Assisted Living Marketing Staff vs Ownership/Management?

Lots Of Responsibility, Little Authority

Some assisted living marketing directors and representatives get little support for their efforts - from management and/or staff. I really feel for them. Yes, I do realize that operations are critical. In the care business, you must provide great care. However, for a variety of reasons, the marketing personnel and plan are also vital elements in assisted living facility success.

Marketing, and its results, directly affect all the major players in assisted living - owners/management, residents/family members, staff members.

• Enable the owner make a profit, and the management to meet their goals and responsibilities.


• Drive (and increase) the revenue that enables the residents and family members to continue to get superior services.


• Help the staff to keep their jobs and get paid fairly.

I feel ownership/management must give their marketing staff the freedom to make decisions and the resources to be successful. And why not? The return on investment (ROI) in assisted living is pretty good...in most cases the new revenue per move-in is more than $30,000/yr.

Management's Point Of View

On the other side of the coin, would I just give carte blanche to a marketing director or staff member? No way. Authority does not come until a professional shows me that they have a management mindset, a marketing philosophy and a work ethic that they believe in...and I am willing to support. They must prove to me they have a strategy, plan and systems that will get a good return on their time and talent, and on my money. Put bluntly, they must sell me on their ability to make me more successful.

It seems that the road between owner/management and marketing is a two way street.

Working Together, Building Trust

Here are recommendations for developing a business culture that allows ownership/management and marketing to respect and support one another, and work as a team to increase an assisted living census.

Owner/Management

• Hire a person with:
  
  • The necessary marketing, organizational, communication and technical skills.
  
  
  • An ability to continue learning and to keep up with the trends, especially the technology trends.
  
  
  • The heart to care for seniors and to care for your business.
  
  Then trust them and let them do their job.


• Require a strategy and a plan. If your trust level is low, then you should assist the marketing staff in developing their strategy and plan. However, do not micro-manage.


• Set a budget and spending guidelines. Allow a certain amount of money to be spent without approval.
  Note: When a marketing director cannot spend $100 without permission, they lose credibility with their referral sources. In addition, their ability to act with confidence and at the right time is extremely limited.


• Do not laden your marketing staff with serving you. It wastes their time and your money. It also creates stress that saps energy and hurts morale. Instead, support them. Ask "how can I help?" If you want a report, set it up so you can quickly grab the data and/or reports directly from the marketing database.


• In general, put yourself in the marketing staff's place. Look through their eyes.

Marketing

• Treat your responsibilities less like a job and more as an owner would. More support and freedom will come when an owner/management feels that you see their perspective, understand what they are risking (and can lose), and act in their best interest.


• Develop and work a strategy and a plan. To gain trust and support, you may involve owner/management in the development process. Put systems in place that make you more effective and efficient. Update when necessary and keep management "in the loop". Remember, they are also a target market that has to be sold.


• Prioritize and wisely allocate your budget. Show how monies are spent (and will be spent) and what business they generated. That means a good database with a tracking and reporting system that is easy to use and does not bog you (or anyone else) down.


• It is my belief that management should be informed, yet not annoyed by trivial interruptions. To avoid bogging yourself down, set up a template/report in which you can easily update information they like to keep track of. You can "cc" and "forward" important e-mails. And you can even send them Google Analytics reports to show your website traffic.


• In general, put yourself in ownership's and management's place. Look through their eyes.

Choose The Same Side

A lack of respect and/or support between ownership/management and the marketing staff creates tension. Each side wastes energy on their lack of trust and looking for how the "opposition" is messing up. The result - less move-ins.

When a client has a low census, this type of dysfunction is one of the first things I look for. I know that even proven strategies and systems will fall apart when there is internal tension. It is critical that there is only one side when it comes to filling an assisted living facility. Marketing must be integrated into the business and the care culture. Respect and support must flow back and forth between ownership/management and the marketing staff. The result - more move-ins.

Nursing Jobs From Home - Yes, You Can Work From Home!

Do have a dream of working from home? Does the career that you are in seem to be hopeless for allowing a work at home opportunity? There are more work from home careers now than ever. More and more companies are allowing their employees to telecommute. More and more professions are developing opportunities in the work from home field. Even professionals such as nurses can find jobs from home. Yes, it may be surprising, but there are nursing jobs from home that are available out there for nurses that are interested in working from home for whatever reasons.

