Queen City - How to Impress My Husband - Follow These Tips & You Will See Your Husband Like You More
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Married couples, more so those that have been married for long years, could attest that in order to keep the passion in the relationship burning, both partners have to impress each other constantly. If you let life's responsibilities consume both of you, chances are, your husband would look for passion and attention elsewhere.
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How is How to Impress My Husband - Follow These Tips & You Will See Your Husband Like You More
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Accept him for who he is
If you want to impress his with your good nature, begin by letting him know that you love him for all the goodness in him and that you're also willing to accept his weaknesses. Assure him that he will not hear you rant about the characteristics that he lacks.
Be a creative partner in bed
Is it always the missionary style for both of you? Try experimenting at times. Doing so will extremely impress if not excite him.
Don't let him hear your big voice
No man would want to be yelled at so don't let him hear you shout at the top of your lungs. Discuss matters like two, mature individuals. Once he learns that you will never raise your voice at him - ever - then he would surely respect you.
Clean your home
Although guys profess that they'd love you no matter what, reality dictates that at the back of their minds, they want you to serve them somehow. Begin doing this by keeping your home tidy all the time. Doing so will make him feel that your place is a haven of relaxation and comfort.
Don't just be the queen of his heart, be the Queen of the kitchen as well
Cook wondrous meals for your husband and he'll love you with all of his heart. Let him partake of your best recipes and continue acquiring for more impressive ones. Let him arrive to a welcoming aroma in your dining room.
Set up a date when he's too busy to even invite you out
Who says that dating means you have to go and watch a movie somewhere? You can surprise him when he comes home from the office and he finds your home entertainment system set up with popcorn and all! This is a great and non-serious way of reconnecting with your husband.
Be his mistress
Why do guys keep going back to their mistresses? They go back for want of more attention and sexual encounters - what else. So to deter him from ever finding another woman by playing the other woman role so well!
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Primary Care Providers - 2010 Largest Assisted Living Providers.
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While stormy economic conditions buffeted the firm last year, indicators now point to smoother navigation ahead. As businesses in nearly every U.S. Sector struggled to stay afloat last year, assisted living was the buoy in the choppy waters. Steady examine for potential services helped keep companies stable-even if accompanied by a hiatus from major mergers and acquisitions.
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How is 2010 Largest Assisted Living Providers
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As businesses in nearly every U.S. Sector struggled to stay afloat last year, assisted living was the buoy in the choppy waters. Steady examine for potential services helped keep companies stable-even if accompanied by a hiatus from major mergers and acquisitions.
Now, as economic forecasters allude to the end of the "Great Recession," companies like this year's Largest Providers are poised for growth, some of which is already underway. Forty-two of those companies (60%) that made the 2010 list article increases in licensed assisted living resident capacity-though much of that growth was in single-digit percentages. Someone else 16 of the top 70 companies maintained their size, while just 12 reported losses.
Here's a look at Assisted Living Executive's 2010 Largest Providers, and the firm environment, transactions, and trends that landed each firm a spot.
Top Players Hold Steady
In 2009, no assisted living providers merged nor acquired any other perfect company. However, while most deals were small, the year did produce a few large folder acquisitions and requisite reshuffling. The biggest gains and losses were among the biggest players and occurred through straightforward sales and acquisitions.
For the first time since Assisted Living menagerial began compiling this annual Largest Providers list, Sunrise Senior Living, based in McLean, Virginia, no longer sits at No. 1. The company, now No. 2, had no new construction starts and sold off about 9 percent of its assisted living capacity (about 2,896 units) last year. Its biggest transaction was a folder of 21 communities in 11 states to Milwaukee, Wisconsin-based Brookdale Senior Living for 4 million, but Sunrise also sold smaller portfolios to regional providers, such as Baltimore-based Brightview Senior Living (The protection Group), which purchased two of Sunrise's New Jersey communities.
The Sunrise downsize has made Seattle-based Emeritus Senior Living the nation's largest assisted living provider. Emeritus acquired 2,221 new licensed assisted living units and grew by 7 percent in the past year, and it's very likely that Emeritus will not only voice the top spot next year, but expand significantly in 2011. The company's partner, Blackstone Real Estate Advisors, is pursuing the purchase of 134 communities operated by Sunwest Management, which is in chapter 11 bankruptcy. Under a preliminary agreement, Emeritus would conduct the properties with the option to spend up to 10 percent of the equity in a joint venture with Blackstone and Columbia Pacific Management, an entity controlled by Dan Baty, Emeritus chairman and co-Ceo.
Brookdale Senior Living maintained its No. 3 ranking, but also grew by 3,808 residents, or 15 percent, in 2009. Sunwest Management, last year's No. 4 company, comes in at No. 7 this year with 9,186 assisted living residents, a 43 percent drop. The firm will disappear wholly from the 2011 list if Blackstone or Someone else entity receives court approval to buy the remainder of Sunwest's portfolio.
