Real Estate Niche Marketing - Starting an Assisted Living Home

You can try to be an expert in many phases of real estate, or you can specialize in a niche markets and become the authority in that markets.

There are a number of very successful real estate agents and brokers that have narrowed their real estate marketing niche focus to a specific geographical area, a type of property or a category of consumer. Recognizing the opportunities that are out there and selecting a niche that appeals to you can be a lucrative strategy.

Consider the niche market of opening Assisted Living Homes. It is a common assumption that it take millions of dollars to successfully open and operate an Assisted Living Facility, and while this may be true for a large facility, there is a huge niche market being ignored. Tens of millions of baby boomers are approaching retirement age. Many of them will need medical or personal care. A growing majority of these seniors do not want to spend the rest of their lives in a nursing home. They want to be in an environment that seems like home, with caregivers who seem like family. So where do they turn to?

These homes are often called Board and Care homes or Assisted Living Homes. They generally have no more than twenty residents and in most cases less than ten residents at any given time. The big difference between an Assisted Living Home and an Assisted Living Facility is level of care. Typically the business model of an Assisted Living Facility does not allow a significant amount of one on one time with each resident. What this means is that when a resident needs more than minimal assistance with daily needs or if they need two people to assist in providing those daily needs, the resident will generally be moved to either a different unit in that facility or the family will need to move their loved one to a different setting.

An Assisted Living Home (or a Board & Care Home) has the ability to be very flexible with the residents they choose to do business with. More often than not, once residents move into an Assisted Living Home they will be allowed to live out the rest of their lives in these familiar surroundings.

How can you get involved in this niche? To start with you are going to have to view yourself as a problem solver. You will need to:

• Educate yourself on the rules as they pertain to your City, County and State. Be aware that just like with building or zoning codes each city may be a little different than the other.


• Have a general knowledge of the typical rates residents pay.


• Have a general idea of the typical expenses associated with operating an Assisted Living home


• Establish a network with those who provide services in this industry.

Many smaller homes operate very successfully in both the private pay and Medicare arenas.

Think of the home in your current inventory, do you have any four or five bedroom homes? Do you have Seller's who can be creative? Do you have several homes close to each other? All of these could be great candidates for starting an Assisted Living Home.

Who are you Buyers? Your Buyer could be the Caregiver who wants to rent a few rooms and be able to work from home. Your Buyer could be the Doctor or Investor that wants several homes that they manage but may or may not work directly in the home.

Do you have buyers that are facing foreclosure or even bankruptcy because of their mortgages? Would they be willing to do a lease purchase? By leasing to someone who is starting an Assisted Living Home, you can feel much more confident that they will fulfill their obligations and not leave you or your Client in a bad situation.

I urge you to take the time to study this niche. Find the information you need to be the problem solver for your Clients, who knows you may even wind up owning a few yourselves!

Accidents Involving Roofers Can Give Rise To Injury Claims

Roofing is a high risk job meaning that roofers are at an increased risk of being injured or killed at work should an accident take place than workers in other professions such as shop workers, cleaners, office workers, etc. Falls from heights is the greatest risk faced by people working in the roofing industry. Falls from heights can cause serious injuries and can also lead to fatalities.

Other than falls from heights, there are numerous other dangers faced by workers in the roofing industry. Any person who is required to work as a roofer must be adequately trained. Employers must ensure that roofers are fully trained for the tasks they are required to carry out. If you have been injured at work whilst working as a roofer and if your employer is to be blamed for your injuries, you may be able to put up an injury claim.

Common Types of Roofing Accidents

There are numerous types of roofing accidents for which a work accident claim can be made. Here is a look at some of the main types.

Burns and Scalds

Roofing jobs usually require the workers to make use of blow lamps, compressed gas, bitumen or blow torches. All these things can cause burn and scald injuries if workers are not adequately trained on how to use them safely. In addition, burn injuries and scalds can also be sustained if workers do not have appropriate personal protective equipment such as safety gloves, glasses, long sleeve clothing, long trousers and protective boots.

Being Struck By Falling Objects

Roofers can also be injured as a result of objects falling on them from above. When work at height is carried out, it is essential that workers are provided with proper waste chutes as well as a safe means of transporting materials from the ground to the roof and vice versa. In such cases, they must also be provided with personal protective equipment such as safety boots and hard hats.

Manual Handling And Lifting Accidents

Depending on the type of job being performed, roofers may also be required to lift, move or transport heavy supplies, tools and equipments to and from the roof. Manual handling and heavy lifting tasks can be hazardous and if they are not performed correctly, they can cause accidents and injuries. If you are required to perform such tasks, it is essential that you are fully trained and provided with the right equipment or mechanical assistance. In the event that you are not, your employer will be held liable for your injuries.

Long Term Care for Our Elders - Who Will Pay?

While my father continues to live with me, I have still begun the process of looking into assisted living facilities and nursing care homes so that I'll be prepared if or when the time comes that I'll no longer be able to care for him at home. Assisted living costs can run between $3500.00 and $7000.00 per month depending upon the degree of "assistance" a resident might require and the amenities that the facility provides.

Nursing homes are even more expensive, with a price tag of up to $7000.00 per month. This is a daily worry for me. What if my father falls and breaks a hip? What if he has a stroke?

Let's look at the options.

There are basically 4 ways to pay for long term care:

1. Private funds

2. Insurances

a. Medicare
b. Supplemental Policies
c. Long Term Care Policies

3. Veteran's Administration Funds

4. Medicaid

Private funds are, of course, those monies that come from the individual (or individual's family) who is being care for in assisted living or in a nursing home. This is the method that many people are required to use once their Medicare and Insurance monies are gone and BEFORE they can qualify for Medicaid.

Some people have long term care policies in place (which are in and of themselves, quite expensive to purchase) and may be fortunate enough to have a large portion of their long term care paid for using this method; however, many long term care policies have a long list of pre-existing conditions that will then make a person ineligible for coverage.

Medicare (the national health care program for citizens aged 65 and over ) and its supplemental policies can help with payment somewhat but it provides only short term assistance. For instance, at best, it will only pay for 100 days of nursing home care AFTER an approved hospitalization. (If you have a Medicare supplemental plan, this 3 day hospitalization may not be necessary.) They will pay 100% of the first 20 days but then will assess close to a $120 per day deductible for the rest of the stay. Once this 100 days has run out, private funds must be utilized if the patient does not qualify for Medicaid. If the patient is discharged from a nursing home facility and remains stable for 60 consecutive days, they are then eligible for another 100 days nursing home care but again AFTER an approved hospital stay.

Unfortunately, the glitch to this scenario is that the patient must be receiving SKILLED nursing care and must continue to IMPROVE. If there is no improvement, Medicare will not continue to pay. At that point, the patient's own funds are expected to be utilized. Also, Medicare does NOT pay for assisted living. Most of the assisted living facilities that I've spoken with have asked for a 2-3 year guaranteed private fund payment and then they will accept Medicaid for coverage. Basically, "we'll use up all your money and for that we promise we won't kick you to the curb".

Another HUGE glitch is that Medicare does not pay for care for patients with Alzheimer's, Parkinson's and other dementia, even though, there is medical care involved in their treatment. I will note that some cares are being covered now that Alzheimer's is an accepted diagnosis.

Veteran's Administration funds is an area which I am not knowledgeable enough to share any information other than that they play a small role in the larger health care arena.

The 4th payment option is Medicaid.

So how does Medicaid work?
Medicaid is a benefit program which is primarily funded by federal dollars and whose monies are administered separately by each state; therefore, the rules vary from state to state. (For specific rules, consult an attorney that specializes in elder law. And I will say that consulting an attorney specializing in this form of law is definitely worth the investment because they are so many rules and the planning must be put into affect at least 5 years before a patient has need of long term care.) It is probably the payment form that is utilized the most.

In order to be eligible for Medicaid, there must be proof of medical necessity, of course (Medicaid does provide coverage for Alzheimer's, Parkinson's and other dementia) AND there must be financial eligibility.
Qualifying financially for Medicaid is the difficult part (well, difficult if there is a desire to preserve any of the patient's assets at all).

When determining qualification for Medicaid, "exempt" and "non-exempt" (or countable) assets will be examined. "Exempt" assets are those which Medicaid does NOT take into account when determining eligibility. These include a primary home (with an equity of up to approximately $500,000.00 - may be different in each state) which is the principal residence, personal belongings and household goods, ONE car or truck (even if married), burial spaces and items related to burial for both applicant and spouse (there is a maximum amount that can be designated, so again, check with your own state's rules), IRREVOCABLE prepaid funeral contract (it MUST be irrevocable or it does not qualify), a life insurance policy with a limited face value (again, check with your own state for the maximum allowable face value), and a monthly income of $2022 if single or $4044.00 if married. Special needs trusts for survivors (for instance, if a child with cerebral palsy or other handicap needs to continue to be provided for ) are also exempt. Additionally, in some states, a home may be placed in trust for a disabled child to continue to live in after their parent dies.

Many people ask "according to the federal gift tax law, aren't I allowed to give away up to $12,000.00 per year without penalty?" No, that's only for taxes. Medicaid will "look back" 5 years to see what was given away and it can count against your eligibility. Sometimes, an argument can be made that shows that the patient did not EXPECT to be needing long term care for at least 5 years after the gift was given, and an exception can be made.

"Non-exempt" assets (or those that Medicaid will count against your qualification) are basically anything that is money, can be cashed out as money, or is extra. This includes cash, all bank accounts, credit union accounts, CDs, IRAs, 401ks, prepaid funeral contracts which can be canceled, additional car(s), additional property, boats and recreational vehicles, tools, stocks, bonds, mutual funds, etc. Even if a child's name is on the account in addition to the patient, it is still considered non-exempt.

