The Agnes Story

A modest white clapboard and red-brick fronted ranch house nestles on 4989 Hickory Signpost Road, a suburban street off John Tyler Highway, in Williamsburg, Virginia. The few dried leaves scattered about the yard are the only indication that the season is transitioning, for the white oak and ash trees still hold their leaves. Everything looks orderly on this mild, early October day, as we follow the driveway behind the house to park alongside the tired-looking Ford Econoline van and a pickup truck that clearly has seen some better days. A knock on the front door brings no response, but we are given a broad wave from the rear deck to come into the kitchen. Welcome to Martha's Place, a residential home for disabled adults.

In this family reside individuals with physical and intellectual disabilities, people with autism and those with impairments that need support to meet daily challenges. A tall, strongly-built woman, her hair tied in a brown floral kerchief that matches her caftan, greets us with a warm handshake and beaming smile, which belies the fatigue in her eyes. She bids us take a seat on one of the stools at the kitchen counter. She, however, alights only briefly, as there is a minor night situation to be resolved, morning food to be prepared, and a day to be organized.

Sr. Agnes hails originally from Nairobi, a family of eight children. The neighborhood that makes up Jolly Pond, her first home for disabled adults is a world away from her original intention of joining the cloistered, contemplative Dominicans. On a home visit, her father's encouragement to "do what you have to do" led her to the Little Sisters of St. Francis (LSOSF). At this point, Rose, a young client sporting new whitelaced black sneakers, bustles into the room, wanting to know when the hairdresser is coming to give her braids. Sr. Agnes, for the first of a dozen times, patiently explains all the chores and activities that must first be accomplished before the hairdresser will arrive. Rose hugs her and sits down for a few minutes before repeating the question. This is her birthday present, and she is particularly anxious.

Without pause, Sr. Agnes compares her spiritual and professional path to the seasons, how "one must plant, plow, and then harvest. But first you must prepare and create the rains; and don't forget the weeding." To prepare, she attended the University of Rochester and the National Technical Institute for the Deaf (NTID), where she lived with the Sisters of Mercy; and then Gallaudet University in Washington, D.C., where, with her background in special education, she decided that she could best serve God and her community through the opening of residential homes for disabled people. This realization has been a thorny process at times. Financial and visa obstacles had to be overcome. Her passion was not always embraced by others. "Some say I am crazy," she chuckles, "but they eventually came around, maybe grudgingly." She also says she prayed a lot. Sr. Agnes believes one person can make a difference, and she views the homes she has purchased and manages-sleeping on a nightly rotation in each one-much like the small scale farms back in Kenya, where the cow's milk nourishes the family, who are then able to grow the crops that feed the village.

The complexities of managing five homes, with more to come, has meant Sr. Agnes' circle of caring people has expanded, along with her own knowledge. Compassionate and enlightened individuals have offered wise tax, mortgage, and legal advice. She rolls her eyes at the term 'interest rates,' and acknowledges her deep gratitude towards others' expertise. Her vision is once again turning toward East Africa. Globalization has brought economic benefits, but other problems as well. Her face saddens as she recalls her youth, when neighbors casually visited back and forth. "There are fences now; people are busy; generations coming down the road will have it very rough."

Her indefatigable optimism demands a resolution, and so turns towards helping the children. This is much like planting a new crop. With the enthusiasm of her American friends and Sr. Agnes' understanding of her culture, there are plans to build an orphanage. The challenge is to build a home, to provide the psychological and emotional support-a family-that will create the cultural roots for those children who have lost parents to disease and war. "What type of spirit must we have?" she asks.

Sr. Agnes has planted roots that have brought forth greater community understanding. The residents of Jolly Pond, Martha's Place, Hickory Signpost, St. Charles of Lwanga Home, Lwanga "G" Home, Seaton House, and St. Michael's Day Support Program are our neighbors. They are not segregated in institutions, but are people achieving to the best of their ability. Sr. Agnes, the other sisters of the diocese, and those who work with these individuals are their advocates; they provide an abundance of support, from the daily logistics of cooking and cleaning to transportation. At times they nurse, teach, or listen. They remember holidays, favorite television shows, and birthdays. Sr. Agnes and her community model the success that comes from inspired action. She has taken a dream and with her strong faith and determination brought it to fruition. Now the hairdresser has arrived, and Rose will get her braids.