In terms of percentage growth, the clear winner is Solana Beach, California-based Senior resource Group, Someone else beneficiary of Sunwest's financial woes. The firm picked up administration contracts for 41 properties in 11 states, under the name LaVida Communities, when institutional investor Lone Star Funds of Dallas acquired the properties in the first big deal of 2009. Senior resource Group catapults from No. 55 to No. 11, having grown its assisted living resident capacity more than 500 percent, to 4,897.
Big Movers
For the next Largest Providers percentage spike, look to Crl Senior Living Communities, which enters the list at No. 57, thanks to more than doubling its assisted living capacity from 502 to 1,019. Also on the growth path, Frontier administration expanded by 64 percent, from 828 to 1,358 licensed assisted living units, thanks to seven new administration contracts and two new buildings. Frontier administration jumps 15 spots from No. 57 to No. 42. Watch this Western regional victualer to grow further next year as any more new buildings open.
The fourth-largest list jumper is Carmichael, California-based Eskaton Senior Residences and Services, rising 12 spots to No. 56. The firm reports 1,036 licensed assisted living units (up from 732 last year) due to either expansions or applications for further assisted living licensing.
Only seven other providers article gains of 20 percent or more in the past year, and among them is Bradley, Illinois- based Bma Management. Because of its focus on the affordable market, the firm continues to advantage from accessible financing sources not available to original providers. Bma Management's assisted living resident capacity jumped 27 percent in the past year as the firm opened six new communities. In 2010, the firm moves up the list by three spots, advent in at No. 21.
Other companies that increased their licensed assisted living capacity include Capital Senior Living Corporation (No. 20), which grew by 25 percent, and Bonaventure Senior Living (No. 23), whose assisted living capacity surged by 21 percent to 2,595. Assisted living capacity for Carlsbad, California-based Integral Senior Living (No. 24) rose 24 percent. Benedictine health theory (No. 41) grew by 20 percent, and Brightview Senior Living (No. 52, up from No. 62 last year) expanded by 29 percent, thanks to the Sunrise deal, which added 240 residents. Someone else chart-jumper was relaxation Living Management, which vaulted nine places from No. 58 in 2009 to No. 49 this year plainly by adding 200 residents (22 percent).
The vast majority of increasing providers, however, had gains of less than 10 percent. But a diminutive growth can go a long way when nearly 60 percent of companies on the Largest Providers list have fewer than 2,000 assisted living residents.
In Someone else indication of assisted living growth, Independent Healthcare Properties, the smallest firm on the list at No. 70, only kept its 2009 rank thanks to an 18 percent capacity gain from 706 to 833. Most of the 2009-ranked companies that did not make this year's list either maintained capacity or had very small gains. Someone else reason for higher numbers at the bottom of the list is attributed to data from five providers not previously listed-Spectrum seclusion Communities (No. 28), Mountain View seclusion (No. 50), Crl Senior Living Communities (No. 57), Welcome Home administration firm (No. 64), and Elder Care Alliance (No. 66).
Other than Sunwest, the firm with the most dramatic drop in licensed assisted living capacity was Northstar Senior Living, which shed 1,068 residents, or 55 percent of its 2009 capacity, falling from No. 28 to No. 67. Again, because of modest uncut numbers, decreases were most renowned toward the bottom of the top 70 list. Grace administration saw a 30 percent decline from 1,399 to 979 and dropped from No. 37 in 2009 to No. 61 this year. Carillon Assisted Living, No. 49 in 2009, decreased its capacity by 24 percent from 1,024 to 775, removing it from the list altogether.
Several companies that didn't make this year's list but may show up in 2011 include Trinity Lifestyles Management, which nearly doubled in size to 480 assisted living residents after picking up three Atlanta-area EdenCare properties, once operated by Sunrise Senior Living. Wichita, Kansas-based Legend Senior Living has been raising its assisted living component steadily with new construction, increasing Someone else 18 percent to 692 in 2010. And finally, AdCare health Systems, based in Springfield, Ohio, remains a smaller victualer at 231, but that reflects a 38 percent growth over the prior year, and the firm recently announced raising .5 million to fund acquisitions.
More carport Times Ahead
"The fact that we'll be able to point to this time period-the worst economic downturn in our lifetimes-and say that our business weathered it pretty well and even continued to grow is significant," says Granger Cobb, president and co- Ceo of Emeritus Senior Living.
The past two recessions hit assisted living hard, and many providers at the start of 2009 were implicated that the stalled housing market, depleted stock market earnings, and high unemployment among the adult children of potential residents could cause occupancy rates to plummet. Instead, after modest 2008 rate declines and a rent growth slowdown to 2 percent from 2.9 percent in 2008 and 4 percent in 2007, the needs-based component of assisted living seemed to trump economic concerns. Move-ins could be postponed but only for so long.
By second quarter 2009, signs of stabilization began to emerge, followed by a slow but upward trend, says Robert G. Kramer, president of the Annapolis, Maryland-based National venture town for the Seniors Housing & Care business (Nic). While national unemployment still hovered at a troubling 10 percent in January, Kramer says he's cautiously optimistic about the future, especially since the business saw its largest absorption rate in the third quarter of 2009 since the first quarter of 2006- 1,400 assisted living units in the top 30 urban markets and slightly stronger in the top 100 markets.
