Differences Between Nursing Homes, Assisted Living & Continuing Care Retirement Communities

Benjamin Franklin said it best - “nothing in life is certain except death and taxes” but with daily advancements in science, technology and health care, Americans are living longer than ever before*. This blessing however, has created a unique dilemma for modern American families: How to plan for and prepare for one's retirement years.

Have you taken a road-trip lately? Almost every highway is graced with large bill-boards providing the locations of new planned communities where couples can spend their retirement years dedicated to recreational pursuits. I doubt you will find a local newspaper that doesn’t have at least one ad promoting the amenities found at a local assisted living facility. Try to search for “nursing homes in Virginia” on the Internet and thousands of web pages will appear. Each and every day new facilities offering different programs are being built and marketed across the state.

Is such a facility right for you and your family? If so, which facility? We often hear the terms “retirement community,” “nursing home,” and “assisted living facility” but rarely consider what these terms actually mean. The differences however, are striking and it is imperative to understand these differences when making choices for yourself or your loved ones.

Differences Between Nursing Homes, Assisted Living & Continuing Care Retirement Communities

NURSING HOMES

In Virginia, a nursing home means any facility with the primary function of providing long-term nursing care, nursing services and health-related services on a continuing basis, for the treatment and inpatient care of two or more non-related individuals**. Put simply, a nursing home is a facility designed for someone who needs less care than a hospital, but requires daily health care assistance.

The Virginia Department of Health licenses such facilities and has established guidelines regulating various aspects of their operations, programs, and staffing needs, etc***. For example, a nursing home must: (a) have written policies and procedures regarding the treatment of residents and the management of resident care which are available to residents and their families (12VAC5-360-20); (b) provide emergency medical services within 15 minutes, under normal conditions (12VAC5-360-50); (c) be subject to unannounced on-site inspections of the nursing facility by State employees (12VAC5-371-60); (d) have a written agreement with one or more physicians licensed by the Virginia Board of Medicine to serve as medical director (12VAC5-371-230); and (e) each resident shall be under the care of a physician licensed by the Virginia Board of Medicine (12VAC5-371-240).

In addition, residents of nursing homes are also given certain rights as defined by Virginia Code §32.1-138. See http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+32.1-138. Nursing homes are the most regulated and structured residential options for our Seniors requiring some level of daily health care. If the facility provides care through Medicare and Medicaid programs, it is deemed a "Certified nursing facility" (Virginia Code §32.1-123; Virginia Code §32.1-127) and must be in compliance with both federal and state laws.

Of course, the more rules and regulations that define and control the daily operations of a nursing home, the greater the responsibility of the staff. These are the people who will be charged with the daily task of caring for your loved one, and making sure they are in compliance with state and federal laws. No matter how nice and or attractive the facility might be, the staff will make the difference between your loved one being cared for and encouraged, or not.

A nursing home is best suited for someone:

Who requires daily health care – such as assistance getting in and out of bed; taking medicine; or using the restroom. Who may have dementia or Alzheimer’s and as a result, is unable to eat and or bathe daily without reminder or assistance; Who is recovering from a fall or accident and is therefore unable to walk, dress and or eat without assistance
ASSISTED LIVING FACILITY

“Assisted living facility” means an adult care residence which has been licensed by the Virginia Department of Social Services to provide a level of service for adults who may have physical or mental impairments and require at least moderate assistance with the activities of daily living. Within assisted living, there are two types: regular assisted living for those seniors (typically) who need assistance with one or more daily activity; and intensive assisted living for someone who may be incapable of performing activities due to mental and/or severe physical impairment (12VAC30-120-450).

The Virginia Department of Social Services licenses assisted living facilities but does not regulate in the way the Department of Health regulates nursing homes. While there are Virginia guidelines regulating aspects of assisted living facilities, they are limited: An assisted living facility must: (a) provide or coordinate personal and health care services; and (b) provide 24-hour supervision.

