, Fla., in her presentation “Practical Strategies to Control the Spread of C. difficile in Healthcare,” broadcast during the 2013 Clostridium difficile Educational and Consensus Conference. The community-based nature of skilled nursing facilities (SNFs) often creates special problems when caring for residents with C. diff, especially if there is no way to cohort infected residents. Semi-private rooms with shared bathrooms can cause issues if a resident needs the toilet immediately, yet using bedside commodes or bedpans can pose risks to caregivers. The ideal protocol would be to isolate infected residents, but it’s not practical or even possible in most long-term care settings, Segal says. “You can’t just move them. It’s their bedroom in their home, they have all their things set up and their pictures on the wall. it’s a huge challenge for long-term care.”  One thing caregivers can do is control what happens upon entering and exiting the resident’s room. The use of gloves and gowns is crucial since the disease is capable of surviving on surfaces for five months and also spreads via spores, Segal explains.  Vibrant disagreement surrounds the effectiveness of alcohol-based hand sanitizers vs. hand-washing.Alcohol-based sanitizers are appropriate in many instances, but they are not a silver bullet for everything. For example, hand-washing is crucial if the skin comes into contact with feces, since alcohol-based hand sanitizers cannot penetrate protein material, Segal says. “We’ve come a long way with hand hygiene, but we still have a long way to go. One of the biggest problems in LTCis the injudicious use of antimicrobials.”  Segal also suggests that all LTC facilities form an antimicrobial stewardship program to educate all staff, including non-medical departments like housekeeping. Stewardship techniques include Positive Deviance and Team STEPPS, but Segal says regardless of the approach, teams should include housekeeping, administration and  pharmacists as well as nurses and physicians. “The best approach is a group of healthcare workers who are experts in different areas united as a team,” she says. APIC’s Guide to Preventing Clostridium difficile Infections encourages SNFs to use the following strategies when caring for a resident with C. diff.:

●Gloves should be put on before entering and taken off before exiting the resident’s room.

●If a bedpan is needed, use a disposable one. For commodes, consider disposable liners.

●Suspend the use of rectal thermometers.

●Don’t share medical devices or equipment among infected and non-infected residents.

●If a roommate is unavoidable, choose someone who is not taking antibiotics and is healthy enough to fend off infections.

●Anything that has come in contact with fecal material from an infected patient should beconsidered infectious material. Proper cleaning and/or proper disposal is essential.

●Cleaning products must be able to kill the C. diff spores as well as the cells in order to beeffective. The Environmental Protection Agency considers bleach-based or strong hydrogenperoxide disinfectants to be the best spore-killers.

Policy Experts Agree: The U.S. System for Financing Long-Term Care is Crumbling
By Howard GleckmanAmerica’s system for financing long-term care is failing, and the window for creating a paymentsystem that works is rapidly closing. That was the conclusion of a morning-long expert sessionsponsored last week by the SCAN Foundation. While the participants differed on specificsolutions, most agreed on four key issues:
●The existing system for funding paid long-term supports and services is built on a wobblythree-legged stool: low private savings, an underfunded Medicaid program, and a hobbled privatelong-term care insurance market.

●The solution must include an affordable way for Americans to prefund their long-term care costs. This could include tapping financial assets or home equity, or buying insurance (either government, private, or some combination of both). Low-income people would require some form of safety net protection.

●Any future system should finance high-quality long-term supports and services that are well-integrated with medical care. This is especially important since recipients of care services suffer from chronic disease or injury that often requires complex medical interventions.

●There is currently no political consensus on how to do any of this.

