Austin, Texas, United States Luxury Real Estate and Homes for Sales #austin,


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186 Luxury Homes for Sale in Austin

Amenities

2 Fireplaces 3 Car Garage 3+ Fireplaces 4 Car Garage 5 + Car Garage Agricultural Easement(s) Artist Studio Barn Bay View Billiards Room Boat House Boat Slip Breakfast Bar Bowling Alley Built-in Vacuum Butler’s Pantry Carriage House Casita Catering Kitchen Cathedral Ceilings Cattle Ranch City / Strip Views Concierge Services Country Club Community Deck Dock Doorman Eco-Friendly (Green) Elk Ranch Exercise Room Farm Assessment Gardens Gated Community Geothermal Heating Golf Cart Garage Golf Community Golf View Granite Countertops Guard Gated Guest House Guest Ranch Hardwood Flooring Helipad Horse Facilities Horse Ranch Hunting Ranch Indoor Basketball Court Indoor Pool Indoor Racquetball Court In-Home Fitness Center In-Law Suite Intercom System Investment Ranch Library Marble Countertop Marble Flooring Media Room / Home Theater Mountain Views Ocean Front Outdoor Kitchen Outdoor Pool Porte-Cochere Private Airport Private Elevator Private Lake Radiant Floor Heating Recreational Ranch Scenic View Screen Room Security System Ski-In / Ski-Out Solar Power Heating Spa / Hot Tub Sporting Ranch Stables Staff Quarters Steam Room Tennis Court Terrace / Outdoor Space Underground Lawn Sprinkler Vaulted Ceilings Vineyard Walk-in Closets Water View Waterfront Wet Bar Wine Cellar / Grotto Winery Zoned Air Conditioning

Lifestyle

55+ Retirement Community Aquatic Activities Bay / Beach Club Beach Resort Community Boating Casino / Gambling Country Club Country Living Equestrian / Polo Fishing Fly-In Community Game Farm / Safari Golf Green Living Historic / Antique Island Lakefront Metropolitan Mountain Ocean / Beach Outdoor Activities Privacy Ranch / Farm / Plantation Resort Riverfront Skiing Suburban Tennis Univ / College Community Waterfront Water View Wine Country Yacht Club

Architectural style

1 Level Ranch Apartment Art Deco Art Nouveau Arts Crafts Bungalow Cape Cod Castle Chateau Colonial Colonial – American Colonial – Dutch Colonial – French Colonial – Salt Box Condo Condominium Contemporary Co-Op Cottage Country Home Craftsman Custom Estate European Federal Flat Georgian Georgian – Greek Revival Georgian – Neo Classicism Historic Lodge Loft Log Low Country Modern Multi-level Northwest Contemporary Post Beam Raised Ranch Saltbox Spanish/Mediterranean Split Level Townhouse Traditional Tudor Tuscan Victorian Victorian – Gothic Revival Victorian – Italianate Victorian – Queen Anne Victorian – Shingle Victorian – Stick Villa

Latest Luxury Real Estate Publication

Art Home is a literary collaboration between Sotheby’s and Sotheby’s International Realty, showcasing all the elements of an extraordinary life. Published eight times a year, it engages readers with sophisticated content and beautiful images related to the art and real estate worlds. Rich editorial about art, design and extraordinary properties- presented by the venerable brand that is Sotheby’s..

Search for Austin luxury homes with the Sotheby’s International Realty network, your premier resource for Austin homes. We have 186 luxury homes for sale in Austin, and 2,456 homes in all of Texas. Homes listings include vacation homes, apartments, penthouses, luxury retreats, lake homes, ski chalets, villas, and many more lifestyle options. Each sale listing includes detailed descriptions, photos, amenities and neighborhood information for Austin.

Real Estate Listings Near Austin

Find luxury home listings in cities near Austin, TX


Health Homes #hospice #stories

#home health care services

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Health Homes

The Affordable Care Act of 2010, Section 2703, created an optional Medicaid State Plan benefit for states to establish Health Homes to coordinate care for people with Medicaid who have chronic conditions by adding Section 1945 of the Social Security Act. CMS expects states health home providers to operate under a whole-person philosophy. Health Homes providers will integrate and coordinate all primary, acute, behavioral health, and long-term services and supports to treat the whole person.

Who Is Eligible for a Health Home?

Health Homes are for people with Medicaid who:

  • Have 2 or more chronic conditions
  • Have one chronic condition and are at risk for a second
  • Have one serious and persistent mental health condition

Chronic conditions listed in the statute include mental health, substance abuse, asthma, diabetes, heart disease and being overweight. Additional chronic conditions, such as HIV/AIDS, may be considered by CMS for approval.

  • States can target health home services geographically
  • States can not exclude people with both Medicaid and Medicare from health home services

Health Home Services

  • Comprehensive care management
  • Care coordination
  • Health promotion
  • Comprehensive transitional care/follow-up
  • Patient family support
  • Referral to community social support services

Health Home Providers

States have flexibility to determine eligible health home providers. Health home providers can be:

  • A designated provider: May be a physician, clinical/group practice, rural health clinic, community health center, community mental health center, home health agency, pediatrician, OB/GYN, or other provider.
  • A team of health professionals: May include physicians, nurse care coordinators, nutritionists, social workers, behavioral health professionals, and can be free-standing, virtual, hospital-based, or a community mental health center.
  • A health team: Must include medical specialists, nurses, pharmacists, nutritionists, dieticians, social workers, behavioral health providers, chiropractics, licensed complementary and alternative practitioners.

Reporting Requirements

Health Home service providers must report quality measures to the state. States are also required to report utilization, expenditure and quality data for an interim survey and an independent evaluation.

Health Home Financing

States have the flexibility in designing their payment methodologies and may propose alternatives.

States receive a 90% enhanced Federal Medical Assistance Percentage (FMAP) for the specific health home services in Section 2703. The enhanced match doesn t apply to the underlying Medicaid services also provided to people enrolled in a health home.

The 90% enhanced FMAP is good for the first eight quarters the program is effective. A state can get more than one period of enhanced FMAP, but can only claim the enhanced FMAP for a total of eight quarters for one enrollee.

The Health Home Information Resource Center located on Medicaid.gov provides useful information to States considering the health home Medicaid State Plan option HHIRC. Technical assistance is available to support state Medicaid agencies in developing and implementing health home programs under Section 2703 of the Affordable Care Act.

Related Resources

Technical Assistance

A federal government managed website by the Centers for Medicare Medicaid Services. 7500 Security Boulevard Baltimore, MD 21244





Assisted Living Facilities, Nursing Homes and Every Senior Care Option #www.hospice

#assisted living

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Comprehensive And Unbiased Info On Over 70,000 Senior Living Options

Assisted Senior Living is:

  • One of the most comprehensive senior directories on the web. The database can be searched by care type, location, organization name, review status, cost and more.
  • A complete resources. The site includes information about
    • Assisted Living (Adult Foster Care) Facilities
    • Nursing Homes
    • Alzheimer’s and Dementia Care Centers
    • Independent Living Facilities
    • Adult Day Care
    • In-home Care
    • Hospice Care
    • Continuing Care Retirement Communities (CCRC)
    • Retirement Communities
    • Respite or Temporary Adult Care
  • Totally unbiased. The directory was originally based on government data combined with other independent sources. It has since been expanded to include detailed listing for many of the larger corporations since they present easy access to details about their facilities. It is NOT a paid-inclusion corporate site so every senior care organization gets fair exposure.

Why use Assisted Senior Living? The site includes

  • Location based search – Our advanced Geo-location search shows the nearest 40 senior care options to any desired location based on a zip code, city, or street address. Click on the map and get instant driving directions to each option.
  • Hot lists – Users can build a custom list of possible services and print that list with full contact information.
  • Complete listing information – We provide full contact information, photos, costs, and other details (where available) so users can compare apples to apples.
  • Safe usage – User may fill out a form to get personalized help but that is totally optional.
  • Reviews – The site includes both positive and negative reviews.

Reviews are a key part of the decision making process but many users don’t return to this site to create a review after they found a service provider. That is why we created a contest in 2011 to get more people to create reviews.

Advanced Search

User Tools

Assisted Living

Nursing Homes





Foundation Repair #foundation #repair, #foundation #contractor, #house #leveling, #foundation #repairs, #anchor #bolts,


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Why We re the Best

Experience like no other. Repairing and constructing over 7,000+ foundations. We know homes.

There are a lot of companies offering foundation repair in the Los Angeles area. How do you know which one is best? We believe experience should be the deciding factor. Julian Construction was formed in 1994, and our focus has always been on building foundations, doing repair, replacement, earthquake retrofitting and house leveling. We have inspected over 16,500 foundations .

If you also talk to another foundation contractor, ask how long they have been doing foundation repair. Not how long they have been in business. But how long they have been doing foundation work. There are some contractors in the LA area who have been doing foundation work for a year or less. Would you trust the safety of your home to them?

When the safety of your home and family are at stake, we think you ll want to go with Julian, the company that has been working under homes for nearly 20 years.

Best value. Our affordability comes from the efficiency of expertise and smooth-running crews. All equipment and vehicles are company owned. Julian Construction also offers 0% financing .

100% expert oversight. From start to finish, licensed and expert managers oversee all projects, ensuring perfection, timeliness and safety.


Nursing Homes and Hospice Facilities: Understanding Admissions #sani #beach #hotel

#hospice care facilities

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Options for Extra Care: Nursing Homes and Hospice Facilities

The services offered by nursing homes, assisted living facilities, or hospice are all very different. Find out more about each one and the costs associated with them.

By Linda Foster, MA
Medically reviewed by Pat F. Bass III, MD, MPH

Most people hope to live out their last years at home, but health circumstances may necessitate moves to nursing homes or assisted living facilities. When a loved one s illness is terminal, hospice facilities or hospice care at home may be the most caring solution.

According to admissions director Janice Harris of Pickersgill Retirement Community in Towson, Md. each facility serves a different purpose and entails different costs.

Assisted Living Facilities

If your loved one is not incapacitated to the point that you need to consider the skilled care offered by a nursing home, assisted living can be a viable solution. Many are in pleasant, planned communities and can be a terrific option for people who are unable to maintain their own homes any longer or take care of daily needs such as cooking or driving; they may be experiencing decreased sensory perceptions and delayed reaction times or confusion, but don t need round-the-clock nursing care.

The down side is the high cost. Assisted living facilities can run from $1,000 to $5,000 per month or more, says Bill Guerra, RN, BSN, with the Seven Hills Surgery Center in Henderson, Nev. Some assisted living facilities also charge extra for services like administering medications, providing trips to the physician, bathing, and so forth.

Medicaid will pay for assisted living for certain patients, depending on their income and personal resources.

Nursing homes provide care when patients can t take attend to their basic needs, are incapacitated by illness, or have dementia, says Guerra. Some, like memory centers, cater to patients with dementia who are prone to wandering leaving home and getting lost or hurting themselves unintentionally, though they can usually walk and talk.