Those statistics suggest that the uncut photo is much rosier for assisted living than for other real estate sectors, along with multifamily, hotels, and offices, Kramer notes. "Basically, we are finding operators holding the line with regard to rates," he adds. "We certainly are finding more concessions out there, but at the same time, those concessions tend to be very much market-specific, property-specific, or even unit-specific."
Still, move-in delays due to economic factors have amplified a trend already developing pre-recession-residents tend to be older and frailer, says Jim Moore, president of Moore Diversified Services and author of "Strategic Forecast," published in Assisted Living Executive's January/February 2010 issue. The result is heightened chance in dementia care, which is even more needs-based than assisted living, he adds. Indeed, a number of top 70 operators reported having converted independent units to assisted living or assisted living to memory care.
As for new construction, buildings already in the pipeline continued to open, but few companies launched new developments, and by January 2010, the number of new construction starts had fallen to the bottom point since Nic started tracking senior housing trends. No companies went communal in 2009.
Forecast for 2010
Access to capital will remain the original challenge for development in 2010, although new properties financed before the retreat will continue to open through the third quarter of 2010. But the lack of new properties isn't necessarily bad news for assisted living.
"We're going to go through a duration of very diminutive new stock advent online, but if that coincides with pent-up examine and a salvage in the economy, all should bode well for occupancies and rent growth in assisted living," Kramer says. "Outside of external economic factors that we don't have any control over, the greatest risk to assisted living is overbuilding."
Fannie Mae and Freddie Mac will continue to be dependable sources of permanent 10-year financing, but when it comes to construction loans, developers have few options. Some very diminutive Hud 232 financing will be available, but more likely, the few projects that activate will do so because of relationships with local lenders.
Indeed, The Arbor Company, based in Atlanta, lacks the cash to produce properties on its own, but thanks to a partnership with Formation Capital, Arbor will conduct two new properties scheduled to break ground this fall, says Coo Judd Harper. "We feel much stronger and more optimistic about the assisted living occupancies in today's slowly recovering economy, but are optimistic about independent living's rebound in the future," he adds. "As population get jobs, they no longer are going to be able to care for a parent at home."
A exciting spot in the acquisitions arena, hidden equity entities are starting to eye assisted living as a desirable sector again, and the major Reits in senior housing are well-positioned to spend again, Kramer notes. Emeritus will be a firm to watch thanks to the Blackstone deal, and while it only plans one new construction in 2010, the firm actively will be finding for other acquisition opportunities at exciting prices.
"If a firm has liquidity, cash flow, and a reasonably wholesome equilibrium sheet, it will be in a great position because there are opportunities right now," Cobb says. That advantage isn't just for big companies like Emeritus, but also for regional and even small mom-and-pop players with targeted expansion plans, he adds, noting that "interest rates have not changed that much over the last integrate of years, but the number of equity and coverage ratios you have to have in place has become more stringent, as well as the underwriting."
Fanwood, New Jersey-based Chelsea Senior Living leveraged a strong association with a local lender to purchase a former Sunwest asset in New Jersey last fall and is actively finding for more deals, says Roger Bernier, president and Coo. "Some population are likely to see their debt maturing and be unable to refinance," he forecasts. "Ultimately we'd like to grow by two communities per year, but it has to be the right deal for us to take a look."
Much of the acquisitions performance in 2010 is likely to remain with distressed properties, however, and no one expects lots of high-end properties to come on the market this year, says Steve Monroe of Senior Care Investor. "High-performing properties are only going to sell if owners can get a good price, although that may start to turn later in 2010."
Still, wise operators should not be blinded by exciting price tags so much that they forget to reconsider how well the acquisition fits into their existing folder and evolving demands of seniors and their families, Moore cautions. "Senior psychographics are changing," he adds. "It's not so much the World War Ii homemaker widow as 80-year-olds who have been in the pro workforce."
Another area of chance in 2010 may be new administration contracts for owners and lenders who may be unhappy with their current management, Moore suggests. And for many companies, the wisest move in 2010 may be just to edge internal operations, he says.
Although Greensboro, North Carolina- based Bell Senior Living is open to the right deal within the mid-Atlantic states in which it already operates, the latter strategy will be the company's prime priority this year, says President Steve Morton. "I'd say it's a time to focus on operations, improve operating results along with administration and wage streams, and put together the requisite tools to maximize and run communities in the most effective manner possible," he says. "This is something we can do because we don't have five acquisitions or development deals."
Finally, unstable financial markets still make it unlikely that any firm will go communal in 2010, but if conditions improve, Moore says, the two companies to watch continue to be Atria Senior Living Group (No. 4) and Hcr ManorCare (No. 10).
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Primary Care Providers - Does Your State Accept Medicaid For Assisted Living Facilities?
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Do you know about - Does Your State Accept Medicaid For Assisted Living Facilities?
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Before private state governments passed much-needed legislation, many assisted living facilities were only private pay situations. Fortunately, for many older Americans facing housing dilemmas, Medicaid waiver programs have taken up much of the slack that Medicare did not. Providing funds for placement in assisted living facilities as well as a number of other helpful services, Medicaid helps lower-income, elderly individuals receive the care they need.