As reflected in the table below, assisted living facilities have no obligation to provide health care and/or have health care staff available to assist your loved one. In addition, with no obligation to provide such services, there is the question as to whether or not they owe a duty to warn or treat residents with illnesses or diseases that could be transmitted from other residents.

While a nursing home will have many nurses on staff and doctors hired to monitor the residents, assisted living is more analogous to an apartment building or college dorm where laundry and food services are provided and residents are on their own for the rest of the day.

An assisted living Facility is best suited for someone:

Who is basically independent but may not be able or willing to prepare their own food or drive to doctors’ appointments; Someone who wants to scale back and anticipates needing assistance with laundry, cooking, etc. in the near future. A couple where one spouse is independent but may need assistance in feeding and or providing for needs of other spouse.
CONTINUING CARE RETIREMENT COMMUNITY

In Virginia you may also see advertisements for a retirement community. They are popping up all around our favorite College Towns and Tourist destinations.

A Continuing Care Retirement Community provides care depending on your current needs. Like an insurance policy, the resident pays an entrance fee and periodic adjustable payments, which in turn gives the resident a package of residential and healthcare services that the CCRC is obligated to provide at the time these residential and health care services are required. For example, if upon entering, all you want is help with your meals, that is the only service which will be provided. If you require intensive physical therapy or God forbid, daily assistance for a Dementia patient, the CCRC has assisted living services or nursing home services available under your contract. Continuing care contracts are regulated by the Virginia Bureau of Insurance of the Virginia State Corporation Commission.

Many CCRCs can have nursing home services available either on-site, or at licensed facilities off-site (12VAC5-360-10). While you may be entering the Retirement Community as a very healthy independent and capable resident, as your needs change, so will your contract with the Community and in turn, the facility’s obligations to you.

A Continuing Care Retirement Community Facility is best suited for someone:

Who is basically independent but anticipates the need for daily health care for themselves or a spouse in the near future; Someone who is physically disabled and would be unable to care for themselves or a spouse if the disability grew worse. With at least three very different choices, it is very important to do your research:

To research assisted living facilities in Virginia, go to Department of Social Services website: http://www.dss.state.va.us/facility/search/alf.cgi.

To research nursing homes, go to Medicare’s website: http://www.medicare.gov

AND LAST BUT NOT LEAST

It is always best to speak to a family member of a current resident and spend time getting to know the staff, no matter what type of facility you are looking into. If looking and researching is not enough, then consider the chart below – a comparison of the legal duties of a nursing home compared to the legal duties of an assisted living facility in Virginia.

DUTY or REQUIREMENT

NURSING HOME

ASSISTED LIVING

Duty to provide nursing care and or monitor resident’s health?

YES

NO

Doctor required to supervise residents?

YES

NO

Each resident shall be under the care of a physician licensed by the Virginia Board of Medicine?

YES

NO

Must have nurses on staff?

YES

NO

Must offer rehabilitative services?

YES

NO

Must have ongoing consultation from a registered dietitian or dietitian on staff?

YES

NO

24 Hour Supervision required?

YES

YES

Must develop a written plan upon admission of resident?

YES

YES

Staff must undergo criminal background check?

YES

YES

Monitored by Virginia Center for Quality Health Care Services and Consumer Protection

YES

NO

Monitored by Department of Social Services

NO

YES

*Life expectancy increased dramatically during the past century, from 47 years for Americans born in 1900 to 77 years for those born in 2001. These same factors—improved medical care and prevention efforts— that are partly responsible for the dramatic increases in life expectancy have also produced a major shift in the leading causes of death in the United States in the past century, from infectious diseases and acute illnesses to chronic diseases and degenerative illnesses.” The State of Aging and Health in America 2004, published by the Center for Disease Control, available at http://www.cdc.gov/aging/pdf/State_of_Aging_and_Health_in_America_2004.pdf.

