Saturday, July 6, 2013

Assisted Living and Retirement Communities: Great Food Equals Happy Residents


Meal times are bar none the most important activity of the day for seniors living in retirement and assisted living communities. Eating is an immensely enjoyable activity when you're young (as evidenced by our 60% overweight population) and for the elderly, and is often the only enjoyable activity of the day. And while fattening home cooked dishes will always be on menus - just watch the uprising if they took away chicken fried steak from anywhere south of the Mason-Dixon line - communities should still be striving for quality and freshness.


  1. Our seniors spent their whole lives deciding when and what they wanted to eat. Isn't it only fair that they get to do that now? While many communities have limited meal times - and this is not necessarily bad, it's certainly better to have an all day dining program in place. When is the last time someone told you that lunch was served at 11AM sharp? Our seniors aren't children and they're paying a lot of coin to live in these places. Communities should attempt to be as flexible as possible in their scheduling to be respectful of the decision-making ability of these folks, even if they come in at the same time. Every. Single. Day.

  2. It's just as important to give seniors the choice of where to sit. Senior communities can be like high school with folks moving in and out of social circles. Wouldn't you get sick of sitting next to the same person every day? What if you didn't like them? Assigned seating should be reserved only for residents with very high care needs who need extra attention.

  3. Knowledgeable Food & Beverage Director. All the better if the chef is a nutritionist (and in some states it's the law). Even if no need exists now, he or she should be able to tell you what they can and can not do in the event diets change for health reasons. Diabetes, chewing problems and diverticulitis, among many others - are fairly common ailments among an aging population and something to think about when considering a move.

  4. Quality and Quantity. Look to see how extensive the menu is. Residents should be given at least three options at every meal, one hearty, one healthy, and one light. Even home style dishes should be made with fresh ingredients and a minimum of salt, and served with fruits and vegetables that will be pleasing to any palate.

  5. Cleanliness and Atmosphere. Keeping the kitchen and dining room clean are incredibly important to help prevent the spread of illness within a more frail population prone to picking up every little bug. Check food safety inspections and be sure to walk all the way into the dining room (and in the kitchen if they allow it) to make sure staff looks clean and crisp, salt and pepper shakers free of any visible debris, table surfaces sanitized, and glasses and silverware spotless.

  6. Don't forget to try the food. While every community claims to have the best around, make sure you ask to try it for yourself. Your taste buds don't lie and it will give you a much better idea of what the community is really like as a whole.

Gone Fishing - The Struggles of Retirement


How is retirement? It must be good to be able to sleep in each morning. I envy you. Do you have any travel plans? How is your golf game? I have heard these comments many times in the last six months, and as I respond, I deal with a flood of feelings and thoughts. It is assumed that I have come to that time of life when I can take it easy, do as I please, and wait until God calls me home to glory. Retirement is perceived by some to be a soft life with no more workplace responsibilities. Life goals are complete. These questions can be interpreted as demeaning, degrading, or even condescending, especially by the person who has had an active life. That person may respond with anger, feeling put down, and with disgust over others lack of understanding. The dictionary does not help by defining retire in this manner: to withdraw from business or public life so as to live at leisure on one's income, savings, or pension. Many of the misperceptions of retirement are created by people who have reached this stage of life. They may say, I have been there, done that, and I don't want to be involved, or Don't ask me to do anything I have done my time. They may carry an aura of bitterness at being set aside. Some have held prestigious positions, and suddenly they feel they have lost their identities. What is my worth my value? It is easier to withdraw. Many become depressed. But the biblical view of retirement is vastly different from these views. Old age is to be a position of honor and respect. With age comes wisdom. Rise in the presence of the aged, show respect for the elderly and revere your God. I am the Lord (Lev. 19:32). Listen, my sons, to a fathers instruction; pay attention and gain understanding (Prov. 4:1). They will still bear fruit in old age, they will stay fresh and green (Ps. 92:14). Retirement is getting off the freeway and enjoying the country roads. It is a time of growth and change, of refocusing, retooling, and renewal. But above all it is a time of reflection, contemplation, meditation, and prayer.

My first retirement took place in my late 50s after 30 years in the public education arena. I had experienced fulfillment as a school psychologist, an administrator, an adjunct college professor, and a marriage and family therapist. The prospect of a leisurely life flashed its seductive beams my way, but God in his wisdom placed in my pathway opportunities that were more appealing to me. Heeding the Holy Spirits nudges, I seized the day carpe diem. The next 10 years proved to be the most fulfilling of my life! My very diversified career preparations suddenly came together into a meaningful whole. The old mans dream spoken of by the prophet Joel (2:28) and reinforced by the apostle Peter on the Day of Pentecost (Acts 2:17) came into fruition. Programs became realities, people were blessed, and the power of God's presence filled me with abundant joy. Yet at every stage of development, life presents its problems. This is especially true with the Christian life. The Scriptures never depict this life as one of ease or as a bed of roses. We are called to participate in the sufferings of Christ in order that we can share in his glory (2 Cor. 1:5; 1 Peter 3:14, 17; 4:1, 12-19). The apostle Paul often wrote of the hardships he suffered as a servant of Jesus Christ, but he also rejoiced in the comfort and blessings he received in abundance. In like manner, the Christian counselor must be cautious about portraying the good life over 60. These years can be the happiest years of a seasoned citizen's life, filled with opportunities for inventiveness and creativity. Yet the retirement years can also be fraught with health, emotional, and financial problems.

*The Counselors Role*
The Christian counselor can play a significant role in helping the prospective retiree redefine the term retirement. As life expectancy increases and Baby Boomers age, the number of persons over 65 will
increase dramatically. Retirement can be a time of joy, hope, and fulfillment. Granted, there will be financial problems for some, the scourge of depression and loneliness for others, problems brought on by physical disabilities and poor health for still others. Yet the astute counselor can guide a concerned individual into a change of attitude in dealing with these issues. The role of the Christian counselor is to provide a solid platform upon which to build a strong behavioral structure for the individual who is approaching retirement. Help the client to redefine the words freedom, productivity, and time in terms that are relevant to his or her new life style. Freedom is the greatest gift retirement gives freedom to follow one's own interests, pursue one's dreams, develop one's talents, and discover new avenues of fulfillment; freedom to do those things one has always wanted to do. But freedom can be abused if used as an escape from purposeful endeavors. Freedom defined within the spiritual realm can take on new meaning. It is for freedom that Christ has set us free. Stand firm, then, and do not let yourselves be burdened again by a yoke of slavery (Gal. 5:1). Proper use of this newfound freedom can provide the space needed to make new discoveries about one's abilities and talents.

Productivity within the world of work provided a means of financial gain, but in retirement, the product of a person's endeavor may bring not monetary reward but the personal satisfaction of achievement in a whole new vista never before explored. The pressure of earning a living is now off, and retired people can start to live freer, more elective lives. Motivation to produce is now a free choice, without the fear of failure or disapproval. Be willing to take a risk. It may not always be in the persons comfort zone, but it can open up new avenues which lead to aliveness, bringing a new freshness to his or her day. Time takes on a whole new dimension. The eight-hour workday can be decreased or expanded by whatever the task at hand requires. Flexibility becomes the key word in reference to time. Quantity and quality of sleep are very Important for the person who is growing older. If an evening's activity extends to late night hours, the flexible schedule allows for sleeping in the next morning. However, it is easy to flounder when time is not anchored to a specific mooring, especially when no parameters are set for the day.

Guidance is needed to help the prospective retiree establish goals, a purpose in life, and a strategic plan for the future. It is good to have something to get up for in the morning. One advantage of retirement is
that one can devote more time and energy to the things one considers Important. For some, it may be difficult to set long-range goals. Affirm them in establishing short-term retirement goals, perhaps planning no more than a year ahead. A real service is provided to prospective retirees by helping them anticipate the inevitable bumps in the road. A knowledge of the problem areas that may be encountered will help establish coping power to deal with them and perhaps avoid late-life crises. As we grow older, we know that eventually we can expect physical decline and debilitation. But the apostle Paul tells us not to lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day. For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all (2 Cor. 4:16-17). When our physical bodies begin to seem more like burdens than blessings, as persons of faith, we have the assurance that the life of Jesus is working within us that God may be glorified. It is easy for elderly people to perseverate on the state of their health. It can become an obsession, the primary topic of conversation. People can become so preoccupied with their health that there is little else about which to talk. And the more they talk, the higher the anxiety level. Joy and contentment are possible even when health is fragile and waning. We do not need perfect health to be productive. There are people of all ages who have learned how to live with disabilities. My mother-in-law was confined to a recliner and wheelchair 24 hours a day. Yet in her 80s, she was still extremely active, conducting Bible studies, editing a newspaper for the nursing home, and ministering to individuals of all ages. It was a joy to be in her presence. As Robert Seymour says in his excellent book, Aging without Apology, It is a good thing to have health, but our obsession with health is unhealthy.

*Emotional Problems in Retirement Years*
Equally debilitating as physical ailments are the emotional problems that occur in later life. Retirement is often considered a period of loss: loss of good health and physical strength; loss of work, income, and prestige; loss of relatives and friends through death. Grief over these losses can dominate every aspect of a person's behavior to a point of complete inertia. The loss of a lifelong mate where attachments have been strong can be devastating. As with all losses, a strong support group of caring individuals who are adept at listening and limited on advice-giving will help alleviate the emotional pain. If this grief is not appropriately dealt with, it may evolve into withdrawal, loneliness, and depression.