That is where everyone agreed. Here is where they did not:
Several panelists focused on ways to enhance private insurance, where the market for traditional long-term care coverage has effectively collapsed. A paper by Marc Cohen of Lifeplans, Inc. and professors Richard Frank and Neale Mahoney of Harvard described a broad package of design changes that might make policies more attractive. Their ideas include simplifying and standardizing insurance products, indexing premiums annually instead of requiring carriers to ask for big rate increases every few years, allowing insurers to sell high-deductible plans (where buyers could be responsible for as much as two years of LTC costs), and better educating consumers about the price of long-term care and the limited government resources available to pay for it.  They also propose industry-funded reinsurance pools that would protect in insurers against unanticipated risks. Another suggestion: Require that companies over a certain size offer LTC insurance and force workers to buy unless they make an active choice to reject insurance.They also recommend new highly-targeted government subsidies, such as tax credits, to encourage moderate-income consumers to purchase long-term care insurance.  Finally, they suggest linking long-term care and health insurance, an idea I raised last year.  Several of their proposals, such as catastrophic coverage and standardized plan designs, are aimed at substantially lowering rates.  Expanding the role of employers may be especially critical since 80 percent of workers currently have no access to coverage through their jobs, according to a separate paper by Jeremy Pincus and colleagues at the insurance industry consulting firm Forbes Consulting Group. Like Cohen, Frank, and Mahoney; Pincus also believes an employer mandate would significantly boost the number of workers who would buy LTC insurance. But all that may not be enough.Other conference participants felt that even with these broad-based changes, voluntary private insurance would remain unattractive for many people. As a result, some sort universal coverageis the only way to make LTC insurance truly affordable for middle-income households.Voluntary insurance, even with reforms, would remain out of reach for tens of millions of middle-income people.  Anne Tumlinson of the consulting firm Avalere Health, Josh Wiener of RTI International  and their co-authors found that mandatory insurance would be significantly less expensive than voluntary coverage. Tumlinson said that maintaining the voluntary system would do little more than preserve the unworkable status quo. Insurance officials tell me privately that, even in the best case, perhaps 20 percent of Americans would buy voluntary LTC insurance. Perhaps another one-third have lifetime incomes so low that they can’t be expected to pay for their own care, either through savings or insurance, and will need some sort of public support.  That leaves perhaps half the country at risk. The challenge for policy makers and the market is to figure out what will work for them. The SCAN program was a great start, but much more needs to be done.

Older adults have sexual needs, which have often been minimized by the rest of the population. Furthermore, older adults that live in nursing home environments also have sexual needs that often are left unaddressed. Although addressing the topic has often been a sticky subject, a British nursing home has recently made the news by addressing the sexual needs of their elderly in a less than commonly accepted therapeutic modality.  They have used prostitutes! Chaseley nursing home in Eastbourne, England has allegedly been using prostitutes to come into the facility to address the sexual needs of their older adult clientele.  The Times of London writes that those that have these special sexual encounters meet with the prostitute in a special designated room of the facility that is often identified by a hanging “red sock” on the door to in form everyone that the room is currently being used for the sexual therapeutic intervention.  A former manager for the nursing care center says that the nursing home’s use of prostitutes, which supposedly are acquired through a “third party contact,” helps to serve the sexual needs of the elderly. According to the staff member, not only is this serving a therapeutic need of the individual, but once their sexual needs are satisfied, it helps to address the needs of the institutional environment as well, by preventing residents from touching or groping other residents due to unsatisfied sexual needs.
A note from the editor of this blog: Prostitution is a legal business activity in England. The only place in the USA where prostitution is legal is the state of Nevada. If your facility is not in Nevada, proceed with caution!

Emeritus Gets Clobbered – Is it fair?
by Steve Moran

It was painful to read the news reports about the Emeritus guilty verdict.  After reading the first article about the case a few weeks ago, I assumed Emeritus was going to get dinged on this one,but it was unclear how bad it would be.  I first wrote about it in this article:  Case Study – “Suit:Facility let woman ‘waste away’”.  According to the story in the March 6, Sacramento Bee Story,the jury found Emeritus to be guilty, finding that “that an employee, officer, director or a managing agent acted with recklessness, malice, oppression and fraud.”  The family was given an initial award of more than $4,000,000 which will likely be reduced to around $250,000 because of statutory pain and suffering limits.  Then on Friday the jury awarded an additional $23 million in punitive damages. In the damage story, it came out that Emeritus had made a pretrial settlement offer of $3.5 million suggesting that from the very beginning they were expecting to get hurt.

What it Means

Emeritus is not known as a company that scrimps on resident care.  In fact the Emeritus people I know have a huge commitment to providing quality care and services to their resident.  It seems pretty clear this was an isolated problem at one community, with one resident  . . . something that happened 5 years ago.  Don’t get me wrong, I do think it was probably not unreasonable that Emeritus pay something.

That being said . . .
To take one single incident and use it to imply “recklessness, malice, oppression and fraud” is a huge stretch.  This is particularly true because in Emeritus is a good company and runs good senior communities. It is particularly frustrating that the Sacramento Bee was essentially a shill for the plaintiff attorneys.  They ran at least 3 stories that were heavily slanted against Emeritus. Most egregious is it appears that the article on closing arguments only covered the plantiff’s side and not the Emeritus defense. That is not reporting. To be honest, it appears there were some real problems with this particular situation:

●Several people have wondered if this woman should have ever been admitted.  It is a good question, but without seeing the specific facts, it seems to me that it was a reasonable, better quality of life for the resident, decision.