Information on Sr. Agnes' residential homes and day support services for adults with disabilities and the Franciscan Brethren of St. Philip in Virginia The Franciscan Brethren of St. Philip is a private, non-profit organization that provides residential and day support services to adults with disabilities. Our philosophy is that all people have an inherent dignity and each individual will be treated with respect, regardless of age, race, creed, color, financial status, or developmental/intellectual, mental, or physical impairment. We have two Intellectual Developmental Disability Waiver Group Homes and two Assisted Living Facilities. Each home is in a beautiful residential neighborhood and may only have six to eight residents. The home provides meals, medication management, laundry services, and twenty-four hour supervision and individualized training. We also offer an Intellectual/ Developmental Disability Waiver Day Support Program.

Sr. Anges Redisdential and Day Support Programs

1) Jolly Pond Residential Facility, Williamsburg, VA-26 acres

2) Martha's Place Group Home, Williamsburg, VA-1 翻 acres

3) Seaton House Group Home, Quinton, VA-25 acres

4) Lwanga "G" Home Assisted Living Facility, Williamsburg, VA-1 翻 acres

5) St. Charles of Lwanga Home, Williamsburg, VA-34 acres

6) St. Michael's Day Support Program, Williamsburg, VA-4 acres

Little Sisters of St. Francis, Friends and Volunteers Currently, the Little Sisters of St. Francis manage five homes for disabled adults in the Williamsburg, Virginia area. They were recently licensed to provide daycare support for disabled adults in the state of Virginia.

On the other side of the globe, The Little Sisters of St. Francis in Kenya and Uganda are involved in finding homes for orphans in Kenya and Uganda. Sister Agnes hopes to return home someday to continue their efforts and mission work in Africa.

This article was co-authored by Dolly Parker and Mary Lyons

Avoid Nursing Homes By Planning Ahead

Most people see long term care insurance as nursing home insurance when if fact it is the opposite. Long term care insurance provides options to avoid nursing home placement, unless a nursing home is where an individual prefers to live. And please do not misunderstand, nursing homes have changed significantly over time and many are now very clean and nice facilities. However, a nursing home is usually not where an individual would choose to remain for the final days or months of their life unless there are no other options.

Long term care insurance is becoming more popular as consumers realize it provides options for independence. Many studies indicate that two thirds of individuals over age 65 will require a long term care stay. A long term care stay is a nice way of saying nursing home or skilled facility stay. And over forty percent individuals over age 65 will experience a long term care stay lasting two or more years. This is a long time if you are in a facility in a shared room -- not a private room, with a roommate you dislike. Think back to those college years and consider how you might like to be in a similar situation at age eighty.

And surprise, Medicare will not pay for a long term stay. Medicare usually covers days 1-20 if medically necessary and progress for rehabilitation occurs. On days 21-100 the individual pays an insurance co-pay of $128 per day (in 2008) and after 100 days, the individual is totally responsible for one hundred percent of the cost which averages between $175-220 per day (in 2008). As with anything these costs are expected to increase each year by 3-5% percent.

Long term care insurance not only will pay for these long term care stays, it will pay for care to be provided at home, which is where most individuals prefer to live as long as possible. It also pays for day care, assisted living, home modifications and other services depending on the policy.

Many individuals mistakenly think that long term care is too expensive. As opposed to what I ask you? As opposed to $6,000 per month in a long term care facility? Compare a monthly premium of $200 to the cost of $200 PER DAY in a long term care facility and tell me if long term care is too expensive?

Many are shocked when the cost of one year in a long term care facility at $75,000 eats up most of their retirement savings. Or when they have to "spend down" to qualify for public assistance called Medicaid. The government has determined that with the increasing numbers of baby boomers who will require medical care in the future that there is no possible way that the government can fund this care.

Thus the Debt Reduction Act of 2005. This Act states that individuals wishing to qualify for Medicaid assistance will need to spend all of their assets prior to qualifying for Medicaid. And there is a five year look back period to ensure that assets like homes and money were NOT given away to family members in an attempt to avoid the government receiving these funds. When money or resources are given away, the government imposes a penalty equal to the financial amount given away divided by the cost of one month in a long term care facility. So for example, if your parents gave away $60,000 today and wish to qualify for Medicaid in 2009, Medicaid will accept the application and penalize them for ten months of care. This means that they cannot receive services through Medicaid for a period of ten months from the date of their Medicaid application. Which means that if the care is truly necessary, children and other family members will pay personally for the care.