Nursing homes can be private-pay facilities or state-run homes covered through the Medicaid system for people who can t afford the costs on their own. Qualifying for Medicaid is a complicated procedure, and it might be a good idea to consult with an elder law attorney. If you have time to plan ahead, you can take out a long-term care insurance policy to cover some or all costs, should a nursing home be necessary later in life. Medicare pays only for very limited stays under certain circumstances and not continual, long-term residence.

Hospice facilities offer end-of-life care care that is often administered in the patient s home, though there are physical hospice facilities, too. Some hospice programs are independent, others might be within hospital settings. Tina Daniel, RN, a nurse manager with Gilchrist Hospice Care in Towson, Md. says that anyone can request an evaluation for hospice care: the patient, the doctor, friends, or family members. At some facilities, a representative from the hospice or a nurse can determine if hospice is appropriate by visiting your loved one in their home, assisted living facility, or nursing home, says Daniel.

It does not matter whether you have personal insurance, Medicare, or Medicaid. If your loved one is terminally ill, you do not ever have to pay for hospice care services as there are non-profit hospice facilities that offer services for free, says Guerra.

Gilchrist Hospice Care, where Daniel works, is an example of a non-profit facility and admits patients for hospice services regardless of their ability to pay. Medicare covers 100 percent of services relating to terminal illness at home and at a long-term-care facility, says Daniel. However, Medicare does not pay for room and board. The services covered are clinical support, equipment, and medication relating to the terminal illness. Insurance may assist with a portion of the cost of room and board. Daniel says, We work with all insurances and discuss the benefits and co-pay with you.

Your loved one s medical team, the support staff at the hospital where treatment was given, and non-profit organizations are ways to get suggestions for local hospice facilities.

Your first step is deciding which facility is right for your loved one s needs at this stage of his or her life. Then you ll need to research costs, figure out what resources are available to pay for it, and whether your loved one qualifies for financial assistance or has any insurance. Investigate what your loved one may be entitled to from Medicare and Medicaid. Depending on the person’s age and health status, there may be time to get long-term insurance for the future.

Once you know your budget, you can begin interviewing facilities about the level of care they offered and find the best one to meet your loved one s needs.

Go to our partner site, RevolutionHealth.com. to find senior housing.





MASTERMAN – Park Homes – Sales and Hire #masterman, #park #homes, #sales,


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Masterman Park Homes Ltd

At Masterman we pride ourselves in good service a great product and unrivalled value for money.

Welcome to the Masterman Park Homes Ltd Website. Our family business has over 30 years experience in supplying off site park homes, hire/sale static caravans and mobile homes to both the trade and public and are Omar Homes main distributor. Our prices offer the very best discount and our ex-display models are an exceptional deal.

We are suppliers of the high quality, affordable British built Masterhome range, designed by ourselves using our unique knowledge of our customer requirements and preferences. Farmers, builders and other own land or plot owners are amongst our main customers our homes are also supplied as the perfect low cost granny annexe and in many cases planning permission is not always required.

The Masterhome range offers unrivalled value for money and is built to very exacting standards, conforming to all the latest safety and insulation requirements all included within the BS 3632:2015 full residential specification.

At our Wymondham Norfolk premises we stock Masterhome park homes. We also have on display a large selection of static caravans for both sale and hire.

Masterman’s unique static/mobile home caravan hire service offers 2 and 3 bedroom temporary accommodation for hire. Perfect for agricultural workers, self builders, renovators, property repairs due to fire, flood disaster and anywhere temporary accommodation is needed promptly and cost effectively.

Testimonials

Julie was really brilliant. I think I must have been one of their most testing clients and Julie was always patient and always helpful. The advice that I was given was always exactly what I needed. Spot on.

Masterman Homes always provided exactly what we asked for. They were always very friendly and helpful. Overall it was an excellent service!

We have hired caravans from Masterman Homes for the last 20 years. We have about 3 caravans from them at the moment, 2 of which we’ve had for about a year. Julie from Masterman Homes is very efficient and we always find them extremely helpful and friendly, with competitive rates.


Sell my house FAST – We Buy Houses “AS-IS” Fast For Cash


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WE BUY HOUSTON AREA HOUSES

FAST For CASH! Any Price Range! Any Condition!

We’ll make a FAST CASH offer on your real estate!

We’ll buy your property “as-is” no repairs required!

We’ll ease the process and handle the paperwork!

We’ll close quickly and work within your schedule!

get a FAST no obligation offer:

Sell my house FAST for CASH!

We buy houses in Houston, TX and the surrounding areas. You ve come to the right place if you re asking yourself how can I sell my house FAST for CASH. Our specialty is assisting homeowners who find themselves needing to stop a foreclosure, behind on payments, behind on taxes, going through a divorce, settling an estate, relocating, or needing to unload an unwanted rental. We can also assist if you re unable to afford repairs, have experienced a bankruptcy, were laid off from work, or just want to sell FAST for CASH. Regardless of the condition of your home, your reason for selling, or where in the Houston and surrounding area the house is located, we can evaluate your situation and help to identify your options.

Contact us today! Once you ve accepted our offer, we re usually able to pay in CASH and can typically close very quickly. Again, if you re asking yourself how can I sell my house fast simply complete the form found at the bottom of this page, click the button below, or call us 24 hours a day at 832-866-FAST (3278). We buy houses as-is FAST for CASH!


Key Colony Beach Real Estate – Key Colony Beach FL Homes For

#key colony beach motel

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Key Colony Beach FL Real Estate

Why use Zillow?

Zillow helps you find the newest Key Colony Beach real estate listings. By analyzing information on thousands of single family homes for sale in Key Colony Beach, Florida and across the United States, we calculate home values (Zestimates) and the Zillow Home Value Price Index for Key Colony Beach proper, its neighborhoods, and surrounding areas. There are currently 77 for sale listings in Monroe County FL zip codes. including condos. bank owned homes. short sales. townhomes. duplexes. land and luxury listings. If you’re looking to rent in Key Colony Beach FL. check out our extensive list of luxury apartments and townhomes. We make it easy to find your dream home by filtering home types, price, and size. Filtering with keyword search is also possible, like “waterfront” or “Remodeled kitchen ” homes in Key Colony Beach.

Cities Near Key Colony Beach

ZIPs Near Key Colony Beach

Disclaimer: School attendance zone boundaries are supplied by Maponics and are subject to change. Check with the applicable school district prior to making a decision based on these boundaries.





Compare the Best Home Insurance – Reviews, Rates – Ratings #home, #home


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Compare the Best Home Insurance

Reflects Credio s analysis of each company s policy rate offerings across several of the states in which it operates, and across a variety of demographics. A high (green) rating indicates that the company s rates are relatively lower than its competitors .

Show the top Home Insurance Companies with the highest Affordability Rating

An HO-2 only covers named risks; though the list tends to be quite long. It does not cover damage from accidental losses. Since typical accidental losses are likely to be relatively small compared to the total value of a home, it might be best to accept the risk and purchase an HO-2 policy. Note that not many companies offer this policy at the present, as HO-3s are far more popular.

By far the most common policy, it covers a vast array of risks, including fire, wind, theft and vandalism, freezing, and accidental damage. Most companies exclude the following from HO-3s: floods, sewer backups, earthquakes, termites, pets, mold, rot, and explosions. This policy also covers personal property, but only for named perils, and covers the personal property for replacement cost after adjustment for depreciation, not the full replacement cost.

It is the same as an HO-3 policy, except that it includes replacement cost coverage for personal property and insures personal property against all perils except specifically excluded perils.

An HO-8 policy typically pays only for damages up to the actual cash value of what is lost, versus allowing the owner to insure for full replacement cost. HO-8 policies are most appropriate for those with older homes, and are intended to consider that older homes often have ornate woodwork and other features that are very expensive to replace. Replacing such features may cost more than the home is actually worth, and HO-8 policies will repair or replace what is damaged.

Insurance for tenants who are renting.

Reflects a company s national complaint ratio, as determined by the National Association of Insurance Commissioners (NAIC). A high (green) rating means fewer complaints made against a company. Each year, the NAIC tallies up all the complaints that have been made by customers against a company to their respective state insurance departments. The ratio is then calculated by dividing the number of complaints by the amount of gross premiums written (in millions of dollars) by the company that year.

Best Home Insurance Companies Sorted by Customer Complaint Rating (out of 5)

What to Watch for in Home Insurance

Ratings
Don’t automatically select one of the most popular or well-known companies. As the comparison shows, the companies with the largest NAIC Market Shares are not necessarily the top-rated options. Bigger does not always mean better.

Premiums
Although sample premiums are used to make general comparisons across home insurance companies, don’t base your personal decision exclusively on the sample premiums. Premiums vary tremendously by location, age of the house, construction type, etc. Contact different companies to receive personalized quotes before making your final decision.

Complaint Ratios
Avoid companies with high complaint ratios, as this may indicate poor customer service. Each state’s Department of Insurance provides consumers with complaint ratio data for all of the home insurance companies in their state. Before deciding on an insurance company, make sure that it has a low complaint ratio.

Your List Your List is the collection of listings you have seen or added to compare. Clear

Add a home insurance company to your list

Select the “Add to Compare” link located below the tile of any listing to add an item to your list.

Related Topics On

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    Select Solar Panels, PV, 12V Solar Panel Kits UK #select #solar, #12v


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    My wife and I chose Select Solar, to install a photovoltaic (PV) system after lengthy research and talking to other solar installers. What impressed us first was how easy it was to talk with Colin Howe and how knowledgeable he was with the current state of the solar industry. We had two requirements in reducing our electrical cost; find a way to reduce our daily demand and then create supplemental power that we would use in our house and feed back to the local electric grid.

    the order arrived the next day.

    Easy to order and no problems whatsoever.100% happy.

    Ace Solar Power

    Like your website

    Most cost effective quote. Install is of high quality and they were good to work with. I recommend them if you are considering putting solar at your home.

    good. web site easy and fun

    Thank you Colin. I had a technical enquiry that was dealt with by Colin over the telephone. Very professional service and answered in terms that I could understand. My specific technical enquiry was dealt with a professional manner but without the salesman jargon that I had been getting all day.

    Take a look at our featured products.

    Select Solar – the solar power specialists

    Select Solar – the solar power specialists, with one of the biggest and best selection of solar pv energy products for business and leisure. We sell top quality branded solar products backed by full warranties, complete technical specifications, and excellent uk customer service.

    Whether you need 12V or 24V solar panels or just components (such as a charger for your motorhome or boat) or full solar panel kits with accessories for professional business or leisure projects, Battery Back-up for your existing Solar Installation, we may well have exactly what it is you are looking for.

    If you just want green energy products to use around the house, we have those too. If you require any technical information or other help, we ll be delighted to advise you.

    Click here to read more about Select Solar and our group of companies.

    Latest Blog Post

    Select Solar Supply the most comprehensive and tested range of eco products including 12v Solar Panels ranging from 10w up to any amount. Read more

    Our Guarantee

    If you are not happy, send it back within 14 days for a full refund. Read more here .

    We send to anywhere in the world, dispatching most items within 3 working days of order. We will let you know if it will be longer. Full delivery details here.


    Custom business website #cruise #america #rv #rentals, #rv #for #sale, #four #winds


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    Signs

    Signarama is a full service sign center that can help with any type of project, whether it is temporary signs for an occasion or a permanent stone monument for a business. We can help direct traffic and advertise for a community event or brand and create a street presence for a new business.