Loneliness and depression are two of the most frequently encountered emotional problems among the elderly. The active individual who is suddenly thrust into an environment where vital relationships are not present feels the aloneness and the personal lack of significance. Depression then presents itself in many varieties. An excellent discussion of these varieties can be found in Emotional Problems in Later Life: Intervention Strategies for Professional Care givers, 2nd edition, by Dan Blazer, M.D., Ph.D., Professor of Psychiatry and Behavioral Sciences and Dean of Medical Education at Duke University Medical Center. This book is a tremendous resource for dealing with all emotional problems experienced by the elderly. Many seniors also have serious concerns about their financial situation. Will there be sufficient funds to care for my bills? they ask. It is true some have limited old_resources, but many, if properly counseled, can live comfortably as long as they are judicious in their spending. Everyone should start early in making wise investments for the later years. Also, long-term insurance is wise in order to avoid depleting savings with costly nursing-home care if it should be required. Many reputable investment firms provide inexpensive seminars and literature that can be very helpful. There is an initial difficult time in retirement of making the transition from a monthly paycheck to retirement funds. Spending must be significantly reduced but, with creative planning, the life style need not change. The Christian counselor has guided many through the stormy waters of a mid-life crisis. Now the opportunity presents itself to assist the aging individual into a new stage of life, a stage that can bring new opportunities for fulfillment and joy. Instead of a period to be dreaded, it can be an adventurous journey to explore new areas of endeavor.

*Stage of Spirituality*
Perhaps this stage of life should be referred to as the Stage of Spirituality. It is a time in which to allow God to do his perfect work in us, molding us more and more into the Image of his dear Son. The seasoned senior has the opportunity to grow in the area of the spiritual disciplines, as is so poignantly described in Richard Fosters book, Celebration of Discipline. There is time now to contemplate and meditate on the riches of God's grace, his majesty and glory. The most Important ministry at this time of life is prayer, constantly communicating with the Father on behalf of others. We have been given the responsibility to tell the next generation the praiseworthy deeds of the Lord, his power, and the wonders he has done (Ps. 78:4). New opportunities of this nature are now being developed in many areas. Elder Quest is developing an institute where college students are paired with seasoned seniors for an intergenerational week of dialogue and fellowship. A pilot program will be held on the campus of Palm Beach Atlantic College in the spring of 2000. Elder Quest also provides stimulating programs for older people at various Christian conference centers throughout the country. Not only is this an opportunity for Christian fellowship but a time to explore God's Word as well as other areas of interest. Focus on the Family has just begun a new ministry to those who are over 50 and entitled it, appropriately, Focus over Fifty. Their new publication, Life Wise, should be a tremendous resource for seniors. As Christian counselors, let us encourage those entering the retirement years to keep active spiritually, mentally, and physically. Let us help restore the older person to a biblical position of honor, respect, and dignity. Seasoned seniors will encounter many roadblocks on their journey, but even as the apostle Paul struggled with his thorn in the flesh and
pleaded with the Lord to take it away, the Lord responded, My grace is sufficient for you, for my power is made perfect in weakness (2 Cor. 12:9). God's grace is sufficient for all of us, no matter what the situation might be. Prospective retirees and their counselors can rejoice! The best is yet to be! Online Christian Counseling is a nice way to get suggestions.

Ten Reasons Why You Should Start a Career Academy in Your High School


Reason number one is that your school has over a student population of one thousand students. Students tend to be safer and more engaged if they are in a smaller group within a big high school.

Your school wants to connect the rigor of college-prep courses with the relevancy of the "real" world is the second reason. If the "real" world context is embedded in the classroom, students are motivated to learn.

Reason three includes that your school wants to consider high school reform efforts that are inclusive of all students including high achievers and those at-risk for failure. Schools should not be tracking students. All students are smart in some way, so teachers need to help students figure out how they are smart and can succeed with the "smarts" they have.

The fourth reason is that your school wants to find proven methods of increasing attendance and graduation rates. Academies support students and make them feel welcome and valued. Of course, students who feel wanted stay in school.

Your school wants to build partnerships among educators, employers, parents, and community leaders is number five. Most business leaders don't know to "get their arms around" a high school, but, these same leaders know how to connect with a health academy or an engineering academy.

Sixth is that your school wants to implement strategies that increase teacher job satisfaction and effectiveness. Teaching can be a lonely profession when a teacher closes the classroom door. Most teachers love being part of a team and sharing ideas and strategies with other teachers.

Reason number seven is that your school wants to build a sense of belonging and well-being among its students. Think of the career academy as a gang - except this is a positive gang. Why do students join a gang? The answer is to belong and be accepted.

Your school wants to find proactive ways to decrease discipline problems and prevent violence is number eight. Again, students who feel welcome and accepted don't need to cause discipline problems to be noticed.

Nine is that your school wants to challenge students to perform at their full potential. Because career academies are a school within a school, teachers know each individual student and can challenge students to a higher level of achievement.

Number ten and lastly is that you want to do all that you can to prepare your students to succeed in the workplace and to assume roles of responsible citizenship. Teachers in a career academy generally have more autonomy and can accomplish more than the regular high school teacher or counselor or administrator.

Nursing Discipline - How the Bureaucracy Hurts You


The Healthcare Integrity and Protection Data Bank is a federal database that keeps track of nurses and other healthcare professionals who have been disciplined for a variety of reasons. According the website at the Department of Health and Human Services, the HIPDB was created in 1996, "to combat fraud and abuse in health insurance and health care delivery." These are very noble and lofty goals, and work to instill confidence of the general public into the hands of nurses nationwide. Certainly most nurses don't want to have to work around people who are negligent and unsafe. They also want patients to trust them. Any breech of that trust reflects poorly on the profession as a whole.

The unfortunate part of the issue is that at this time, the federal government will not provide you access to the information contained in your particular file. Suppose you were accused of something and written up in absentia. Through the court system and throughout all of labor law, you would be entitled to some course of action against the offending party. As the situation exists, you are not even privy to the knowledge that your file contains.

Under Section 1128E of the Social Security Act, "the Secretary [of HHS] will...provide for...disclosure of the information, upon request, to the health care provider, supplier, or licensed practitioner." The problem, like many things in the federal system, is that bureaucracy makes this information gathering almost completely unavailable. According to NPR, not even the hiring agencies that employ nurses, such as hospitals and nursing homes can access the database. A recent feature story says that Dr. Sidney Wolfe, CEO of the Public Citizen's Health Research Group, "notes that there are more than 102,000 nurses, nurse aides, pharmacists and pharmacy assistants who've been disciplined and included in the registry, but that hospitals and nursing homes can't check the data bank." This useful tool to protect the profession is just something else to be thrown in the trash bin of bureaucracy.

All Aboard! This Is the China CCRC Express!


"It took more than one man to change my name to Shanghai Lily," purrs Marlene Dietrich in Josef von Sternberg's film 1932 adaptation of Harry Hervey's book Shanghai Express. She certainly has her well-manicured talons sunk into more men than she can count in this exotic far-Eastern, chiaroscuro-cinematographic adventure. Among her fellow passengers on the Shanghai Express are her disenchanted former fiance', unshakable British medical officer Clive Brook; over-zealous missionary Lawrence Grant; dope smuggler Gustav von Seyffertitz; and enigmatic Eurasian businessman Warner Oland. Coincidently, Oland made frequent appearances in other China-themed movies, most notably as Charlie Chan, the benevolent and heroic Chinese detective based in Honolulu as well as a future movie character for this article.

As the train chugs through the more treacherous passages of war-torn China, Oland reveals himself as the leader of a rebel group, who plans to hold the passengers hostage to secure the release of his imprisoned constituents. In Boule de Suif fashion, Dietrich, who portrays a notorious "Chinese coaster" has remained sexually remote throughout the trip, gives herself to Oland to save the life of Brook, the man she truly loves. Directed by Josef von Sternberg at his most orgiastic (check out the long, lingering dissolves!), Shanghai Express is 80% style and 20% substance.

Tickets, please....

This article is about China's 3 largest and most visible geriatric care developments to date. I warn you in advance, this article is painfully long but the information conveyed is important for those interested in senior living in China. Each of these projects has been in the market for at least 2 years and in one case nearly 5 years. I call them CCRC's (continuing care retirement communities) because, well, that is what they set out to be and in some part that is what the developers have accomplished...or, better yet, are clearly struggling to accomplish. One of these developments had the benefit of limited foreign assistance, the others did not. The one that did clearly benefited and consequently has the best aged-care program in China today. All are chugging along with common weaknesses and each has their strengths. In sum, it is a mixed bag and to the inexperienced eye (read: China senior living experience, not western senior living experience; I say this as nearly all western geriatric care practitioners who see their first China project immediately conclude that all China senior care is a train wreck) it might seem as if the idea of senior living in China is just on the wrong track. But it is early and the train hasn't left the station, at least not just yet.

Those who seek to conduct the senior care business in China are well advised to remember a few important rules of the China elder care experience: first, China senior living is where Western geriatric care was in 1950 but gathering steam quickly; second, never judge a project out of context, meaning: comparing a project in Chongqing to a project in Santa Barbara is meaningless as the buyers of the Chongqing project don't have that choice much less that perspective; third, the higher one stays in the acuity chain, the more leverage one has...which translates into success; and finally, stay in the 1st class coach, period.

Before this train departs, I would like to make one last observation. My thoughts below are a mildly critical analysis bordering on subjective evaluation and at times, some literary lampooning. Lest I be detained by the People's Senior Living Police at Beijing Nan Zhan (FYI: an enormous train station), I beg merciful consideration that these contemplations be seen not as cruel condemnation, malicious denigration, negative commentary or, heaven forbid, Confucian blasphemy of any CCRC discussed here or China's senior living potential in general. Quite the contrary, I am no apostate; I see a bright future and if these three communities are indications of what the Chinese can accomplish right out of the box, then the next decade will be outstanding for professionals in the China geriatric care business.

