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.

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

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

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

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

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

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

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

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

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.

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

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.

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

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

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

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.

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.

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.

If you want the right kind of SEO marketing for your insurance agency, then you need to find a real insurance marketing pro; ideally one with experience in the insurance industry. There are not a lot of SEO outfits that fit that bill, so when you find one, it’s time to find out what they can do specifically for you. Marketing insurance is difficult on a good day, and in this economy, you need all the help you can get. It’s a competitive industry and you want to stand out ahead of the pack.

Of course by now, you likely already have a website but perhaps are not that thrilled with the way it is, or is not, performing for you. You get visitors, but they don’t stay long. They sometimes ask for quotes, but then don’t respond to your call. This issue could be solved in a variety of ways. For instance, you may not yet have added an instant quoting function to your website. This will jump your traffic quite nicely and offer customers what they want – instant information.

Insurance websites with an instant quoting function do provide more quotes and write more policies than a site that does not offer a service like that. People want things right away when they make up their minds that the time is right to buy something, and that includes insurance policies. If your website offers them what they want and you follow up and provide excellent service, you will start converting your traffic to sales —- a huge bonus.

If you do not yet have a website and want to get going, then you need a design team with insurance experience building insurance websites. Throw in the SEO experience, a dynamite web designer, solid writing for your monthly articles and news releases (to keep the search engines happy) and you have a winning combination. Think it is expensive? It does come with a price tag, but a properly designed SEO marketing strategy offers you the highest ROI for your marketing dollars, and bottom line, it is more affordable than advertising on the radio, in papers and magazines or on T.V.

Besides, there is another adage about spending money to make money that holds true in these kinds of circumstances. If you want to attract customers and increase your revenue, you need to have a site that captures their attention and converts them to customers.

Ready to Quote is an insurance marketing company, ReadytoQuote.com. ReadytoQuote.com specializes in marketing insurance websites online. Learn more at http://www.readytoquote.com.
Ready to Quote is an insurance marketing company, ReadytoQuote.com. ReadytoQuote.com specializes in marketing insurance websites online. Learn more at ReadytoQuote.com.

by Steve Moran

Suit: Facility let woman ‘waste away’ is the title of a front page article in the Sacramento Bee, my local paper. Here is a brief summary of the lawsuit: Joan Boice was suffering from Alzheimer’s and was no longer able to live at home. In September 2008 she was moved into Emeritus at Emerald Hills, in Auburn (a community in the foothills outside of Sacramento) Three months later the community discovered pressure ulcers had formed on both of her feet, her right hip and her right elbow. Emerald Hills staff immediately began the process of having her transferred to a skilled nursing facility. She died 3 months after being moved the memory care building to a skilled nursing building. Here are the charges being made by the family: Emeritus is only commitment is to growing their empire and making money. They had inadequate staffing and staff training They should never have admitted her to the community as frail as she was It is unclear if they are suggesting they should have never let the wounds develop or if the primary error was not promptly noticing and addressing them. Here are the questions/issues (some legal, some operational) Should she have been admitted in the first place? Did she have pressure sores when she was admitted? When were the pressure sores first discovered? (There is conflicting evidence) Should the community have discovered the pressure sores sooner? Is this a case of being too aggressive about getting one more head in a bed? At what point should care givers have noticed newly formed pressure sores? Is this just a case of greedy lawyers taking advantage of a terrible situation or do they have a righteous cause? Who’s fault was this . . . if anyone’s? Does the family have any responsibility in all of this? Given that she may very well have died in the same time frame, should the company have any financial obligation here?

US News and World Reports 2013 Best Nursing Homes Report

by Steve Moran

California has better nursing homes than any other state in the US . . . it has to be a joke right? The vaunted magazine US News & World Report has just released their 2013 list of best nursing homes. I was astonished to see that California led the way in having the most and highest percentage of highly rated skilled nursing facilities. California did not lead by just a little bit. It “has twice as many highly rated homes as any other state, or in a region”. I found myself saying “Huh?” I live in California and in my many years in the senior housing industry I have been in maybe 2 or 3 thousand senior housing communities across with country and in more than half of all the licensed skilled nursing buildings in the State of California. I don’t think anyone who is objective about skilled nursing in this country, would ever try to make a credible argument that overall, California has the best nursing homes in the country. Within the skilled nursing community it is well known that the 5 star system is very flawed and in fact provides consumers very little in the way of useful information. A quick google search will provide a variety of articles that question the 5 star rating system. Here is my take after reading the article and browsing the list: US News & World Report has done a shabby job of reporting. In fact, they didn’t do any serious reporting or they would have been more cautious about equating a 5 star rating with the highest quality care. It confirms that the 5 star system continues to be flawed. This is not to say it has no value, but I would argue that at best, it’s value is primarily as a early detection tool to identify and rule out terrible nursing homes. The one reliable conclusion you can draw from the list is that the highly rated skilled buildings are experts at getting a high rating 5 star rating. There are some really great skilled nursing buildings in California and other states that don’t have a 5 star rating. In fact often these buildings take on patients with complex problems and get terrific results, but because those patients are complex it hurts their star rating.

How do you place your MDS Coordinator on the organizational chart?

Do they report to the DON or to the NHA? Analyzing trends related to enhanced realized gains/maximization. We agree that the MDS Coordinator role is “intrinsically integrative,” with potential to impact quality of care. However, the potential of the MDS Coordinator to influence important care processes such as assessment, decision-making and care planning may be moderated by the quality of their relationship patterns across the organization. Maximizing that potential by attention to relationships patterns among staff can help to unlock that capacity of the MDS Coordinator to positively influence care processes and improve quality of care. Its not Just the DON or NHA Good connections exists when there is latitude to interact and freedom to share information with others who can best use that information. Some connections occur naturally when staff members interact to do work. The number, variety, and quality of these connections influence the extent to which staff learns and the extent to which the organization is capable of change. New information flow refers to the exchange of information within or across levels of the organization. New information of good quality provides knowledge that the staff can use to adjust their work behavior. This information may be general, such as the mission of an organization, or specific, such as communication from a Certified Nursing Assistant (CNA) to a floor nurse that a resident appears more confused than is usual. This new information flow promotes mutual exchange of information for the purpose of understanding and making sense of a situation, allowing staff to adjust their behavior to meet emerging demands

Family Communications Important Aspect of Long-Term Care Facility Norovirus Prevention Measures

From Groupcast

Norovirus prevention measures implemented at senior living and skilled nursing centers demand improved family and visitor communications. Restricted access and containment measures are often at odds with family members’ desire to visit their loved ones. Immediate and ongoing communications with family members at the outset and during the quarantine are key to success. The norovirus, a fast-moving gastrointestinal virus, spreads quickly in settings where the community members are in close proximity and share eating facilities. Nursing homes, cruise ships, hotels, and schools are all locations where such a virus can rapidly spread from member to member. Unlike the vast majority of schools in the US, which now have implemented school-wide notification systems, many senior living and skilled nursing centers lack the ability to immediately reach key family members. For nursing facilities, the CDC recommends fast action to prevent norovirus outbreaks, including restricting visitation, separating residents during mealtimes, restricted activities, and quarantining known cases. Each of these measures can be of major concern to a family member, especially those who are accustomed to unfettered access to their mom, dad, or other senior family member. The key to addressing the concerns of family members is by increasing the level and frequency of communication, preferably by way of direct messaging, beginning with the instant the heightened measures are implemented. With a system such as GroupCast, which is already in use at numerous senior living centers, a facility administrator could effortlessly record a personal message to family members and broadcast it instantly to their home and cell phone numbers. As the conditions persist or expire, periodic norovirus communications should also be sent advising family members of facility conditions, how to get more information on the loved one’s status, expectations as to the duration of the restrictions,etc. According to the CDC, nearly 60% of norovirus cases occur at long-term care facilities: “Healthcare facilities, including nursing homes and hospitals, are the most commonly reported settings for norovirus outbreaks in the United States and other industrialized countries (see Norovirus in Healthcare Settings). Nearly two-thirds of all norovirus outbreaks reported in the United States occur in long-term care facilities.”

Outbreaks can sometimes last months according to the CDC: “Outbreaks in these settings can be quite long, sometimes lasting months. Illness can be more severe, occasionally even fatal, in hospitalized or nursing home patients compared with otherwise healthy people.” Prolonged modification of visitation and care programs can place extreme stress on caring family members. Heightened levels of mass communication with the family members is the key to successful disease management. Otherwise, the facility will be fighting two battles – the norovirus and irate family members demanding to know what is happening with their loved ones. Proactive communication will reduce stress on both sides and will serve to reduce inquiries to care staff from family members seeking information on the restrictions and when they will be lifted. Systems like GroupCast are the answer. Low-cost, easy-to-use, and highly effective, a mass notification system such as GroupCast can cover all forms of notification including phone broadcast, email broadcast and text messages. These are the very reasons why they have been so heavily embraced by schools, and why they should be equally embraced by long-term care facilities.

by Steve Moran

Suit: Facility let woman ‘waste away’ is the title of a front page article in the Sacramento Bee, my local paper. Here is a brief summary of the lawsuit: Joan Boice was suffering from Alzheimer’s and was no longer able to live at home. In September 2008 she was moved into Emeritus at Emerald Hills, in Auburn (a community in the foothills outside of Sacramento) Three months later the community discovered pressure ulcers had formed on both of her feet, her right hip and her right elbow. Emerald Hills staff immediately began the process of having her transferred to a skilled nursing facility. She died 3 months after being moved the memory care building to a skilled nursing building. Here are the charges being made by the family: Emeritus is only commitment is to growing their empire and making money. They had inadequate staffing and staff training They should never have admitted her to the community as frail as she was It is unclear if they are suggesting they should have never let the wounds develop or if the primary error was not promptly noticing and addressing them. Here are the questions/issues (some legal, some operational) Should she have been admitted in the first place? Did she have pressure sores when she was admitted? When were the pressure sores first discovered? (There is conflicting evidence) Should the community have discovered the pressure sores sooner? Is this a case of being too aggressive about getting one more head in a bed? At what point should care givers have noticed newly formed pressure sores? Is this just a case of greedy lawyers taking advantage of a terrible situation or do they have a righteous cause? Who’s fault was this . . . if anyone’s? Does the family have any responsibility in all of this? Given that she may very well have died in the same time frame, should the company have any financial obligation here?

US News and World Reports 2013 Best Nursing Homes Report

by Steve Moran

California has better nursing homes than any other state in the US . . . it has to be a joke right? The vaunted magazine US News & World Report has just released their 2013 list of best nursing homes. I was astonished to see that California led the way in having the most and highest percentage of highly rated skilled nursing facilities. California did not lead by just a little bit. It “has twice as many highly rated homes as any other state, or in a region”. I found myself saying “Huh?” I live in California and in my many years in the senior housing industry I have been in maybe 2 or 3 thousand senior housing communities across with country and in more than half of all the licensed skilled nursing buildings in the State of California. I don’t think anyone who is objective about skilled nursing in this country, would ever try to make a credible argument that overall, California has the best nursing homes in the country. Within the skilled nursing community it is well known that the 5 star system is very flawed and in fact provides consumers very little in the way of useful information. A quick google search will provide a variety of articles that question the 5 star rating system. Here is my take after reading the article and browsing the list: US News & World Report has done a shabby job of reporting. In fact, they didn’t do any serious reporting or they would have been more cautious about equating a 5 star rating with the highest quality care. It confirms that the 5 star system continues to be flawed. This is not to say it has no value, but I would argue that at best, it’s value is primarily as a early detection tool to identify and rule out terrible nursing homes. The one reliable conclusion you can draw from the list is that the highly rated skilled buildings are experts at getting a high rating 5 star rating. There are some really great skilled nursing buildings in California and other states that don’t have a 5 star rating. In fact often these buildings take on patients with complex problems and get terrific results, but because those patients are complex it hurts their star rating.

How do you place your MDS Coordinator on the organizational chart?

Do they report to the DON or to the NHA? Analyzing trends related to enhanced realized gains/maximization. We agree that the MDS Coordinator role is “intrinsically integrative,” with potential to impact quality of care. However, the potential of the MDS Coordinator to influence important care processes such as assessment, decision-making and care planning may be moderated by the quality of their relationship patterns across the organization. Maximizing that potential by attention to relationships patterns among staff can help to unlock that capacity of the MDS Coordinator to positively influence care processes and improve quality of care. Its not Just the DON or NHA Good connections exists when there is latitude to interact and freedom to share information with others who can best use that information. Some connections occur naturally when staff members interact to do work. The number, variety, and quality of these connections influence the extent to which staff learns and the extent to which the organization is capable of change. New information flow refers to the exchange of information within or across levels of the organization. New information of good quality provides knowledge that the staff can use to adjust their work behavior. This information may be general, such as the mission of an organization, or specific, such as communication from a Certified Nursing Assistant (CNA) to a floor nurse that a resident appears more confused than is usual. This new information flow promotes mutual exchange of information for the purpose of understanding and making sense of a situation, allowing staff to adjust their behavior to meet emerging demands

Family Communications Important Aspect of Long-Term Care Facility Norovirus Prevention Measures

From Groupcast

Norovirus prevention measures implemented at senior living and skilled nursing centers demand improved family and visitor communications. Restricted access and containment measures are often at odds with family members’ desire to visit their loved ones. Immediate and ongoing communications with family members at the outset and during the quarantine are key to success. The norovirus, a fast-moving gastrointestinal virus, spreads quickly in settings where the community members are in close proximity and share eating facilities. Nursing homes, cruise ships, hotels, and schools are all locations where such a virus can rapidly spread from member to member. Unlike the vast majority of schools in the US, which now have implemented school-wide notification systems, many senior living and skilled nursing centers lack the ability to immediately reach key family members. For nursing facilities, the CDC recommends fast action to prevent norovirus outbreaks, including restricting visitation, separating residents during mealtimes, restricted activities, and quarantining known cases. Each of these measures can be of major concern to a family member, especially those who are accustomed to unfettered access to their mom, dad, or other senior family member. The key to addressing the concerns of family members is by increasing the level and frequency of communication, preferably by way of direct messaging, beginning with the instant the heightened measures are implemented. With a system such as GroupCast, which is already in use at numerous senior living centers, a facility administrator could effortlessly record a personal message to family members and broadcast it instantly to their home and cell phone numbers. As the conditions persist or expire, periodic norovirus communications should also be sent advising family members of facility conditions, how to get more information on the loved one’s status, expectations as to the duration of the restrictions,etc. According to the CDC, nearly 60% of norovirus cases occur at long-term care facilities: “Healthcare facilities, including nursing homes and hospitals, are the most commonly reported settings for norovirus outbreaks in the United States and other industrialized countries (see Norovirus in Healthcare Settings). Nearly two-thirds of all norovirus outbreaks reported in the United States occur in long-term care facilities.”

Outbreaks can sometimes last months according to the CDC: “Outbreaks in these settings can be quite long, sometimes lasting months. Illness can be more severe, occasionally even fatal, in hospitalized or nursing home patients compared with otherwise healthy people.” Prolonged modification of visitation and care programs can place extreme stress on caring family members. Heightened levels of mass communication with the family members is the key to successful disease management. Otherwise, the facility will be fighting two battles – the norovirus and irate family members demanding to know what is happening with their loved ones. Proactive communication will reduce stress on both sides and will serve to reduce inquiries to care staff from family members seeking information on the restrictions and when they will be lifted. Systems like GroupCast are the answer. Low-cost, easy-to-use, and highly effective, a mass notification system such as GroupCast can cover all forms of notification including phone broadcast, email broadcast and text messages. These are the very reasons why they have been so heavily embraced by schools, and why they should be equally embraced by long-term care facilities.

Think back over the last few times you have been surfing on the Internet – perhaps looking at your competitor’s websites. What stood out the most for you? See something you really like and want to emulate? Loved the colors on one site and think they would work well for yours? Think that being really off-the-wall creative will gain you more traffic?

Do you remember which insurance website was the easiest to read? Probably not, because that is one of its selling points. Easy to read, eye appealing, easy to remember content and in black and white, right? Black text on white space is easier to read, and even though you may love the idea of being colorful, your website visitors may not like it. For instance, you do not want to have red text on a black background – which makes the letters seem like neon, pulsating lights – and you do not want to try white text on soft gray, for that “see if you can guess if there is text on this website” effect.

No one is saying don’t have color on your insurance website, as color is terrific for websites. It’s just that the color should only be used in/on page borders, graphics, the odd bit of flashy text perhaps and other enhancing elements on the site. But when it comes to text, stick to the tried, tested and true combination of black text on a white background.

That being said, color of course, is not the only element to consider carefully before having an insurance website designed. Step back and take a look at the bigger picture. What do you want your website to achieve; besides a good ranking on Google? You want it to be memorable, useful, professional, interactive, interesting and eye-catching (but not in a gaudy way).

Overall, the site has to pique people’s interest. Offer them something they want and need. Provide them with relevant information. Offer products they need and want. In other words, an insurance website needs to be chockfull of all the things someone could want when they are searching for the right insurance policy for their situation. It also needs to be done in up-to-the-minute coding to comply with the latest changes in browsers, mobile compliant and ready-to-go to be hooked into social media platforms.

There are a lot of things to do, as insurance marketing is not a 1-2-3 process any longer. If you’re not sure what needs to be done, find a qualified search engine optimization company with insurance industry experience. It will look good on you.

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

Insurance website are really best left to stand alone on their own devices, as background music may drive potential customers away, which is counterintuitive. However, if you insist that some music be present, work in partnership with the website designer and add in soft button rollover sound effects. If the music or sound effects are not intrusive or obnoxious, it can then be a subtle complement to the overall site.

Think long and hard about what your message is before adding extra doo-dads to it that might affect the overall image. Your insurance agency is your business and a direct reflection on you; so ideally, your insurance website should reflect professionalism, carry up-to-date information on the latest changes in the insurance industry, offer instant quotes and have a current blog with interesting facts and figures for people to read.

It’s a good idea to have fresh content in the form of articles and news releases, at least once a month, or more often if you are maintaining your own website. Most insurance agents these days have enough on their hands just running their brick and mortar location, without worrying about what is happening online. Ideally, to boost your online presence, find a search engine optimization firm with experience in the insurance industry. They understand your needs and requirements better than anyone. After all, they have “been there and done that.” Experience like that can help your web presence immensely.

Another gimmick to stay well away from if you are tackling your own website creation is centering all the text down the middle of the page in a strange font with an unusual background color. Think about that for a minute and you will realize that the main reason most text on the Internet is black on white relates directly to the fact that it is easy to read.

Put red text on a black background or pale green text on a blue background and the only thing you get is irritated readers that cannot read the text. If they can’t read the text or it’s just too much work trying to decipher what it says, they leave. Since you are in business to make money, driving website visitors away with a poorly designed site costs you business.

Not sure how to design an insurance website that looks good, loads fast, offers top notch information and is professional and gets attention? Hire the job out. It’s the best money you will ever spend.

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

Okay, the honest truth is that yes, Twitter can be a bit silly, and you might wonder why you would want to plug your business into the service. The best answer to that question is that Twitter is not just addle-pated commentary. It actually has real, legitimate people on it, and those people are an audience that generates web traffic to your insurance website.

In today’s online world, marketing any kind of business requires some form of social media networking. It’s just how it works. More and more of your audience use mobile devices daily and some even use them exclusively. It’s a market you need to woo, and the only way to do that is to appeal to them by using social media. So yes, that means Twitter and Facebook and other networks that reach your existing demographics, and those you want to court for business.

But back to your insurance website. Just what would you need to make it “socially” compliant and ready to roll? There are a couple of ways that you could go, using plugins. What is used is largely dependent on what type of platform your website and/or blog is built on. Other than that, it’s a relatively simple concept. Here is how it works: when you blog, you post a Tweet. That Tweet links back to your website. And, when you Tweet, you can post a blog on your website. Sweet. Easy. Simple and you can get downright creative with the whole idea too.

Not sure this kind of feature is something you need for your insurance website? Then call the experts and ask more questions. Your best bet is to contact a search engine optimization company with many years of experience in the insurance industry. Now that gives your insurance marketing plan a whole new life, your blog a new attitude and your Tweets a bit of relish.

If your goal is to grow your business, social media is a fast and interesting way to do it. It also gives you a good return on your investment.

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

Health systems are re-examining their post-acute care strategies and SNF partnerships.

By Julie Schulz, MD

After steadily migrating out of the skilled nursing facility (SNF) market over the past decade,health systems are re-examining their post-acute care (PAC) strategies and the potential value of SNF partnerships. This renewed consideration is directly tied to health systems’ growing accountability for the quality and cost of services delivered across the care continuum, including the need to improve care continuity, reduce readmissions and improve patient and family satisfaction.
Aside from discharges to home, SNFs are the most common post-acute destination, representing 19 percent of PAC transfers. Partnerships with freestanding SNFs provide an effective option for hospitals to improve PAC quality and efficiency without the financial risk of ownership.
Readmission penalties and a shift toward bundled payment for full episodes of care will require hospitals to more actively oversee the services their patients receive after transfer to a SNF. Congestive heart failure and pneumonia, two of the three conditions for which readmission penalties began in 2012, are among the top 10 diagnostic-related groups for SNF admissions.Additionally, joint replacements likely will be among the first procedures to be reimbursed through bundled payments that include PAC, given their high volumes and expenditures among Medicare patients.
New Care Pathways
Cost per case, length of stay and readmission rates vary significantly across SNFs. Even compared with other PAC sites, SNFs have notoriously high risk-adjusted readmission rates. The most effective health system-SNF relationships will have both the right partnership structure and care delivery model to avoid readmission penalties and improve PAC. To begin, there areseven major building blocks that can optimize the role SNFs play within a system of care(clinical alignment and resource effectiveness). How an individual system prioritizes these building blocks will depend on its service portfolio and local market dynamics.
Care pathways: Ensure that hospitals and SNFs work together to develop evidence-based protocols that standardize and optimize care across acute and PAC settings.Care coordination: Form cross-continuum teams that cover both PAC and acute care sites to identify and address problems in care transitions, using coordinators to bridge both settings.Quality rehabilitation: Ensure that inpatient discharge planners are familiar with the therapy staff and technology available at area SNFs to select destinations that best meet patients’ rehabilitation needs. Alignment strategy: Inventory area PAC facilities to determine SNF supply and alternate PAC options. Identify top performers in quality metrics to help patients make educated SNF choices.This may include the decision to create a formal SNF network. Handoffs/communication: Engage hospital physicians to increase their accountability for handoffs and any subsequent read missions. Better link patients’ primary care physicians with emergency department physicians to avert avoidable admissions. Create comprehensive medication and personalized care records for all patients.Information technology: Explore software applications that enable discharge planners to search electronically for area SNFs that best match patients’ care needs. Automate data sharing with SNF medical directors on key quality metrics.Transfers/access: Utilize a standardized transfer form, formalize a referral system with area SNFs and facilitate real-time information on bed availability. Future Considerations: A number of variables must be considered when determining how SNFs factor into your system’s ability to optimize care across the continuum and respond to changing market conditions and payment models.  Begin by determining your organization’s short- and long-term strategy for working with — and possibly within — the PAC sector (i.e., partnership, ownership, conversion to becoming a PAC provider). Along with this, evaluate whether your organization intends to pursue bundled payment projects or risk-sharing models that will include PAC services.  Next,assess your current case mix of patients discharged to SNFs to determine the demand for rehabilitation services vs. medically complex services. Hold regular forums for collaboration between hospital and SNF medical directors, as well as chief nursing officers and PAC nursing staff. Forums should include the sharing of data on potentially avoidable admissions and readmissions and root cause analyses for problematic trends.

Giving Positive Feedback to Staff Nurses managers can empower staff to advocate for quality care.

By Joan M. Lorenz, RN, PMHCNS-BC

When Mildred Jones, RN, became the nurse manager on an acute psychiatric unit that had experienced a lack of leadership for many years, her goal was to raise the quality of patient care by advancing the staffs’ knowledge and empowering them to advocate for themselves and their patients. Each time Mildred walked through the unit her critical-thinking mind went into overdrive thinking about how much work needed to be done.  Occasionally, she pulled staff aside to alert them to the problems she noticed and shared with them the best practices for the current patient care situation. Her intent was to use point-in-time learning to raise awareness and provide guidance; however, some staff saw her actions as condemnation and ridicule. What could Mildred do? She asked for help from a trusted colleague and set about developing ways to give positive feedback.
Many nurses are like Mildred. Nursing education emphasizes critical thinking. Nurses are taught to approach patient care situations with an eye for what is out of place or needs attention. This makes us excellent observers and keen problem solvers. It becomes natural for us to enter a patient care situation and begin immediate analysis, often taking action and giving direction at the same time. Being able to do this is a great asset. But like any asset it can also be a liability as Nurse Manager Jones found out. Her critical thinking mind, allowed to dominate, looked for and found problems and immediately began to problem solve. However, this had negative consequences on her relationships with others.
Use Your Critical Eye to Find What Works
Giving positive feedback to others is crucial to any nurse’s work success and collegialrelationships with co-workers.  But many of us find that it does not comes naturally. Indeed, ifwe allow our critical thinking minds to take over, constantly seeking out problems, we often donot even see what is working well. Giving positive feedback to others takes practice. Whennurses become aware of an overactive critical thinking mind they can begin to practiceredirecting themselves to look for what is going well in addition for looking for what needsattention. So the road to giving positive feedback is to develop a more balanced approach to ourwork and relationships with co-workers. Allow your critical thinking mind to see what areas needto be addressed at the same time that you ask it to seek out what is going well and needs to beacknowledged and praised.  There are a variety of ways that you can balance your point of viewat work and help your critical thinking mind to become a more appreciative mind. Four things topractice include:
1. Developing an attitude of gratitude.
2. Actively looking for what is going well.
3. Letting people know how much you appreciate them
4. Using a gentle positive approach when giving constructive criticism
Develop an Attitude of Gratitude
How do you develop an attitude of gratitude? It’s simple – start by saying ‘thank you’.
In a work situation you can start by noticing the little things that people do each day. A simple’thank you’ can mean a lot. Go ahead – try it. Thank the CNA for making up the bed, combing the patient’s hair, changing the bed linens, or passing out the water for the patients. Thank a colleague for giving out medications on time, talking with a distraught family member, or taking the time to answer a patient’s question (even though it wasn’t his patient). At the end of the day,express thanks to your team members for making it a pleasant day. It is especially helpful to thank others when things haven’t gone so well, “Thanks for holding your cool today when everything seemed to break loose at the same time.”  When you do this you might see a smile creep across your colleague’s face – that in itself is a simple reward for your efforts. Of course,some might be suspicious of this new behavior. Reassure them by letting them know that you are trying to acknowledge what you have always noticed by kept to yourself. When you begin to say’thank you’ you might find too that you begin to notice more and more things to be thankful for.And who knows – it might become contagious.
Actively Look for What is Going Well
When you walk into a patient’s room remind your critical mind to look for what is going well notjust for what is not. Do not passively wait for something to strike you as going well. Seek it out.Some teams use a three-part evaluation for debriefing urgent work situations which can easily beapplied to any work situation. The evaluation asks the group to answer these questions:
What went well? What didn’t go well? What can we do differently next time?
This three-part evaluation helps give balance to the situation. By starting out with what went well we shift the emphasis to the positive and that gives us the opportunity to tell others know that we noticed their contributions. Using this evaluation also models for others a way to give positive feedback. After a stressful staff meeting, the team leader asked the group to list what went well. Members were able to list that even though there were a lot of differing opinions they liked that everyone was given time to express themselves and others were polite enough to listen.
Let People Know How Much You Appreciate Them
How do you show your appreciation of others? Are you genuine in your approach to those you work with? How often do you express appreciation to your team leaders, your Nurse Manger,you nursing administrators for a job well done? A simple “thanks for representing our views” at a hospital wide meeting can go a long way in letting your supervisor know that you appreciate her effort.
Use a Gentle Approach to Constructive Criticism
We all know there are times when we need to offer constructive criticism to others. Following these guidelines suggested by Susan M. Heathfield in “How to Hold a Difficult Conversation”might help make it go smoother. Seek permission to provide the feedback, saying for example: “May I offer a suggestion that might make that go easier for you?” Don’t just dive right in. Let the person know that you need to provide feedback that is difficult but important to share. Share what you’ve noticed in a kind way. Keep it centered on being helpful and on you and the other person. It’s counterproductive to say something like, “Everyone is talking about it.”  Keep it simple, e.g.: “I am talking with you about this concern because it impacts patient safety (goes against policy, seems to cause anxiety for the patient, causes confusion on the unit, etc.).”  Let the nurse know the positive impact her behavioral change will have on the situation. For instance, to a charge nurse staff complains is too aggressive, a nurse manager might say: “You understand the importance of staff working together in an efficient manner. But by lowering your voice and asking others for their opinions you can gain cooperation, reduce anxiety, and help us all get the job done faster”.  After applying some of these techniques to provide positive feedback Jones walks though the nursing unit with a better-tuned appreciative mind. Because she acknowledges the good she sees the staff are more receptive to her guidance because they now hear praise along with the instruction.