Case Manager

One available nursing job that can be done from home is a case manager. As a nursing case manager you have patients that you contact on a daily basis by phone to give them important information about their medical condition. You also provide information about medications, side effects, daily care of wounds, nutritional information, exercise information, etc. As their case manager, you can also answer any questions they may have and, if necessary, refer their case to a home health nurse that will actually go to the patient's home to see them in person.

Teach Nursing Classes Online

You can also teach nursing classes on line as an on line instructor. This is a great nursing job from home. You can use your nursing skills and expertise to help future nurses gain college credits they need to become a nurse. The type of courses you would be eligible to teach and the rate of pay you would receive would depend on the policies of the institution that is offering the job.

Telephone Triage Services

There are also telephone triage services that hire nurses to work from home. A telephone triage service offers nursing jobs from home for registered nurses to provide after hours services to doctor's offices and twenty four hour service to hospitals. These companies hire registered nurses to answer questions for people with non emergency medical concerns. For those people with true emergencies, you would need to refer them to their nearest emergency room or ER.

Even if you didn't know it, there are several job opportunities for nursing jobs from home. Work at home jobs can provide many benefits to you, as well as your family. These benefits can include flexibility, less time away from family and general overall happiness with your career.

If you are interested in working from home and want to find more information on nursing jobs from home, search the internet to find job opportunities. There are many legitimate job banks that offer just such positions. Source: Workfromhomejobsinc dot com

What Is a Licensed Vocational Nurse?

Although most nurses opt to get a registered nursing license, many others opt to get a vocational (often also referred to as practical) nursing licensure. Many registered nurses will embark on their nursing career as a vocational nurse, completing the training to that of a registered nurse only after a few years of working as a practical nurse.

A Licensed Vocational Nurse (LVN) is a nurse who completed a vocational nursing program, and passed the NCLEX-PN licensure exam. This one-to-two year training program is offered by many community colleges and other vocational schools.

The LVNs work is to care for patients in many ways:

• Basic bedside care: The practical nurse will measure and record patients' vital signs such as height, weight, temperature, blood pressure, pulse, and respiration. He or she will also be the one who prepares and gives injections and enemas, monitors catheters, dresses wounds, and gives alcohol rubs and massages. Sometimes the LPN will also be called to assist their patients with bathing, dressing, and personal hygiene, or in moving in bed, standing, and walking. The vocational nurses might also feed patients who need help eating. Experienced LPNs may supervise nursing assistants and aides.


• Collecting and keeping medical data: A licensed vocational nurse will often be called to collect samples for testing, perform routine laboratory tests, and record food and fluid intake and output. She may also be called to help physicians and registered nurses perform tests and procedures. Sometimes she will be asked to monitor her patient and report adverse reactions to medications or treatments.

What are the qualities needed to be a good LVN?

A person aspiring to be a good practical nurse should have a caring, sympathetic nature, with good communication skills. Working with the sick and injured can be stressful, and a person dealing daily with human pain should be emotionally strong and stable. The LVN also needs to be observant, and to have good decision-making skills. As the vocational nurse will often work under the supervision of doctors or registered nurses, a person going into this profession must be able to follow orders and work under close supervision.

The Work Environment

Vocational nurses may be found working in hospitals, clinics and many other healthcare facilities. Others may work in nursing homes, doctors' offices, or in home healthcare.

Most LVNs work a 40-hour week. In some work settings where patients need round-the-clock care, LVNs may have to work nights, weekends, and holidays. About 20 percent of licensed vocational nurses work only part-time.

Demand For Technical Translations Keeps Growing

Technical translations are different from less complicated standard translations in which an average text is translated from one language into another. Technology and science comprise a wide range of highly complex disciplines and subject matters, and your translation service must be able to to handle these complexities.

Globalization of business has led to the increase in the demand for technical translations. As businesses are going global and numerous large and smaller businesses are expanding into different continents throughout the world, the demand for technical translations is also increasing exponentially.