Even more reason to consider long term care insurance not only for yourself, but purchasing a policy for your parents if they cannot afford the premiums. The question is will they pay now or will you pay later for your parent's care. Caring for parents and the emotional and financial stressors significantly impact the retirement prospects of children. Parents always assume that their children will take care of them but do not consider the impact on employment, retirement income and even marriages and children.

Don't put yourself, your parents or your children in a situation of requiring care and not having a back up plan on paying for care. Because we will all pay for care one way or another when we are older. It's inevitable. We will pay because of our ability to have long term care insurance that ensures we decide about our care. We will pay because our parents require care and they have not prepared financially for the cost. We will pay because we did not prepare financially for the cost by having to receive care through public assistance called Medicaid.

Unfortunately the probability that we will all die is one hundred percent absolute. The question is how do you want to spend the last years of your life? In a manner you choose or in a manner chosen for you?

How A Spy Camera Can Detect Elder Abuse

As our population gets older more and more of our senior citizens are faced with the dilemma of where to live in their final years. Many of them are not quite ready for a nursing home but they require a significant amount of attention and help.

The home healthcare industry as well as nursing homes and assisted living facilities as you can imagine are absolutely booming cross the country. In the next five years alone it's estimated that an additional 20 million seniors will be candidates for some kind of assisted living care. That is going to require not only a lot facilities but also a lot of personnel to take care of the seniors.

There is already a shortage of personnel. And because there's a shortage of facilities all that does is drive the cost of those facilities up making home healthcare for some the only option. No matter what your financial situation assisted living, nursing home or home healthcare; it is very expensive.

And because of the shortage of personnel the industry is fraught with unqualified people, who more than likely are underpaid and looking for a free ride. It has been estimated that 40% of all home healthcare facilities report some kind of elder abuse. In home healthcare it is even worse.

So what are you supposed to do to protect your aging parents?

The best thing you can do to protect your folks in an assisted living facility, long term care facility or in a home health care situation is get a spy camera to keep an eye on them and their caregiver to detect any abuse or theft which is very common.

A well placed spy camera can detect any kind of elder abuse in a nursing home or home healthcare situation. It is an extra set of eyes on your loved ones when you can't be there.

When are you getting one?

2010 Largest Assisted Living Providers

While stormy economic conditions buffeted the business last year, indicators now point to smoother sailing ahead. As businesses in nearly every U.S. sector struggled to stay afloat last year, assisted living was the buoy in the choppy waters. Steady demand for quality services helped keep companies stable-even if accompanied by a hiatus from major mergers and acquisitions.

As businesses in nearly every U.S. sector struggled to stay afloat last year, assisted living was the buoy in the choppy waters. Steady demand for quality services helped keep companies stable-even if accompanied by a hiatus from major mergers and acquisitions.

Now, as economic forecasters allude to the end of the "Great Recession," companies like this year's Largest Providers are poised for growth, some of which is already underway. Forty-two of those companies (60%) that made the 2010 list report increases in licensed assisted living resident capacity-though much of that growth was in single-digit percentages. Another 16 of the top 70 companies maintained their size, while just 12 reported losses.

Here's a look at Assisted Living Executive's 2010 Largest Providers, and the business environment, transactions, and trends that landed each company a spot.

Top Players Hold Steady

In 2009, no assisted living providers merged nor acquired any other complete company. However, while most deals were small, the year did produce a few large portfolio acquisitions and considerable reshuffling. The biggest gains and losses were among the biggest players and occurred through simple sales and acquisitions.

For the first time since Assisted Living Executive began compiling this annual Largest Providers list, Sunrise Senior Living, based in McLean, Virginia, no longer sits at No. 1. The company, now No. 2, had no new building starts and sold off about 9 percent of its assisted living capacity (about 2,896 units) last year. Its biggest transaction was a portfolio of 21 communities in 11 states to Milwaukee, Wisconsin-based Brookdale Senior Living for $204 million, but Sunrise also sold smaller portfolios to regional providers, such as Baltimore-based Brightview Senior Living (The Shelter Group), which purchased two of Sunrise's New Jersey communities.

