Alzheimer's - How Can Caregivers Manage Patient Anger?

Alzheimer's patients express their anger by yelling, swearing, pushing, shoving, waving their arms, and in some instances, throwing things. These behaviors not only disturb others, they are threatened by them. Caregivers must learn how to manage anger to ensure the safety of all. I learned this when I was my mother's family caregiver.

For nine years, I felt like my mother was dying right before my eyes. The intelligent, sensible, calm parent of my childhood became verbally and physically aggressive. Her conversation was peppered with swear words and I was shocked when she yelled, "Go to hell!" I was astonished when the assisted living staff told me she was involved in a fist fight. I was embarrassed when she stole someone's teddy bear.

Who was this person?

Gradually, I learned to tell the difference between the anger of confusion and the anger of self-defense. According to "Anger Management Therapy for Dementia Patients," an article on the Answers 4 Alzheimer's website, some patients become so angry they stop talking. Others yell and gesture excitedly when they become upset. Anger management therapy, the ability to understand consequences and redirect anger, helps some patients.

But the problem with anger management therapy is that the person has to remember it. My mother could barely remember her name. From the caregiver's perspective, anger management may look like futile effort. Though the therapy may be only partially successful, the article says "any progress is undoubtedly helpful."

Anger may be a sign of sundowning, the late afternoon mood changes, agitation, fear, pacing and rocking that many patients experience. After my mother threatened to run away her doctor transferred her to nursing care. Mom thought I had put her in a mental institution and was furious. When I visited her one afternoon I observed her sundowning behavior. She paced back and forth and looked out the window nervously. Later conversations revealed that she was having hallucinations.

Similar behavior is described in an article, "Sundowners Syndrome," published on the Alzheimer's A Place for Mom website. Caregivers can dispel anger by sticking to a routine, monitoring diet, controlling noise, opening curtains to let light in, and turning on more lights. Redirecting the person (reading to him or her, playing soft music, giving them a glass of juice) may also help.

Exercise also helps to quell anger, according to "Managing Common Symptoms and Problems, an article on the Help Guide website. But it has to be regular and purposeful exercise. My mother did not like the exercise activities, yet she participated in them. One activity involved sitting in a circle and throwing a ball. "Don't they think I can catch a ball?" she asked.

In the later stages of the disease Alzheimer's patients may become belligerent and aggressive. Caregivers have to protect Alzheimer's patients from harming themselves, the article notes. Provoked as you may be (and my mother certainly provoked me), do not answer accusations, confront the person, or discuss angry behavior. "The person with dementia cannot reflect on their unacceptable behavior and cannot learn to control it."

Get some help if the patient is overly aggressive. You may also say, "I have to leave now, but will come back later," and walk away. Caregivers need to remain calm and look for aggression patterns, such as the anger of sundowning. Remember, anger comes comes from the disease and not the person.

Copyright 2010 by Harriet Hodgson

The Successful Assisted Living Marketing Plan Is Evolving

Some Things Are The Same

In our many years of working with the assisted living and senior care industry, the fundamentals of increasing the census have remained pretty much the same. Simply put, the backbone of an effective marketing strategy remains:

• Developing services that target a specific senior market.


• Providing "evidence" of how you care, and how much you care for that specific senior market.


• Building notoriety through word of mouth.


• Creating a "referral pipeline" among professionals.


• Matching your care to the prospects issues and solving their problems.


• Developing follow-up and keep-in-touch systems that build the trust of your prospects.


• Regularly providing new tools that help those who like you (family members, friends, referral sources) to promote your facility.

Some Things Are Different

The big changes in the selling and buying process have come in the execution of this strategy. The availability and the amazing functions of the internet, smart phones, social networks and other technologies have changed how the public expects to find your facility and interacts your with staff. These new communication mediums are now "required" and must be integrated into the selling process.

In addition, many assisted living prospects now "demand" to have easier access to information, be engaged during the buying process and have a higher level of control. They want to be aware, up-dated and reassured so they can trust their buying decision (when they are ready to make it), and then win over their family members.

Ideas & Suggested Changes

Here are some suggestions for adjusting your marketing to the evolving selling and buying process.

• Utilize a database. This will help you keep track of multiple phone numbers and e-mail addresses, personalize group communications, and keep track of where prospects sit in their buying process.


• Ask every prospect, family member and referral source how they prefer to be contacted. Highlight this preference in your database, smartphone and social networks.


• Improve your website and make it the hub of marketing communications. It should include very current evidence of your care and services, integrate your updates with social networks and keep-in-touch systems, encourage return visits and the sharing of your site, and provide new tools for people who want to promote you.


• Utilize e-mail and social networks to make people aware of your updates. The key is to not overdue contact so people stop paying attention. Mix up the updates with your Activity Scrapbook entries, Caregiver Tips, videos and articles about seniors. We have found that two valuable updates per month is usually sufficient.

Replace & Integrate

Many in the senior care industry will read this article and tremble at the thought of more work. At the beginning, setting up your systems will add work. However, once systems are developed and in place, the evolved marketing plan will be more efficient. Updates to your website and social networks that are filled with emotion and reality can take a marketing director little time, and be lots of fun. E-mail and social networks that highlight those updates can reach hundreds (or thousands) of people on the three key lists with little effort and cost.

When you compare the investment of time and money needed in this technology strategy with what goes into hosting the standard one-time, generic, small-attendance open house, this is a real bargain. Note: By the way, well done updates can make an open house a much more effective marketing tool over a longer period of time. It can also bring the event to those who could not attend. And for those who choose to pass on such an event, a great update system can replace many (but not all) of the benefits of an open house.

Even The Building Of Professional Relationships Is Evolving

In the old days, the typical marketing plan built relationships by visiting doctor offices and hospitals, dropping off a brochure and maybe some cookies, and chatting a little. The building of relationships is still necessary today. However, many face-to-face visits may evolve into a "tech" visit. The cookies may be replaced by photos of your chef baking, a cookie recipe for diabetics, or a Caregiver Tip on helping seniors with little appetite.

Now I know that many people consider technology to be cold and have no feeling. I agree...when it is left on its own. However, what I am recommending is using the mediums of technology to highlight the warmth, care and expertise of assisted living, and making these valuable assets accessible to more people in the method they prefer (and at their convenience).

It's Worth The Effort

The rapid changes in technology are forcing the marketing world to adapt and change, and at a faster rate than it did in the past. This does put an additional burden on assisted living marketing departments and small home owners. (So does a low census.) Plans and strategies must continue to evolve to meet the demands of the "current" buyer and referral source. A higher census (and less financial stress) will prove it was well worth the effort.

Overview of Contingency Fees - Attorneys Who Only Get Paid If They Win

A contingency fee means that an attorney agrees to take on a case without charging any up front or hourly fee. In exchange for working for free and taking the risk that a recovery will be made, the lawyer receives a percentage of what is recovered when the case is over. While lawyers in every state handle some cases on a contingency basis, this article specifically provides an overview of cases Illinois attorneys can handle on the basis of they only get paid if they win.

In Illinois, contingency fee cases are most commonly found in injury cases like workers compensation, personal injury, medical malpractice and nursing home abuse. There are occasionally small fees to obtain medical records in a malpractice case. Other cases include legal malpractice and class actions. Illinois legal malpractice cases attorneys will want to see financial damages as a result of an attorney's unprofessional conduct that would make it financially worthwhile. For example, if a divorce attorney's misconduct resulted in less than desirable visitation, a lawyer will probably not take the case on a contingency basis. However, if as a result of a divorce lawyer's unprofessional conduct the client losses $100,000 from the ex's pension, a legal malpractice attorney may take the case on a contingency basis. In class action cases, attorneys work on a contingency basis because so many people have been wronged that if the lawyer wins the damages awarded will be substantial to compensate all of the clients. The attorney will take a percentage of the damages awarded to compensate for the work.

Other cases that are sometimes, but now always done on a contingency basis include challenges to a will, commercial litigation, overtime or compensation cases from employment law, collections (if the amount owed is enough) and some child support cases. When challenging a will in Illinois, a lawyer can work on a contingency if there is a real dispute. Illinois law prevents them from taking a percentage of what is recovered if it is just normal representation of an estate. In employment law and overtime cases, lawyers will work on a contingency basis if the dollar amounts owed are large enough. For example, if a client is missing one paycheck a lawyer will probably not take the case on a contingency basis. In child support cases, it is rare to find a lawyer to work on a contingency unless there is money that can be collected.

Lawyers are prohibited from handling a divorce or criminal case on a contingency basis in Illinois. Illinois attorneys also do not handle defense of civil lawsuits on a contingency basis because there would be no way to get paid.

The fees that an Illinois lawyer charges for a contingency case depends on the type of case and risk involved. In workers' compensation claims for Illinois, the law limits the fee to 20% of any settlement. In medical malpractice cases there is a fee schedule that changes depending on how much is recovered. In most other matters, it is customary for the lawyer to recover 1/3 of the money awarded. In some cases this fee will go as high as 40% or more, especially if there is a trial and/or appeal.

Top 9 Emotional Issues You'll Deal With When Moving Your Elder to a Nursing Home

Hopefully you are never faced with a decision that far too many are. Those who are forced to deal with the terrible nursing home placement decision normally do so for one of several reasons:

Your elder becomes too frail to live at home on their own

Your elder becomes too confused with his or her surroundings and become a danger to themselves

Your elder suddenly has become violent with others - striking out at them for no apparent reason

Your elder has just had a major medical issue that requires full time care

Having to make a sudden decision on a nursing homes for a loved one can easily be one of the most difficult decisions a person will have to face in their entire life. One way to help with this situation is to make a plan for such an possibility far in advance of ever needing to make such a decision. This way, even if you are faced with an urgent situation, you'll be able to refer to the plan you put together that was based on sound judgment and plenty of research, rather than letting your emotions drive the decision. Any plan should be discussed with your elder and should adhere to their wishes as closely as possible.