    Our professional staff can help define the material, size, color and location of your signage based on the scope of your event or project.

    Building Directory Signs

    Yard & Real Estate Signs

    Banners

    Decals

    Signarama is the place to call for all varieties of custom decal stickers designed to get your message across right where you need it. Custom decals from Signarama include a world of shapes, materials, sizes, colors, typestyles or fonts or special features. The many uses of decals range from stickers for a Blood Drive to a logo on a Basketball floor.

    More custom decals applications:

    Letters for vehicle windows

    Store front windows

    OSHA safety decals

    Custom decals promoting store or event

    Our experts will work with you to achieve the look you are after to help you design decals that differentiate you from the competition. Our efficient approach means that your custom decal sticker products will be on time and to your satisfaction.

    Call Signarama Today!

    Visit Full Site 2017 Signarama. All Rights Reserved.

    Vehicle Signs

    Vehicle wraps are the most impactful way to create a buzz for your advertising message on the street. No other form of advertising has a lower cost per impression, which can generate thousands of impressions daily.

    Signarama designs and installs vehicle graphics on your company trucks and cars. Our range of designs can consist of simple lettering to full color vehicle wraps, partial vehicle wraps, and magnetic signs .

    Our Signarama sign centers have the capabilities of lettering small passenger cars, trucks, box trucks, vans, buses, trailers and boats .

    We also have marine grade printable vinyl that can be used to customize boats. Boat graphics can also range from individual letters to a full boat wrap.

    Whether you have a fleet of vehicles or a start-up company, we can help advertise your company clearly and artfully to thousands of your customers a day.

    Call Signarama Today!

    Visit Full Site 2017 Signarama. All Rights Reserved.

    Letters – Illuminated Signs

    Lettering can be created out of various materials and in different styles. Some of these materials are metals, foam, wood, plastic and vinyl. Choosing the correct material and style for your project is very important.

    Metal dimensional letters can often times convey a sense of integrity and permanence to customers. Plastic and foam letters are easily customized and do an excellent job of identification.

    Vinyl letters can be used for windows, vehicles and boats. Restaurants, taverns, stores, even tanning salons are frequent purchasers of Signarama Custom Channel Letters.

    Whether you are looking for dimensional letters, channel letters or wall letters, Signarama is your one-stop shop who will tailor to your sign needs!

    Visit Full Site 2017 Signarama. All Rights Reserved.

    Sidewalk Signs

    Our sidewalk signs are powerful displays that bring the message to your customer right on the street! Signarama creates and sells many A-frame signs, temporary signs, sandwich boards, and other outdoor durable products to help you promote your business or products. These products are custom made, yet affordable and specific to your needs. Our expert designers and state of the art equipment allows us to offer a large variety of sign products that are commonly classified as Signarama sidewalk signs.

    Visit Full Site 2017 Signarama. All Rights Reserved.

    Buy a Franchise

    Signarama has been at the forefront of this growth, successfully franchising the full-service sign center concept for more than 25 years. Being the #1 sign franchise in the world has its advantages, Signarama has the largest support team and state-of-the-art training facility in the industry, has been ranked the #1 franchise in the industry for eight consecutive years by Entrepreneur magazine, and is the only franchise ever to receive the prestigious “E” Award given by the U.S. Department of Commerce and the President of the United States.

    Visit Full Site 2017 Signarama. All Rights Reserved.

    Custom Sign – Create

    At Signarama, we understand that your requirements can demand “custom” that goes beyond the visual appearance of your sign. Whether you need to use Earth-friendly and sustainable products, indoor or outdoor, permanent or temporary, Signarama custom sign solutions will answer the demand.

    Many businesses and individuals rely on Signarama for their custom signs, including:

    Real estate agents

    Hotels and hospitality businesses

    Sports and sporting goods

    Call Signarama Today and you will understand why Signarama is the worldwide leader in custom signs and sign products for over 25 years!

    Visit Full Site 2017 Signarama. All Rights Reserved.

    Trade Show Displays

    Signarama Pop up displays and retractable banner stands have become the top choice for many exhibitors because they are lightweight and durable. Signarama appeals to the frequent exhibitor because of the versatility and portability features of our pop up displays and retractable banner stands.

    Whether you need a floor model or one for a tabletop, pop up trade show displays come in a variety of sizes and shapes, including straight, curved, serpentine, and more. We have several different custom pop up displays that are easily transportable in convenient carry cases, and are very simple to assemble. In fact, they set up in minutes!

    Stand out at your next trade show or event with our Pop up displays and retractable banners from Signarama!

    Visit Full Site 2017 Signarama. All Rights Reserved.


    Tredd s Self Storage Software – Home Page #self, #storage, #software, #self


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    Tredd s Self Storage Software is intuitive, easy-to-use, and priced right at $495 with no monthly or yearly licensing fees. Check out some of our features and be sure to view some of our actual program screens.

    When you purchase our software, we go the extra mile for our customers. All building graphics are drawn, billing cycle settings are entered, and your business information is entered. You simply install the software and start clicking your way to adding customers, accepting payments, charging credit cards, viewing reports, printing customer letters, and managing your self-storage business like never before.

    Our Maintenance Plan includes for one year: unlimited customer support, unlimited upgrades, unlimited software licenses, unlimited customer SMS texting. and unlimited use of our online Cloud backup server.

    Click here for a quick online demonstration of our software or call us toll free at 1-800-690-7956 for a no-hassle consultation about our software.

    New in v7.2.2.C : New [Pay In Full] button on Receive Payment window, ability to send custom SMS text messages to customers, added Word like capabilities to customer letters, and more.

    We are celebrating our�20th year�of producing quality software for the self storage industry with our latest release 7.2.2.C on 15 June 2017. Check out the What’s New to read about the 50+ new features we added in the past year including Credit Card Processing with Authorize.net and many more features requested by our customers, such as how our software can help you be Earth Friendly and Green .

    Our software is 100% compatible with all latest versions of Windows including XP, Vista, Windows 7, Windows 8, and Windows 10. We are also compatible with all latest Window server editions.

    If you have any questions about our software, please contact us.


    Auto Insurance Fullerton 714 526 5588 Car Insurance Fullerton #auto #insurance #fullerton,


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    Williams Insurance
    (714) 526-5588

    THERE IS NO SUBSTITUTE FOR EXPERIENCE

    Williams Insurance has been a Family-owned and operated independent agency serving the Southern California community for over 70 years. Our knowledgeable, experienced and independent agents will find you premier coverage for the lowest price. We can help with any of your insurance needs, providing, personal, and commercial, life and health policies. In just a few minutes, our agents will determine your true coverage needs, knowing that the cheapest insurance is not necessarily the right insurance.

    THE PERSONAL TOUCH

    We do not use voice mail; clients who phone Williams Insurance are greeted by a live person. Customers are directed to their own individual agent who is familiar with their insurance needs.

    SERVING ALL OF ORANGE COUNTY

    Williams Insurance is located in Fullerton and has been serving the communities of Fullerton, Brea, Anaheim, Placentia, Yorba Linda, Buena Park, La Habra, Orange, Tustin, Santa Ana, Irvine, Costa Mesa, Huntington Beach, Newport Beach and all of Orange County since 1941.

    Over the years, we have supported dozens of local charities and community activities, understanding that it is the people of Orange County that make this place great. Our mission is to continue to grow the trust these communities have placed in us, while providing excellent customer service.


    South Oaks Rehabilitation And Healthcare Center – 55 Plus Retirement Communities Living


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    RetireNet.com

    The Retirement Net Premier retirement living featuring retirement communities and retirement homes in planned active developments. Worldwide resource for active retirement senior communities, rv/resort homes, vacation homes and assisted living facilities. The Retirement Net is the most comprehensive resource of premier retirement communities throughout the world featuring site built homes, manufactured homes, assisted living facilities, planned active retirement communities and various retirement properties worldwide. See also: senior housing, retirement communities, retirement living, elder care network.

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    Kerry Wilson Insurance – Gadsden, AL – Mobile Home Insurance #cycle, #home,


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    Kerry Wilson Insurance

    Since 1991, As Low As Per Year, Automobile Rates As Low As Per Month, Call & Regquest Your Free Rate Quote Now. Corn Panies To Give, Don’t Walt Hours On Quotes We Give Free, Free Rate Quotes, Full Coverage or Liability Coverage, Get a Prefed Risk f.

    Kerry Wilson Insurance was established in 1991, in Gadsden, AL – Etowah County and is a business listed in the categories Insurance, Insurance Mobile Homes, Mobile Home Insurance, Insurance Companies, By Name, Insurance Automobile, Insurance Flood, Insurance Motorcycles, Automobile Insurance and Flood Insurance and offers CYCLE, Home and LOW DOWN PAYMENTS. If you did business with Kerry Wilson Insurance, please leave a review and help us improve and help other people. Also, don’t forget to mention Hubbiz.

    Insurance, Insurance Mobile Homes, Mobile Home Insurance, Insurance Companies, by Name, Insurance Automobile, Insurance Flood, Insurance Motorcycles, Automobile Insurance, Flood Insurance

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    Credit Card, Payment Plans

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    Florida – Immobilien in Cape Coral, Fort Myers und Naples – Makler


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    Hier finden Sie das beste Angebot am Markt!

    HпїЅuser und Wohnungen fпїЅr ab US$ 70,000.-
    Wenn man in der Lage ist etwa mehr auszugeben, zum Beispiel um die US$ 70,000, erhпїЅlt man in der Regel etwas neuere Einsteiger-Bungalows und Wohnungen oder etwas bessere Lagen zur Stadt. Je nach GrпїЅsse und Lage der Immobilie sollte man jedoch auch in dieser Preislage mit allerlei Renovierungsaufgaben rechnen. Gegebenenfalls helfen wir Ihnen die passenden Handwerker zu vermitteln.

    Was kauft Ihnen US$ 100,000 bis US$ 125,000?
    FпїЅr um die US$ 100,000 finden sich bereits HпїЅuser mit 4 Schlafzimmer und neueren Baujahrs. Einem Pool werden Sie in dieser Preislage jedoch nur bei Wohnungen mit Gemeinschaftsanlge finden kпїЅnnen. Generell sind Sie meistens in dieser Preislage etwas weiter auf dem Lande, jedoch selten mehr als 5 Minuten Fahrt zum nпїЅchsten Einkaufszentrum.

    Um die US$ 150,000 kauft Ihnen ein grosses Haus
    Ein wenig hпїЅher im Preis, um die US$ 150,000, und sie erhalten mit etwas GlпїЅck ein grosses Haus in angenehmer Lage. Manchmal ist sogar schon ein eigener Pool dabei. Viele der Angebote verkaufen sich innerhalb weniger Tage nachdem diese VerпїЅffentlicht werden. Es ist eine sehr beliebte Preislage die den Traum Florida vielen Familien verwirklicht.