Fortunately, Medicaid now takes into account the surviving spouse of the patient and will not make them "spend down" into poverty before allowing the patient to become eligible for Medicaid coverage.

Additionally, there are a number of strategies that can be used to qualify a patient without using up all of the family financial resources. Getting the advice of an elder-care attorney will help to protect your loved one and family from financial ruin. Your local Area On Aging is often a good source for attorneys specializing in elder-care (and advice is sometimes offered without a fee).

The key to avoiding a financial crisis is to become prepared early.

Medical Office Administration Career and Training Prospects

A variety of management tasks need to be completed daily to ensure medical offices function efficiently. Medical office administration career and training prospects are available through various schools and colleges. The work conducted by professionals establishes an environment where all health records and billing information is correctly handled. The knowledge needed to perform duties can be obtained through several concentrated programs.

Vocational colleges offer programs that develop the skills needed to prepare students to successfully enter the medical office administration industry. Training is offered to prepare students to handle medical records, patient records, scheduling issues, and insurance claims. General programs cover office administration duties, which can include working with insurance codes, billing practices, and medical reports. Upon graduation of programs students are able to step into careers and become:

• Medical Secretaries


• Medical Transcriptionists


• Medical Office Administrators

Students have the opportunities to complete certificate and associates degree programs. Vocational colleges offer programs in concentrated areas, which prepare students for different aspects of medical office administration. Many of today's professionals have completed training in programs like medical transcription, billing, and coding. Each area develops the skills needed to be medical office administrators but train students to exclusively work in regards to one area. Programs like this are highly beneficial for professionals that work in large medical offices. Smaller offices typically have professionals handling all administrative tasks, which can be learned inside general programs that cover all areas.

A general program at the associate's degree level teaches students to perform basic procedures inside healthcare offices. Training encompasses multiple areas that include business communication, components of disease, and hospital safety. Students that step into careers with this degree are generalists who conduct a variety of tasks. Office work typically has professionals handling correspondences, completing insurance forms, maintaining billing tasks, and scheduling appointments. Students that want to work in specific areas should research vocational colleges that offer training.

Students can enter medical billing programs and study how to coordinate and manage all payment invoices. Programs are focused on providing students with the skills to process all service fees that insurance companies need to have a record of. Coursework focuses on multiple areas such as education in health information management, insurance reimbursement, data entry, computer keyboarding, and spreadsheet software. Programs teach students to handle all areas regarding billing such as unpaid accounts, collections, and customer service practices.

As a transcriptionist professionals work to take a physicians notes and make official medical records. Education covers how to take dictated notations and transcribe them into documents that are used for patient files. Coursework covers many areas, which may include medical terminology, medical law, human anatomy, surgical procedure, and proofreading. Students that complete associates degree programs will increase their chances of finding work.

Medical coders assign codes to insurance claims that correspond to the billing process. Students will learn to use computer programs to classify different medical treatments and procedures that patients receive inside healthcare facilities. Course subjects may include anesthesia coding, medical insurance procedure, and current procedural terminology.

Students that enroll in accredited training programs will obtain the skills needed to succeed. The Commission on Accreditation of Allied Health Education Programs ( http://www.caahep.org/ ) approves medical office administration schools and colleges for full accreditation in order to provide proof that they offer the best quality training. Careers can be entered in less than two years so students should find vocational colleges that offer programs they're interested in.

DISCLAIMER: Above is a GENERIC OUTLINE and may or may not depict precise methods, courses and/or focuses related to ANY ONE specific school(s) that may or may not be advertised at PETAP.org.

Copyright 2010 - All rights reserved by PETAP.org.

Learn About Assisted Living And Elderly Transportation Facilities

Aging and illnesses that comes with the process are real. Numerous of you are already caring for old folks and you understand the difficulties involved. That is why most people end up choosing assisted living homes for their aging parents and relatives. These are alternatives for old people with no one to take care of them, including their busy children. If you are looking to take someone in these facilities, encourage everyone concerned to get involved.

It is always a good idea to gather around, as family members, to deliberate the long term care issue. What is more, the old, sickly father or mother should be part of the discussion. He or she can speak out his or her feelings and help everyone else know all the necessities. Usually, most senior people get emotional or feel as if their children want to desert them. This is often not the case and that is exactly the reason why these people need support and understanding.

It is imperative to focus on the senior person's medical history if known. If not known, then the next of kin should make an effort of taking the aged parent to the doctor for a proper check up. Generally, these people suffer stroke, diabetes, heart diseases, cancers, arthritis, and joint pains and so on. Getting a good scrutiny of their health condition is necessary.

It would help the immediate family to find an assisted living and transportation facility that would manage to fulfill the doctor's instructions. Pay attention to the kind of foods and drinks that a given organization provides as well as sanitation standards. Does it offer any recreational activities to help the old work out and relax? As far as this is concerned, many organizations are available and they have unique facilities and arrangement of services.

This means that some organizations would only provide fun and leisure activities for the old. Others would take care of their health and medical issues, as they have nurses and doctors. Additionally, some companies offer transportation services with their own shuttle buses. The long term care insurance as far as transportation is concerned is often not a burden for the seniors. In fact, some non-profit and government organizations offer insured free of charge services. Additionally, given companies have special autos for transporting old people, their wheel chairs and other tools.

A few go a step further to provide built-in entertainment gadgets in the autos, making them completely equipped and comfortable. If you choose an all round long term care home, then it means that you would give your aging mum, dad or relative a second residence. The only way to find and choose a good company is taking time to research. Visit the home and evaluate its facilities too.

Retirement Communities or Nursing Homes - Post Retirement Planning Beforehand

A proper, beforehand planning is necessary to safeguard self-dignity and to attain a secured after-retirement life. We all admit that.

Life is never the same after-retirement. Some people want to live close to the hard-earned friends or family whereas some people want to live unaided or in Nursing Homes, Retirement Communities, Home Health Care, Retirement Homes, Active Adult Communities, Senior Apartments. Whatever the reason be, some basic calculations are necessary for a better future.

Let us answer two simple and primary questions-

What is my primary consideration in the decision on where to reside?

It may be closeness to family, state retirement benefits, medical reasons, dream location, specific medical care or other reasons.

Which type of care am I searching?

It may be assisted living, nursing home, retirement community (Active Adult), Residential Care, Home Health Care, CCRC, hospice care or some other types.

Individuals must explain each little question to themselves to live a hustle-free post retirement life. At times, the simplest of the task turns out to be an epic one.
For example, selecting the right nursing home is often a very hectic job as different nursing home specializes in different features.

Some minute details, in general, tend to be of high importance while selecting a nursing home for future, like the distance from a specific location. Apart from taking information on costs and fees, one must also note the types of care offered and types of aid accepted by that particular house. Even climbing stairs may be a bigger problem in future.

Budgeting is one of the most important aspects that need repeated critical assessment. The financial condition is not the same for everyone and one must sensibly figure out the budget on which he or she can comfortable sustain themselves for rest of life. Additional and hidden costs must be clarified beforehand.

One must take care of some seemingly insignificant issues that in future may become critical. It is always better if the home is in an easy-to-visit location for family and friends.

It is always recommended that the nursing homes should consult the family physician before consulting somebody else. The family members should make it sure that the nursing home uses or may use (if necessary) hospitals where the family physician practices.

Direct interactions with the present residents of the nursing home always provide a lot of information about the living standards and other characteristics.

The post retirement life should be self-planned to seize the most out of life, for which you have worked so hard so far.

Celebrating In An Elder Care Facility

Celebrating the holidays doesn't mean giving up on old family traditions for those living in an elder care facility. Christmas, Easter and even birthdays can still be joyous times for the entire family as long as memories are made. This guide offers suggestions on how to make the most of family celebrations regardless of where they are held.

Celebrating Birthdays

Many elder care facilities typically hold birthday parties once a month for all the residents who were born during that month. They are held in a common area with cake and coffee or tea served. Families can make this day even more special by personally celebrating with the birthday guest. Check the rules of the elder care facility about parties, but some ideas for celebrating a senior's birthday include:

• Decorating his or her room or apartment with balloons, streamers and birthday signs


• Holding a private party for family members in the dining room with dinner (brought in by the family), dessert and gifts


• If possible, taking the resident out to dinner at a nice restaurant or at the home of a family member


• Celebrating with cake and ice cream in the resident's room or apartment


• Having fresh flowers delivered

Thanksgiving Celebration

Because Thanksgiving is typically celebrated with a large feast, it is nice to celebrate the day at the elder care facility where you or your loved one lives. Family members can check with the administration ahead of time for cost and availability, but ask about sharing in the holiday meal that the residents eat on Thanksgiving. What a wonderful day to celebrate new traditions! Many of the residents who are alone on this day will also enjoy the company.

Another option on Thanksgiving is to bring in a home-cooked meal to eat in the resident's room, apartment or even the dining room during the off-hours. Arrange this ahead of time. Finally, some restaurants serve full Thanksgiving meals on this holiday. A family dinner at a nice restaurant also is a pleasant way to spend the day.

Festive Christmas

Christmas is a wonderful holiday to spend with family and friends, and even though you or your loved one aren't in a traditional home setting, you can still make many memories together. Here are some ideas to make the holidays a little merrier:

• Before you or your loved one moves into an elder care facility, make sure a family member saves and packs away some of the more sentimental Christmas ornaments and decorations. These will brighten up room or apartment during the holidays


• Pipe in some old-time Christmas favorites such as White Christmas or Silent Night via iPod or CD player


• Decorate the room with a wreath, cinnamon-scented pine cones and a small, artificial tree. Stay away from live trees and Christmas lights because of their fire or safety hazards


• Make a scrapbook or photo album of earlier Christmas holidays


• Bring in some family favorite Christmas foods


• Eat a family dinner at a nice restaurant on Christmas Eve

Points to Remember

Holiday visits to elder care facilities should follow the house rules. Plan to visit around the meal and medication schedules. Call ahead to make arrangements to take the resident out for an afternoon or evening of holiday cheer.