Vascular PRN now offers custom sewn pneumatic garments for bariatric patients
By Greg Grambor

Fitting a bariatric patient, particularly a very large patient, with lymphedema sleeves can be quite a challenge. Therapists,  LTC and hospital personnel go through a great deal of trouble, sometimes without a good outcome. Leg and arm sleeves are zipped together, two or three extension inserts are tried, often with little or no success in some of the largest patients. This is no longer a problem! Medical professionals can now contact Vascular PRN for custom sewn lymphedema sleeves. The company provides a measuring guide, measuring advice from trained experts, and in a few weeks, the patient’s lymphedema is being properly treated with pneumatic compression. Custom sleeves for amputees are also available, so now, no patient with lymphedema, no matter what the complication, needs to go without adequate treatment.
Prescribers are reminded that compression therapy should not be used during the inflammatory phlebitis process or during episodes of pulmonary embolism, congestive heart failure, pulmonary edema, suspected deep vein thrombosis or in any instances where increased venous and lymphatic return is undesirable. Vascular PRN may be reached at 800-886-4331.

Elderly woman stuck in nursing home elevator for 29 hours
by Robert Walker

As the holidays of 2012 wrapped up, millions of families across North America gathered to enjoy each others’ company, exchange presents and enjoy sumptuous food. But for one woman living in a Canadian nursing home didn’t have the chance to spend the holidays with friends; instead, she spent 29 hours stuck in the home’s elevator. As reported in the Sun News Network, 87 year-old Rosalie Rowsell, a resident of Malton Village Long Term Care Facility, a Toronto assisted living community, returned to the community in the evening of December 23 after spending time with family. It was then Rowsell is believed to have been stuck in an off-duty residential elevator, and although she did not return to her room that evening, staff believed she was still with her family. Rowsell was found 29 hours, still in the elevator, after her family realized she never made it home. The news source reports that she could not reach the elevator’s emergency button to call for assistance. She was eventually found on December 25 in the elevator, and after being taken to hospital, she was released the same day. As a result of the incident, the Ontario Ministry of Health and Long-Term Care is conducting an investigation to determine what went wrong. The assisted living community is apologetic, and vows to prevent any such incidents in the future. “We sincerely regret that this gap in our duty resulted in endangering a resident and causing her family distress,” Emil Kolb of the Region of Peel, which operates the facility, told the news source.

Mean Girls in Assisted Living. What happens to bullies? Some of them become old bullies.

By Paula Span

When Rhea Basroon’s mother moved into a New Jersey assisted living facility a few years ago,she found a good friend in an new neighbor named Irene. Her daughters, long concerned that their widowed mother had become isolated and depressed, were initially delighted. “She and Irene were inseparable,” Ms. Basroon told me. “Whenever there was an activity, they’d both go.Whoever got there first saved a seat.” The two even discouraged others from joining them: “It was just her and Irene.” Then, disaster. Irene was lured away by another resident, abandoning Ms. Basroon’s mother. “She was so lonely. There was no one else she’d bonded with,” Ms. Basroon recalled. “She was completely devastated.” But wait! The third woman apparently eventually tired of her prize, or perhaps moved on to other prey. “She dumped Irene, and Irene came back to my mother,” Ms. Basroon said. They remained fast friends until Irene’s death several months later. In senior residences, Ms. Basroon concluded, “it’s like junior high, with that cliquishness, that excluding” of others. This phenomenon, a sort of social bullying, apparently comes as no surprise to administrators of senior apartments, assisted living facilities, nursing homes and senior centers. “What happens to mean girls? Some of them go on to be come mean old ladies,” said Marsha Frankel, clinical director of senior services at Jewish Family and Children’s Services in Boston, who has led workshops (innocuously called “Creating a Caring Community”) for staff and residents. What sort of behavior are we talking about? Ms. Frankeland Robin Bonifas, an assistant professor of social work at Arizona State who has begun research on senior bullying, described various situations:
Attempts to turn public spaces into private fiefdoms. “There’s a TV lounge meant to be used by everyone, but one person tries to monopolize it — what show is on, whether the blinds are open or shut, who can sit where,” said Dr. Bonifas.
Exclusion. “Dining room issues are ubiquitous,” said Ms. Frankel. When there’s no assigned seating, a resident may loudly announce that she’s saving a seat, even if no one else is expected,to avoid someone she dislikes. In an exercise class, added Ms. Frankel, who has gathered examples from administrators at several Massachusetts facilities, “one resident told another, in a condescending way, that she was doing it all wrong and shouldn’t be allowed to take the class.”General nastiness. “People loudly and publicly say insulting things. ‘You’re stupid.’ ‘You don’t know what you’re talking about.’” Ms. Frankel said. In a Newton, Mass., facility she observed, a resident actually discouraged her daughter from visiting, because the daughter was obese and her mother didn’t want her subjected to disparaging gossip. Racial and ethnic differences can also set off malicious comments.
Could all this be a consequence of cognitive impairment? Sometimes, Ms. Frankel said. Dementia can lead to disinhibition, and people say things they might once merely have thought.But social manipulation and exclusion seem to have more to do with acquiring power, a feeling of control, at a point in life when older people can feel powerless. (Adolescence is another of those points, of course.)  “Perhaps people don’t have ways to get that sense of control in healthy ways, so it’s done by dominating others,” said Dr. Bonifas, a former nursing home social worker.“It gives them a sense that they’re important.” Some intended victims can shrug off this petty tyranny, but others suffer. They withdraw from activities and social situations, perhaps experience anxiety or depression, want to move out. “It can get pretty nasty, and these are vulnerable people,” Ms. Frankel said.  She hasn’t found her caring community workshops very effective at getting mean seniors to behave better, since nobody considers himself or herself a bully, but they do appear to embolden the staff to intervene. That can make a difference: At a Massachusetts class in conversational English, five of the regulars — all elderly Russian women with scientific backgrounds — turned on a less-educated newcomer from Hong Kong. They rolled their eyes when she spoke, and they sniped in Russian. The instructor, a social work graduate student and former teacher, finally announced that she would not tolerate abusive behavior in the classroom and threatened to end the session the next time it happened. “That worked,” Ms. Frankel reported. But bolstering old people’s ability to stand up for themselves might also work. Dr. Bonifas has undertaken a pilot research program on bullying in two Phoenix senior apartment complexes and has noticed that, as with youth bullies, not everyone is equally likely to be a target. She’s contemplating how to teach someone to say, “You’re not going to treat me like that. Every chair here is available to anyone, and I’ll sit where I want.” That way, she thinks, “the bully doesn’t derive power from the interaction.” Perhaps it shouldn’t startle us that this behavior arises in senior residences — people are people, after all, wherever they live — but I’ll admit to some surprise. We all remember this harassment from the cafeteria, but we’d like to think that people learn something in the intervening seven or so decades, right? “We have expectations that as we grow older we become more mature — the stereotype of the wise old  person who knows how to conduct herself,” Dr. Bonifas said. “That’s not necessarily the case.”

Health systems are re-examining their post-acute care strategies and SNF partnerships.

By Julie Schulz, MD

After steadily migrating out of the skilled nursing facility (SNF) market over the past decade,health systems are re-examining their post-acute care (PAC) strategies and the potential value of SNF partnerships. This renewed consideration is directly tied to health systems’ growing accountability for the quality and cost of services delivered across the care continuum, including the need to improve care continuity, reduce readmissions and improve patient and family satisfaction.
Aside from discharges to home, SNFs are the most common post-acute destination, representing 19 percent of PAC transfers. Partnerships with freestanding SNFs provide an effective option for hospitals to improve PAC quality and efficiency without the financial risk of ownership.
Readmission penalties and a shift toward bundled payment for full episodes of care will require hospitals to more actively oversee the services their patients receive after transfer to a SNF. Congestive heart failure and pneumonia, two of the three conditions for which readmission penalties began in 2012, are among the top 10 diagnostic-related groups for SNF admissions.Additionally, joint replacements likely will be among the first procedures to be reimbursed through bundled payments that include PAC, given their high volumes and expenditures among Medicare patients.
New Care Pathways
Cost per case, length of stay and readmission rates vary significantly across SNFs. Even compared with other PAC sites, SNFs have notoriously high risk-adjusted readmission rates. The most effective health system-SNF relationships will have both the right partnership structure and care delivery model to avoid readmission penalties and improve PAC. To begin, there areseven major building blocks that can optimize the role SNFs play within a system of care(clinical alignment and resource effectiveness). How an individual system prioritizes these building blocks will depend on its service portfolio and local market dynamics.
Care pathways: Ensure that hospitals and SNFs work together to develop evidence-based protocols that standardize and optimize care across acute and PAC settings.Care coordination: Form cross-continuum teams that cover both PAC and acute care sites to identify and address problems in care transitions, using coordinators to bridge both settings.Quality rehabilitation: Ensure that inpatient discharge planners are familiar with the therapy staff and technology available at area SNFs to select destinations that best meet patients’ rehabilitation needs. Alignment strategy: Inventory area PAC facilities to determine SNF supply and alternate PAC options. Identify top performers in quality metrics to help patients make educated SNF choices.This may include the decision to create a formal SNF network. Handoffs/communication: Engage hospital physicians to increase their accountability for handoffs and any subsequent read missions. Better link patients’ primary care physicians with emergency department physicians to avert avoidable admissions. Create comprehensive medication and personalized care records for all patients.Information technology: Explore software applications that enable discharge planners to search electronically for area SNFs that best match patients’ care needs. Automate data sharing with SNF medical directors on key quality metrics.Transfers/access: Utilize a standardized transfer form, formalize a referral system with area SNFs and facilitate real-time information on bed availability. Future Considerations: A number of variables must be considered when determining how SNFs factor into your system’s ability to optimize care across the continuum and respond to changing market conditions and payment models.  Begin by determining your organization’s short- and long-term strategy for working with — and possibly within — the PAC sector (i.e., partnership, ownership, conversion to becoming a PAC provider). Along with this, evaluate whether your organization intends to pursue bundled payment projects or risk-sharing models that will include PAC services.  Next,assess your current case mix of patients discharged to SNFs to determine the demand for rehabilitation services vs. medically complex services. Hold regular forums for collaboration between hospital and SNF medical directors, as well as chief nursing officers and PAC nursing staff. Forums should include the sharing of data on potentially avoidable admissions and readmissions and root cause analyses for problematic trends.

Giving Positive Feedback to Staff Nurses managers can empower staff to advocate for quality care.

By Joan M. Lorenz, RN, PMHCNS-BC

When Mildred Jones, RN, became the nurse manager on an acute psychiatric unit that had experienced a lack of leadership for many years, her goal was to raise the quality of patient care by advancing the staffs’ knowledge and empowering them to advocate for themselves and their patients. Each time Mildred walked through the unit her critical-thinking mind went into overdrive thinking about how much work needed to be done.  Occasionally, she pulled staff aside to alert them to the problems she noticed and shared with them the best practices for the current patient care situation. Her intent was to use point-in-time learning to raise awareness and provide guidance; however, some staff saw her actions as condemnation and ridicule. What could Mildred do? She asked for help from a trusted colleague and set about developing ways to give positive feedback.
Many nurses are like Mildred. Nursing education emphasizes critical thinking. Nurses are taught to approach patient care situations with an eye for what is out of place or needs attention. This makes us excellent observers and keen problem solvers. It becomes natural for us to enter a patient care situation and begin immediate analysis, often taking action and giving direction at the same time. Being able to do this is a great asset. But like any asset it can also be a liability as Nurse Manager Jones found out. Her critical thinking mind, allowed to dominate, looked for and found problems and immediately began to problem solve. However, this had negative consequences on her relationships with others.
Use Your Critical Eye to Find What Works
Giving positive feedback to others is crucial to any nurse’s work success and collegialrelationships with co-workers.  But many of us find that it does not comes naturally. Indeed, ifwe allow our critical thinking minds to take over, constantly seeking out problems, we often donot even see what is working well. Giving positive feedback to others takes practice. Whennurses become aware of an overactive critical thinking mind they can begin to practiceredirecting themselves to look for what is going well in addition for looking for what needsattention. So the road to giving positive feedback is to develop a more balanced approach to ourwork and relationships with co-workers. Allow your critical thinking mind to see what areas needto be addressed at the same time that you ask it to seek out what is going well and needs to beacknowledged and praised.  There are a variety of ways that you can balance your point of viewat work and help your critical thinking mind to become a more appreciative mind. Four things topractice include:
1. Developing an attitude of gratitude.
2. Actively looking for what is going well.
3. Letting people know how much you appreciate them
4. Using a gentle positive approach when giving constructive criticism
Develop an Attitude of Gratitude
How do you develop an attitude of gratitude? It’s simple – start by saying ‘thank you’.
In a work situation you can start by noticing the little things that people do each day. A simple’thank you’ can mean a lot. Go ahead – try it. Thank the CNA for making up the bed, combing the patient’s hair, changing the bed linens, or passing out the water for the patients. Thank a colleague for giving out medications on time, talking with a distraught family member, or taking the time to answer a patient’s question (even though it wasn’t his patient). At the end of the day,express thanks to your team members for making it a pleasant day. It is especially helpful to thank others when things haven’t gone so well, “Thanks for holding your cool today when everything seemed to break loose at the same time.”  When you do this you might see a smile creep across your colleague’s face – that in itself is a simple reward for your efforts. Of course,some might be suspicious of this new behavior. Reassure them by letting them know that you are trying to acknowledge what you have always noticed by kept to yourself. When you begin to say’thank you’ you might find too that you begin to notice more and more things to be thankful for.And who knows – it might become contagious.
Actively Look for What is Going Well
When you walk into a patient’s room remind your critical mind to look for what is going well notjust for what is not. Do not passively wait for something to strike you as going well. Seek it out.Some teams use a three-part evaluation for debriefing urgent work situations which can easily beapplied to any work situation. The evaluation asks the group to answer these questions:
What went well? What didn’t go well? What can we do differently next time?
This three-part evaluation helps give balance to the situation. By starting out with what went well we shift the emphasis to the positive and that gives us the opportunity to tell others know that we noticed their contributions. Using this evaluation also models for others a way to give positive feedback. After a stressful staff meeting, the team leader asked the group to list what went well. Members were able to list that even though there were a lot of differing opinions they liked that everyone was given time to express themselves and others were polite enough to listen.
Let People Know How Much You Appreciate Them
How do you show your appreciation of others? Are you genuine in your approach to those you work with? How often do you express appreciation to your team leaders, your Nurse Manger,you nursing administrators for a job well done? A simple “thanks for representing our views” at a hospital wide meeting can go a long way in letting your supervisor know that you appreciate her effort.
Use a Gentle Approach to Constructive Criticism
We all know there are times when we need to offer constructive criticism to others. Following these guidelines suggested by Susan M. Heathfield in “How to Hold a Difficult Conversation”might help make it go smoother. Seek permission to provide the feedback, saying for example: “May I offer a suggestion that might make that go easier for you?” Don’t just dive right in. Let the person know that you need to provide feedback that is difficult but important to share. Share what you’ve noticed in a kind way. Keep it centered on being helpful and on you and the other person. It’s counterproductive to say something like, “Everyone is talking about it.”  Keep it simple, e.g.: “I am talking with you about this concern because it impacts patient safety (goes against policy, seems to cause anxiety for the patient, causes confusion on the unit, etc.).”  Let the nurse know the positive impact her behavioral change will have on the situation. For instance, to a charge nurse staff complains is too aggressive, a nurse manager might say: “You understand the importance of staff working together in an efficient manner. But by lowering your voice and asking others for their opinions you can gain cooperation, reduce anxiety, and help us all get the job done faster”.  After applying some of these techniques to provide positive feedback Jones walks though the nursing unit with a better-tuned appreciative mind. Because she acknowledges the good she sees the staff are more receptive to her guidance because they now hear praise along with the instruction.

Vascular PRN now offers custom sewn pneumatic garments for bariatric patients
By Greg Grambor

Fitting a bariatric patient, particularly a very large patient, with lymphedema sleeves can be quite a challenge. Therapists,  LTC and hospital personnel go through a great deal of trouble, sometimes without a good outcome. Leg and arm sleeves are zipped together, two or three extension inserts are tried, often with little or no success in some of the largest patients. This is no longer a problem! Medical professionals can now contact Vascular PRN for custom sewn lymphedema sleeves. The company provides a measuring guide, measuring advice from trained experts, and in a few weeks, the patient’s lymphedema is being properly treated with pneumatic compression. Custom sleeves for amputees are also available, so now, no patient with lymphedema, no matter what the complication, needs to go without adequate treatment.
Prescribers are reminded that compression therapy should not be used during the inflammatory phlebitis process or during episodes of pulmonary embolism, congestive heart failure, pulmonary edema, suspected deep vein thrombosis or in any instances where increased venous and lymphatic return is undesirable. Vascular PRN may be reached at 800-886-4331.

Elderly woman stuck in nursing home elevator for 29 hours
by Robert Walker

As the holidays of 2012 wrapped up, millions of families across North America gathered to enjoy each others’ company, exchange presents and enjoy sumptuous food. But for one woman living in a Canadian nursing home didn’t have the chance to spend the holidays with friends; instead, she spent 29 hours stuck in the home’s elevator. As reported in the Sun News Network, 87 year-old Rosalie Rowsell, a resident of Malton Village Long Term Care Facility, a Toronto assisted living community, returned to the community in the evening of December 23 after spending time with family. It was then Rowsell is believed to have been stuck in an off-duty residential elevator, and although she did not return to her room that evening, staff believed she was still with her family. Rowsell was found 29 hours, still in the elevator, after her family realized she never made it home. The news source reports that she could not reach the elevator’s emergency button to call for assistance. She was eventually found on December 25 in the elevator, and after being taken to hospital, she was released the same day. As a result of the incident, the Ontario Ministry of Health and Long-Term Care is conducting an investigation to determine what went wrong. The assisted living community is apologetic, and vows to prevent any such incidents in the future. “We sincerely regret that this gap in our duty resulted in endangering a resident and causing her family distress,” Emil Kolb of the Region of Peel, which operates the facility, told the news source.

Mean Girls in Assisted Living. What happens to bullies? Some of them become old bullies.

By Paula Span

When Rhea Basroon’s mother moved into a New Jersey assisted living facility a few years ago,she found a good friend in an new neighbor named Irene. Her daughters, long concerned that their widowed mother had become isolated and depressed, were initially delighted. “She and Irene were inseparable,” Ms. Basroon told me. “Whenever there was an activity, they’d both go.Whoever got there first saved a seat.” The two even discouraged others from joining them: “It was just her and Irene.” Then, disaster. Irene was lured away by another resident, abandoning Ms. Basroon’s mother. “She was so lonely. There was no one else she’d bonded with,” Ms. Basroon recalled. “She was completely devastated.” But wait! The third woman apparently eventually tired of her prize, or perhaps moved on to other prey. “She dumped Irene, and Irene came back to my mother,” Ms. Basroon said. They remained fast friends until Irene’s death several months later. In senior residences, Ms. Basroon concluded, “it’s like junior high, with that cliquishness, that excluding” of others. This phenomenon, a sort of social bullying, apparently comes as no surprise to administrators of senior apartments, assisted living facilities, nursing homes and senior centers. “What happens to mean girls? Some of them go on to be come mean old ladies,” said Marsha Frankel, clinical director of senior services at Jewish Family and Children’s Services in Boston, who has led workshops (innocuously called “Creating a Caring Community”) for staff and residents. What sort of behavior are we talking about? Ms. Frankeland Robin Bonifas, an assistant professor of social work at Arizona State who has begun research on senior bullying, described various situations:
Attempts to turn public spaces into private fiefdoms. “There’s a TV lounge meant to be used by everyone, but one person tries to monopolize it — what show is on, whether the blinds are open or shut, who can sit where,” said Dr. Bonifas.
Exclusion. “Dining room issues are ubiquitous,” said Ms. Frankel. When there’s no assigned seating, a resident may loudly announce that she’s saving a seat, even if no one else is expected,to avoid someone she dislikes. In an exercise class, added Ms. Frankel, who has gathered examples from administrators at several Massachusetts facilities, “one resident told another, in a condescending way, that she was doing it all wrong and shouldn’t be allowed to take the class.”General nastiness. “People loudly and publicly say insulting things. ‘You’re stupid.’ ‘You don’t know what you’re talking about.’” Ms. Frankel said. In a Newton, Mass., facility she observed, a resident actually discouraged her daughter from visiting, because the daughter was obese and her mother didn’t want her subjected to disparaging gossip. Racial and ethnic differences can also set off malicious comments.
Could all this be a consequence of cognitive impairment? Sometimes, Ms. Frankel said. Dementia can lead to disinhibition, and people say things they might once merely have thought.But social manipulation and exclusion seem to have more to do with acquiring power, a feeling of control, at a point in life when older people can feel powerless. (Adolescence is another of those points, of course.)  “Perhaps people don’t have ways to get that sense of control in healthy ways, so it’s done by dominating others,” said Dr. Bonifas, a former nursing home social worker.“It gives them a sense that they’re important.” Some intended victims can shrug off this petty tyranny, but others suffer. They withdraw from activities and social situations, perhaps experience anxiety or depression, want to move out. “It can get pretty nasty, and these are vulnerable people,” Ms. Frankel said.  She hasn’t found her caring community workshops very effective at getting mean seniors to behave better, since nobody considers himself or herself a bully, but they do appear to embolden the staff to intervene. That can make a difference: At a Massachusetts class in conversational English, five of the regulars — all elderly Russian women with scientific backgrounds — turned on a less-educated newcomer from Hong Kong. They rolled their eyes when she spoke, and they sniped in Russian. The instructor, a social work graduate student and former teacher, finally announced that she would not tolerate abusive behavior in the classroom and threatened to end the session the next time it happened. “That worked,” Ms. Frankel reported. But bolstering old people’s ability to stand up for themselves might also work. Dr. Bonifas has undertaken a pilot research program on bullying in two Phoenix senior apartment complexes and has noticed that, as with youth bullies, not everyone is equally likely to be a target. She’s contemplating how to teach someone to say, “You’re not going to treat me like that. Every chair here is available to anyone, and I’ll sit where I want.” That way, she thinks, “the bully doesn’t derive power from the interaction.” Perhaps it shouldn’t startle us that this behavior arises in senior residences — people are people, after all, wherever they live — but I’ll admit to some surprise. We all remember this harassment from the cafeteria, but we’d like to think that people learn something in the intervening seven or so decades, right? “We have expectations that as we grow older we become more mature — the stereotype of the wise old  person who knows how to conduct herself,” Dr. Bonifas said. “That’s not necessarily the case.”

Ignoring consumer trends in the social media may mean big trouble for your business. Consumers are the beacons of change, the origin of what is trending at any given time in the online world. If you want your insurance agency to be a success, you need to keep in step with the latest in online trends relating to what customers want when it comes to insurance.

Your market is highly diverse and has many cultural components. What that means is that not all of your policies may suit everyone, large and small. This is something that you need to be aware of and have alternatives for those who do not wish traditional insurance coverage, or will not buy certain policies due to other beliefs. Since this is your business, you need to know how to best provide service to that market segment, because even if you only have one customer like that, they are linked, by word-of-mouth to hundreds of others. If you serve them well, you stand a good chance of landing more customers.

Today’s marketing must involve social media and the use of mobile devices. This is a whole other market compared to the online world you are likely used to working in for the last few years. Now, your insurance website needs to be easily viewed on a regular computer and a smartphone. You need to know, in detail, what your demographics are by culture to get a firm grip on how to market your products. Your market needs to be targeted in precisely the right manner to get a good return on your marketing investment dollars.

To be in step today, marketing needs to involve cutting edge social media optimization, and employ a variety of social networks, such as Twitter and Facebook. There are a number of ways to accomplish that and it may also be done by using mobile advertising utilizing a tailored, custom-made pay-per-click campaign.

Insurance marketing online is basically the same as it has always been, with a social media twist with other exciting options to expand your ability to market your products. The bottom line is still the same as well, and that is if you give your customers what they want, they give your their business. One way to do that is to offer customers mobile apps and social network profiles that make their lives easier. Offer coupons and specials that are interesting, and at some point, include the use of the word “free.” That catches people’s attention in a hurry.

Of course, you cannot do all this on your own. Find a company with search engine optimization experience, one with roots in the insurance industry, and find out what they can do for you. It’s the best investment of marketing dollars you will ever make.