And finally, as the whistle blows, for those readers not entirely familiar with a CCRC, they are usually defined as a campus style residential complex assembling a mix of independent living residences for active but senior adults, assisted living units for older adults needing some support with their daily activities and skilled nursing care for frail or infirm adults requiring frequent assistance or acute medical care. Additionally, there are often a variety of cultural amenities, exercise facilities and commercial support services which offer basic necessities and provisions, such as hair salon, laundry/dry cleaners and variety store.

First stop, General's Garden.....General's Garden!

When I first visited General's Garden nearly two years ago, I thought, "This is it....modern senior living has indeed arrived in China". But after my fourth trip and some pretty rigorous investigation and analysis, I began to see the cracks in both hardware and software, in a sense, the General's Garden's locomotive was running out of steam.

General's Garden was opened to the public around 2009. It is located in the northeast quadrant of Beijing (off 4th ring road), not far from Beijing Capital International airport and the Museum of Film. The land was Ministry of Transport land and the property's perimeter remains a testing track for China's high-speed railway (true). I refer to General's Garden as a CCRC as it loosely embodies a simple definition of a CCRC, as outlined above. Indeed, General's Garden offers 51 villas or large townhouse style residences with private gardens, 160 independent/assisted living apartments and 280 skilled nursing units all within a gated compound. This facility also offers a 3-hole golf course (plus driving range), an unusual, man-made forested park, an unfeasibly large and as of yet unfinished 17,000m2 hot-spring clubhouse, an 160 room inn for visitors and a clinic specializing in traditional Chinese medicine.

So what happened? Well, as of January 2012, only 14 of the Villas had sold and less than 10 residents purchased golf course memberships (which by the way, through October of last year, boasted an expensive, resident Australian PGA Pro to give lessons to all those resident members) since the opening 2 years ago. I would get into detail about the amenity membership program but it is way too complicated (ex. Golf course membership is priced on ball usage). The villas ranging in size from 700-800 square meters, carry a price tag of between RMB 45 million and RMB 55 million for unfinished space and the IL/AL units go for RMB 1.5 million plus services on an as needed, menu basis. And while the IL/AL living apartments and the skilled nursing units are fairly well occupied (75%-80%), there are likely a number of reasons for the stalled performance of the villas. As an aside, I have to note that the best thing about General's Garden is the aged-care program; it was set up by an Australian group and they did a superlative job. Until recently, an Australian also continued to manage this section of the facility; he has a great deal of experience and insight into how Chinese seniors need/want geriatric care. Kudos to this master of the China senior care experience! Our access to General's Garden's business plan has allowed us to tabulate much of their rental and sales data which we share with clients.

Unlike the Little Engine That Could, ("I think I can, I think I can...") the General's Garden villas have never made it up the hill. I believe this is because:

1) the land on which the facility is built is known as "collective land" which does not convey fee title to the buyer, only a long term lease (approximately 50 years for either a villa or an IL/AL unit). Consequently, potential purchasers are faced with an unappealing opportunity to buy an enormously expensive, depreciating asset which under Chinese law cannot be hypothecated,

2) General's Garden never seemed to have a comprehensive marketing plan and buyer outreach program other than pursuing the ownership's network of political contacts for unit sales, and

3) perhaps the least understood aspect of the facility, its capitalization and financial game-plan which seemed, at best, ad-hoc. Beginning early last fall the warning signals were as subtle as a diesel engine's piercing whistle at 4am: contractors stopped receiving payments and construction stopped on the remaining units and clubhouse, there was a sharp increase in deferred maintenance, a hostile takeover occurred and subsequently, most senior management ceased receiving paychecks.

On the other hand the IL/AL units are comparatively speaking a success. And while ownership, meaning title conveyed, of such a unit is no different than that with a villa, they are much less expensive (in fact they are well priced at an average of RMB12,000m2). It is interesting to note that there has been a trend of older adults buying these units for their children to live in.....however odd. Despite its raison d'etre as a CCRC, no writ of Chinese law prevents young people from living there. I guess this is an indication of the facility's pricing as much as its attractiveness, or more likely, the parents intend to move in at some future date.

In late January 2012, new management at General's Garden, reeling from the enormity of their poorly analyzed, hostile acquisition, fired 12 persons many of whom were experienced senior managers. The terminal analysis is likely that General's Garden neglected to fully understand their market, didn't identify a target buyer and never adequately projected unit absorption against capital requirements to identify a breakeven point; a lethal mistake.

I will say though, in all fairness, this review of General's Garden must contain praise for the original management whose fundamental concept of this CCRC is a sound, well integrated facility; it is just the execution and some software that jumped the track. I have met the previous General Manager and those in his inner circle and believe he/they are talented people capable of positively impacting the senior living industry in China. His early efforts at the facility are proof of this and had it not been for the hostile take-over, General's Garden would continue to benefit from his leadership and likely turn the train around. However, without him General's Garden lacks vision and perspective; it faces a number of critical switches in the track ahead.

A fellow writer recently wrote a piece on this facility using a favorite song of mine to illuminate the bridge over troubled waters that General's Garden presently crosses and more importantly, its choppy history. I find his story on target and I salute his perspective; he has taken a measured approach to this facility's analysis. De-accelerating and moving forward less hurried is always a good thing in China.

At this point, I will step away from rock 'n roll metaphors and, given the time of year, select a more solemn reference as a testament to this facility's narrative. With its fall from grace, perhaps we can call General's Garden and its story, "The Prodigal CCRC", a parable of squandered opportunity; now lost, can and better yet will, General's Garden atone for its marketing and financial sins and find its way again?

Yanda....next stop......Yanda!

Now this is a facility to behold. While its full name is a mouthful, Yanda Golden Age Health Nursing Center, the facility is frequently referred to as Yanda. One arrives at Yanda entering under an enormous, ceremonial gate and into a Tiananmen Square-like plaza large enough to park 500 tractor trailers. After parking your car, walking around Yanda is, frankly, a little creepy and reminds me of the cities created in the narcotic-induced dreams of Dom Cobb in Christopher Nolan's Inception,.......beautiful, large, vacant and crumbling.

Yanda's first impediment is its location, situated a hard hour's drive from Chaoyang district, Beijing in adjacent Hebei province, it is tough to get too. Second, Yanda simply is overbuilt. So much of what has transpired at this facility is unclear, even the basic facts such as room count and beds are, in typical Chinese fashion, opaque. We are told there are 1,200 units at Yanda, but it feels like more. There is a 3,000 bed hospital and a 200 bed geriatric nursing facility which, management professes is quite busy but there aren't a lot of cars in the parking lot and not a single ambulance arrived during my 3 hour tour (I arrived at lunch time). But hey, I won't let my lying eyes fool me, I saw not a single patient in the nursing care center. Wait...there is more: a 250+ room hotel and four places of worship (seriously): Buddhist, Muslim, Christian and Jesuit/Catholic all sited next to a bank (presumably for those whose faith favors Mammon). And if that isn't enough, ownership built a 30 story building that serves as living quarters for the healthcare workers who will, hopefully, arrive someday soon. Whew! What a budget!

Truly statuesque, in the lifeless sense of the word, this project should be renamed the "Colossus of Hebei" as colossal is the only term that adequately defines Yanda (well, maybe "stalled" has relevance here as well but lacks a certain visual "onomatopoeia"). Now, when confronted with the enigmatic and incomprehensible my imagination always runs wild. In fact, Yanda inspired in me a rewrite of those last few dreadful lines from the famous Shelley poem Ozymandias:

"....My name is Yanda, King of CCRC's: Look on my campus, ye mighty, and despair! Few residents remain. Round the decay of that colossal wreck, budget-less and bare, the congested Chinese conurbation stretches far away".

In all seriousness, here is the punch line: Yanda is only 20 percent occupied and it could well be less. I take this fact on face value from what we are told by the tour guide. But having been there at lunch, my favorite time to visit a facility as it reveals a lot, there certainly wasn't too much activity.

This is what we do know about Yanda: unlike General's Garden, Yanda is a pure rental scheme. Most occupants lease units on a year basis, but management also quotes 2 and 3 year options. Independent and assisted living units (1 and 2 bedrooms) rent for RMB 5,600 to RMB 9,600 per month plus services which can be selected from a menu. The nursing facility offers beds/units beginning at RMB 13,600 to RMB 16,800 per month, also depending on size and acuity. There is also another quirk to the pricing; the sponsor offers a kind of sinking fund whereby if you deposit sufficient monies with them, they will pay a 6% return on your money that is equal to your monthly rent (the number of takers for this generous offer is unknown). The young lady who showed me and my staff around, gave us the above 'rack rate" pricing (and a sheet with greater detail on it) but was eager to mention that we are very lucky customers and our visit today was auspicious; management has instructed her to offer high status individuals, such as ourselves, a one-time only, VIP discount of 40% on a full year lease for IL/AL units and a whopping 60% discount for nursing units. Days later, subsequent phones calls to verify information were met with the same offer. Ok.....no surprise here.

Yanda opened up in 2010 and blew its steam before getting out of the station. The ROI has to be hurting by now and somebody is likely to take a loss going forward. It isn't an ugly project, in fact I found the basic design "ok" by China CCRC standards; but somebody has to take control of the marketing here, drive absorption aggressively and simplify the rental scheme before the buildings fall apart resolving the problem forever. This is the only prospect here: try and compete on price and program in an attempt to overcome Yanda's real weakness: location. Believe it or not, there is land allocated for a phase II....someday.