    Perfekt fпїЅr die Ferienvermietung ab US$ 200,000
    FпїЅr um die US$ 200,000 kann man bereits einfache HпїЅuser komplett einzugsfertig bekommen. Das Ausgabe/Gewinn-VerhпїЅltnis fпїЅr eine effektive Kostendeckung durch Ferienvermietung ist in dieser Preislage sehr attraktiv. Siehe auch Berechnungsmodell Diese Preislage bietet manchmal sogar die Lage an einem Kanal oder See, jedoch ohne das diese mit dem Meer verbunden sind. Die Option Bootzugang zum Meer kostet mindestens saftige US$ 100,000 mehr bei пїЅhnlicher Immobilie.

    Gehobene Mittelklasse fпїЅr um die US$ 300,000
    FпїЅr um die US$ 300,000 finden sich bereits HпїЅuser mit 4 Schlafzimmer und 3 BпїЅder. SпїЅd Fort Myers ist in der Regel etwas teurer als Cape Coral. In dieser Preislage findet man schon in beiden StпїЅdten sehr anschauliche HпїЅuser. Einige davon werden sogar bereits auf WassergrundstпїЅcken sein, jedoch nur die пїЅlteren, kleinen HпїЅuser mit Boot-Zugang zum Golf von Mexico / Meer.

    HпїЅuser mit Pool – ab US$ 400,000 bereits Luxusklasse
    Wer in der glпїЅcklichen Lage ist um die US$ 400,000 fпїЅr ein Haus investieren zu kпїЅnnen, findet oft einen grosszпїЅgig gestalteten Pool und kann bei seltenen Angeboten bereits ein Boot dazu planen. In dieser Preislage finden sich bereits einige Angebote die alles haben, schпїЅnes, grosses Haus mit guter Ausstattung, einen Pool, einen Whirlpool, und einen eigenen Bootsanlager mit Wasserzugang пїЅber KanпїЅle zum offenen Meer.

    Wir bieten Ihnen fпїЅr Ihren Aufenthalt zum Immobilien shoppen oder einfach nur Urlaub folgende
    tageweise oder wпїЅchentlich mietbaren voll ausgestatteten FerienunterkпїЅnfte.
    Alle UnterkпїЅnfte sind mit Internet-Computer ausgestattet und Sie kпїЅnnen von dort aus
    sehr bequem Ihre Immobilien-Kauf-Suche lenken.
    Nebensaison ab 55 Euro pro Nacht wesentlich mehr Ausstattung als ein Hotelzimmer:


    Time-Share Donations Offer Owners Little Tax Benefits and Big Headache #timeshare #donation,


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    The Hidden Costs of Donating a Time-Share

    Donating a time-share can have hidden costs.

    Getting out from under a vacation property often means a passel of hassles.

    Time-share owners frequently discover that the resale value of their piece of paradise is only a fraction of what they paid; many are reduced to listing time-shares on Craigslist or eBay for pennies on the dollar, or paying shady resellers hundreds or even thousands of dollars to take the properties off their hands .

    Meanwhile, those annual maintenance fees keep rising. That’s why AARP member Linda Milgate, 61, of Santa Cruz, Calif. asked On Your Side about donating a time-share to charity via an organization called Donate for a Cause (DFC).

    Leaving AARP.org Website

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    Donations Done Right

    Daniel Borochoff, president of the nonprofit watchdog organization CharityWatch, offers these tips on how to donate with confidence.

    1. Check sites like CharityWatch.org. CharityNavigator.org. GuideStar.org and that of the Better Business Bureau (bbb.org/charity) to see financial statements and get charity ratings.

    2. Look for charities that direct at least 65 percent of their funds to program expenses.

    3. Don’t be swayed by free stickers and calendars. It’s illegal for charities to demand payment for unordered items.

    For owners trying to avoid myriad resale scams. DFC looks promising. It offers to help transfer title, sell the property and donate a portion of the proceeds to charities like the American Cancer Society. The owner can write off the fair market value of the time-share on his or her federal income tax return. In theory, everyone wins.

    But unloading your vacation villa might not be as simple or inexpensive as the DFC pitch portrays. To donate a time-share, you first transfer title to the nonprofit DFC, founded by attorney Jim Tarpey — who also owns Resort Closings, a for-profit title company with which the charity shares staff and facilities in Bozeman, Mont. DFC funnels prospective donors to Resort Closings, which collects $2,495 from most owners to process the title transfer and other paperwork. Donors are told they can recoup several times that amount ($6,000, according to the website) by claiming the time-share’s market value as a charitable donation on their income tax returns.

    Not so fast, warns the IRS. While time-share owners may be tempted to claim a five-figure value based on their original purchase price or what the resort is asking for similar units, the amount you can legally deduct depends on the fair market value — what a knowledgeable buyer would pay, not what a friendly appraiser says it might be worth. Time-shares donated to DFC sometimes sell for as little as $50, Tarpey admits — a figure DFC reports to the IRS.

    So DFC may be able to help you escape your time-share (at a cost of a few thousand dollars), but don’t count on safely claiming a big tax write-off. And note that the average donation generates only about $400 to downstream charities, according to DFC. If philanthropy is your priority, just write a check directly to a charity of your choice.

    Consumer advocate Ron Burley writes the On Your Side column for AARP and is the author of Unscrewed: The Consumer’s Guide to Getting What You Paid For.

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    Residential Care Homes – Division of Licensing and Protection #best #deals #on

    #residential home care

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    Residential Care Homes

    Residential care homes are state-licensed group living arrangements designed to meet the needs of people who cannot live independently and usually do not require the type of care provided in a nursing home. When needed, help is provided with daily activities such as eating, walking, toileting, bathing, and dressing. Residential care homes may provide nursing home level of care to residents under certain conditions. Daily rates at residential care homes are usually less than rates at nursing homes.

    Residential care homes are divided into two groups – Level III or Level IV — depending upon the level of care they provide.

    • Level III homes provide nursing overview, but not full-time nursing care
    • Level IV homes provide neither nursing overview nor nursing care

    There are Level III homes which are designated as Enhanced Residential Care (ERC) providers. The ERC designation allows the residential care home to designate a number of beds for residents requiring a higher level of care.

    Click on the individual residential care facility for contact information and service descriptions.

    Review the findings of Standard Survey Results in the DLP Registry .

    Personal tools

    State of Vermont Web Policies and Copyright





    Residential Care Homes #pallitive #care

    #residential home care

    #

    Residential care

    We offer residential care within the warm, safe and friendly surroundings of Anchor’s care homes. Our 24-hour personal and practical support is provided by well-trained, caring staff and is designed to ensure you continue to enjoy maximum independence as well as peace of mind, knowing that help is always at hand.

    At Anchor we provide personally tailored care that is tailored to the needs of our customers whilst maintaining and enhancing their quality of life.

    Privacy and choice are high on our priority list. We understand and respect that most older people value keeping their independence and so we encourage you to choose how your care is planned and delivered. Our carers work with customers and their loved ones to create detailed care plans that encompass every aspect of wellbeing to ensure individual health and care needs are continually met.

    Staying active at our residential care homes

    Being interested in what is going on and taking part in fun activities is a vital part of life. Our approach to residential care focuses on ensuring all of our care homes offer a stimulating range of activities which are designed to reflect the wishes and interests of our customers and help them maintain close bonds with their local community.

    Many of our care homes have a dedicated Activities Co-ordinator who arranges a variety of opportunities for our customers to enjoy daily activities in the home as well as in the local area. These can range from day trips to leisure facilities and places of interest, to arts, crafts, games, using the iPad and social events in the home. We work in partnership with the National Association for Providers of Activities for Older People (NAPA ) and encourage activities that enhance our residents’ lifestyle, hobbies, health and wellbeing.

    Visitors are welcome at any time and if they wish can stay for meals. Some of our homes also have overnight guest rooms. Residents are encouraged to maintain links with the wider community and to come and go as they please.

    Health and personal care

    We work together with a number of health and social care professionals who either visit our homes on a regular basis or who will make visits by arrangement. These include the local GP, district nurse, dentist, optician, physiotherapist, chiropodist and holistic therapists. Most of our homes also have their own hairdressing salon.

    Freshly cooked meals

    Mealtimes are a social and enjoyable time of the day, and central to our residential care. All our menus offer freshly cooked, wholesome, appetising and nutritionally balanced meals with a different seasonal choice every day.

    Our experienced chefs attend our in-house, nationally recognised training programme and we use the Standard Nutritional Assessment check in all of our homes. This enables us to understand the nutritional requirements of each resident and to meet their needs accordingly. Anchor is proud to have won national recognition for the quality of its food and catering service.

    The right people

    Our dedicated care teams undergo intensive training and are required to complete QCF (Quality care framework) qualifications.

    Our carers are passionate about what they do and at Anchor we specially select staff for their personal qualities, such as being instinctively warm with a natural desire to help others. Customers can rest assured that our residential care is delivered by well qualified, welcoming, and caring professional staff.

    Our care homes aim to provide an environment where you will feel at home with the benefit of having your care needs supported. Find out more about our care homes here .

    Use our Find a service tool to find Anchor care homes providing residential care in your desired area.

    Choosing a care home?

    For many people, moving to a care home is a big decision and it can be difficult to know where to start. Download our free guide to choosing a care home for information about the different types of care available, what life is really like in a care home and care home fees.





    Guidance on caring for your rat & rodents #rats #in #homes


    #

    Fatwire Article Portlet

    Rats are intelligent, highly social animals and are normally active at night and dawn and dusk. They have an excellent sense of touch, and have a wonderful sense of smell. Provided their needs are met, rats are incredibly rewarding animals to look after and can form close human-animal bonds with their carers.

    There are several different kinds of rat, varying mainly in colour. Usually, rats live for around 2 years, but some may live for longer. Although this may appear a short time in comparison to other pet animals, owning rats is still a big responsibility and commitment. Rats have complex needs and are not easy to look after well.

    Take a look at our pet search to see all the rats available for rehoming .

    Your duty of Care

    Owning and caring for a rat can be fun and rewarding, but it is also a big responsibility and a long-term commitment. If you own or are responsible for rats, even on a temporary basis, you are required under the Animal Welfare Act to care for them properly.

    Understanding rat s needs

    There is no one perfect way to care for all rats, because every rat and every situation is different. It is up to you how you look after your rats but you must take reasonable steps to ensure that you meet all their needs.

    Read our expert reviewed pet care information to find out more about the needs of rats and how to make sure that they are happy and healthy: Environment. Diet. Behaviour. Company. and Health and welfare .

    Clarification of terminology

    Bedding material is used to describe the material or substrate that is used to cover the bottom of the cage.

    Nesting material is used to describe the material provided in addition to bedding material, which is given to animals for nest building and nesting behaviour.

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    Advocate Hospice Review – Nursing Homes in Downers Grove, IL – BBB

    #advocate hospice

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    Advocate Hospice

    BBB Accreditation

    This business is not BBB accredited.

    Businesses are under no obligation to seek BBB accreditation, and some businesses are not accredited because they have not sought BBB accreditation.

    To be accredited by BBB, a business must apply for accreditation and BBB must determine that the business meets BBB accreditation standards, which include a commitment to make a good faith effort to resolve any consumer complaints. BBB Accredited Businesses must pay a fee for accreditation review/monitoring and for support of BBB services to the public.

