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There Are Two Kinds of People in the US – Those Who View Health As Static and Those Who Don’t

Introduction: We’re Not #1

I believe Americans need a new way of thinking about health. Look where our current perspectives on the subject have gotten us – we are last among the world’s 17 most industrialized nations in all the key indicators of health. It’s hard to believe but true: we’re last in life expectancy; we have the highest rates of obesity, infant mortality, low birth weights, heart disease, diabetes, chronic lung disease, homicide rates, teen pregnancy and sexually transmitted diseases.

The lead author of the Institute of Medicine, NIH sponsored study that revealed this situation remarked that “Americans get sicker, die sooner and sustain more injuries than people in all other high-income countries.” (That’s a quote from the report.) Then he added this coup de grace: “We were stunned by the propensity of findings all on the negative side – the scope of the disadvantage covers all ages, from babies to seniors, both sexes, all classes of society. If we fail to act, life spans will continue to shorten and children will face greater rates of illness than those in other nations.”

Two Ways to Think of Health

I believe Americans are overly passive about their health. Good health can only be attained and maintained by conscious deeds. These deeds require planning and disciple. Examples include exercising regularly and vigorously, dining in ways that nourish the body without causing problems and otherwise behaving in positive, active ways.

The level of health you will enjoy is clearly affected by your lifestyle choices. Your health status depends to a great extent on whether you invest in your well being or not. If you make little or no such investments, your health will depend on chance, genetics, the aging process and the timeliness of the quality of medical care you receive.

If, on the other hand, you do invest, if you seek, protect and defend an advanced state of well being, the nature of the health status you will have will be dramatically different – and better.

Therefore, we need to distinguish these two kinds of health situations – one passive, one active.

The Institute of Health report that places America last reflects that segment of America that is passive. If the quite small segment of the American population that practices active health were separated, if their health data were compiled and compared, I’m sure we would be #1. For these and related reasons, I propose we view health in two different ways – by making a distinction between static health – which is how most view and approach their health, and earned health. The latter is what you get when you invest wisely in your own well being.

It’s a way of life I call REAL wellness.

Health As Currently Perceived

The WHO definition of health is unrealistic (nobody, not even the most devout wellite, enjoys “complete physical, mental and social well-being,” at least not every day). Most think of health in far less exalted ways. Most think they are well if they are not sick. This is pathetic. It equates with not needing immediate medical attention. For the vast majority, this is a “good enough” view of health. Thinking that way is a self-fulfilling prophesy. It means that not healthy is the best you can hope for. This is the static definition of health and it must be reformed and at least accompanied by another, comparison perspective for those Americans willing to do their part. That would be earned health.

I think we need ideas about health that remind people of a key fact, namely, that a passive situation is not as effective, desirable, protective or rewarding as a dynamic earned state of health. We should all be aware that static health, the default setting you get for just existing and doing nothing special to enhance health, can and must be reinforced and boosted.

Employing a term like earned health might remind people that health can be much more than non-illness. The term earned health can signal the availability of a richer level of well being. It can remind everyone that health at its best is more than a static condition. Health is a dynamic state; it gets better with effort, worse if ignored.

Earned health represents a higher health standard. Earned health is more ambitious and more consistent with a REAL wellness mindset and lifestyle than the current norm of health as non-sickness.

The Static/Earned Health Continuum

This continuum is another way of expressing Dr. John Travis’ original, simple line drawing model of health along a continuum, with “premature death” on the far left side of his continuum) and an ever-changing dynamic of “high level wellness” at the other, right side extreme. The “0” in the middle represents a neutral point, which could be simple non-sickness.

The Static/Earned Health Continuum

-10 ______________ 0 ______________ +10

Earned health is what happens from the neutral point to the +10 indicator. Everyone moves along an imaginary continuum of this kind every day, because health is dynamic, under constant change. By living wisely with the right behaviors, we fuel a state of health that is better than if we allow health status to be determined by the passage of time (i.e., the aging process, chance, medical interventions, circumstances and events.

This continuum is a simple way of depicting the basic fact that earned health evolves largely due to our own efforts to improve and protect our well being; static health, on the other side is affected by what happens to you.

By the way, Dr. Travis made regular expansions to his original model. You can view the latest edition and read more the continuum here. A related construct that will interest wellness enthusiasts is Dr. Travis Wellness Energy System.