Cherish Yearn, last stop.......everybody off!

This facility's operations are as curious as its name. Located in a distant corner of Pudong, on a former duck farm, Cherish Yearn came to market about five years ago. It was an early arrival to the China senior living space and its organization, facility design and ambience all reflect its vintage. I first visited Cherish Yearn in late 2010 and quite honestly, I thought it was a disaster. From the desert like landscaping to the mold-stained stucco on the buildings it had little ambience, few residents and zero energy.

Cherish Yearn was completed in 2006 and the first residents occupied in 2007. For years it struggled with occupancy and when I returned for a second visit in early 2012, I was pleasantly surprised. Apparently, over the past two years, a new marketing program was implemented and brought census up from a low of 20% to what is reported now as nearly 80%; and after my tour I believe the true figure is not far from this level. Activity rooms are busy with geriatric calligraphers, libraries are full of bespectacled Mandarins gazing over the Central Committee daily and even the computer rooms are full of elderly Chinese pecking away on keyboards. Indeed there is so much activity at Cherish Yearn its resurrection earns it a new name: the "Lazarus of Pudong"...so there is indeed hope for The Prodigal CCRC and the Colossus of Hebei.

Like its sister facilities, Cherish Yearn is large. It offers nearly 800+ units in 15 different mid-rise buildings. Independent living accounts for at least 600 units and there is a 300 bed nursing facility. The independent units have a reported 80% occupancy but it is entirely unclear how many residents are in the nursing facility. Access to the upper floors is prohibited but the first floor, which does indeed have patient rooms, reveals no activity whatsoever and is largely dark.

Cherish Yearn's business model is founded on a membership scheme with an upfront fee and annual rental payments plus usage charges for the clubhouse and other amenities such as the dining hall. There are 2 basic plans: Plan A essentially confers title to the occupant for an entry fee of RMB 890,000. Once admitted, the resident may choose from 3 basic size units: large units (108m2 or 1150ft2), medium units (70m2 or 740ft2) and small units (58m2 or 625ft2) each of which charges an annual fee according to size. A resident who has purchased a unit under Plan A may sell the unit himself at some future date or offer to the sponsor who will re-purchase it for 90% of the entry fee or market price, whichever is less. Plan B confers a 15 year right of use for an entry fee beginning at RMB 880,000 for a large unit, the smaller units have lower entry fees; there is also a static annual fee of RMB 29,800 across all unit types. Plan B's entry fee is refundable on a straight declining basis (calculated monthly) over the 15 year lease period.

Plan A seems to be most popular with children who wish to purchase a unit for their parents and Plan B seems to be the choice for elderly who buy for themselves. There are substantially more Plan B buyers than those who avail themselves of Plan A. We have completed a full tabular analysis of Cherish Yearn's fee structure which, again, is available to clients.

It is fair to mention that in the past, Cherish Yearn experienced some controversy over both its fundamental ability to offer sub-acute care services as well as its adherence to the original land grant use rights. The issues here may have been cleared up but there has been at least one published article in the media discussing the facility's "land rights" issue the details of which was supported by a credible, well connected source who has since spoken to me directly. In some quiet corners, rumors persist regarding the facility's legality, but in the end, I can see how this may just be envious chatter over Cherish Yearn's unprecedented success. Let's not forget, the truth in China has many layers.

So, in submissive genuflection, I offer faithful congratulations to the Lazarus of Pudong. Despite all, I believe it to be the most successful CCRC project today in China and its program is unique: truly a Chinese sui generis model.

The Terminus

Shanghai Lilly's assertion regarding the time and effort it took to secure her reputation whistles true and sharp about many endeavors in China; virtues such as patience and fortitude are essential. Likewise, it will take more than just a few attempts at CCRC development to perfect the model in China. CCRC's are complex undertakings and even in the West, developers with all their access to data and experience often misstep and build mistakes. So it is no surprise that the Chinese incarnation of a CCRC is a wobbly work in waiting. While I see near term success for the smaller, sub-acute facilities currently being built along the east coast of China by both foreign experts and local developers, nothing will dissuade, much less disabuse, the Chinese entrepreneur from pulling the heavy freight of a senior living mega-project. These immense CCRC's may be the track the industry ultimately takes, but for now were I an investor or owner/operator; my concentration would remain focused on the light at the end of a tunnel: more manageable, higher acuity and, say, narrow-gauge projects; let's call them the "Shanghai geriatric express".

In closing, I have taken this article's theme, meaning Chinese films or films with a China theme, quite far...in fact I have extended it further than I ever thought. And this posting was indeed the longest of all postings to date; I did pile it on you, the reader, with endless literary metaphor on top of a mildly amusing allegory, and for this I have not a single pang of guilt. And while I often wonder about Jiang and her whereabouts, I needed to get back to the mechanics of senior living in China; thus the nuts and bolts of this post. No worries, we will revisit the human side of this business again soon and some! I have two more postings of this ilk remaining which I will publish before the summer. After a break, I will return in September with something new and refreshing, but if you have an idea or are curious about an aspect of this business; as always, I am only too happy to listen.

Book Review: The Four Essential Questions


This is the third book I have read from Beca Lewis in her "The Shift Series". Just like some of her other books, this publication clears your path you walk on to discover more about your spirituality, your emotional-being, as well as your life goals.

The Four Essential Questions will assist the reader in finding answers to questions that keep many us in captivity within our own life. The reader is guided to use the Shift Series Approach to break the negative pattern you might be stuck in, and to start living the way we really want to, here and now.

One of Lewis' quotes that I have seen in other books by her hand is "What we perceive to be true, magnifies". This statement is used as the basic approach to start living an improved life, to the full intend. The reader is assisted by Lewis by reading about strategies, stories of her own live as well as of others, and by completing short assignments that focus on some of the content, or on short assignments that focus on the reader's own reflection on life. This is respectfully done by connecting to the Divine.

Chapters 1 to 3 prepare the reader to the 4 questions asked, and provide the needed back ground information, as well as some assignments for self-exploration. I found that it is good to wait with reading chapter 4 and on until you have a clear understanding of what was discussed in the chapters 1 to 3, and until you have done all the short assignments. Why rush through a journey for spiritual improvement when you do not fully grasp the concepts?

Chapter 4 to 7 reflect on the 4 essential questions in great detail, and I enjoyed reading chapter 7 the most, which deals with the question: "Am I lying?" This essential question goes so much further than just these 3 words, and I highly recommend reading this book if it were only to learn something from chapter 7. Each of the chapters 4 to 7 could be taken out of this publication and further developed in a stand-alone book, as those essential questions touch on the inner core of our beliefs and thoughts.

If you enjoy structures self-help resources that follow a proven concept, and enjoy the reflection and philosophy aspects of your life, this book should be one to have in your Kindle Library. Not only could it assist you in improving your purpose in life, but it could also give you the tools to help out some of your friends, relatives, or children.

Friday, July 5, 2013

When Alzheimer's Turns Abusive


There are secrets within the ranks of the Alzheimer's community that remain closed to the general public. While some memory loss is normal as we age, the initial symptoms of Alzheimer's can be deceiving and even go unnoticed. The perplexing aspect of this disease manifests itself in extremes ranging from lucidity to paranoia and total irrational behavior. In the majority of cases, the spouse is the first to recognize strange and unusual conduct. Over a period of time, these "odd" behaviors can become habitual and out of control. It is not out of the ordinary for Alzheimer's patients to hallucinate and see or hear images that are not there. The spouse or partner is often falsely accused of infidelity, or even worse attempting to inflict bodily harm. Yet the silence is deafening as the loved one endures such indignities out of loyalty, sympathy, and guilt. Why? Perhaps the best explanation goes back to the age old expression that love is indeed blind. After years of shared experiences such as child rearing, sharing finances, and growing old together - it is difficult to witness a loved one lose cognitive function. Even when that loved one becomes violent, which does happen more than reported, the state of denial is so powerful that many families continue to deny the obvious. Admitting a loved one to an assisted living facility or nursing home is a major step that a lot of family members simply aren't willing to take from an emotional or psychological standpoint. We must also factor in the financial component and its role in making this all important decision.

Going back to the abuse that takes place within marriages, and families in general, it is prudent to recognize this is a knife that cuts both ways. Caretakers come in many shades and that includes abusers. There are situations in which the individual diagnosed with Alzheimer's is being abused by a spouse, another family member, or some other party. This abuse comes in many forms including physical, verbal, emotional, and abuse of financial resources. It may occur for a brief period of time or continue for years without going detected. In fact, most cases of abuse are reported by a person outside of the family such as a social worker, doctor, or even a neighbor. When a person has Alzheimer's they may lack the ability to discern what behaviors are appropriate and those which are not acceptable. If physical abuse is involved, Alzheimer's patients may not understand why they are the subject of pain and discomfort. In extreme cases, they may not recognize the spouse or family member inflicting the pain and may equate the abuse with a painful experience in the past. As society continues to grow older and more susceptible, awareness of abuse and related issues are critical in our understanding of Alzheimer's and other forms of dementia.

Nursing Home Abuse - A Sobering Reality


According to a 1991 report given by the National Advisory Council on Aging, the number of injuries and deaths clearly indicates that abuse of nursing home residents is an alarmingly growing problem.