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

Hospitals Face Pressure to Avert Re-admissions
By JORDAN RAU

After years of gently prodding hospitals to make sure discharged patients do not need to return,the federal government is now using its financial muscle to discourage re-admissions.THE NEW OLD AGE New Efforts to Close Hospitals’ Revolving Doors Spurred by new financial penalties that Medicare started imposing on places with too many re-admissions, hospitals are doing more outreach to make sure patients are following their discharge program. Medicare last month began levying financial penalties against 2,217 hospitals it says have had too many re-admissions. Of those hospitals, 307 will receive the maximum punishment, a 1 percent reduction in Medicare’s regular payments for every patient over the next year, federal records show.  One of those is Barnes-Jewish Hospital in St. Louis, which will lose$2 million this year. Dr. John Lynch, the chief medical officer, said Barnes-Jewish could absorb that loss this year, but “over time, if the penalties accumulate, it will probably take resources away from other key patient programs.” The crackdown on re-admissions is at the vanguard of the Affordable Care Act’s effort to eliminate unnecessary care and curb Medicare’s growing  spending, which reached $556 billion this year. Hospital inpatient costs make up a quarter of that spending and are projected to grow by more than 4 percent annually in coming years, according to the Congressional Budget Office.  The readmission penalties will recoup about $300 million this year. But the goal is to pressure hospitals to pay attention to what happens to their patients after they walk out the door. The penalties have captured the attention of hospitals, and many are trying to improve their supervision of discharged patients’ recoveries. “I’ve been doing this for over two decades and talking to hospital leaders about re-admissions, and I used to get polite but blank stares,” said Dr. Eric Coleman, a professor at the University of Colorado Anschutz Medical Campus who has devised widely adopted methods to reduce hospitalizations. “Now they’repaying attention.” With nearly one in five Medicare patients returning to the hospital within a month — about two million people a year — re-admissions cost the government more than $17 billion annually. Hospitals’ traditional reluctance to tackle re-admissions is rooted in Medicare’s payment system. Medicare generally pays hospitals a set fee for a patient’s stay, so the shorter the visit, the more revenue a hospital can keep. Hospitals also get paid when patients return. Until the new penalties kicked in, hospitals had no incentive to make sure patients didn’t wind upcoming back. The maximum penalty is set to double next October and then reach 3 percent of reimbursements in October 2015. Medicare also is expanding the list of conditions it will assess in setting punishments. Right now it only evaluates re-admissions of heart attack, heart failure and pneumonia patients, counting every rebound, even ones not related to the original reason for hospitalization. The penalties are based on readmission rates in the past and applied to future payments for all Medicare patients. Researchers say that while some re-admissions are unavoidable, many are caused by the short shrift hospitals have given patients on their way out.Jonathan Blum, principal deputy administrator for the Centers for Medicare and Medicaid Services, said the penalties had helped galvanize hospitals’ efforts to avoid re-admissions. “We’ve seen a small but significant reduction,” he said. “That tells me we’ve focused the industry on improvement.”  Medicare’s tough love is not going over well everywhere. Academic medical centers are complaining that the penalties do not take into account the extra challenges posed by extremely sick and low-income patients. For these people, getting medicine and follow-up care can be a struggle. At Barnes-Jewish Hospital, Dr. Lynch said physicians from all over the Midwest referred their sickest heart patients to his facility for transplants and other major interventions. But those patients can skew his hospital’s re-admissions numbers, he said: “The weaker your heart, the more advanced your emphysema, the more likely you are to be re-admitted to the hospital.” Dr. Lynch said Barnes-Jewish set up follow-up appointments for patients who didn’t have their own doctors. But about half of the patients never showed up, he said, even after the hospital made reminder phone calls and arranged for free rides. Sending nurses to see patients at home did not significantly reduce readmission rates either, he said. “Many of us have been working on this for other reasons than a penalty for many years, and we’ve found it’s very hard to move,” Dr. Lynch said. He said the penalties were unfair to hospitals with the double burden of caring for very sick and very poor patients. “For us, it’s not a re-admissions penalty,” he said. “It’s a mission penalty.” Various studies, including one commissioned by Medicare, have found thatthe hospitals with the most poor and African-American patients tended to have higher re-admission rates than hospitals with more affluent and Caucasian patients. But the studies also determined that some safety-net hospitals performed better than average, showing that hospitals can overcome the challenges posed by the kinds of patients they treat. In some ways, the debate parallels the one on education — specifically, whether educators should be held accountable for lower rates of progress among children from poor families. “Just blaming the patients or saying‘it’s destiny’ or ‘we can’t do any better’ is a premature conclusion and is likely to be wrong,” said Dr. Harlan Krumholz, director of the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital, which prepared the study for Medicare. “I’ve got to believe we can do much,much better.” Some researchers fear the Medicare penalties are so steep, they will distract hospitals from other pressing issues, like reducing infections and surgical mistakes and ensuring patients’ needs are met promptly. “It should not be our top priority,” said Dr. Ashish Jha, a professor at the Harvard School of Public Health who has studied re-admissions. “If you think of all the things in the Affordable Care Act, this is the one that has the biggest penalties, and that’s just crazy.” With pressure to avert re-admissions rising, some hospitals have been suspected of sending patients home within 24 hours, so they can bill for the services but not have the stay-counted as an admission. But most hospitals are scrambling to reduce the number of repeat patients, with mixed success. A few days after Eda Laurion was discharged from the Banner Del E. Webb Medical Center near Phoenix after treatment for her congestive heart failure in August,a nurse showed up at her house. “She helped explained the medicines I’m taking, the side effects,what they do for you,” said Ms. Laurion, 91, of Sun City West. Still, re-admissions can’t always be prevented. The nurse, Sue Koner, sent Ms. Laurion back to the hospital after two weeks for dangerously low sodium caused by an un-diagnosed kidney problem. However, Ms. Laurion avoided re-hospitalization in October when Ms. Koner deduced that her hallucinations were a reaction to an antibiotic. Overseeing former patients is expensive and time-consuming, so many hospitals are relying on financing from community health organizations and foundations. Ms. Koner works for Sun Health, a foundation-supported nonprofit. Since Sun Health started its program in November 2011, only nine of 213 patients have been readmitted. Dr. Krumholz said hospitals should think of re-admissions as a challenge to overcome. “One day, we’ll look back,”he said, “and we’ll be incredulous that one out of every five patients ended up back in the hospital.”

The Ten Most Common Nursing Home Violations
By Long Term Care Solutions
Pro Publica analyzed 262,500 deficiencies with its u Nursing Home Inspect tool, which includes deficiencies identified by government regulators and the U.S. Centers for Medicare and Medicaid Services over the past three years.  Since releasing this information on its website this summer,has added details of historical violations found in nursing homes. The agency now releases narrative reports of these problems from a home’s last three inspection cycles — or about three years.  Here is their list of the 10 regulations most commonly violated by nursing homes:
•    Facility is Free of Accident Hazards: 17,331     •    Facility Establishes Infection Control Program: 14,186     •    Provide Necessary Care for Highest Practicable Well-Being: 13,401     •    Store/Prepare/ Distribute Food Under Sanitary Conditions: 11,746     •    Develop Comprehensive Care Plans: 9,070     •    Services Provided Meet Professional Standards: 8,986     •    Clinical Records Meet Professional Standards: 7,962     •    Not Employ Persons Guilty of Abuse: 7,288     •    Drug Regimen is Free from Unnecessary Drugs: 7,040     •    Dignity: 6,605

OIG Issues Compendium of Unimplemented Recommendations
from Dixon Health Care Solutions, Inc.

The Office of Inspector General issued is Compendium of Unimplemented Recommendations. It summarizes significant monetary and non monetary recommendations that, when implemented,will result in cost savings and / or improvements in program efficiency and effectiveness. This includes two unimplemented issues for home health agencies, three unimplemented issues for hospices, and an unimplemented issue for Recovery Audit Contractors. For more information please utilize the following link:

https://oig.hhs.gov/reports-and-publications/compendium/files/compendium2012.pdf

Avoiding Sexual Harassment by Residents
by Ted Boehm

A recent lawsuit filed by the U.S. Equal Employment Opportunity Commission (“EEOC”)against a healthcare facility in Virginia highlights a legal liability to which nursing homes and other long-term care facilities are particularly vulnerable: harassment of employees by residents.The lawsuit in question was filed under Title VII of the Civil Rights Act and it alleged that a female receptionist was subjected to a “sexually hostile work environment” on the basis of harassment by a resident. The lawsuit further alleged that the employee made numerous complaints to her supervisor about the harassment yet the employer failed to take proper corrective action.
Harassment Problems Specific to the Resident Care Arena
Sexual harassment is a difficult issue in any employment setting, but perhaps nowhere more sothan in the resident care arena. A number of different nursing home employees have regular,physical contact with non-employees – primarily the residents for whom they care (and the familymembers of those residents). Under Title VII, nursing home employees are protected fromharassment by residents just as they are from co-workers and supervisors. Hospitals, nursinghomes, assisted living facilities and other patient-care entities are responsible for providing aworkplace free of sexual harassment, regardless of whether the harassment is perpetrated by aco-worker or by a paying resident. Most nursing home employers have experienced episodes inwhich a resident acts out in an inappropriate manner. Often, the inappropriate behavior is due tothe resident having a deteriorated mental condition such as dementia or Alzheimer’s. As a resultof this condition, residents may not understand that their actions are inappropriate. However, thismental condition does not act to shield nursing home employers from liability.
How Employers Can Minimize the Risk of Harassment
Where sexual harassment has been alleged, a court will likely first look to whether the employerknew or should have known about the harassment and whether the employer did anything tocorrect the offending conduct. Of course a nursing home employer is somewhat constrained inhow it can respond to complaints of sexual harassment by residents. For example, a residentcannot be transferred unless the transfer complies with the Bill of Rights for Residents ofLong-Term Care Facilities. However, this constraint does not mean an employer should donothing. While it may not be possible to completely prevent harassment in the long-term caresetting due to the mental conditions of residents, employers can take steps to address andminimize the risk. First, employers should maintain a policy that addresses harassment byresidents or other third parties. The policy should specifically address how employees can reportthe harassment when it occurs. Maintaining a “reporting” policy is critical for another reasonbecause it provides employers with important legal defenses in situations involving allegedharassment by a supervisor. Second, employers should regularly train its employees on how toreact when they are harassed by a resident. Because the duties of a nursing home employee oftenrequire him or her to work in close contact with residents, there is an increased potential forharassment. If employees are trained to react properly and promptly, the unwelcome conduct maybe stopped before it becomes “severe or pervasive” – the standard used by courts in analyzingsexual harassment claims. Third, employers must respond to complaints appropriately. While theresponse will depend on the circumstances of the complaint, there are several “best practices”that employers should consider. For example, employers could make staffing adjustments so thatthe employee does not care for the resident by his or herself. Other options include assigning theresident to another employee’s care or discussing with the employee whether he or she wants totransfer to another part of the facility.
Respond to Complaints – But Do Not Retaliate
While it is critical for an employer to respond meaningfully to a complaint, it is just as importantthat the response does nothing to permit an employee to argue that he or she was retaliatedagainst for making the complaint. Retaliation claims have increased within all industries in recentyears and the long-term care industry is no exception. An employer should not take any actionthat is “materially adverse” to the employee -such as transferring the employee to a position thathas more onerous job duties. The most effective way to minimize the risk of harassment in yourlong term care facility is to conduct regular training on your policies or to implement policiesnow if they do not exist.

Why Long-Term Care Facilities Need to Embrace Change David Rubenstein, a speaker at the marcus evans Long-Term Care CXO Summit Spring 2013, on how long-termcare facilities need to move along with the industry. Interview with: David Rubenstein, Chief Operating Officer, AdCare Health Systems “Do not be static,” is the message that David Rubenstein, Chief Operating Officer at AdCareHealth Systems wanted to convey to long-term care (LTC) facility directors. The healthcareindustry is changing, and facilities have to embrace that to take advantage of businessopportunities, he commented. Ahead of the marcus evans Long-Term Care CXO Summit Spring 2013, in Los Angeles,California, January 28-29, Rubenstein exchanges his ideas on ensuring a LTC facility is patientcentered and evolving with the industry. Q: How can LTC facilities build a person-centered culture? DR: It is important to remember that we do not make products in this industry, but take care ofpeople. A lot of facilities get wrapped up in numbers, rules and regulations, but at the end of theday, our job is to take care of people. I always encourage management to walk the floors of theirfacility every morning before they go to their office and start dealing with all the technical issues,to keep that person-centered focus. Q: How is culture change best done? What do employees resist the most and what is the wayaround it? DR: Most people get into a rhythm of doing things the way they have always done. The problemis that the healthcare industry is constantly changing, whether it is the regulations, referralsources or the types of residents we admit. The facilities that do not embrace change are thosethat typically end up having problems or cannot achieve their goals. They will not achieve themif they do things the way they did ten years ago. LTC facilities need to be ahead of the curve. Weencourage folks to adapt their policies and procedures, so things are not static. For employees to embrace change, the leaders must spend a lot of time communicating andexplaining the game plan. Too often they send out budgets or expectations, without explainingthe rationale behind them. Q: How could LTC facilities be more profitable? What opportunities can they capitalize on at themoment? DR: Each facility needs to assess every department, expenditure, and resident before they comein. The margins in this business are not so large that they can overlook some expenses.Establishing par levels and expectations for supplies and commodities, such as food, could proveeffective. There is also value in outsourcing certain services, housekeeping and laundry forexample, to specialists who can do a better job. It is important to be as efficient as possible on the expense side, and to ensure that the facility isable to attract residents. Q: How will President Obama’s re-election impact the LTC industry? DR: All aspects of healthcare are going to be affected. The nursing home industry is the smallestsector of the healthcare budget, and we have gone through some radical adjustments in theMedicare payment rates over the last few years. We need to meet with our state leaders andlobbying groups to make sure they understand that right now a nursing home is the lowest costalternative for a patient who needs the services we provide. Interview by: Sarin Kouyoumdjian-Gurunlian, Press Manager, marcus evans, Summits Division About the Long-Term Care CXO Summit Spring 2013 This unique forum will take place at the Westin Long Beach, Los Angeles, California, January28-29, 2013. Offering much more than any conference, exhibition or trade show, this exclusivemeeting will bring together esteemed industry thought leaders and solution providers to a highlyfocused and interactive networking event. The Summit includes presentations on AccountableCare Organizations, reimbursement maximization, staff recruitment and retention, and electronicmedical record implementation. For more information please email d.drey@marcusevansch.com, or alternatively, feel free to call416-800-2481.

Hospitals Face Pressure to Avert Re-admissions
By JORDAN RAU

After years of gently prodding hospitals to make sure discharged patients do not need to return,the federal government is now using its financial muscle to discourage re-admissions.THE NEW OLD AGE New Efforts to Close Hospitals’ Revolving Doors Spurred by new financial penalties that Medicare started imposing on places with too many re-admissions, hospitals are doing more outreach to make sure patients are following their discharge program. Medicare last month began levying financial penalties against 2,217 hospitals it says have had too many re-admissions. Of those hospitals, 307 will receive the maximum punishment, a 1 percent reduction in Medicare’s regular payments for every patient over the next year, federal records show.  One of those is Barnes-Jewish Hospital in St. Louis, which will lose$2 million this year. Dr. John Lynch, the chief medical officer, said Barnes-Jewish could absorb that loss this year, but “over time, if the penalties accumulate, it will probably take resources away from other key patient programs.” The crackdown on re-admissions is at the vanguard of the Affordable Care Act’s effort to eliminate unnecessary care and curb Medicare’s growing  spending, which reached $556 billion this year. Hospital inpatient costs make up a quarter of that spending and are projected to grow by more than 4 percent annually in coming years, according to the Congressional Budget Office.  The readmission penalties will recoup about $300 million this year. But the goal is to pressure hospitals to pay attention to what happens to their patients after they walk out the door. The penalties have captured the attention of hospitals, and many are trying to improve their supervision of discharged patients’ recoveries. “I’ve been doing this for over two decades and talking to hospital leaders about re-admissions, and I used to get polite but blank stares,” said Dr. Eric Coleman, a professor at the University of Colorado Anschutz Medical Campus who has devised widely adopted methods to reduce hospitalizations. “Now they’repaying attention.” With nearly one in five Medicare patients returning to the hospital within a month — about two million people a year — re-admissions cost the government more than $17 billion annually. Hospitals’ traditional reluctance to tackle re-admissions is rooted in Medicare’s payment system. Medicare generally pays hospitals a set fee for a patient’s stay, so the shorter the visit, the more revenue a hospital can keep. Hospitals also get paid when patients return. Until the new penalties kicked in, hospitals had no incentive to make sure patients didn’t wind upcoming back. The maximum penalty is set to double next October and then reach 3 percent of reimbursements in October 2015. Medicare also is expanding the list of conditions it will assess in setting punishments. Right now it only evaluates re-admissions of heart attack, heart failure and pneumonia patients, counting every rebound, even ones not related to the original reason for hospitalization. The penalties are based on readmission rates in the past and applied to future payments for all Medicare patients. Researchers say that while some re-admissions are unavoidable, many are caused by the short shrift hospitals have given patients on their way out.Jonathan Blum, principal deputy administrator for the Centers for Medicare and Medicaid Services, said the penalties had helped galvanize hospitals’ efforts to avoid re-admissions. “We’ve seen a small but significant reduction,” he said. “That tells me we’ve focused the industry on improvement.”  Medicare’s tough love is not going over well everywhere. Academic medical centers are complaining that the penalties do not take into account the extra challenges posed by extremely sick and low-income patients. For these people, getting medicine and follow-up care can be a struggle. At Barnes-Jewish Hospital, Dr. Lynch said physicians from all over the Midwest referred their sickest heart patients to his facility for transplants and other major interventions. But those patients can skew his hospital’s re-admissions numbers, he said: “The weaker your heart, the more advanced your emphysema, the more likely you are to be re-admitted to the hospital.” Dr. Lynch said Barnes-Jewish set up follow-up appointments for patients who didn’t have their own doctors. But about half of the patients never showed up, he said, even after the hospital made reminder phone calls and arranged for free rides. Sending nurses to see patients at home did not significantly reduce readmission rates either, he said. “Many of us have been working on this for other reasons than a penalty for many years, and we’ve found it’s very hard to move,” Dr. Lynch said. He said the penalties were unfair to hospitals with the double burden of caring for very sick and very poor patients. “For us, it’s not a re-admissions penalty,” he said. “It’s a mission penalty.” Various studies, including one commissioned by Medicare, have found thatthe hospitals with the most poor and African-American patients tended to have higher re-admission rates than hospitals with more affluent and Caucasian patients. But the studies also determined that some safety-net hospitals performed better than average, showing that hospitals can overcome the challenges posed by the kinds of patients they treat. In some ways, the debate parallels the one on education — specifically, whether educators should be held accountable for lower rates of progress among children from poor families. “Just blaming the patients or saying‘it’s destiny’ or ‘we can’t do any better’ is a premature conclusion and is likely to be wrong,” said Dr. Harlan Krumholz, director of the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital, which prepared the study for Medicare. “I’ve got to believe we can do much,much better.” Some researchers fear the Medicare penalties are so steep, they will distract hospitals from other pressing issues, like reducing infections and surgical mistakes and ensuring patients’ needs are met promptly. “It should not be our top priority,” said Dr. Ashish Jha, a professor at the Harvard School of Public Health who has studied re-admissions. “If you think of all the things in the Affordable Care Act, this is the one that has the biggest penalties, and that’s just crazy.” With pressure to avert re-admissions rising, some hospitals have been suspected of sending patients home within 24 hours, so they can bill for the services but not have the stay-counted as an admission. But most hospitals are scrambling to reduce the number of repeat patients, with mixed success. A few days after Eda Laurion was discharged from the Banner Del E. Webb Medical Center near Phoenix after treatment for her congestive heart failure in August,a nurse showed up at her house. “She helped explained the medicines I’m taking, the side effects,what they do for you,” said Ms. Laurion, 91, of Sun City West. Still, re-admissions can’t always be prevented. The nurse, Sue Koner, sent Ms. Laurion back to the hospital after two weeks for dangerously low sodium caused by an un-diagnosed kidney problem. However, Ms. Laurion avoided re-hospitalization in October when Ms. Koner deduced that her hallucinations were a reaction to an antibiotic. Overseeing former patients is expensive and time-consuming, so many hospitals are relying on financing from community health organizations and foundations. Ms. Koner works for Sun Health, a foundation-supported nonprofit. Since Sun Health started its program in November 2011, only nine of 213 patients have been readmitted. Dr. Krumholz said hospitals should think of re-admissions as a challenge to overcome. “One day, we’ll look back,”he said, “and we’ll be incredulous that one out of every five patients ended up back in the hospital.”

The Ten Most Common Nursing Home Violations
By Long Term Care Solutions
Pro Publica analyzed 262,500 deficiencies with its u Nursing Home Inspect tool, which includes deficiencies identified by government regulators and the U.S. Centers for Medicare and Medicaid Services over the past three years.  Since releasing this information on its website this summer,has added details of historical violations found in nursing homes. The agency now releases narrative reports of these problems from a home’s last three inspection cycles — or about three years.  Here is their list of the 10 regulations most commonly violated by nursing homes:
•    Facility is Free of Accident Hazards: 17,331     •    Facility Establishes Infection Control Program: 14,186     •    Provide Necessary Care for Highest Practicable Well-Being: 13,401     •    Store/Prepare/ Distribute Food Under Sanitary Conditions: 11,746     •    Develop Comprehensive Care Plans: 9,070     •    Services Provided Meet Professional Standards: 8,986     •    Clinical Records Meet Professional Standards: 7,962     •    Not Employ Persons Guilty of Abuse: 7,288     •    Drug Regimen is Free from Unnecessary Drugs: 7,040     •    Dignity: 6,605

OIG Issues Compendium of Unimplemented Recommendations
from Dixon Health Care Solutions, Inc.

The Office of Inspector General issued is Compendium of Unimplemented Recommendations. It summarizes significant monetary and non monetary recommendations that, when implemented,will result in cost savings and / or improvements in program efficiency and effectiveness. This includes two unimplemented issues for home health agencies, three unimplemented issues for hospices, and an unimplemented issue for Recovery Audit Contractors. For more information please utilize the following link:

https://oig.hhs.gov/reports-and-publications/compendium/files/compendium2012.pdf

Avoiding Sexual Harassment by Residents
by Ted Boehm

A recent lawsuit filed by the U.S. Equal Employment Opportunity Commission (“EEOC”)against a healthcare facility in Virginia highlights a legal liability to which nursing homes and other long-term care facilities are particularly vulnerable: harassment of employees by residents.The lawsuit in question was filed under Title VII of the Civil Rights Act and it alleged that a female receptionist was subjected to a “sexually hostile work environment” on the basis of harassment by a resident. The lawsuit further alleged that the employee made numerous complaints to her supervisor about the harassment yet the employer failed to take proper corrective action.
Harassment Problems Specific to the Resident Care Arena
Sexual harassment is a difficult issue in any employment setting, but perhaps nowhere more sothan in the resident care arena. A number of different nursing home employees have regular,physical contact with non-employees – primarily the residents for whom they care (and the familymembers of those residents). Under Title VII, nursing home employees are protected fromharassment by residents just as they are from co-workers and supervisors. Hospitals, nursinghomes, assisted living facilities and other patient-care entities are responsible for providing aworkplace free of sexual harassment, regardless of whether the harassment is perpetrated by aco-worker or by a paying resident. Most nursing home employers have experienced episodes inwhich a resident acts out in an inappropriate manner. Often, the inappropriate behavior is due tothe resident having a deteriorated mental condition such as dementia or Alzheimer’s. As a resultof this condition, residents may not understand that their actions are inappropriate. However, thismental condition does not act to shield nursing home employers from liability.
How Employers Can Minimize the Risk of Harassment
Where sexual harassment has been alleged, a court will likely first look to whether the employerknew or should have known about the harassment and whether the employer did anything tocorrect the offending conduct. Of course a nursing home employer is somewhat constrained inhow it can respond to complaints of sexual harassment by residents. For example, a residentcannot be transferred unless the transfer complies with the Bill of Rights for Residents ofLong-Term Care Facilities. However, this constraint does not mean an employer should donothing. While it may not be possible to completely prevent harassment in the long-term caresetting due to the mental conditions of residents, employers can take steps to address andminimize the risk. First, employers should maintain a policy that addresses harassment byresidents or other third parties. The policy should specifically address how employees can reportthe harassment when it occurs. Maintaining a “reporting” policy is critical for another reasonbecause it provides employers with important legal defenses in situations involving allegedharassment by a supervisor. Second, employers should regularly train its employees on how toreact when they are harassed by a resident. Because the duties of a nursing home employee oftenrequire him or her to work in close contact with residents, there is an increased potential forharassment. If employees are trained to react properly and promptly, the unwelcome conduct maybe stopped before it becomes “severe or pervasive” – the standard used by courts in analyzingsexual harassment claims. Third, employers must respond to complaints appropriately. While theresponse will depend on the circumstances of the complaint, there are several “best practices”that employers should consider. For example, employers could make staffing adjustments so thatthe employee does not care for the resident by his or herself. Other options include assigning theresident to another employee’s care or discussing with the employee whether he or she wants totransfer to another part of the facility.
Respond to Complaints – But Do Not Retaliate
While it is critical for an employer to respond meaningfully to a complaint, it is just as importantthat the response does nothing to permit an employee to argue that he or she was retaliatedagainst for making the complaint. Retaliation claims have increased within all industries in recentyears and the long-term care industry is no exception. An employer should not take any actionthat is “materially adverse” to the employee -such as transferring the employee to a position thathas more onerous job duties. The most effective way to minimize the risk of harassment in yourlong term care facility is to conduct regular training on your policies or to implement policiesnow if they do not exist.

Why Long-Term Care Facilities Need to Embrace Change David Rubenstein, a speaker at the marcus evans Long-Term Care CXO Summit Spring 2013, on how long-termcare facilities need to move along with the industry. Interview with: David Rubenstein, Chief Operating Officer, AdCare Health Systems “Do not be static,” is the message that David Rubenstein, Chief Operating Officer at AdCareHealth Systems wanted to convey to long-term care (LTC) facility directors. The healthcareindustry is changing, and facilities have to embrace that to take advantage of businessopportunities, he commented. Ahead of the marcus evans Long-Term Care CXO Summit Spring 2013, in Los Angeles,California, January 28-29, Rubenstein exchanges his ideas on ensuring a LTC facility is patientcentered and evolving with the industry. Q: How can LTC facilities build a person-centered culture? DR: It is important to remember that we do not make products in this industry, but take care ofpeople. A lot of facilities get wrapped up in numbers, rules and regulations, but at the end of theday, our job is to take care of people. I always encourage management to walk the floors of theirfacility every morning before they go to their office and start dealing with all the technical issues,to keep that person-centered focus. Q: How is culture change best done? What do employees resist the most and what is the wayaround it? DR: Most people get into a rhythm of doing things the way they have always done. The problemis that the healthcare industry is constantly changing, whether it is the regulations, referralsources or the types of residents we admit. The facilities that do not embrace change are thosethat typically end up having problems or cannot achieve their goals. They will not achieve themif they do things the way they did ten years ago. LTC facilities need to be ahead of the curve. Weencourage folks to adapt their policies and procedures, so things are not static. For employees to embrace change, the leaders must spend a lot of time communicating andexplaining the game plan. Too often they send out budgets or expectations, without explainingthe rationale behind them. Q: How could LTC facilities be more profitable? What opportunities can they capitalize on at themoment? DR: Each facility needs to assess every department, expenditure, and resident before they comein. The margins in this business are not so large that they can overlook some expenses.Establishing par levels and expectations for supplies and commodities, such as food, could proveeffective. There is also value in outsourcing certain services, housekeeping and laundry forexample, to specialists who can do a better job. It is important to be as efficient as possible on the expense side, and to ensure that the facility isable to attract residents. Q: How will President Obama’s re-election impact the LTC industry? DR: All aspects of healthcare are going to be affected. The nursing home industry is the smallestsector of the healthcare budget, and we have gone through some radical adjustments in theMedicare payment rates over the last few years. We need to meet with our state leaders andlobbying groups to make sure they understand that right now a nursing home is the lowest costalternative for a patient who needs the services we provide. Interview by: Sarin Kouyoumdjian-Gurunlian, Press Manager, marcus evans, Summits Division About the Long-Term Care CXO Summit Spring 2013 This unique forum will take place at the Westin Long Beach, Los Angeles, California, January28-29, 2013. Offering much more than any conference, exhibition or trade show, this exclusivemeeting will bring together esteemed industry thought leaders and solution providers to a highlyfocused and interactive networking event. The Summit includes presentations on AccountableCare Organizations, reimbursement maximization, staff recruitment and retention, and electronicmedical record implementation. For more information please email d.drey@marcusevansch.com, or alternatively, feel free to call416-800-2481.