Strategic Forecast

While key elements of today's external economic environment are certainly challenging, the assisted living business and its market fundamentals remain strong. For most senior living companies, 2010 is the year to sharpen strategic focus-laying a solid foundation for a potentially strong future for assisted living- despite being amid the most significant economic recession since the Great Depression. An unemployment rate that hovered around 10 percent toward the end of 2009, a credit crisis, depressed home sales, significant consumer savings/ investment portfolio losses, and low consumer confidence all contributed to a slow-down in business.

Early indicators of a modest recovery are gradually surfacing, but the overall economic recession recovery time will be extensive and largely unpredictable. During this recovery period, consumer spending and the availability of consumer and business credit will likely involve more cautious and conservative consumer and lender decisions.

Supply-Demand Balance

The current economic environment has directly impacted typical senior consumers' saving and investment portfolios and their ability to sell their homes. Thus, the industry is experiencing delayed demand and absorption for senior living units. However, this delayed demand will ultimately result in a relatively strong upside once the housing market stabilizes and senior consumer investment portfolios partially recover from current losses. That's because of a growing assisted living supply-demand imbalance.

Construction of new communities is currently at an all-time low, and there are significant barriers to entry for new projects in terms of production cost and approvals. In terms of pent-up demand, age- and income-qualified demographics continue to grow at a predictable and moderate pace. Plus, the need for assisted living as an affordable alternative to both independent living and skilled nursing continues to increase. Stabilized occupancy for assisted living as reported by the National Investment Center for the Seniors Housing & Care Industry (NIC) was at 89 percent in late 2009-down approximately 0.4 percent from 2008. However, assisted living occupancy declines may have bottomed out as they actually increased in the last half of 2009. Average monthly service fees have increased by 2 percent from late 2008. This favorable supply-demand situation will eventually lead to a relatively strong assisted living recovery.

In 2010, however, the margin for senior living performance error has narrowed considerably. Astute operators realize that while they cannot completely control the external market, they can control and optimize their internal operations. In fact, a number of owner/operators have sustained their operating profit margins by reducing expenses to compensate for declining occupancy. The opportunity for realizing significant growth and upside potential within existing assisted living properties-also known as organic growth-is significant this year. There are two areas offering significant opportunities: optimizing occupancy in difficult markets and operations enhancement through expense reduction.

Optimizing Occupancy

Astute owner/operators know the opportunity cost of a vacant apartment or room. Simply stated, they are investing more in sales and marketing during these difficult times because the potential returns on that investment are very significant. Here is a basic scenario that outlines typical opportunity cost.

OPPORTUNITY COST OF A TYPICAL VACANCY

For every additional occupied room (occupancies in excess of 80 percent), one could assume approximately 30 percent of the additional monthly service fee would go for new, incremental expenses. That is because at relatively high occupancies most operating costs are already "sunk"-they are incurred and covered. As an example, you may not have to buy more raw food or hire another employee for one additional resident.

o Approximately 70 percent of the additional monthly service fee represents a very high incremental profit margin-new cash that drops right to the bottom line.

o For a single community assisted living operator with a typical baseline monthly service fee of $3,300 per month, the 70 percent incremental profit margin results in a new cash benefit of $2,310 per month, or a $27,720 annual increase in cash flow for each additional occupied room.

o If a four-community operator increased occupancy by just two rooms per community, the potential financial enhancement is $55,440 (27,720 ∞ 2) per community per year-times four communities equals $221,760 per year. With a 9.5 percent cap rate, this could increase the value of the four-property portfolio by up to $2.3 million.

Focus on Improvements

If assisted living operators begin to feel a financial pinch, they are forced to focus on existing operations. Why not focus on existing operations more consistently? Here is a typical real world operations enhancement scenario.

TYPICAL SCENARIO FOR OPERATIONS ENHANCEMENT

A typical 80-room assisted living community operates with 26,280 resident days per year (80 units at 90 percent stabilized occupancy equals 72 units ∞ 365 days per year). Typical assisted living operating expenses are currently benchmarked at approximately $80 - $108 per resident-day (PRD). This wide range is influenced by resident acuity and resulting direct care costs.

o An operating expense reduction of just $1 per resident-day (PRD) is a reasonable goal. It represents approximately 1 percent of current total operating expenses PRD. With 26,280 annual resident-days, the $1 cash savings going right to the bottom line would be $26,280 per year.

o With a 9.5 percent valuation cap rate, the cash savings in this scenario could have a favorable increased value impact of at least $275,000 for a single, 80-room, free-standing assisted living community.

For some, this operations enhancement scenario may appear to be a hypothetical exercise in arithmetic. But, if you are a single community assisted living operator, you're probably constantly fighting economies of scale and every dollar really counts. Look for that $1 PRD savings within two of your cost centers: sharpened, hands-on direct care costs and total dietary costs (raw food, labor, etc.), which should not exceed $20 PRD.

A multi-community operator can benefit significantly from operations enhancement. If an operator had a portfolio of four 80-room assisted living communities, that $1 PRD reduction would translate into an increased annual cash flow of approximately $105,120 (four properties Σ 26,280 resident-days per property at a $1 per resident-day expense reduction). Capitalized at 9.5 percent, that would result in an increased portfolio value impact of $1.1 million.

Profit Margin Benchmarks

The ultimate financial performance metric, profit margins are defined as net operating income or EBITDAR (Earnings Before Interest, Taxes, Depreciation, Amortization, and Rent/ Lease payments). Today, assisted living profit margins are typically ranging between 27 and 30 percent. Some assisted living communities have higher profit margins, but many experience much lower returns while having unrealized upside potential. Savvy owner/operators know they must strike that delicate balance between profit margins, high standards of care, clinical excellence, and optimum resident satisfaction.

Overall, 2010 will likely be another challenging year, but there will also be some real operational opportunities for assisted living operators. While not all of the positive financial enhancements outlined here can be realized simultaneously, just a small portion of each of them can easily have a significant positive and largely permanent financial impact on senior living operations. This year is the year that assisted living owner/ operators must look back with 20/20 hindsight and, most importantly, look forward with an entrepreneurial vision.

Senior Caregiver Job Applicant Questions

Senior caregiving provides fulfilling work for individuals who are compassionate and dependable. Many opportunities exist as seniors often need just part-time care when family members are not able to check in during the week or when recovering from an illness or surgery. Some caregiving positions require certification as a nursing aide or home health aide and other positions simply require a caring personality. Senior home care agencies typically train caregivers for each assignment. Nursing homes and assisted living communities offer positions as activities director and nursing aides.

What questions should you ask to make sure the individual will be trustworthy and caring? Here is a list of suggested questions which are typically used by professional senior home care agencies when interviewing caregivers to join their care team.

1. What attracted you to entering the profession of senior caregiver?


2. Please share a story about an interaction you have had with a senior in your life, as a relative, friend, or caregiver.


3. Please walk me through your employment history and tell me what you liked the most and the least about each job.


4. What are your short-term and long-term goals for employment?


5. Based on your experiences with the elderly, what do you like most about spending time with seniors?


6. What do you think are a seniors greatest fears and concerns?


7. What do you think are the characteristics of a good caregiver?


8. Which of those characteristics do you feel you posses?


9. What skills do you feel you would need to improve upon or develop as a senior caregiver?


10. Do you have experience in providing personal assistance (bathing, toileting, feeding)?


11. How would you handle a situation where the senior does not want to cooperate? Example: the senior does not want to take their medications at the scheduled time.


12. How would you handle or behave in an emergency situation?


13. How would you begin to develop a friendly relationship with a new client on your first day?


14. Please let me know what medical conditions you have personal or professional experience in working with: Alzheimer's Disease/Memory Loss, Parkinson's disease, hip replacement, stroke, diabetes, cancer, M.S., others?

These questions have been developed by human resource professionals with years of experience and will achieve the goal of finding out the caregiver applicant's interest in performing care as an employee and their skills and dependability.

It is also important to perform background checks on potential caregivers.

Beware of any background check service that is offered for free or in tandem with a subscription service as a good background check will cost at least $15.00 for a one-time purchase by an individual.

This is because courts do require an entry fee, similar to how a nightclub charges, and it is important to also have computer records verified by a person in counties that do not keep their criminal databases updated daily.

Most background checks that are given for "free" are simply a name and social security number match. When hiring a caregiver, you may want to learn about the background check laws in your state. The best way to make sure you have all the necessary insurance protections and active management for a caregiver is to hire a professional senior home care agency which will provide worker's compensation insurance, professional liability insurance and a training and performance reviews for the caregiver.

The Need for Effective Leadership in Education Has Never Been Greater

Pick up the newspaper, listen to the news, visit a school, think of your own children and those in your community - has there ever been a time when our country needed greater leadership in education? Anyone in the education field is keenly aware of this need.

If you're currently in the field of education and aspire to become involved in a leadership position, you can pursue your goals while maintaining your current responsibilities with online education.

Effective Leadership Requires Effective Training

The importance of effective leadership in any educational setting cannot be overstated. Education administrators take on a position of leadership with tremendous influence on every aspect of the organization. They provide instructional leadership as well as manage the day-to-day activities in schools, preschools, daycare centers, colleges and universities. They also direct educational programs of businesses, correctional institutions, museums, and job training and community service organizations. Regardless of the setting, effective, innovative leaders are needed.

The Responsibility of Education Administration

Today's Education Administrator has a position of great responsibility, thus, proper education and credentials are imperative for effective leadership as well as professional advancement in this vital field. These responsibilities can include setting educational standards, goals, policies, developing academic programs, and staff supervision. The ability to lead and inspire can be capitalized upon by exposing oneself to the best practices and current trends in education through online study.