Some Statistics

Elderly people in these institutions are handled in a rough manner. They are grossly vulnerable to sexual assault. Sometimes they are swindled out of their life-savings. Often, they suffer rampant negligence on the part of the staff.

An astonishing number of elderly residents are not even provided with enough food. This is quite a worrisome trend, considering the fact that seniors in Canada represent approximately 14% of the total population. (From 2011 census)

The council on Aging reports that by the year 2021, one Canadian in five will be over the age of 65. Currently, the number of seniors living in institutions operated by charitable organizations, municipalities, private individuals and corporations stands at approximately 250,000.

These homes must get licensed and approved by provincial and territorial health ministries. The requirements for licensing include training, quality of food, number of employees, and medical care.

Growing Problem

Governments also approve unlicensed homes. Some of these homes provide exceedingly poor services. Their administration is similar to that of boarding houses, which are regulated by municipal code. Consequently, there is no regulation of services provided in such nursing homes.

With the rapidly aging population, a growing number of senior citizens suffer due to lack of adequate nursing home facilities. Further aggravating the problem is that the parties responsible for nursing home abuse and neglect are rarely held accountable.

More often than not, the cases of abuse remain hidden from the public eye. Many of these facilities are actually not safe for the elderly. Nursing home abuse manifests itself in various ways. The residents are victims of physical, verbal, psychological, emotional, sexual, and financial abuse. This leaves a devastating impact on not only the residents but also their families who entrust nursing homes to care for their loved ones.

Moreover, many of the elderly residents have no family to check in on them. Therefore, it is nearly impossible for them to cope with betrayal and frustration. They are isolated and alone.

What can be done?

We need more facilities with better checks and balances. If this problem is not resolved, then in a matter of a few short years, the number of seniors in need of nursing home care would far exceed that of good nursing homes.

Due to the possible overcrowding of these institutions, it would be even more difficult to control the abuse and neglect at the hands of concerned employees. Therefore, it is no exaggeration to say that a major chunk of the Canadian population would be leading a life of helplessness and agony.

To curb the escalating problem of nursing home abuse, it is very important to provide adequate training to the workers and have outside independent monitoring of facilities that are charged the care of the elderly. There are personal injury lawyers that can help get compensation for victims of this type of abuse.

In closing, if you suspect a friend or family member has faced abuse in a nursing home, then you must not hesitate to call the police and report your concerns to any and all authorities that have an interest in this type of crime keeping in mind that in a few short years it may be you who are at the receiving end of this type of abuse.

Authors Note: Why not "adopt" an elderly person that has no family nearby, it's surprising what a little loving kindness can accomplish. I have personal experienced the rewards of doing this. It's truly on of life's "win win" situations.

Culture Change and Dining Innovations in Long-Term Care


Culture change is making its way throughout nursing homes and other long-term care settings across the nation and one of the most exciting innovations in culture change is in the dietary department. Some people believe that the kitchen has been one of the most forgotten and underrated place within long-term care. But, not any more! Many facilities that implement person-centered care as a part of their culture change start in the kitchen because it can lead to significant improvements in the quality of dietary services. Everyone looks forward to great food and how food is served, and these changes are highly visible to residents, their families, and staff. Also, there are endless possibilities and opportunities for change in dietary.

Hippocrates made the connection between food and health over 2000 years ago. He said "Let food be your medicine". Food is a very important part of health and in addition to its nourishing aspects, food has the power to heal and comfort people. Food is also a powerful symbol of nurturing, love and celebration. But, food has to be attractive and desired. It has to be served in ways that appeal to people. Uneaten food has no nutritional value and does nothing but go to waste. Remember, meals many times are often the highlight of our resident's day.

One goal of making dietary changes is to bring in the concept of "home" as much as possible to the dinning experience. Think of your own homes. You can find and have a snack anytime you want. You can make a meal for yourself or for your entire family. You can drink what you want when you want. You can put on a fresh pot of coffee, make tea, have a glass of ice water or whatever else you wish. You can eat with your family, in front of the television, while reading, or chatting on the phone with friends. You make a grocery list, hang it on the refrigerator, anyone can add to it, and then you go shopping. Just as we choose foods to eat, resident councils choose their own menus. Ethnic food choices are also important to consider.

Another goal when making changes in dietary is to offer flexible meal times. In person-centered care, the point is to de-institutionalize meal times and the dining experience. To facilitate residents sleeping in later in the morning, we must develop systems to serve meals to our residents at the times they choose to eat. We will have to become more flexible in how we think about food service. And as residents come and go we may have to further tweak our dining services. Many long-term care facilities have decided to implement flexible meal schedules such as the following: breakfast will be offered between 7:30am to 9:30am weekdays and maybe slightly later on the weekends; lunch will be served between 11:30am and 1:30pm; and dinner will be served between 4:30pm (for the "early birds") until 6:30pm for those who prefer it later. Flexible meal times offers choice and freedom to residents and simply makes the meal experience better, because they can choose when they prefer to eat.

Another goal of change in dietary services is to be innovative and creative in how food is served. Some of the more common dinning styles utilized in long-term care facilities include buffet-style dinning, restaurant-style dinning, 24-hour room service, and open access to food. These styles offer more choice to residents and can make meal times more enjoyable. Buffet-style dinning involves a hot steam table in a central area (dinning room) or placed in multiple sites within the facility (i.e. on each unit or wing). Many facilities have indicated that the buffet works very well for breakfast. Restaurant-style dinning can be used in the main dinning room and those employees working in the dinning room can wear chef coats and black pants, to create a restaurant atmosphere. A restaurant-style menu is placed on each table and residents order whatever they wish from it. The menu can be changed once a month, quarterly or seasonally. Many facilities have always offered room service, but perhaps never called it "room service" and indicated that it was available 24-hours a day. This is a nice feature for residents who are up at night and prefer to sleep throughout the day. It is also a nice option for family visitors who work odd shifts and visit their loved one during late evening hours. And finally, all residents, family and staff may have access to snacks 24-hours a day by creating or building small, kitchenette areas in the facility. And, don't stock it with just healthy snacks. Stock it with what residents and families want.

Other innovations in dinning include a private dinning room for special occasions, dinning areas that have a warm and comfortable appearance, bread- and cookie-baking throughout the day to create a more homelike atmosphere and to stimulate the diet, replacing 4-top tables with larger dinning room tables that seat 8 or more people, natural lighting or attractive lighting, salt and pepper shakers, hot sauce, and sugar bowls placed on each table, and kitchenettes complete with microwaves, small refrigerators, coffee pots, and storage space for snacks.

Dietary services are important in long-term care and culture change is providing great ideas concerning how to become more innovative and creative with food and how it is served. Food is vital to life and the kinds of food and how it is served should enhance the quality of life for residents in long-term care.

James H. Collins, Ph.D.

Four Things You Need To Know About Nursing Home Applications


Are you looking for a nursing home jobs? Health care is a very extensive industry. Health care professionals can opt to work in hospitals, doctor's clinic or nursing homes. This is one of the most popular places that health care professionals choose to work at.

Experts believe that in the next eight to ten years, the need for nursing home staffs will grow because of the millions baby boomers or those people born between 1946 and 1964 are nearing retirement. According to research, about 75 million baby boomers are in America and it corresponds to 29% of the total population of the world's most powerful country. In Canada, there are around six million baby boomers.

Having that said, many health care professionals are seeking jobs in nursing homes because of the opportunity for career advancement and potential increase in salaries. If you are like the many, looking to join the nursing home roster, here are some important reminders.

Jobs In Nursing Homes
Home health care refers to the assisted care given to the patient or residents by the health care professionals. There are four types of jobs available in these kinds of facilities. They are the carers or the caregivers, nurses, support and managerial staff. Carers or caregivers spend most of their time with the residents. They assist the residents in their daily activities like dressing, bathing and eating. Nurses on the other hand, make personal care plans for the individual residents. They are the ones who manage the activities of the caregivers and they are responsible for dispensing drugs and medicine to the residents. Support staff includes the housekeeper, the maintenance people and the catering services. Managerial staff includes the home manager, the unit and clinical manager. They are in charge with recruitment, budget and trainings and development.

Searching For Nursing Home Jobs
Before, when people are seeking for jobs, the best place to look is at magazines or broadsheets. Now with the advancement of technology, people can simply apply online. There are thousands of jobs offering position in these facilities. You can be specific in your search and type in your preferred location. If applying internationally, you can check the requirements before you apply, because these institutions may require you documents like a diploma from previous work experience or educational certification.

Documents To Prepare
The documents for application vary. Different facilities require different credentials and requirements. Commonly, if you are applying for a position in a nursing home, you need to prepare your comprehensive resume, your passport, birth certificate, driving licence and national identity card. If married, you can prepare your marriage certificate and other bills with your address printed. These are just the basic requirements that most employers will ask of you, but it still depends on the institution. A bachelor's degree and a clinical license may also be required of you. Generally, the bachelor's degree should be in health care administration. You can also check the state licensing board where you wish to apply on how you can be certified. Your education and experience are important in your application.

After The Interview
If you are successful with the interview, the recruitment department will give you the job offer. The job offer can come in formally by letter or an informal offer by telephone or email. Do check your salary details and benefits. Check yours shifting schedule and other allowance that you will get with the job.

Working in a nursing home can be very rewarding especially for those who love to care and attend to the needs of the sick, elderly and people with different abilities. Above are some of the important things you need to know when applying as a staff in a nursing home. Consider them before you hunt for a job.

Nursing Home Design


Nursing homes are designed to serve patients who require preventive, therapeutic, and rehabilitative nursing care services for non-acute, long-term conditions. Usually residents are elderly and frail, but not bedridden, although many will require canes, walkers, or wheelchairs to help them get around.