The Sunrise downsize has made Seattle-based Emeritus Senior Living the nation's largest assisted living provider. Emeritus acquired 2,221 new licensed assisted living units and grew by 7 percent in the past year, and it's very likely that Emeritus will not only maintain the top spot next year, but expand significantly in 2011. The company's partner, Blackstone Real Estate Advisors, is pursuing the purchase of 134 communities operated by Sunwest Management, which is in Chapter 11 bankruptcy. Under a preliminary agreement, Emeritus would manage the properties with the option to invest up to 10 percent of the equity in a joint venture with Blackstone and Columbia Pacific Management, an entity controlled by Dan Baty, Emeritus chairman and co-CEO.

Brookdale Senior Living maintained its No. 3 ranking, but also grew by 3,808 residents, or 15 percent, in 2009. Sunwest Management, last year's No. 4 company, comes in at No. 7 this year with 9,186 assisted living residents, a 43 percent drop. The company will disappear completely from the 2011 list if Blackstone or another entity receives court approval to buy the remainder of Sunwest's portfolio.

In terms of percentage growth, the clear winner is Solana Beach, California-based Senior Resource Group, another beneficiary of Sunwest's financial woes. The company picked up management contracts for 41 properties in 11 states, under the name LaVida Communities, when institutional investor Lone Star Funds of Dallas acquired the properties in the first big deal of 2009. Senior Resource Group catapults from No. 55 to No. 11, having grown its assisted living resident capacity more than 500 percent, to 4,897.

Big Movers

For the next Largest Providers percentage spike, look to CRL Senior Living Communities, which enters the list at No. 57, thanks to more than doubling its assisted living capacity from 502 to 1,019. Also on the growth path, Frontier Management expanded by 64 percent, from 828 to 1,358 licensed assisted living units, thanks to seven new management contracts and two new buildings. Frontier Management jumps 15 spots from No. 57 to No. 42. Watch this Western regional provider to grow further next year as several more new buildings open.

The fourth-largest list jumper is Carmichael, California-based Eskaton Senior Residences and Services, rising 12 spots to No. 56. The company reports 1,036 licensed assisted living units (up from 732 last year) due to either expansions or applications for additional assisted living licensing.

Only seven other providers report gains of 20 percent or more in the past year, and among them is Bradley, Illinois- based BMA Management. Because of its focus on the affordable market, the company continues to benefit from accessible financing sources not available to traditional providers. BMA Management's assisted living resident capacity jumped 27 percent in the past year as the company opened six new communities. In 2010, the company moves up the list by three spots, coming in at No. 21.

Other companies that increased their licensed assisted living capacity include Capital Senior Living Corporation (No. 20), which grew by 25 percent, and Bonaventure Senior Living (No. 23), whose assisted living capacity surged by 21 percent to 2,595. Assisted living capacity for Carlsbad, California-based Integral Senior Living (No. 24) rose 24 percent. Benedictine Health System (No. 41) grew by 20 percent, and Brightview Senior Living (No. 52, up from No. 62 last year) expanded by 29 percent, thanks to the Sunrise deal, which added 240 residents. Another chart-jumper was Leisure Living Management, which vaulted nine places from No. 58 in 2009 to No. 49 this year simply by adding 200 residents (22 percent).

The vast majority of expanding providers, however, had gains of less than 10 percent. But a little growth can go a long way when nearly 60 percent of companies on the Largest Providers list have fewer than 2,000 assisted living residents.

In another indication of assisted living growth, Independent Healthcare Properties, the smallest company on the list at No. 70, only kept its 2009 rank thanks to an 18 percent capacity gain from 706 to 833. Most of the 2009-ranked companies that did not make this year's list either maintained capacity or had very small gains. Another reason for higher numbers at the bottom of the list is attributed to data from five providers not previously listed-Spectrum Retirement Communities (No. 28), Mountain View Retirement (No. 50), CRL Senior Living Communities (No. 57), Welcome Home Management Company (No. 64), and Elder Care Alliance (No. 66).

Other than Sunwest, the company with the most dramatic drop in licensed assisted living capacity was Northstar Senior Living, which shed 1,068 residents, or 55 percent of its 2009 capacity, falling from No. 28 to No. 67. Again, because of modest overall numbers, decreases were most notable toward the bottom of the top 70 list. Grace Management saw a 30 percent decline from 1,399 to 979 and dropped from No. 37 in 2009 to No. 61 this year. Carillon Assisted Living, No. 49 in 2009, decreased its capacity by 24 percent from 1,024 to 775, removing it from the list altogether.