Advance Your Degree

Earning an educational leadership degree from an accredited online college or university can help you advance your career in the education field or take on the exciting job of education administrator.

Increase Your Salary Options

Education leadership degrees, such as master's or Ph.D., may increase your salary and open up new advancement opportunities.

Courses in Educational Leadership cover topics such as:

School leadership

School law

Finance and budgeting

Curriculum development and evaluation

Research design and data analysis

Community relations

Politics in education

Counseling

Job Opportunities Remain High in the Field

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Why Should Someone Hire a Car Accident Attorney?

Most people don't get a car accident attorney for themselves whenever they want to file claims due to car accidents. However, if someone is injured in an accident by which someone else is at fault, obtaining one maybe required in order to acquire a just settlement. To be able to do so, lots of things ought to be done like submitting proofs that will establish facts in regard to the negligence of the other party which resulted in such a mishap. Arguing out accident cases to obtain what's desired is a difficult experience. It doesn't help either that, instead of getting a fair share of the claim, insurance firms are likely to be the one who will try to take advantage of the victim and the situation itself.

The clients should know the rightful worth of the claim. Most accident victims don't have any idea on the exact amount of money that they may be able to acquire from the injury suffered. Sometimes, with the use of relevant tools like an injury settlement calculator, they can perhaps obtain a rough amount on the financial value of a claim. The only downside is that this tool only determines the initial calculation and cannot otherwise provide the final settlement value. It seems too inappropriate to think that by just merely using this tool, anyone can determine the real settlement value of a case. Actually, to be able to reap the highest worth in settlement terms, it takes more than a sheer calculating tool. It needs a more in-depth understanding when it comes to the subtleties of a specific accident case and an accident attorney ought to know several aspects such as injury evaluation, determining the severity of the suffering and pain, understanding how insurance firms work on their advantage and settlement negotiation.

The attorney and client need to understand the entire process. Though the injured party knows the possible worth of the settlement yet they could be unfamiliar with the proceedings and the risks of obtaining the desired high settlement value is somehow high. Some people are not even awarded with compensation at all. Going through the process without a car accident attorney can sometime give insurance firms high hopes of winning out the case. However, with the right knowledge and expertise, it can provide a greater threat to the defending party and it could give a better to get a fair settlement from the claim.

Furthermore, car accident attorneys can help take some cases to the court. Most accident cases don't lead to trials. Both parties often end up in a settlement since bringing cases to court is costly and very time-consuming and sometimes it takes years to finish. Whenever negotiations don't work, that's the time cases are brought up to the court. Typically, insurance firms don't want to go to trials. Aside from the fact that a settlement would cost less, it can settle issues in a short span of time. Car accident attorneys can be used as a bargaining piece to elevate injury claims and perhaps bring a quicker end to a trial.

In the end, the car accident attorney ought to know what the best approach to a case is. Whilst the client should know about the potential worth and methods about filing a claim, they also need to make sure they have the right attorney in order for the case to go in the client's favor and to receive the right amount of compensation.

Tips to Preparing a Room for Handicapped, Convalescent or Palliative Care in Your Home

Preparing a room in your home so that a loved one can be in comfortable and familiar surroundings while they recover from injury or illness, or live out the last days of their life, is not as difficult a task as it may seem, even if the room or space available is not very big. The physical and emotional comfort of the patient is of primary importance, but the needs of the caregiver also have to be remembered.

1. Space. The first thing you will need to do is figure out which room in your home is available and most suitable for the patient. Will the individual be able to get up to use the wash room, in which case an ensuite bathroom or one very close by would be most appropriate. Can you afford to add a bathroom or renovate in any way? Do you have the time to renovate prior to the patient coming home? Do you actually have an available room or will the person have to be accommodated in part of your main living area? What about stairs? Will your person be able to go outside with a wheelchair at some stage, or even walk with assistance within the home? Do you need to remove rugs from the floor or pieces of furniture that might become a hazard? Once you have sorted out this problem, you can proceed with furnishings for the room.


2. Bed. A hospital bed is usually more comfortable for the patient, and it is easier for the caregiver who will attend them. Which bed you buy will depend largely on how much money you have available. A full electric bed will allow for all adjustments to be made with the touch of a button. A semi-electric bed allows raising and lowering of the head and foot of the bed electrically, but raising and lowering of the bed itself is done manually via an easily accessible handle at the foot of the bed. With a manual bed, all adjustments are made manually using various levers at the foot of the bed. What is the patient's weight? Is a bariatric bed required?


3. Patient Lift. Is the patient handicapped but mobile enough to use a wheelchair? If this is the case, a patient lift may be required to get the individual from bed to wheelchair and back again. As with beds, patient lifts can be electric or manual, and bariatric lifts are available.


4. Stair Lift. If the patient must be accommodated upstairs, do you need and can you afford to put in a stair lift so that they can be safely transported up and down the stairs? Installation of a stair lift should be done by a professional, is a quick procedure, and the lift can be easily removed afterwards.


5. Accessories. Is a stand alone commode required that is nearby or can the patient use a commode over the toilet? What about a walker? And in the case of both of these pieces of equipment, are wheels necessary? Do you need to install grab bars in the bathroom - in the shower and by the toilet?

The above tips will help get you started on preparing a room for your loved one. Personal touches within the room will help to make it seem more like home, things like familiar pictures or pieces of furniture if there is sufficient space in the room. The comfort and happiness of your loved one is paramount.

Assisted Living - What Can You Expect?

In today's world, finding suitable care for our elderly loved ones is becoming a complicated choice. It's hard enough deciding what type of care makes the most sense from both a practical and financial standpoint. And even then you still have to sort through all the jargon to choose between various levels of in home care as well as the many different types of facilities that may advertise senior care, senior living, independent living and even Alzheimer's care.

But perhaps the biggest factor in deciding what type of care to choose for an elderly parent or loved one should be made in consideration of what type of lifestyle they currently have and are trying to maintain. And if your senior is somewhat independent and wants to stay that way as long as possible, assisted living might be just what they need.

A look at daily life

Housing - Each resident or couple will usually have their own apartment or living space to themselves. These housing units will include standard furniture such as beds and dressers, private bath facilities and may potentially include full kitchen accessories such as a stove and refrigerator. They can come and go as they please, although most facilities will encourage residents to check in for their own safety.

Daily Living - Each resident may have different needs for what services they need depending on their level of lifestyle and mobility. Daily living services can including anything from housekeeping services like cleaning and laundry to more personal services such as help with bathing and dressing. As an individual or couple's situation changes, the services provided can also be altered to meet their new needs.

Common Areas - Common areas will typically include a restaurant style area for serving meals, as well as areas for games, activities and social gatherings. Some facilities may even include things like a library, movie theater, fitness center and a pool. It is also common to find quiet areas for reading as well as a chapel of some sort.

Meals - Many senior apartments will come equipped with a basic kitchen, but meals are typically provided at set times in a common area. However, the quality and types of meals may vary widely.

Medicine - Getting help administering and managing daily medication is one of the primary functions at an assisted living facility.

Activities - No discussion of senior living would be complete without at least a mention of activities which rival cruise lines when it comes to fun.

The bottom line is that a facility that describes itself as assisted living is more than likely best suited for a relatively mobile and independent senior. For example, the facility staff will help seniors manage their medication and other important daily activities; but it would not be suitable for seniors that need close supervision or help.

Caring for Seniors Does Not Mean Nursing Homes

As our parents grow older, our relationship with them changes. A role reversal takes place and suddenly adult children become caregivers. This can create stress among both parties. For aging parents, they find themselves losing self-sufficiency and independents. Adult children now have the burden of caring for aging parents.

Whether it is providing transportation to the market, doctors' visits and the pharmacy, cooking meals, managing financial matters or cleaning, the relationship between each party changes fundamentally. In the past, these changes often resulted in the parent moving into a long term nursing home. Today there are many more, and oftentimes better, options available. This essay will look at the two best options.

In Home Care

In home care is growing option. Here, seniors do not need to even leave their own care. Here, caregivers stop by for a few ours or move in to provide care. They are available to drive seniors around to appointments or to the market. They can help cook meals help out around the house. For a senior who is not ready to leave home. This is ideal. By bringing in a part or full time caregiver, adult children are able to help take care of their parent's life without disrupting their own. There is a particularly good option if adult children have moved far away from home. If you are living on the other side of the country, having a set of eyes, ears, and hand you can trust can make all the difference.

Supportive/Assisted Living

Supportive or assisted living is the modern version of the nursing home. However, they do away with the hospital-style wards. Instead, seniors are able to live in their own apartments with a kitchen and their own furniture. Living spaces are designed with limited mobility and medical needs in mind. There is 24 hour staff on hand in case of emergency, daily activities, group dinners, and outing; all of the things that seniors need to thrive. If they want to stay at home and read or play bridge, either option is available. In many cases, if a senior can still drive, they can go out and about to see friends and family. Assisted and supportive living provides seniors with a safety net that their adult children cannot provide. An additional advantage supportive living has, is that they are often times connected to a traditional long term care nursing home. If something does happen, there is a medical team on hand. They are never too far away from their support system.

GPS Tracking Technology for Alzheimer's Patients

Anyone who has a loved one afflicted with Alzheimer's disease understands the worry of a wandering incident.

Alzheimer's disease is a form of dementia that causes its sufferer to become paranoid, confused, and have memory problems. Being confused about their surroundings, many patients wander around aimlessly, which can lead to life-threatening situations, such as walking into lanes of traffic. The Alzheimer's patient may now know where they've wandered too, where they live, or even their name.