    Reason for Rating

    Factors that raised the rating for Advocate Hospice include:

    • Length of time business has been operating
    • No complaints filed with BBB

    Customer Complaints Summary

    0 complaints closed with BBB in last 3 years | 0 closed in last 12 months

    What is a BBB Business Review?

    We offer free reviews on businesses that include background, licensing, consumer experience and other information such as governmental actions that is known to BBB. These reviews are provided for businesses that are BBB accredited and also for businesses that are not BBB accredited.

    About BBB Business Review Content & Services:

    Some Better Business Bureaus offer additional content & services in BBB Business Reviews.
    The additional content & services are typically regional in nature or, in some cases, a new product or service that is being tested prior to a more general release.
    Not all enhanced content & services are available at all Better Business Bureaus.

    Professional Affiliations X

    Types of Complaints Handled by BBB

    BBB handles the following types of complaints between businesses and their customers so long as they are not, or have not been, litigated:

    • Advertising or Sales
    • Billing or Collection
    • Problems with Products or Services
    • Delivery
    • Guarantee or Warranty

    We do not handle workplace disputes, discrimination claims or claims about the quality of health or legal services.

    BBB Complaint Process

    Your complaint will be forwarded to the business within two business days. The business will be asked to respond within 14 days, and if a response is not received, a second request will be made. You will be notified of the business’s response when we receive it (or notified that we received no response). Complaints are usually closed within 30 business days.

    What is BBB Advertising Review?

    BBB promotes truth in advertising by contacting advertisers whose claims conflict with the BBB Code of Advertising. These claims come to our attention from our internal review of advertising, consumer complaints and competitor challenges. BBB asks advertisers to prove their claims, change ads to make offers more clear to consumers, and remove misleading or deceptive statements.

    What government actions does BBB report on?

    BBB reports on known government actions that are relevant to the business’s marketplace dealings with the public.

    Thank you for your feedback!

    BBB Reporting Policy

    As a matter of policy, BBB does not endorse any product, service or business.

    BBB Business Reviews are provided solely to assist you in exercising your own best judgment. Information in this BBB Business Review is believed reliable but not guaranteed as to accuracy.

    BBB Business Reviews generally cover a three-year reporting period. BBB Business Reviews are subject to change at any time.

    Additional Phone Numbers

    Find a Location X




    Care Homes For Jewish People #grand #hotel

    #nightingale house hospice

    #

    WELCOME TO NIGHTINGALE HAMMERSON

    Nightingale Hammerson is an independent charity which has been serving the community for over 170 years. We offer a range of services tailored to meet the needs of each of our residents.

    We run three homes: Nightingale House in South West London, Hammerson House in North West London and Belmont Lodge in Bushey Herts which is supported sheltered housing home.

    We are one of the Jewish community’s leading providers of care for older people. We pride ourselves in providing high quality holistic care in a safe and stimulating environment.

    Nightingale House, providing residential. nursing and dementia care. accommodates 170 residents. Hammerson House can care for 85 residents and provides short stay residential and nursing care as well as assisted living accommodation. Belmont Lodge provides accommodation for up to 12 tenants.

    Our dedicated, well trained team of staff and volunteers ensure that individuals living in our homes receive attention all day, every day.

    Hammerson House – Relatives News

    Text NGHP16 £10 to 70070

    to donate to Nightingale Hammerson

    and make a difference today

    © Nightingale Hammerson – Registered Charity 207316 – Tel: 020 8673 3495





    Assisted Living: Facilities in Florida (FL); Senior & Long Term Care #florida


    #

    Florida Assisted Living Facilities & Senior Care

    Don’t be fooledby the Questionable Tactics used by many assisted living sites

    This page should serve as a starting point for learning about many of the different assisted living facilities and long term care options throughout the State of Florida.

    The facilities listed on this page may be contacted directly and safely!

    Florida is one of the most popular states among seniors and retirees due to the great climate, senior care options and assisted living facilities that the state has to offer. Naturally, the need for assisted living and long-term care has grown over the years along with this increase in the number of seniors living here.

    Florida Assisted Living Waiver Program: How To Apply Eligibility How To Apply Eligibility

    As with most states, Florida has a very specific definition of what assisted living is . and what basic services are included. Essentially, Assisted Living Facilities in Florida provide “full-time living arrangements in the least restrictive and most home-like setting.” The size of the facility may range from one resident, to hundreds – and can include individual apartments or rooms that may be shared, or single occupancy.

    ***The Median Monthly Cost for Assisted Living in Florida (Private, One-Bedroom) is: $3,045

    To see a full definition for “assisted living” and a description of the basic services that an assisted living facility in Florida may provide, please see the Florida Agency for Health Care Administration .pdf here . Intro by D. Besnette

    How To Learn Average Costs for Assisted Living by Area In Florida

    Video Produced by Assisted Living Directory

    Our mini-interview with the Colorado Assisted Living Association’s Communications Director.

    Florida Assisted Living: Featured Facilities Services

    Number of licensed beds/capacity: 15

    Hobe Sound, Palm Beach County, Indian River

    Family Private Care

    Private Care Referral Services Family Private Care is a Nurse Registry licensed in the State of Florida (License Number NR30210962). We specialize in providing excellent, cost-conscious private care referral services for clients in their homes, in hospitals, assisted living facilities, and nursing homes. Our goal is for your family to enjoy peace of mind and for your loved one to maintain the highest possible level of independence. Family Private Care serves clients in Palm Beach, Martin, St. Lucie, Indian River and Okeechobee Counties on Florida’s southeast coast. Contact us at 800-962-0884 or by email at [email protected] We have facilities in Hobe Sound, Indian River and Palm Beach County Florida

    Do you have a love one, parent, adult family member or a friend that needs looking after while you are at work or just need some time for your self? Our company “Angeles Assisted Living Facility, Inc.” is state certified and Insured to take care for your loved one, we provide the transportation round trip. Our service’s are available daily Monday thru Friday from 6:00 A.M. till 4:00 P.M. and all this is at No Cost to you or anyone in your family.

    For more information please feel free in contacting us at (786) 234-3055 or email us at [email protected] and ask for Liz.

    “ALF” ASSISTED LIVING FACILITY/ADULT DAY CARE FOR THE ELDERLY THERE’s NO PLACE LIKE HOME!

    Sometimes, nursing homes or retirement centers seem like the only options for care.We will immediately change your outlook on home care services by offering your loved one a comfortable environment that closely resembles home living.

    We are a licensed 6 resident Assisted Living Facility (ALF) and an Adult day care facility for 5. Our home is located in a residential neighborhood in Homestead, FL. It is owned and operated by family members, family that understand how difficult it is to make such decisions.

    We are committed to providing the most exceptional,secure and rewarding home care. We proudly welcome you to take a private tour of our home.

    SERENITY ADULT HOME CARE SERVICES, LLC

    15401 SW 277 ST, HOMESTEAD, FLORIDA. Please contact us at

    Homestead Manor is an 88-bed Skilled Nursing Facility. Conveniently located right next to Homestead Hospital, Homestead Manor offers a wide range of health care options. We provide long-term care nursing for individuals who require personal assistance for an extended period.

    1330 NW 1st Avenue

    Homestead, FL 33030

    Indian Harbour Beach

    Beachside Assisted Living at Indian Harbour

    Southern Comfort Inn, Adult Care Residence – All the Comforts of Home!

    Southern Comfort Inn is a new Adult Care Residence located in Ruskin Fl, Hillsborugh County. We offer individualized care for assisted living, independent living and Special Day Care at affordable rates. More details are available by calling 813-625-9642 for a tour and personal care plan.

    Renaissance Retirement Community

    At Renaissance we feature beautiful private accommodations on 13 acres.

    Each unit is carpeted, has a full kitchen and a private patio. And we provide weekly housekeeping and free laundry facilities, so you’ll be free to pursue the activities you choose.

    For your security, each unit has emergency call response systems in the bedrooms and bathrooms.

    RETIREMENT, ASSISTED LIVING,

    • Private One Two Bedroom Suites
    • 24-Hour Staffing and Emergency Response Systems
    • Visiting Physician, Podiatry Services In House Therapies
    • Adult Day Care, Respite Care Hospice
    • Diversion Program Accepted, American Eldercare

    Call 407-323-7306 For More Information

    Pines of Sarasota – Assisted Living Facility

    The Assisted Living Center at Pines of Sarasota is designed for those who need extra support and personal care assistance but don’t require the intense medical services of a nursing home. It is a non-medical facility with the capacity to provide a comfortable home for 72 residents. Each room is private, with an adjoining bath, and fully furnished including TV and telephone

    1501 N. Orange Ave.

    Sarasota, Florida 34236


    Nursing Homes #motels #in #san #antonio

    #nursing home

    #

    Nursing Homes

    Illinois has approximately 1,200 long-term care facilities serving more than 100,000 residents, from the young to the elderly. These facilities are licensed, regulated and inspected at least annually by the Illinois Department of Public Health. The Department also assists the U.S. Centers for Medicare and Medicaid Services (CMS) with certifying these facilities for participation in federal payment reimbursement programs.

    The Department’s Bureau of Long-term Care is responsible for making sure nursing homes comply with the provisions of the state Nursing Home Care Act. In addition, under a cooperative agreement with CMS, the Department conducts certification surveys to ensure facilities receiving Medicaid (state) or Medicare (federal) money for resident payment abide by applicable federal regulations.

    Each year, Department surveyors conduct about 10,000 surveys, including annual licensure inspections, complaint investigations and reinspections. The Department’s 24-hour a day Nursing Home Hotline (800-252-4343) receives nearly 19,000 calls and, as a result, staff respond to more than 5,000 complaints.

    Nursing homes in Illinois are licensed, regulated, inspected and/or certified by a number of public and private agencies at the state and federal levels, including the Illinois Department of Public Health (IDPH) and the U.S. Department of Health and Human Services’ Health Care Financing Administration (HCFA). These agencies have separate — yet sometimes overlapping — jurisdictions.

    This listing of nursing homes by county provides the address, name of the administrator, the type of payment accepted, the number of beds and type of license classification (e.g. sheltered, intermediate, skilled), and ownership information for each facility.

    When a person can no longer live independently, a decision must be made about the best alternative arrangement for care. Such a decision often must be made during a time of crisis, frequently when the person is ready to leave the hospital after a serious illness or operation. This booklet serves as a guide for those faced with the test of selecting an appropriate care setting for a person who no longer is able to live independently.

    This database provides information about the performance of every Medicare and Medicaid certified nursing home in Illinois based on the most recent state inspection. The database also contains information reported by the nursing homes prior to the last state inspection, including nursing home and resident characteristics.

    This report contains a listing of disciplinary action initiated by the Illinois Department of Public Health in the last quarter against facilities that have been determined to be in violation of the Nursing Home Care Act, or have been recommended for decertification to the Illinois Department of Public Aid or the U.S. Department of Health and Human Services.

    You have a right to make decisions about the health care you receive now and in the future. An advance directive is a written statement about how you want medical decisions made when you can no longer make them. Illinois has three advance directives: health care power of attorney, living will and mental health treatment preference declaration. Read more about advance directives and access the forms you need to fill out for each.