**See generally, Virginia Code §32.1-123, as amended and Virginia Administrative Code § 12VAC5-360-10.

***It is a Felony under Virginia law to operate a nursing facility without a license. See generally, 12VAC5-371-30.

Differences Between Nursing Homes, Assisted Living & Continuing Care Retirement Communities
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Lauren Ellerman is an attorney with Frith Law Firm in Roanoke, Virginia. She concentrates her practice on medical malpractice, nursing home abuse, nursing home neglect, lead paint poisoning, and business torts. You may view her complete profile at [http://www.frithlawfirm.com/lauren.htm] and the firm’s home page at http://www.frithlawfirm.com

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More and more people are leaving online classifieds in favor of free internet dating communities. These communities have several advantages over personals on classified sites. You can view photo albums and videos. You can instant message and email other members. You can chat to members on webcam or watch them as "they" chat on webcam. And, best of all, these sites are "heavily regulated" to avoid con artists making fake profiles and trying to sell you something. They take these matters seriously because they know how badly it can ruin our dating experience. These communities use clever software that sniffs out fake profiles and, therefore, prevents internet marketers from pestering you. This is great news because it means everyone who contacts us (10 people or 1000 people) are all real and are actually interested in hooking up with us. So, join millions of other people, make a profile, upload a photo of yourself, and start communicating with "real people".

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History of the Celtic Druids

The Druids were an ancient order of Celtic priests in the societies of Western Europe, Britain and Ireland. The Celtic Druids served their communities by combining the duties of seer, priest, poet, philosopher, historian, scholar, teacher, doctor, astronomer and astrologer. The Celts had developed a highly sophisticated religious system, with three divisions of men who were held in exceptional honor; the lowest division were called the Ovates, the second division were called the Bards and then the Druids. The ovates were the healers and seers; the bards memorised the songs, poems, and stories of the tribe (historians); while the druids taught moral philosophy and were experts in the workings of natural science.

The Celtic Druids were advisers to the rulers of that time, acted as judges in the event of disputes, supervised executions and even controlled the legal system. They were held in such respect that if they intervened between two armies they could stop the battle. The Druid priests and priestesses acted as mediums through which the spirits could be summoned and heard, with rituals throughout the history of the Celtic Druids being enacted in sacred groves of oak trees and circles of standing stones

The first surviving and fullest account of the druids and their religion is that given by Julius Caesar in his Commentarii de Bello Gallico, book VI, written in Gaul in 59-51 BC. Overall, not much can be said of the druids with assurance as the sources of information about them is limited. However they continued to feature prominently in later sources of Irish myth and literature. Thus, the history of the Celtic Druids presents many obscurities and our main literary sources date back to the 2nd century BC with Pliny and The Commentaries of Caeser.

History of the Celtic Druids

"The principal point of their doctrine", Caesar wrote, "is that the soul does not die and that after death it passes from one body into another."

Caesar continued:

"With regard to their actual course of studies, the main object of all education is, in their opinion, to imbue their scholars with a firm belief in the indestructibility of the human soul, which, according to their belief, merely passes at death from one tenement to another; for by such doctrine alone, they say, which robs death of all its terrors, can the highest form of human courage be developed. Subsidiary to the teachings of this main principle, they hold various lectures and discussions on astronomy, on the extent and geographical distribution of the globe, on the different branches of natural philosophy, and on many problems connected with religion".
-Julius Cesar, "De Bello Gallico", VI, 13

After the first century BC the continental druids disappeared entirely and were referred to only on very rare occasions. However, there is some evidence that the druids of Ireland survived into the mid- to late-seventh century. In the De Mirabilibus Sacrae Scripturae of Augustinus Hibernicus, there is mention of local magi who teach a doctrine of reincarnation in the form of birds.

During the first millennium, Celtic and Druid spirituality was preserved by the Christian clerics who performed the valuable service of recording many of the stories and myths by which the oral teachings of the Druids were conveyed. People who think that Druidry was destroyed with the coming of Christianity fail to understand the resilience of spiritual teachings when they are encoded in myths and stories: and it is thanks to the clerics' recording of these tales that we can be inspired by them today. St Patrick also recorded all of the old Druid laws in Ireland - providing us with invaluable information on the ethics and social structure of Celtic Druid culture.