Patient stays are on the whole relatively long, with the majority of residents staying for the remaining months or years of their life. Most UK Nursing homes will also care for a number of convalescent patients who are in recovery from acute illnesses, but no longer require hospitalisation.

Nursing homes present special design challenges in that for most residents the nursing home is not just a facility, but indeed their home. The reality is that in most cases the residents will live there for the rest of their lives and, moreover, rarely leave the premises at all. The nursing home therefore becomes their entire world. The challenge is to design an environment that is sensitive and responsive to long-term human needs and well-being, both physical and emotional. Thankfully there are a growing number of companies who specialize in the manufacture and supply of stylish yet practical Nursing Home furniture, which means designers are no longer limited in terms of interior décor.

Building Attributes

Nursing homes are primarily patient care focused rather than medically focused, and consequently its more important attributes are those focusing on the general happiness of its residents rather than high-tech considerations. Features of a well designed nursing home are as follows:

Homely environment

The impact of surroundings and environment on the recovery of Nursing Home patients cannot be underestimated. Both the building's architect and interior designer needs to gain a thorough understanding of the function of the venue and the profile of its patients. Attention must be paid to ensuring that the exterior and interior design cater for physical and mental disabilities along with loss of sight. This should all be packaged in such as way as to suggest a home away from home as opposed to a medical institute.

Efficiency

In order to create the most efficient space possible for both staff and patients, the nursing home's design should promote efficiency by minimizing the distance it is necessary to travel between spaces that are most frequently used such as recreational rooms, dining areas and toilets.
Ease of supervision is another essential feature, as allowing supervision of patients by minimal members of staff can reduce the total number of employees required by the nursing home, and can free up nursing staff to perform other tasks at any one time.

Cleanliness and Sanitation

Odour control is a priority for all nursing homes, since many patients are likely to experience occasional incontinence. The resulting odour can give the impression of poor hyginene and uncleanliness to family and other visitors. In addition to operational practices and careful choice of nursing home furniture, the following design features can also help:

Highly visible toilet rooms in key locations near spaces where residents congregate

The use of appropriate, durable finishes for each space used by residents

Proper detailing of such features as doorframes, casework, and finish transitions to avoid dirt-catching and hard-to-clean crevices and joints

Adequate and appropriately located housekeeping spaces

Effective ventilation, which may need to exceed nominal design levels.

How To Be A Successful Entrepreneur Nurse


Nowadays, as nursing profession has become innovative and flexible, nurses have been able to get new ideas, learn, and expand beyond their traditional roles. Since nurses have inherent talents, knowledge and abilities through the rigors of their nursing education, they have started to think outside the box and freed themselves from external restrictions. Their persevering spirit to accomplish greater things has motivated them to advance their degrees, start and grow their own business, join healthcare projects, and hold executive roles in the field of health care. Their ability to lead and innovate enables them to venture a new nursing experience, the nursing entrepreneurship.

Just like in other business, being a nurse entrepreneur can be achieved in a step-by-step basis. You cannot simply be a successful entrepreneur overnight. You have to have sufficient training experience and perseverance in order to grow and thrive as a nurse entrepreneur. Here are some tips on how to become a successful entrepreneur:

1. Practical Approach to your Business

If you're planning to start a business as a nurse, you have to think twice or thrice before venturing to this field. Entering a business of course entails investment and money so you have to be very sure and dedicated before establishing a business. Also, if you have started one, you have to innovate in whatever you do and discover the latest ideas in the field of nursing. You have to be a good leader to gain the respect of the people working for you as well as the trust of your clients. You have to develop your skills and knowledge, and you have to prove that you really take good care of your clients.

2. Starting up your Business

Do not start a business or any undertaking without preparation and planning. You have to think of all the things that could be relevant to your business, like the initial investment, the time you will need to establish your business, the target population of your business, the timetable you will pursue to regain your investment, and the necessary expenses such as purchasing of business equipments and advertising expenses to promote your business.

3. Be Optimistic

Always look at the positive side of things and do not lose hope when it seems that your business does not profit. Also, when you are planning, always have a persevering spirit that would prompt you to innovate and lead in your nursing field or even in other fields. Believe in yourself and always think that you have unique talents and capabilities to accomplish greater things.

4. Fall back alternatives

Just in case your business does not succeed, do not lose hope. Thinking of other alternatives for your business does not meaning being negative, but would mean being practical. Face the reality that not all businesses succeed and take it as a chance to innovate, redefine your business, and further expand your roles. Besides, you have many other options as a nurse. You can be a teacher, a public speaker in conferences, a researcher, and a consultant under medical field, among others.

Of course, being a successful nurse entrepreneur could give you much advantages and benefits. Here are some:

1. Many Opportunities

Since being a nurse is the most in demand profession in many countries nowadays, being a nurse entrepreneurship can be a plus especially when you are working in hospitals and other health sectors. Since you have proven innovative skills and knowledge in entrepreneurship, nurse entrepreneurs are much more very welcomed in their medical field.

2. Flexible Roles

Having started a business as nurse, you have proven to be a leader to the people working for you. You also have all the authority to delegate people and adjust working time and schedule. As a result, your role as an entrepreneur becomes really flexible. Because of that, you still have more time to work other than your business like being a nurse in nursing homes for adults, maternity homes, and other medical facilities.

However, when starting a business, you still have to take into account things other than the advantages of entrepreneurship. You should take heed of certain disadvantages and possible problems that may occur when establishing a business.

1. Nursing Business Needs Experience

You have to remember that managing and handling a business needs enough experience. Do not venture into any kind of business if you are not 100% sure of what you're going to do. If you know someone who has already run a business that matches yours, you can team up with him or her to ensure a more firm and stable business.

2. Funds

Of course, you cannot start a business without money and capital. Make sure you have enough funds to offset any shortage that may occur and to pay future expenses you will need to improve your business

Travel Nursing: A Unique Career Path for Nurses

Aside from being an entrepreneur nurse, another possible option for nurses is travel nursing. As the name implies, travel nurses are nurses who travel a lot and go to new and different locations to provide their service to their clients. Since this job is highly compensated and could give some a unique life experience to travel in many places with all the travel, housing, as well as health and malpractice insurance and costs paid, travel nursing has become an alluring career path for many nurses.

If you're thinking of shifting into this career path as a nurse, here are some things you need to consider first:

• The hours, responsibilities, required skills and salary- If you do not want to regret in the end, you have to know these things before signing any contract.

• Network roles - Contact other travel nurses you know and ask them about their experiences in their work. You can also inquire to the most credible travel nurse agencies in you location about the nature of travel nursing.

• Your dedication to get the job - Traveling could be enticing since you will be able to see new places; however, also consider your comfort and convenience with short assignments and frequent change of residence.

• Weighing options - If you're still unsure about travel nursing, you can consult a healthcare staffing agency to enlighten you about the pros and cons of this nursing career. Tell them your options, your motivation, your hesitations, as well as the benefits and disadvantages you consider about travel nursing. Doing so may help you make a decision about this new venture.

Thursday, July 4, 2013

How Long Does It Take to Settle a Car Accident Claim?


How long does it take to settle a car accident claim after you've experienced a crash involving another vehicle? This is an important question that requires immediate answers for many people who have reasons to settle as soon as possible, because of issues such as serious car damage, physical injury and loss of finances due to inability to work. There are also doctor bills, hospital bills and other considerations, especially if an accident is severe. Here are some basic answers to some of the most important questions regarding how long does it take to settle a car accident claim.

What if the accident is the other person's fault?
If the vehicular accident that you were involved in is ruled clearly the other person's fault and the other person does not challenge the ruling, then you will find that generally the case can be settled in a matter of a few weeks. In cases where the other party challenges the ruling and secures a lawyer to fight for his or her case, you could end up dealing with the claim for several months or a year or two. The best case scenario is for both parties to quickly come to an agreement about a settlement so that the claim can be processed.

Will the libel insurance company process a claim quickly?
Yes and no, depending on their competence, quality of service and attitude. Professional attitude has a lot to do with how quickly a libel insurance company will process your claim. In cases of dealing with a reputable company, you can easily settle a claim in a few weeks or possibly 2-3 months, depending on how large the accident claim is. On the other hand, if you are unfortunate enough to deal with companies that stall and attempt to intimidate the party who is making a claim request, you may want to secure the services of a lawyer to take up your case.

Can a lawyer expedite a car accident claim?
Generally yes, if you choose an experienced attorney who has dealt successfully with similar cases. Resist the temptation to hire just anyone. Those who specialize in vehicle accident claims and have very successful track records are the best to hire. For example, a lawyer that specializes in family court cases, may not be the best to take over your accident claim, even if he is your brother-in-law! A good attorney can expedite the matter, save you money and perhaps win an important accident claim that can help you in the future with all the losses you may have experienced as a result of the accident.

If you're an accident victim who wonders how long does it take to settle a car accident claim, remember the first rule of thumb in getting the best settlement, is to be patient. Some victims are so desperate to settle a claim because they are in difficult straits financially and physically injured, that they accept much less when offered a settlement, rather than allowing a good attorney to strategically deal with the libel insurance company for a better settlement.

Things You Need to Know About Child Care Lawsuits


Every day, thousands of children all across the country are placed in the care of child care facilities. Since more and more families are struggling financially, it is quite common that both parents need to work, making child care an attractive option. Child care facilities provide a safe place for children to learn, communicate, and interact with other children on a daily basis. While the majority of these facilities are quite reputable and provide great care when parents are not able to do so themselves, there are times when children are harmed while in the care of others. These injuries can range in severity from very minor cuts and scrapes, to more significant injuries such as broken bones, head injuries, and even death.