    Apartments in Charlotte, NC – Auston Woods Apartment Homes – Apartments for


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    Community Amenities

    • Two Relaxing Swimming Pools with Wireless Internet Access
    • Two State-of-the-Art Fitness Centers
    • Pilates/Stretching Room
    • Playground and Picnic Areas
    • Garages and Storage Rental Available
    • Interactive Club Room with Billiard Table and Lounging Areas
    • Resident Activity Center
    • Internet Café with Wireless Internet
    • Business Center
    • Private Conference Center
    • Bark Park
    • Sand Volleyball Court
    • Outdoor Grilling and Picnic Areas
    • more

    *Certain features available in select apartment homes.*

    Interior Features

    • Quality Craftsmanship You Must See to Believe
    • Expansive 9 Foot Ceilings with Crown Molding for a Light, Open Feel
    • Cathedral Ceilings Available
    • Large Inviting Floor Plans, Some with Sun Rooms
    • Signature HHHunt Kitchens with Preferred GE Appliances
    • White-on-White Kitchen and Bath Cabinetry
    • Maple Cabinetry with Black Appliances
    • Built-In Microwaves
    • Expansive Walk-In Closets
    • Full-Size Washer/Dryer Included
    • Over Sized Garden Tubs
    • 2-Inch Plantation Blinds
    • High-Speed Internet Access Available
    • Some Homes Available with Private Entries
    • more

    Local Schools

    • Hornets Nest Elementary (K-5)
      980-343-6110
    • Ranson Middle School (6-8)
      980-343-6800
    • Hopewell High School (9-12)
      980-343-5988

    Pet Policy

    • Cats welcome
    • Dogs welcome (breed restrictions do apply)
    • No exotic pets allowed
    • 2 pets maximum

    Key Colony Beach Real Estate – Key Colony Beach FL Homes For

    #key colony beach motel

    #

    Key Colony Beach FL Real Estate

    Why use Zillow?

    Zillow helps you find the newest Key Colony Beach real estate listings. By analyzing information on thousands of single family homes for sale in Key Colony Beach, Florida and across the United States, we calculate home values (Zestimates) and the Zillow Home Value Price Index for Key Colony Beach proper, its neighborhoods, and surrounding areas. There are currently 77 for sale listings in Monroe County FL zip codes. including condos. bank owned homes. short sales. townhomes. duplexes. land and luxury listings. If you’re looking to rent in Key Colony Beach FL. check out our extensive list of luxury apartments and townhomes. We make it easy to find your dream home by filtering home types, price, and size. Filtering with keyword search is also possible, like “waterfront” or “Remodeled kitchen ” homes in Key Colony Beach.

    Cities Near Key Colony Beach

    ZIPs Near Key Colony Beach

    Disclaimer: School attendance zone boundaries are supplied by Maponics and are subject to change. Check with the applicable school district prior to making a decision based on these boundaries.





    Bank Foreclosed Listings – Foreclosed Properties #foreclosed #properties, #houses #for #sale, #foreclosed


    #

    Foreclosures as Low as $10,000

    Bank Foreclosed Home Listings

    Search for foreclosed homes and bank-owned property for sale including: Bank Foreclosed Home Listings, Government Foreclosed Listings, HUD Foreclosed Listings, VA Foreclosed Listings, and REO Listings. Learn more about foreclosures. Find bank-owned homes, pre-foreclosure homes, and government-ownedhomes for sale in your area. Save money on the purchase of a home by searching our bank foreclosed listings.

    Sample Foreclosed Listings

    This cozy three-bedroom home features two full baths, a large living room, and a newly-upgraded kitchen.

  • This pleasant, wood-finished two-story rambler includes four bedrooms and two-and-a-half baths.

  • Situated on a half-acre, this one-story beauty is primed for family fun with a large yard, perfect for running around.

    Service may not be free in all areas


  • BARBOUR, Teresa – McInnis – Holloway Funeral Homes – Cremation Services #hospise

    #sarcee hospice

    #

    BARBOUR, Teresa

    October 3, 1929 – Middlesbrough, England
    January 1, 2015 – Calgary, Alberta

    Peacefully on January 1, 2015 at Sarcee Hospice, Teresa (nee McDonough). Beloved wife of the late William (Bill), dearly loved mother of Gillian and Anne. A much loved grandmother and great-grandmother. Also a dear sister to Elfreda, Anthony, and the late Harry, Eileen and Marjorie her twin.

    Funeral Mass will be celebrated at St. Peter’s Catholic Church (541 Silvergrove Drive N.W.) on Wednesday, January 7, 2015 at 11:00 a.m. Condolences may be forwarded through www.mcinnisandholloway.com. If friends so desire a donation can be made in Teresa’s name to the Carewest Sarcee Hospice 3504 Sarcee Rd SW, Calgary T3E 4T4

    On whose Soul Sweet Jesus have Mercy. R.I.P.
    Our Lady of Lourdes pray for her.

    In living memory of Teresa Barbour, a tree will be planted at Fish Creek Provincial Park by McINNIS HOLLOWAY FUNERAL HOMES, Crowfoot, 82 CROWFOOT CIRCLE N.W. Telephone: 403-241-0044.

    Condolence Messages

    Freda,Katherine and John.

    Remembering Terry, a loved sister and aunt. May she rest in peace. Our thoughts and prayers are with you today and always.

    My sincere sympathy is extended for the loss of your lovely mother. My thoughts and prayers are with you all.

    Leave Your Condolence Cancel reply

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    Care – Nursing Homes UK #what #is #palliative #treatment

    #springhill hospice

    #

    Why Springhill?

    Quality of life is the focus at Springhill Care. Our award winning residential care homes and services are warm and welcoming; each with its own homely surroundings where our team support people to achieve their aspirations. Our aim is to support people to be the best they can be. We are proud to offer purpose-built care homes with state of the art facilities combined with award winning person-centred care and support.

    Types of Care

    We provide a wide range of award winning specialist person-centred care and support services for adults and older people with a wide range of needs. These care services include nursing care, specialist dementia care, respite and day care services, specialist end of life care, and specialist care for people with complex healthcare needs, including young people with learning difficulties.

    Springhill Residential Care Group





    Care plans in nursing homes #jobs #with #hospice

    #hospice nursing care plans

    #

    What’s a care plan in a nursing home?

    The nursing home staff will get your health information and review your health condition to prepare your care plan. You (if you’re able), your family (with your permission), or someone acting on your behalf has the right to take part in planning your care with the nursing home staff.

    The basic care plan includes:

    • A health assessment (a review of your health condition) that begins on the day you’re admitted, and must be completed within 14 days of admission
    • A health assessment at least every 90 days after your first review, and possibly more often if your medical status changes
    • Ongoing, regular assessments of your condition to see if your health status has changed, with adjustments to your care plan as needed

    Nursing homes are required to submit this information to the federal government. This information is used for quality measures, nursing home payment, and state inspections.

    Depending on your needs, your care plan may include:

    • What kind of personal or health care services you need
    • What type of staff should give you these services
    • How often you need the services
    • What kind of equipment or supplies you need (like a wheelchair or feeding tube)
    • What kind of diet you need (if you need a special one) and your food preferences
    • Your health and personal goals
    • How your care plan will help you reach your goals
    • Information on whether you plan on returning to the community and, if so, a plan to assist you in meeting that goal

    Find someone to talk to

    Find someone to talk to in your state

    Is your test, item, or service covered?





    Care Homes For Jewish People #hotels #in #mumbai

    #nightingale house hospice

    #

    WELCOME TO NIGHTINGALE HAMMERSON

    Nightingale Hammerson is an independent charity which has been serving the community for over 170 years. We offer a range of services tailored to meet the needs of each of our residents.

    We run three homes: Nightingale House in South West London, Hammerson House in North West London and Belmont Lodge in Bushey Herts which is supported sheltered housing home.

    We are one of the Jewish community’s leading providers of care for older people. We pride ourselves in providing high quality holistic care in a safe and stimulating environment.

    Nightingale House, providing residential. nursing and dementia care. accommodates 170 residents. Hammerson House can care for 85 residents and provides short stay residential and nursing care as well as assisted living accommodation. Belmont Lodge provides accommodation for up to 12 tenants.

    Our dedicated, well trained team of staff and volunteers ensure that individuals living in our homes receive attention all day, every day.

    Hammerson House – Relatives News

    Text NGHP16 £10 to 70070

    to donate to Nightingale Hammerson

    and make a difference today

    © Nightingale Hammerson – Registered Charity 207316 – Tel: 020 8673 3495





    Assisted Living Facilities, Nursing Homes and Every Senior Care Option #medicare #home

    #assisted living

    #

    Comprehensive And Unbiased Info On Over 70,000 Senior Living Options

    Assisted Senior Living is:

    • One of the most comprehensive senior directories on the web. The database can be searched by care type, location, organization name, review status, cost and more.
    • A complete resources. The site includes information about
      • Assisted Living (Adult Foster Care) Facilities
      • Nursing Homes
      • Alzheimer’s and Dementia Care Centers
      • Independent Living Facilities
      • Adult Day Care
      • In-home Care
      • Hospice Care
      • Continuing Care Retirement Communities (CCRC)
      • Retirement Communities
      • Respite or Temporary Adult Care
    • Totally unbiased. The directory was originally based on government data combined with other independent sources. It has since been expanded to include detailed listing for many of the larger corporations since they present easy access to details about their facilities. It is NOT a paid-inclusion corporate site so every senior care organization gets fair exposure.

    Why use Assisted Senior Living? The site includes

    • Location based search – Our advanced Geo-location search shows the nearest 40 senior care options to any desired location based on a zip code, city, or street address. Click on the map and get instant driving directions to each option.
    • Hot lists – Users can build a custom list of possible services and print that list with full contact information.
    • Complete listing information – We provide full contact information, photos, costs, and other details (where available) so users can compare apples to apples.
    • Safe usage – User may fill out a form to get personalized help but that is totally optional.
    • Reviews – The site includes both positive and negative reviews.

    Reviews are a key part of the decision making process but many users don’t return to this site to create a review after they found a service provider. That is why we created a contest in 2011 to get more people to create reviews.

    Advanced Search

    User Tools

    Assisted Living

    Nursing Homes





    New Federal Regulations Affect Nursing Homes, Hospices #red #deer #hospice

    #hospice regulations

    #

    New Federal Regulations Affect Nursing Homes, Hospices

    Long-term facilities such as skilled nursing homes or facilities for people with intellectual disabilities often work with hospices. In some cases it goes well. But in other cases, communication can go by the wayside, affecting quality of patient care.

    New federal regulations from the Centers for Medicare and Medicaid hope to smooth the transition between the facilities as well as give the patient more choice.

    They went into effect on Monday.

    Patients in long-term care facilities basically now have two options:

    • Option 1: They can arrange for hospice services through an agreement with one or more Medicare-certified hospices.
    • Option 2: They can not arrange for hospice services at the facility they are at, and the facility has to assist the patient by transferring them to a facility that will arrange for the provision of hospice services when the patient requests that transfer.