There’s a lot in writing about using social media, and some people breathe it in daily, while others think it’s a waste of time. It truly depends on what you are doing as to whether or not social media will boost your business. If you use it in the right manner, it does attract potential clients and establish you as an expert in insurance.

Wondering what search engine optimization (SEO) benefits you can derive from having a solid social media marketing strategy? There are many benefits that businesses overlook at first glance. In fact, when faced with the decision to add social media to a marketing plan, many insurance agents wonder if it will help or harm them.

When used in conjunction with other marketing efforts, social media is a winner. It helps to understand that social media, website optimization, website design and blogging, and Facebook work together in sync, as a part of a comprehensive online insurance marketing strategy. Still not so sure? Then consider this: After the most recent algorithm changes, brought in by Google, you must make changes to stay relevant, and not lose your online ranking. That means whatever SEO you have in effect now, must be changed to keep be compliant.

Interestingly enough, after the dust mostly settled after the introduction of the Penguin algorithm, is the observation that unique content is critical. You have heard the saying that “Content is King.” That has not changed. It has always been that way, it’s just that since Google tweaked their online ranking system again, everyone is frantically striving for unique content and talking about how to keep their online material fresh and relevant.

It’s not just content that you need to pay attention too though. Part of the Penguin changes means that Google added weight to social media things, such as shares and likes. And nowadays, Bing and Google are using data from social media sites and factoring them into their results. So you need to pay attention to the wave of now, and get your insurance agency fully compliant with social media marketing practices. Find the right SEO firm that understands insurance marketing, because they do it every day, and you are on a roll.

Jason Bland is with insurance marketing company, ReadytoQuote.com. ReadytoQuote.com specializes in marketing insurance websites online. Learn more at ReadytoQuote.com.

Since the main focus of your day-to-day work is running an insurance agency, you want an insurance website that turns surfers into prospects — prospects who ultimately buy something from you. In simple terms, this means your website must convert visitors. Don’t have a clue as to how to accomplish that? It doesn’t matter, because if you have the right search engine optimization (SEO) company onboard with you, they take care of those details.

So, down to business. You know you have a good SEO company to handle your insurance website design if they take the time to ask you questions about what you like about your competition’s sites and what you like about other websites you have visited. This tells them what appeals to you, and how to translate that into an insurance website design that suits your needs.

Think it’s bad form to copy your competition? Indeed it is, but this is not what the SEO company does. Just like you, they need to know what the competition is doing, and how well they are doing it, to allow them to distinguish your insurance agency from the other ones out there. What you ultimately need to do is do what your competition is NOT doing, and you need to do it well. In other words, find your own style, one that does not duplicate another agency or agent. And you don’t need to just check out other insurance websites. Look around in other industries and see what appeals to you. There is always a better way to present information in a clear and precise manner.

Stuck at the starting gate? Not sure what you could possibly find that would make your site unique? This is something best left to the SEO pros. They are typically on top of the newest trends in web design, HTML5 and CSS. If you have an SEO firm working for you that does not know what the latest trends in website design are, it’s time to move on – fast.

Your website is not a static entity. It is alive and vibrant, showcasing your style, your products, your business and your presence. You need to be up-to-the-minute to stay on top of the various trends online, in order to stay relevant. Today, the world belongs to the mobile users. Your insurance website needs to show well on a mobile device as well.

Lots of things to consider. Some may be daunting and incomprehensible, but they do not need to be when you have the right SEO firm handling your website and SEO needs.

Jason Bland is with insurance marketing company, ReadytoQuote.com. ReadytoQuote.com specializes in marketing insurance websites online. Learn more at ReadytoQuote.com.

This week, the OIG released the results of a study just completed on the billing practices ofskilled nursing facilities to Medicare. The study located a stunning amount of “inaccurate,medically unnecessary, and fraudulent claims.” The main focus of the study was to focus onbilling practices for therapy provided skilled nursing facilities. The study located over a billiondollars in inappropriate billing in 2009 alone. The recommendations of the study included:
Increase and expand reviews of SNF claims,
Use its Fraud Prevention System to identify SNFs that are billing for higher paying RUGs,
Monitor compliance with new therapy assessments,
Change the current method for determining how much therapy is needed to ensure appropriatepayments,
Improve the accuracy of MDS items, and
Follow up on the SNFs that billed in error.
Skilled nursing facilities are certain to come under more scrutiny regarding billing practices forMedicare services. Make certain your organization has procedures in place to prevent codingerrors as well as other prohibitied billing practices including employing individuals listed on theOIG exclusion list.

Know How to Have the Right Family and Job Balance to Have Fulfilling Family Life

We are all living in a fast paced work environment and this makes it very difficult for us tobalance the family and job in the way it has to be done for getting greater degree of harmony andfulfillment. But this is not easy and not everyone in a high demanding career is able to giveenough time to their families. Usually it is the family life that suffers in case of a high payingcareer that takes away the time you have to allot for the family.  In the present days the mobilephones and the tablet computers, and the laptops are stealing the time you are spending with yourfamily and are effectively bringing down the quality of time you spend with your spouse and yourkids.
This is not a healthy situation for the present day executives who have to be very efficient andhave to fulfill their awfully demanding job requirements. This makes them unable to devote asmuch time they want to their families straining the relationships, and bringing down the qualityof their family life. But this must be avoided at all costs and maintaining good balance of thefamily and job is necessary for a perfectly happy life.  You must not forget the fact that all yourearnings and the hard work you put in your office is for giving a better life to your family and assuch it is the family that must have the priority over your work pressures.
There are many ways of making a good balance of family and job and this must be done rightfrom the day of entering your first job so that it becomes a way of life. Once you forget to do thisit may be very difficult to achieve this later in life. To avoid personal unhappiness and a hollowpersonal life create a clear demarcation of your family and business life. There are many socialand cultural factors that come in the way of creating that balanced family and business life. Yetyou must strive hard to create one and stay with it so that you are able to become a good spouseand father in your home as you become a good worker in your business place.
A perfect balance in family and job can be achieved by adhering to certain basic principles thatgives a better understanding of your priorities and that of each one of your family. This gives theright ways of getting them arranged in the order of importance so that you can easily find theways to achieve them. You can make way for the resources required in terms of your time andpersonal attention so that everyone in your family gets what they value most in a natural way.Plan ahead and make it a habit to have time to be together with all of the family each day. Shareyour thoughts for the day and this will really boost the way to enhance the feeling of togethernessin the family.
Taking part in your kid’s activities and devoting a part of your time towards this will give a betteropportunity to understand your kids well. Planning ahead and setting apart time for this is sure tomake your time at your office more efficient as you try to leave your office in time to be withyour kids you will be able to find the right balance for your family and job. Leave work at yourwork and be free at least for some time without your ringing mobile phone or that laptop waitingfor your attention when you are spending your time with your family. Thus do not sacrifice yourfamily life for your business life and always try to have that perfect family and job balance tohave a fulfilling life.

Have you every been a resident in your own building?

By Ken Tack

Here I am in my 40th year of long-term care. That is an eternity when you spend it in a field thathas had so many changes. Earlier this year, I was looking forward to a comfortable time, havingrecently stepped down from the CEO position of a regional group of homes that I had helped tofound many years ago. The next generation was doing a good job of running the company, and Iwas hidden away in one of the campuses as an executive director. I was back doing what I loved:running a nursing home, and interacting with the elders.
On April 15, my world changed. I was involved in a motorcycle collision. I was flown to aregional hospital. After surgery and some observation, I volunteered to transfer to one of ourcompany’s nursing homes, where I was for a month. I had never dreamed of being a resident in anursing home, at least at this age, but here I was. With little to do but observe, I had the greatest educational experience of my career. I saw withmy eyes, heard with my ears, and felt with my heart the low level of compassion the care staffwas experiencing. All the hopes and dreams of making life better that filled them when they firststarted had been slowly sucked from them. They were running on empty and I was very much apart of the problem.
Before I proceed further, let me publicly profess that I am deeply grieved by the callous manner Ihave treated the caregivers in our organization. Although I have never knowingly hurt any staffmember, I have been neglectful of many as an individual and as a person. All my training and thevolumes of regulations have helped to create this inappropriate conduct. With one eye on thebottom line and the other on the regulating bodies, I never saw what was occurring in front of mynose.
Our people, the backbone of each organization, our caregivers, are hurting. The stress of holdingto tightly tailored PPD numbers, conflicts with co-workers, family members, and the occasionalspouse, coupled with a career that forces you to have relationships that end in death, can suck theair from anyone’s compassion balloon. When you mix in the stress of being a parent, spouse,family financier, chauffeur, and referee, you can end up with a person who is bankrupt ofcompassion.
The thing that is most disturbing to me is how we have accepted this in the profession as “Justthe way things are.” We say that this attitude on everyone’s part is simply a part of our business —it’s nothing personal. But I believe it does not have to be this way. When we open our eyes to thispractice of devouring our own limited resources we begin to see it. What happens when acaregiver begins to lose their compassion and then their performance slips? Our traditionalresponse is to have a discussion with them about their performance, reminding them howimportant they are to our elder’s lives.  When that doesn’t correct the problem, and it rarely does,we give them a second, sterner warning (a written warning in many cases). Finally, exasperatedwith their poor showing, we are forced to terminate them only to begin the process over and hopewe achieve a better result.
We see this every day when we see employees hiding in a room, having attendance problems,leaving an elder in a mess, talking over the elders’ head, and taking too frequent breaks. We labelthem a bad employee and place them on the “do not rehire” list when they resign, or we terminatethem. Did we ever see this caregiver, once filled with hopes and dreams of what they might dofor these aging individuals, as a person in need of a compassion refilling?  For the first time I wasable to see employees in this new light.
When we have epiphanies like these we may ask, ‘What can we do about it?’ The answer is wecan begin by caring and letting employees know that we do that we care about them. We canspend as much time preventing the problem of compassion bankruptcy, as we do in fixing theresults. We still try to find good applicants, interview them, process them, train them and directthem. But we also can look them in the eye everyday and see the person that is there. We can askthem how things are doing and actually take the time to hear what they have to say. When theyhave a problem, whether it is work-related or not, we can make an effort to give them the supportand caring we ask that they give our elders.
Here are some suggestions of various ways we have attempted to support and care about ourmost precious asset:
Nourishment station in the staff lounge. We offer various fruits, crackers, bagels, ice cream,Popsicles, etc.Wider variety of scheduling options to permit an improved mesh of personal life with workA monthly dish day where we provide the main course and the caregivers bring their favorite sidedish or desert. (The kitchen staff does not prepare the main course: remember they are a part ofthe caregiver team.)Surprise gifts, including door prizes and other giveaways at in-house in-servicesAdministration and department supervisors are encouraged to take an employee out to eat, alongwith a caregiver’s family member. We cover the meals and the time it takes them for a leisurelyvisit.We send birthday cards to the caregiver’s house.Training supervisors to look for signs of compassion fatigue and then supporting them as theyassist their staff.The most important thing we have tried to do is let each care partner know that we truly careabout him or her. We are attempting to celebrate their joys and support employees in theirsorrows, praise them for what we had just taken for granted, and understand when they arestruggling.  It’s not our goal to be their closest friend, but we can be a support and inflate theirballoon of compassion when it starts to shrink.
Forty years of doing something wrong can make change a little difficult, but this is now theearliest I can begin to make the change. I have begun making rounds with an entirely differentobjective.
As one who contributed far more than my share to the draining of this compassion, I have done a180-degree turn. If I am to ever be remembered by the long-term care industry, I pray that it willbe for helping to put compassion back in our caregivers, not the financially successful company Ihave helped to build.

This week, the OIG released the results of a study just completed on the billing practices ofskilled nursing facilities to Medicare. The study located a stunning amount of “inaccurate,medically unnecessary, and fraudulent claims.” The main focus of the study was to focus onbilling practices for therapy provided skilled nursing facilities. The study located over a billiondollars in inappropriate billing in 2009 alone. The recommendations of the study included:
Increase and expand reviews of SNF claims,
Use its Fraud Prevention System to identify SNFs that are billing for higher paying RUGs,
Monitor compliance with new therapy assessments,
Change the current method for determining how much therapy is needed to ensure appropriatepayments,
Improve the accuracy of MDS items, and
Follow up on the SNFs that billed in error.
Skilled nursing facilities are certain to come under more scrutiny regarding billing practices forMedicare services. Make certain your organization has procedures in place to prevent codingerrors as well as other prohibitied billing practices including employing individuals listed on theOIG exclusion list.

Know How to Have the Right Family and Job Balance to Have Fulfilling Family Life

We are all living in a fast paced work environment and this makes it very difficult for us tobalance the family and job in the way it has to be done for getting greater degree of harmony andfulfillment. But this is not easy and not everyone in a high demanding career is able to giveenough time to their families. Usually it is the family life that suffers in case of a high payingcareer that takes away the time you have to allot for the family.  In the present days the mobilephones and the tablet computers, and the laptops are stealing the time you are spending with yourfamily and are effectively bringing down the quality of time you spend with your spouse and yourkids.
This is not a healthy situation for the present day executives who have to be very efficient andhave to fulfill their awfully demanding job requirements. This makes them unable to devote asmuch time they want to their families straining the relationships, and bringing down the qualityof their family life. But this must be avoided at all costs and maintaining good balance of thefamily and job is necessary for a perfectly happy life.  You must not forget the fact that all yourearnings and the hard work you put in your office is for giving a better life to your family and assuch it is the family that must have the priority over your work pressures.
There are many ways of making a good balance of family and job and this must be done rightfrom the day of entering your first job so that it becomes a way of life. Once you forget to do thisit may be very difficult to achieve this later in life. To avoid personal unhappiness and a hollowpersonal life create a clear demarcation of your family and business life. There are many socialand cultural factors that come in the way of creating that balanced family and business life. Yetyou must strive hard to create one and stay with it so that you are able to become a good spouseand father in your home as you become a good worker in your business place.
A perfect balance in family and job can be achieved by adhering to certain basic principles thatgives a better understanding of your priorities and that of each one of your family. This gives theright ways of getting them arranged in the order of importance so that you can easily find theways to achieve them. You can make way for the resources required in terms of your time andpersonal attention so that everyone in your family gets what they value most in a natural way.Plan ahead and make it a habit to have time to be together with all of the family each day. Shareyour thoughts for the day and this will really boost the way to enhance the feeling of togethernessin the family.
Taking part in your kid’s activities and devoting a part of your time towards this will give a betteropportunity to understand your kids well. Planning ahead and setting apart time for this is sure tomake your time at your office more efficient as you try to leave your office in time to be withyour kids you will be able to find the right balance for your family and job. Leave work at yourwork and be free at least for some time without your ringing mobile phone or that laptop waitingfor your attention when you are spending your time with your family. Thus do not sacrifice yourfamily life for your business life and always try to have that perfect family and job balance tohave a fulfilling life.

Have you every been a resident in your own building?

By Ken Tack

Here I am in my 40th year of long-term care. That is an eternity when you spend it in a field thathas had so many changes. Earlier this year, I was looking forward to a comfortable time, havingrecently stepped down from the CEO position of a regional group of homes that I had helped tofound many years ago. The next generation was doing a good job of running the company, and Iwas hidden away in one of the campuses as an executive director. I was back doing what I loved:running a nursing home, and interacting with the elders.
On April 15, my world changed. I was involved in a motorcycle collision. I was flown to aregional hospital. After surgery and some observation, I volunteered to transfer to one of ourcompany’s nursing homes, where I was for a month. I had never dreamed of being a resident in anursing home, at least at this age, but here I was. With little to do but observe, I had the greatest educational experience of my career. I saw withmy eyes, heard with my ears, and felt with my heart the low level of compassion the care staffwas experiencing. All the hopes and dreams of making life better that filled them when they firststarted had been slowly sucked from them. They were running on empty and I was very much apart of the problem.
Before I proceed further, let me publicly profess that I am deeply grieved by the callous manner Ihave treated the caregivers in our organization. Although I have never knowingly hurt any staffmember, I have been neglectful of many as an individual and as a person. All my training and thevolumes of regulations have helped to create this inappropriate conduct. With one eye on thebottom line and the other on the regulating bodies, I never saw what was occurring in front of mynose.
Our people, the backbone of each organization, our caregivers, are hurting. The stress of holdingto tightly tailored PPD numbers, conflicts with co-workers, family members, and the occasionalspouse, coupled with a career that forces you to have relationships that end in death, can suck theair from anyone’s compassion balloon. When you mix in the stress of being a parent, spouse,family financier, chauffeur, and referee, you can end up with a person who is bankrupt ofcompassion.
The thing that is most disturbing to me is how we have accepted this in the profession as “Justthe way things are.” We say that this attitude on everyone’s part is simply a part of our business —it’s nothing personal. But I believe it does not have to be this way. When we open our eyes to thispractice of devouring our own limited resources we begin to see it. What happens when acaregiver begins to lose their compassion and then their performance slips? Our traditionalresponse is to have a discussion with them about their performance, reminding them howimportant they are to our elder’s lives.  When that doesn’t correct the problem, and it rarely does,we give them a second, sterner warning (a written warning in many cases). Finally, exasperatedwith their poor showing, we are forced to terminate them only to begin the process over and hopewe achieve a better result.
We see this every day when we see employees hiding in a room, having attendance problems,leaving an elder in a mess, talking over the elders’ head, and taking too frequent breaks. We labelthem a bad employee and place them on the “do not rehire” list when they resign, or we terminatethem. Did we ever see this caregiver, once filled with hopes and dreams of what they might dofor these aging individuals, as a person in need of a compassion refilling?  For the first time I wasable to see employees in this new light.
When we have epiphanies like these we may ask, ‘What can we do about it?’ The answer is wecan begin by caring and letting employees know that we do that we care about them. We canspend as much time preventing the problem of compassion bankruptcy, as we do in fixing theresults. We still try to find good applicants, interview them, process them, train them and directthem. But we also can look them in the eye everyday and see the person that is there. We can askthem how things are doing and actually take the time to hear what they have to say. When theyhave a problem, whether it is work-related or not, we can make an effort to give them the supportand caring we ask that they give our elders.
Here are some suggestions of various ways we have attempted to support and care about ourmost precious asset:
Nourishment station in the staff lounge. We offer various fruits, crackers, bagels, ice cream,Popsicles, etc.Wider variety of scheduling options to permit an improved mesh of personal life with workA monthly dish day where we provide the main course and the caregivers bring their favorite sidedish or desert. (The kitchen staff does not prepare the main course: remember they are a part ofthe caregiver team.)Surprise gifts, including door prizes and other giveaways at in-house in-servicesAdministration and department supervisors are encouraged to take an employee out to eat, alongwith a caregiver’s family member. We cover the meals and the time it takes them for a leisurelyvisit.We send birthday cards to the caregiver’s house.Training supervisors to look for signs of compassion fatigue and then supporting them as theyassist their staff.The most important thing we have tried to do is let each care partner know that we truly careabout him or her. We are attempting to celebrate their joys and support employees in theirsorrows, praise them for what we had just taken for granted, and understand when they arestruggling.  It’s not our goal to be their closest friend, but we can be a support and inflate theirballoon of compassion when it starts to shrink.
Forty years of doing something wrong can make change a little difficult, but this is now theearliest I can begin to make the change. I have begun making rounds with an entirely differentobjective.
As one who contributed far more than my share to the draining of this compassion, I have done a180-degree turn. If I am to ever be remembered by the long-term care industry, I pray that it willbe for helping to put compassion back in our caregivers, not the financially successful company Ihave helped to build.

You are proud of your insurance website and put a lot of work into it. You did everything right, as far as you know, but in tracking your online traffic, you discover potential clients did not go past your home page. What’s up with that? By the way, this happens to a lot of insurance agents, so don’t worry too much.

What’s happening is this: your new website was designed to get attention from the search engines, but that alone is not enough. It needs to do more than just sit there and look pretty. Pretty might appeal to some visitors, but they are not visiting your website to look at how nice it is, they are there to get information and buy a product. If your site does not offer them what they need, they will leave – in droves.

While your website might be pretty nifty, or was done the way you asked for it to be done, the results are not making you happy. Here is something you can do to find out what is going on, and what you can do to turn things around: Perform usability testing. This means asking a wide variety of experienced online users to visit your site, and give you feedback. Remember, your site was not designed just for you and your staff, it is for customers who want to use your services and buy your products, and that is a different point of view.

If you can put yourself in your customer’s shoes, you have a better chance of designing something they need and want to help them make informed decisions about their insurance needs. When your users offer feedback, immediately fix what does not work, is vague or that no one seems to understands. Then stick with what works, and learn the lesson of seeing your insurance website through the eyes of your potential customers.

If you do not have the experience to design your own website, or even track the results when people visit it, then consider hiring an experienced search engine optimization company, with a proven track record. Find one with a track record in the insurance industry, and you have two birds in one bush, and are well on your way to having a website that does what you need it to do – perform and convert customers.

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

Just because it takes two components to make an effective search engine optimized website perform well on the Internet, that does not mean you need two kinds on online companies, marketers and designers. Ideally, those two necessary components work as one to produce what you need.

There is a long-standing debate over making a website chockfull of words or making it pretty. Both are right, because if you design an ugly website with good content, visitors are not likely to convert. So, no matter how much traffic that website may get, it does you no good in the long run.

Check this out for yourself by surfing Google for your competition. The first page-ranked websites are well designed, clean, professional, and crisp and upload fast. They also have superior content. It is no surprise these insurance websites rank where they do. It is simple: clean, professional websites convert better and rank higher – period.

You may be wondering why many SEO companies don’t pay much attention to professional website design. SEO companies are typically run by analytical specialists, whose main goal is to get a website ranked well. They are not artists or designers. This is why it takes two to tango when performing SEO on an insurance website. Both factions make the whole shebang work seamlessly.

In the design phase, ask the designer what strategy they use to maximize your SEO exposure. Understand they do not deal with the analytical side of this equation, but they do understand what not to do to allow the SEO gurus to do their job when they are done. For instance, they strive for a clean look, with calls to action at the top of the page. This strategy converts well. You may see that in action by checking out insurance websites with instant price quoting available to consumers, visible the moment they land on a page.

Chose to work with a guaranteed SEO company? If you are shooting for a first page ranking, the company may require you to update your website design to make it more Internet and search engine compliant. So, as you can see, design makes a “huge” difference. With easy to read text, that is straightforward, clear and to the point, an easy to navigate site and simple vertical layouts, the search engines will love your site – and rank you better. Sweet.

Here’s the scoop. Find a SEO company with an in-house website designer. Now you are well on your way to a good Google ranking.

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

Although few would plan for the years after retirement to be spent in a nursing home, unforeseen illness and declining mobility could render dreams of traveling the country by RV or perfecting agolf swing unlikely. According to a 2004 report compiled by the Centers for Disease Control(CDC), 27 percent of Americans over the age of 65—1.3 million—were residing in nursing homes.  What’s more, the Census Bureau predicts that the population of people 65 and over willmore than double to 86.7 million in 2050 from 36.3 million in 2004, a number that reveals the potential rise in health issues as a result of an aging population whose life span has become increasingly higher than in previous years.  But with many elderly people stubbornly resisting the transition to a nursing home—stereotypes of loneliness, isolation and stifled independence abounding—is there any alternative other than home health care for people requiring day to day care? Based on the teachings of Dr. Bill Thomas, a geriatrician whose Eden Alternative philosophy teaches that “aging should be a continued state of development and growth, rather than a period of decline,” the Sarah Neuman nursing home in Mamaroneck plans to build a freestanding set of buildings modeled after Thomas’ Green House project, which will address what Thomas says are the basic problems affecting nursing home residents: loneliness, boredom and helplessness.  In a poignant quote from a National Public Radio (NPR) interview in 2005, Thomas said, “I believe that in the nursing home every year, thousands and thousands of people die of a broken heart. They die not so much because their organs fail, but because their grip on life has failed.”  Please continue reading at:http://nanuet.patch.com/articles/nursing-home-of-the-future-mamaroneck-s-sarah-neuman-pioneering-resident-centered-care

Former CMS administrator scolds long-term care providers — but he has it all wrong!
By Steve Moran, Senior Housing Forum

McKnight’s Long-Term Care published an article titled “Former top Medicare official scalds long-term care leaders”  on September 26. According to this article, Tom Scully, the former chief of the Medicare & Medicaid Services Administration, brutally chastised the long-term care industry for exploiting a change in the Medicare reimbursement rules that allowed providers to extract an extra $5 billion from the system in less than a year.His proposition was that the long-term care providers should have known that it would not last and would damage their lobbying efforts for the foreseeable future. He has it wrong on so many counts. Last year, I pointed out:
The system, as designed by the government, is adversarial in nature, meaning that the government works to pay out as little possible and the providers work to get paid as much as possible while not breaking the rules, which is exactly what they did.The government is that stupid! If they had thought out the rule change it would have been easy to  figure out how the providers would react. This was an easily predictable outcome.You could even make a case that if the providers had not taken advantage of the rule change, they would have been violating their responsibility to their investors.The providers did nothing that was illegal or even against the rules. It is hard to even figure out how to apply morality to this particular situation. At the end of the day, even with the “take backs”, the long-term care providers who were the most aggressive in taking advantage of the system ended up financially better off than if they had not. At least some of those providers who”did the right thing” ended being penalized for not taking advantage of the system.The blame for this colossal waste of tax money, my money and your money, lies squarely at the feet of the CMS.