Child care facilities, like all personal premises and other types of businesses, are expected to exercise a duty of reasonable care in order to avoid harm coming to all third parties who are on their property. If for any reason this duty of reasonable care is not properly exercised, and injuries result, there may be a strong case of negligence. When negligence happens, a legal claim may be possible in order to seek damages for the injuries that have occurred.

Negligence can occur at child care facilities in a number of ways. One of the most common ways is based upon the legal theory of premises liability. This theory requires all operators and owners of a particular property to be held liable for any injuries that take place on that property. These cases are especially important if the injury that occurred was foreseeable and could have and should have been avoided.

While some might argue that children are more susceptible to injuries because of their developing motor skills and curious nature, and that it is natural for children to suffer minor bumps, bruises, and scrapes, there is simply no excuse for serious injuries to take place. When children are placed in the care of a child care facility, this facility is taking on the role of the parent for a range of designated hours. This means that the facility needs to exercise a high level of care in order to prevent the children from becoming injured while in their care. All precautions should be taken in advance of the children arriving, and all staff should be adequately trained in how to deal with children and protect them at all times.

While this may seem like a no brainer, each year, thousands of children are injured while in the care of child care facilities. Some of the more common injuries happen because of conditions that are considered to be unsafe and unfit for children. Examples of unsafe conditions for children include light sockets that are not properly covered up, stairs that are not properly barricaded, hot items such as a stove or fireplace that are left available for children to touch, pets that are vicious and bite children, non child friendly toys that are thrown or pose pinching or choking hazards, and rugs or other items that are left in travel areas that pose tripping hazards. All of these issues are grounds for a lawsuit should an injury be sustained.

On top of issues with the premises and environmental hazards, there is also the issue of negligence on the part of employees working at the child care facility. Each year a large number of children are harmed because of the carelessness or blatant disregard of employees. Issues such as dropping a child, hitting a child, allowing a child to run off unsupervised, not stopping another child from hitting or hurting a child, or even physically, emotionally, or sexually abusing a child can all give rise to liability and are all grounds for a lawsuit.

Another issue that sometimes plagues child care facilities and is grounds for a legal claim is that of child neglect. There have been a number of cases of children being left completely alone for hours on end, while they were supposed to be in the care of a professional. During these unattended hours children were left in squalor conditions, were not fed, and were left to wander unsupervised causing physical and emotional harm. In these cases the absence of reasonable care is most definitely grounds for a legal claim, as the adults in charge made a conscious decision not to provide proper care for the children they vowed to watch and protect.

While it is quite obvious that the children are the ones who really suffer the most in these situations because they are harmed either physically or mentally, and in some cases, both, the parents also suffer a bit of harm. The guilt that is experienced on the part of a parent whose child has been hurt because of a decision he or she made to place them in someone else's care can often be unbearable. There have even been cases of parents becoming so overwrought with guilt that they have taken their own lives because they could not stand their feelings. These cases are devastating on so many levels, and are all because someone chose not to do the right thing and act in a responsible manner.

If your child or the child of someone you know has be injured while in the care of others at a child care facility is important that you seek legal assistance as soon as possible. These cases hinge on concrete evidence, and small details, and a personal injury attorney who specializes in this area of the law will know exactly how to proceed.

From start to finish, and every step of the way in between, a personal injury attorney will handle all aspects of your case. He or she will gather the needed information, interview witnesses, and compile medical reports. Even though a personal injury attorney cannot undo the harm that the child has experienced, he or she can obtain financial compensation to help cover the cost of past, present, and future medical bills, as well as pain and suffering.

Nursing Care Plans - An Organizational Tool For Elder Care


Nursing care plans are used by professional care providers for hospital stays, nursing home care, where skilled nursing is needed, and for home care services. If you will be the home care provider, you can help construct a plan using criteria developed by the North American Nursing Diagnosis Association (NANDA).

Knowing what a plan entails will help you decide if any of the services can be handled by family or if they must be contracted out to a licensed professional or other provider.

For example, there is a plan for "Impaired Home Maintenance Management," i.e., your parent is not keeping up with personal hygiene, household chores, nutrition, etc., even though he believes he is still independent.

Assess the Problem

Each plan starts with a comprehensive assessment. The information will come from:

* The observations of family and friends (referred to as "signs" of a problem or disorder);
* Complaints or statements from the elder (called "symptoms");
* The elder's medical and social history;
* The observations and testing by one or more professionals.

Set Attainable Goals

From the assessment a list is made of any medical diagnoses and the daily challenges confronting the patient, family or relationship problems, and existing strengths and supports. If you are conducting this process yourself without input from health professionals, this is a good time to consult with the elder's primary care provider, who can help you interpret the information you have gathered and provide direction for next steps.

With your "challenges and strengths" list in hand, ask whether each problem area can improve. If so, then set a reasonable time to work on improvement, and assess whether improvement has been made at the end of this time period. It is important that this improvement be:

* Specific--a goal you are looking for (such as "grandpa can walk to the bathroom by himself", rather than that "grandpa is better")
* Measurable (you can list what will be done to reach the goal and when)
* Attainable (break big challenges into smaller steps).

If the challenge or problem presented is not going to improve, then your care plan can focus on preventing it from becoming worse. Again, specific, measurable and attainable goals are set.

Nursing care plans are useful organizational and brainstorming tools. They are not a substitute for professional advice and judgment. Please consult a physician or other professional where the health or safety of a loved one is concerned.

Consider A Consultant

When evaluating a nursing care plan or any other elder care, it is often helpful to consult an experienced, objective advisor as to how to plan and implement the services your elder requires and deserves. It is best to entrust your care only to those with the highest level of training, broad expertise, experience and ethical standards.

A variety of semi-professional organizations and franchises have arisen in response to the greater demands of our aging population. While some may be competent, carefully assess the reliability and accountability of any provider, as oversight laws are often slow to adapt to rapidly changing industries such as this.

Established professionals are already well regulated through government bodies and professional licensing organizations, providing a measure of comfort and security that you will be well served.

Leaders Communication Takes Effort


We must never forget that the most powerful communication isn't what you say, it's what you do. What counts, in the final analysis, is not what people are told but what they accept. It is this concept of the role of communication in industry that characterizes effective leadership. - Frank E. Fischer

The majority of people who are considered excellent conversationalists will tell you that they spend far more time listening than speaking. They also ask questions of clarification, making sure they fully understand what is being said before contributing their own thoughts about the topic. This as you may know is easier said than done. It takes practice, practice and more practice.

Chances are when you are participating in a conversation you are listening from a defensive posture to interject you views at the expense of the other individual. Part of the reason for this is that we are emotionally bonded to our views. Believing in your views is a good thing except when the evidence suggests that they are not correct. Don't be so possessive of your views that you will not change them in a heart beat when presented with contrary evidence.

The best way to ensure that you are listening completely is to imagine that your mind's inner voice is a tape recorder. As the person speaks repeat everything that is said in your mind's inner voice. This process helps you in a variety of ways: you are not going to interrupt the conversation prematurely because you are repeating what is said in your mind, you are increasing you understanding of the issue because you first hear it, then repeat it.

The next step is to ask questions of clarification or check for understanding. Once the question is asked start the process all over again. Continue this process until the other person has finished. Once you fully understand the other person's position or point of view you can begin to present your view.

This process takes time however the long term benefits are that you will be considered a leader who is trustworthy, understanding, supportive and accepted by the people who you supervise and your supervisors. You will immediately distinguish yourself as a leader worthy of being followed.

There will be times, when it is not possible to have a two way conversation, to gather ideas, suggestions and options. One way communication should be reserved for emergencies, deadlines, directives and after you have considered all the views, options, and suggestions of your team to make the final decision.

The final outcome is to make far more good decisions than poor judgments. If things do go wrong, bring your team together to review how the poor outcome could have been avoided and prevent it from occurring next time. Some may call this process quality improvement and others call it an after action report. It doesn't matter what you call it; the process is what is important.

Your success as a leader depends on how good a listener you are and the quality of your questions. You may think that as a leader you should control the conversation and wonder how that can be done when you are repeating everything that is said in your mind and asking clarification questions. Think of it this way when you ask an informed question based upon what you have heard and repeated aren't you really determining the direction of the conversation?

Active listening, mentally repeating what is said and asking clarification questions is a win, win process for everyone involved.

Feel free to use this article, in your publications; in its entirety provided you include the following notice: 穢 Copyright 2011, Kenneth E Strong, Jr, Columbus, Ohio.

Online Job Openings - Easiest Way to Succeed!


Jobs are the fuel that keeps society going. Job is the one thing that everyone wants to have to earn their living with all the skills one has. We all know that the world was hit by recession. But the bad time is over now. There are many job openings in every sector and in every field. Most of the people face difficulties in finding a job. The truth is that most of the job openings are not widely advertised. But now internet has changed the scenario, finding a good job is not a problem.

If you are looking for a new job, an online job search may be one of your best tools for finding a new position. Online Jobs are basically the jobs that can be done via the internet or via the World Wide Web. The Internet is an endless resource of information and data, which you would need for everyday living. There are hundreds, if not thousands of people, who are making good money on the Internet today.

Today, there are a good number of sites on the web that provide good opportunities to earn. These sites provide complete details about different types of jobs. So, you can directly access them. There are many types of jobs available on the internet according to your comforts. There are full time jobs and part time jobs are also available as well. Those who can't afford to go out for a job they can simply earn their livings by working from home as there are many job opening firms which provide the opportunity to work from home. So you can choose the job depending on the kind of work you prefer.