Earned health is not determined or advanced by medical interventions. Static health, that is, health along the continuum from the center to the left of the of the continuum, is so influenced.

The Path to REAL Wellness

To become healthier in an earned sense, it’s up to us to act so as to move along the right side of the continuum.

The failure to appreciate the different nature of health, earned from static, partly accounts for why America can have so much medical care and yet not enjoy the best quality of health status. After all, modern medicine is a wonderful thing but there are two problems: people expect too much of it and too little of themselves. Understanding the difference between static and earned health might encourage people to be less passive – to realize the need for and value of REAL wellness lifestyles.

A Fable

Here is a fable to express the limits of medicine to boost health status versus the power of our own behaviors.

Imagine a country where everyone owns high powered luxury cars – they cost next to nothing and are easily replaced. In this mythical country, everyone gets unlimited free medical care of the highest quality, plus all the medications they need plus there are highly skilled trauma teams set up at every intersection. The thing is, the people in this mythical country can do whatever they like – there are no laws governing auto safety. Everyone drives way over the speed limits, nobody wears seat belts, there are no air bags and no stop signs, traffic signals or rules of the road. One more thing – brakes haven’t been invented yet.

Interpretation of the Fable

The greatest advances in the mythical society would not follow from introducing more doctors, hospitals, drugs or trauma teams. Changes in customs and driver behaviors would, on the other hand, go a long way to promote a healthier society.

Changes in lifestyles are also the key to better health outcomes in the real world, our country in particular. We have a great health care system – now we need sensible people making wise lifestyle choices that make life not just healthier but more rewarding, more fulfilling and more attractive. We need to help people understand that health is not only a static phenomenon: Earned health offers so much more.

The philosopher Epicurus (c. 341-270 BCE) offered this bit of wisdom long ago: “It is impossible to live pleasurably without living prudently, honorably, and justly; or to live prudently, honorably, and justly, without living pleasurably.”

We all want to live pleasurably. Let’s recognize and act on the other qualities that enable us to earn active positive health. Let’s embrace REAL wellness lifestyles.

All About Affordable Health Insurance Plans

While consumers search for affordable health insurance, they have price in their mind as the top priority. A general conception among the consumers is that cheap health plans should not be costly-the cheapest health plan available in the market is their target. However, this approach is not good. Sometimes, paying for a cheap health insurance plan but still not getting the required level of coverage results only in wastage of money.

With the implementation of the affordable care act, the reach of affordable health plans is set to increase. Or at least, this is what is believed to be the objective of healthcare reforms. However, lots of consumers are still in confusion about how things would work. In this article, we will discuss some detailed options that consumers can try while looking to buy affordable health plans.

To get a hand on affordable health insurance plans, consumers need to take of certain things. First among them is about knowing the options in the particular state of the residence. There are lots of state and federal government-run programs that could be suitable for consumers. Knowing the options is pretty important. Next would be to understand the terms and conditions of all the programs and check the eligibility criteria for each one of them. Further, consumers should know their rights after the implementation of healthcare reforms, and something within a few days, they may qualify for a particular program or could be allowed to avail a particular health insurance plan. If consumers take care of these steps, there is no reason why consumers can’t land on an affordable health plan that could cater to the medical care needs.

Let’s discuss some options related to affordable health insurance plans state-wise:

State-run affordable health insurance programs in California

While considering California, there are three affordable health insurance plans that are run by the state government. Consumers can surely get benefitted by these if they are eligible for the benefits. • Major Risk Medical Insurance Program (MRMIP)

This program is a very handy one offering limited health benefits to California residents. If consumers are unable to purchase health plans due to a preexisting medical condition, they can see if they qualify for this program and get benefits.

• Healthy Families Program

Healthy Families Program offers Californians with low cost health, dental, and vision coverage. This is mainly geared to children whose parents earn too much to qualify for public assistance. This program is administered by MRMIP.

• Access for Infants and Mothers Program (AIM)

Access for Infants and Mothers Program provides prenatal and preventive care for pregnant women having low income in California. It is administered by a five-person board that has established a comprehensive benefits package that includes both inpatient and outpatient care for program enrollees.