Simple Products That Can Make Mobility Easier
by Lynda Shrager, The Organized Caregiver

After 33 years of practicing in the field of occupational therapy, it still never ceases to amaze me how a simple piece of adaptive equipment can so highly impact how a person completes a task.Whether they have joint limitations, decreased strength, loss of the use of one extremity, poor balance, or difficulty mobilizing, a simple modification can often turn an impossible task into an achievable one. One of my principles of health organizing is to gather all of the equipment you need ahead of time before undertaking a task:The Organized Caregiver’s Top Ten Choices for Products That Will Make Life Easier and Safer:
1. Elastic shoe laces: Lace in shoes, pull to desired tension, tie a bow and then never have to tie your shoes again! It turns tie shoes into slip-ons.
2. Button hook/Zipper pull: The button hook is inserted through the button hole, hooks the buttonand easily pulls it back through. The zipper pull easily grabs hard to grasp zippers. This is a greattool for people with decreased fine coordination or arthritis.
3. Rocker knife: Simultaneously stabilizes and cuts food. The knife has a sharp, curved blade thateasily cuts when rocked back and forth over food. For one handed use, decreased coordination orweakness.
4. Spike board: A cutting board with several long nails protruding up to stab meats, vegetablesand fruits for cutting or peeling. Look for suction cup legs and a raised corner against which apiece of bread can be placed for buttering. This is a good product for people with weakness, onehanded use, a lack of coordination or low vision.
5. Bed rail: Available in many types and sizes, this small rail provides support to help people safely get in and out of bed. Many have a base that fits between the mattress and box spring with no assembly required!
6. Sock aide: An incredible gadget that helps you put on socks without bending over. An inexpensive tool that is helpful for those with limited mobility or recovering from hip replacement surgery.
7. Raised toilet seat with handles: If you have decreased mobility in the hips, knees or back your toilet can seem very low. This product raises it about four inches and has armrests for added safety and support.
8. Reacher: Helps you pick up things more than an arm’s length away for people with limited reach or strength. Various types have different “jaws” depending on what type of objects you need to grab.
9. Bathtub transfer bench: Two legs sit outside of the tub and two are in. The person sits down and slides in without needing to step over the wall of the tub.
10. Grab bars: I saved the best for last. Place them in the shower, on the way into the tub, by the toilet, or near the door jam on the way out of the house. Be sure they are installed properly and have a textured surface making them easier to grasp. This simple bar will increase safety and make transfers easier.
You may purchase most of these items in your neighborhood home medical supply store. Many drugstores or big box stores also carry them. For more information, pictures of the products and where to purchase, go online to “Home Health Care Equipment and Supplies” or Google the name of the item.

Lawsuit Filed Over Negligence In DVT Prevention and Treatment
Tampa, FL (Law Firm Newswire) October 10, 2012 –

A lawsuit has been filed against an Illinois nursing home over negligence in the prevention and treatment of deep vein thrombosis (DVT). Carol Harrison, 63, was admitted to Maple Ridge Care Centre for rehabilitation and ventilator care following complications from surgery. As with many patients in long-term care, Harrison was at risk for blood clots. According to the lawsuit, medical staff failed to detect the fact that Harrison had developed DVT. Her leg had to be amputated, which allegedly hastened her death. DVT is a potentially fatal condition that staff at hospitals and nursing homes must be alert to, as anyone with limited mobility may be at risk due to compromised blood circulation. DVT happens when a blood clot is created in the veins of the legs or pelvis. If the clot breaks free and travels through the bloodstream, it becomes an embolism. Common symptoms of DVT include discoloration and swelling of the limb, usually the leg. Patients at risk may be prescribed blood thinners like Warfarin, but pneumatic compression therapy is another alternative. “Some doctors prescribe blood thinners like Warfarin to reduce the chance of blood clots, but these drugs are expensive, and have potentially dangerous side effects, which can be as serious as the clots themselves,” said Greg Grambor, owner of VascularPRN, a distributor of DVT prevention devices. “Pneumatic compression therapy is a far less expensive alternative, which is every bit as effective as the drugs, with absolutely no dangerous side effects.”Maple Ridge Care Centre is a nursing home in Lincoln, Illinois specializing in wound care,pulmonary diseases and physical therapy. The facility provides respiratory care through a partnership with the Springfield Clinic and Southern Illinois University Pulmonology. The nursing home lawsuit was filed in Macon County Circuit Court by Harrison’s husband. To learn more about a Sequential Compression Device, SCD boots, visit www.vascularprn.com or call 800-886-4331.

There has been significant discussion regarding hospital readmissions and the impact tocompensation. CMS has just begun a study looking at readmissions from nursing homes.
by Candyce Henry

A 79 year old woman had advanced heart failure, chronic lung disease and diabetes. She recently had signed a D.N.R., “do not resuscitate” order and there was nothing more that could be done to care for her at the hospital. The cardiologist called her doctor and they agreed that they would respect her wishes to be kept out of the hospital. Within a few hours after being placed in long term care, the staff noticed her very low oxygen levels and contacted another doctor who was not familiar with the woman’s medical history who gave the order to send her back to the hospital.The situation highlights problems with long-term care that frequently frustrate caregivers and that are receiving fresh attention from medical providers and Medicare. The nursing home staff had no knowledge of the woman’s D.N.R. and the patient was unable to provide information. This might not have happened if the woman’s D.N.R. order had traveled with her when she was discharged from the hospital. It is a common problem that results in the default option being to send the individual back to the hospital. When the patient goes to the hospital, she will be seen by a physician who doesn’t know her, usually for only a few minutes. Because the medical history is not readily available for nursing home patients, the doctor will order a number of tests which will likely show abnormalities because of the patient’s age and medical conditions. Then ext step is to readmit the woman to the hospital for more evaluation and observation. The patient will become afraid and disoriented because of the unknown situation, little sleep, and noise. She then will receive aggressive medications and be confined to her bed.
Few caregivers realize this is a likely chain of events. Rarely do nursing home doctors or nursessit down and explain the risks of hospitalizing a frail older person who is profoundly physicallyand mentally compromised. This is the set of problems that a new pilot program of the Centersfor Medicare and Medicaid Services (CMS) hopes to address in Alabama, Indiana, Missouri,Nebraska, Nevada, New York and Pennsylvania later this year. Seven organizations arepartnering with 145 Nursing Facilities to reduce avoidable hospitalizations. CMS will fundorganizations that provide enhanced on site services to support nursing facility residents. Nearlytwo-thirds of nursing facility residents are enrolled in Medicaid, and most are also enrolled inMedicare. These Medicare-Medicaid enrollees are among the most fragile and chronically illindividuals served by the programs. Research found that approximately 45 percent ofhospitalizations among Medicare-Medicaid enrollees receiving skilled nursing facility servicescould have been avoided. Total costs for these potentially avoidable hospitalizations forMedicare-Medicaid enrollees for 2011 were estimated to be between $7 and 8 billion. Allselected organizations will have on-site staff to partner with the existing nursing facility staff toprovide preventive services as well as improve assessments and management of medicalconditions. Participants will also work toward more seamless beneficiary transitions of care, andleverage use of emerging technologies, among many other activities. Each model will be subjectto a rigorous external evaluation.  The Initiative will be run collaboratively by the CMSMedicare-Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation,both created by the Affordable Care Act to improve health care quality and reduce costs in theMedicare and Medicaid programs. http://innovations.cms.gov/initiatives/rahnfr/.

Although few would plan for the years after retirement to be spent in a nursing home, unforeseen illness and declining mobility could render dreams of traveling the country by RV or perfecting agolf swing unlikely. According to a 2004 report compiled by the Centers for Disease Control(CDC), 27 percent of Americans over the age of 65—1.3 million—were residing in nursing homes.  What’s more, the Census Bureau predicts that the population of people 65 and over willmore than double to 86.7 million in 2050 from 36.3 million in 2004, a number that reveals the potential rise in health issues as a result of an aging population whose life span has become increasingly higher than in previous years.  But with many elderly people stubbornly resisting the transition to a nursing home—stereotypes of loneliness, isolation and stifled independence abounding—is there any alternative other than home health care for people requiring day to day care? Based on the teachings of Dr. Bill Thomas, a geriatrician whose Eden Alternative philosophy teaches that “aging should be a continued state of development and growth, rather than a period of decline,” the Sarah Neuman nursing home in Mamaroneck plans to build a freestanding set of buildings modeled after Thomas’ Green House project, which will address what Thomas says are the basic problems affecting nursing home residents: loneliness, boredom and helplessness.  In a poignant quote from a National Public Radio (NPR) interview in 2005, Thomas said, “I believe that in the nursing home every year, thousands and thousands of people die of a broken heart. They die not so much because their organs fail, but because their grip on life has failed.”  Please continue reading at:http://nanuet.patch.com/articles/nursing-home-of-the-future-mamaroneck-s-sarah-neuman-pioneering-resident-centered-care

Former CMS administrator scolds long-term care providers — but he has it all wrong!
By Steve Moran, Senior Housing Forum

McKnight’s Long-Term Care published an article titled “Former top Medicare official scalds long-term care leaders”  on September 26. According to this article, Tom Scully, the former chief of the Medicare & Medicaid Services Administration, brutally chastised the long-term care industry for exploiting a change in the Medicare reimbursement rules that allowed providers to extract an extra $5 billion from the system in less than a year.His proposition was that the long-term care providers should have known that it would not last and would damage their lobbying efforts for the foreseeable future. He has it wrong on so many counts. Last year, I pointed out:
The system, as designed by the government, is adversarial in nature, meaning that the government works to pay out as little possible and the providers work to get paid as much as possible while not breaking the rules, which is exactly what they did.The government is that stupid! If they had thought out the rule change it would have been easy to  figure out how the providers would react. This was an easily predictable outcome.You could even make a case that if the providers had not taken advantage of the rule change, they would have been violating their responsibility to their investors.The providers did nothing that was illegal or even against the rules. It is hard to even figure out how to apply morality to this particular situation. At the end of the day, even with the “take backs”, the long-term care providers who were the most aggressive in taking advantage of the system ended up financially better off than if they had not. At least some of those providers who”did the right thing” ended being penalized for not taking advantage of the system.The blame for this colossal waste of tax money, my money and your money, lies squarely at the feet of the CMS.

Simple Products That Can Make Mobility Easier
by Lynda Shrager, The Organized Caregiver

After 33 years of practicing in the field of occupational therapy, it still never ceases to amaze me how a simple piece of adaptive equipment can so highly impact how a person completes a task.Whether they have joint limitations, decreased strength, loss of the use of one extremity, poor balance, or difficulty mobilizing, a simple modification can often turn an impossible task into an achievable one. One of my principles of health organizing is to gather all of the equipment you need ahead of time before undertaking a task:The Organized Caregiver’s Top Ten Choices for Products That Will Make Life Easier and Safer:
1. Elastic shoe laces: Lace in shoes, pull to desired tension, tie a bow and then never have to tie your shoes again! It turns tie shoes into slip-ons.
2. Button hook/Zipper pull: The button hook is inserted through the button hole, hooks the buttonand easily pulls it back through. The zipper pull easily grabs hard to grasp zippers. This is a greattool for people with decreased fine coordination or arthritis.
3. Rocker knife: Simultaneously stabilizes and cuts food. The knife has a sharp, curved blade thateasily cuts when rocked back and forth over food. For one handed use, decreased coordination orweakness.
4. Spike board: A cutting board with several long nails protruding up to stab meats, vegetablesand fruits for cutting or peeling. Look for suction cup legs and a raised corner against which apiece of bread can be placed for buttering. This is a good product for people with weakness, onehanded use, a lack of coordination or low vision.
5. Bed rail: Available in many types and sizes, this small rail provides support to help people safely get in and out of bed. Many have a base that fits between the mattress and box spring with no assembly required!
6. Sock aide: An incredible gadget that helps you put on socks without bending over. An inexpensive tool that is helpful for those with limited mobility or recovering from hip replacement surgery.
7. Raised toilet seat with handles: If you have decreased mobility in the hips, knees or back your toilet can seem very low. This product raises it about four inches and has armrests for added safety and support.
8. Reacher: Helps you pick up things more than an arm’s length away for people with limited reach or strength. Various types have different “jaws” depending on what type of objects you need to grab.
9. Bathtub transfer bench: Two legs sit outside of the tub and two are in. The person sits down and slides in without needing to step over the wall of the tub.
10. Grab bars: I saved the best for last. Place them in the shower, on the way into the tub, by the toilet, or near the door jam on the way out of the house. Be sure they are installed properly and have a textured surface making them easier to grasp. This simple bar will increase safety and make transfers easier.
You may purchase most of these items in your neighborhood home medical supply store. Many drugstores or big box stores also carry them. For more information, pictures of the products and where to purchase, go online to “Home Health Care Equipment and Supplies” or Google the name of the item.

Lawsuit Filed Over Negligence In DVT Prevention and Treatment
Tampa, FL (Law Firm Newswire) October 10, 2012 –

A lawsuit has been filed against an Illinois nursing home over negligence in the prevention and treatment of deep vein thrombosis (DVT). Carol Harrison, 63, was admitted to Maple Ridge Care Centre for rehabilitation and ventilator care following complications from surgery. As with many patients in long-term care, Harrison was at risk for blood clots. According to the lawsuit, medical staff failed to detect the fact that Harrison had developed DVT. Her leg had to be amputated, which allegedly hastened her death. DVT is a potentially fatal condition that staff at hospitals and nursing homes must be alert to, as anyone with limited mobility may be at risk due to compromised blood circulation. DVT happens when a blood clot is created in the veins of the legs or pelvis. If the clot breaks free and travels through the bloodstream, it becomes an embolism. Common symptoms of DVT include discoloration and swelling of the limb, usually the leg. Patients at risk may be prescribed blood thinners like Warfarin, but pneumatic compression therapy is another alternative. “Some doctors prescribe blood thinners like Warfarin to reduce the chance of blood clots, but these drugs are expensive, and have potentially dangerous side effects, which can be as serious as the clots themselves,” said Greg Grambor, owner of VascularPRN, a distributor of DVT prevention devices. “Pneumatic compression therapy is a far less expensive alternative, which is every bit as effective as the drugs, with absolutely no dangerous side effects.”Maple Ridge Care Centre is a nursing home in Lincoln, Illinois specializing in wound care,pulmonary diseases and physical therapy. The facility provides respiratory care through a partnership with the Springfield Clinic and Southern Illinois University Pulmonology. The nursing home lawsuit was filed in Macon County Circuit Court by Harrison’s husband. To learn more about a Sequential Compression Device, SCD boots, visit www.vascularprn.com or call 800-886-4331.

There has been significant discussion regarding hospital readmissions and the impact tocompensation. CMS has just begun a study looking at readmissions from nursing homes.
by Candyce Henry

A 79 year old woman had advanced heart failure, chronic lung disease and diabetes. She recently had signed a D.N.R., “do not resuscitate” order and there was nothing more that could be done to care for her at the hospital. The cardiologist called her doctor and they agreed that they would respect her wishes to be kept out of the hospital. Within a few hours after being placed in long term care, the staff noticed her very low oxygen levels and contacted another doctor who was not familiar with the woman’s medical history who gave the order to send her back to the hospital.The situation highlights problems with long-term care that frequently frustrate caregivers and that are receiving fresh attention from medical providers and Medicare. The nursing home staff had no knowledge of the woman’s D.N.R. and the patient was unable to provide information. This might not have happened if the woman’s D.N.R. order had traveled with her when she was discharged from the hospital. It is a common problem that results in the default option being to send the individual back to the hospital. When the patient goes to the hospital, she will be seen by a physician who doesn’t know her, usually for only a few minutes. Because the medical history is not readily available for nursing home patients, the doctor will order a number of tests which will likely show abnormalities because of the patient’s age and medical conditions. Then ext step is to readmit the woman to the hospital for more evaluation and observation. The patient will become afraid and disoriented because of the unknown situation, little sleep, and noise. She then will receive aggressive medications and be confined to her bed.
Few caregivers realize this is a likely chain of events. Rarely do nursing home doctors or nursessit down and explain the risks of hospitalizing a frail older person who is profoundly physicallyand mentally compromised. This is the set of problems that a new pilot program of the Centersfor Medicare and Medicaid Services (CMS) hopes to address in Alabama, Indiana, Missouri,Nebraska, Nevada, New York and Pennsylvania later this year. Seven organizations arepartnering with 145 Nursing Facilities to reduce avoidable hospitalizations. CMS will fundorganizations that provide enhanced on site services to support nursing facility residents. Nearlytwo-thirds of nursing facility residents are enrolled in Medicaid, and most are also enrolled inMedicare. These Medicare-Medicaid enrollees are among the most fragile and chronically illindividuals served by the programs. Research found that approximately 45 percent ofhospitalizations among Medicare-Medicaid enrollees receiving skilled nursing facility servicescould have been avoided. Total costs for these potentially avoidable hospitalizations forMedicare-Medicaid enrollees for 2011 were estimated to be between $7 and 8 billion. Allselected organizations will have on-site staff to partner with the existing nursing facility staff toprovide preventive services as well as improve assessments and management of medicalconditions. Participants will also work toward more seamless beneficiary transitions of care, andleverage use of emerging technologies, among many other activities. Each model will be subjectto a rigorous external evaluation.  The Initiative will be run collaboratively by the CMSMedicare-Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation,both created by the Affordable Care Act to improve health care quality and reduce costs in theMedicare and Medicaid programs. http://innovations.cms.gov/initiatives/rahnfr/.

If you do take the time to study some analytics relating to your insurance website, you might have run across the term, “bounce rate.” All that means is how many people visited one page of your site, and then click away form your site. If you have a high bounce rate, it usually means people just see the one page they landed on, and then they leave. If the bounce rate is low, this is generally good news, as it means visitors are staying on your site and checking out other pages.

Does it matter if people bounce off? Yes, it does, as the longer they stay, the higher the chances they become a customer, and convert by buying something. What can you do to reduce your bounce rate? If your insurance website only has one contact form on the home page, this significantly reduces the chances that someone fills it out. The solution is to have a short contact form on all the pages on your site. Keep in mind that visitors don’t always land on the home page.

Overall, you want a lower bounce rate, and want people to stay on your site longer and read the content. Having said that, is it a critical failure for your insurance website to have a higher bounce rate than you might like? The answer is no, a single page visit is not necessarily a bad thing, and does not affect your ranking. It means the visitor has found what they wanted, with either one or two clicks; a good sign for your insurance company.

Certainly, there are many ways to interpret bounce rate statistics, and this is something that will help you focus your website content. However, it is also something that not every insurance agent has time to do. This is where a top flight insurance search engine optimization (SEO) company comes to bat for you. They are able to not only help you choose the right content for your insurance website, but know the ins and outs of working with natural SEO conversion rates, and why, when dealing with “that” conversion rate, the bounce rate does matter.

Of course, SEO is more than just the bounce rate. It involves social media, news releases, articles, blogs and other connections, like Twitter and Facebook. For the whole picture that looks good on your insurance website, partner up with an insurance search engine optimization company. Reap the conversion rewards.

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

Some insurance marketing companies lay claim to being insurance search engine optimization (SEO) gurus, but are they really? Usually not. There are very few SEO companies that can claim they have over 25 years of insurance experience. However, when you find such a company, this is the answer to your insurance marketing prayers.

One of the first things you should be told by an “expert” insurance SEO company is that your website needs to be created with conversion in mind and needs to be user friendly. That merely means is it easy to navigate, is the information on it easy to access, is it relevant information for users and are you easy to contact? While many think that insurance SEO in just about keyword placement, this is a myth. Insurance website optimization is not just about keywords, it is about optimizing the experience the user has when they visit your site.

At one time, websites thrived on inbound links. Then, Google said they were going to block paid links, link exchanges, website directories and any links about anything that had nothing to do with your insurance website. In other words, relevancy has become the watchword of the day. If it’s not relevant, and a quality link, it does not do you any good in your marketing and ranking attempts. Relevant, quality links are real links and thus valuable for your website.

This isn’t to say you can’t still get links from some website directories, because you can, they just need to be respected and well, relevant. For instance, Yahoo Directory or Joeaunt.com.  Using insurance directories or resource guides helps to drive quality traffic to your site, because their content is relevant to your insurance website. The most important point here is that content driven links are highly valued. News releases, articles and blogs published within niche communities offer high quality links with long-term benefits.

One important thing to keep in mind is that your content, and any other activity, needs to be synced with LinkedIn, Twitter and Facebook, and Google +. Today, social media is the driving force behind insurance website marketing. The more active your insurance agency, the better it looks to followers and the search engines.

If you want to be rock stars, find an insurance SEO company with experience in the insurance industry. Your insurance website and all other optimization techniques will be highly relevant, because they have the experience to market insurance websites.

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

Get Rid of That Bathroom Key… or Lose Leads!
By Patty Cisco, Creative Catalyst for CISCO & CO. For effective marketing, sales and customer strategies thatconnect you with your customers visit www.ciscoco.comWhen was the last time you visited a nursing home and had to use the rest room? Interestingtopic, right? Well, when you have to go, the last thing you want to do is have to hunt thebathroom down and then have to find the key to unlock it! How visitor friendly is that?
I could probably have a contest to see how many interesting key chains are used by nursinghomes. Wooden dowels, heavy ceramic rectangles, large metal rings; the list goes on. Not tomention where the keys are stored! I’m sure there is some regulation that exists that created theneed to keep the public restroom locked. I mean, let’s face it, we can lose residents, right? In theage of person-centered care, is the visitor becoming a focus? When do we evaluate ways to makeour services ‘user’ friendly? Why have we made basic human needs – like using a restroom – socomplicated? Recently, I was delighted to have a positive experience in a nursing home where Icould easily find the restroom, AND to my surprise it wasn’t locked. There was no key!Remember, it doesn’t have to cost a lot of money to create and deliver positive customerexperiences. Sometimes it’s the little things that can make or break that word-of-mouth referral.Is it time to throw your keys away? What changes can you make in 2013 to help deliver apositive customer experience?

Clostridium difficile transmission and mortality rates are far higher in nursing homes andother healthcare settings than the most recent government statistics suggest, aninvestigation has found.
From Pedagogy.comThe Centers for Disease Control and Prevention estimated in March that c. diff kills 14,000people a year, based on death certificate records. However, a USA Today analysis of recordsfrom the federal Agency for Healthcare Research and Quality found over 30,000 c. diff fatalitiesper year. The newspaper’s analysis looked at hospital billing rates rather than death certificates,which do not always list the cause of death as complications from c. diff.  The report suggestsaround 500,000 people contract the disease each year.  Experts say that U.S. officials could get abetter handle on c. diff by requiring nursing home and hospitals to report c. diff infections andantibiotic usage rates to federal regulators, a tactic that has helped healthcare facilities in Europereduce c. diff rates. One focus will likely be on environmental services for healthcare facilities, asthe newspaper reported that many hospitals have cut housekeeping budgets up to 25% in recentyears. U.S. hospitals will be required to report their rates of c. diff in 2013, but there are no suchregulations — yet — for nursing homes.
To view the original article:http://www.pedagogy-inc.com/Home/Classes/Infection-Control/Clostridium-Difficile.aspx
Pedagogy Inc. has an online continuing education course for nurses, medical health careprofessionals, and other interested individuals ”Clostridium Difficile Colitis Prevention AndManagement” Clostridium difficile is an inimitable organism that normally lives in the gut.When an antibiotic is taken to treat an infection, helpful or normal bacteria are destroyed, causingan overgrowth of the C. difficile bacteria. Clostridium difficile localizes to the large bowel,where it manifests as diarrhea and colitis. The symptoms of CDI can be mild or life-threatening. Clostridium difficile is the leading cause of infectious diarrhea in hospitals and has become,along with methicillin-resistant Staphylococcus aureus, one of the most common causes of healthcare–associated infections.¹ The incidence and severity of C. difficile infection (CDI) haveincreased dramatically since 2000, and CDI is estimated to cause as many as 20,000 deaths andto cost as much as $3.2 billion per year in US acute care facilities alone.² CDI outbreaks havebecome more common, and infection control–based CDI prevention efforts appear to be lesseffective than in the past. How does your facility prevent patients from getting a CDI during theirstay? In this course you will learn the characteristics and transmission of CDI, best practices formonitoring these infections, and the recommended practices for prevention and control.
To learn more about the course curriculum, price and to purchase go tohttp://www.pedagogy-inc.com/Home/Classes/Infection-Control/Clostridium-Difficile.aspx

Get Rid of That Bathroom Key… or Lose Leads!
By Patty Cisco, Creative Catalyst for CISCO & CO. For effective marketing, sales and customer strategies thatconnect you with your customers visit www.ciscoco.comWhen was the last time you visited a nursing home and had to use the rest room? Interestingtopic, right? Well, when you have to go, the last thing you want to do is have to hunt thebathroom down and then have to find the key to unlock it! How visitor friendly is that?
I could probably have a contest to see how many interesting key chains are used by nursinghomes. Wooden dowels, heavy ceramic rectangles, large metal rings; the list goes on. Not tomention where the keys are stored! I’m sure there is some regulation that exists that created theneed to keep the public restroom locked. I mean, let’s face it, we can lose residents, right? In theage of person-centered care, is the visitor becoming a focus? When do we evaluate ways to makeour services ‘user’ friendly? Why have we made basic human needs – like using a restroom – socomplicated? Recently, I was delighted to have a positive experience in a nursing home where Icould easily find the restroom, AND to my surprise it wasn’t locked. There was no key!Remember, it doesn’t have to cost a lot of money to create and deliver positive customerexperiences. Sometimes it’s the little things that can make or break that word-of-mouth referral.Is it time to throw your keys away? What changes can you make in 2013 to help deliver apositive customer experience?

Clostridium difficile transmission and mortality rates are far higher in nursing homes andother healthcare settings than the most recent government statistics suggest, aninvestigation has found.
From Pedagogy.comThe Centers for Disease Control and Prevention estimated in March that c. diff kills 14,000people a year, based on death certificate records. However, a USA Today analysis of recordsfrom the federal Agency for Healthcare Research and Quality found over 30,000 c. diff fatalitiesper year. The newspaper’s analysis looked at hospital billing rates rather than death certificates,which do not always list the cause of death as complications from c. diff.  The report suggestsaround 500,000 people contract the disease each year.  Experts say that U.S. officials could get abetter handle on c. diff by requiring nursing home and hospitals to report c. diff infections andantibiotic usage rates to federal regulators, a tactic that has helped healthcare facilities in Europereduce c. diff rates. One focus will likely be on environmental services for healthcare facilities, asthe newspaper reported that many hospitals have cut housekeeping budgets up to 25% in recentyears. U.S. hospitals will be required to report their rates of c. diff in 2013, but there are no suchregulations — yet — for nursing homes.
To view the original article:http://www.pedagogy-inc.com/Home/Classes/Infection-Control/Clostridium-Difficile.aspx
Pedagogy Inc. has an online continuing education course for nurses, medical health careprofessionals, and other interested individuals ”Clostridium Difficile Colitis Prevention AndManagement” Clostridium difficile is an inimitable organism that normally lives in the gut.When an antibiotic is taken to treat an infection, helpful or normal bacteria are destroyed, causingan overgrowth of the C. difficile bacteria. Clostridium difficile localizes to the large bowel,where it manifests as diarrhea and colitis. The symptoms of CDI can be mild or life-threatening. Clostridium difficile is the leading cause of infectious diarrhea in hospitals and has become,along with methicillin-resistant Staphylococcus aureus, one of the most common causes of healthcare–associated infections.¹ The incidence and severity of C. difficile infection (CDI) haveincreased dramatically since 2000, and CDI is estimated to cause as many as 20,000 deaths andto cost as much as $3.2 billion per year in US acute care facilities alone.² CDI outbreaks havebecome more common, and infection control–based CDI prevention efforts appear to be lesseffective than in the past. How does your facility prevent patients from getting a CDI during theirstay? In this course you will learn the characteristics and transmission of CDI, best practices formonitoring these infections, and the recommended practices for prevention and control.
To learn more about the course curriculum, price and to purchase go tohttp://www.pedagogy-inc.com/Home/Classes/Infection-Control/Clostridium-Difficile.aspx

One in five short-stay nursing home patients sustains a fall after their admission. The study, published in the Journal of the American Geriatrics Society, also found that certified nursingassistant (CNA) staff was associated with a decreased risk of falls. Pedagogy has released a fall prevention course “Managing Falls in the Nursing Home: Who,Why and What Next?” There is more to fall prevention than the management of the environment. In this online continuing education course the student will learn a comprehensive program of interventions that can be taken to manage falls within the nursing home. View the course curriculum here: http://bit.ly/T3BSZ0 While you are there, stop by our home page and test yourfall prevention knowledge with our Quick Quiz: http://bit.ly/n8vZ5W
Medicare Reimbursements for SNFs: “It was the best of times, it was the worst oftimes . . .”