Unfortunately, even if you have a plan, you are very likely to run into several significant emotional issues when the time comes to finalize long term nursing home care. You certainly won't be alone in this situation - any caring person will run into at least some of these feelings. Hopefully by knowing what you will expect when or if the day ever comes, you'll be better prepared to deal with these emotions.

1. A strong sense of relief

Now that you don't have to worry about the responsibility of caring for your elder, you'll likely feel a strong sense of relief.

2. Guilt

Once your feelings of relief begin to subside, feelings of guilt will likely set in - because you feel relieved.

3. Selfishness

You'll feel selfish because you are looking forward to your life returning to normal.

4. Self-reproach

Because you were not able to live up to the promise you made to your elder that they would never have to live in a home.

5. Remorse

Because you feel that you abandoned your elder.

6. Embarrassment

You'll feel embarrassed that you couldn't afford a better nursing home than the one that your elder ended up in.

7. Anger

That the costs of long term nursing home care are such a financial drain - on your or your elder's finances.

8. Fear

That the nursing home administrator will call you one day and tell you that you need to take your elder home because things aren't working out at the nursing home for any number of reasons.

9. Guilt

If #8 happens, you'll feel guilty because you don't want to bring your elder home to live with you.

It's very important to realize that all of these emotions are completely natural. It's also important to realize that having to place your loved on in a nursing home is not your fault and is something that simply can't be avoided. The later years in life can be very cruel to both elderly folks and family members alike - and none of us have a choice in the matter. You simply have to do the best that you can to deal with your emotions and not let them interfere with what's best for both you and your elder.

Chicagoland Assisted Living For Maximum Life Enjoyment

Assisted living means freedom and dignity for people in need of help to maintain their daily lives. Assisted living facilities are in the middle between nursing homes and independent living. Independent living is for the elderly who are able to live on their own but who do not want to maintain their own home. Many people like life in a community of people of similar age who share their interests. Independent retirement living communities provide many social activities, trips, and community service. Often independent living facilities also provide all meals prepared, and they also provide a wide variety of services and amenities. Unlike residents of independent living communities, residents of assisted living are people who are not able to live alone; but neither do they need the continual care of a nursing home. Assisted living facilities differ from nursing homes in that nursing homes care for people who are too frail for independent living, and who need continual medical supervision. The elderly who are basically self-sufficient and require less constant assistance are better served by assisted living facilities. These Chicagoland assisted living facilities make a point of encouraging the elderly to be as independent as possible. The philosophy is one of respect for the dignity of the individual - their right to make their own decisions. Assisted living facilities often combine with independent residences on the one hand and with nursing homes on the other, to create a continuing care community in which residents whose needs change over time can transfer from one type of care unit to another with a minimum of stress.

Assisted living means help with dressing, walking, bathing, eating, laundry, and housekeeping. People who are experiencing confusion or memory loss can also receive special assistance. Help with medications and medical assistance are also readily available. There are many different types of facilities offering different accommodations, but typically residents have private rooms and meals are taken communally. Recreational and social activities are provided, as well as opportunities for community participation.

There are assisted living Illinois facilities of all types and financial ranges for people in many different financial circumstances; and help in securing financial assistance is also available. Usually upon admission a service plan tailored to the needs of each resident details the individual services which are required and which the facility will provide. This plan is regularly updated to reflect changes in the patient's condition. There are usually three types of contract available. All of them include home, services, amenities, and emergency care options. They can be extensive, modified, or pay per service. The extensive contract is the most expensive, but over the long pull may be the most cost effective. Extensive usually includes unlimited nursing care without increasing cost. Modified contracts include a specified amount of nursing care, with any additional required care paid by the patient. The pay per service contract, which is usually cheapest, does not include nursing care.

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.

Mental and Emotional Injuries

When you suffer from a personal injury or a traumatic event, it may not be just your body that has ill effects. Your mind can be just as harmed as your body. Mental or emotional injuries can be complex and can take a long time to heal.

While some people may think of mental injuries as oversensitivity and as weaknesses, there are some things that are out of your control. People who suffer from this type of harm may not be able to control the way they feel about a traumatic event, and treatment for mental injuries can include coping methods to help you deal with them.

Probably the most well-known mental injury is posttraumatic stress disorder, or PTSD. Studies estimate that 7-8% of the population will suffer from PTSD at some point in their lives. Although we most often associated PTSD with military or combat experience, any traumatic or emotionally taxing event can contribute to this problem. Physical or sexual assault, natural disasters, serious accidents, divorce, and loss of employment can also cause PTSD.

Not only does PTSD cause emotional withdrawal, but it can also contribute to things like irritability, withdrawal, phobias, and hypersensitivities. Additionally, one of the three main symptoms of PTSD is intense flashbacks, nightmares, and memories. These can cause blackouts that may interfere with your ability to carry on a normal life.

Acute stress disorder is another mental disorder than stems from experiencing, witnessing, or confronting a traumatic event. Like PTSD, acute stress disorder can cause flashbacks and hypersensitivity to people, places, or things that remind a person of their traumatic event. Also, acute stress disorder can hinder someone from his or her regular lifestyle due to the feeling of being in a daze and the loss of awareness of surroundings.

Another example of emotional injury is verbal abuse or neglect. Verbal abuse, where one person degrades another by calling him or her stupid, ugly, incompetent, etc., can destroy a person's self-esteem and make it difficult to function normally. Suffering from verbal abuse can cause someone to "escape" by picking up self-destructive habits like binge drinking and drugs.

Neglect, such as nursing home neglect, can also degrade a person's self-respect. In a nursing home, neglect can not only cause physical damages, but it can wrongly teach a helpless elderly person that he or she is so unwanted and unloved that they do not warrant attention and care.

If you or someone you know has suffered from mental anguish stemming from nursing home malpractice, such as neglect or verbal abuse, these mental and emotional scars can be hard to heal. To help you fight for your rights, check out the Law Offices of William K. Goldfarb today.

Are Your Nursing Assistants in the Know About Emotional Losses of the Elderly?

It's part of life. As people get older, they are forced to deal with a greater number of serious emotional losses. Do your nursing assistants have an understanding of the types of losses experienced by the elderly? Do your CNAs know how to help their elderly clients deal with those losses? Consider sharing the following information at your next CNA inservice meeting.

Emotional Losses of the Elderly

There's no way around it. Losses are painful and often sad. They represent an end to something-and this ending creates an emotional wound. This is especially true for the elderly who must endure a number of different emotional losses. For example:

• At age 65, Sarah Smith retires from her job. Even though this gives her more free time, she misses the daily contact with her former coworkers. A year later, Sarah's husband dies. His sudden death leaves her devastated...and in some financial trouble.


• During that same time, Sarah is diagnosed with both diabetes and hypertension. She also develops chronic back pain.


• On her 67th birthday, Sarah receives word that her sister has passed away. Three months later, Sarah's best friend dies from cancer.


• Six months later, her son decides that she should no longer live alone. He helps Sarah sell her house and moves her into an assisted living facility.


• To the staff at the facility, Sarah seems like a grumpy, forgetful woman who keeps to herself and seems impossible to please. No one is very fond of her. But look at things from Sarah's point of view. Within two short years, she has lost her work, her friends, her health, her husband and her home. Is it any wonder that she tends to be grumpy and withdrawn?

Just like physical injuries need time to heal...so do emotional wounds. People who spend time grieving are doing what they need to heal their emotional wounds. The only "cure" for grief is to go through the grieving process. People must do this in their own way and at their own pace.

Grieving is hard work and can leave people physically and emotionally exhausted. In the end, the process of grieving encourages people to take charge of their own lives and to move forward.

Keep reading to learn more about the losses people face as they age, the different ways these losses can affect people and what you can do to help.

The Loss of Youth

As people lose their youth, they may start to realize that their days on earth are growing short. Some people react to this by considering every day to be precious. They work hard to live each day to the fullest. Others react by becoming depressed and by giving up their youthful hopes and dreams.

What You Can Do to Help

• If you have negative feelings about getting older, don't let them show during your work with your clients.


• Help your clients focus on the things they are still able to do, rather than dwelling on the things they can't do anymore.


• Talk to your clients about current events, such as politics, music and movies. Keeping up with the times helps people stay "young at heart".

The Loss of Family & Friends

As people age, it's common for them to lose a number of loved ones. They must face the deaths of their parents, their siblings and their friends. However, it's not always death that takes away family and friends. Longtime friends may move away-to retirement homes or nursing facilities. Children and grandchildren may also move. But no matter what the cause, the result is the same: older people feel they have lost their loved ones.

People who have lost friends and/or family members may feel unloved and unappreciated. They are at risk for depression.

What You Can Do to Help

• Don't dismiss the grief that older people feel when they lose their parents. For example, if your 75-year-old client loses her 95-year-old mother, her grief may run very deep. Encourage her to talk about her feelings and reminisce about her childhood.


• Remember that social connections are important for seniors. You can help by encouraging them to talk or write to friends and family members on a regular basis. And remember...it's never too late to make new friends.

The Loss of Work

Some people look forward to retiring at age 65. Others keep on working well past retirement age. However, even people who are looking forward to retirement feel some grief over the loss of work. Older people may feel pain over losing their daily schedule. They miss having someplace to go every day.