Several companies that didn't make this year's list but may show up in 2011 include Trinity Lifestyles Management, which nearly doubled in size to 480 assisted living residents after picking up three Atlanta-area EdenCare properties, formerly operated by Sunrise Senior Living. Wichita, Kansas-based Legend Senior Living has been raising its assisted living component steadily with new construction, expanding another 18 percent to 692 in 2010. And finally, AdCare Health Systems, based in Springfield, Ohio, remains a smaller provider at 231, but that reflects a 38 percent increase over the prior year, and the company recently announced raising $2.5 million to fund acquisitions.

More Stable Times Ahead

"The fact that we'll be able to point to this time period-the worst economic downturn in our lifetimes-and say that our industry weathered it pretty well and even continued to grow is significant," says Granger Cobb, president and co- CEO of Emeritus Senior Living.

The past two recessions hit assisted living hard, and many providers at the start of 2009 were concerned that the stalled housing market, depleted stock market earnings, and high unemployment among the adult children of potential residents could cause occupancy rates to plummet. Instead, after modest 2008 rate declines and a rent growth slowdown to 2 percent from 2.9 percent in 2008 and 4 percent in 2007, the needs-based component of assisted living seemed to trump economic concerns. Move-ins could be postponed but only for so long.

By second quarter 2009, signs of stabilization began to emerge, followed by a slow but upward trend, says Robert G. Kramer, president of the Annapolis, Maryland-based National Investment Center for the Seniors Housing & Care Industry (NIC). While national unemployment still hovered at a troubling 10 percent in January, Kramer says he's cautiously optimistic about the future, especially since the industry saw its largest absorption rate in the third quarter of 2009 since the first quarter of 2006- 1,400 assisted living units in the top 30 urban markets and slightly stronger in the top 100 markets.

Those statistics suggest that the overall picture is much rosier for assisted living than for other real estate sectors, including multifamily, hotels, and offices, Kramer notes. "Basically, we are seeing operators holding the line with regard to rates," he adds. "We certainly are seeing more concessions out there, but at the same time, those concessions tend to be very much market-specific, property-specific, or even unit-specific."

Still, move-in delays due to economic factors have amplified a trend already developing pre-recession-residents tend to be older and frailer, says Jim Moore, president of Moore Diversified Services and author of "Strategic Forecast," published in Assisted Living Executive's January/February 2010 issue. The result is heightened opportunity in dementia care, which is even more needs-based than assisted living, he adds. Indeed, a number of top 70 operators reported having converted independent units to assisted living or assisted living to memory care.

As for new construction, buildings already in the pipeline continued to open, but few companies launched new developments, and by January 2010, the number of new building starts had fallen to the lowest point since NIC started tracking senior housing trends. No companies went public in 2009.

Forecast for 2010

Access to capital will remain the primary challenge for development in 2010, although new properties financed before the recession will continue to open through the third quarter of 2010. But the lack of new properties isn't necessarily bad news for assisted living.

"We're going to go through a period of very little new product coming online, but if that coincides with pent-up demand and a recovery in the economy, all should bode well for occupancies and rent growth in assisted living," Kramer says. "Outside of external economic factors that we don't have any control over, the greatest risk to assisted living is overbuilding."

Fannie Mae and Freddie Mac will continue to be dependable sources of permanent 10-year financing, but when it comes to construction loans, developers have few options. Some very limited HUD 232 financing will be available, but more likely, the few projects that launch will do so because of relationships with local lenders.

Indeed, The Arbor Company, based in Atlanta, lacks the cash to develop properties on its own, but thanks to a partnership with Formation Capital, Arbor will manage two new properties scheduled to break ground this fall, says COO Judd Harper. "We feel much stronger and more optimistic about the assisted living occupancies in today's slowly recovering economy, but are optimistic about independent living's rebound in the future," he adds. "As people get jobs, they no longer are going to be able to care for a parent at home."

A bright spot in the acquisitions arena, private equity entities are beginning to eye assisted living as a desirable sector again, and the major REITs in senior housing are well-positioned to invest again, Kramer notes. Emeritus will be a company to watch thanks to the Blackstone deal, and while it only plans one new building in 2010, the company actively will be looking for other acquisition opportunities at attractive prices.