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How is Does Your State Accept Medicaid For Assisted Living Facilities?
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All states accept funds from Medicaid waiver programs for placement within a nursing home, which are usually more expensive than assisted living facilities. While many states do not recognize funds from Medicaid waiver programs for assisted living, those that do are settled throughout the country and offer many options to aging Americans needing assistance with daily living activities. After searching high and low, seeing a normal overview of states that offer the Medicaid waiver schedule for assisted living was rather nonexistent, but my explore is your gain.
Medicaid Waiver Programs State Line-Up
As of publication, there are no definitive lists that outline states with Medicaid waiver programs for assisted living facilities. At best, the government (via the Centers of Medicare and Medicaid Services) has created an online list of all Medicaid waiver programs (1), meaning visitors have to spend time seeing the desired information. Although I've outlined the states that do accept Medicaid waiver programs, determined impediments may be in place to securing a Medicaid-covered bed in an assisted living facility. Be aware that some states may offer the schedule on a trial basis, succeed miniature participation quotas, or are just introducing the schedule to state residents. As always, verify eligibility requirements with the Centers for Medicare and Medicaid Services.
i. Arkansas - Aged and disabled schedule participants are in case,granted with adult residential care, assisted living, and medication assistance and consulting till death.
ii. California - beginning in 2003, California began offering Medicaid waiver programs to aged individuals.
iii. Delaware - schedule participants with Alzheimer's, dementia, corporeal disabilities, or needing assistance with activities of daily living (Adls) are in case,granted with funds for assisted living facilities.
iv. Florida - There are quite a few Medicaid waiver programs for the state of Florida, together with a broad waiver for all individuals aged 65 or older; individuals with Alzheimer's disease and dementia; case management services; assisted living; incontinence supplies to frail, elderly, and disabled individuals aged 60 or older; and a home and community based waiver that offers mental health services to seniors in definite areas of the state.
v. Iowa - Many assisted living facilities across the state accept money from Medicaid waiver programs; however, the number of residents in a factory using these funds is limited.
vi. Indiana - Aged and disabled individuals are in case,granted with case management, transportation, assisted living, medical equipment, congregate care, home delivered meals, nutritional supplements, and much more. The state also offers a targeted assisted living waiver schedule that focuses on therapeutic communal and recreational programming.
vii. Maryland - schedule participants are assessed and, if deemed eligible, are offered either services in the home or placement in an assisted living facility.
viii. Mississippi - Medicaid waiver programs for this state cover individuals requiring assisted living services due to disabilities, Alzheimer's disease, and dementia as well as individuals aged 65 and older needing adult residential care.
ix. Missouri - schedule participants aged 65 and older needing assisted living services are eligible.
x. Nebraska - Individuals aged 65 or older who agree to partake in medical and health care evaluations are eligible for home services or can be settled in an assisted living factory (2).
xi. New Jersey - Under the Enhanced community Options waiver (3), individuals can either remain at home to receive assistive services or be settled in an assisted living facility.
xii. Ohio - The Ohio department of Aging is responsible for determining applicants' waiver eligibility, estimation of disabilities, prognoses, and financial assets for proper placement within assisted living facilities.
xiii. Rhode Island - Aged and disabled individuals are in case,granted with assisted living services, case management, and specialized medical equipment.
xiv. Vermont - Eligible Medicaid recipients are in case,granted with assisted living services under Choices for Care, 1115 Long-Term Care Medicaid Waiver, as well as a number of other care options.
xv. Virginia - This state's Medicaid waiver programs apply only to individuals with Alzheimer's disease or dementia who want the services of assisted living facilities. Depending upon the medical circumstances, age limits may be in effect.
xvi. Washington - The waiver schedule provides for aged and disabled residents at assisted living facilities.
xvii. West Virginia - Aged and disabled schedule participants are in case,granted with adult residential care and assisted living services.
Additionally, some states offer details on restrictions and eligibility that can be downloaded by navigating to each respective state's Medicaid waiver informational link: www.cms.hhs.gov/MedicaidStWaivProgDemoPgi/Mwdl/list.asp?intNumPerPage=all&submit=Go
What to Look for in the Future
State governments resolve eligibility based on income, giving lower-income seniors an opportunity to be settled in a factory that will look after their needs and supervise daily activities. With the baby boomers retiring as we speak and well into the arrival years, will we see increase in the number of Medicaid-eligible assisted living facilities in other states? possibly the thirty-three or so other states will comprehend the foreseen, benefits to both seniors and community in general.
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Primary Care Doctors - Differences between Nursing Homes, Assisted Living & persisting Care retirement Communities
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Do you know about - Differences between Nursing Homes, Assisted Living & persisting Care retirement Communities
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Benjamin Franklin said it best - “nothing in life is unavoidable except death and taxes” but with daily advancements in science, technology and health care, Americans are living longer than ever before*. This blessing however, has created a unique dilemma for contemporary American families: How to plan for and get ready for one's seclusion years.