●It sounds like this woman was frail and was probably assisted with bathing, so the fact that the decubitus ulcers were not caught, documented, reported and addressed earlier is problematic.

●This has to be the worst nightmare for operators, because assuming there was a problem, it could very well come down to one or two staff members who didn’t do the things should have done.

●It seems unlikely that whatever happened had a substantial impact on the resident’s longevity which makes the $23 million look ridiculous.

●There seem to be several “facts” that proved Emeritus provided substandard care, that even if true, don’t seem to have substantive relevance to the case.  The one that really caught my eye was the allegation that on at least one occasion, there was no dedicated night shift memory care staff member (or at least no record of it).  This seems to be mostly emotional smoke without fire;surely not an ideal thing, but the implication that somehow this caused the community to miss the skin problems makes no sense

●I feel particularly bad for all the hardworking dedicated Emeritus team members who work hard each day providing great care for their seniors that have now been tainted.

●It suggests it is now open season, at least in California, for assisted living providers.  Again something that will make it harder to provide great care for seniors.
In truth, this week and in the weeks to follow, the fine providers of assisted living, includingthose who work for Emeritus will continue to provide quality compassionate care to seniors in the state of California.  This case and the on-going threat of litigation will force senior communities to be more careful, to expend more time and energy on protecting themselves from predatory attorneys.  This in turn means higher costs.
Union contracts drive 5 Connecticut nursing homes into bankruptcy.
By Bill McMorris

The Washington Free Beacon

Lucrative union contracts have driven five Connecticut nursing homes at the center of a labor dispute into bankruptcy. HealthBridge Management has entered five of its nursing homes into Chapter 11 bankruptcy to escape labor contracts that left the company losing $1.3 million each month, according to senior vice president of labor relations Lisa Crutchfield.  “The centers have a bright future if they can operate under labor agreements that reflect today’s financial realities, but the fact is the centers will not survive unless we have relief from the crushing burden of unsustainable labor costs, especially the spiraling costs of pension and health care obligations,” Crutchfield said in a press release.  The nursing homes’ costs have soared after negotiating lush contracts with the politically powerful Service Employees International Union Local 1199 NE in 2004, according to the company. The company spent nearly 50 percent more on employee benefits than the average Connecticut nursing home.  “There is no getting around the fact that SEIU District 1199 labor agreements are the leading reason for nursing home closures in Connecticut. That’s bad for patients, employees, physicians and the communities they serve,”Ms. Crutchfield said. “In our case, the union’s collective bargaining agreements hobble the centers with labor costs that are well above state averages and which are simply unsustainable.”  The nursing homes are asking a New Jersey bankruptcy court to amend the contracts since the union has not accepted concessions on pay and benefits. “This bankruptcy filing is the latest in along string of actions by HealthBridge aimed at avoiding their legal obligations to more than 600 hardworking nursing home caregivers across Connecticut and at chipping away at the quality of care for patients—a cynical evasion of responsibility to Connecticut working families and their communities,” District 1199 president David Pickus said.  HealthBridge was left with few options after the embattled National Labor Relations Board ordered the company to rehire 600 striking union members despite allegations that the workers endangered patients during a July walkout. The Connecticut State Police are investigating whether union members mixed up patient medical records and identification documents during the strike.
Lorraine Mulligan, a veteran nurse, pleaded with the NLRB to keep the accused union members away from patients. “The nature and severity of the … incidents … put the safety, health, and well-being of the residents of those facilities in immediate jeopardy,” she said in a legal brief filed by HealthBridge. “A court order requiring the reinstatement of any of them or additionally those who had knowledge of sabotage and failed to act would expose the residents to immediate danger and put them at risk of suffering serious harm or death.”  HealthBridge and Care One,another nursing home company, are suing the union on charges of racketeering and extortion in connection to the walkout and other instances of alleged vandalism. The bankruptcy declaration will put that suit on hold for the time being, according to a source familiar with the case. The company claims it is just the latest victim of financial giveaways to the union. SEIU 1199represents 19,000 workers in Connecticut and has contracts in place at nearly 30 percent of state nursing homes. Nearly 70 percent of state nursing home bankruptcies have emerged in centers with SEIU contracts in place, according to HealthBridge.