Some facts about affordable health insurance in Florida

While talking about affordable health insurance options in Florida, consumers can think about below mentioned options:

• Floridians who lost employer’s group health insurance may qualify for COBRA continuation coverage in Florida. At the same time, Floridians, who lost group health insurance due to involuntary termination of employment occurring between September 1, 2008 and December 31, 2009 may qualify for a federal tax credit. This credit helps in paying COBRA or state continuation coverage premiums for up to nine months.

• Floridians who had been uninsured for 6 months may be eligible to buy a limited health benefit plan through Cover Florida.

• Florida Medicaid program can be tried by Floridians having low or modest household income. Through this program, pregnant women, families with children, medically needy, elderly, and disabled individuals may get help.

• Florida KidCare program can help the Floridian children under the age of 19 years and not eligible for Medicaid and currently uninsured or underinsured.

• A federal tax credit to help pay for new health coverage to Floridians who lost their health coverage but are receiving benefits from the Trade Adjustment Assistance (TAA) Program. This credit is called the Health Coverage Tax Credit (HCTC). At the same time, Floridians who are retirees and are aged 55-65 and are receiving pension benefits from Pension Benefit Guarantee Corporation (PBGC), may qualify for the HCTC.

Some facts about affordable health insurance in Virginia

While talking about affordable health insurance options in Virginia, consumers need to consider their rights:

• Virginians who lost their employer’s group health insurance may apply for COBRA or state continuation coverage in Virginia.

• Virginians must note that they have the right to buy individual health plans from either Anthem Blue Cross Blue Shield or CareFirst Blue Cross Blue Shield.

• Virginia Medicaid program helps Virginians having low or modest household income may qualify for free or subsidized health coverage. Through this program, pregnant women, families with children, and elderly and disabled individuals are helped.

• Family Access to Medical Insurance Security (FAMIS) helps Virginian children under the age of 18 years having no health insurance.

• In Virginia, the Every Woman’s Life Program offers free breast and cervical cancer screening. Through this program, if women are diagnosed with cancer, they may be eligible for treatment through the Virginia Medicaid Program.

Some facts about affordable health insurance in Texas While talking about affordable health insurance options in Texas, consumers need to consider their rights:

• Texans who have group insurance in Texas cannot be denied or limited in terms of coverage, nor can be required to pay more, because of the health status. Further, Texans having group health insurance can’t have exclusion of pre-existing conditions.

• In Texas, insurers cannot drop Texans off coverage when they get sick. At the same time, Texans who lost their group health insurance but are HIPAA eligible may apply for COBRA or state continuation coverage in Texas.

• Texas Medicaid program helps Texans having low or modest household income may qualify for free or subsidized health coverage. Through this program, pregnant women, families with children, elderly and disabled individuals are helped. At the same time, if a woman is diagnosed with breast or cervical cancer, she may be eligible for medical care through Medicaid.

• The Texas Children’s Health Insurance Program (CHIP) offers subsidized health coverage for certain uninsured children. Further children in Texas can stay in their parent’s health insurance policy as dependents till the age of 26 years. This clause has been implemented by the healthcare reforms.

• The Texas Breast and Cervical Cancer Control program offers free cancer screening for qualified residents. If a woman is diagnosed with breast or cervical cancer through this program, she may qualify for medical care through Medicaid.

Like this, consumers need to consider state-wise options when they search for affordable health coverage. It goes without saying that shopping around and getting oneself well-equipped with necessary information is pretty much important to make sure consumers have the right kind of health plans.

Ten Tips for Comparing Health Care Policies

Australians already know that health coverage can provide security for individuals and families when a medical need arises. Many, however, do not know how to find the best value when comparing health insurance policies.

Below are 10 tips everyone should read before shopping for private health coverage.

1. Choose coverage that concentrates on your specific health needs, or potential health needs.

The first thing you should do before comparing your health plan options is determine which policy features best fit your needs. A 30-year-old accountant, for instance, is going to need very different coverage than a 55year-old pro golfer, or a 75-year-old retired veterinarian. By understanding the health needs that most often correspond to people in your age and activity level group – your life stage – you can save money by purchasing only the coverage you need and avoid unnecessary services that aren’t relevant. For instance, a young family with two small children isn’t going to need coverage for joint replacement or cataract surgery. A 60-year-old school teacher isn’t going to need pregnancy and birth control-related services.

Whether it’s high level comprehensive care you’re after, or the least expensive option to exempt you from the Medical Levy Surcharge while providing basic care coverage, always make sure you’re comparing health insurance policies with only those services that make sense for you and your family.