"If a company has liquidity, cash flow, and a reasonably healthy balance sheet, it will be in a great position because there are opportunities right now," Cobb says. That advantage isn't just for big companies like Emeritus, but also for regional and even small mom-and-pop players with targeted expansion plans, he adds, noting that "interest rates have not changed that much over the last couple of years, but the amount of equity and coverage ratios you have to have in place has become more stringent, as well as the underwriting."

Fanwood, New Jersey-based Chelsea Senior Living leveraged a strong relationship with a local lender to purchase a former Sunwest property in New Jersey last fall and is actively looking for more deals, says Roger Bernier, president and COO. "Some people are likely to see their debt maturing and be unable to refinance," he forecasts. "Ultimately we'd like to grow by two communities per year, but it has to be the right deal for us to take a look."

Much of the acquisitions action in 2010 is likely to remain with distressed properties, however, and no one expects lots of high-end properties to come on the market this year, says Steve Monroe of Senior Care Investor. "High-performing properties are only going to sell if owners can get a good price, although that may start to change later in 2010."

Still, wise operators should not be blinded by attractive price tags so much that they forget to consider how well the acquisition fits into their existing portfolio and evolving demands of seniors and their families, Moore cautions. "Senior psychographics are changing," he adds. "It's not so much the World War II homemaker widow as 80-year-olds who have been in the professional workforce."

Another area of opportunity in 2010 may be new management contracts for owners and lenders who may be unhappy with their current management, Moore suggests. And for many companies, the wisest move in 2010 may be just to sharpen internal operations, he says.

Although Greensboro, North Carolina- based Bell Senior Living is open to the right deal within the mid-Atlantic states in which it already operates, the latter strategy will be the company's prime priority this year, says President Steve Morton. "I'd say it's a time to focus on operations, improve operating results including management and revenue streams, and put together the necessary tools to maximize and run communities in the most effective manner possible," he says. "This is something we can do because we don't have five acquisitions or development deals."

Finally, unstable financial markets still make it unlikely that any company will go public in 2010, but if conditions improve, Moore says, the two companies to watch continue to be Atria Senior Living Group (No. 4) and HCR ManorCare (No. 10).

Disabled Equipment to Aid Daily Living

Being unable to do something because of a disability is saddening, not to mention it hurts your self-esteem. Disability of the legs or the whole lower limb will compromise your ability to mobilise. There is a whole range of disabled equipment that aims to aid people with any form of disability. Basically, almost every thing or object we have is supposed to help us with something, but the disability equipment is to help maintain or regain the body's function. To keep the function closest to normal is the master plan behind this range of equipment.

Disabled equipment covers a wide-ranging list of products of all shapes and sizes. They are not limited to equipment which is tasked to help you mobilise or assist you in walking. They include all things that can aid people with any kind of disability. For example, a person who has a disability to see things vividly due to an eye condition like myopia, or even astigmatism, wearing a contact lens is a form of assistance.

As people can be exposed to situations which can leave them with different disabilities, more and more disabled equipment is being made to match people's preference and conditions. Items that are usually available are mobility aids like walkers, crutches, wheelchairs and gaits. These help with mobility problems which are usually caused by accidents of deformities of the legs. Other equipments are kitchen aids, bathing and shower aids, eating and drinking aids and writing aids. The purpose is to help every individual as much as possible to maintain regular routine activities as if they never had the condition leading to the disability.

There are a lot of providers of such disabled equipment. You can also ask your doctor what kind of equipment suits your condition. As these products are usually connected to your health condition, the doctor you have is sure to have answers and suggestions for your curiosity. Products in the market are usually modern, high quality, easy to use and are user-friendly. As it is built to help you on a daily basis, you can also cast your doubts aside durability wise. Also, it is often possible to trial or watch as walking or mobility aids are demonstrated, which helps to determine whether a particular product is most suited to your individual needs. Being disabled, or having a certain disability must not stop someone to lead a normal life.

Physician Recruitment and Retention Strategies

Many medical facilities battle the challenges that come with physician recruitment and retention. Building and maintaining a safe, profitable, and stable office, hospital or any other medical facility depends on more than just the management. Every person involved in your organization needs to be committed to excellence. Because of this, most medical facility owners seriously consider who they hire-but how many seriously consider how they hire? Believe it or not, how a company hires their physicians can play a huge role in its ability to recruit and retain physicians.