Many people take pleasure in being productive. A large part of their identity comes from their work-whether they are paid for it or not. If they lose the ability to be productive, they may feel worthless. They may start to think, "I am no good to anybody...I'm just taking up space."

What You Can Do to Help

• Remember that the goal for most seniors is to fill their time in a rewarding way-rather than to have each day drag on with no purpose. So, help your clients find a variety of interesting and fun ways to pass their time.


• Help your clients feel valuable by recognizing the knowledge and wisdom they have gained through the years. For example, ask for their opinion on a current event or on an issue such as how to invest money or discipline a child.

The Loss of a Spouse

Losing a spouse, especially after a long term marriage, can be especially devastating. With the death of a spouse, many people lose their best friend, their confidante and their sexual partner. Every area of life is affected.

As married couples age, they usually hope to grow old together, but death often interrupts these plans. Most people live out their final years alone-especially women. (Among senior citizens, over half the women are widows. Only 13% of men have lost their wives.)

What You Can Do to Help

• Encourage your client to share some special memories of their spouse with you.


• Avoid offering false comfort such as, "You'll get over it some day." or "It was for the best." It's better to say nothing at all than to use "clich矇s" like these.


• Ask your supervisor is there is a support group that might help your grieving client.

The Loss of Health

As people age, they can experience a loss of health in a number of different ways. It can be a gradual process...slowly losing eyesight, hearing, muscle strength or memory. Or the loss of health can be a dramatic process...a sudden heart attack, stroke or tumor.

Some people react to a loss of health by denying that they have any problems. They continue with unhealthy habits such as eating too much, drinking too much and smoking cigarettes. Their attitude is, "Well, I'm going to die anyway...might as well do what I want."

Other people react to a loss of health by getting angry. They feel betrayed by their bodies and "cheated" out of a healthy future. Still others react by focusing on every little ache and pain. Their reaction is based on fear. They anxiously wait for the next health problem to appear-and they look for death around every corner.

What You Can Do to Help

• Help your clients maintain their health as much as possible by eating a healthy diet, quitting smoking and avoiding too much alcohol.


• Because chronic pain can be a problem in the elderly, learn all you can about pain management.


• Be patient with elderly clients who are dealing with chronic illnesses. It may sound to you like they are constantly complaining about their health, but would you trade places with them...even for just one day?

The Loss of Independence

Many elderly people can still function on their own-they just take longer! Others may only need help for certain tasks like shopping for groceries or balancing their checkbooks. And, some seniors need help with basic everyday activities, such as bathing, grooming and dressing. Losing the ability to perform their own personal care can make your clients feel like children again. This can be difficult for many people to accept.

People who feel as if they have no control over their own lives may lose self-esteem. They may also become depressed and uninterested in doing anything for themselves.

What You Can Do to Help

• Allow your elderly clients to make as many of their own decisions as possible. This allows them to feel "in control" and may keep them from becoming more and more dependent on you.


• Enhance your clients' sense of purpose by giving them a responsibility: caring for a potted plant, straightening their room or folding their laundry.


• Above all, treat your clients with respect and dignity!

Remember...You'll Be Old One Day, Too!

As you work with elderly clients, do your best to maintain your patience and your sense of compassion. Your clients deserve it! Here's a little reminder, from a poem by Shel Silverstein.

Said the little boy, "Sometimes I drop my spoon."

Said the old man, "I do that too."

The little boy whispered, "I wet my pants."

"I do that too," laughed the old man.

Said the little boy, "I often cry."

The old man nodded, "So do I."

"But worst of all," said the boy, "it seems grown-ups don't pay attention to me."

And he felt the warmth of a wrinkled old hand.

"I know what you mean, " said the old man.

Board and Care Homes - What Are They?

Board and Care homes (also known as RCFE's - Residential Care Facilities for the Elderly) are residential private homes that have been licensed by the Department of Social Services to provide services to seniors. Most accept no more than six residents, but offer a cozy, home-like setting for frail seniors. At least one caregiver is on the premises at all times to assist residents.

Board and care homes come with a variety of characteristics. Rooms can be shared or private and may include a shared or private bathroom. Limited social activities are provided, but not to the extent of an assisted living facility. Specific needs can be met in this small setting, such as language, ethnic or food preferences, even accommodating a loved pet. Meals, laundry, housekeeping, transportation to doctor appointments are usually included. Most provide assistance with dressing, bathing, grooming, eating, medication management, and hygiene and continence issues. With hundreds of these homes scattered throughout most geographic areas, there is hardly a situation that cannot be met in a board and care home.

With most board and care homes, a resident will interact with just three or four caregivers each week. This allows caregivers and residents to form a close bond, which many seniors prefer. Homes range in care giving levels, from simply providing a personal presence for seniors to dealing with severe medical conditions. If fact, some specialize in very specific areas of healthcare and their related needs, such as non-ambulatory residents, stroke or paralysis residents, diabetes care, oxygen needs, catheters, colostomy's, and cognitive and memory impairments such as dementia, Parkinson's and Alzheimer's disease. Some medical conditions such as a feeding tubes or tracheotomies cannot be handled by board and care homes.

Generally, Board and Care homes are managed and owned by an individual or family who are closely involved in the day-to-day activities of the home. Board and care homes are a refreshing alternative to the more business like approach of an assisted living or skilled nursing facility.

The Myths on Long Term Care

The insurance business is something that I've been working in for more than a decade now and I have listened to a lot of peoples explanations on why they avoid buying insurance coverage. Most of the challenge comes from long held ideas which people look at to be true, while others are entirely false. It appears that most scenarios, for which we need insurance unless required by law, provide us an "option". Nevertheless, knowledge really is our finest educator and Long Term Care Insurance is no exemption. Any person who has experienced care for the elderly understands, with no doubt, just how significant this protection can be.

These are the four myths which guide people to think that they will never need this essential coverage.

1. My loved ones will take care of me, so I really don't need Long Term Care!

This is a really common belief and one that I have seen over and over again. In the 1950's when grandma required a place to live she usually journeyed amongst her kids. Nowadays; things are a little bit different. People are now having fewer children with the outcome being that the obligation for parental care may turn out to be the job of only one or two siblings supposing they are accessible AND have the time and money to take care of grandma. There's an old quote, "One mother can take care of ten children, but ten children can't take care of one mother?" This just goes to show that probably moving grandma around in the 1950's didn't work and it absolutely doesn't work nowadays. Include the fact that in many households where both spouses work, marriages frequently end in divorce and seniors are living for a longer time than they ever have. I absolutely don't want to live long enough to turn out to be a problem for my children.

2. When I'm old, Medicare will pay for whatever I need! Right?

Medicare was never created to pay for Long Term care expenses. Quoting the Medicare website, "Medicare doesn't pay for help with activities of daily living or other care which people can do themselves. Medicare will only pay for skilled nursing or home health care if one meets certain specific criteria. "

3. If I can't find the money, than Medicaid will pay for what I need! Right??!!

This is completely accurate! BUT! In order for a person to be eligible for Medicaid they need to first meet really strict guidelines with respect to assets. Simply put, they need to confirm that they are indigent. Furthermore, if there is a partner involved, any assets relocated from one to another are subject to a five year look back. For that reason, if you have assets including a house, a vehicle, or a 401K, this will provide some very huge problems needing the service of elder care professionals such as lawyers and planners and need to be done prior to the problem occurring. Even if you are eligible for a Medicaid price cut, your family may continue to wind up paying in over half the amount of your monthly rent at a experienced medical center. Are you informed that in some urban locations monthly nursing home expenses are between $10K and $15K per month?

4. I can take care of myself! I saved up enough money!

Sure, you can pay your long term care bills from your own savings account. Having said that, you need to think about the cost of long term care providers before depending on "private pay" as a strategy of financing care. Here are the latest national costs for long term care companies:

• $20/hour for a home health assistant
• $61/day for care in an adult day care facility
• $3,270/month for care in an assisted living facility
• $207/day for a semiprivate room in a nursing home
• $235/day for a private room in a nursing home

In 2011, the "average" value of a semiprivate bedroom in a nursing household, nationwide, was $75,555. In respect to the U.S dept of Health and Human Services, the typical period of stay in a nursing home is 2.4 years. Are you regimented enough to conserve this type of money? Is this where you want your savings to go if you are competent of such discipline?

Becoming a Certified Nursing Assistant (CNA)

Have you been looking for ways to make a true impact on those around you? If the answer is yes, then you are not alone. There are tons of people who are beginning to feel the desire to make a difference in the world. And they are taking on the role of the helper in many ways, ranging from that of the philanthropist who donates money to causes that mean something to them, to those who get their hands in the dirt and build homes for Habitat for Humanity and other positive organizations. But if your desire to help others is reflected in a need to interact on a one-on-one basis then you might want to consider a career as a certified nursing assistant.

What is a Certified Nursing Assistant (CNA)?

The field of nursing is considered to be a "direct care giving" field. Whether you are a home health aide, personal care assistant, patient care technician, or certified nursing assistant (CNA), your specialty lies in your ability to care for a person on a one-on-one basis.

In a doctor's office, the certified nursing assistant is typically the person who you first work with when called to the back. This is the person who will take your "vitals," weigh you, then take you into the examination room where they will then question the symptoms of your condition, and essentially make you feel comfortable and settled until the nurse practitioner or doctor comes in to see you.

Certified nursing assistants work under the supervision of a nurse and usually are in charge of performing the general needs for the patient. Some of these tasks include, but are not limited to: dressing, bathing and feeding patients, assisting with bedpans and urinals, checking vital signs, assisting with catheter care, answering a call light when needed, helping the patient perform range of motion exercises as a supplement to physical therapy, assisting patients in wheelchairs, keeping living quarters neat for patients, and accurately documenting all care provided to patients as well as any mental or physical changes.