DRUID'S CIRCLES
A Druid's Circle is a popular name for circles of standing stones such as Stonehenge, which is the most famous example. These are also known as the "Temples of the Druids". Great mounds of earth were also built where the practice of seeking rebirth within the Earth was performed (in which initiates would sit in darkness awaiting the time of their rebirth). The best example of this is found at New Grange in Ireland, where a shaft is oriented to the Winter Solstice sunrise, so that the dawn rays can bathe the initiate in sunlight after his or her vigil through the night.

History of the Celtic Druids
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Benefits of Leisure and Recreation

Although it may not seem so, in reality, Leisure and Recreation is the largest industry in the world. The benefits of leisure and recreation as an important part of life are easy to see. As an industry, it offers a variety of related employment and creates billions of dollars in revenue. Workers in parks and recreation, community agencies, sports agencies, youth development organizations, non-profit organizations, rehab and hospital agencies, the travel and entertainment industries all utilize and benefit from parks and recreation facilities world-wide. Additional benefits of leisure and recreation include environmental improvements from expanding green spaces, health benefits, and personal satisfaction benefits.

There are many civic benefits of leisure and recreation activities. Sports and youth activities offer leadership development for adults and children. Strong communities are built as parks become a hub of community life. Benefits extend to all ages, childhood, youth, young adults, families, and seniors. Both care for environment and wellness through green spaces are enhanced by beauty. This same beauty helps combat stress through the opportunity for mild exercise and mediation upon natural beauty. Wilderness experiences are available in some locations.

For personal benefits, leisure activities may include:
Hobbies
Exercise
Sports
Gardening
Crafts
Health
Coping
Family Bonding

Benefits of Leisure and Recreation

Physical benefits include increased lung capacity from sports participation, plus reducing serum cholesterol and hypertension, increasing bone mass, strengthening the spine, reducing disease, increase in feelings of well being, reduction in stress hormones, improved attitudes and performances, and improved social skills. For childhood development, recreational areas assist in learning, can keep kids off the streets, and enhance their confidence. Studies confirm that physical activity can aid the learning process in children. Sports activities enhance large motor skill development and social skills. Adult leaders offer positive role models to children. Group sports are well known for promoting social support, networking, and developing friendships.

As if all the above is not enough to encourage support of leisure and recreational activities, consider the following additional benefits:

Stress management - the mild stress of leisure activity can reduce overall negative stress by contributing to relaxation.

Self esteem - especially in children and seniors, mild exercise, group activities, and hobbies and crafts will help create positive self images.

Positive lifestyle development - contributing to society, social interaction, development of leaders, being part of organized sports all encourage good lifetime activities.

Personal satisfaction - any creative outlet will enhance personal satisfaction. Being part of the leadership offers self satisfaction, and those who work in the recreational areas can feel the pride in keeping these areas vital and available to others.

Quality of life - fresh air, sunshine, social interaction, health benefits and self esteem all will improve quality of life.

Preventative health - regular exercise, physiological benefits from mild exercise, and stress reduction all are made easier by having leisure and recreational activities readily available.

Since the future seems to be headed for a shorter work week and more extra time, support of leisure and recreational outlets and locations would be prudent, and benefit all involved.

Benefits of Leisure and Recreation
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Social Networking, The Pros and Cons of Social Networks

Social Networking has become increasingly popular nowadays as there are a lot of sites that offer this service. MySpace and Friendster are two of the most popular sites that aim to build communities of people who share common interests and activities, or who are interested in exploring the interests and activities of others.

THE PROS

A social networking site is like a virtual meeting place where people can hang out and discuss different topics. Anything under the sun, in fact. Some use these networking sites to promote their blogs, to post bulletins and updates or to use them as a bridge to a future love interest.

Social Networking, The Pros and Cons of Social Networks

These are just a few of the reasons why social networking is getting a lot of attention lately -- it makes life more exciting for many people.