Many companies invest precious time and money in creating technical materials but do not take sufficient account of the needs of their global audiences. To conduct international business effectively, these companies must present their technical documents in a language comprehensible to the people of the country where they are conducting business.

For normal business correspondence, a general translator who has mastered an average business vocabulary is sufficient for the job. But technical translations demand specialized translators who have in depth know-how of the technical concepts and terminology. Only a specialized technical translator will be able to represent a complex technical text properly in a foreign language and ensure that the foreign audience can fully comprehend the complex technical information conveyed in these documents.

For this reason it is always important to select a reliable and reputable

translation company, whether you are dealing with a translation business in Edmonton or a translation company in Regina. Your translation provider must select highly trained and experienced translators for your project to ensure top quality for your finished translation project. Technical translations may involve the translations of a wide range of technical documents, for example:

• Instruction manuals
• Assembly instructions
• Technical training manuals
• Technical newsletters
• Manufacturing specifications
• Quality assurance documentation
• Software development translations
• Engineering documents
• Software installation guides
• Scientific dissertations
• Product catalogs and texts containing high amount of terminology.

Such translations require a technical expert to accurately deliver a high quality translation. Some of the major languages in which translations are commonly done are Japanese, Russian, German, Swedish, French, Spanish, Chinese, Italian, Hindi, Korean, Norwegian and more.

Suppose, if you want to sell your software in a foreign country then you have to offer the software in the local language that people understand there. If you offer your software in the local language then it will be convenient and effortless for the user to use and implement it. Software localization is an important field of technical translations.

Accuracy is critical in technical translations. Even a minor misrepresentation or error in language can be troublesome for the end user if something is connected wrongly or installed incorrectly. Technical translations do not leave any room for errors. For this reason it is in your best interest to choose a translation service provider, whether it be it a translation company in Regina or a translation business in Edmonton, that has a good track record of delivering accurate translations within given deadlines.

Technical translations need to be completed by technical translators with excellent linguistic proficiency and in depth technical expertise. Therefore choose a translation service provider be it a translation business in Edmonton or a translation service in Regina that ensures translations of impeccable quality.

Healthcare Challenges With Food Service Design

Food creates emotion. When we add the word healthcare into the conversation, well, one can guess what emotion will arise. Healthcare food services, whether in continuing care retirement communities (CCRC), assistant living, skilled care, hospitals, rehabilitation facilities, daycare or meals on wheels, have the opportunity to improve current outcomes.

As with any emotional challenge, focusing on the problem and drilling down to identify deficiencies will determine which next steps are needed to solve or limit the concern. The reason the word "limit" is used is that in many situations healthcare consumers may not have a choice in selecting their favorite foods based on medical-related restrictions. With this in mind, the challenge starts in developing and designing food service operations that meet the needs of our compromised food audiences.

Thinking about our targeted audiences, I like to start with our CCRC and assisted living operations. These programs require kitchen designs that resemble a traditional table-service restaurant offering a variety of food selections. However, these designs need to be flexible, to control nutritional requirements and overcome physical limitations.

Hospitals and rehabilitation facilities are much more complicated to design than traditional CCRC or assisted living from a food service equipment and layout perspective. The design and capability of the equipment must allow food service personnel to create the perception of food choices. food service staff must also meet the requirements of patients' nutritional needs, not to mention the 12 or more menu spreads, coordinating med-pass, clinical procedures, meal delivery obstacles and related concerns.

Skilled nursing facilities have historically used hospital-feeding concepts but, over the past few years, have moved away from this approach in feeding residents by creating decentralized buffet-type service programs that help to create more of a perception of choice. Terminology used in the industry is country kitchen or point of service, just to name two. The challenges in trying to offer a buffet food concept include the fact that residents require feeding, frequently wish to eat in their rooms, and limited staffing. The financial abilities of skilled facilities to add staff for meal service is rare, which requires that a food service design maximize staff optimization.

Daycare and meals-on-wheels programs have still other conceptual requirements. Because the audience lives in the community, meal service needs to match the ethnic flavor expectations and social gathering environments of different neighborhoods, which are just two of the factors to which clients are accustomed. This does not take into account the specialty equipment necessary for cooking for table and delivery service, not to mention the skilled staff required to produce the meals.