Opportunities for CNA's are vast and can provide work in places such as nursing homes, adult health centers, assisted living facilities, hospitals, and sometimes with personal home care services. Other CNA's have found work in areas of hospice care and comforting those who are dying. While this particular area can be very rewarding for some who find solace in ushering a person to the other side, some become overwhelmed by the concept of death, so deciding to participate in this aspect must be thought out carefully.

How to Become a Certified Nursing Assistant

There are several ways to get your foot in the door as a CNA. One way is to enter a training program through the Red Cross. They offer a nursing assistant program designed to teach you the necessities of the field, including learning medical terminology, basic human anatomy, communication skills, basic math skills, and how to care for patients with Alzheimer's disease. In addition, they give you hands-on experience in a health care setting. Toward the end of the course, you learn how to launch your career as a CNA. They provide instruction on how to conduct a successful job search, create an effective résumé, develop interviewing techniques, and eventually excel to new careers within the field if interested.

Other ways to step into the field are to take classes through your local community college or through a medical facility. Whichever route you choose to educate yourself, you will be provided with instruction generally be a registered nurse who will teach the ins and outs of the skill. Of course, all of the classes in the world cannot measure up to the experience needed in day-to-day activity, so before certification is obtained, it is advised that you begin pursuing opportunities to develop and perfect your new skill.

The Life of a Certified Nursing Assistant

Any person who is or has been a certified nursing assistant will profess to the number of challenges that face them. First and foremost, if you are not a people person, this field is not for you. Clearly, if you're a person with a short temper, you will not be as suitable for this field because of the multitude of people with short tempers you will have to deal with. You have to have "spine," if you will deal with possible sexist comments, racial comments and anything else the person conjures up to say or do (spit, kick, hit) to you. Your goal will have to be to take care of this person no matter what their personal issue may be with you, learning to forgive them for their ignorance, and believing that they deserve top-notch care no matter how they treat you. This is not easy for some people and is definitely something you need to take into consideration before committing to this field.

Also, if you have a weak stomach to blood, bodily odors, and bodily fluids, you are definitely in the wrong field. Often times, your job as a CNA is more "graphic" than that of a doctor because the doctor does not change bed pans or help patients shower, but you do. So you have to be ready and willing to face hygiene issues that others are not ready to handle. You may have to be in charge of the daily care of a person who is unable to move without your assistance, which means you will be responsible for helping them use the restroom, bathe, cleaning their bed sores, and much more.

Another issue with being a certified nursing assistant is often times the shortage of nursing assistants in one location. There are nursing assistants who find that they are caring for an insurmountable number of patients at one time and become quickly overwhelmed, resulting in them leaving the field altogether. This is especially true of those assistants who are sensitive to the physical and emotional ailments of their patients and absorb their pain on a deeply personal level. However, if being a nursing assistant is what you really want, you must not let this deter you and work diligently to find the work environment and set of circumstances that more closely suit you.

Becoming a certified nursing assistant can be a very rewarding field for those who have a great interest in helping others. But if you're unsure of whether you're able to handle the vast array of personalities you might encounter, or even what you might face from patients physically, you might want to take time to strongly consider your decision. There is nothing worse the choosing an important career such is this just for the money; not only will your patients suffer from the lack of caring you display, but you will also suffer from the lack of fulfillment you will feel. Be sure to conduct plenty of research on becoming a certified nursing assistant first then if you still feel inclined to take this career on, do so with a kind, open and warm heart.

What Should You Expect As a Nurse in a Nursing Home?

With baby boomers nearing retirement, the need for quality nursing homes is expected to grow by more than 500 percent within the next 8 to 10 years. With more long-term care facilities opening their doors to communities throughout the nation, the need for qualified health care professionals will proportionately increase. If you are a CNA, an LPN, or a RN, consider the advantages of working in a nursing home or long-term care facility. As the fastest-growing part of the healthcare industry, nursing homes offer an opportunity for advancement and increased earning potential. Before you start applying for a position like this you should understand what to expect in the work environment. Decide if this nature of work is right for you and start a meaningful and fulfilling career.

Nursing Assistants Must Be In Shape and Capable of Physical Labor

All nursing assistants must be able to work on their feet. In long-term care facilities, nursing assistants can expect more intensive labor than in hospitals. The primary reason why these positions are more intensive is because a majority of people in long-term care require assistance transferring. CNAs will help lift and transfer patients in addition to performing bed baths and changing bedding while it is occupied. If you are a CNA it is important to understand that CNAs must deal with heavy work and stressful working conditions. The stress and heavy work load are the primary reasons why turnover in nursing homes is so high. Many long-term care facilities will raise wages to encourage nursing assistants to stay as the need for CNAs grows.

Registered Nurses and LPNs

While CNAs do handle heavy lifting, RNs and LPNs may have to perform these duties if an assistant is not available. While the job does sound difficult and many people have the idea that nursing homes and long-term care facilities are depressing, many nurses enter this atmosphere and never want to leave. Nurses who have been in long-term care for more than a decade, state that their job has become their passion. One of the main reasons why registered nurses and LPNs love to work in nursing homes is because they are made part of an interdisciplinary team made up of social workers, physical therapists, dieticians, managers, activity directors and more. The entire team works together to discuss the plan of care for a patient. Compared to hospital environments, nursing homes make nurses an integral part of care for residents.

Another reason why CNAs, RNs, and LPNs find a passion in nursing homes is because of the residents. When you deal with patients who live at the facility you can build a relationship with them. This bond is what keeps nurses in their careers. While building a bond can be difficult in some situations, the friendships you make will create lifelong memories.

Nurses who are employed in nursing homes need to be compassionate and knowledgeable. If you are looking for a stable opportunity that could change your life, consider the benefits of applying for nursing home positions.

Granny Flats Kit Homes: Tips in Choosing One for Your Elderly Relative

Granny flats kit homes are most popular in North America, Britain, and Australia. These are custom-built small houses that are commonly built in the same plot of land as that of the main house. These are particularly ideal for elderly members of the family who don't prefer to enter nursing homes but can't live on their own. Having these flats gives them a sense of independence as they will have their own living quarters that's very accessible to their loved ones. If you're planning to get one for your elderly relative, below are some pointers that may come handy when you look for kit home designs.

Searching for kit home designs:
While it's quite expensive to build houses these days, you can be cost-effective when building flats for your elderly loved ones. Kit homes are popular budget-friendly alternatives for people who aspire to build and have their own homes. The first thing you can do is to search for known companies that offer customizable and modern kit home designs you can avail for the family. You can check out their photo and work galleries online so you can save a lot of time trying to find ideal designs.

On choosing the flat designs and colors:
Since the flat will be built alongside that of the main family's home, it's best to go for designs and colors that will match or complement the original design scheme for your own home. Neutral shades can also give the house a classier appearance and impression.

Basic knowledge about zoning laws and land permit:
Before you purchase a personalized kit home design or decide to build a secondary building yourself, it's important to be informed with essential zoning laws and necessary permits you need to have beforehand. It's highly recommended to consult with local housing authorities right from the start so you can choose more suitable designs and proceed with your construction with no problems.

Deciding on the size:
Your elderly relative's lifestyle and specific preferences are important in determining the ideal size of their homes. While granny flats are commonly built with only one bedroom, you can still search for designs with 2 or more rooms if these are more preferable to them. Having at least 2 bedrooms is also ideal if there are visiting relatives and/or there's a live-in nurse taking care of your elderly parents. Single-storey flats are also most popular because utmost importance is given to safety and comfortableness.

On maximizing space:
Granny flats are usually smaller extensions to the main house and are generally small. However, you can still maximize space by going for comfy and highly needed fixtures and appliances at home. Also settle for color schemes that can give the impression of wider space, and don't forget to make the most of available light and natural ventilation.

Selecting a Nursing Home - Your Guide to Finding the Right Long-Term Care Facility

The choice to place a loved one in a nursing home is often difficult, emotional, and not without misgivings. Unfortunately, once the decision has been made, the stress does not disappear. Choosing the right elder care facility is of paramount importance, and with more than 16,100 nursing homes in the country, finding the right one is a daunting task.

There is no magic formula for choosing the right long term care facility for a parent or grandparent, but following some basic steps can help make the task more manageable.

Step 1: Be Prepared
A large portion of nursing home admissions occur after a stay in the hospital, usually following an injury, surgery, or a medical scare. Because of this, you may only have 24-48 hours to find a long term care facility. This is not enough time. Being prepared and aware of your options before being placed in this situation will help to eliminate the stress, second guessing, and often overwhelming pressure. Do your research before you are forced to make a decision. A tip for the unprepared: You may be able to appeal a hospital discharge, buying you more time.

Step 2: Do Your Reading and Research
Before you make a list of nursing homes, before you visit any facilities, and before you have to choose a nursing home, you should do a little reading and research. For many, this step may be a luxury or seem unnecessary, but it is very important. Ideally in the early stages of your nursing home search, you will have time to read and review the wealth of literature, both on and off-line, about nursing homes and elder care. The American Association of Retired Persons and Medicare websites include numerous tools, articles, fact-sheets, check-lists and more. These reliable sources provide information about elder care facility inspections, the rights of nursing home residents, alternatives, payment options, and much more. Knowledge is your best tool.