THE CONS

However, it would be best to make sure that safety and security are the topmost concerns of the social networking site that you currently use. This is because social networking sites require or give you the option to provide personal information such as your name, location, and email address. Unfortunately some people can take this as an opportunity for identity theft. They can copy your information and pretend to be "you" when engaging in illegal activities. Bad news! So be cautious with what you enter into an online networking site.

You could fall into the trap of someone who pretends to be somebody else. For example, they might offer you a job or want to meet up with you just to get your money. This can lead to cyberstalking, where the stalker uses electronic media such as the Internet to pursue or harass you.

THE CONCLUSION

So take your time and be careful in choosing who to trust so you can hopefully avoid this sort of unpleasant thing happening to you. Apart from that, social networking is great thing.

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e-Marketing Strategy: 7 Dimensions to Consider (the e-Marketing Mix)

What is e-Marketing?

e-Marketing is still quite a controversial subject to talk about, since no one succeeded to unify the various theories around it; however there is one thing upon which there is no doubt - that e-Marketing first appeared under the form of various techniques deployed by pioneer companies selling their products via the internet in the early 90's.

The frenzy around these new marketing techniques created by e-tailers and supported by the internet rapidly gave birth to a new dimension of what we knew as Marketing: the e-Marketing (electronic Marketing).

e-Marketing Strategy: 7 Dimensions to Consider (the e-Marketing Mix)

There are many definitions to what e-Marketing is, the simplest and shortest one being formulated by Mark Sceats: e-Marketing is Marketing that uses the internet as manifestation media. A working definition is that coming from a group of CISCO specialists: e-Marketing is the sum of all activities a business conducts through the internet with the purpose of finding, attracting, winning and retaining customers.

e-Marketing Strategy

The e-Marketing Strategy is normally based and built upon the principles that govern the traditional, offline Marketing - the well-known 4 P's (Product - Price - Promotion - Positioning) that form the classic Marketing mix. Add the extra 3 P's (People - Processes - Proof) and you got the whole extended Marketing mix.

Until here, there are no much aspects to differentiate e-Marketing from the traditional Marketing performed offline: the extended Marketing mix (4 + 3 P's) is built around the concept of "transactional" and its elements perform transactional functions defined by the exchange paradigm. What gives e-Marketing its uniqueness is a series of specific functions, relational functions, that can be synthesized in the 2P + 2C+ 3S formula: Personalization, Privacy, Customer Service, Community, Site, Security, Sales Promotion.

These 7 functions of the e-Marketing stay at the base of any e-Marketing strategy and they have a moderating character, unlike the classic Marketing mix that comprises situational functions only. Moderating functions of e-Marketing have the quality of moderate, operate upon all situational functions of the mix (the classic 4 P's) and upon each other.

1. Personalization

The fundamental concept of personalization as a part of the e-Marketing mix lies in the need of recognizing, identifying a certain customer in order to establish relations (establishing relations is a fundamental objective of Marketing). It is crucial to be able to identify our customers on individual level and gather all possible information about them, with the purpose of knowing our market and be able to develop customized, personalized products and services.

For example, a cookie strategically placed on the website visitor's computer can let us know vital information concerning the access speed available: in consequence, if we know the visitor is using a slow connection (eg. dial-up) we will offer a low-volume variation of our website, with reduced graphic content and no multimedia or flash applications. This will ease our customer's experience on our website and he will be prevented from leaving the website on the reason that it takes too long to load its pages.

Personalization can be applied to any component of the Marketing mix; therefore, it is a moderating function.

2. Privacy

Privacy is an element of the mix very much connected to the previous one - personalization. When we gather and store information about our customers and potential customers (therefore, when we perform the personalization part of the e-Marketing mix) a crucial issue arises: that of the way this information will be used, and by whom. A major task to do when implementing an e-Marketing strategy is that of creating and developing a policy upon access procedures to the collected information.