2. Consider options such as Excess or Co-payment to reduce your premium costs.

When you agree to pay for a specified out-of-pocket amount in the event you are hospitalized, you sign an Excess or Co-payment option that will reduce your health insurance premium.

If you choose the Excess option, you agree to pay a predetermined, specific amount when you go to hospital, no matter how long your stay lasts. With a Co-payment option, you agree to pay a daily sum up to a pre-agreed amount. For example, if Joanne has an Excess of $250 on her medical coverage policy and is admitted to hospital, regardless of how long her stay turns out to be, she will pay $250 of the final bill. If Andrew has signed a $75×4 Co-payment with his provider, he will pay $75 per day for just the first the first four days of his hospitalization.

For younger individuals who are healthy and fit with no reason to expect to land in hospital any time soon, either of these options are great ways to reduce the monthly cost of your medical insurance premiums.
Keep in mind that different private insurers have their own rules when it comes to Excess and Co-payments, including how many payments you will need to make annually on either option. It is important to read the policy thoroughly and ask questions in advance in order to have a clear understanding of what you are paying for, and what you can expect coverage-wise in the event that you are hospitalized. Also, make sure you choose an Excess option greater than $500 if you’re purchasing an individual policy, or $1,000 for family coverage, in order to be exempted from the Medicare Levy Surcharge. 3. Pay your health insurance premium in advance before the cost increases.

Each year insurance providers increase their premiums by approximately five percent sometime around the first of April, a practice approved by the Minister of Health. By instituting these annual increases, your health insurance provider retains the ability to fulfill their obligations to policyholders despite increasing medical costs.

Most private medical policy providers allow policy holders to pay for one year’s premium in advance, which locks them into the previous year’s rate for an additional 12 months – a great way to save money. In order to take advantage of the savings offered, most insurers require payment in full be made within the first quarter of the year, between January and March.

4. Lock in to low cost health insurance at an early age.

The most obvious advantage any Australian can take when it comes to saving money on your insurance premiums is to buy in early to the least expensive rate available. And by early, we mean before age 31. Everyone who is eligible for Medicare will receive at least a 30 percent rebate from the government on the price of their health care premium, no matter what age you are. However, by purchasing hospital coverage before the July first following your 31st birthday, you can be ensured the lowest premium rate available.

After age 31, your health insurance rate is subjected to a two percent penalty rate increase for every year after age 30 that you did not have health insurance. Therefore, if you wait to purchase private health coverage until you’re age 35, you will pay 10 percent more annually than you would have if you had purchased it at age 30.

There are exemptions for some people who were overseas when they turned 30, or for new immigrants, and certain others under special exception status. However, if you purchased private insurance after age 30 and are paying an age loading penalty on your health coverage, you will be relieved of the excess penalty after 10 years of continual coverage.

The earlier in life that you lock in to a private health plan, the more money you will save both immediately and over your lifetime.

5. Choose a health care provider who already works with your health fund.

Determine which hospital you prefer if and when the need for treatment does arise, and seek out those health insurance providers that have an agreement with your hospital of choice before making a decision on your health insurance purchase.

It’s a good idea to also find out if your insurer has a list of “preferred providers,” which would include those physicians and practitioners who also have made arrangements with the health funds regarding their charges for services. Request this information from every provider when comparing health insurance policies. This way you can be sure you’ll receive the full gamut of benefits available at the lowest possible cost. These preferred providers often have “no gap” cover – special rates that reduce or eliminate out-of-pocket expenses to policyholders.

6. Double check your health insurance policy before you schedule any treatment or procedures to make sure you have coverage.

Any time you are headed to a private hospital for treatment, first check to see if the hospital and your health insurance provider have an agreement to be absolutely sure you have adequate coverage. At the same time, check with your insurance provider, physician and the hospital to see if there is a Gap between their fees and the government’s Medicare Benefits. This is extremely important because if your physician charges more than Medicare covers and you do not have a “no Gap” plan set up, you could find yourself responsible for a considerable bill. Simply contact your doctor and your insurance company to double check on these items, and avoid being saddled with an out-of-pocket expense your weren’t expecting.