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How is Differences between Nursing Homes, Assisted Living & persisting Care retirement Communities
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Have you taken a road-trip lately? almost every highway is graced with large bill-boards providing the locations of new planned communities where couples can spend their seclusion years dedicated to recreational pursuits. I doubt you will find a local newspaper that doesn’t have at least one ad promoting the amenities found at a local assisted living facility. Try to crusade for “nursing homes in Virginia” on the Internet and thousands of web pages will appear. Each and every day new facilities offering different programs are being built and marketed across the state.
Is such a factory right for you and your family? If so, which facility? We often hear the terms “retirement community,” “nursing home,” and “assisted living facility” but rarely reconsider what these terms precisely mean. The differences however, are astonishing and it is imperative to understand these differences when manufacture choices for yourself or your loved ones.
Nursing Homes
In Virginia, a nursing home means any factory with the traditional function of providing long-term nursing care, nursing services and health-related services on a persisting basis, for the treatment and inpatient care of two or more non-related individuals**. Put simply, a nursing home is a factory designed for man who needs less care than a hospital, but requires daily health care assistance.
The Virginia agency of health licenses such facilities and has established guidelines regulating varied aspects of their operations, programs, and staffing needs, etc***. For example, a nursing home must: (a) have written policies and procedures about the treatment of residents and the supervision of resident care which are ready to residents and their families (12Vac5-360-20); (b) provide urgency healing services within 15 minutes, under general conditions (12Vac5-360-50); (c) be field to unannounced on-site inspections of the nursing factory by State employees (12Vac5-371-60); (d) have a written deal with one or more physicians licensed by the Virginia Board of treatment to serve as healing director (12Vac5-371-230); and (e) each resident shall be under the care of a doctor licensed by the Virginia Board of treatment (12Vac5-371-240).
In addition, residents of nursing homes are also given unavoidable rights as defined by Virginia Code §32.1-138. See http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+32.1-138. Nursing homes are the most regulated and structured residential options for our Seniors requiring some level of daily health care. If the factory provides care through Medicare and Medicaid programs, it is deemed a "Certified nursing facility" (Virginia Code §32.1-123; Virginia Code §32.1-127) and must be in yielding with both federal and state laws.
Of course, the more rules and regulations that define and control the daily operations of a nursing home, the greater the accountability of the staff. These are the population who will be charged with the daily task of caring for your loved one, and manufacture sure they are in yielding with state and federal laws. No matter how nice and or challenging the factory might be, the staff will make the variation in the middle of your loved one being cared for and encouraged, or not.
A nursing home is best great for someone:
Who requires daily health care – such as aid getting in and out of bed; taking medicine; or using the restroom. Who may have dementia or Alzheimer’s and as a result, is unable to eat and or bathe daily without reminder or assistance; Who is recovering from a fall or urgency and is therefore unable to walk, dress and or eat without aid Assisted Living Facility
“Assisted living facility” means an adult care abode which has been licensed by the Virginia agency of social Services to provide a level of assistance for adults who may have corporal or reasoning impairments and wish at least moderate aid with the activities of daily living. Within assisted living, there are two types: quarterly assisted living for those seniors (typically) who need aid with one or more daily activity; and laberious assisted living for man who may be incapable of performing activities due to reasoning and/or severe corporal impairment (12Vac30-120-450).
The Virginia agency of social Services licenses assisted living facilities but does not regulate in the way the agency of health regulates nursing homes. While there are Virginia guidelines regulating aspects of assisted living facilities, they are limited: An assisted living factory must: (a) provide or coordinate personal and health care services; and (b) provide 24-hour supervision.
As reflected in the table below, assisted living facilities have no obligation to provide health care and/or have health care staff ready to help your loved one. In addition, with no obligation to provide such services, there is the query as to whether or not they owe a duty to warn or treat residents with illnesses or diseases that could be transmitted from other residents.
While a nursing home will have many nurses on staff and doctors hired to monitor the residents, assisted living is more analogous to an apartment construction or college dorm where laundry and food services are provided and residents are on their own for the rest of the day.
An assisted living factory is best great for someone:
Who is basically independent but may not be able or willing to get ready their own food or drive to doctors’ appointments; Someone who wants to scale back and anticipates needing aid with laundry, cooking, etc. In the near future. A join where one spouse is independent but may need aid in feeding and or providing for needs of other spouse. Continuing Care seclusion Community
In Virginia you may also see advertisements for a seclusion community. They are popping up all colse to our favorite College Towns and tourist destinations.
A persisting Care seclusion society provides care depending on your current needs. Like an insurance policy, the resident pays an entrance fee and periodic adjustable payments, which in turn gives the resident a container of residential and healthcare services that the Ccrc is obligated to provide at the time these residential and health care services are required. For example, if upon entering, all you want is help with your meals, that is the only assistance which will be provided. If you wish laberious corporal therapy or God forbid, daily aid for a Dementia patient, the Ccrc has assisted living services or nursing home services ready under your contract. persisting care contracts are regulated by the Virginia Bureau of insurance of the Virginia State Corporation Commission.
Many Ccrcs can have nursing home services ready whether on-site, or at licensed facilities off-site (12Vac5-360-10). While you may be entering the seclusion society as a very wholesome independent and capable resident, as your needs change, so will your ageement with the society and in turn, the facility’s obligations to you.