In each of these examples, healthcare food service designs and concepts need to focus on delivery of service and meeting the expectations of the audience by placing customers at the center of the design and not as an off-shoot of it. Services are not peripheral activities, but are an integral part of society. Just because healthcare has been institutionalized, its food service operations should not lose sight of the service requirements of its varied audiences.

Nursing Interventions in the Diagnosis of Bipolar Disorder

Diagnosis Bipolar Disorder: "Bipolar disorder is a severe biologic illness characterized by recurrent fluctuations in mood. Typically, patients experience alternating episodes in which mood is abnormally elevated or abnormally depressed-separated by periods in which mood is relatively normal." (Lehne, 2004, p. 321)

The following is a short synopsis according to the DSM-IV-TR, "Criteria for Bipolar Disorder" includes a distinct period of abnormality and persistently elevated, expansive, or irritable mood for at least:
- 4 days for hypomania
- week for mania

During the period of mood disturbance, at least three or more of the following symptoms have persisted and have been present to a significant degree:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual or pressure to keep talking
- Excessive involvement in pleasurable activities that have a high potential for painful consequences." (American Psychiatric Association [APA], 2000).

Psychodynamics of the Disease The onset of the disease usually occurs during late adolescence or in the mid twenties. However, the disease has been known to occur up into the fifth decade of life. The mood swings that accompany this disorder are of several types. They are as follows: the Pure Manic Episode, evidenced by hyperactivity, excessive enthusiasm, and flight of ideas, constant wakefulness without sleep,

Impairment in normal social functioning usually requiring hospitalization; Hypomanic Episode, evidenced by a milder form of the Pure Mania, without the loss of normal functioning that would require hospitalization; Major Depressive Episode, characterized by depressed mood consisting of symptoms such as anhedonia, avolition, alogia, affective flattening and thoughts of suicide and death; the last episode associated with Bipolar disorders is the Mixed Episode in which, "patients experience symptoms of mania and depression simultaneously. The combination of high energy and depression puts them at significant risk of suicide." (Lehne, 2004, p. 321)

Case Presentation
A Caucasian woman in her mid twenties presented signs and symptoms of self mutilation with a straight edge razor inflicted gash across her lower abdomen approximately six inches below the umbilicus. The depth of the gash just stopped at the abdominal fascia. The patient was sent from the emergency room to the psychiatric floor. Upon meeting the patient one day after her admission to E.R., she appeared dressed in pajama bottoms and a t-shirt, shuffling down the hall in her socks. She was holding her abdomen with one hand and appeared in some discomfort. Her black hair was short and disheveled. When the patient arrived at her room she sat down on her bed. She acknowledged with blunted affect that she cannot stop self mutilation, and described how she cut herself through the muscles in her abdomen almost down to the fascia. Her voice was tremulous and fast paced. This could be due to the fact that she had just been given her first dose of Clozaril. She stated that her mouth was dry and that she needed to drink some water. She then went on to say that she was getting very sleepy. The client felt comfortable with the interview.

She shared personal information in regards to being sexually abused by her bother beginning at the age of seven until the age of fifteen. Her brother was two years older than her and died in an automobile accident at the age of eighteen. She went on to say that her mother never knew or acknowledged the sexual abuse and that she could not tell her because the mother idolized the son. The client was receptive to cognitive reframing; however she was very critical of herself and stated that she felt worthless and ashamed. She appeared very tired and stated that she wanted to sleep.

Table 1
Textbook characteristics of Bipolar disorder versus client characteristics observed

Textbook Characteristics:
Pure Manic Episode
Hypomanic Episode
Major Depressive Episode-
Affective Flattening
Alogia
Avolition-apathy
Anhedonia
Mixed Episode
Rapid-Cycling Bipolar Disorder- Patients experience four or Client

Characteristics Observed:
No current symptoms
Rapid breathing, rapid speech, however due to medication a client was concurrently exhibiting lethargy
Client acknowledged sadness/ worthlessness
Facial expression flat
Thoughts of dying, hard to focus
Hair/clothes unkempt
Expressed no interest in children or own

Client's Symptoms
1. Hypomania
2. Depression
a.) Affective Flattening
b.) Alogia
c.) Avolition & Apathy
d.) Anhedonia
3. Mixed Episode
4. Rapid Cycling
(Varcarolis, 2004, p. 485)