This is a duty and a must for any conscious marketer to consider all aspects of privacy, as long as data are collected and stored, data about individual persons.

Privacy is even more important when establishing the e-Marketing mix since there are many regulations and legal aspects to be considered regarding collection and usage of such information.

3. Customer Service

Customer service is one of the necessary and required activities among the support functions needed in transactional situations.

We will connect the apparition of the customer service processes to the inclusion of the "time" parameter in transactions. When switching from a situational perspective to a relational one, and e-Marketing is mostly based on a relational perspective, the marketer saw himself somehow forced into considering support and assistance on a non-temporal level, permanently, over time.

For these reasons, we should consider the Customer Service function (in its fullest and largest definition) as an essential one within the e-Marketing mix.

As we can easily figure out, the service (or assistance if you wish) can be performed upon any element from the classic 4 P's, hence its moderating character.

4. Community

We can all agree that e-Marketing is conditioned by the existence of this impressive network that the internet is. The merely existence of such a network implies that individuals as well as groups will eventually interact. A group of entities that interact for a common purpose is what we call a "community" and we will soon see why it is of absolute importance to participate, to be part of a community.

The Metcalf law (named after Robert Metcalf) states that the value of a network is given by the number of its components, more exactly the value of a network equals the square of the number of components. We can apply this simple law to communities, since they are a network: we will then conclude that the value of a community rises with the number of its members. This is the power of communities; this is why we have to be a part of it.

The customers / clients of a business can be seen as part of a community where they interact (either independent or influenced by the marketer) - therefore developing a community is a task to be performed by any business, even though it is not always seen as essential.

Interactions among members of such a community can address any of the other functions of e-Marketing, so it can be placed next to other moderating functions.

5. Site

We have seen and agreed that e-Marketing interactions take place on a digital media - the internet. But such interactions and relations also need a proper location, to be available at any moment and from any place - a digital location for digital interactions.

Such a location is what we call a "site", which is the most widespread name for it. It is now the time to mention that the "website" is merely a form of a "site" and should not be mistaken or seen as synonyms. The "site" can take other forms too, such as a Palm Pilot or any other handheld device, for example.

This special location, accessible through all sort of digital technologies is moderating all other functions of the e-Marketing - it is then a moderating function.

6. Security

The "security" function emerged as an essential function of e-Marketing once transactions began to be performed through internet channels.

What we need to keep in mind as marketers are the following two issues on security:

- security during transactions performed on our website, where we have to take all possible precautions that third parties will not be able to access any part of a developing transaction;

- security of data collected and stored, about our customers and visitors.

A honest marketer will have to consider these possible causes of further trouble and has to co-operate with the company's IT department in order to be able to formulate convincing (and true, honest!) messages towards the customers that their personal details are protected from unauthorized eyes.

7. Sales Promotion

At least but not last, we have to consider sales promotions when we build an e-Marketing strategy. Sales promotions are widely used in traditional Marketing as well, we all know this, and it is an excellent efficient strategy to achieve immediate sales goals in terms of volume.

This function counts on the marketer's ability to think creatively: a lot of work and inspiration is required in order to find new possibilities and new approaches for developing an efficient promotion plan.

On the other hand, the marketer needs to continuously keep up with the latest internet technologies and applications so that he can fully exploit them.

To conclude, we have seen that e-Marketing implies new dimensions to be considered aside of those inherited from the traditional Marketing. These dimensions revolve around the concept of relational functions and they are a must to be included in any e-Marketing strategy in order for it to be efficient and deliver results.

e-Marketing Strategy: 7 Dimensions to Consider (the e-Marketing Mix)
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Otilia Otlacan is a young certified professional with expertise in e-Marketing and e-Business, currently working as independent consultant and e-publisher. She developed and teach her own online course in "Principles of e-Marketing" and is also a volunteer Economics teacher.

You can contact her via her personal website at BRAINmarketing.net [http://www.brainmarketing.net] or check out her latest developing Marketing resources project at TeaWithEdge.com

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