Last week brought good reimbursement news for SNFs after what seemed like years of Medicare bummers: The federal government raises Medicare payments by 1.8 percent in fiscal year 2013. Even AHCA praised CMS for the news:  “After years of reimbursement volatility, today’s update to Medicare payments is welcome news to skilled nursing providers. AHCA appreciates CMS’ balanced approach to this year’s Medicare payment system after recognizing the many rounds of government reductions the profession has already endured. Stable Medicare funding will help ensure America’s seniors continue to have access to high quality, post-acute care.” Rejoice! The tides have turned! After the dreaded Oct. 1, 2011, cuts of 11.1% (sorta), and declining state revenues and reimbursement uncertainty, SNFs finally get some good news. Right? And then the buzz kill. This analysis from Avalere Health says brace for $65 billion in cumulative Medicare cuts over the next 10 years. There are two main reasons: New rules that reduce the amount Medicare reimburses for bad debt (such as unpaid deductibles and copays), and the “sequestration” cuts (fixed cuts that were part of the congressional budget compromise),which include a 2 percent Medicare reduction.  But wait again, hope returns! The White House has 30 days to submit it’s plan for the sequestration cuts to Congress, which opens some hope for a plan that might minimize the effectof cuts on skilled nursing facilities. The lesson from this churning cycle of hope and despair? SNFs must keep focusing on the basics, despite the highs and lows of Medicare reimbursements. Focus on building quality census. Increase your Medicare census (no matter what, higher Medicare census still means more revenue). Maximize margins to invest in your mission of quality patient care and life experience. Medicare cuts don’t mean the sky is falling. Far from it, in fact; many providers are thriving. Instead of being paralyzed with panic over the things they can’t control (moving reimbursement targets),  SNFs must continue to take charge of the things that they do control (working faster and smarter to build and maintain quality census).

Accreditation Improves Care in Nursing Homes
by Zachary Zlotoff with Senior Home Blog

According to a new study, nursing homes that have gone through the process of accreditation report a stronger safety culture than non-accredited facilities. The study was published in the May 2012 issue of the “Joint Commission Journal on Quality and Patient Safety,” which is published monthly by Joint Commission Resources. Findings Are Significant : The study has found that Joint Commission accreditation at more than 4,000 facilities across the United States has a positive influence on administrative level functions such as hiring, staff training and teamwork, openness in communication, and reserving punishment on smaller mistakes. These positive influences lead to a stronger culture of safety and care. Few studies have looked at the impact of Joint Commission accreditation in senior living facilities, so the findings that accreditation leads to positive changes that affects the care of residents is significant. Laura M. Wagner, Ph.D., R.N., and assistant professor at the New York University College of Nursingat the Hartford Institute for Geriatric Nursing, was the lead author of the study. She notes that the managers who were surveyed such as nursing home administrators and nursing directors can wield a great amount of influence over an organization’s culture, and the research is “both timely and of great importance.” Benefits Outweigh the Costs:  Even though accreditation can be a costly process for many facilities, studies such as Wagner’s show that the benefits are much better for those facilities in the long run. With staff profiting from better training, team work, and communication, the resulting culture of safety is reflected in better care given to residents. According to Wagner, “[i]t has been suggested that the process of sustaining the level of standards compliance required for accreditation can create asafety-oriented culture within a facility, and our results appear to support this contention.” “Although there are costs associated with accreditation, these findings suggest that the benefits ofvoluntary accreditation may ultimately outweigh the extra costs,” she adds. An earlier one of Wagner’s studies also demonstrated the benefits of Joint Commission accreditation for long term care facilities and their residents. Appearing in the March 5 issue of the journal “The Gerontologist” in an article titled “Impact of Voluntary Accreditation on Deficiency Citations in U.S. Nursing Homes,” showed that Joint Commission accredited facilities had fewer deficiency citations than nonaccredited facilities. Additionally, Wagner and her co-authors have a forthcoming study to be published in the journal “Policy, Politics & Nursing Practice.” This latest study will show that long term care facilities with Joint Commission accreditation have better resident outcomes that continue to improve over time. Perhaps with this and continued evidence of the positive influences of accreditation on senior living facilities, more will take part in the accreditation process.

Nursing homes urged to improve with incentives
from USA Today

For years, states have struggled to raise the quality of care in nursing homes by using a regulatory stick — citations, fines and other sanctions — when serious problems are discovered. Last month, Ohio adopted a distinctly different, carrot-like approach by using financial incentives that encourage better services for frail seniors. It’s the latest effort to address longstanding concerns such as too few nurses, too many patients who develop painful bed sores and high staff turnover. Under Ohio’s new approach, almost 10% of the Medicaid payments to nursing homes will depend on factors including residents’ satisfaction, rates of medical complications and the number of nurses on staff. Medicaid, a federal-state health program for low-income people, is the largest funder of nursing home services in the nation. Seven other states have programs of this sort, but Ohio’s will be the largest. Meanwhile, Medicare, the federal health plan for seniors, plans to roll out a similar program for nursing homes nationally in the next several years, after government officials evaluate results of a three-year demonstration project in Arizona, New York and Wisconsin that ended July 1. Medicare pays for short nursing home stays for some patients who need skilled care after a hospitalization. Whether the strategy will improve nursing homecare is far from certain. “A number of states have attempted, this but most programs have been short-lived and haven’t really made much of a difference,” said David Grabowski, a professor of health policy at Harvard Medical School and lead investigator for the Medicare demonstration project. That may reflect design shortcomings rather than the failure of the underlying concept, several experts suggest. “There is a lot of room to improve the way programs are structured and to maximize their impact,” said Dr. Rachel Werner, an associate professor of medicine at the University of Pennsylvania and author of an unpublished study on states’ nursing home “pay-for-performance” efforts.  States such as Colorado, Georgia, Kansas, Nevada, Oklahoma, Utah and Vermont award a small bonus (from 60 cents to $6.16 per patient per day) if facilities achieve various standards. But industry representatives say those incentives are insufficient, says Nicholas Castle, who has surveyed nursing home administrators and is a professor of health policy at the University of Pittsburgh. Meeting the standards: Under the new Ohio program, a payment of up to $16.44 a day for each Medicaid patient depends on the facility meeting five of 20 quality standards. Ohio’s approach provides a “much more powerful incentive,” said Michael Cheek, vice president of long-term care policy at the American Health Care Association, an industry trade group. The goal of the initiative, as well as a broader health care overhaul launched last year by Republican Gov. John Kasich, is to create a “coordinated, comprehensive, patient-centered health care system in Ohio” that “reimburses forquality” and lowers the sharply rising trajectory of health care costs, explained Bonnie Kantor-Burman, director of the Ohio Department of Aging. “We’re dealing with a very challenging environment,” but Ohio’s 970 nursing homes generally support the state’s new quality initiative, in part because most will qualify for new, quality-based incentive payments without much trouble, said Peter Van Runkle, executive director of the Ohio Health Care Association.The threshold for receiving those payments has been the most controversial element of the state’s plan. “It just doesn’t seem that (nursing homes) will have to stretch themselves enough, and I’ll be advocating for raising the threshold in the future,” said Beverley Laubert, Ohio’s long-term care ombudsman. Initially, she had advocated that homes meet 15 of 20 standards, a goal that many would have found difficult to achieve. State officials say it was important to start with a program that the industry would accept and that would not penalize large numbers of nursing homes. “Our plan is to up the ante” over time, said Kantor-Burman. Differing views: Ultimately, Ohio’s program will depend on institutions such as Welcome Nursing Home in Oberlin, a 102-bed facility operated by the same family since 1945. Jill Herron, the administrator, said her facility will meet 18 out of 20 standards, but she questions how well those requirements reflect quality care. Take the standard specifying that at least 50% of Medicaid-certified beds be in private rooms. The Welcome home has only six rooms of this type. “Private rooms may be essential for market choice — people may want them and like them — but I don’t think they’re essential for quality care,” Herron said. Irene DuRell, an 82-year-old former nurse, has lived at the Welcome home for the past year with a 90-something roommate she calls “wonderful.” Asked what she likes best about Welcome, DuRell said, “They’ve been real good about helping out when I needed it. And they listen to me.”

Nothing to do with Long Term Care but you’ll all enjoy reading this………
Chocolate Each Day May Keep Strokes Away
By Cole Petrochko, Associate Staff Writer, MedPage Today

Published: August 29, 2012Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Bostonand Dorothy Caputo, MA, BSN, RN, Nurse Planner

Men who ate a moderate amount of chocolate every week had a reduced risk of stroke, Swedish researchers found. In a prospective, longitudinal study, those who consumed a median 62.9 g of chocolate a week were at a significantly lower relative stroke risk than those who ate a median of zero grams weekly (RR 0.83, 95% CI 0.7 to 0.99), according to Susanna Larsson, PhD, of the Karolinska Institutet in Stockholm, and colleagues. The researchers also found significant and similar results in a meta-analysis of studies in men and women, with those in the highest quartile of weekly chocolate consumption being significantly less likely to experience a stroke compared with those in the lowest quartile (RR 0.81, 95% CI0.73 to 0.90), Larsson’s group wrote in the Sept. 18 issue of Neurology. ”Flavonoids in chocolate may be protective against cardiovascular disease through antioxidant, antiplatelet, and anti-inflammatory effects,” the authors explained. “Flavonoids in chocolate may also decrease blood concentrations of low density lipoprotein (LDL) cholesterol and reduce LDL oxidation as well as improve endothelial function,” the group wrote. Please continue reading athttp://www.medpagetoday.com/Cardiology/Strokes/34472?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&xid=NL_DHE_2012-08-30&eun=g393447d0r&userid=393447&email=greg@medsupplyoftampa.net&mu_id=5386199

Medicare To Penalize 2,211 Hospitals For Excess Readmissions

By Jordan Rau KHN Staff Writer
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 about $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 slightly above 19 percent for several years, even as many hospitals have worked harder to lower theirs. Please continue reading at:http://www.kaiserhealthnews.org/Stories/2012/August/13/medicare-hospitals-readmissions-penalties.aspx?goback=%2Egde_144864_member_146634479

RetirementHomes.com reported yesterday that one of the most common misconceptions about aging is that older people don’t have sex. However, an Australian study, as reported by theTelegraph newspaper, found that in many Australian nursing care homes, elderly residents are effectively being prevented from having sex by staff. The study, commissioned by the Australian Centre for Evidence-Based Aged Care, discovered that a combination of age discrimination, lack of privacy, and even worry about legal consequences on the part of nursing care homes, have contributed to the practical prevention of sexual activity among residents. “For residents withdementia, sexuality is viewed with even greater anxiety, either being labeled ‘inappropriate’ or a‘challenging’ behavior or as a risk to the resident,” according to the study. The newspaper cited the study, which mentioned that there are legal implications for many nursing care communities for residents with cognitive decline, but because there are stages to dementia, not everyone with mental decay should be treated the same way, and that there should be multiple approaches to sexuality among seniors. For example, the study said, people with early stage dementia may be impacted by simply being forgetful, while people with more developed dementia may besignificantly less capable of taking care of themselves.

Examining Bed Width as a Contributor to Risk of Falls From Bed in Long-TermCare
By Guy Fragala, PhD, PE, CSP, CSPHP • Bonnie Perry, MS • Maren Fragala, PhD, CSCSD

Healthcare practitioners are discovering that the concepts of ergonomics can provide much value when used to create safer environments in healthcare facilities. Through the application of ergonomic principles, progress has been made in healthcare safety, benefitting both patients and caregivers; however, the long-term care (LTC) environment continues to expose residents tomany hazards, despite striving to provide quality care to the aging population. One such hazard, especially among LTC residents with deteriorating functional abilities, is falls. Prevention of resident falls demands serious attention, and healthcare practitioners need to continue to seek effective solutions to reduce falls risk in this population. This article examines the issue of falls from bed, a major contributor to the overall falls problem. Background information on the magnitude of the problem is provided and thoughts about causation are discussed. We also describe the results of our small pilot laboratory study, which was conducted to investigate howbed surface width might impact falls risk. This study sheds light on how equipment design improvements can reduce risk of falls among high-risk populations.
The Magnitude of Resident Falls
Residents’ high risk of falling and the frequent occurrence of falls in the LTC setting have beenwell documented. It has been estimated that 45% to 70% of residents fall each year, of whom 50% experience multiple falls.1,2 It has also been determined that older adults residing in LTC settings are two to three times more likely to experience multiple falls than their community-dwelling counterparts.2-6 Approximately 50% of the falls that occur in LTC settings involve falling from bed. 7,8 Bedside falls are associated with significant physical and psychological complications, including hip injuries, fractures, immobility resulting in muscle weakness, functional disability, and psychological distress, such as depression and fear of falling. 7 They are also associated with an increased risk of subsequent falls. Please continue reading at:http://www.annalsoflongtermcare.com/article/examining-bed-width-contributor-risk-falls-bed-long-term-care?page=0,0&goback=%2Egde_134913_member_126485789

Hospitalization increases chances of poor outcomes in Alzheimer’s patients
By Carolyne Krupa

Staying in a hospital can be a difficult and unsettling experience for anybody, but it can be especially problematic for dementia patients — who have a harder time coping in unfamiliar surroundings. Hospitalization of individuals with Alzheimer’s disease greatly increases their riskof adverse outcomes, such as institutionalization, mental decline or death, according to a June 19Annals of Internal Medicine study. The risk is amplified for those who develop delirium duringan inpatient stay. Knowing this, Alzheimer’s experts recommend that physicians try to keep people with the disease out of the hospital. When such patients are hospitalized, physicians should work with other medical staff to help keep patients oriented and avoid medications or procedures that can contribute to delirium.  Please continue reading at:http://www.ama-assn.org/amednews/2012/06/25/hlsa0625.htm

Competition Heats Up As Senior Living Providers Prepare for Boomers
Alyssa Gerace, Boston Globe

Providing plenty of choice for the coming generation of senior living residents seems to be a key component of differentiating communities and rising above the competition, and a Boston Globe article suggests that current residents in many communities are getting a first taste of what’s to come. That first taste, unlike in times past, won’t be Jell-O, says the article: Choice is the buzzword for a wave of high-end senior communities opening or expanding in area communities. As the industry prepares for the aging baby boomers, it’s starting to practice on their elders, who increasingly demand more options and financial flexibility. The products are not just indoor swimming pools and granite countertops but also a la carte pricing that allows retirees to tailor their services. “The traditional ways aren’t necessarily the best ways,” said Patrick McShane, a spokesman for the Groves in Lincoln, a $130 million independent-living development that offers residents the nursing or personal care they need to stay in whichever apartment or cottage they choose.  “As the boomers continue to age, this is certainly a segment of the population that is very used to having choice and being able to shape where they live and what they drive and what they eat, and that should never end.”  From wine-tastings and day spas to more flexible accommodations for couples who may require different levels of care, senior living communities are ramping up their product offerings as they try to persuade older adults to leave their homes.

As Medicaid enrollments and healthcare costs rise, state budgets reach breaking point
from www.woundrounds.com

In a new report, findings concluded that whether or not states decided to expand Medicaid, states are in the midst of a fiscal crisis relating to rising healthcare costs and government pension obligations. Medicaid currently pays for the bulk of care in skilled nursing facilities. With increasing Medicaid enrollments and rising healthcare costs, Medicaid cost growth will surpass revenue growth by a wide margin.  The authors point out that a larger problem than healthcare is unfunded state government pension obligations that could end up totaling as much as $3 trillion. In addition, the authors said that states cannot control Medicaid spending without assistance of the federal government. “Reaching agreement on how to control federal and state costs, while assuring the basic goals of enlarging and improving healthcare for persons who cannot now afford private insurance, is a major political and economic challenge that should be addressed sooner rather than later,” the authors stated. The State Budget Crisis Task Force panel was organized by Former Federal Reserve Chairman Paul Volcker and former New York Lt. Gov.Richard Ravitch (D). The task force focused on six states’ budgets: California, Illinois, New Jersey, New York, Texas and Virginia.

by CaringForward.com
We recently looked at how the 11.1 percent Medicare cuts from October 2011 affected top-3 U.S.SNF provider Kindred Healthcare. The short answer—probably not in the ways, or nearly to the extent, that you’ve read about in the press. But what about other major providers? At least among big public SNF companies, the sky seems securely in place. Although all providers cite the challenges posed by the Medicare cuts, have most reported positive financial results and outlooks, some quite remarkable. Let’s look at a few other financial filings for public SNFcompanies*:
Ensign Group (103 SNFs, based in Mission Viejo, California): Ensign opened its 2011 report citing the “unprecedented 11.1% reduction in Medicare rates to skilled nursing facilities,” but that was in reference to its “better-than-expected operating results.” “The fourth quarter marked the most daunting challenge to Ensign’s facility-centric leadership structure and operating model to date, and perhaps the best test of our flexibility, responsiveness and resilience that we will ever experience,” said Ensign CEO Christopher Christensen. Even with the calculated actual Medicare rate cut impact of 14% for Ensign (much higher than many SNFs likely encountered), facilities performed well. Christensen cited the fundamentals—improving census and skilled mix. “Our facilities were able to make up much of the loss in the form of increased skilled days, as our skilled mix continues to shift higher,” he said. We’ll say it again—the same things that made business sense for SNFs on Sept. 30, 2011 made sense on Oct. 1, 2011.  The strategy and performance has carried over into 2012, with Ensign reporting record financials in Q1 2012. By the numbers for 2011:
2011 consolidated revenues up 16.7% to $758.3 million2011 net income climbed 17.6% to $47.7 million. Bullish on growth, acquiring six new SNFs in Q4For Q1 2012:
Record revenues of $202.2 million, up 10.5%Record EBITDA of $30.3 million, up 5.4% over Q4 2011 and an increase of 19.1% over Q42011Facility census was up 4.4% over Q1 2011 and by 1.7 percent over Q4 2011, too 83.6%, with Medicare days increasing by 3.6% over Q1 2011 National Healthcare Corporation (NHC, 75 SNFs, based in Murfreesboro, Tennessee): NHC seems to say only the minimum with its financial reporting, providing less management perspective than most of the other public SNFs. So we’ll jump right to the numbers:
2011:
Net income to shareholders up 25.8% to $55.4 million from $44 in 2010. Annual operating revenues up 7.3% to $773 million from $723 million Q4 2011 0perating revenues increased 0.5% to $192 million over Q4 2010, with net income for shareholders increasing by 12.2% (adjusted to exclude a one-time asset recovery gain from Q4 2010).  Advocat/Diversicare (Est. 50 SNFs, based in Franklin, Tennessee): Advocat reports some interesting performance numbers, with its Medicare reimbursement rate increasing 11.9%, even with the 11.1% cuts effective October 1. That supports our analysis from last year that some providers could see average rates increase depending on case mix. “This rate increase is a direct reflection of our efforts to deliver high quality skilled nursing and rehabilitation services,” said Advocat CEO Kelly Gill. Some of the other numbers bear out strong top line growth for thecompany:
Revenues increased 8.5% over 2010, from $290 million to $314.7 millionSkilled census (Medicare and managed care) up 11.9% to 16.3% of total censusMedicare Part B revenues up $2.1 million Q4 2011 Highlights:
Overall census up 17% over Q4 2010. Revenue increased 3% over Q4 2010, to $77.8 million compared to $75.5 million. For Q1 2012, revenues were almost identical to Q1 2011, despite the Medicare cuts—$77.1million.
Even with healthy revenue measures, Advocat reported modest net losses in Q4 2011 and Q1 2012. Interestingly, CEO Gill cites several reasons for the losses, primarily related to strategic growth investments in facility remodeling, marketing and sales, and EHR implementation. Gill does not identify Medicare rate cuts as a reason for the losses. Skilled Healthcare Group (74SNFs, based in Foothill Ranch, California): Chairman and CEO Boyd Hendrickson commended his company’s ability to “focus on high quality patient care while navigating through dramatic changes to Medicare,” noting that Q4 performance remained strong and that the company has “been able to see results from our mitigation efforts more rapidly than we expected.”  This positive performance reflected the following:
Revenue up 6% in 2011 to $869.7 million from $820.2 in 2010. Adjusted EBITDA up 8.1% to $131.3 million from $121.5 million. Skilled mix up 0.5% to 23.2 percent Skilled Healthcare Group did report overall losses, but similarly to Kindred, those losses were due to a one-time charge for impaired assets of about $270 million. So what does all this mean? Clearly, many major SNF providers are thriving, not just surviving, in the face of 11.1% Medicare cuts. Other nursing homes can emerge from self-imposed retreat from strategic projects and investments and start to reconsider the things they may have put on hold in September 2011. We close with links to the five recommendations from the “11.1% Survival Guide for SNFs,” perhaps more relevant now than when we first posted them back in October 2011:
Arm Yourself with the Right Tools for Battle: Outmaneuver Your Competitors While They Stand Still, Know Your Situation and Surroundings: Capture Business Intelligence to Support Smarter—And Bolder—Strategies, Master the Mix: Optimize Your Payer Mix—It’s More Important Than Ever, Replenish Your Resources: Focus on Generating Revenue to Overcome Reimbursement Cuts, Choose Fight Over Flight: Stay On Course with Sound Strategies, Especially for Sales and Marketing

Fatigue Tied to Landing in Hospital for COPD

By Todd Neale, Senior Staff Writer, MedPage TodayPublished: June 16, 2012Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, SanFrancisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Patients with chronic obstructive pulmonary disease (COPD) who report high levels of fatigue appear to be at increased risk for being hospitalized, a small Australian study showed. Compared with the one-third of patients that reported the least fatigue, those reporting the most had an 11-to 14-fold greater risk of being hospitalized within the next 20 months, Johanna Paddison, PhD, of Repatriation General Hospital in Adelaide, Australia, and colleagues reported online in European Respiratory Journal. Hospitalization “is itself an important driver of impaired qualityof life, negative impact on self and family, escalation of personal and societal costs, and ongoing instability and mortality,” they wrote. Behind dyspnea, fatigue is the second most common symptom among patients with COPD. But the clinical significance of fatigue in this patient population is unclear, according to the researchers. To explore the issue, they looked at data from 100 consecutive patients who were undergoing assessment before starting pulmonary rehabilitation. The average forced expiratory volume in 1 second (FEV1) — 53% of predicted –indicated moderate disease. Fatigue was measured using the Identity-Consequences Fatigue Scale, which assesses five domains:
Feelings of fatigue, Feelings of vigor, Impacts on concentration, Impacts on energy, Impacts on daily activities. The “fatigue experiences” summary score averages scores for the first three domains and the “fatigue impacts” summary score averages scores for the last two.
Fatigue was significantly associated with COPD severity, as measured by the BODE score,which incorporates body mass, level of airflow obstruction, disablement due to dyspnea, andexercise capacity. During a follow-up of 20 months, six patients died and 24 were hospitalized atleast once. Of those with a hospital stay, 58% were admitted more than once. Compared withpatients with the least amount of fatigue, those with the most fatigue were more likely to behospitalized during follow-up. That relationship was significant for both the fatigue experiencesscore (HR 11.4, 95% CI 2.6 to 50.5) and the fatigue impacts score (HR 13.6, 95% CI 2.5 to74.2). The researchers found that the average intensity of fatigue among the patients with COPDwas similar to that for patients with colorectal cancer and those with HIV. “The occurrence ofchronic inflammation that is common to these three situations may help to explain thisobservation,” the authors wrote. “Other common explanations may include fear and otherpsychological reactions to potentially or ultimately fatal diseases or factors such as sleepdisturbance and disruption to circadian rhythms.” They acknowledged some limitations of thestudy, including the inclusion of more symptomatic patients with COPD who were startingpulmonary rehabilitation and the lack of information on admissions to private hospitals or tohospitals other than the patients’ local tertiary centers. The results require replication, they added.