Approximately 60 percent of people inflicted with Alzheimer's disease are prone to wander. This is a concerning statistic for family members and caretakers of Alzheimer's and dementia patients, particularly if it's impossible to keep a close eye on them every second of every day.

As the number of baby boomers approaching the age of 65 reaches the millions, the rate of Alzheimer's sufferers is predicted to affect up to 16 million by 2050, according to the 2011 Alzheimer's Disease Facts and Figures report published by the Alzheimer's Association.

Whether a family member or health care facility professional, caregivers of Alzheimer's patients may soon breathe a sigh of relief however, thanks to GPS technology.

With the expected rise in the number of Alzheimer's patients, real-time GPS tracking devices have become an essential tool for both family in-home caregivers and assisted living homes alike. Without a GPS tracking device, the task of finding a wandering Alzheimer's patient is quite challenging.

Real-time GPS tracking devices for Alzheimer's patients are available in a number of different forms today. For instance, they can be attached to a person's clothing or worn as a piece of jewelry, like a watch or bracelet. GPS tracking devices for memory-challenged individuals can even be implemented in shoes. In this case, the GPS tracker is implanted directly into the heel of the shoe, giving the shoe a natural look and appearance.

These on-person GPS tracking devices can be used to track a patient for several miles, providing accurate, real-time patient location. Some devices offer the ability to alert the caregiver when a patient wanders out of range, while others can provide an alert if the Alzheimer's patient falls.

In 2011, approximately 5.4 million Americans have Alzheimer's and an estimated one in eight people over the age of 65 have Alzheimer's.

Cost effective GPS tracking solutions can locate in real-time and on demand vehicles, people and property from any web based computer or mobile device.

Nursing Homes - How to Select A Nursing Home For Your Loved One

Choosing a nursing home can be a very difficult decision. Many people faced with the prospect of choosing a nursing home for a loved one may never have visited a nursing home before and so don't know what to look for to distinguish a good nursing home from a less good one.

The following pointers are important to consider when looking for a nursing home. Whilst this list of important things to look for is not exhaustive it provides a starting point for looking for a home.

The first things to consider relate to the environment of the nursing home. It is important to remember that this is to be your loved ones home and whilst of course there are practicalities associated with people that need a lot of care, a home should not feel too institutionalized. Many people in nursing homes are much happier if they can have their own rooms, and they can furnish them with their own things from their homes. Generally a much easier transition can be made from home to a nursing home when the resident is surrounded by their own possessions.

Also take into consideration communal areas. Are they clean, pleasant and well lit? Residents prefer to be in rooms where the tables and chairs are arranged into small groups rather than one large circle as this is better for socializing. Like any home it is also likely to feel more welcoming if the areas are bright, well lit and open. Many residents also greatly enjoy having some well kept outdoor space.

It is also important to check the food menus and actually try the food. Remember, this will be all that the resident eats so it needs to be both nutritious and tasty.

The second thing to consider is the staff in the home. Most people will be concerned with staff ratios, but it is also important to consider staff turnover. Generally the longer the staff are there and the less staff turnover there is, the better. This is because staff that have been there longer tend to be more committed to the individual patients and better understand their individual needs. Also, for people with dementia or memory loss having familiar people around can be helpful and reassuring.

As well as looking at the number of staff, take into consideration how they behave towards residents. Not only is it important to consider whether they use correct lifting techniques and follow procedures correctly but also if they treat residents with respect and try to help them as much as possible. Staff should, wherever possible, be trying to arrange life for the residents as they would wish it, rather than to make things easier for themselves.

Take care to ensure that there are plenty of activities on offer in the nursing home, as these can help to keep people mentally alert. Social activities also increase residents happiness dramatically as they increase socializing between residents. Some homes claim to offer activities but due to staff shortages they don't always happen. Ask other residents whether the activities that the home offers actually take place.

Check the homes policies on drugs. Some homes like to keep patients heavily sedated as it means less work for staff. This is usually not in the best interests of the residents.

The most important thing to remember is that for residents to be happy they need to have as much control over their lives as possible. This means that they should be able to treat the nursing home as their home, getting up, eating, and socializing at the times that they want to wherever possible. They should be given every freedom that can be given and the home should be arranged for the benefit of the patients comfort rather than for the benefit of the staff.

The last thing that should be taken into account is that the needs of the resident may change over time. Where possible select a home that will be able to adapt to the changing needs of the resident, otherwise when their needs change they will be forced to change homes again which can be upsetting and unsettling.

Consideration of all of these factors should help to guide you towards choosing the home that is right for your loved one. Please remember where possible to also take the prospective residents views into account.

Hiring Heaters for Care Homes and Nursing Homes

Hired heaters can literally save lives

During a particularly cold snap, heating at a home can prove inadequate. This is where the option to hire additional portable heaters (to supplement an existing system that is probably running over and above capacity) can literally prove 'a life saver', particularly at weekends when an oil supply for a fixed system can run out, with no prospect of supplies being replenished until the following week.

Some of the more serious cases of care homes being left without heat, have been documented by the media: they often involve heating failure over a bank holiday or Christmas and leave residents wearing body warmers, fleeces and blankets around the clock.

While there is no strict minimum temperature to be provided for residents or patients at UK care homes or nursing homes, Health and Safety Executive guidelines state that managers have a duty of care towards people on their premises, this includes the provision of reasonable heat.

The elderly need not be without heat

With the elderly often being frail and susceptible to illness (particularly chest-related illnesses, when temperatures dramatically fall), any heating failure at a care home is particularly worrying.

The tragedy of it all is that in the vast majority of cases one phone call to a heater leasing specialist who operates a 24/7 emergency call-out service could immediately solve the problem.

In such situations, small heaters (e.g., oil-filled radiators, 3kW DE-25 units...) would be used as they are unobtrusive, have simple controls, are very safe, and are easily powered (most portable electric hired heaters work off a standard 13a 240v power supply).

Heater hire engineers will situate the rented heaters safely, ensuring that supply cables will not be a trip hazard for residents with vision or maneuverability challenges.

Hired mobile heaters can be used to heat large rooms and communal areas as well as individual bedrooms, so everyday life at a home could continue without upheaval or upset being caused.

How contingency plans can mean peace of mind

Premises managers can safeguard themselves against the consequences of a heating system failure in winter by formulating a contingency plan with a heater hire specialist, during the autumn months. As part of the plan, the specialist will perform a site survey. They will consider factors such as: their fastest possible response time, access to the building, available power there, budget, etc., and will then be thoroughly prepared and primed to respond immediately to an emergency call-out.

The many benefits to hiring heaters

As well as being the ideal emergency back-up option, leased portable heating units are energy efficient, environmentally-friendly, and can be:

Used immediately;

Easily stored;

Rented on a short contract basis;

The perfect stop-gap between the removal of an existing (fixed) heating system at a care home or nursing home, and the installation of a new one;

Added to an existing heating solution when extra heating is required.
Portable heaters can also be hired during planned servicing or maintenance work to a fixed heating system at a care home or nursing home, of course.

Specialists will pull out all the stops

Specialist heater hire companies recognise just how vital it is that care homes and nursing homes are properly heated in winter, and so will offer a 24/7 service in order to provide a stop-gap heating solution until a built-in heating system at a home is repaired and operating fully again.

The Growing Problem of Elder Abuse

Many uncompensated caregivers - spouses, adult children, relatives and friends - find caring for an elder to be satisfying and enriching. However, the responsibilities and demands of elder caregiving, can be extremely stressful. The stress of elder care can lead to mental and physical health problems that contribute to caregiver burn out. This stress often leads to unintentional as well as intentional elder abuse.

Even caregivers in institutional settings experience stress at levels that lead to elder abuse. Nursing homes may be susceptible to elder abuse issues if their employees do not receive adequate training, or have too many patients or responsibilities, and/or work under poor conditions.

The symptoms of caregiver stress include:

o Withdrawal
o Sleeplessness
o Sleeping difficulty
o Lack of concentration
o Weight loss/gain
o Drug/alcohol abuse
o Eating disorder
o Mood swings
o Chronic fatigue
o Feeling overwhelmed

Several of these symptoms can affect a person's ability to "think straight" or control their anger.

The different types of elder abuse

Abuse of the elderly takes many different forms, some involving physical or emotional intimidation, and neglect, sexual, financial and medical fraud. The following defines the different types of elder abuse.

Physical abuse

Physical elder abuse is non-accidental use of force against an elderly person that results in physical pain, injury, or impairment. Such abuse includes:

o Slapping, punching, hitting or pushing.
o Inappropriate use of drugs for the purpose of sedation
o Hand or ankle restraints
o Confinement to a room also constitutes physical abuse. This type of abuse most often occurs in an institutional setting.

Emotional abuse or intimidation

Emotional or psychological abuse and intimidation consists of:

o Verbal threats
o Withholding food or drink as a form of punishment
o Humiliation and ridicule
o Ignoring the elderly person
o Isolating an elder from friends or activities

Sexual abuse

Sexual elder abuse is contact with an elderly person without the elder's consent and consists of:

o Physical sexual contact with a person unable to consent
o Forcing older person to watch sex acts
o Forcing the elder to undress
o Forcing a person to look at pornographic material

Neglect or abandonment

Neglect or abandonment is describes as not fulfilling caretaker obligations whether a family member or professional caregiver. This category of abuse accounts for more than half of all reported cases of elder abuse in the US. It can be intentional or unintentional, based on factors such as ignorance or the denial that an older person needs as much care as he or she does.