A persisting Care seclusion society factory is best great for someone:
Who is basically independent but anticipates the need for daily health care for themselves or a spouse in the near future; Someone who is physically disabled and would be unable to care for themselves or a spouse if the disability grew worse. With at least three very different choices, it is very foremost to do your research:
To study assisted living facilities in Virginia, go to agency of social Services website: http://www.dss.state.va.us/facility/search/alf.cgi.
To study nursing homes, go to Medicare’s website: http://www.medicare.gov
And Last But Not Least
It is all the time best to speak to a house member of a current resident and spend time getting to know the staff, no matter what type of factory you are looking into. If looking and researching is not enough, then reconsider the chart below – a comparison of the legal duties of a nursing home compared to the legal duties of an assisted living factory in Virginia.
Duty or Requirement
Nursing Home
Assisted Living
Duty to provide nursing care and or monitor resident’s health?
Yes
No
Doctor required to supervise residents?
Yes
No
Each resident shall be under the care of a doctor licensed by the Virginia Board of Medicine?
Yes
No
Must have nurses on staff?
Yes
No
Must offer rehabilitative services?
Yes
No
Must have ongoing consultation from a registered dietitian or dietitian on staff?
Yes
No
24 Hour supervision required?
Yes
Yes
Must fabricate a written plan upon admission of resident?
Yes
Yes
Staff must feel criminal background check?
Yes
Yes
Monitored by Virginia center for quality health Care Services and buyer Protection
Yes
No
Monitored by agency of social Services
No
Yes
*Life expectancy increased dramatically during the past century, from 47 years for Americans born in 1900 to 77 years for those born in 2001. These same factors—improved healing care and stoppage efforts— that are partly responsible for the dramatic increases in life expectancy have also produced a major shift in the foremost causes of death in the United States in the past century, from infectious diseases and acute illnesses to persisting diseases and degenerative illnesses.” The State of Aging and health in America 2004, published by the center for Disease Control, ready at http://www.cdc.gov/aging/pdf/State_of_Aging_and_Health_in_America_2004.pdf.
**See generally, Virginia Code §32.1-123, as amended and Virginia executive Code § 12Vac5-360-10.
***It is a Felony under Virginia law to control a nursing factory without a license. See generally, 12Vac5-371-30.
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Primary Care Providers - 2010 Largest Assisted Living Providers
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While stormy economic conditions buffeted the business last year, indicators now point to smoother sailing ahead. As businesses in nearly every U.S. Sector struggled to stay afloat last year, assisted living was the buoy in the choppy waters. Steady query for ability services helped keep associates stable-even if accompanied by a hiatus from major mergers and acquisitions.
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As businesses in nearly every U.S. Sector struggled to stay afloat last year, assisted living was the buoy in the choppy waters. Steady query for ability services helped keep associates stable-even if accompanied by a hiatus from major mergers and acquisitions.
Now, as economic forecasters allude to the end of the "Great Recession," associates like this year's Largest Providers are poised for growth, some of which is already underway. Forty-two of those associates (60%) that made the 2010 list description increases in licensed assisted living resident capacity-though much of that growth was in single-digit percentages. Other 16 of the top 70 associates maintained their size, while just 12 reported losses.
Here's a look at Assisted Living Executive's 2010 Largest Providers, and the business environment, transactions, and trends that landed each business a spot.
Top Players Hold Steady
In 2009, no assisted living providers merged nor acquired any other complete company. However, while most deals were small, the year did yield a few large briefcase acquisitions and vital reshuffling. The biggest gains and losses were among the biggest players and occurred through easy sales and acquisitions.
For the first time since Assisted Living menagerial began compiling this yearly Largest Providers list, Sunrise Senior Living, based in McLean, Virginia, no longer sits at No. 1. The company, now No. 2, had no new construction starts and sold off about 9 percent of its assisted living capacity (about 2,896 units) last year. Its biggest transaction was a briefcase of 21 communities in 11 states to Milwaukee, Wisconsin-based Brookdale Senior Living for 4 million, but Sunrise also sold smaller portfolios to regional providers, such as Baltimore-based Brightview Senior Living (The protection Group), which purchased two of Sunrise's New Jersey communities.
The Sunrise downsize has made Seattle-based Emeritus Senior Living the nation's largest assisted living provider. Emeritus acquired 2,221 new licensed assisted living units and grew by 7 percent in the past year, and it's very likely that Emeritus will not only profess the top spot next year, but advance significantly in 2011. The company's partner, Blackstone Real Estate Advisors, is pursuing the buy of 134 communities operated by Sunwest Management, which is in part 11 bankruptcy. Under a preliminary agreement, Emeritus would administrate the properties with the option to invest up to 10 percent of the equity in a joint speculation with Blackstone and Columbia Pacific Management, an entity controlled by Dan Baty, Emeritus chairman and co-Ceo.