7. File your expense claims promptly.

When you have a health insurance membership card, you can file a claim against your benefits at the time of treatment with no additional paperwork or filing to worry about, at least in most cases. Sometimes, you may still need to file a claim with your insurance provider. When that happens, make sure to file your claim promptly. The typical cut off for insurers to pay health care claims is two years. You can file your health insurance claim directly with your provider or at your area Medicare office, which has a reciprocal agreement in place with most insurance providers. 8. Whenever you travel overseas, suspend your health coverage.

Anytime you travel overseas for more than a few weeks but less than 24 months, certain medical insurance providers allow policyholders to suspend their memberships for the time they’re out of the country, freeing the policyholders from paying premiums during that time period. While your insurance policy is suspended, your Lifetime Health Cover status remains intact, so you do not have to worry about age loading added when you return home. Contact your health insurance provider to make sure of their policy and rules regarding waiting periods and re-activation.

Remember too that Australia has reciprocal arrangements in certain countries, including New Zealand, Finland, Ireland, Italy, Malta, the Netherlands, Sweden and the U.K. For more information, visit http://www.smartraveller.gov.au.

9. Review your policy benefits annually.

Lifestyles change, individuals get married, have children, age – children grow up and move out on their own, couples separate. A lot can happen in the span of 12 months, which is why the Private Health Insurance Ombudsman recommends that everyone review their policy benefits once every year to make sure your coverage still fits your needs.

Regardless of your life changes, your Lifetime Health Cover status remains protected, and waiting periods for benefits that equal your current coverage are waived in compliance with the Private Health Insurance Act of 2007. This means you will be able to file claims related to features you had before you made any changes without interruption in benefits.

10. Compare policies to get the best price and the coverage you need.

To make sure that you are getting the best possible price on your health insurance premium, you must compare policies from different insurers, Make sure you are comparing policies that reflect the treatment plan and coverage you need, without filler services that you won’t need. The more you know about private health coverage and government sponsored Medicare, the more likely you will find the best value for your money when it comes time to purchasing or renewing your health coverage.

Patient Abandonment – Home Health Care

Elements of the Cause of Action for Abandonment

Each of the following five elements must be present for a patient to have a proper civil cause of action for the tort of abandonment:

1. Health care treatment was unreasonably discontinued.

2. The termination of health care was contrary to the patient’s will or without the patient’s knowledge.

3. The health care provider failed to arrange for care by another appropriate skilled health care provider.

4. The health care provider should have reasonably foreseen that harm to the patient would arise from the termination of the care (proximate cause).

5. The patient actually suffered harm or loss as a result of the discontinuance of care.

Physicians, nurses, and other health care professionals have an ethical, as well as a legal, duty to avoid abandonment of patients. The health care professional has a duty to give his or her patient all necessary attention as long as the case required it and should not leave the patient in a critical stage without giving reasonable notice or making suitable arrangements for the attendance of another. [2]

Abandonment by the Physician

When a physician undertakes treatment of a patient, treatment must continue until the patient’s circumstances no longer warrant the treatment, the physician and the patient mutually consent to end the treatment by that physician, or the patient discharges the physician. Moreover, the physician may unilaterally terminate the relationship and withdraw from treating that patient only if he or she provides the patient proper notice of his or her intent to withdraw and an opportunity to obtain proper substitute care.

In the home health setting, the physician-patient relationship does not terminate merely because a patient’s care shifts in its location from the hospital to the home. If the patient continues to need medical services, supervised health care, therapy, or other home health services, the attending physician should ensure that he or she was properly discharged his or her-duties to the patient. Virtually every situation ‘in which home care is approved by Medicare, Medicaid, or an insurer will be one in which the patient’s ‘needs for care have continued. The physician-patient relationship that existed in the hospital will continue unless it has been formally terminated by notice to the patient and a reasonable attempt to refer the patient to another appropriate physician. Otherwise, the physician will retain his or her duty toward the patient when the patient is discharged from the hospital to the home. Failure to follow through on the part of the physician will constitute the tort of abandonment if the patient is injured as a result. This abandonment may expose the physician, the hospital, and the home health agency to liability for the tort of abandonment.

The attending physician in the hospital should ensure that a proper referral is made to a physician who will be responsible for the home health patient’s care while it is being delivered by the home health provider, unless the physician intends to continue to supervise that home care personally. Even more important, if the hospital-based physician arranges to have the patient’s care assumed by another physician, the patient must fully understand this change, and it should be carefully documented.