Step 3: Making a List
Whether you have time to do preliminary research or not, you will need to compile a list of long term care facilities that are your options. While you may be tempted to Google nursing homes in your area, and this may be time efficient, it is not in your best interest, or the best interest of your loved one. There are a number of ways to compile a list, and rather than just using one, you should take what you find from all of them to make your final list. In terms of online tools, using Medicare's website is your best option for finding local long term care facilities. However, don't forget to ask hospital social workers or discharge planner for a list of local homes; providing this information is their job. One of your best sources for the names of nursing homes in your area is actually people that you know and trust: friends, family, doctors, or clergy. Ask for their input and consider their recommendations. Finally, you can call the Eldercare Locator (1-800-677-1116) for information about elder care facilities near you. Combining all these sources will help you come up with a list of viable nursing homes to choose from.

Step 4: Making the Visit
Before choosing a nursing home to send your loved one to, you should visit the home, more than once, to assess it in person. For your first visit, schedule a formal tour and go over basic details (what services they provide, what fees they charge). Ask to see a copy of the state's most recent inspection report. All facilities are required to provide these. Signs that the home may not be run well include the smell or urine or feces, unclean bathrooms, and residents wearing restraints. Your second visit should be on a different day, at a different time, and unannounced. Staffing often varies, and this will help you get a better picture of home the facility is operated. Asking to join the residents for a council meeting can also provide a window into their lives.

Step 5: The Choice and Beyond
Following the steps above should provide you with an accurate picture of your options. Based on the information you have gathered, the condition of the elder care facilities, the cost, proximity, etc, you should be able to make an informed decision. Here is the final, important tip: Keep visiting the elder care facility. Monitor the condition of the patient, make sure that the care plan is being followed, and let the staff know that you are an involved relative. While it may seem wrong, nursing home staff members know what residents receive regular visits, and these residents are likely to receive a little additional care, just to avoid the possibility of complaints.

Simple Living - High Thinking

What is the source of all happiness? Is it money? Or is it power, name, fame and recognition? Nothing appears to be true as most of the wealthiest, famed and powerful people are no happier than the ordinary people. If it is true, why do we all strive to achieve these material goals to achieve happiness?

The answer seems simple. We always crave for what we do not possess in the anticipation that once we get what we want, we should feel happy. This concept seems to have originated from our basic desire to satisfy our hunger. When you are hungry, you desperately seek food. You feel satisfied once your stomach is full, yet the craving returns after a few hours once the food is digested.

No animal except man has understood this simple truth. Hence man did not feel satisfied after satisfying his hunger as he learned that the craving will come back. Hence he anticipated the future by using his thought, and started cultivating and storing food and grains so that he would be free from the necessity of satisfying his basic need. Once he had taken care of his basic needs, he started thinking high about larger things of life like the understanding of the material world and even thoughts of God or the Creator of the universe.

Jesus said that a man will not live for bread alone. It is because man is the most superior creation of the world and he cannot be satisfied by merely living to eat and reproduce. He eats only to live. The goal of his life is to think high, as high as the thoughts of God.

Then, why most human beings are not happy? The answer seems to be that they fail to follow their nature and seek happiness in satisfaction of their basic instincts just like any other animal. In order to feel happy he has to think high, not only for the human being but also for all the creations of the universe. It is only by developing proper understanding of the world that we can feel happy as happiness can come only if we are able to know the minds of the people and understand the reason for their action. Improper understanding of the world causes frustration since we always find that actions of other people to be wrong and unreasonable.

Creativity

Right knowledge is necessary to understand the world. Yet knowledge is often available in the form of written words which are created in a particular context. Since the world changes with every passing moment and we never deal with the same people and the same situations again, we can never use old knowledge to solve new problems. We have no option but to create new knowledge for ourselves taking help from the old knowledge. The new knowledge must be useful for understanding the present world and solve the present problems. This capability of human beings to create new and useful knowledge is often called "Creativity".

Creative people not only solve their own problems but they also help other people and societies in solving their problems. The world always seeks people who can create new knowledge for the present realities of the world based on the knowledge of the past. These people are able to create knowledge as they can understand the secret of knowledge and modify it to suit changes in time and values.

Creative people are capable of thinking beyond the obvious, beyond the written words of literature or beyond the senses? What are the necessary conditions for creating such thoughts which are relevant yet eternal? How do people create such thoughts? What motivates them to create new thoughts? How can one become such a high thinking person?

Maslow's Law of Hierarchy

This theory was best expressed by Maslow in his 1943 paper "A Theory of Human Motivation". The basic concept is that the higher needs in this hierarchy only come into focus once all the needs that are lower down in the pyramid are mainly or entirely satisfied.

Maslow believed that the most essential need of man is physiological needs or the deficiency needs. As per this theory, man can think high, viz. the stage of "self- actualization", only after all his lower level needs like food, water, security, confidence, self-esteem and respect by others are satisfied. These needs are called as the worldly needs since they are material in nature.

After man has satisfied all his worldly needs and he has reached to the top of the world in power and riches, he may still not be satisfied as he seeks to grow further beyond the world, i.e. near to God. Maslow termed it as growth needs associated with psychological needs. It was termed so because it is unique in each individual and this need is non-materialistic in nature. As per the theory, these innate growth forces constantly create upward movement in the hierarchy unless basic needs remain unmet.

The Validity of Needs of Hierarchy

Mysterious are the ways in which the world functions. For every theory, there seems to be a counter-theory. Often, thoughts that sound logical and satisfy our commonsense, turn out to be nothing more than an illusion created by logic and accepted by man without application of his mind.

It appears that most of the creative men made their best creations when even the basic needs were not met. For example, Einstein wrote three best papers on photoelectric effect, Brownian motion and theory of relativity at the young age of 25 when he did not have a decent job, had no recognition, had little wealth and had been facing the worst period of his life financially and emotionally.

All through history, people reached to the self-actualization phase not as the last step of the ladder of their development but often in the first step itself and the rest of the stages followed thereafter.

It appears that satisfaction of worldly needs is not the beginning of creativity or high thinking but often the end of it. Even the greatest creators lost their creativity once their worldly needs were satisfied and they got recognition and respect, power and wealth from the world. Thus worldly possessions seem to be the biggest enemy of creativity as they kill creativity as soon as they meet each other. They are like antiparticles that annihilate each other as soon as they are brought into contact with each other.

Indian thoughts on Creativity

Indian philosophers realized, many thousand years back, the need for creation of a separate class or caste for creation of knowledge. They understood that worldly desires can only create materialistic knowledge which can make rich people richer, powerful more powerful and create an unequal society. The materialistic knowledge can only create a materialistic society where people would be fighting with each other for more wealth and power. The purpose of true knowledge is to unite the world and bring peace, happiness and prosperity to all and not only to a few.

They discovered that worldly possessions are in reality the biggest enemy of the true knowledge. They, therefore, attempted to create a class members whereof could be kept away permanently from the worldly pleasures, so that they could focus on the creation and distribution of knowledge. They called such professionals as Brahmins or the "knower of the universe" and gave them the highest place in the society but without any material achievements.

Brahmins held the responsibility for acquisition of knowledge and wisdom for the world. They wrote the earliest books for mankind. The Vedas are now accepted as the oldest creation of human mind. The earliest Veda i.e. Rig Veda originated around 3500 BC- 1500 BC. The Vedas were followed by the Upanishads and then by the Bhagavatdgita, the most famous treatise of the Indian philosophy.

However, the life of a Brahmin was the most difficult. As per the Shastras (holy books) their duties comprised of teaching, learning, performing Yajna (vedic rituals), accept charity and give charity.

The typical daily schedule of a Brahmin, according to the Sastras, is described as following:
o A Brahmin must get up two hours before the sunrise (Brahma muhurta).
o After getting up, he cleans his teeth, bathes in cold water and performs prayer
o Next he performs rites or sacrifices to the gods
o Next is the daily study and chanting of the Vedas
o In the second part of the daytime, the Brahmin must teach his disciples the Vedas
o Afterwards he must gather flowers himself for the worship he is to perform.
o Since he is not expected to earn a salary, he must beg for his food and also for the materials for the conduct of various sacrifices.

Shastras gave Brahmins the right to beg for their food and other requirements. They were not expected to accumulate wealth and own lands. They must donate excess charity to the priests. Brahmins were permitted to eat only Sattvik or simple food which included raw fruits and vegetables, milk, and limited cereals.

The daily schedule, eating habits and duties prescribed for Brahmins, were based on long experience of Indian philosophers. They had understood that the only method to create divine or eternal knowledge was to rise above the worldly pleasures of senses.

Simple Living: the only method for high thinking

The proof of any theory lies in the real-life examples of the world. We can ourselves see that all great thinkers of the world led a simple life. Some of them continued to remain simple and hence, they maintained their creativity till their last moment, while others fell prey to the worldly temptations and lost their genius.

Gautama Buddha is one of the greatest philosophers of the world, who was born in 563 BC. He founded Buddhism, one of the greatest religions of the world. He was the son of King Shuddodhan and was brought up in luxuries of life. He got married and had a son. However, at the age of 29, he renounced all the material possessions including his family and became a monk. He wandered in all places and meditated for six years before he got enlightenment or true knowledge at the age of 35.

Jesus Christ was the founder of Christianity, the most popular religion of the world. He was born at Bethlehem from Joseph and Mary. He assisted his father in carpentry. His parents escaped to Egypt to protect their child from the reach of the Judean king, Herod the Great. Jesus was lost at the age of 12 and no account of his life is available till he attained the age of 30, when he was baptized. Following his baptism, Jesus fasted for forty days and forty nights. During this time, the devil appeared to him and tempted Jesus thrice. Each time, Jesus refused each temptation. He started his public discourses thereafter, which attracted a large number of people and gradually gave birth to Christianity.