Many medical facilities struggle with retaining quality physicians who are committed to helping the facility deliver top-notch services. Some reasons for a physician's voluntary resignation might be that they are unhappy with the practice's culture, unsatisfied with the community, seeking higher compensation or wanting a different work schedule. However significant it may seem, income does not drive a physician's overall practice satisfaction and does not have to be the only determiner of your recruitment and retention success.

Before you begin the interview process, make sure that you have a clear understanding of what each candidate can bring to the job. It's also important to be clear in the job description so that each potential interviewee has a good idea of what his or her future with your company could be.

During the interview process, it's important to invite the highly considered candidates for an onsite interview. Offering to pay for your interviewees' travel and lodging expenses will help your potential physicians establish a positive opinion about your company. Keep in mind that their decisions on accepting your job offer will affect their families-so include their spouses in the process by inviting them to ask questions and visit the facility.

If the interview is successful, spend time negotiating a fair employment agreement. Describe duties and the call schedules, and be willing to explain how the schedule would compare to other physicians in the office. If you specify the minimum number of work hours, be sure to also declare the maximum.

Discuss the compensation package that your new physician will receive. Points of discussion should include base salary as well as other incentives. Often, pay-for-performance programs, bonuses, and things such as relocation expense reimbursements help give your vacant job the appealing advantage that it needs to recruit the most qualified physicians. For even more recruitment incentives you may consider agreeing to pay your physician's malpractice tail insurance upon their job expiration or termination of employment.

Each new physician employment agreement should define whether or not he or she is on the track to becoming a potential shareholder. If that is in the agreement, provide descriptions of when the physician might expect this opportunity and the possible cost of buying in.

Before your physician begins his or her new job, make sure he or she has the proper training on all of your facility's patient care systems. This could range from software training to referring patients to outside specialized physicians, prescription refill policies, or even the steps your office takes in handling medical emergencies.

Once everything is in place, welcome the physician to the staff and connect him or her with the physician chief, nursing supervisor, and administrator. Particularly for the beginning months of the physician's time on the job, make sure he or she is feeling comfortable in his or her performance. You can do this by scheduling formal monthly or quarterly performance reviews.

Sometimes the most difficult step in the recruiting and retention process is finding candidates to interview. This first step can be done in several ways. Some depend on word of mouth and outside medical contacts to recommend a job or a physician, while others use a physician recruitment firm. A physician recruitment or staffing agency can speed up your hiring process, and a reliable one will put you in touch with physicians that are most qualified to fill you vacant positions. Some firms even offer locum tenens staffing services to help fill vacancies while you recruit permanent physicians, cover short-term absences, or build a new programs or service lines. As you improve you recruitment and retention efforts you will realize that your business' success does not solely depend on who you hire, but also how you hire.

Choosing A Senior Citizens' Residence Or Nursing Home In Barbados

When choosing an elderly care facility, it is important to know the difference between a nursing home and a senior citizens' residence. Barbados nursing homes usually provide short or long term nursing care in private or semi-private rooms, including, meals, activities, and personal care. Barbados nursing homes must have a registered nurse on duty at all times. Barbados Senior citizen residences provide short or long term nursing care (assisted living) in private or semi-private rooms, including, meals, activities, and personal care but do not require a registered nurse at all times. However, a registered nurse must be on call when required at a senior citizens' residence. The differences between a nursing home and a senior citizens' residence do not necessarily define the quality of care but basically helps you to identify the level of care you or your family member may require.

Choosing either a senior citizen residence or a nursing home may be stressful for you and your loved ones. It is helpful to plan ahead and understand the level of care that may be required. You should visit and compare a range of nursing care facilities or have someone visit and compare them for you. Make good financial plans early. Planning ahead gives you and your family more control and can help ensure that your short or long-term care needs are met. Both Barbados nursing homes and Barbados Senior citizen residences provides care for the elderly who can no longer care for themselves at home due to physical or other health related issues.

Steps to choosing a Barbados nursing home or senior citizens' residence that meet your needs:

1. Find out about the various services provided by the facility.
2. Find out how facility compare in quality.
3. Visit the facility you are interested in, or have one of their registered nurses visit your family member for an assessment.
4. Choose the facility that best meets the need of your family member and you.
5. Ask other people you know who have a friend or family member in the facility you are evaluating, if they are or were satisfied with the quality of care they received at the senior citizens' residence or nursing home.