As supported by case law, the types of actions that will lead to liability for abandonment of a patient will include: • premature discharge of the patient by the physician

• failure of the physician to provide proper instructions before discharging the patient

• the statement by the physician to the patient that the physician will no longer treat the patient

• refusal of the physician to respond to calls or to further attend the patient

• the physician’s leaving the patient after surgery or failing to follow up on postsurgical care. [3]

Generally, abandonment does not occur if the physician responsible for the patient arranges for a substitute physician to take his or her place. This change may occur because of vacations, relocation of the physician, illness, distance from the patient’s home, or retirement of the physician. As long as care by an appropriately trained physician, sufficiently knowledgeable of the patient’s special conditions, if any, has been arranged, the courts will usually not find that abandonment has occurred. [4] Even where a patient refuses to pay for the care or is unable to pay for the care, the physician is not at liberty to terminate the relationship unilaterally. The physician must still take steps to have the patient’s care assumed by another [5] or to give a sufficiently reasonable period of time to locate another prior to ceasing to provide care.

Although most of the cases discussed concern the physician-patient relationship, as pointed out previously, the same principles apply to all health care providers. Furthermore, because the care rendered by the home health agency is provided pursuant to a physician’s plan of care, even if the patient sued the physician for abandonment because of the actions (or inactions of the home health agency’s staff), the physician may seek indemnification from the home health provider. [6]

ABANDONMENT BY THE NURSE OR HOME HEALTH AGENCY

Similar principles to those that apply to physicians apply to the home health professional and the home health provider. A home health agency, as the direct provider of care to the homebound patient, may be held to the same legal obligation and duty to deliver care that addresses the patient’s needs as is the physician. Furthermore, there may be both a legal and an ethical obligation to continue delivering care, if the patient has no alternatives. An ethical obligation may still exist to the patient even though the home health provider has fulfilled all legal obligations. [7]

When a home health provider furnishes treatment to a patient, the duty to continue providing care to the patient is a duty owed by the agency itself and not by the individual professional who may be the employee or the contractor of the agency. The home health provider does not have a duty to continue providing the same nurse, therapist, or aide to the patient throughout the course of treatment, so long as the provider continues to use appropriate, competent personnel to administer the course of treatment consistently with the plan of care. From the perspective of patient satisfaction and continuity of care, it may be in the best interests of the home health provider to attempt to provide the same individual practitioner to the patient. The development of a personal relationship with the provider’s personnel may improve communications and a greater degree of trust and compliance on the part of the patient. It should help to alleviate many of the problems that arise in the health care’ setting.

If the patient requests replacement of a particular nurse, therapist, technician, or home health aide, the home health provider still has a duty to provide care to the patient, unless the patient also specifically states he or she no longer desires the provider’s service. Home health agency supervisors should always follow up on such patient requests to determine the reasons regarding the dismissal, to detect “problem” employees, and to ensure no incident has taken place that might give rise to liability. The home health agency should continue providing care to the patient until definitively told not to do so by the patient.

COPING WITH THE ABUSIVE PATIENT

Home health provider personnel may occasionally encounter an abusive patient. This abuse mayor may not be a result of the medical condition for which the care is being provided. Personal safety of the individual health care provider should be paramount. Should the patient pose a physical danger to the individual, he or she should leave the premises immediately. The provider should document in the medical record the facts surrounding the inability to complete the treatment for that visit as objectively as possible. Management personnel should inform supervisory personnel at the home health provider and should complete an internal incident report. If it appears that a criminal act has taken place, such as a physical assault, attempted rape, or other such act, this act should be reported immediately to local law enforcement agencies. The home care provider should also immediately notify both the patient and the physician that the provider will terminate its relationship with the patient and that an alternative provider for these services should be obtained.

Other less serious circumstances may, nevertheless, lead the home health provider to determine that it should terminate its relationship with a particular patient. Examples may include particularly abusive patients, patients who solicit -the home health provider professional to break the law (for example, by providing illegal drugs or providing non-covered services and equipment and billing them as something else), or consistently noncompliant patients. Once treatment is undertaken, however, the home health provider is usually obliged to continue providing services until the patient has had a reasonable opportunity to obtain a substitute provider. The same principles apply to failure of a patient to pay for the services or equipment provided.