The best thing about online job sites is that they are so easy to use, and can be quite effective as tools for accessing a large number of employment opportunities. There are many sites available online from where you can search for multiple job opportunities. You can also search jobs by state and city, and view everything that is posted. The sites with a large quantity of jobs usually have a feature to filter jobs based upon your interest. Many of these websites are paid. You are also available with many free online websites. These websites also update you with the latest job openings and news related to various jobs. So, all you need to do is a quick search and in no time plenty of job opportunities will be available to you.

Easing the Financial Burden of Long-Term Care


Providing senior care for a loved one can be overwhelming both emotionally and financially. According to the 2009 Genworth Cost of Care Survey, median annual costs for various types of senior care in the Bay Area can reach burdensome levels:

Adult Day Care - $20,410 annually - based on eight hours a day, five days a week.
In-Home Services - Assistance with activities of daily living, including dressing, personal hygiene, bathing, etc. - $52,634 annually, based on 44 hours a week.
Assisted Living Facility -$39,960 annually - private one-bedroom
Nursing Homes - $82,125 - semi-private, and $102,018 - private, annually

I hear stories daily from adults regarding the financial challenges associated with providing their aging parents with assistance. Such assistance may be provided at home, assisted living facilities, residential care homes or nursing homes. As they go through the process, seniors commonly say, "I do not want to be a burden on my kids as I age." I've highlighted below some of the options that will help pay, fully or partially, for needed assistance or care:

Medicare/Medi-Cal
Most private health insurance plans follow the same general rules as Medicare. If any long-term care is covered, it is usually for only skilled, short-term and medically necessary care. Homecare is limited only to medically necessary skilled care. Custodial or personal care is not covered by health insurance. The coverage in a skilled nursing facility must follow a hospital stay and is limited up to 100 days. If you meet Med-Cal's financial eligibility status, you must select a skilled nursing facility that accepts Medi-Cal.

Long Term Care Insurance
Long-term care insurance could be the best investment one can make. Unless medically necessary, you can avoid skilled nursing facilities by residing at assisted living facilities, residential care homes or at a home with the needed in-home care. This type of insurance makes it much easier to cope with most otherwise uncovered health issues as you get older.

Long-term care insurance should be as important as your healthcare insurance, life insurance and homeowner's insurance. Generally, long-term care is needed for conditions that cannot be cured or healed, and for helping people with routine activities such as dressing, bathing, transferring, continence care, toileting and eating. Long-term care insurance extends for a long period of time, covering care for various types of dementia, including Alzheimer's disease. Long-term care insurance, which can reduce the burden from your family and your peace of mind, should be a very serious consideration.

Life Insurance
There are various ways you can use your life insurance to help pay for long term care, including accelerated death benefits, viatical settlements and life settlements.

Accelerated Death Benefit - An accelerated death benefit is a life insurance death benefit paid in cash in advance, tax free.
Life Settlements - Life settlements give you the ability to raise cash by selling your life insurance policy at its present value. The proceeds may be used for any reason including paying for long term care.

Viatical Settlement - This settlement allows you to sell your life insurance policy to a third party and use the money your receive to pay for your care. This option is only possible if you are terminally ill.

Veterans Aid and Attendance
The aid and attendance pension benefit offered by the Department of Veterans Affairs may be available to wartime veterans and surviving spouses who have in-home care or who live in assisted living facilities or nursing homes. The current monthly benefit can be up to $1,948.

Though there are minimum qualifications, I have listed the prerequisites for review below:
*Served in the military during time of war, or spouse.
*Have less than $80,000 in investments excluding home/car. Note: There are other options still to consider if this wasn't checked.
*Monthly income less than the monthly cost of care including prescriptions.Need help from others in one or more of activities of daily living.
*If surviving spouse, married to the veteran at the time of death.
*Have sufficient resources to pay for care while awaiting a decision from the VA - may take up to four to 12 months.

As you can see, while providing senior care for your loved one may be emotionally and financially challenging, there are a variety of available options to substantially ease the burden.

Urinary Tract Infections Cause Dementia in the Elderly?


Recently I helped a family find a private care home for their mother who was in her mid 80's, living in a large assisted living facility and suffering from dementia, depression and loneliness. Her depression and loneliness had come on suddenly and she was talking about not wanting to live any longer. Her doctor had told the family that her dementia was progressing and made the suggestion that she move to a smaller care home where she would have more one-on-one attention.

During my evaluation with "Mom", I noticed that she was overly emotional and confused. The family and I realized that it was possible that her medications may not have been appropriately monitored or that she might need an adjustment, but I also pointed out that due to her emotional and mental state at the time of my visit, the family should have her checked out for a urinary tract infection and dehydration. I explained that it is believed that there is a connection to sudden symptoms of dementia or an increase in dementia symptoms and urinary tract infections. They were surprised at my suggestion, but also relieved that there could be an explanation other than a sudden progression of her dementia.

What is a Urinary Tract Infection (UTI)?

Urinary tract infection (UTI) is one of the most common infections and women tend to get UTIs more frequently than men. UTIs are infections of the urinary system, which consist of the kidneys, ureters, bladder and urethra. They can be very serious and sometimes life threatening. It can be difficult to determine if an Alzheimer's or dementia patient has a UTI because they may not be able to fully verbalize how they feel.

They may not understand or be able to express pain, feeling the need to urinate frequently, etc. An infection can cause an imbalance in the substances and salts in the blood and reduce the production of a hormone that contributes to the formation of red blood cells. UTIs in the elderly or people with Alzheimer's/dementias cannot only profoundly affect their physical health, but also severely impact their behavior such as disorganized thinking, disorientation to time and place, apathy or increased agitation.

Dr. Rajesh Tamp, Director of Psychiatry for Masonicare, feels that the connection between dementias and UTIs is not a widely understood as it needs to be and that people with urinary tract infections are often misdiagnosed as just a sign of dementia. A significant difference is that confusion or changes in behavior brought on by an infection will come about much more quickly than confusion resulting from dementia.

So, if an older person shows sudden signs of confusion or behavioral changes, it may not be connected to their dementia. The key here is to remember that even if an elderly person has Alzheimer's or dementia and is exhibiting sudden changes in physical, mental or emotional health, it would be advised to have them examined for a urinary tract infection. With treatment, their symptoms should ease and perhaps reverse altogether.

Wednesday, July 3, 2013

How to Decide on a Nursing Home For Your Loved One


Choosing a nursing home for a loved one can be one of the most stressful things you will ever have to do. Your support and care are important to help the person adjust to having to move into a long term care facility. Include the person you are helping in the decision making process whenever possible. If they feel decisions are being made with their needs and preferences in mind, it will make the process easier for everyone involved.   

Paying for nursing home care is the first consideration to be made. It's important to know that Medicare does not cover long-term care in a nursing home. Short-term rehabilitative care after a hospital stay is covered by Medicare, but not nursing home residency. Room and board in a nursing facility is paid from personal resources, long-term insurance, state government or Medicaid if the person is eligible. Check with the U.S. Centers for Medicare & Medicaid Services (CMS) for more information on paying for nursing facilities. If the elderly person has a Medicare health plan, coverage will continue for doctor visits, hospital care, and prescription drugs while living in a nursing home.

The Centers for Medicare & Medicaid recommends the following guidelines for choosing a nursing home:


  • Make sure the nursing home is Medicare- or Medicaid-certified, and that it provides the level of care you need, either skilled or custodial. Also make certain the facility has necessary services available in case of dementia, or for rehabilitation. Choose a nursing home that is located near friends and family. 

  • Visit the facility on separate occasions and note if the residents are clean, well groomed and appropriately dressed. The facility itself should be clean, well maintained and free from unpleasant odors. The air temperature should be comfortable; all areas should be well lit, and noise levels in common areas like the dining room should be pleasant. Smoking should be limited to specific areas.  Furnishings should be attractive and comfortable. 

  • Note the relationship of the staff to residents; is the atmosphere warm and polite? The staff should wear name tags and be courteous at all times, address residents by their names and knock before entering a person's room. Nursing staff should be on duty 24 hours a day, 7 days a week. A registered nurse (RN) should be on call at least 8 hours every day, along with a full-time social worker, and a licensed medical doctor who can be reached around the clock. Ask if the nursing home does background checks on all staff, including maintenance workers. 

  • Residents should be able to keep personal belongings, including furniture, in their rooms. Closet and dresser should provide ample storage space. Every bedroom should have a window. Residents should be able to choose their roommates and have access to a personal telephone and television. 

  • There should be a choice of food at each meal, and snacks should be available when desired. If help is needed at mealtime, staff should assist with eating and drinking. 

  • A variety of activities should be provided on a daily basis, even for those who are unable to leave their rooms. Outdoor areas for fresh-air activities should be available year-round and staff should be on hand to help residents go outside. 

  • Make sure residents get preventive care such as a yearly flu shot and dental visits. Residents should be able to see their private physician and the nursing home should provide transportation. Ask what arrangements the nursing home has with a nearby hospital in case of an emergency.  

  • Arrange regular meetings with staff to discuss your relative's needs and care. Make sure friends and family members can visit frequently and unexpectedly. There should be regular and frequent communication between staff and family of the resident.   

Finally, trust your instincts. If you didn't like what you saw on a visit, say, the facility wasn't clean or you were uncomfortable talking to the staff, you might want to consider another nursing home. Take time to find the right facility for your loved one and your own peace of mind.