Nursing Interventions

1. Observe the client every 15 minutes while suicidal, remove all dangerous, sharp objects from room.

2. Reinforce that she is worth while,
a.) Assist the client in evaluating the positive as well as the negative aspects of her life
b.) Encourage the appropriate expression of angry feelings.
c.) Schedule regular periods of time throughout the day for recreational/occupational therapy, encourage client to groom self, offer praise for completing grooming.
d.) Ensure client's participation in taking mood stabilizing medications. Watch client swallow medication.
3. Engage client in interpersonal therapies, cognitive-behavioral therapy,
4. Encourage client to attend group therapy, and journal episodes.

Table 2
Medical Interventions, Bipolar Disorder
Drug therapy using
Mood stabilizer
Antidepressants
Antipsychotics
Education and Psychotherapy
ECT
(Varcarolis, 2002, p. 483)

Clients Medical Interventions
Drug therapy includes
Lithium 300mg every h.s.
Not taking any Clozaril
Client is receiving psychotherapy, family counseling, group therapy while in hospital, and cognitive restructuring.
None

Senior Housing Options in British Columbia, Canada

Seniors in British Columbia have a wide range of housing alternatives. From living independently in the family home, to the programs and support offered by different senior housing providers.

British Columbia is the first province in Canada to regulate assisted living residences. The Assisted Living Registrar is responsible for ensuring the safety and health standards at publicly subsidized and private-pay Assisted Living facilities.

In British Columbia community care facilities are regulated by Community Care and Assisted Living Act.

British Columbia has both private and public options for senior care. Government options are subsidized by the provincial government and are referred to as funded, and private options are paid for directly by the consumer and are referred to as market.

Market senior housing options include different levels of care, and can be classified into the following groups:

• Independent Retirement Residences (also known as Independent Living Facilities) - this option is ideal for seniors who are relatively independent, but need help with daily living activities. These activities might include: meals, light housekeeping, laundry, 24-hour emergency response, social and recreational programs. Such residences can range in cost from $1500 to $5000/month depending on the location, amenities, staffing level, and service package options.

• Complex Care facilities (also known as Residential Care facilities) are best suited to seniors who require 24-hour professional nursing and support.

Significant physical frailty and/or cognitive impairment would be the prerequisite for complex care services. In BC, both profit and nonprofit independent operators deliver complex care under contract to government in a campus-like setting. Such health campuses often include Independent Retirement Residences and Complex Care facilities in the same campus, thus allowing the appropriate level of service as residents' health-related needs change. All complex-care facilities in British Columbia are regulated under the Community and Assisted Living Act and must be registered with the Office of the Assisted Living Registrar (OALR). Market complex care can cost up to $8,000/month.

Funded programs include two forms of seniors' housing in BC. They are:

• Assisted Living, known as the Independent Living BC (ILBC) program
• Seniors' Supportive Housing, known as the SSH Program

Independent Living BC (ILBC) program is administered through one of the five regional health authorities in BC, and it's subsidized by both the health authority, and BC Housing - provincial housing authority responsible for subsidized housing. In order to qualify for this program, you must meet the eligibility criteria in the following key areas:

• Applicants must require accommodation, hospitality services, and personal care services.
• Applicants must be able to make decisions on their own behalf, rather than someone making these decisions on their behalf.
• Applicants must be able to respond in case there is an emergency situation (i.e. fire in the building).

If the resident is accepted in the ILBC program, the health authority representative will refer the resident to specific available residences within the region that participate in the ILBC program. Not all of the residences will be available, and there might be a waiting list.

Seniors' Supportive Housing (SSH) program provides specially equipped rental properties to primarily low-income seniors who need some assistance to continue living independently. Such properties are modified to enhance accessibility and improve safety systems. The program also provides support services, such as housekeeping, meals, and social activities. SSH program is administered through BC Housing, and is available in select communities throughout the province.

Sometimes, funded and market units can co-exist in the same project, and in this case there will be effectively two or more programs operating in the same residence. As funded programs require specific elements to be incorporated into the service package, this can define the service package for the entire project.