Brookdale Senior Living maintained its No. 3 ranking, but also grew by 3,808 residents, or 15 percent, in 2009. Sunwest Management, last year's No. 4 company, comes in at No. 7 this year with 9,186 assisted living residents, a 43 percent drop. The business will disappear fully from the 2011 list if Blackstone or Other entity receives court approval to buy the remainder of Sunwest's portfolio.
In terms of ration growth, the clear winner is Solana Beach, California-based Senior reserved supply Group, Other beneficiary of Sunwest's financial woes. The business picked up administration contracts for 41 properties in 11 states, under the name LaVida Communities, when institutional investor Lone Star Funds of Dallas acquired the properties in the first big deal of 2009. Senior reserved supply Group catapults from No. 55 to No. 11, having grown its assisted living resident capacity more than 500 percent, to 4,897.
Big Movers
For the next Largest Providers ration spike, look to Crl Senior Living Communities, which enters the list at No. 57, thanks to more than doubling its assisted living capacity from 502 to 1,019. Also on the growth path, Frontier administration extensive by 64 percent, from 828 to 1,358 licensed assisted living units, thanks to seven new administration contracts and two new buildings. Frontier administration jumps 15 spots from No. 57 to No. 42. Watch this Western regional provider to grow added next year as several more new buildings open.
The fourth-largest list jumper is Carmichael, California-based Eskaton Senior Residences and Services, rising 12 spots to No. 56. The business reports 1,036 licensed assisted living units (up from 732 last year) due to either expansions or applications for added assisted living licensing.
Only seven other providers description gains of 20 percent or more in the past year, and among them is Bradley, Illinois- based Bma Management. Because of its focus on the affordable market, the business continues to benefit from accessible financing sources not available to former providers. Bma Management's assisted living resident capacity jumped 27 percent in the past year as the business opened six new communities. In 2010, the business moves up the list by three spots, coming in at No. 21.
Other associates that increased their licensed assisted living capacity comprise Capital Senior Living Corporation (No. 20), which grew by 25 percent, and Bonaventure Senior Living (No. 23), whose assisted living capacity surged by 21 percent to 2,595. Assisted living capacity for Carlsbad, California-based Integral Senior Living (No. 24) rose 24 percent. Benedictine condition ideas (No. 41) grew by 20 percent, and Brightview Senior Living (No. 52, up from No. 62 last year) extensive by 29 percent, thanks to the Sunrise deal, which added 240 residents. Other chart-jumper was free time Living Management, which vaulted nine places from No. 58 in 2009 to No. 49 this year simply by adding 200 residents (22 percent).
The vast majority of addition providers, however, had gains of less than 10 percent. But a tiny growth can go a long way when nearly 60 percent of associates on the Largest Providers list have fewer than 2,000 assisted living residents.
In Other indication of assisted living growth, Independent Healthcare Properties, the smallest business on the list at No. 70, only kept its 2009 rank thanks to an 18 percent capacity gain from 706 to 833. Most of the 2009-ranked associates that did not make this year's list either maintained capacity or had very small gains. Other intuit for higher numbers at the lowest of the list is attributed to data from five providers not previously listed-Spectrum relinquishment Communities (No. 28), Mountain View relinquishment (No. 50), Crl Senior Living Communities (No. 57), Welcome Home administration business (No. 64), and Elder Care Alliance (No. 66).
Other than Sunwest, the business with the most dramatic drop in licensed assisted living capacity was Northstar Senior Living, which shed 1,068 residents, or 55 percent of its 2009 capacity, falling from No. 28 to No. 67. Again, because of modest ample numbers, decreases were most renowned toward the lowest of the top 70 list. Grace administration saw a 30 percent decline from 1,399 to 979 and dropped from No. 37 in 2009 to No. 61 this year. Carillon Assisted Living, No. 49 in 2009, decreased its capacity by 24 percent from 1,024 to 775, removing it from the list altogether.
Several associates that didn't make this year's list but may show up in 2011 comprise Trinity Lifestyles Management, which nearly doubled in size to 480 assisted living residents after picking up three Atlanta-area EdenCare properties, formerly operated by Sunrise Senior Living. Wichita, Kansas-based Legend Senior Living has been raising its assisted living component steadily with new construction, addition Other 18 percent to 692 in 2010. And finally, AdCare condition Systems, based in Springfield, Ohio, remains a smaller provider at 231, but that reflects a 38 percent growth over the prior year, and the business recently announced raising .5 million to fund acquisitions.
More carport Times Ahead
"The fact that we'll be able to point to this time period-the worst economic downturn in our lifetimes-and say that our manufactures weathered it pretty well and even prolonged to grow is significant," says Granger Cobb, president and co- Ceo of Emeritus Senior Living.
The past two recessions hit assisted living hard, and many providers at the start of 2009 were implicated that the stalled housing market, depleted stock store earnings, and high unemployment among the adult children of inherent residents could cause occupancy rates to plummet. Instead, after modest 2008 rate declines and a rent growth slowdown to 2 percent from 2.9 percent in 2008 and 4 percent in 2007, the needs-based component of assisted living seemed to trump economic concerns. Move-ins could be postponed but only for so long.