Lonely, Alone: Predictors of Poor Health

By John Gever, Senior Editor, MedPage TodayPublished: June 18, 2012Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, SanFrancisco

Many older people living alone, or those just feeling lonely, are at heightened risk for death and disability, researchers said. Among nearly 45,000 individuals 45 and older either with or at risk for atherothrombosis, those living by themselves were at significantly higher risk for all-cause and cardiovascular mortality, according to investigators in the so-called REACH study. And in adifferent longitudinal study involving some 1,600 people 60 and older, those reporting feelings ofloneliness — irrespective of their actual household status — were about 60% more likely to experience declines in the ability to perform daily tasks (adjusted risk 1.59, 95% CI 1.23 to 2.07)and were 45% more likely to die (adjusted hazard ratio 1.45, 95% 1.11 to 1.88). Both studies were reported online in Archives of Internal Medicine. In an accompanying comment, two Yale University researchers cautioned that “social support” — presumably the thing missing from the lonely and the alone — is a squishy concept, especially as a contributor to improved health outcomes. Emily Bucholz, MPH, and Harlan Krumholz, MD, SM, of the Yale University School of Medicine, observed that neither of the new studies shed much light on mechanisms by which social support could help people stave off death and disability. They suggested that future research look more carefully at how social support is defined and measured — though, in the meantime, “scientists examining social support should build on studies such as those published in this issue and be challenged to investigate mechanisms as well as practical interventions,” Bucholz and Krumholz wrote. The REACH study (REduction of Atherothrombosis forContinued Health), reported by Deepak L. Bhatt, MD, MPH, of the VA Boston Healthcare System in Boston, and colleagues, was a registry project involving 44,573 people in 44 countries. Participants either had doctor-diagnosed cardiovascular disease or at least three risk factors for it and were followed for 4 years after recruitment. In this cohort were 8,594 individuals who reported that they lived alone. The raw data indicated that these participants had higher all-cause mortality (14.1% compared with 11.1% for participants with other household members, P<0.01)and cardiovascular death (8.6% versus 6.8%, P<0.01). Age appeared to mediate some but not all of this effect. Living alone was not a risk factor for mortality for those older than 80. But itremained significant for all-cause mortality in younger participants:
Age 45 to 65: adjusted hazard ratio 1.24 (95% CI 1.01 to 1.51)Age 66 to 80: adjusted HR 1.12 (95% CI 1.01 to 1.26)
Gender, race/ethnicity, and geography did not affect the associations between living alone and increased mortality. But curiously, employment status did. The increased risk of death among those living alone was mainly seen in those who were employed either part time (adjusted HR1.50, 95% CI 1.05 to 2.14) or full time (adjusted HR 1.56, 95% CI 1.07 to 2.27). In contrast, living alone did not make a difference in mortality among the retired, unemployed, and incapacitated — a finding for which Bhatt and colleagues offered no explanation. The other study examined 1,604 participants in a psychosocial portion of the Health and Retirement Study that began in 2002 with follow-up through 2008. It was reported in Archives of Internal Medicine by Carla M. Perissinotto, MD, MHS, of the University of California San Francisco, and colleagues. Mean age in the study was about 71. As part of this substudy, participants were asked three questions about feelings of loneliness (“left out,” “isolated,” or “lack companionship”). Those responding “some of the time” or “often” to any of these questions — 43% of the sample — were categorized as lonely. Only 27% of those considered lonely were living alone, the researchers noted. Loneliness was significantly associated with the following negative outcomes (expressedas adjusted risk ratios):
-Decline in activities of daily living: 1.59 (95% CI 1.23 to 2.07)-New difficulties with activities using the arms: 1.28 (95% CI 1.08 to 1.52)-Decline in mobility: 1.18 (95% CI 0.99 to 1.41)-More difficulty with climbing: 1.31 (95% CI 1.10 to 1.57)
When Perissinotto and colleagues treated loneliness as a scalable variable, depending on the frequency or number of different lonely feelings, they found that increasing loneliness was associated with increasing risk of disability. “On the basis of our findings, we hypothesize that health outcomes in older people may be improved by focusing on policies that promote social engagement and, more importantly, by helping elders develop and maintain satisfying interpersonal relationships,” the researchers wrote. “These findings suggest a need to look into interventions that explore strategies of mitigating loneliness, such as diverse living arrangements and telephone support.” Bucholz and Krumholz suggested that, to some extent, interventions maybe worthwhile simply because loneliness is unpleasant. “Loneliness is a negative feeling that would be worth addressing even if the condition had no health implications,” they wrote, even as they argued that more research is needed to validate the effectiveness of interventions.

Diabetes May Speed Cognitive Decline

By Kristina Fiore, Staff Writer, MedPage Today Published: June 18, 2012Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Having diabetes may put older patients on a faster path to cognitive impairment, researchers found. Over 9 years, those who had diabetes had significantly worse cognitive decline on two separate tests compared with those who didn’t have the disease (P=0.008 and P=0.001), Kristine Yaffe, MD, of the University of California San Francisco, and colleagues reported online in the Archives of Neurology. The findings suggest that preventing diabetes may help maintain cognitive function in older patients, the researchers said. To assess whether diabetes increases the risk of cognitive decline, and whether poor glucose control is associated with worse cognitive performance among elderly adults, Yaffe and colleagues conducted the prospective Health,Aging, and Body Composition (Health ABC) Study at two community clinics, totaling 3,069patients whose mean age was 74.2 at baseline. Patients completed the Modified Mini-Mental State Examination (3MS) and the Digit Symbol Substitution Test (DSST) at baseline and at certain intervals over the following 10 years. They also had their HbA1c levels measured at baseline, and 4, 6, and 10 years later. At baseline, 23.4% of patients had diabetes, and 159 people, or 5.2%, developed diabetes over the course of the study. The researchers found that at baseline, those with diabetes had significantly lower scores on both tests of cognitive function than those without the condition (P=0.001 for both), and adjusting for age, race, sex, and education didn’t change the results. After 9 years, Yaffe and colleagues saw greater cognitive decline among those who had diabetes at baseline than those who didn’t have diabetes (P=0.008for 3MS, P=0.001 for DSST), and the results remained the same in multivariate models. Patients who developed diabetes over the course of the study tended to score between the other two groups, but they weren’t statistically different from the group without diabetes, the researchers said. They also found that among patients who were diabetic at baseline, higher HbA1c levels were associated with lower mean cognitive scores. Over about 3.5 years, patients with a mid-range (7% to 8%) or high (8% or up) HbA1c level had significantly lower mean cognitive scores than those with a low level (7% or less) (P=0.003 for 3MS, P=0.04 for DSST). After adjustment, the findings remained significant for 3Ms scores, but not for DSST scores, theyreported. Yaffe and colleagues said the findings are consistent with prior studies, and suggest that the severity of diabetes may contribute to accelerated cognitive aging. Some of the mechanisms linking diabetes with cognitive decline include greater inflammation and microvascular disease, as well as the fact that patients with diabetes are at risk of renal disease, depression, stroke, hypertension, hyperlipidemia, and cardiovascular disease — all of which can impair cognitive performance. Thus, delaying or preventing the onset of diabetes may be beneficial formaintaining cognitive function in older adults, the researchers wrote. The study was limited by the small number of patients who developed diabetes over the course of the study, and by a lackof information on duration or severity of diabetes for patients with the condition at baseline.Other limitations included only two measures of cognitive function, small differences on the cognitive function tests between groups, and inability to evaluate HbA1c well over time due to use of different assays during different years. Still, the researchers said further studies are needed to determine whether early diagnosis and treatment of diabetes diminishes the risk of developing cognitive impairment.

Ventas Sells 12 Communities to Assisted Living Concepts for $100 Million

Alyssa Gerace | June 18, 2012
Healthcare real estate investment trust Ventas, Inc. (NYSE:VTR) announced on Monday that it has sold 12 senior housing communities to operator Assisted Living Concepts, Inc. (NYSE:ALC)for $100 million in cash. ALC had been the tenant for these communities. Its leases with Ventas were terminated at the transaction closing, and the REIT no longer owns any assets that ALC operates. With the lease termination, Ventas’s pending litigation against ALC for lease violation has been dismissed. “Ventas stands for excellence in seniors housing. This transaction allows ALC’s new chief executive officer and its Board of Directors to focus their attention and resources on providing quality care for its residents,” Ventas Chairman and Chief Executive Officer Debra A. Cafaro said in a statement. Ventas’s total annual base rent under its leases with ALC was about $7.2 million on a GAAP basis, and $6.6 million on a cash basis. The 12 communities sold to ALC had a total of 696 units in five states. The transaction terms included ALC paying for Ventas’s expenses incurred from the lawsuit.

NEWS FROM ABROAD………………………………

Care home nurses to be taught to play board games with dementia patients to stop them being prescribed chemical cosh

By Sophie Borland, London Daily Mail
Nurses in care homes will be taught to play board games with dementia patients to prevent thembeing prescribed anti-psychotic medication. Under a Government-backed scheme, they will be encouraged to help patients with hobbies such as baking and painting in the hope it will help their symptoms. It follows concerns that thousands of the elderly with dementia are being givendrugs to sedate them and stop them wandering off. Such drugs – dubbed a ‘chemical cosh’ –have been found to double the risk of death and actually worsen patients’ symptoms leaving them unable to walk or speak coherently. Over the next few month nurses in 150 care homes in the UK will be trained to care for patients as people, rather than just a condition. They will be taught tofind out what hobbies patients used to enjoy when they were younger and encouraging them to take part in the activites in the care home.
Read more:http://www.dailymail.co.uk/news/article-2160003/Care-home-nurses-taught-play-board-games-dementia-patients-stop-prescribed-chemical-cosh.html#ixzz1ySFwtSVw

Time to face up to reality of elder abuse

The Irish Times – Friday, June 15, 2012
TODAY MARKS World Elder Abuse Awareness Day. Elder abuse is a societal issue and can occur to any older person, regardless of social class, age or dependency, although increasing age increases risk. Like child protection and domestic violence, elder abuse remains a difficult topic, shrouded in secrecy, particularly as most abuse occurs within the home environment and by family members. Thus, disclosure is mired in issues of family allegiance, embarrassment, anxiety regarding legal entanglement and if the perpetrator is the main care-giver, forced admission to a nursing home may be a fear. Defining elder abuse is challenging but there is a professional consensus that it may be perpetrated in many ways, such as physical abuse, sexual abuse, psychological abuse, financial/material abuse and neglect. Separate research undertaken by the International Network for the Prevention of Elder Abuse, Age Action Ireland and research in both the UK and Sweden indicates elder abuse is perceived by older people themselves as being influenced by societal and political realities, as well as a lack of valuing of the individual olderperson. In this regard, ageist attitudes and practices certainly contribute to abuse of older people and its tolerance by society. One significant response to ageism is the ongoing United Nations focus on consolidating the rights of older people within a dedicated convention, similar to the1989 Convention on the Rights of the Child. This will underpin a clear focus on protecting olderpeople and ensuring equal rights with other age groups. But such a convention is needed now. There is no time for delay.
Read more:http://www.irishtimes.com/newspaper/opinion/2012/0615/1224317977647.html?goback=%2Egde_134913_member_124879507

BACK HOME………………
Oxygen Devices Recalled

By Cole Petrochko, Associate Staff Writer, MedPage TodayPublished: June 20, 2012
WASHINGTON — The FDA has issued a class I recall for several models of oxygen concentrators because of a potential fire hazard. A capacitor failure in the Nidek Medical Mark5Nuvo and Nuvo Lite may cause fire and loss of supplemental oxygen, according to a statement from manufacturer Nidek Medical Products. The recall affects devices manufactured and distributed from January 2004 to May 2010 and includes serial numbers 042-10000 to102-09335. A full list of the 11 affected device models is available in the recall notice. The company had not received any injury reports at the time of the recall. The concentrators are indicated to provide supplemental oxygen in a home setting and are not considered life-supportdevices. The manufacturer said it will supply replacement capacitors for affected devices.

Nurse ‘threatened to nail dementia patient’s hand to the floor’

From The Telegraph, London

A nurse told a vulnerable patient suffering from dementia she would “f—ing nail your hand tothe floor” if she touched her buzzer again, a misconduct hearing heard. Sally Miller pushed,grabbed and swore at patients in her care, telling one vulnerable resident “I’m sick of you”adding: “if you keep coming and complaining, I will sort you out.” She also confided in acolleague she wanted to put a pillow over one elderly patient’s head, adding: “That’s the way theymake me feel sometimes.” The nurse, who began working at the Rosendale Nursing Home inAmsdell, Lytham St Annes, Lancashire, which cares for patients with Dementia, in 2007, faces amisconduct hearing at the Nursing and Midwifery Council (NMC). Ms Miller did not attend thecentral London hearing today, stating that she is “not well” and her career as a nurse is alreadyover. She faces being struck off from the profession if it is found her fitness to practice isimpaired. Kristian Garsed, representing the NMC, told the hearing: “She has herself decided hernursing career is over and has decided not to actively participate in the proceedings.”  Thehearing was told concerns were first raised about the nurses’ abusive behaviour towards elderlyresidents in April 2010, two and half years after she began working at the home. Staff claimedMs Miller was “verbally abusive, threatening and aggressive” behaviour towards residents andcolleagues. Nurse Mohammed Shahid told his managers how Ms Miller forced a patient, knownas ‘Resident A’ to drink tap water instead of orange juice, before telling her “If you fucking touchthis buzzer again, I am going to fucking nail your hand to the floor.” He also told how on anotheroccasion, she pushed ‘Resident B’, saying: “I am sick of you and I don’t want to hear yourmoaning, and if you keep coming and complaining, I will sort you out.” In a letter to the NMC,she also admitted abusing ‘Resident B’, adding: “I am truly very sorry for my outburst. I wasinappropriate towards this resident by shouting at her.” Jayne Bamber, another colleague,revealed how she later grabbed ‘Resident C’, pushed her into a chair and shouted at her: “Don’tyou leave this room now and sit in this fucking chair,” the hearing was told. Nurse SuzanneWhatmough became so concerned about a telephone conversation she had with Ms Miller, inwhich she talked about putting a pillow over a female patient’s head, she gave a statement to hermanagers. During the conversation, Ms Whatmough said “you can’t say things like that,” towhich the nurse replied: “No, I’m serious,” adding “that’s how they make me feel sometimes” inreference to the patient’s family. Ms Miller later admitted the comment, saying she was “unableto cope with her duties” at the time and had “no one to turn to for help.” Mr Garsed told thehearing: “Those members of staff raised specific allegations. An investigation was carried outfollowing information received. The case was referred to the NMC. “The allegations were put tothe registrant and she was suspended pending disciplinary. “But immediately upon beinginformed of her suspension the registrant provided her written notice of resignation.” The hearingcontinues.

For the Elderly, Emergency Rooms of Their Own
By Anemona Hartocollis

Phyllis Spielberger, a retired hat seller at Bendel’s, picked at a plastic dish of beets and corn asher husband, Jason, sat at the foot of her hospital bed, telling her to eat. Although she had beenrushed to Manhattan’s busy Mount Sinai Hospital by ambulance when her leg gave out, theatmosphere she encountered upon her arrival was eerily calm. There were no beeping machinesor blinking lights or scurrying medical residents. A volunteer circulated among the patients like aflight attendant, making soothing conversation and offering reading glasses, Sudoku puzzles andhearing aids. Above them, an artificial sun shined through a skylight imprinted with aphotographic rendering of a robin’s-egg-blue sky, puffy clouds and leafy trees.  Ms. Spielberger,who is in her 80s, was even getting into the spirit of the place, despite her unnerving condition.“It’s beautiful,” she said. “Everything here is wonderful.”  Yet this was an emergency room, onespecifically designed for the elderly, part of a growing trend of hospitals’ trying to cater to themedical needs and sensibilities of aging baby boomers and their parents.Please continue reading at:  http://www.nytimes.com/2012/04/10/nyregion/geriatric-emergency-units-opening-at-us-hospitals.html?pagewanted=1&_r=1&goback=.gde_111042_member_106919671

Sen. Corker: Long-Term Care is “Heading for a National Crisis”

By Howard Gleckman

Senator Bob Corker (R-Tenn) warned today that long-term care financing is “a major trainwreck” and “heading for a national crisis.” Corker, the senior Republican on the Senate AgingCommittee, said he was very worried about the viability of private long-term care insurance andadded , “there is no doubt there is a public sector role” in the future of financing long-term caresupports and services.  At a time when the issue has fallen victim to partisan demagoguery(Exhibit A: the CLASS Act)  Corker’s remarks, at a Senate Aging Committee hearing onlong-term care,  suggested an opening to build a consensus on future financing and deliveryreforms. Interestingly, Corker was speaking on the same day a House committee proposedcompletely eliminating the federal  Social Service block grant program which, among otherthings, funds Meals on Wheels and other critical programs for the frail elderly living at home.Corker was not the only participant in today’s hearing who was worried about private long-termcare insurance.  John O’Brien, Director of Healthcare and Insurance at the federal Office ofPersonnel Management, proudly told the panel that enrollment in the federal LTC insuranceprogram rose 20 percent this year, to about 270,000 employees. But he also expressed concernthat only one carrier bid for the federal contract in 2011 and that so many insurers have left thebusiness.Please continue reading at:http://howardgleckman.com/blog/?p=690&goback=%2Egde_111042_member_108886079

What Does the Future Hold for Nursing Homes?
By Anthony Cirillo, FACHE, ABC

The Affordable Care Act has freed up $3 billion in grant money available to states looking tokeep elderly and disabled individuals out of long-term care facilities. New Hampshire will be thefirst state to receive a grant. “No one should have to live in an institution or nursing home if theycan live in their homes and communities with the right mix of affordable supports,” said CindyMann, director of the CMS Center for Medicaid and CHIP Services. No matter how much theindustry fights, it is inevitable that people want to age-in-place. My argument has been that therewill always be people that need the acute level of care offered by skilled nursing facilities. Andwhile I still believe that as a society we do not take self-responsibility, where chronic disease isrampant and obesity becoming the epidemic du jour, it is also true that technology and supportservices are increasing at such a rapid state that perhaps people with acute needs can age in place.
Of course there is still a lot of confusion in the industry and coordination of services is far fromideal. So perhaps the industry has some time to figure out their next move. Some already have bymoving into the rehabilitation business. And while hip and knee surgeries are predicted to growphenomenally, not every person will need skilled rehabilitation care and more of this will moveto outpatient setting. Then with the number of nursing homes almost triple that of hospitals, notevery skilled provider will be a fit for a hospital. In the era of accountable care, culture fit, patientexperience and clinical quality will be the indicators that hospitals will use to pick their skillednursing partners.
I see three scenarios.
First, there will be more mergers and acquisitions as well as facility closings.
A select few will excel in the rehabilitation arena.
And a visionary microscopic few will understand that they need to extend their brand bydeveloping service and product offerings that cover more of the continuum of care.
Still, many will do nothing and one of these scenarios will occur naturally. I see it on the hospitalside of my business. While many hospitals are becoming leaner and improving quality, few arepreparing for an inevitable shift to wellness, bundled payments and the reality the empty hospitalbeds, long talked about, will indeed be the norm.
Where do you fit?

Recognize depression-in-the-elderly, you may save a life
By Richard Lewis, Vice President Operations at AFFECTS LLC, STAR Preventive WellnessDivision

Depression-in-the-elderly is a common occurrence and is not always recognized. Whendepression-in-the-elderly is not  recognized, the condition is not treated. This can be seriousbecause depression is a major cause of morbidity and mortality for the elderly. It can result inimpaired physical, mental, and social functioning. And depression too often leads to suicide.People aged 65 and older account for 16% of the suicides annually. Some people think thatdepression is a part of getting older. Nothing could be further from the truth. Depression is not anatural part of aging. It is not normal to feel depressed all the time as you get older.
Risk factors for depression-in-the-elderly include:
Prior episode of major depressionFamily history of depressive disordersCurrent alcohol/substance abuseMedical co-morbidity (presence of one or more additional disease processes)Functional disability (especially new functional loss)Loss of spouse or partnerOlder family caregiver, especially if caring for persons with dementiaSocial isolation/absence of social supportCognitive distortions, stressful life events (especially loss), chronic stress, low self-esteem andexpectations, and no faith.
The characteristics of major depression are the persistent low mood, discouragement,worthlessness, sleep and appetite disturbances, or thoughts of suicide. How can you recognizedepression in yourself, a friend, or family member? Please continue reading at:http://www.vitality-retirement.com/depression-in-the-elderly.html?goback=%2Egde_135634_member_109578915

Quality of Life: Help Residents Who Require Enteral Nutrition Meet These Needs
If a resident feels self-conscious, you can do this, suggests activity expert. Nurse attorney BarbaraMiltenberger predicts surveyors will be taking a closer look at socialization for the person withtube feedings. “Due to culture change, there’s more emphasis on quality of life,” she points out.Initially released survey guidance for tube feedings (F322), which CMS had at press timetemporarily withdrawn, says that “to assure that the resident being fed by a feeding tubemaintains the highest degree of quality of life possible, it is important to minimize possible socialisolation or negative psychosocial impact to the degree possible (e.g., continuing to engage inappropriate activities, socializing in the dining room).  Overcome this potential obstacle: If aresident receiving continuous tube feedings feels self-conscious of being attached to a feedingpump while out of their room, you can ask for a routine order for ‘feeding interruption time. Thiscan be done with a PRN order for a specified time frame, i.e., PRN disconnect feed for no morethan one hour and 30 minutes to attend out of room activities. At Northern Oaks Living andRehabilitation Center, “we encourage all residents to get out of their rooms and to attendactivities of their choice,” says Barbara Lohman, MSW, social services director for the facility inAbilene, Texas. “If a resident who is tube fed wants to attend an activity, the activity directormakes sure that they get to that activity,” she tells Eli. “Some of our residents like to pass thetime ‘people watching’ in our lobby.” “The activity director and social services director makeroom visits to those who do not like to get out of their rooms much. Room activities mightinclude one-on-one conversational visits, reading a book to the resident, pet therapy visits, orreading their mail to them,” Lohman adds. Underwood also notes that “just because someonereceives food from a tube doesn’t mean that they should be isolated or excluded fromfood-related activities. Please continue reading at: http://www.elihealthcare.com/long-term-care/quality-of-life-help-residents-who-require-enteral-nutrition-meet-these-needs/?goback=%2Egde_156336_member_109874655

RN named the top job of 2012 by U.S. News
By Scrubs • March 7, 2012

At the end of last month, U.S. News & World Report released its annual “Best Jobs” list for2012, and the news is good for nurses. Very good. Registered Nurse comes in at the number onespot on the list this year, and the magazine points out a number of factors for this top position.Among them is the fact that the occupation has grown even in the tough economy, and theBureau of Labor Statistics reports that Registered Nurse will be one of the fastest growingoccupations in the country between now and 2020, adding over 700,000 jobs to the already 2.7million strong RN workforce. Other perks include the strong median annual salary ($64,690) andthe opportunities for specialization within the career. Now, the real question is: Is it true? Isnursing, with all the long shifts, heavy lifting and the daily risk of being squirted with bodilyfluids, really such a great job? Only nurses would know the answer. So, we asked Facebook fansfor their opinions. This is what you said:
“I love the variety of positions and different shifts. I love travel nursing the best of all!”–DavidIrthum“You may not get the position you want, but you will find a job! I love being an RN!”–LucindaPerniciaro“We deserve it–now more than ever!”–Bonita Pink“I’ll be an RN in a few months, getting capped & pinned on May 24th!” —Mandie Lurz“I love being an RN!!”–Debbie Streske ”I love being an RN too and never had trouble finding a job.” —Maggie Ornberg“Hello? C’mon young people—be a nurse!” —Cynthia Caudle“I love being an LPN and proud to have all the RNs around me as either mentors or even theirteacher!” —Sherri L Brotzman-Meyer Morse“Darn, I wish I hadn’t retired 10 years ago! 35 years was a long time to nurse, but I wouldn’thave missed it for the world!” –Carol Bock TumidiskiCongratulations, nurses! We here at Scrubs believe that nurses are the best ever—no matter theseason!

Morgan Stanley Research estimates that in five years there will be more cell phone web users than desktop web users. Cell phones enable people to take pictures, watch movies, check the news and weather and play games, among many other things. It can be a tool for the masses to get involved in social movements and causes. The American Red Cross used the simple form of texting to help raise money. Donors from all over the country contributed $10 by simply texting the American Red Cross, raising $30 million dollars for the Haiti earthquake victims relief fund.

New cell technology is not only for social causes. With talks of implementing the smart grid technology by 2030, which will upgrade our current existing electric power distribution network, the commercial wireless network will innovate and also support it. This will bring more reliability, new capabilities and extra security for wireless consumers. It is also a chance to take part in the modernized, more effective electricity distribution networks, allowing consumers to save on their electric bills and use 20 percent or more of renewable energy resources.

As for commercial viability, cell phone consumers will be at the pulse of that change, also. It is not surprising to see businesses, even small businesses, coming up with mobile versions of their websites.

You can now download coupons to your cell phone and show the coupon on your cell phone screen to the cashier to get an instant discount. There is no need to clip coupons in certain cases. Mobile devices and web applications are changing customer interaction immensely and boosting businesses’ web traffic simply through their own mobile channel. There is now an estimate of 53 million (and climbing) smart phone users. Just think what mobile coupons could do for the upcoming Christmas season if all the chains and stores participate in this growing market.

Technological ingenuity keeps evolving and grass roots and social movements, renewable energy advocates, businesses and major corporations will find ways to utilize the cell phone to reach their consumers and supporters.

Jeff Gasner is with CPR-Cell Phone repair. The leader in Cell Phone Repair and iPod Repair offering cell phone repair services nationwide. Visit http://www.chicagocellrepair.com.

The wireless bionetwork’s ecosphere has grown exponentially, and at a faster rate than any other part of the world. For example, Americans are consuming wireless products and services, utilizing approximately 824 minutes a month, compared to 160 minutes a month in Europe. What accounts for such a vast difference? Basically, Americans are getting more for their money because the revenue per minute in the U.S. is so much cheaper.

The American wireless industry is now a model for the rest of the wireless world to follow. Other countries are now expanding their calling plans and are trying to revamp their policies on technology requirements to make them more flexible. Since 2008 – two short years since the induction of “apps” – there are now thousands of them available on many different platforms for wireless customers nationwide.

The wireless industry wants to concentrate more on wireless broadband and is lobbying policymakers to help make it affordable and accessible to everyone; therefore making the industry’s race for quality and capability the forerunner for dynamic competition.

What it boils down to is that American consumers can choose from a variety of network providers: national and regional carriers as well as resellers. To add to the list, consumers can also choose a contract or the pay-as-you-go or prepaid option for their network services. Therefore, the wireless consumer has many choices. If consumers don’t like a plan or service, they can opt to go take their money elsewhere.

Wireless technology is providing us with the hottest new products that are selling like crazy. Now, 4G services are expanding nationwide and 3G has practically gone through every nook and cranny. At least 92 percent of American wireless consumers have access to 3G coverage.

Great value, great technologies, and an array of products and services to choose from help the U.S. wireless ecosystem propel its own evolution into the next generation, one wireless customer at a time.

Jeff Gasner is with CPR-Cell Phone repair. The leader in Cell Phone Repair and iPod Repair offering cell phone repair services nationwide. Visit http://www.chicagocellrepair.com.

The Wi-Fi consortium has brought its members heads together and is coming up with a new standard – and that standard is called “Wi-Fi Direct”. They say it will allow wireless devices to connect and work together without an access point or Internet connection.

This Wi-Fi Direct standard will allow users to print, synchronize files and share data all on the fly. Compatible wireless devices will include notebooks, netbooks, smart phones and tablets. The new certified products will still be able to connect to a non-Wi-Fi Direct product. What that means is that Wi-Fi Direct certified devices can connect one-to-one or to many, and not all connected products need to be Wi-Fi Direct certified. Therefore, one Wi-Fi Direct enabled device can connect to legacy Wi-Fi certified devices.

“Connecting Wi-Fi Direct-certified devices are easy and simple, in many cases only requiring the push of a button. Moreover, all Wi-Fi Direct connections are protected by WPA2TM, the latest Wi-Fi security technology,” the Wi-Fi Alliance said on its website.

How does this all come together? Like when most technologies get rolled out, other technology industries that collaborate and support each other jump on the bandwagon. Cisco and Netgear will be rolling out new Wi-Fi direct networking devices, and chip and technology companies such as Broadcom, Intel, Ralink, Realtek and Atheros are also supporting Wi-Fi Direct.

Wi-Fi Direct’s embedded “Soft AP” will direct and route network traffic over Bluetooth for a more simplified and seamless connection when necessary. The difference between the old technology and the new is it will have broader range and better connection, just like access points and routers. Due to the widespread adoption of Wi-Fi in smaller devices, the need for working spur-of-the-moment networking has grown. Wi-Fi Direct will enable wireless devices to share resources, and it is now possible to find printers, cameras, scanners and many other common devices with Wi-Fi, like USB.