    “What it translates to for the patients and families that have a loved one residing in a nursing facility is that they cannot be denied access to care by regulation,” said Barbara Ivanko, president and CEO of Family Hospice and Palliative Care, one of hundreds of hospices in Pennsylvania. “By regulation, the nursing facility has to make sure that they are provided with care by the hospice of their choice even if that facility they themselves cannot provide it.”

    These new rules are meant to work with rules from 2008 that established program requirements for hospices that provide hospice services to those at long-term care facilities.

    There are other requirements in the contracts — that the hospice specify what services they’ll provide, including medical direction and management of the patient, nursing, counseling, medical supplies, medications and whatever else is needed to alleviate pain associated with terminal illness.

    And there will be authorized contracts written before the patient enters hospice care specifying the role and responsibility of each entity.

    Franco Insana, chief financial officer at Family Hospice and Palliative Care, said the rules have not always been so clear.

    “The Medicare regulations have been somewhat unclear,” he said. “Medicare regulations have several sections. There’s a section for instance that speaks solely to the requirements of hospices, another section that speaks to the requirements of skilled nursing facilities; there’s another section for hospitals, etc. and I think over time, those parts of the regulation have evolved and created some confusion.”

    Occasionally this lack of clarity led to a decay in quality.

    “Hospice providers and skilled nursing facilities were not always on the same page,” he said. “In some cases there were duplication of services, and in some cases there were gaps.”

    Some hospices already have contracts in place with long-term care facilities that comply with these new conditions. Now they all will.





    Key Colony Beach Real Estate – Key Colony Beach FL Homes For

    #key colony beach motel

    #

    Key Colony Beach FL Real Estate

    Why use Zillow?

    Zillow helps you find the newest Key Colony Beach real estate listings. By analyzing information on thousands of single family homes for sale in Key Colony Beach, Florida and across the United States, we calculate home values (Zestimates) and the Zillow Home Value Price Index for Key Colony Beach proper, its neighborhoods, and surrounding areas. There are currently 77 for sale listings in Monroe County FL zip codes. including condos. bank owned homes. short sales. townhomes. duplexes. land and luxury listings. If you’re looking to rent in Key Colony Beach FL. check out our extensive list of luxury apartments and townhomes. We make it easy to find your dream home by filtering home types, price, and size. Filtering with keyword search is also possible, like “waterfront” or “Remodeled kitchen ” homes in Key Colony Beach.

    Cities Near Key Colony Beach

    ZIPs Near Key Colony Beach

    Disclaimer: School attendance zone boundaries are supplied by Maponics and are subject to change. Check with the applicable school district prior to making a decision based on these boundaries.





    Sunset Motel on the Bay Rooms and Vacation Homes #hospice #of #the

    #sunset motel

    #

    Sunset Motel on the Bay and Vacation Homes of Upper Michigan.

    Sunset Motel on the Bay is located directly on Munising Bay. Your room is within 75′ of the waters edge. We offer many room types for couples, family and friends. We are your waterfront lodging with incredible scenic views and sunsets. We also offer visitors our beautiful Munising Vacation Homes. Both homes are fully furnished and include: linens, towels, all kitchen supplies, and a washer and dryer. Our Munising Michigan Vacation Homes are within 150′ of the lake. Please click More Info to view great interior photos of each of the rooms.

    1 King Bed Unit

    Enjoy our King Bed Unit with Microwave, Refrigerator, Coffee Maker. All of our rooms come with expanded cable TV and FREE wireless internet. Please click More Info to view great interior photos of this room.

    2 Queen Bed Unit with Full Kitchen

    Relax here in Munising and reserve a comfy 2 Queen Bed with Full Kitchen sitting area. This 2 Qn Bed Unit comes with Microwave, Stove, Refrigerator, Coffee Maker, toaster all Cooking Utensils. Please click More Info to view great interior photos of this room.

    1 King Bed Suite with Balcony

    Place yourself on our veranda overlooking Lake Superior! Perfect for honeymooners and couples, our suite was recently built and the interiors are gorgeous! This spacious room comes with King Bed, Microwave, Refrigerator, Coffee Maker, and great views! Please click More Info to view great interior photos of this room.

    2 Queen Bed / 2 Room Unit

    This spacious unit comes with 2 Queen Beds in 2 separate rooms, Microwave, Coffee Maker Refrigerator, MAXIMUM OCCUPANCY: 5 People. Please click More Info to view great interior photos of this room.

    2 Bedroom Unit with Living Room

    Lots of space for the family. 2 Bedroom Unit w/ Queen Beds comes with Living Room,and Pull Out Sleeper Sofa, Microwave, Coffee Maker, Refrigerator. MAXIMUM OCCUPANCY: 4 Adults 2 small children, or 5 Adults. Please click More Info to view great interior photos of this room.





    SWENARCHUK, Janet – McInnis – Holloway Funeral Homes – Cremation Services #hospice

    #sarcee hospice

    #

    SWENARCHUK, Janet

    March 17, 1919 – October 10, 2011

    Our beloved matriarch, Janet Swenarchuk, passed away peacefully at the Carewest Sarcee Hospice on Monday, October 10, 2011 at the age of 92.

    Janet was born in Canora, SK, the youngest of seven children of George and Makrina Osadchuk. Janet grew up in the Canora / Burgis area and married a young teacher, Michael Swenarchuk, in 1938. Their long, loving marriage lasted 72 years, until Michael’s death on February 26, 2011. They raised three children and made a significant contribution to every community in which they lived.

    Janet had many talents. She was an excellent homemaker and mother, demonstrating expert skills in cooking, baking, knitting, sewing and embroidery. She was an avid reader, a creative writer (published), a top student when she pursued a psychology degree at the University of Saskatchewan in her 40’s. She graduated with distinction in 1965 along with her son Lauren, and embarked upon a successful career as a social worker. She was a pioneer in the interracial and international adoption placement of older children from the province of Saskatchewan.

    Janet and Michael were devoted members of the Ukrainian Orthodox Church. Both of them held leadership positions in the Saskatoon, Regina and Kelowna congregations. Janet was the editor of From Dreams to Reality, a book profiling the senior citizens of the Regina Ukrainian Orthodox community and their families.

    In 1980 Janet and Michael retired to Kelowna, BC where they enjoyed life until 2006. Ill health precipitated their move to Calgary to be closer to family. They enjoyed their five years at The Lodge at Valley Ridge, particularly appreciating their new friendships and the kindness and attention of staff members.

    Janet is survived by her daughter Bonnie Zwack and son Dr. Lauren Swenarchuk; four grandchildren Michael (Alyson) Zwack, Andrea Zwack (Michael Vermette), Kathryn Zwack (Brian Allison) and Larissa Swenarchuk; her seven great-grandchildren Annalise and Nicholas Zwack, Robert, Jonathon and Meskele Allison, Lindsay and Julia Vermette. She is also survived by nephew Robert (Chris) Swenarchuk and niece Olive (Al) King, and several other nieces and nephews.

    Janet was predeceased by her six siblings, her youngest child Michelle (2008) and her son-in-law Robert Zwack (1986).

    Janet’s family is grateful for the care and attention given to her at the Valley Ridge Lodge and the Carewest Sarcee Hospice. She felt loved and pampered at the hospice by all who cared for her. At the lodge she appreciated the friendship and support of Alice Dewis and Lori Morris, and the tender loving care of Dorian, Elizabeth and others. Margaret Thorson visited her often and was much loved by both Janet and Michael.

    Relatives and friends are invited to Prayers at McINNIS HOLLOWAY’S Crowfoot Chapel (82 Crowfoot Circle NW), on Friday, October 14, 2011 at 7:00 p.m.

    Requiem Service will be held at St. Vladimir’s Ukrainian Orthodox Church (402 Meredith Road NE) on Saturday, October 15, 2011 at 10:00 a.m. Graveside Service to follow at Mountain View Memorial Gardens. Condolences may be forwarded through www.mcinnisandholloway.com.

    If friends so desire, memorial tributes may be made directly to St. Vladimir’s Ukrainian Orthodox Church (402 Meredith Road NE, Calgary, T2E 5A6) or to the Carewest Sarcee Hospice (3504 Sarcee Road SW, Calgary, T3E 4T4 ) or to a charity of their choice.

    In living memory of Janet Swenarchuk, a tree will be planted at Fish Creek Provincial Park by McINNIS HOLLOWAY FUNERAL HOMES, Crowfoot Chapel, 82 CROWFOOT CIRCLE NW Telephone: (403) 241-0044.





    Pain Management in Nursing Homes and Hospice Care #gold #coast #motel

    #hospice pain management

    #

    Pain Management in Nursing Homes and Hospice Care

    Hospice is a term given to specialized care that is intended to provide comfort and support to patients and their families when illness no longer responds to treatment and death is inevitable. Pain control is one of the central goals of hospice care. Federal guidelines regulating hospice require that the hospice make every reasonable effort to assure that the patient’s pain is controlled. Most state laws governing hospice also make pain control a primary and required component of hospice care.

    Federal Regulations (42 CFR Section 418.54) state that: “The medical director…assumes overall responsibility for the medical component of the hospice’s patient care program.”

    42 CFR Section 418.50 states: “A hospice must…make…drugs… routinely available on a 24 hour basis”; [and] “make…covered services available …to the extent necessary to meet the needs of individuals for care that is reasonable and necessary for the palliation and management of terminal illness and related conditions.” Palliation is the relief of symptoms, and pain is one of the main symptoms which hospice must focus on relieving.

    Pain control during the last weeks of life can be a challenging patient management problem. Despite periodic entreaties in medical journals to improve pain control, inadequate pain management exists. 1 In contrast to the simplicity of providing pain control, the cost of not providing it is high; both in terms of impaired function and quality of life. Patients with pain also are less able to commit to fighting their disease.

    In most cases, hospice services assure that patients receive pain medication necessary to control pain. The hospice interdisciplinary team, including the certified hospice nurse, focuses on the patient’s comfort. A team approach is essential to address both the medical and psychosocial issues of patients. The attending physician should be focused on the same goal and, in most cases, does order pain medication.

    Treatment of pain should be a top priority in end-of-life care. This must include the physical, emotional and spiritual aspects of pain management. However, excellence in pain control and symptom management has not been adopted as a “mission” of many physicians. Although patients do not die of pain, evidence suggests that untreated pain begets worse pain. 2

    Under-treatment of Pain Still an Issue

    Unfortunately, for varying reasons, some physicians may not order the medication necessary to adequately control the patient’s pain. There is no doubt that opioid medications for pain are well accepted in the medical community. These medications are used successfully to control pain and keep patients comfortable. However, effective pain management for the terminally ill patient requires an understanding of pain control strategies. 3

    Under-treatment of pain is a persistent clinical problem. A recent study by Won, et al found that of 49% of nursing home residents with non-malignant persistent pain, 24.5% received no analgesics. 5 Another study that investigated the treatment of pain in nursing home residents with cancer, 26% of the residents who were in daily pain received no analgesic medication.6 Other studies also have indicated indicated that patients older than 85 years, or minorities, were more likely to receive no analgesics. 7-9

    “Hospice’s goal is to reduce pain to a level that is acceptable to the patient—namely, a totally ‘subjective’ approach to care.”