Conquering C. difficile in LTC
by Pamela Tabar, Senior Editor, Long Term

Living Clostridium difficile (C. diff.) leads to 14,000 deaths per year in the United States, and the numbers are on the rise. The illness often plagues those who have received antibiotics,exacerbated by the fact that C. diff itself is resistant to antibiotic treatments. A single infected patient costs an average of $35,000 to treat, according to the newly updated Guide to Preventing Clostridium difficile Infections released yesterday. The virulent microbe and the challenges it poses across healthcare settings is the topic of a two-day educational conference this week hosted by the Association for Professionals in Infection Control and Epidemiology (APIC).  C. diff outbreaks can be especially difficult to contain and eradicate within long-term and post-acutecare settings, said Phenelle Segal, RN, CIC, president of Infection Control Consulting Services, Delray Beach, Fla., in her presentation “Practical Strategies to Control the Spread of C. difficile in Healthcare,” broadcast during the 2013 Clostridium difficile Educational and Consensus Conference. The community-based nature of skilled nursing facilities (SNFs) often creates special problems when caring for residents with C. diff, especially if there is no way to cohort infected residents. Semi-private rooms with shared bathrooms can cause issues if a resident needs the toilet immediately, yet using bedside commodes or bedpans can pose risks to caregivers. The ideal protocol would be to isolate infected residents, but it’s not practical or even possible in most long-term care settings, Segal says. “You can’t just move them. It’s their bedroom in their home, they have all their things set up and their pictures on the wall. it’s a huge challenge for long-term care.”  One thing caregivers can do is control what happens upon entering and exiting the resident’s room. The use of gloves and gowns is crucial since the disease is capable of surviving on surfaces for five months and also spreads via spores, Segal explains.  Vibrant disagreement surrounds the effectiveness of alcohol-based hand sanitizers vs. hand-washing.Alcohol-based sanitizers are appropriate in many instances, but they are not a silver bullet for everything. For example, hand-washing is crucial if the skin comes into contact with feces, since alcohol-based hand sanitizers cannot penetrate protein material, Segal says. “We’ve come a long way with hand hygiene, but we still have a long way to go. One of the biggest problems in LTCis the injudicious use of antimicrobials.”  Segal also suggests that all LTC facilities form an antimicrobial stewardship program to educate all staff, including non-medical departments like housekeeping. Stewardship techniques include Positive Deviance and Team STEPPS, but Segal says regardless of the approach, teams should include housekeeping, administration and  pharmacists as well as nurses and physicians. “The best approach is a group of healthcare workers who are experts in different areas united as a team,” she says. APIC’s Guide to Preventing Clostridium difficile Infections encourages SNFs to use the following strategies when caring for a resident with C. diff.:

●Gloves should be put on before entering and taken off before exiting the resident’s room.

●If a bedpan is needed, use a disposable one. For commodes, consider disposable liners.

●Suspend the use of rectal thermometers.

●Don’t share medical devices or equipment among infected and non-infected residents.

●If a roommate is unavoidable, choose someone who is not taking antibiotics and is healthy enough to fend off infections.

●Anything that has come in contact with fecal material from an infected patient should beconsidered infectious material. Proper cleaning and/or proper disposal is essential.

●Cleaning products must be able to kill the C. diff spores as well as the cells in order to beeffective. The Environmental Protection Agency considers bleach-based or strong hydrogenperoxide disinfectants to be the best spore-killers.

Policy Experts Agree: The U.S. System for Financing Long-Term Care is Crumbling
By Howard GleckmanAmerica’s system for financing long-term care is failing, and the window for creating a paymentsystem that works is rapidly closing. That was the conclusion of a morning-long expert sessionsponsored last week by the SCAN Foundation. While the participants differed on specificsolutions, most agreed on four key issues:
●The existing system for funding paid long-term supports and services is built on a wobblythree-legged stool: low private savings, an underfunded Medicaid program, and a hobbled privatelong-term care insurance market.

●The solution must include an affordable way for Americans to prefund their long-term care costs. This could include tapping financial assets or home equity, or buying insurance (either government, private, or some combination of both). Low-income people would require some form of safety net protection.

●Any future system should finance high-quality long-term supports and services that are well-integrated with medical care. This is especially important since recipients of care services suffer from chronic disease or injury that often requires complex medical interventions.