The Wi-Fi consortium came together because the process of adding Wi-Fi to smaller devices has accelerated and they wanted a universal capability to address the increasing need.

Even more exciting news is that this new technology may be available by this holiday season.

Jeff Gasner is with CPR-Cell Phone repair. The leader in Cell Phone Repair and iPod Repair offering cell phone repair services nationwide. Visit http://www.chicagocellrepair.com.

Cisco, the networking conglomerate, conducted a global study called the Cisco Connected World Report which found that 66 percent of the world’s population is prepared to work for less if given the time and flexibility of working at home, as opposed to the stringent grid of having to report and spend working hours in an office building.

There is now evidence that businesses can benefit from letting employees work from home. For one, their employees’ productivity will increase because workers tend to put in a few more hours than people who commute. But the biggest payoff is that computer networks are gaining more strength and speed to help support telecommuters, and are increasingly more secure.

There are also many apps on a variety of cell phones that increase productivity. There are iPhone applications called “Apps for Work”, which is a series of apps to suit a person’s business needs. The Bento app is a personal and business tool to help keep a person’s life in order with to-do lists, logs, event planning and business contacts. There is also FedEx Mobile, which helps keep track of your shipments. The app iTimesheet creates invoices and activity reports that can be exported into an Excel spreadsheet.

Then there’s Motorola’s Droid smart phone, geared up with the most insane applications a person could ever think of. The Work Clock is a handy tool for telecommuters and freelancers. It tells you how much longer you plan on working and it does the math for you. Another cool Droid app is Note Everything. It lets you create text and voice notes that you can share with others and you can import into MS Outlook, Droid Calendar and Google Calendar.

In the long run, workers can stay connected virtually anywhere – keeping abreast on various things and staying organized with work and data – with the help of the new cell-phone and Smartphone apps and the four major platforms such as Microsoft Windows 7. Overall, it is not only the employees who desire to work from home, but also the changing economics, which is solidifying the possibility of more and more workers transitioning to a telecommuting, work-from-home position.

Jeff Gasner is with CPR-Cell Phone repair. The leader in Cell Phone Repair and iPod Repair offering cell phone repair services nationwide. Visit http://www.chicagocellrepair.com.

The EVO 4G’s Android foundation has only been around some two-odd years. The short list includes the G1, the Nexus One, the Motorola Cliq and the Droid. This little black slab of pure engineering and marketing has an impressive spec sheet. A 1GHz Snapdragon process, 4.3-inch WVGA display, 8 megapixel camera with 720p High Def recording, HDMI-out(for viewing those HD videos on your TV) and WiMax compatibility.

Even the packaging the phone comes in has evolved significantly in the past few years. It appears that cell phone manufacturers have noticed that consumers do, in fact, care about the environment and are tired of seeing phones that weigh only 4 ounces in a box that’s large enough for a laptop. As we’ve seen the boxes get smaller, we haven’t seen them get weird, until now.

The packaging looks like a microwave meal. But don’t worry about opening it, there isn’t any steam that could burn you. Under the recycled flip top you find just the bare essentials: the usual manuals and documents, a micro USB cable, a USB wall charger, a 1500mAh battery, an 8 GB microSD card, the EVO device and last but not least, an envelope for recycling your old phone.

The EVO 4G exemplifies the philosophy of “content, not chrome” that Microsoft has claimed as its mantra for the design of Windows Phone 7. Every square millimeter of the EVO seems to serve a purpose, with no fluff thrown in simply for the sake of the design. This phone will get noticed by passersby whether it is against your face or set on a table. The no-frills simplicity goes well with the sheer magnitude of its specifications.

But we don’t live in a perfect world. What happens when the EVO 4G falls out of your pocket while you’re running inside to keep the EVO 4G from getting wet and pockmarked during a hailstorm? The screen gets damaged and even worse, the dreaded warranty buster – water damage. What makes the best sense is to pick up your EVO out of that icy puddle and bring it to a local independent repair shop.

Jeff Gasner is with CPR-Cell Phone repair. The leader in Cell Phone Repair and iPod Repair offering cell phone repair services nationwide. Visit http://www.chicagocellrepair.com.

The Motorola Cliq is an Android smartphone with a full QWERTY sliding keyboard. Even more important is the keyboard’s association as an incorporated part of MotoBlur – a combination of software and Web services designed to unify all of your communications into a single, user-friendly medium.

The Motorola Cliq may remind you of an iPhone. It has similar round corners with a metallic frame. The “home” button is placed in almost the same spot, in the phone’s lower center. But any comparisons end there.

The Cliq has a true physical keyboard. Apple has not exercised this option onto its iPhone in a move to save space. The Cliq might be thicker, but it feels good and solid, not to mention that it is generally easier, faster and nicer to type on an actual keyboard. If you prefer the virtual keyboard, the Cliq also comes with it.

MotoBlur is one of the most unique parts of the Cliq. What’s not to like about a Web service with a client software on the phone that can help you import contacts from popular e-mail and social networking services, locate your phone on a map, perform a remote wipe to delete all data on your phone in case of corporate espionage and access help and tutorial files from your phone? Depending on your e-mail setup, you may be able to initiate this from your phone. All you have to do is provide a login for all the services you wish MotoBlur to access.

So yes, the Cliq is no clack. But accidents can still happen, and the manufacturers’ warranty won’t last forever.

You might be walking down the street, checking out your friend’s Facebook status updates, minding your own business, and suddenly it happens – someone jealously swats your Cliq right out of your hands and its screen breaks on the pavement. You realize that your warranty just expired yesterday and a new phone is just going to cost too much right now. Your best hope is to take it to an authorized local repair shop. Cliq – clack – Cliq – if you do that, now you’d be clicking.

Jeff Gasner is with CPR-Cell Phone repair. The leader in Cell Phone Repair and iPod Repair offering cell phone repair services nationwide. Visit http://www.chicagocellrepair.com.

It’s happening. The big names and the not-so-big names are riding Apple’s wake with tablet devices of their own. Who would have thunk it: Perhaps Moses or someone Biblical-sounding. “There will come hither and thither a swarm of tablets, not with the nine commandments chiseled into their LCD screens, but all will feature mobile microprocessors, and the devices will be smart, and have apps, and allow you to take more naps.” Will they be spotted in the red sky at dawn, along with a cloud of locusts? No, these apparitions that the prophets failed to envision will be seen at electronics trade shows, and such Expos, a veritable swarm of novel devices that the deity has blessed, until they break.

These tablets, and e-readers, and mini-laptops, and whatnots will first be handed to you, perhaps by a salesperson who has not died, different versions of androids and smartphones and yes, the gadgets of whatnot, with names like Ubiquitous and Armadillo but not necessarily, and the dumb phones will become extinct, or at least consumers won’t buy them as much because they won’t be trendy, and it won’t be long before they’ll be in the hands of millions of U.S. consumers.

Magical machines, these, blessed with apps, and with a kind of functionality that is bordering on scary – until that moment – that calamitous moment – when all the correct and intelligent design in the world won’t be able to save them simply because they’ll be in the hands of … the careless consumers of which there are always bound to be a surprising number, who will crack their devices like eggs, who will drop them onto a rock or a hard place, who will accidentally flush them prior to a hasty retrieval.

When this should occur, it will be CPR time, device savings time, and the hands of an expert CPR service technician is not only going to be infinitely safer, but the fixing is upon you, the fixing is upon you – no matter what you have – or what have you – in the manner of iPad device – albeit part of a tablet swarm. Who would have thunk it? That CPR would be ready.

To learn more about Cell phone repair, ipod repair, cell repair services, visit Chicagocellrepair.com.

The R & D wing of Sony Corp. has been busy as Claus elves the past several months. Informed speculation has it that a new lineup of handheld products are on the way, including a smart phone approaching genius levels: The thing will supposedly be able to download and play video games – which is about the only thing that smart phones haven’t had an app for, until now.

That’s not all. The Japanese electronics giant has almost at-the-ready a portable gadget that will be a close kin to netbooks – nearly incestuous in fact – not to mention electronic book readers and handheld game machines. If this thing comes to be, it could be an excellent strategic counterpart to such devices as Apple’s iPad tablet – which is also close to coming off the drawing board, so Sony is trying to stay competitive.

The new products are the vanguard for Sony’s new online media platform – an answer to Apple’s iTunes that the Nipponese hope will be a declarative statement. Sony’s new platform will offer many of the same movies, television shows, and songs that iTunes has already made available to consumers. While sales of Sony’s PSP – once hailed as the “Walkman for the 21st century” are slipping badly, Sony is likely to make a better showing with their new platform and associated lineup.

The smart phone promises to be the centerpiece. Imagine – a device actually able to download and play video games.

But what will it mean to play video games merrily and excitedly, to become immersed in imaginative worlds 24-7, and to suddenly have the techno-symbolic umbilical cord severed, to lose contact with those video game realms, because your toy is … broken?

The multifunction device will be working online with Sony’s new online multimedia platform and then, suddenly – it breaks – what then?

Wait, don’t despair. The solution is at hand. You will be able to take these devices to your nearest independent repair shop, and know the truth of the matter in your heart of hearts … that even your Sony newfangled things can be fixed.

Jeff Gasner is with CPR-Cell Phone repair. The leader in Cell Phone Repair and iPod repair offering cell phone repair services nationwide. To learn more about Cell phone repair, ipod repair, cell repair services, visit Chicagocellrepair.com.

Motorola had been developing its new Devour for awhile, as a marketplace competitor to Google’s Nexus. Before the Ides of March, yea Brutus, it will be out. While nobody knows what the little beast will cost, it will have a touchscreen and slide-out keyboard; facilitate Facebook and Twitter exchanges, and stream content to the phone in real time. It’s way more advanced than Motorola’s Cliq, distributed through T-Mobile, which came out last year.

Motorola isn’t resting on their laurels, either. The company will be launching 20 Android smart phones in 2010, perhaps even a model called the “Sarah Palin” for those who have visited the state of Alaska and can prove it. But for now, it is just the Droid, and the Devour.

It’s all in a name sometimes. Droid is not much of a mystery, it’s just a brevity for Android, enough said. But why Devour? Because Americans eat, that’s why, and they eat quite a lot. There’s even an obesity epidemic, certainly among children, which is tragic enough, but perhaps even among centenarians, which would be infinitely more tragic for reasons as yet unexplained. That said, imagine the potential for accidents when American consumers, coincidentally while consuming food, perhaps even devouring food if they’re ravenously hungry, bring a cute little Devour smarty party phone into a restaurant where meatballs are on the menu. Imagine a tiny crack in the Devour’s touchscreen resulting when the consumer accidentally drops the Motorola device somewhere nasty. Imagine a little smidge of meatball lodged into the crevice created, I know, this is gross, but bear with me. Will Facebook still Twitter? Will content stream or scream? Will the keyboard slide out properly?

Maybe ‘no’ to all these pertinent queries. Enter CPR. At some point when such a catastrophe occurs, and your Devour has become a picky eater, so to speak, and won’t work, CPR’s expert service technicians will be there for you. Asserts the service-technician-without-a-name, let’s call him “Pete,” who has recently joined CPR’s stellar team, “Bring your Devour into us so that I can fix it for Pete’s sake. I know I can get that meatball out from inside its touchscreen.”

To learn more about Cell phone repair, ipod repair, cell repair services, visit Chicagocellrepair.com.

It will be Sprint’s first WiMax-enabled smartphone, an Android named Supersonic, although that’s a code-name. It will have a 4.3 inch touchscreen, an FM radio (what, no satellite radio?) and should include HTC’s Sense user interface atop an Android operating system. The Supersonic will boast a Snapdragon processor running at 1GHz like a Google Nexus One, which is also an HTC innovation. Although the Snapdragon doesn’t really function with WiMax, it will someday. Sprint’s WiMax network is rapid tech at 3 and 6 Mbit/sec, and it will soon be accommodating 4G.

The Android operating system, especially smartphones using it, is becoming a trend. Google’s Android phones now command a 5.2% share of the U.S. market – and climbing. Android is not yet synonymous with RIM’s Blackberry platform (41.6% U.S. market share) but Google’s Android Nexus is gaining, and Google is a relative neophyte in the smartphone marketplace. Palm and Microsoft have been sliding, while Nokia still claims 40% of the global smartphone market, it’s numbers impressively Blackberry-like.

An estimated 234 million people age 13 and older were using mobile devices in the United States as of December 2009, with Motorola the premier OEM with 23.5% of U.S. mobile devices. But statistics aside, there is something more phenomenal going on. As more Americans dance to whatever drumbeat they’re hearing with smartphones in hand, the likelihood for accidents is also increasing. People drop them and they break. They spill an amazing variety of substances upon their delicate and relatively fragile “private parts.” Even the Supersonic is not going to be immune from getting wet. If it falls into a swimming pool, the device will fail to function and be in need of repair.

That’s when CPR gets into the act. CPR’s expert service technicians will know how to fix the Supersonic, just as they already have repaired thousands of Palm Pre, Blackberry, Nokia, Google, and every cell phone and smartphone and a myriad of devices sold. “We don’t care that much what is,” said Anon, a CPR expert service technician who didn’t want to give his name due to his modesty and other superlative qualities. “We just fix it.”

To learn more about Cell phone repair, ipod repair, cell repair services, visit Chicagocellrepair.com.

The Blackberry Curve Series has been arguably the most popular series of smartphones ever marketed. Their design is elegant, stylish, and to use a tinge of jargon deemed apt for the most recent entry into the retail consumer sweepstakes, “incredibly approachable.” The nouveau smartphone is the Blackberry Curve 8520, and it comes in another “color” besides black, “frost”, which is a combination of silver, gray, and white, yet has nothing to do with winter. T-Mobile USA and Research in Motion have outdone themselves this time.

Like many so-called “smartphones,” the Blackberry Curve 8520 provides easy access to such communication venues as email, messaging (IM, SMS, MMS), and popular social networking sites (including Facebook and MySpace). Its full QWERTY keyboard is highly tactile, making comfortable, accurate typing relatively easy. Multimedia capabilities are built-in, and music, games, and entertainment mobile applications are at the ready. The thing is Wi-Fi enabled; aren’t they all these days?

But what if another feature worth mentioning – its touch-sensitive optical trackpad – won’t scroll for you all of a sudden? What if navigating the trackpad comes to resemble rubbing your fingers over a patch of cacti? What if the Curve 8520’s dedicated media keys suddenly begin to seem as if they’re dedicated to someone else instead of you?

If your Blackberry, even the newest models like the Curve 8520 begin to get, well, a little too QWERTY on you, it might be time to take the thing into an independent repair shop, specifically, your nearest CPR location.

“The Blackberry is the top selling smartphone brand in the United States,” says expert CPR technician Johnson H. Johnson III, a geek if there ever was one, “but the marvelous thing is that we fix ‘em, we make them work again, so you can text to your heart’s content, little one.”

A colleague of Johnson’s, John-John Doe, agrees. “I bet you’re wondering how I got the name John-John even though I’m not a Kennedy, but more significantly, Johnson H. is correct. We do fix Blackberries, even the curvy ones that can get too QWERTY on you in a hurry.”

Johnson H. Johnson III has more to say, which is a revelation, because he usually is a man of few words. “I want to say that a lot can go wrong with a Blackberry, and when something does, we can make it right.”

To learn more about Cell phone repair, ipod repair, cell repair services, visit Chicagocellrepair.com.

The Twist’s features don’t end there. It’s compatible with VZ Navigator SM, V CAST video as well as Music with Rhapsody, Visual Voice Mail, Mobile Broadband Connect, and Corporate Email. Its exclusive habitat mode activates a special interface for visualizing a consumer’s social circle on any of a dozen popular social networking groups, while allowing its customers to easily organize their calls and messaging history. Its 3.0 megapixel camera is also a camcorder with flash and autofocus with a dedicated camera/video key built-in. The Twist allows users to operate customized slideshows. Its Media Center is capable of downloading games, a panoply of ring tones, and more. You can edit photos with this device. Threaded messaging helps users keep track of multiple conversations – like a kind of stellar audio multi-tasking. Twist has an exciting “Post to Blogs” feature. It has a built-in mirror. It supports Bluetooth Profiles. It retails for $99.99 before mail-in rebate, just $49.99 after. What’s not to like?

A simple question seems relevant. What if it breaks?

With this “Twist,” it wouldn’t take much of a fateful twist for the device to suddenly not function – either partially or entirely. Historically, when such inexpensive, mass distributed devices appear, and their novelty wears off, so does their manufacturer’s warranty. With so many components, an independent repair shop may become the only option to get that QWERTY into revealing itself again. Fixing whatever isn’t functioning reasonably and in a timely manner will become a Twist owner’s top priority.

Jeff Gasner is with CPR-Cell Phone repair. The leader in Cell Phone Repair and iPod repair offering cell phone repair services nationwide. To learn more about Cell phone repair, ipod repair, cell repair services, visit Chicagocellrepair.com.

While American cell phone manufacturers have reluctantly begun to voluntarily release emission levels on specific phones, it’s still a daunting task to determine which phone is the healthiest of all, or even if the phone you own is relatively safe, safer, or safest. It would be nice if U.S. laws required cell phone manufacturers to include radiation information on their printed materials and advertising, but they don’t – and probably won’t anytime soon.

Cell phones, PDAs, and Smartphones, as a generic species of electronic device, do raise health concerns – such as the risk of cancer due to exposure to radiation. Recent studies have found significant increases in salivary gland and brain tumors in consumers using cell phones, especially over long periods such as a decade or more. Excessive use of radiation-emitting devices, such as cell phones (but not limited to cell phones) pose special dangers to children because their skin is softer and their skulls less developed – and less able to protect their younger brains from excessive radiation. A child’s brain can absorb up to twice as much radiation as an adult’s brain. Commercial interests involved with the manufacture and distribution of cell phones and similar electronic devices – perhaps the most lucrative commercial enterprise geared to consumers in decades — don’t wish to “rock the boat” with more conclusive studies. The very idea that the ubiquitous cell phone might pose health risks is controversial, especially to capitalists – somewhat in the way that Global Warming was just a few years ago.

But while American industry and regulators are quite passive when it comes to these touchy topics, governments in the UK, France, Germany, Finland, Switzerland, and Israel have cautioned their citizens against excessive cell phone use, especially by children. As far as radiation emitters, the worst offenders are manufactured by Motorola and distributed by Verizon Wireless and U.S. Cellular. Among ten phones that emit the most radiation, half are Motorola phones, two are T-Mobile, two are Blackberries, and the odd phone out is a Kyocera Jax distributed by Virgin Mobile. Another Motorola model, the RAZR V8 distributed by Cellular ONE, ranks among the safest phones, oddly enough. Except for that RAZR model, five of the six safest phones are various models produced by Samsung.

Jeff Gasner is with CPR-Cell Phone repair. The leader in Cell Phone Repair and iPod repair offering cell phone repair services nationwide. To learn more about Cell phone repair, ipod repair, cell repair services, visit Chicagocellrepair.com.

Solomobi makes them. The electronic gadget is called the Cool8800C and it’s a mix of cell phone gaming and transformer, a pretty smart machine made smarter theoretically when it’s combined with a way to play Nintendo games via dual sim cards. This foldable PlayStation Portable comes complete with a d-pad, and does everything it’s hawked to do – read E-books, play its FM radio or an inserted MP3 or MP4, when it’s functioning. The problem is it’s so cheaply made; the “C” only works to a certain extent when it does function. But while NES games are mentioned, no titles ever appear or even information to find titles should they miraculously turn up. This device ‘made and marketed in China’ doesn’t exactly inspire confidence. What “functioning” of the Cool8800C really implies is a slow page-turning for reading E-books that can drive users to distraction, an FM buzzing that emits fuzzy sound in a radius of about six feet from the source and no further, MP3 or MP4 recordings that come out sounding like Alvin and the Chipmunks rescued from pop music antiquity land, and if a user ever tries to learn what to do from the manufacturer, a company called Solomobi, they are out of luck unless they speak a hybrid strain of Mandarin & Cantonese Chinese quite fluently.

Enter CPR. Imagine a scenario when a customer saunters into one of our independent repair outlets, and drops a malfunctioning Cool one, an 8800C, on the counter. “Can you make it work?” the owner of the peculiar little device might ask in a very plaintive tone.

“Sure, I’ll crack it open,” our intrepid and expert service technician might offer bravely. There is no swagger but we will try, as a song from “The Impossible Dream” blends with a selection from “The Miracle Worker” on the thing’s tiny FM radio.

The next day the customer returns to CPR. “Well, is my Cool8800C working again?” he asks, still sounding as plaintive as ever.

“I have good news,” our expert technician says, “Yes, it’s functioning as well as it ever did.” He turns it on like you would begin playing a Nintendo game back in 1978. Strains of music begin emanating. What is heard if you listen very closely is the high-pitched squeals of chipmunks. The customer smiles slowly, satisfied, a bit like the Mona Lisa.

To learn more about Cell phone repair, ipod repair, cell repair services, visit Chicagocellrepair.com.

It wasn’t long ago when the first iPod Nano knockoffs were brought naked into our unsuspecting repair shops, one after the other. They came from China, maybe Taiwan, maybe the mainland. Who actually manufactured them and sold them to gullible but thrifty Americans in the United States is anybody’s guess. One prominent distributor being mentioned was a bizarro referred to only cryptically as ‘Nanohead.’ He looked a little like ‘Eraserhead’ from that classic film of the same name, circa 1980, but this is innuendo, since no CPR employee has ever actually seen him.

An iPod Nano is constructed with several capacities, but the worst of the Nano nonos are these: 512MB, 1GB, and 2GB. Each is ugly as sine, as in critical function, a gadget reeking of cheap construction with little attention paid to detail. On the iPod Nano’s dial, this knockoff is made to resemble a genuine Apple, one suspects, until one of CPR’s observant technicians happened to notice that instead of “Menu,” a Nano customer has to settle for an “M,” while the gadget’s “play” button is in the center of the dial, gazing back at you like a Cyclops arrived fresh from the junker heaps in Hades. Greek mythology aside, volume is controlled at the dial’s bottom, why, no one really knows, unless it has something to do with a spanking. With that instruction in mind, sometimes a CPR technician’s well-placed little tap made the Nano “M” hum again.

Another fake iPod got their start as part of a U.S. government giveaway program. A group called “Voice for Humanity” began passing out customized digital audio players that looked like the trendy iPods, only they were pink—the hue having something to do with the gadgets intended as literacy tools for Afghan women inhabiting remote villages. Several of these “pinkies,” as they came to be called by our clever service technicians always at the ready, made their way through the doors of selected CPR storefronts.

We were as adept at fixing these as we’d been at repairing the Nanos, even if our service technicians instinctively recoiled from their litany of National Public Radio-like sounds, primarily public service messages on topics including human rights, women’s rights, Afghanistan’s elections, and reproductive health, in other words – what went on under the burka. Fortunately, these too were relatively easy to fix.

To learn more about Cell phone repair, ipod repair, cell repair services, visit Chicagocellrepair.com.

Cell phone gaming and transformers were a marriage that was bound to happen, sooner or later. One smart electronic gadget is morphing into another. This Cool8800C, a Nokia Smart Phone knockoff, is the newest techno-entry from Solomobi, a Chinese manufacturer and distributor of mobile phones. The thinga-gizmo is delicate, in the sense of cardboard, because it opens up into a PlayStation portable mode, complete with a d-pad. But its features are amazing for a hybrid, including trendy innovations that seem increasingly indispensable: E-book reader, FM radio, MP3/MP4, and an attractive LCD screen. When it works, the E-book reader is a real page-turner, the FM radio speakers are tiny but can be clearly heard up to six feet from their source, MP3 recordings sound tinny but are impressive considering that we’re still in the midst of the War on Terror and can’t be greedy, MP4 recordings are fainter but still barely audible– and that’s a good thing — and the embedded LCD screen comes in several flavors, including tutti-fruity.

But this level of performance can’t always be depended upon with the Cool8800C. Even the LCD screens can lose their luster when the knockoff is knocked around a bit. Other features of the thingee are even more impressive. NES games, also described as “old school” Nintendo, are mentioned, although titles don’t appear and there’s no clue about how to actually access them during “the best of times,” as Dickens might have said.

This hybrid contraption is a heck of a lot better than any Sony-made genuine PSP phone, especially when you consider that Sony does Skype which doesn’t really count. It’s true that this “C” thing barely functions when you look at it from a naysayer’s vantage, but what is really worrisome from Pollyanna’s perspective is what happens if your treasured little knockoff (still selling at $140.00)crashes completely?

The independent cell phone repair shops are the only place you can dare bring it to, when the unthinkable happens. Soon enough, your Cool8800C will be nifty again, and you’ll be able to turn the pages of any E-book of your choice. You’ll be so engrossed in the text by then that you won’t want to do anything else.

Jeff Gasner is with CPR-Cell Phone repair. The leader in Cell Phone Repair and iPod repair offering cell phone repair services nationwide. To learn more about Cell phone repair, ipod repair, cell repair services, visit Chicagocellrepair.com.

You might have already heard about the “iPods for Democracy” program, a distribution of iPod knockoffs as some kind of goodwill propaganda effort sponsored by an American organization called Voice for Humanity. This bellicose-related fit of mind flu is ostensibly a showcase for American idealism, a benevolence dubiously demonstrated on the backs of angry donkeys and Arabian horses trekking through isolated regions of rural Afghanistan bearing pink iPods as gifts to curious Afghan women eager to leap burka-first into the twenty-first century. This supposedly invaluable stepping stone toward literacy is genuinely gender-conscious; being pink, but otherwise only resembles a real iPod. Aid workers dutifully distributed 65,800 of these customized digital audio recorders, which cost $50.00 each – an iPod knockoff manufactured in China and loaded with public service messages on topics such as human rights, women’s rights, Afghanistan’s election process, and reproductive health.

Incredibly, dozens of these have been turning up lately broken in various ways, sometimes brought in by family members of Afghans now living in the United States, especially to independent repair shops specializing in cell phones, and electronic gadgets, including pseudo-iPods. A few were turned in with bullet holes lodged in their cheaply-assembled LCD screens. Perhaps ill-advised gifts in the first place, being remote Afghan villages, technicians at a number of independent shops have described the little pink gadgets being recycled as “scary” and very difficult to repair. “I’m not sure what they’re supposed to contain,” admits one less than impressed expert service technician who was soon seeing pink.

From the island of Taiwan, iPod knockoffs have been flying off the shelves fast enough to prompt repeated warnings from Apple. These Chinese substitutes can cost as little as a third of a genuine Apple, and come in various storage capacities from 512 MB up to 2 GB. These knockoffs look like the real Macintosh except for a less clearly delineated “menu” and have a play button in the center of the dial that is typically the first component to break. “I hate those things too,” said one service technician working at an independent repair shop who refused to be identified.

Jeff Gasner is with CPR-Cell Phone repair. The leader in Cell Phone Repair and iPod repair offering cell phone repair services nationwide. To learn more about Cell phone repair, ipod repair, cell repair services, visit Chicagocellrepair.com.