By second quarter 2009, signs of stabilization began to emerge, followed by a slow but upward trend, says Robert G. Kramer, president of the Annapolis, Maryland-based National speculation center for the Seniors Housing & Care manufactures (Nic). While national unemployment still hovered at a troubling 10 percent in January, Kramer says he's cautiously optimistic about the future, especially since the manufactures saw its largest absorption rate in the third quarter of 2009 since the first quarter of 2006- 1,400 assisted living units in the top 30 urban markets and slightly stronger in the top 100 markets.
Those statistics suggest that the ample photo is much rosier for assisted living than for other real estate sectors, including multifamily, hotels, and offices, Kramer notes. "Basically, we are seeing operators keeping the line with regard to rates," he adds. "We de facto are seeing more concessions out there, but at the same time, those concessions tend to be very much market-specific, property-specific, or even unit-specific."
Still, move-in delays due to economic factors have amplified a trend already developing pre-recession-residents tend to be older and frailer, says Jim Moore, president of Moore Diversified Services and author of "Strategic Forecast," published in Assisted Living Executive's January/February 2010 issue. The succeed is heightened occasion in dementia care, which is even more needs-based than assisted living, he adds. Indeed, a whole of top 70 operators reported having converted independent units to assisted living or assisted living to memory care.
As for new construction, buildings already in the pipeline prolonged to open, but few associates launched new developments, and by January 2010, the whole of new construction starts had fallen to the lowest point since Nic started tracking senior housing trends. No associates went public in 2009.
Forecast for 2010
Access to capital will remain the former challenge for improvement in 2010, although new properties financed before the retreat will continue to open through the third quarter of 2010. But the lack of new properties isn't necessarily bad news for assisted living.
"We're going to go through a duration of very tiny new stock coming online, but if that coincides with pent-up query and a rescue in the economy, all should bode well for occupancies and rent growth in assisted living," Kramer says. "Outside of external economic factors that we don't have any operate over, the greatest risk to assisted living is overbuilding."
Fannie Mae and Freddie Mac will continue to be trustworthy sources of permanent 10-year financing, but when it comes to construction loans, developers have few options. Some very tiny Hud 232 financing will be available, but more likely, the few projects that embark on will do so because of relationships with local lenders.
Indeed, The Arbor Company, based in Atlanta, lacks the cash to fabricate properties on its own, but thanks to a partnership with Formation Capital, Arbor will administrate two new properties scheduled to break ground this fall, says Coo Judd Harper. "We feel much stronger and more optimistic about the assisted living occupancies in today's gently recovering economy, but are optimistic about independent living's rebound in the future," he adds. "As people get jobs, they no longer are going to be able to care for a parent at home."
A challenging spot in the acquisitions arena, secret equity entities are starting to eye assisted living as a desirable sector again, and the major Reits in senior housing are well-positioned to invest again, Kramer notes. Emeritus will be a business to watch thanks to the Blackstone deal, and while it only plans one new construction in 2010, the business actively will be seeing for other acquisition opportunities at challenging prices.
"If a business has liquidity, cash flow, and a reasonably salutary balance sheet, it will be in a great position because there are opportunities right now," Cobb says. That benefit isn't just for big associates like Emeritus, but also for regional and even small mom-and-pop players with targeted expansion plans, he adds, noting that "interest rates have not changed that much over the last combine of years, but the whole of equity and coverage ratios you have to have in place has come to be more stringent, as well as the underwriting."
Fanwood, New Jersey-based Chelsea Senior Living leveraged a strong relationship with a local lender to buy a former Sunwest asset in New Jersey last fall and is actively seeing for more deals, says Roger Bernier, president and Coo. "Some people are likely to see their debt maturing and be unable to refinance," he forecasts. "Ultimately we'd like to grow by two communities per year, but it has to be the right deal for us to take a look."
Much of the acquisitions performance in 2010 is likely to remain with distressed properties, however, and no one expects lots of high-end properties to come on the store this year, says Steve Monroe of Senior Care Investor. "High-performing properties are only going to sell if owners can get a good price, although that may start to convert later in 2010."
Still, wise operators should not be blinded by challenging price tags so much that they forget to consider how well the acquisition fits into their existing briefcase and evolving demands of seniors and their families, Moore cautions. "Senior psychographics are changing," he adds. "It's not so much the World War Ii homemaker widow as 80-year-olds who have been in the pro workforce."
Another area of occasion in 2010 may be new administration contracts for owners and lenders who may be unhappy with their current management, Moore suggests. And for many companies, the wisest move in 2010 may be just to sharpen internal operations, he says.
Although Greensboro, North Carolina- based Bell Senior Living is open to the right deal within the mid-Atlantic states in which it already operates, the latter strategy will be the company's prime priority this year, says President Steve Morton. "I'd say it's a time to focus on operations, improve operating results including administration and revenue streams, and put together the vital tools to maximize and run communities in the most productive manner possible," he says. "This is something we can do because we don't have five acquisitions or improvement deals."
Finally, unstable financial markets still make it unlikely that any business will go public in 2010, but if conditions improve, Moore says, the two associates to watch continue to be Atria Senior Living Group (No. 4) and Hcr ManorCare (No. 10).
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