Albert Einstein is widely regarded as the greatest scientist of the 20th century and even of all time. He could not find a teaching job due to his unconventional thoughts. The father of a classmate helped him obtain employment as a technical assistant examiner at the Swiss Patent Office in 1902. The job barely provided him enough salary to make both ends meet. During these years, he stayed in a single room apartment with bare minimum facilities. Yet in 1905, he wrote four papers that changed the world forever and gave birth to modern physics. Most physicists agree that three of those papers (on Brownian motion, the photoelectric effect, and special relativity) deserved Nobel Prizes. He was awarded Nobel Prize for his paper on Photoelectric Effect in 1921, i.e. 16 years after its publication. Despite being world-famous, he maintained a simple life-style and lived in a small apartment at Princeton University. He limited his wardrobe so as to save time in selecting his dress.

We can find similar lifestyles among all great thinkers and philosophers like Mahatma Gandhi, Darwin, Newton, Mirza Galib (Urdu Poet), Tusidas, Kabirdas and innumerable other great thinkers of the world.. In the history of mankind, no king, or dictator, or rich man has ever earned recognition as a creative genius, though they had fulfilled all their physiological needs.

Conclusion: The time to think high is now or never

Most people believe in the Maslow's law of hierarchy, which stated creativity or self- actualization as the last stage of fulfillment of human needs, only after all the worldly needs were satisfied. They, therefore, strive in their life to satisfy all their worldly needs in the hope that after they have achieved all their worldly goals, they would strive for self-actualization or doing things which interest them most or the things they love most. In the process, their life is passed and they never get time to understand and acquire the right knowledge of the world, which is necessary not only for the spiritual quest of man but also for making him happy. Since happiness is the goal of every man or woman, hence, the right time to start thinking high is now or it would never come.

Information On Licensed Practical Nurses

The home health care providers are not really full nurses. These are usually nurse's aides or LPN, i.e., Licensed Practical Nurses. These nurses deal with the entire health care arena and usually do not specialize in any particular field. They provide medical assistance to the patients that suffer from chronic illnesses, long healing and recuperating terms or are just too old to take care of themselves. Most homes comprise at least one of the above cited members in their family and not all family are capable of providing the much needed health care on their won. They need someone to rely on - someone whose job and training entail specifically just that. That is where the LPNs come in.

These nurses are generally restricted to provide care for patients in their own home but are now being employed by hospitals and other health care institutions. They can carry out all the duties of the regular nurses without needing to undergo further training.

They are generally of two main types when it comes to home care - full-time and part-time. The part-time ones have specific work hours scheduled during which they are required to carry out the care of the patient. In most homes, other members of the family willingly and happily care for the patient but because of school or work restraints cannot be there all 24 hours in the day. Therefore, the nurse is hired for those hours that there is no one at home.

In the case of the full-time ones there is no fixed time that they are allocated to carry out their duties. They are usually present 24 hours a day, 7 days a week. In fact, they live in the same house as the patient so that they can be called upon at any hour. They are generally required not just for convenience but also because most of the times the patient requires specialized medical care which is not possible to be carried out by an untrained member of the family.

These LPNs work with diligence and complete professionalism and are therefore quite sought after. They are also extremely helpful in case of any medical emergency because they are trained to carry out emergency procedures. Their skill, training and years of training can be very helpful to the patient and his or her care and comfort is made top priority!

Exploring a Variety of Nurse Practice Settings

If you are currently in a nursing school program and wondering where you will apply your skills upon graduation you should know that the sky is the limit. Nursing is a helping profession that allows for application of skills in many different settings. Unlike other professions, nursing is very versatile and there is always a need for qualified nursing professionals across a broad spectrum of areas. Finding your nursing niche may take some time but there is definitely a practice setting to suit anyone considering or pursuing the field of nursing.

One of the main practice settings for a nurse is the hospital. Most people are introduced to the hospital nursing setting while in a nursing school program through a clinical. The hospital setting is considered by some to be formal. It is also one of the few practice settings that allows a nurse to experiment with a variety of specialties. In one hospital alone you can gain experience working in neonatal or pediatrics, medical/surgical, the emergency room, the operating room and even the intensive care unit.

Nurses who work in a hospital setting work a variety of different shifts including weekend only options that give them the entire week off if they agree to work Friday, Saturday and Sunday. Hospital practice settings offer lots of overtime and opportunity to advance but can be somewhat stressful given the nursing shortage.

An additional practice setting is a nursing home or a hospice. Nurses who work in nursing homes and hospices are usually devoted to providing quality care to patients who are older and/or stricken with illness. One of the main concerns may be to provide comfort to these patients while they are on their last days. Many of these nurses also work a variety of different shifts available 24/7 and in the nursing home setting you will also find certified nursing assistants who are of valuable help to these particular nurses. Nurses who work in the nursing home or hospice practice setting must be able to have a great amount of compassion and sympathy and the willingness to deal with issues of death and loss. Many of these nurses are available on an on-call basis to deal with sudden deaths or urgent care matters for particular patients.

For those who love interacting with students using your nursing skills in a school may be the practice setting for you. Some consider school nurses public health nurses because they are not working in a clinical environment and many focus on the prevention of disease. School nurses can be found in schools both public and private from kindergarten to university level. Their main job is to ensure the health of the students and the school staff. Many administer immunizations and keep track of these records. Some also provide education on sexually transmitted diseases, promote nutritional programs and provide medical attention to the student body when necessary.

The Future of 3D Animation - The Virtual World on Steroids and Life As Simulator

The future of animation is nearly upon us, where you become your own avatar in a virtual world, interacting with characters and becoming one yourself. Let me explain, a few years backy I met an interesting Gentleman at a Coffee Shop, Robert V. Ries, was his name. Bob expressed to me that he felt our life experience was nothing more than a really good simulator which put us into organic bodies to experience the Earthlings Realm and to test our will and strength of character in a variety of situations.

He went on to say that we were interacting with many other is the same simulator. We talked for hours and his theories seemed somewhat far-fetched, although he did go into a long scientific explanation of how this might work. He explained our advancement of Artificial Intelligence, Simulation, Electronic Gaming, as well as modern day movies such as Vanilla Sky, The Matrix and Fight Club. We discussed the Department of Defense's Net-Centric Battlespaces where your targets came up in augmented reality and how your night vision and eye-tracking systems became human brain-mind-eye interfaces with the silicon world in a 4D world where you could see below, beyond and 360 degrees.

He explained paradigms of time, space and mind. Additionally I brought up other concepts which assisted the conversation; concepts of NASA's ten screen Air Traffic Control Simulators, Sci-Fi writer Ben Bova's insights on the future of Mars and space for entertainment tourism, Bill Gate's investment in Six Flags Magic Mountain and DARPA's research with mapping of a human life studying the experiences, emails, movies, conversations and events from birth to death.

The discussion in fact went through all the technologies of simulation from truck driving to first responders. It became apparent to me that even if the life experience was not a simulator, well with the rapidly approaching technology, it certainly could be. We also discussed issues of one in a state of animation where their bodies did not move but they remained in the life simulation event, which they had chosen, and their bodies were flipped over and biometrically watched as to prevent entropy; similar to the movie Coma.

We decided that perhaps it would not be such a bad life as you could chose your dream or simulation, rather than facing a reality. Another thought came out of the conversation which is intriguing and that is the use of a human collective of minds of those who were currently in their simulator. Since many parts of the brain would not be used they would be hooked together at a quantum level to work on problems and being fully exercised while the other parts of the brain were fully engaged in the simulator. In fact we determined by lengthening the dreamtime of the participant we could extend their life by ten fold and still borrow some of their brain capacity while idling the body.

We further surmised that we could use brain in the simulator during their pretend dream times and take them down to 1-5 Hz frequency for super immune healing of the body, blood filtration cleaning and ion-therapy. Meanwhile while operating at such low frequencies the mind would be straddling what we perceive as time. We could then send others into the simulator for brief visits to ask questions of the participant to see how their life simulator was progressing, interact with them and then report back the findings and possible futures that their brains had picked up on.

When the person woke up they would feel younger, be in perfect health, be many years forward in their actual life and then return to society free from psychological issues, health issues and in the future. But who would volunteer for this? Rather who might pay for this. Our thoughts were anyone dying of a disease, anyone who could not cope, anyone who felt that they were living in the wrong time period or anyone who really wanted to experience an extreme in life. Extreme pleasure, adversity or challenge seekers would be worthy candidates, also it would be great for offenders of society or prison rehabilitation as they would be donating brain capacity to the collective for important projects, learn a new lesson, be cured of their disruptive behavior and so on.

Our conversation ended abruptly as he noticed he needed to get to the airport top catch his plane back to the UK, although I had not gotten his email address for further dialogue to continue this conversation, perhaps me passing it on to you may be just as good. Think on this for me.

About Whiplash Compensation

Are you looking to make a whiplash injury claim? You may be eligible to claim whiplash injury compensation if the accident was not your fault and if it occurred within the past three years.

Whiplash injury can be painful and cause a great deal of discomfort. Whiplash can vary greatly in severity, from slight pain and discomfort to disability. The victim may also need to undergo surgery in some cases. The pain and discomfort can last for few days or a lifetime. In some cases, whiplash injuries caused as a result of road accidents cause long term disabilities as well.

Whiplash Injury Causes

Road accidents involving rear end collisions are one of the most common causes of whiplash. When a collision occurs, there is an unexpected and sudden movement to the neck. Although the body is restrained by a seatbelt, the head is not and this is the reason, occupants in a vehicle are most likely to suffer whiplash injuries when collisions occur.

The speed of the impact doesn't need to be high for whiplash to take place. Such injuries are even possible when the speed of the impact is very low. If a whiplash injury has been sustained following a road accident, the victim may be entitled to make a whiplash injury claim.