    Research by Miller, et al reported that “The prescribing practices portrayed by this study reveal[ed] that many dying nursing home residents in daily pain are receiving no analgesic treatment or are receiving analgesic treatment inconsistent with AMDA (American Medical Directors Association) and other pain management guidelines. Improving the analgesic management of pain in nursing homes is essential if high quality end-of-life care in nursing homes is to be achieved…” 10

    Hospice More Likely to Receive Higher Quality Pain Management

    Hospice has become the accepted and welcome approach to providing care for terminally ill nursing home residents. It has been suggested that hospice care is associated with higher quality pain management and that patients enrolled in hospice are more likely than non-hospice patients to have a record of pain assessment and receive regular treatment for pain. 11

    Miller et al reported that “…controlling for clinical confounders, hospice residents were twice as likely as non-hospice residents to receive regular treatment for daily pain…”. They concluded that “… Findings suggest that analgesic management for daily pain is better for nursing home residents enrolled in hospice.’ 10

    For patients to qualify for hospice, the attending physician must certify that if the disease process runs its normal course, life expectancy is less than six months. Unfortunately, referrals to hospice have a mean length of stay of 22 days, with 32% dying in a week or less. 12 One week is not enough time to ensure good pain management. Clearly, prognosticating death is difficult for most physicians. Predictors of death, independent of age, gender and diagnosis, include:

    • decreased cognitive functioning
    • decrease in the ability to communicate
    • decrease in physical functioning
    • decrease in activities of daily living (ADL)
    • decrease in nutrition (weight loss)
    • incontinence

    These factors may aid the attending physicians to help identify those patients who might be hospice eligible in a more timely manner.

    Improved Training Needed in Pain Management

    Despite the availability of a wide variety of effective pharmacologic and non-pharmacologic treatments, understanding of pain remains a significant problem in nursing homes and hospices.

    Sources of ineffective pain management may be due to misconceptions, cultural mores, etc. For example, for physicians/nurses it may be inadequate knowledge of opioids coupled with a reluctance and even fear of using opioids. For patient and family there may be fear of addiction, fear of opioids in general and fear of being labeled.

    Although it is unclear why healthcare professionals fail to use the best available pain management techniques for their patients, several factors contribute to the problem. Clinical training in pain management—other than for pain specialists—is almost non-existent. Few health care professionals feel that they have received adequate training in pain management in medical school or during their residency.

    • 1. Hill Jr CS. When will adequate pain treatment be the norm? JAMA. 1995. 274: 1881-1882.
    • 2. Troubridge R, Dugan W, Jay SJ, et.al. Determining the Effectiveness of a Clinical Practice Intervention in Improving the Control of Pain in Outpatients with Cancer. Acad Med. 1997. 72: 798-800.
    • 3. Miller KE, Miller MM, Jolley MR. Challenges in Pain Management at the End of Life. American Family Physician. 2001. 64: 1227-1234.
    • 4. Melding PS. Is there such a thing as geriatric pain? (Editorial). Pain. 1991. 46:119-121.
    • 5. Won AB, Lapane KL, Vallone S, et.al. Persistent Non-Malignant Pain and Analgesic Prescribing Patterns in Elderly Nursing Home Residents. Journal of the American Geriatric Society. 2004. 47: 935-942.
    • 6. Bernabei R, Gambassi G, Lapane K, et.al. Management of Pain in Elderly Patients with Cancer. JAMA. 1998. 279: 1877-1882.
    • 7. Bernabei R, Gambassi G, Lapane K, et.al. Management of Pain in Elderly Patients with Cancer. JAMA. 1998. 279:1877-1822.
    • 8. Jaycox A, Carr DB, Payne R, et.al. Clinical Practice Guideline Number 9: Management of Cancer Pain. US Department of Health Human Services; Agency for Healthcare Policy and Research. Rockville, MD. 1994. AMCPP Publication 94-0592.
    • 9. Cleeland CS, Gorin R, Hatfield AK, et.al. Pain and its Treatment in Outpatients with Metastatic Cancer. N Eng J Med. 1994. 330: 592-596.
    • 10. Miller SC, Mor V, Gonzalo P, and Lapane K. Does Receipt of Hospice Care in Nursing Homes Improve tha Management of Pain at End-of-Life? J Am Geriatr Soc. Mar 2002. 50(3): 507-515.
    • 11. Miller SC, Mor V, and Teno J. Hospice Enrollment and Pain Assessment and Management in Nursing Homes. Journal of Pain Symptom Management. 2003. 26: 791-799.
    • 12. National Hospice and Palliative Care Organization. 2003 NHPCO National Data Set Summary Report, 2004. http://www.nhpco.org. Accessed 8/2/09.
    • 13. Melzack R. The tragedy of needless pain. Sci Am. 1990. 262: 27-33.
    • 14. Springhouse (ed.) End of Life: A Nurse s Guide to Compassionate Care. Lippincott, Williams Wilkins. 2007.
    • 15. Portenoy RK. Opiate therapy for chronic non-cancer pain: Can we get past the bias? American Pain Society Bulletin. 1991. 1: 4-7.
    • 16. Kalko RF. Age and Morphine analgesia in cancer patients with post-operative pain. Clin Pharm Ther. 1980. 28: 823-826.
    • 17. Bellville JW, Forrest WH Jr, Miller E, an Brown Jr. BW. Influence of age on Pain Relief from analgesics, A study of post-operative patients. JAMA. 1971. 217: 1835-1841.
    • 18. Kaiko RF, Wallenstein SL, Rogers AG, Gabinski PY, and Houde RW. Opioids in the elderly. Med Clin North Am. 1982. 66: 1079-1089.
    • 19. Pain Diary: Hospice of the Valley. Phoenix, Arizona.
    • 20. World Health Organization. Cancer Pain Relief: With a Guide to Opioid Availability, 2nd Ed. WHO. 1996.

    Last updated on: December 20, 2011

    First published on: September 1, 2009





    Health Homes #palliative #treatment

    #home health care services

    #

    Health Homes

    The Affordable Care Act of 2010, Section 2703, created an optional Medicaid State Plan benefit for states to establish Health Homes to coordinate care for people with Medicaid who have chronic conditions by adding Section 1945 of the Social Security Act. CMS expects states health home providers to operate under a whole-person philosophy. Health Homes providers will integrate and coordinate all primary, acute, behavioral health, and long-term services and supports to treat the whole person.

    Who Is Eligible for a Health Home?

    Health Homes are for people with Medicaid who:

    • Have 2 or more chronic conditions
    • Have one chronic condition and are at risk for a second
    • Have one serious and persistent mental health condition

    Chronic conditions listed in the statute include mental health, substance abuse, asthma, diabetes, heart disease and being overweight. Additional chronic conditions, such as HIV/AIDS, may be considered by CMS for approval.

    • States can target health home services geographically
    • States can not exclude people with both Medicaid and Medicare from health home services

    Health Home Services

    • Comprehensive care management
    • Care coordination
    • Health promotion
    • Comprehensive transitional care/follow-up
    • Patient family support
    • Referral to community social support services

    Health Home Providers

    States have flexibility to determine eligible health home providers. Health home providers can be:

    • A designated provider: May be a physician, clinical/group practice, rural health clinic, community health center, community mental health center, home health agency, pediatrician, OB/GYN, or other provider.
    • A team of health professionals: May include physicians, nurse care coordinators, nutritionists, social workers, behavioral health professionals, and can be free-standing, virtual, hospital-based, or a community mental health center.
    • A health team: Must include medical specialists, nurses, pharmacists, nutritionists, dieticians, social workers, behavioral health providers, chiropractics, licensed complementary and alternative practitioners.

    Reporting Requirements

    Health Home service providers must report quality measures to the state. States are also required to report utilization, expenditure and quality data for an interim survey and an independent evaluation.

    Health Home Financing

    States have the flexibility in designing their payment methodologies and may propose alternatives.

    States receive a 90% enhanced Federal Medical Assistance Percentage (FMAP) for the specific health home services in Section 2703. The enhanced match doesn t apply to the underlying Medicaid services also provided to people enrolled in a health home.

    The 90% enhanced FMAP is good for the first eight quarters the program is effective. A state can get more than one period of enhanced FMAP, but can only claim the enhanced FMAP for a total of eight quarters for one enrollee.

    The Health Home Information Resource Center located on Medicaid.gov provides useful information to States considering the health home Medicaid State Plan option HHIRC. Technical assistance is available to support state Medicaid agencies in developing and implementing health home programs under Section 2703 of the Affordable Care Act.

    Related Resources

    Technical Assistance

    A federal government managed website by the Centers for Medicare Medicaid Services. 7500 Security Boulevard Baltimore, MD 21244





    Nursing Homes #hotel #derek

    #nursing home

    #

    Nursing Homes

    Illinois has approximately 1,200 long-term care facilities serving more than 100,000 residents, from the young to the elderly. These facilities are licensed, regulated and inspected at least annually by the Illinois Department of Public Health. The Department also assists the U.S. Centers for Medicare and Medicaid Services (CMS) with certifying these facilities for participation in federal payment reimbursement programs.

    The Department’s Bureau of Long-term Care is responsible for making sure nursing homes comply with the provisions of the state Nursing Home Care Act. In addition, under a cooperative agreement with CMS, the Department conducts certification surveys to ensure facilities receiving Medicaid (state) or Medicare (federal) money for resident payment abide by applicable federal regulations.

    Each year, Department surveyors conduct about 10,000 surveys, including annual licensure inspections, complaint investigations and reinspections. The Department’s 24-hour a day Nursing Home Hotline (800-252-4343) receives nearly 19,000 calls and, as a result, staff respond to more than 5,000 complaints.

    Nursing homes in Illinois are licensed, regulated, inspected and/or certified by a number of public and private agencies at the state and federal levels, including the Illinois Department of Public Health (IDPH) and the U.S. Department of Health and Human Services’ Health Care Financing Administration (HCFA). These agencies have separate — yet sometimes overlapping — jurisdictions.

    This listing of nursing homes by county provides the address, name of the administrator, the type of payment accepted, the number of beds and type of license classification (e.g. sheltered, intermediate, skilled), and ownership information for each facility.

    When a person can no longer live independently, a decision must be made about the best alternative arrangement for care. Such a decision often must be made during a time of crisis, frequently when the person is ready to leave the hospital after a serious illness or operation. This booklet serves as a guide for those faced with the test of selecting an appropriate care setting for a person who no longer is able to live independently.

    This database provides information about the performance of every Medicare and Medicaid certified nursing home in Illinois based on the most recent state inspection. The database also contains information reported by the nursing homes prior to the last state inspection, including nursing home and resident characteristics.

    This report contains a listing of disciplinary action initiated by the Illinois Department of Public Health in the last quarter against facilities that have been determined to be in violation of the Nursing Home Care Act, or have been recommended for decertification to the Illinois Department of Public Aid or the U.S. Department of Health and Human Services.

    You have a right to make decisions about the health care you receive now and in the future. An advance directive is a written statement about how you want medical decisions made when you can no longer make them. Illinois has three advance directives: health care power of attorney, living will and mental health treatment preference declaration. Read more about advance directives and access the forms you need to fill out for each.