Financial abuse

This can be the most difficult form of abuse to detect, as it involves the use of an elderly person's funds or property, by a caregiver, fraud artist or unscrupulous company. The following provides examples of financial abuse:

o Misuse of personal checks, credit cards, or financial accounts
o Stealing cash, income checks, or household goods
o Forging signature on legal and financial documents
o Identity theft
o Announcements of a "prize" that the elderly person has won but must pay money to claim
o Phony charities
o Investment fraud

Healthcare fraud and abuse

Carried out by unethical doctors, nurses, hospital personnel, and other professional care providers, examples of healthcare fraud and abuse regarding elders include:

o Not providing healthcare, but charging for it
o Overcharging or double-billing for medical care or services to Medicare or Medicaid
o Getting kickbacks for referrals to other providers or for prescribing certain drugs
o Stealing or selling personal information: social security number, credit card number or check routing number.

What can a caregiver do to prevent elder abuse?

Know what behaviors and situations trigger your emotional reactions. Its' not possible to be in control all of the time however by being aware of what "sets you off" you can plan for your response. There are also steps that are useful in understanding and dealing with your feelings.

Identify your feelings. Anxiety, anger, depression are qualitatively different and have different antecedents. Although it is unpleasant, admit and accept that you have a negative feeling.

Put distance between yourself and the situation. Go to the next room. Take a walk.

Take time to figure out what triggers your anger or negative feeling. What it is about a situation that makes you feel a certain way? How do you react? What does the situation mean to you?

Talk about your thoughts and feelings with someone who you trust, or write them down to express them. Sometimes writing helps one to understand, and begins the problem solving process. Talk to a professional if you are getting overwhelmed.

Make a plan. Figure out what you can do differently when you recognize that feeling again. Make the plan very concrete.

Remember there must be a balance between your needs and those of your loved one. Be comfortable with your limits. This means accepting what you are realistically able to do. Remember to be a good caregiver and to go beyond caregiving, your life must continue and be meaningful.

Ask for and be willing to accept help.

What can a long-term care facility do to prevent elder abuse?

Long term care facilities have a moral and legal obligation to make sure that their patients and residents are safe and well care for. They can help address the problem of elder abuse by:

o Increased staffing ratios - few patients per caregiver
o Employee caregiver support group
o Ongoing staff training and development programs
o Expanded training in dementia care
o Offer Employee Assistance Program
o Employee Appreciation events and awards

Professional caregivers are often reticent about asking for help, concerned that it might have a negative impact on job security. This is only one reason why employee support groups as well as EAP's are so important...offering a safe place for a caregiver to share their feelings. Also county funded elder abuse hot lines offer help for caregivers as well as the care recipient.

Please pick up the phone and call a hot line or support group if there is a possibility you might cross the thin line into elder abuse.

How to Use Wood Display Carts to Sell Your Merchandise

There's something appealing about old-fashioned display tools. Buckets, baskets, and wooden crates are popular ways to display certain items, and they bring with them the charm and serenity of a simpler time. Another display tool that can do this for you is a wood display cart. These old-fashioned carts evoke images of covered wagons, flower carts filled with violets, or sturdy crates sitting on docks, filled with exotic goods from around the world. It's worth it to give some thought to how to use wood display carts to sell your merchandise.

Flower Carts

Though you seldom see these charming wood carts being used to sell flowers, there are dozens of other things you can do with them. Set a few tureens on them and serve up coffee, hot chocolate, and baked goods at a cold weather sporting event. In warm weather, change it to iced tea and lemonade. Contract with a local team to sell penants, ball caps, and t-shirts-some of these carts even have wood slats you can hang things from. Make it a sign-up table for volunteers, or stack it with books and wheel it around an assisted living center or hospital. If you run a grocery store or restaurant, set your portable wood cart inside the door so that customers can get an advance taste of what awaits them inside.

Wagon Display Carts

A wooden wagon display cart evokes images of autumn, hayrides, and trips through the pumpkin patch. You can keep your wagon cart stationary and surround it with bales of hay to show off your pumpkins, squash, and other fall produce. You can also take it to all your local fall festivals and push it through the highest traffic areas. Your customers will love that they didn't have to come to you; you came to them!

Crate Display Cart

This kind of wood display cart looks like something that would have been rolled off a dock 150 years ago. It's rectangular and deep, and has three different compartments; you can almost see the stevedores prying the wooden lid off with a crowbar to display the shipment inside. For display purposed, it's adjustable, so it can rest flat like a trunk, vertical like a shelf, or at a slant, to offer different levels for your displays. It rests on a wooden frame that's on casters, so it can be easily rolled to whatever location you can use it best. This is another one that can benefit from seasonal displays, using hay, pumpkins, Christmas wrappings, or a fulsome display of spring or autumn plants and flowers. You can also consider displaying clothing, bolts of cloth, or handmade quilts, which can easily be folded or draped over the wood cart's edges.

Wood display carts are so versatile and charming that people are drawn to them without even being aware of it. Now that you have some ideas on how to use wood display carts to sell your merchandise, use them to display your seasonal merchandise, or just those things that need to be portable and easy to move. You'll never regret investing in a wood display cart for your business.

Winter Is a Popular Season for Slip and Fall Lawyers

Ice, snow and sleet are recipes for disaster when it comes to safety during winter months, and staying on two feet can be a challenge for people of any age when these conditions are present. This is why it's important to understand slip and fall lawsuits, and how serious these accidents can be.

Slipping and falling, especially in icy conditions, can cause severe injury and sometimes even death. In 2009, 212,760 work-related injury cases involved falls, according to the Bureau of Labor and Statistics. In addition, in 2006 there were 52 fatal injuries from a fall due to a floor, walkway or surface.

Those numbers don't even include the falls that happened outside of the workplace. In some instances people will slip and fall on someone else's property, or at a business. Regardless, people who have suffered significant injuries from slipping and falling could potentially be compensated, depending on the following circumstances:

Circumstances that warrant a lawsuit:

• The owner of the property or business has caused the spill, or was responsible for creating the slippery or dangerous surface that created the fall. For example throwing water out on the sidewalk on a cold day, letting a hose or water run on a driveway during winter etc.
• The owner knew about the dangerous surface, such as ice on the steps or snow piled in front of the door, and did nothing about it, when he or she realized that it was dangerous.
• The owner of the property or business should have known about the problem, and it can be proven that another "reasonable" person would have discovered it and repaired it or fixed it.

Circumstances that do NOT warrant a lawsuit:

• The conditions, or surface, where the fall took place were naturally occurring conditions. This would include a natural slop to the surface of the ground, a drainage grate or a manhole
• The natural conditions were those in which the property or business owner could not possibly have prevented or kept under control at all times. This would include a sidewalk during a rainstorm or snow showers.
• The fall was due to the pedestrian not paying attention or being distracted.

There can be a fine line as to whether the circumstances that caused a slip and fall accident warrant a lawsuit, therefore, someone looking to file a lawsuit based on a slip and fall accident should seek the help of an attorney.

A personal injury attorney or slip and fall lawyer would be able to handle this type of lawsuit and help the victim decide if another person is to blame for their fall and injuries. Personal injury attorneys are familiar with their state's procedures and are also familiar with workplace laws and the types of insurance workplaces already provide for slip and fall accidents.

Although slip and fall lawyers can help provide compensation for an accident that was the fault of another, the best way to handle slip and fall lawsuits is to avoid them, especially during the winter. Property owners should maintain the safety of their property during the winter; shovel snow off of stairs, walkways and driveways and make it a habit to check the property for potential hazards. Pedestrians should be mindful of weather conditions and pay attention to where they are walking, limiting distractions in hazardous conditions.

Accidents at Hotels

For many, hotels function as a "home away from home", providing the comfort one is used to from their own house. On a business trip or a fun vacation, hotels provide a warm bed, a hot shower and home-cooked meal for patrons. However, similar to other premises such as restaurants or supermarkets, hotels are responsible for keeping a well-maintained facility, free of hazards that may injure their guests. Management, staff and maintenance teams must keep the hotel is optimal condition, or be subject to premises liability claims. If a patron is injured due to the negligent upkeep of the facility, or some other hazard that should have been addressed, that patron may be able to sue in a court of law.

Injuries and accidents that happen at a hotel can have devastating consequences. Not only are you far away from your comfort zone (and your hometown), you also may be all by yourself with no one around to help you recover. This is the precise reason that premises liability covers not only physical suffering, but emotional suffering as well. In order to make sure you receive the financial compensation that is entitled to you in a court of law, you will want to hire an experience attorney to help present your case.

The following events could take place at a hotel:

繚 Slip and fall accident
繚 Burn injuries from fire hazards or improperly maintained electronics
繚 Harm from defective beds, chairs or couches
繚 Food borne illness from food prepared by hotel kitchen
繚 Safety concerns due to lack of security
繚 Theft by hotel employees
繚 Abuse by staff members
繚 Injuries resulting from inadequate staff training
繚 Lack or malfunction of safety equipment
繚 Lack of visibility or lighting
繚 Swimming pool injuries

Proving negligence can often be difficult in premises liability claims. For this reason, it is imperative to consult with an expert attorney immediately following your incident. If you or someone you love has been hurt by the reckless or negligent behavior of hotel staff member, you have legal rights under the law to help you recover from resulting damages. It is entirely unacceptable to allow these facilities to operate in an unsafe manner and your case can help shed light on this problem.

When Someone Dies in an Accident, Can I Claim Compensation?

The death of a loved one is an upsetting and stressful time in any circumstance, but when the death was due to the fault or negligence of a third party the effects are even more devastating. If a family member has died in a car accident, an accident at work or due to medical negligence, you may be entitled to make a claim. Whilst no amount of money can ever truly compensate for the death of a loved one, it may go some way to easing financial worries.

Who can claim compensation following a loved one's death?

Claim by the Executor

The law in England and Wales regarding who is entitled to claim compensation following a death is contained in the Law Reform (Miscellaneous Provisions) Act 1934 and Fatal Accidents Act 1976. These acts state that it is the deceased's estate which is entitled to claim and is usually brought by the Executor on behalf of all dependants, but if no claim is brought within 6 months from the date of death, then a claim can be brought by any dependent of the deceased. Any compensation received by the estate is distributed in accordance with the Will or, if no Will was left, under the intestacy rules.