Whiplash claims can also be made if someone got involved in a sporting accident due to the negligence of another person. Other causes of whiplash which can give rise to potential injury claims include slips, trips and falls, holiday accidents, horse riding accidents, workplace accidents and even criminal assaults.

Whiplash Recovery

Some people are able to make full recovery quickly, but for others, the restricted movement of the neck and pain can be long lasting. Whiplash is easy to diagnose and it is also easy to establish the severity or extent of the injury. The amount of compensation that the victim receives usually depends on the severity of the injury. The more severe the injury, the higher the amount of compensation will be. This is because severe injuries can affect an individual in a number of ways. It can affect him physically, mentally and financially. Therefore, the compensation entirely depends on the amount of suffering and losses.

Seeking Legal Advice

In order to obtain fair compensation, it is essential to seek legal advice following a whiplash injury. A good injury lawyer will be able to assist you with your case and also help you recover compensation for your pain, suffering and other damages.

Stop Elder Abuse in Assisted Living Facilities by Getting to Know the Caregivers

I'm here with Margie Veis, the Executive Director of Summerhill Villa, an assisted living facility in Santa Clarita, California.

KH: We hear stories about elder abuse and things like that. How can families insure that won't happen?

MV:: Truthfully, I think that fear is always going to be in the back of people's minds.

Same thing as when you drop your child off at preschool. You're trusting strangers to take care of your loved one, so I think you need to be in tune and pay attention to your parent. Obviously, if someone has dementia and they say things you have to take it at face value, but I don't ever poo poo anything. I hate to believe it would ever happen, but I also would never stick my head in the sand and say it never would.

I think, again, getting to know who are the caregivers, getting to know the administrator, getting to know the nurses. Not that you have to be best friends with them but you can really get a feeling. Also, look at your parent and see how they are interacting. If every time a certain care giver walks by your parent they flinch, or it just doesn't feel right, you need to say something.

I don't think anyone could ever tell me it would never happen here because you can never say never. There are bad people and we do everything that we can, not to have them in our building.

KH: The residents could cause the problem. It's not necessarily your own people.

MV: That is true. It could be a resident. It could be a family member, it could be a visitor. I have to be in tune to family members with their parents. There are family members that take advantage financially, and there are family members that are verbally abusive. That's elder abuse. It's not only hitting someone, it's taking their money, it's using their money to buy personal things for you. It's calling your parents stupid, it's threatening them with things like "You know mom if you don't do this I'm not going to pay your bill. You're going to end up out in the street." It's physical. It's emotional. It's neglect. It's isolating. It's a broad spectrum of issues, and we have to be in tune to things like that. We do abuse reporting and those types of things with our staff because we're mandatory reporters.

Allowance For Developing Leadership

The future seems so far away from our day-to-day duties and yet preparing for tomorrow is a principal responsibility of our leadership role. Who will replace us becomes the hardest question of all. This question must be wrestled with without bias on your part. Of course no one can do your job as well as you can, you're not retiring, you're in good health so why think about a succession plan?

Developing your succession plan should be high on your priority list for two reasons. That dream job you always wanted comes along suddenly and because you've spent considerable time developing potential replacements you'll feel good about leaving in a timely fashion and leaving your facility in good hands. Secondly, your facility is an ongoing business; the loss of a key person can be crippling for a period of time. As the incumbent you must not put the facility in this situation. With a ready and able replacement you will lessen this issue.

We are in leadership positions because we demonstrate good judgment. The question becomes, how do you develop good judgment? I believe the most effective way to develop good judgment is through experience and you get experience by performing new assignments and making mistakes.

To develop subordinates for leadership responsibilities and or your replacement, it is critical to create an environment that allows for mistakes as part of the learning process. I remember as a young administrator my father would tell me, "If you're not making mistakes, you're not doing anything." Create an environment where mistakes are considered a normal occurrence. You may want to publicly proclaim, " You will make mistakes, but learn from them."

Your facility can't grow and develop without taking risks and when risks are taken mistakes become part of the process. Do everything you can to eliminate the fear of making mistakes. If you want staff to make ten decisions and seven are mistakes the benefit of the correct (good judgment) will outweigh the mistakes. The mistake is simply a cost of doing business. Whether a mistake or good judgment is the result the follow up question should be "So, What have you learned?" The development of a successor is up to you. I believe it is time well spent.

If you are experiencing fear about deciding to be a leader, laugh your fears away by following this simple plan. Kenneth E. Strong, Jr, and Professor John DiCicco can help you eliminate those fears and give you the confidence to lead.

Download you copy of "Leadership Is A Choice" today at http://www.decidingtolead.com

Feel free to use this article, in your publications, newsletters, blogs, e-zines and web sites in its entirety provided you include the following: Copyright 2008 All rights reserved. Kenneth E Strong, Jr. http://www.decidingtolead.com Front Row Connections, LLC, Virginia Beach, Virginia.

High School Technical and Vocational Training Courses

There was a time that vocational training meant focusing only on skilled trades such as being a mechanic or a welder. But since industries have diversified especially with the advent of the computer age, this now offers people better opportunities such as business and information technology.

The American education system offers students many things in primary and in the secondary grade level. Not only do the children learn how to add or subtract figures but also gives the opportunity to be well-rounded individuals.

This is the reason that Allen was able to learn about computers and pushed this person into pursuing a degree in computer maintenance after graduating from high school.

To Allen's astonishment, there are a lot of vocational schools offering courses related to information technology. Some of these places are out of state while there were also those that are just a few bus rides away.

Here are a few tips that will be helpful in high school or even after graduation when looking for technical and vocational training courses.

1. It will be a good idea to check the vocational schools online so that a brochure can be delivered to the home.

One of the advantages of a vocational school over a university is that tuition is much more affordable. There is also internship or apprenticeship that means those who do well will get a job after completing the course.

2. If the person wants to pursue higher education, it will be a good idea to ask if other universities honor this so the student will not have to start over being a freshman again.

3. The student should ask if the vocational school offers scholarships or grants for those who do not have enough money to pay for tuition.

4. The individual should also ask if the vocational school offers this course part time especially for those who have to work and can only come in campus during the evening. If this is still difficult, perhaps asking the school administrator if there is distance learning.

5. It will also be a good idea to check on the success rate for getting a job if one decides to attend the vocational school.

There are a lot of factors to consider before choosing a technical or vocational course to purse. The person should weight the pros and cons of each before making that big decision.

Items That Your Grandmother Needs in Her Assisted Living Center

If your grandmother is living in an assisted living center, you may be wondering what types of gift or products she could use in her home. There are several things that you can get her that will make her stay easier and more enjoyable.

Lift Chair

When your grandmother relaxes in her room, she needs something in which she will feel completely comfortable. A lift chair will allow her to sit without straining her knees or back. Lift chairs have a mechanism that raises them up so that they will meet the person halfway as they are attempting to sit or stand. The range of motion will make it easier for your grandmother to keep her balance so that she is less likely to fall. This means that your grandmother will be able to safely enjoy relaxing in her chair as she watches television or visits with a guest.

Scooters

If your grandmother is a very social person, she may benefit from a scooter. Scooters for seniors and disabled residents allow them to visit other rooms, go to social events and explore the local garden or park. When you invest in a scooter for your grandmother, she will be able to do all of her favorite activities without worrying about getting tired quickly or becoming fatigued as she is out and about. You can also find some stylish scooter accessories that will allow her to carry her books, knitting, cards or other favorite items with her around the assisted living center.

Television

While some assisted living centers provide televisions for their residents, others require them to bring their own. A television in her room will allow your grandmother to relax and unwind without going to the main sitting area. She will be able to enjoy peace and quiet as she watches her favorite shows from the comfort of her own chair or bed. She will also be able to keep up with the news and the weather whenever she needs. You can even get her a DVD player that will allow her to watch her favorite movies and television series.

If your grandmother has recently moved into an assisted living center, it may take some time for her to adjust. Your gift will make her transition easier. If she has been there for a while, these items will still come in handy as she maintains her social life and enjoys her home.

The China (Senior Living) Syndrome

At long last a post that has fewer than 5,000 words! Last week, I was day one Chairman of the 2^nd annual Retirement Living World China conference in Shanghai. In seeing that this was the second such conference and we are, in effect, in the fourth year of this industry, I began to think that it high time for some quantitative, analytical presentations. Alas, despite my encouragement and pleadings with the corporate sponsor/event manager to set presentation standards, I was frustrated. But there were a few very good presentations and a very welcome announcement from Mark Spitalnik and Tom Hill that they have founded the China chapter of IAHSA. Congratulations! to these visionaries.

Perhaps it is still early and China is, after all, not the most transparent environment for data collection. However, development of presentations which attempt to resolve industry issues should not be binary, meaning a best efforts analysis or not....I mean, it is possible to make studied deductions based on market observations and offer them up for debate without access to reams of data. Insightful presentations can be done in a detailed manner and while they may not carry the weight of an academic, full market scan using tons of publicly available, indisputable data; they are helpful if for nothing else than high quality deliberation.

On day two I was told I offered up such a presentation and I firmly believe it is the first attempt at a supply/demand evaluation of the China senior living market. Here is my hypothesis and what I said:

Hypothesis:

"Near term growth of supply in China senior living assets, particularly the high-end lifestyle product, may significantly outpace demand and if true, the resulting imbalance is likely to persist for the mid-term..."