Although you or your loved one may consider the clean appearance of a nursing home or senior citizens' residence, new paint, sparkling floors or lush surroundings, is no indicator of quality care. Quality care comes from people who work in the facility. You will recognize a well run senior citizens' residence or nursing home by the way you are greeted at the entrance and the way management expresses compassion towards your needs. If you cannot visit the facility yourself, you may want a family member or friend to visit for you.

Take a formal tour:

• Make an appointment and visit the senior citizens' residence or nursing home.
• Trust your senses. If there is an icy atmosphere as you enter or it does not have the homely, welcoming feeling you would expect in such an environment; then reconsider.
• Take a formal tour of the senior citizens' residence or nursing home with the supervisory staff member.
• Look around to get a better picture of the services, activities available, and the level of personal care of the residents.
• Look for safety rails in hallways, bed rails, and grab bars in bathrooms
• Do the nursing assistants seem genuinely fond of the residents?
• Do you see staff smiling or conversing with the residents?
• Is the living environment noisy and confusing or is it pleasant to the eyes and ears?
• Do you hear any laughter?
• Do you hear anyone singing?
• Is a TV blasting or are the call bells annoyingly loud?
• Are pathways and bathrooms kept clear of clutter?
• Are lunch dishes still noticeable unclean after 4PM?
• Is the kitchen screened to maintain a clean environment
• Does the temperature of the room/s feel too hot?
• Are there air conditioned or fan cooled areas?
• Use your sense of smell to detect any unpleasant odors bearing in mind that at any time some of the residents may be incontinent.

Ask questions during your tour:

• Ask questions that can help you compare the senior citizens' residence or nursing home.
• What services does the care facility provide?
• Ask the nursing assistants how long they have worked at the facility.
• Does the care facility have a current license issued by the Ministry of Health?
• Are staff members certified by The Nursing Council of Barbados?
• Do they charge a basic fee for room, meals, and personal care?
• Do they charge extra for other services or care for special medical needs?
• Ask about the length of time the care facility has been in business
• Ask to see residents' living spaces (private or multiple occupancies), hallway, stairs, lounge, bathrooms, dining area, menus, laundry services, activities plan and personal care plan.
• Is there use of a computer, fax machine or email available for quick transmission and receipt of important information?
• Are Admission Forms, Resident Personal Appliance Forms, Resident Valuables and Personal Forms, Leave of Absence Forms, Nursing Care Plan, Medication Charts and Resident Bed-Hold Agreement Forms etc., available?
• Is there a contract that clearly spells out the terms and conditions of the services offered?
• Ask where medications are stored to ensure that they are kept safely.
• Ask about emergency plans and procedures for patients who are ill
• Ask about emergency plans and procedures as it applies to hurricane preparedness.

The most important factor is the staff. The director of nursing or administrator sets the tone for the facility. She or he must demonstrate a sense of compassion, good organizational and interpersonal skills. Those with poor people skills cause high employee turnover. Talk to the nursing assistants to determine if they like working with management and residents. A skilled, friendly nursing staff is the key to good care.

Current Licenses and insurances (property and liability)

Although a current License from the Barbados Ministry of Health may not reflect the true nature of the care facility, ask to see it. By law the institution should operate with current License issued by the Ministry of Health, as well as property and liability insurances. If you receive excuses about why it is not available you may want to reconsider.

Quality of Life

Does the staff treat residents in a respectful way? Are there a variety of social, recreational, religious, or cultural activities? Do the residents have choices about their schedule and living space? Do the residents have privacy for visits or personal care?

Quality of Care

Is there enough staff to ensure that residents are getting the care they need? Can residents still see their personal doctors? Can you visit as often as you wish? Having visitors can make the transition to the senior citizens' residence or nursing home easier for you and your family member.

Preventive Care: Does the nursing home make sure that residents get preventive care to help keep them healthy?

Your informed choice will help you or your loved one in making an agreeable change from living at home to living in a senior citizens' residence or a nursing home. You can be your loved ones' advocate by observing their potential care and living conditions and discussing them with your family or family member.

Remember, there is more to choosing a senior citizens' residence or nursing home that just the price. It is the quality of care that counts.