What compensation can the Executor claim?

•General damages - this compensates for the pain suffering and loss of amenity suffered by the deceased before their death.
•Medical expenses - if the deceased incurred any medical fees for private medical treatment prior to their death the cost of these will be recoverable. Receipts or invoices will be needed to evidence the cost.
•Travel expenses - family and friends who have been visiting the deceased at hospital or at home, over and above the amount they would have visited in normal circumstances, then they are entitled to claim reimbursements of their travel costs. Remember to keep taxi receipts and parking tickets.
•Past losses up to date of death - this will include any loss of earnings if the deceased was unable to work.
•Care and assistance - if help was provided in looking after a friend or loved one whilst they were at home or in hospital, such as helping them wash, assisting with meals, then the cost of the care can be claimed for. Even if no payment was made and the care was gratuitous, a claim can still be made.
•Funeral expenses - the reasonable funeral costs can be recovered if receipts are kept.
•Probate fees - if probate or other legal fees were incurred these are usually recoverable.

Claim by a Family Member or Dependant

What compensation can Relatives and Dependants Claim?

The law states certain relatives to the deceased are entitled to claim a bereavement award. The bereavement award can be claimed by the:

•wife, husband or civil partner of deceased
•where deceased is a minor, his parents where legitimate or mother where illegitimate
•children under 18 years on the death of their parent
•cohabitants of 2 years duration
•unmarried fathers with parental responsibility

Unfortunately the bereavement award is not available to former spouse, children over 18 years of age or step-children. However, there is an argument this may be in breach of rights under Human Rights legislation and you should speak to your lawyer regarding an entitlement to bereavement awarded in other circumstances.

The amount of the bereavement award is fixed by law. Many feel the level of the bereavement award is very low, but unfortunately the amount is fixed and is not a head of claim that is open to negotiation.

How much is the Bereavement Award for a Fatal Accident?

For deaths after 1 January 2008 the bereavement award is 瞿11,800.

Financial and other support provided by the Deceased

For the purposes of a compensation claim, only people who fall within the legal definition of a dependent are entitled to claim compensation. A dependent is defined as the:

•spouse, civil partner, former spouse/ civil partner of the deceased
•cohabitants living as with the deceased as man and wife for at least 2 years prior to death
•parents of the deceased
•any person who the deceased treated as a parent
•any child or descendant of the deceased
•any person who although not the deceased's own child, by reason of marriage or civil partnership was treated by the deceased as a child of the family
•the brother, sister, uncle or aunt of the deceased.

If it can be established that someone is a dependent of the deceased they are entitled to claim compensation for:

Loss of earnings or Pension

Where the deceased was earning an income or private or state pension, from which the dependent benefited, claim can be made by the dependent for the financial loss. This would cover situations where the deceased was responsible for paying the mortgage or other utility bills. Wage slips and information from the department of work and pension will be needed to support the claim. The loss can be calculated up until the dependency would no longer exist. In the case of a spouse this would normally be until the deceased would have retired in the case of loss of earnings. In the case of a child this will normally be until they are 18 years or otherwise financially independent of the deceased.

Dependency of gifts, holidays, luxuries

Courts require clear evidence of proof of gifts and luxuries prior to death. Future levels of dependency will then be assessed by the past evidence.

Loss of services provided by the deceased

Where deceased provided services such as childcare, cooking, cleaning can claim for lost services.

Specialist Lawyers

Claiming compensation when a loved one has died due to an accident or negligence is an upsetting and stressful procedure. It is important that you choose specialist lawyers assist you with the legal process and make sure maximum compensation is recovered to ease the financial burden.

Why Me? I Didn't Ask For This: The Sandwich Generation, Part II

The harsh, cold winters are terrible for the elderly. Many attribute their painful physical conditions to that. There is also the risk of falling on the ice and in snow. The fact is, arthritis not only affects elderly people, but it can affect anyone at any age. However, since seniors believe that arthritis is handled better in warmer climates, many move away from their children to live in Florida where the heat is soothing. However, there are days when Florida's hot and humid weather can also cause pain. Another option that seniors have looked to is the desert climate of Arizona, which is quite advantageous for people with arthritis. Nonetheless, wherever they decide to go, the decision to leave will not diminish the fears or anxieties that their child may have in regards to their parent's well-being, especially when they are an only child. There is always the concern that something can happen that might uproot everyone's lives.

For example, you may have a situation like this:

The telephone rings. You answer. It's the emergency room at the hospital. It's the call you were dreading. The nurse speaks with a concerned voice, "Mrs. J., your mom was crossing the street on foot and was hit by a car. I want to let you know the nature of her injuries. She has internal bleeding; broken vertebrae in her back, a shattered pelvis and her arm and leg are broken as well. It's a wonder she survived. She is in a terrible amount of pain. Your father is very anxious and doesn't make sense when he talks. I think he is in shock. The doctor is examining him now. Can you please come soon? It is extremely urgent. Your mother is asking for you. The seriousness of her injuries requires immediate surgery. Your mother has agreed to it if it would stop the horrendous pain. Even with the surgery, the doctor is not sure if she will ever walk again. I am letting you know that she will have to stay here after her surgery until she is moved into a rehabilitation center."

You sit stunned by the complicating issues in this sudden, unanticipated mess, trying to figure out how best to break the news to your husband and children. How will they react when they find out you have to leave immediately? Who will take care of the kids when you're gone, perhaps a week or more? Taking mental notes, you wonder about the power of attorney and the living will that wasn't made at the time your parents moved, as they were both in full capacity and robust at the time so dad didn't think it was necessary. However, recently, dad has had some health issues with his heart which are causing you great concern. You are worried that dad might have a heart attack with all this stress. You say to yourself, 'I hope there is a will, because this can complicate matters. I don't even know if they both have life insurance and if so, how much? I'll have to take care of that later when I arrive in Florida, as one of my "Must Do's." You suddenly remembered what the nurse said, that your mom was going to be moved to a nursing home or a rehabilitation center after she leaves the hospital, if she leaves the hospital.

Now you are apprehensive, after considering the big "What If," what if they don't have long-term care insurance? My God, between the nursing-home residency, of which Medicare only covers a small portion, and the cost of long-term care, a mind-boggling figure of anywhere between $50,000 to a $100,000 a year may result.. Who is going to pay for that? "I can't think about that now," you say to yourself. "All of this is making me nervous." As you rush and make calls the wheels of your mind are still in motion pondering on the "What Ifs." You are starting to feel queasy and angry at the same time. You stop for a moment and say, "they'll have to sell their home and perhaps move into an assisted living facility which will be costly as well. Come to think of it, the worst could happen, they might just end up moving into my home. If mom can't walk, who will take care of her? Dad can't. Will I have to give up my job? Oh no, this can't be happening. WHY ME, I DIDN'T ASK FOR THIS! I don't mind dad living with us. He is such a sweetheart, but what about mom? It would be sheer hell. We never got along. To make matters worse, Jimmie dislikes my mom and the feeling is mutual. I am almost sure that my home will end up being a battle zone. I don't know what to do, why did she have only one child?" Your hands are shaking. "I hope my mother-in-law will watch the kids while I'm gone. What will Jimmy say? Now this will give him a good reason to leave.

Relieved that you were able to get a flight for that evening, you begin to pack. You inform your employer that you had a serious family emergency and need to leave immediately. You ask him if you could use your vacation time for this. His approval comes as a big relief.

Between the cost of airline tickets and other additional expenses added to the credit card, a hefty bill is tallied, adding more debt to your finances. Plus you lose your vacation time, time that was intended to be used at a later date. Whatever the results, the reality of the situation at hand is adding weight to your already hectic schedule. By now you know what's in store for you; the cost of flying back and forth between New York and Florida will become exorbitant. On the other hand, you could move to where they live, but that would wreak havoc for all back home. Lastly as a dreaded alternative, you could have your parents move into your home. This way you would be able to keep an eye on them even though this arrangement will also wreak havoc for all concerned. You find yourself trapped by making the choice between: "what you would rather do" and "what is required for you to do." You have officially joined the privileged ranks of the "Sandwich Generation," sandwiched between responsibility for those that raised you and choices that define your own life.

Whether the aging parent becomes confined to a nursing home, a rehabilitation center or an assisted living facility, the demands on the Sandwich Generation still exist. These caregiver's nerves are strained to the utmost. They suffer from depression, anxiety and even some may develop heart problems from all the stress. As it is, the wife-mother-daughter generally is a multi-tasked person holding down multiple jobs and responsibilities all at once.

Now let's take a look at another example. Mrs. B. is a sixty year old stay-at-home grandmother who never had to work because her husband always made decent money. Both of her children have married and maintain successful careers. Her daughter, Sue, finally was able to have two children after several unsuccessful attempts. With so much spare time on her hands, Mrs. B. can do all the things she wants to. Travel, play Mahjong with friends every other week, go to Broadway shows and participate in community activities. Since Mrs. B is a stay-at-home wife, she comes to be the lucky candidate who assumes the babysitter role at a moment's notice for her daughter. How can she refuse to take care of her sweet, innocent darlings once in a while? Happy and doing well, she feels her life is blessed. However, add to this context an aging mom with advanced dementia, the situation changes and becomes overwhelming, piling on additional responsibilities. Now Mrs. B's daughter has just received a promotion and has to put in more hours at her job. Sue is so excited, since it will raise her salary $30,000 a year. She's hoping that mom can take care of the kids full-time.