The Fuel Rods

The driver of China's nascent senior living industry is of course its demographics and much has been made of this phenomenon. Not that the demographics of China aren't unusual in their structure or amazing in their enormity, they are indeed; but I have found the attraction to the data and their use to be wholly without critical assessment. For example, everyone speaks about the 170 million Chinese seniors over the age of 65...and this is indeed the figure which has been reported by the various Chinese authorities and supported by the China Research Center on Ageing (CRCA). But this figure is a gross number and hasn't been vetted for those characteristics which might preclude one's use of a senior living facility, which characteristics are namely income and other cultural inclinations. In fact, as of today, no one has really attempted to qualitatively assign a size to what I call the China Senior Living cohort (CSL cohort). The question is: what is the population cohort that can be reliably measured/thought of as consisting of persons that have the requisite characteristics to consider a senior living facility?

Fact is, there are no indisputable figures that would lead one to an unquestionable calculation of the size of the CSL cohort. But I have done a bit of work in on this figure, such as a conjoint analysis of 550 elderly persons, estimates of the number of those older Chinese who earn over RMB 250,000 per year and careful review of certain luxury retail sales from which inferences can be made about population size as well as other observations. Based on these analyses, I strongly believe the CSL cohort of Chinese seniors from which senior living facilities will draw their residents is today approximately 10.2 million or roughly 6% of the total population of Chinese 65 and older (170 million). This CSL cohort will expand 12% over the next 4 years to approximately 11.4 million by 2016 based on standard population growth estimates provided by the CRCA.

The Reactor

Over the past three years, I have traveled from Harbin to Sanya, from Shanghai to Chengdu in my search for and examination of senior living projects in China; my interest lies in their construction not only from a size, design and physical point of view but also in the development of their service and aged-care operations. The result from this exploration has been a database of projects replete with relevant information on their construction, operations, cost and occupancy among other critical industry data. To my knowledge, this data yields the only available metrics on current supply of senior living in China.

At present, based on my personal observations, I know there to be approximately 25 (give or take 2) senior living projects in China. I define "senior living projects" as 1) a western style residential project, 2) built in the last 5 years, 3) specifically constructed and intended for adults over the age of 60, 4) age appropriate amenities for recreation and living support and, 5) offering any one or combination of the following living accommodations: independent living, assisted living and aged-care or skilled nursing capabilities. As a concrete example, this list would include such well known projects as Yue Cheng in Beijing, Yanda International Healthy City in Hebei province and Qinggang Elderly Nursing Center in Chongqing.

It should be well noted that I am not making any distinction between strata title projects, rental projects or any other unique operating characteristic such as a membership program. This analysis is a broad, industry wide compilation of projects which adhere to the 5 criteria set forth above. I readily admit that this is somewhat of an indiscriminate enquiry and as such may restrict the extent to which I can make accurate projections, but we have to start somewhere. Here are some further data on the present inventory and relevant supply conclusions:

• Current supply has a present total bed count of 12,500 (average of 500 beds per project);


• There is a total census (occupancy) in these projects of 4,250 yielding an industry wide occupancy of 35%;


• Using the CSL cohort figure of 10.2 million, it would seem the current penetration rate is approximately .04% (only relevant when compared with western industry standards of 6%-7%).

Loss of Coolant

Measuring future supply and demand is a wholly different matter and this exercise really relies entirely on my firm's presence in the market place and our care in noting all projects currently in planning (i.e., architectural drawings complete and ownership of land) or under construction. This is simply because there is no clearing house for such data presently in China; no one keeps track of these projects, collectively. So other than what we have gathered here, one would need to go out and spend 12 months counting projects, which is the next best alternative. Again, our data on these figures come directly from clients, discussions with prospective clients and visits to local planning commissions or government officials.

Our data, with respect to future supply, is as follows:

• There are 450 new projects currently under planning throughout China, of which I believe 75% (allowing for 25% attrition or cancelled projects) will be completed in 2-5 years;


• If completed, these projects will produce a new supply of 168,750 new beds (500 bed average) yielding a total bed inventory of 181,250 beds.

The vastly more difficult aspect of this exercise is determining what future demand will be. We have long discussed this at my firm, consulted with CRCA friends and it is widely agreed among us that no calculus exists today to estimate future senior living demand. So, after much deliberation, we decided to simply ask a different question, namely: What level of demand would be necessary to achieve two threshold scenarios: 1) an industry wide 75% occupancy (liminal profitability scenario) and, 2) an industry wide 40% occupancy (meltdown scenario) once all 168,750 new beds came online?

• Scenario 1: Sufficient demand growth to 75% occupancy (industry wide) requires 32x increase in bed occupancy (linear calculation of 136,000 occupied beds from 4,250) - penetration rate of 1.2%; and 


• Scenario 2: Growth in demand to 40% occupancy (industry wide) requires 17x increase in bed occupancy (again linear: 72,500 occupied beds from 4,250) and penetration rate of .64%.

Taken alone and without any additional context, these are staggering growth figures and I believe, superficially unachievable. However, there are mitigants and these scenarios as they strictly appear above are not likely to occur. Yet some industry fallout, and some is the operative word, is inevitable.

Moderation of Chain Reaction

The China Syndrome, starring Jack Lemmon, Jane Fonda and Michael Douglas, was a gripping 1979 drama about the potential dangers of nuclear power. The term, China Syndrome, refers to a catastrophic accident, the fictional result of the meltdown of a nuclear reactor beginning with the loss of coolant fluid in the reactor and the partial or complete exposure of the fuel element assemblies.The core elements melt and burn through the containment vessel, the housing building and then notionally through the crust and body of the Earth until reaching the other side of the planet, which in the United States is popularly said to be China.

However, in reality, the physics of a China Syndrome is widely held to be unrealistic for a number of reasons, most notably, gravity. Yet, a large hole, hundreds of miles deep and thoroughly contaminated for thousands of years with deadly radiation is troublesome enough. In similar fashion, a China senior living Syndrome is my fanciful account of what I see as a potentially impaired market based on unrestrained, wildly speculative development of senior facilities. Such a scenario would retard operational growth for quite some time.

It is entirely possible that a China senior living Syndrome will not occur and I have at least 4 reasons as to why (all likely and reassuring):

1. Capital constraints may restrict supply- every developer in China (unlisted) needs cash today and without it he is unlikely to pursue further real estate development;


2. Lumpy, inefficient market- This analysis is admittedly theoretical for a number of reasons but most importantly because it is based on: i) an industry without publicly available data, ii) gross, industry wide averages and iii) a fair share analysis which doesn't strictly apply in nascent situations. It is however, and I stress, not entirely far-fetched;


3. Developer attrition- Neophyte China senior living developers may opt out due to i) eventual realization that senior living isn't really a property business, ii) exceedingly long dated ROI and iii) high degree of complications with having to build operator;


4. The China axiom- Like the early 1990's Nokia cell phone lesson where great debate was held on how many mobile phones should be produced for their first manufacturing run...it was decided that 50 million was sufficient; they learned 3 months later that demand was actually 500 million. In essence, never underestimate China; demand could meet the theoretical supply.

Resumption of controlled fission

I believe it is impossible that the industry will not experience some over-capacity in the near term, in fact with present occupancy at 35% we are already there. But even in the next two years with intensified excess supply, given the nature of an embryonic industry, it will be wholly possible for astute, well prepared developers to "beat the market" and exceed industry averages in terms of occupancy; I have no doubt on this. But preparation and market insight will be the threshold imperatives for such out-performance. Going forward, reliance on one's previous experience, be it western or local, will be inadequate. And finally in this regard, Good News! As a consequence to however severe or mild the over-capacity might be, I project that by 2014 the China senior living landscape will be populated with "value add" opportunities or a new age in distressed investing where the winners are masters of both the real estate and operating sides of the business.

Lastly, I want to make a few remarks about what I perceive as the vast, over-estimation of the high-end senior living market in China. I define the high-end as projects with a membership cost of RMB1.5 million or more, or in the case of a unit sales project, a cost per square meter of RMB30,000 or more. The mid-range is represented by a project with a membership cost of RMB500,000 to RMB1,000,000 or, again in the case of a unit sales project, a cost per square meter of RMB10,000 to RMB20,000.

Today, despite all the market chatter, there is no successful high-end senior living project in China...none, period. In fact, there are a couple examples of very unsuccessful high-end attempts. What is more, the successful (read: moderately successful) projects that exist today are solidly at the mid-range of the market. The reasons for this are just emerging, but I think it has to do with a number of phenomena:

• No truly 5 star senior living operator exists to compliment a high-end facility, so residents are left without meaningful services; and,


• Chinese seniors aged 70+ are children of the revolution, civil war, famine...you name it...they have no shortage of traumatic experiences. All of which has made them very thrifty, frugal spenders....even if they are wealthy. Conspicuous consumption is largely the domain of those born after the death of Mao.

Again, I could be wrong, but it feels like the Emperor has no clothes...there is little to no data to support high-end senior lifestyle facilities. Now my caveat: specifically excluded from this discussion is a high-end, need-based product or sub-acute, long term care facility. I see tremendous demand here as every single skilled geriatric nursing facility in China has a long waiting list, especially the elite hospitals that cater to high government or military officials.

With this article, I am clearly revising my thoughts on the China senior living market. It is not a negative revision at all; I am just fine tuning my outlook to accommodate near term choppy waters. In the long term, I remain very positive. I live, eat and sleep this business and see it evolving on a daily basis but no longer do I have the blind faith in the high-end market I once held: I am now agnostic and suggest a "hold" at best for this sub-sector. Further, the potential over supply and probable slow demand curve concerns me in the near term. I recommend going "long" on the mid to lower-mid range market or swap out to the sub-acute, skilled nursing sector; there's reliable data there and no catastrophic meltdown in sight.