●There is currently no political consensus on how to do any of this.

That is where everyone agreed. Here is where they did not:
Several panelists focused on ways to enhance private insurance, where the market for traditional long-term care coverage has effectively collapsed. A paper by Marc Cohen of Lifeplans, Inc. and professors Richard Frank and Neale Mahoney of Harvard described a broad package of design changes that might make policies more attractive. Their ideas include simplifying and standardizing insurance products, indexing premiums annually instead of requiring carriers to ask for big rate increases every few years, allowing insurers to sell high-deductible plans (where buyers could be responsible for as much as two years of LTC costs), and better educating consumers about the price of long-term care and the limited government resources available to pay for it.  They also propose industry-funded reinsurance pools that would protect in insurers against unanticipated risks. Another suggestion: Require that companies over a certain size offer LTC insurance and force workers to buy unless they make an active choice to reject insurance.They also recommend new highly-targeted government subsidies, such as tax credits, to encourage moderate-income consumers to purchase long-term care insurance.  Finally, they suggest linking long-term care and health insurance, an idea I raised last year.  Several of their proposals, such as catastrophic coverage and standardized plan designs, are aimed at substantially lowering rates.  Expanding the role of employers may be especially critical since 80 percent of workers currently have no access to coverage through their jobs, according to a separate paper by Jeremy Pincus and colleagues at the insurance industry consulting firm Forbes Consulting Group. Like Cohen, Frank, and Mahoney; Pincus also believes an employer mandate would significantly boost the number of workers who would buy LTC insurance. But all that may not be enough.Other conference participants felt that even with these broad-based changes, voluntary private insurance would remain unattractive for many people. As a result, some sort universal coverageis the only way to make LTC insurance truly affordable for middle-income households.Voluntary insurance, even with reforms, would remain out of reach for tens of millions of middle-income people.  Anne Tumlinson of the consulting firm Avalere Health, Josh Wiener of RTI International  and their co-authors found that mandatory insurance would be significantly less expensive than voluntary coverage. Tumlinson said that maintaining the voluntary system would do little more than preserve the unworkable status quo. Insurance officials tell me privately that, even in the best case, perhaps 20 percent of Americans would buy voluntary LTC insurance. Perhaps another one-third have lifetime incomes so low that they can’t be expected to pay for their own care, either through savings or insurance, and will need some sort of public support.  That leaves perhaps half the country at risk. The challenge for policy makers and the market is to figure out what will work for them. The SCAN program was a great start, but much more needs to be done.

Many Tampa flooring contractors choose slate for floors, walls and counter tops, and the reason for their choice is that slate is a natural material and no two tiles are the same. They can be used in a residential or commercial job and still look appealing and attractive. Slate tiles suit any décor.

One of the latest trends is slate flooring in all rooms of the house, but if you prefer, just do the kitchen and bathroom. Slate is very durable; making it an ideal choice for high traffic areas, and being slip resistant means a great choice of flooring. If you are not sure what to use in the room of choice, there are different kinds of slate. Choose what you want according to the theme of the room. For example, black slate will offer a nice contemporary ambiance.  The choices are endless and no matter what you choose, slate will do right by your interior.

You might even want to think about using slate for any countertops in either the bathroom or kitchen. This adds a nice touch of class to any room and you can have whatever look suits your fancy. Slate is regarded as being low maintenance and relatively stain resistant and you can match the countertop to the flooring or select a complementary color instead. You can’t go wrong with slate.

When the interior is done, consider the outside. What about the patio area? Slate does wonders for just about any outside area and provides an appealing touch of charm to any space. Simply choose the right color to suit a mood or theme and then choose the size and pattern that best suits your lifestyle preferences. It’s a slam dunk and will likely be the talk of the neighborhood.

But if you really want to capture people’s attention, use slate tiles on your roof. They’re ideal. Weather resistant and long lasting, not to mention a bit less expensive than other roofing materials you could choose, using slate also means replacing the roof less often; a real bonus in the long run.

In short, slate tiling is highly versatile, attractive, reasonable priced, long lasting, flexible, adaptable, easy to maintain, and looks good in any room. Try to choose the best quality tiling you can, as it will serve you well over the years. If you have concerns about installing it, talk to a local Tampa flooring contractor.

Dean Dupre is with Champion Tile, a Clearwater Flooring, Tampa Flooring, and tile installation company. To learn more, visit Champtile.com.