"Don't get nervous, it's only temporary until I get the hang of it, then I will put them in daycare," she says. At age sixty, Mrs. B. is not looking forward to spending 40 + hours a week taking care of a baby and a two-year-old toddler. She also has the responsibility of an aging mom with dementia. Since her father passed away over three years ago, Mrs. B. has been noticing changes in her mother's personality. Apparently she has been suffering from clinical depression with mood swings, wherein she would become enraged, unresponsive or withdrawn. She also watched her mom slowly fade into the never-ending fog of memory loss, repeating herself over and over again. Mrs. B.'s mom would become increasingly bewildered and confused, even in familiar surroundings. Lately, her appetite has been poor, and to make matters worse, she has developed a foul odor. She has been neglecting her personal hygiene as she does not realize that she has to bathe and change her clothes. Since Mrs. B. is the oldest of three sisters and as she lives the closest to mom, and supposedly had more free time on her hands than the others, she has become the designated primary caregiver, against her wishes. So as a result, Mrs. B.'s mom moves in with her daughter. Both situations have disrupted Mrs. B.'s comfort zone. It also has interfered with the quiet life that she built with her husband since the kids got married and moved out of the house.

The full-time baby-sitting issue in regards to her grandchildren is becoming a serious problem for her, going on for several months now. She cannot understand why it's taking her daughter so long to put them in daycare. Mrs. B. is too tired. She is wound tighter than a rubber band. The baby is teething and crying constantly and the toddler still in diapers is hungry, tugging at her pants. Suddenly the door bell rings. It's her next door neighbor asking if she could pick up her mail for the next four days since she won't be home. Smiling, Mrs. B. agrees and closes the door. She starts to fume, feeling envious of her neighbor, who has the freedom to take off when she wants to while Mrs. B. is trapped at home with two grandchildren, constantly changing diapers and doing the laundry.

She says, "What does she think I am, her errand girl? With all that I am doing, she has the nerve to ask!" Not even the girls at Mahjong call her anymore. They have been avoiding her like the plague. She calls her daughter constantly, complaining about the kids and her mom. The daughter, avoiding the issue, puts her on voice mail. Mrs. B. screams at her mom. She calls her sisters and vents on them for not helping out. She vents to the mailman, the supermarket cashier, whoever might lend an ear. She can't wait to vent on her husband when he comes home. There is no way for him to avoid the sound of her shrilly voice, her expression revealing her anger. He is deeply concerned that she may be having a nervous breakdown. The peaceful life of Mr. and Mrs. B. is long gone.

Meanwhile, Mrs. B. can hear her aging mom fussing because she has a terrible case of the runs, soiling her underwear and nightgown, she needs to be washed and changed just like the grandchildren she routinely babysits. Mrs. B. has found herself in a situation that is not easily solvable. She starts to freak out. She is extremely tired and cranky. She needs sleep in a desperate way. The horrible consciousness and sandwiched existence cause tears to stream from her eyes. "I can't stand it anymore. I hate what I'm doing. I don't want to do this any longer. I want it to go away," she cries. "I am only one person, how can I separate myself into so many pieces and satisfy everyone at the same time? Doesn't anyone care about me? I have needs too." She sits there stressed out, her body wracking with heart wrenching sobs. Frightened by grandma's emotional state, the baby starts to cry and her whole face turns red while the toddler starts to cry as well. Finally, she screams at the top of her lungs and says, "WHY ME? I DIDN'T ASK FOR THIS!"

Do these examples sound familiar? If so, you are not alone. Caring for aging parents is not an easy task. It saps your energy and robs you of your peace of mind. Very few people are emotionally ready to undertake this role. The comfort zone which you have created for yourself, including the freedom to come and go as you please, career fulfillment, and an active social life with your friends becomes completely disrupted. With care-giving, you feel captive to the needs of whoever you are caring for. Also, it puts you in the awkward position of parenting your own parents.

In the final part of this 3 part series, I'll address ways I have had to deal with being a member of the Sandwich Generation, and ways to help cope with the stress involved with being a caregiver.

America's Top 200 Attributes

Technology and Industrialism

1. A phone system that works virtually all of the time
2. Electricity and running water
3. Toilets and toilet paper
4. Easy access to the Internet
5. Email
6. Instant messaging
7. Skype and video chat services for long-distance communication
8. Social networking sites
9. Cell phones and text messaging
10. Shops with free Wi-Fi
11. Digital cameras
12. Central heating and cooling
13. ATMs
14. Washing machines and dryers
15. Food blenders
16. Microwaves
17. Target and Wal-Mart
18. Coffeemakers
19. TiVo and DVR
20. Ability to pay bills online
21. Google
22. YouTube
23. Digital cameras

Capitalism (In flux)

24. The stability of currency
25. The entrepreneurial spirit
26. The stock market, yes, even now
27. Self-employment opportunities galore
28. A diverse job market
29. Mail and delivery services
30. Free interstate commerce

Transportation

31. Airports that are usually well-functioning
32. The interstate highway system
33. Highway rest areas
34. Low gasoline prices (compared to Europe)
35. Public transportation
36. U.S. passports
37. Car and truck dealerships
38. Taxis

Health and Diet

39. The variety of foods available
40. Availability of locally grown produce
41. Foods from all around the world
42. Farmers' Markets
43. Health clubs, gyms, and exercise equipment
44. The vitamin industry
45. WebMD (www.WebMD.com)
46. Organic supermarkets
47. Increasing crop yields
48. Cookbooks
49. DVDs and TV channels dedicated to health, diet, and exercise
50. Availability of flu shots
51. Standards for immunizations
52. Dental and orthodontic care
53. Variety of specialized care available
54. Nursing homes and assisted living facilities

Freedom and Equality

55. The Constitution and its amendments
56. The peaceful transference of power
57. Religious freedom
58. The right to peaceful assembly
59. Freedom of expression
60. Traditional presidential pardons
61. Freedom of speech
62. Freedom of the press
63. Democracy and the right to vote
64. Accessible polls for voting
65. Diversity
66. Social mobility

Access to Information and Education

67. Elementary, middle, and high schools
68. The variety of DVDs, CDs, digital programs, and books available
69. CSPAN
70. Debates on live television
71. Public libraries
72. Business, law, and medical schools, etc.
73. Endowments and scholarship programs
74. Major daily newspapers
75. Live television news
76. Instantly up-to-date online news
77. How-to and do-it-yourself blogs and websites
78. Wikipedia
79. Dictionaries, encyclopedias, and reference books on all topics
80. The community college system
81. Online higher education programs
82. A&E, TLC, and History Channel productions
83. PTA
84. Public museums
85. Standards for literacy

Charity

86. The Red Cross
87. Telethons
88. Per capita contributions to charity organizations
89. The United Way
90. Relief organizations
91. Civic participation and volunteerism
92. Homeless shelters
93. Big brother/big sister programs
94. Goodwill, thrift stores, and consignment shops
95. Senior discounts
96. Foster homes
97. Adoption agencies
98. Meals on Wheels
99. Foundations for cancer research
100. National months of awareness for a variety of issues
101. YMCA and YWCA
102. Salvation Army

Safety and Protection

103. Emergency operating rooms
104. Clean water
105. Air that's safe to breathe
106. Maternity wards
107. Emergency response systems
108. Ambulances and emergency rooms
109. Free clinics
110. Urgent care centers
111. The U.S. Department of Defense
112. Clean, safe streets and highways
113. Traffic lights, well-marked road signs and lanes
114. Copyright laws
115. Restaurant and food sanitation standards
116. The FDA
117. Free public restrooms
118. The watchdog aspect of the press
119. The system of juris prudence (usually)
120. Daycare centers
121. Seatbelts and airbags
122. The Armed Forces
123. The police force
124. The fire department
125. Neighborhood watch programs
126. Adopt-a-street and adopt-a-waterway programs
127. Pets on leashes (usually)
128. Trash and recycling pick-up

Traditions and Ceremonies

129. Cookouts and barbecues
130. Graduation ceremonies
131. Family farms
132. Family reunions
133. Baby and wedding showers
134. Easter egg hunts
135. Trick or treat-ing
136. Exchanging Christmas gifts
137. Memorial Day, Labor Day
138. Thanksgiving
139. 4th of July celebrations and fireworks
140. The Times Square New Year's Eve celebration and ball drop

Entertainment

141. Theme parks
142. State fairs
143. Rock and roll music
144. Country music
145. Disney World, Disney Land
146. Universal Studios
147. Sea World
148. Variety in music
149. Magazines for every interest
150. Mp3 players
151. Little Leagues
152. Talk Radio
153. Award shows
154. Major League Baseball
155. National Football League
156. National Hockey League
157. Major League Soccer
158. Professional golf, tennis, and other sports
159. College sports
160. Comedians
161. Public recreation facilities
162. Hiking, walking, and biking trails
163. Zoos
164. Aviaries
165. Aquariums
166. Sport camps
167. Podcasts and webcasts
168. Venues for music and the dramatic arts
169. Cultural festivals
170. Arts festivals, music festivals
171. Ski resorts

Sites and Attractions

172. The national park system
173. The reclamation of lakes and waterways
174. Safe campgrounds
175. The beaches
176. The mountain ranges
177. Varied geography, even within states
178. Variety of sizes of towns and cities
179. The Grand Canyon
180. Mt. Rushmore
181. Nashville, Tennessee
182. Chicago
183. Hawaii
184. Golden Gate Bridge, San Francisco
185. Niagra Falls, New York

Organizations and Institutions

186. The American Dental Association
187. Senior communities
188. Scouting organizations
189. Colleges and universities
190. American Association of Retired Persons
191. National Association for the Advancement of Colored People
192. American Medical Association
193. American Bar Association

Historical Landmarks

194. Washington, D.C.
195. Jamestown
196. Alaska
197. New York City
198. Boston
199. College towns
200. Gettysburg