As health care professionals, HHA personnel should have training on how to handle the difficult patient responsibly. Arguments or emotional comments should be avoided. If it becomes clear that a certain provider and patient are not likely to be compatible, a substitute provider should be tried. Should it appear that the problem lies with the patient and that it is necessary for the HHA to terminate its relationship with the patient, the following seven steps should be taken:

1. The circumstances should be documented in the patient’s record.

2. The home health provider should give or send a letter to the patient explaining the circumstances surrounding the termination of care.

3. The letter should be sent by certified mail, return receipt requested, or other measures to document patient receipt of the letter. A copy of the letter should be placed in the patient’s record.

4. If possible, the patient should be given a certain period of time to obtain replacement care. Usually 30 days is sufficient.

5. If the patient has a life-threatening condition or a medical condition that might deteriorate in the absence of continuing care, this condition should be clearly stated in the letter. The necessity of the patient’s obtaining replacement home health care should be emphasized. 6. The patient should be informed of the location of the nearest hospital emergency department. The patient should be told to either go to the nearest hospital emergency department in case of a medical emergency or to call the local emergency number for ambulance transportation.

7. A copy of the letter should be sent to the patient’s attending physician via certified mail, return receipt requested.

These steps should not be undertaken lightly. Before such steps are taken, the patient’s case should be thoroughly discussed with the home health provider’s risk manager, legal counsel, medical director, and the patient’s attending physician.

The inappropriate discharge of a patient from health care coverage by the home health provider, whether because of termination of entitlement, inability to pay, or other reasons, may also lead to liability for the tort of abandonment. [8]

Nurses who passively stand by and observe negligence by a physician or anyone else will personally become accountable to the patient who is injured as a result of that negligence… [H]ealthcare facilities and their nursing staff owe an independent duty to patients beyond the duty owed by physicians. When a physician’s order to discharge is inappropriate, the nurses will be help liable for following an order that they knew or should know is below the standard of care. [9]

Similar principles may apply to make the home health provider vicariously liable, as well.

Liability to the patient for the tort of abandonment may also result from the home health care professional’s failure to observe, examine, assess, or monitor a patient’s condition. [10] Liability for abandonment may arise from failing to take timely action, as well as failing to summon a physician when a physician is needed. [11] Failing to provide adequate staff to meet the patient’s needs may also constitute abandonment on the part of the HHA. [12] Ignoring a patient’s complaints and failing to follow a physician’s orders may likewise constitute a tort of abandonment for a nurse or other professional staff member.

1. Lee v. Dewbre, 362 S.W.2d 900 (Tex. Civ. App. 7th Dist. 1962).

2. Kattsetos v. Nolan, 368 A.2d 172 (Conn. 1976).

3. 61 AM. Jur. 2d, Physicians and Surgeons § 237 (1981).

4. See, e.g., Tripp v. Pate, 271 S.E.2d 407 (N.C. App. 1980).

5. Ricks v. Budge, 64 P.2d 208 (Utah 1937).

6. M.D. Nathanson, Home Healthcare Answer Book: Legal Issues for Providers 212 (1995).

7. See, generally, E.P. Burnzeig, The Nurse’s Liability for Malpractice (1981).

8. Sheryl Feutz-Harter, Nursing Caselaw Update: In appropriate Discharging of Patients, 2 J. Nursing L. 49 (1995).

9. Id., 53.

10. See, e.g., Pisel v. Stamford Hosp., 430 A.2d1 (Conn. 1980) (nurses were held liable for failing to monitor the condition of a patient).

11. See, e.g., Sanchez v. Bay General Hosp., 172 Cal. Rptr. 342 (Cal. App. 1981); Valdez v. Lyman-Roberts Hosp., Inc. 638 S.W. 2d 111 (Tex. 1982).

12. Czubinsky v. Doctors Hosp., 188 CAl. Rptr. 685 (1983).

What Attracts Internet Users to Read Technology and Gadgets Blog

Blog is similar to a website, generally owned by a single person. Be it technology news, general news, recent updates, general discussion, image uploads, thought sharing; anything can take its place within a blog. The person, responsible for updating the blog with latest posts is called a blogger. Well, Technology blog is no different from others. Interestingly, technology and Gadgets blogs are the two most popularly read blogs. There are certain reasons as to why internet users prefer reading technology blogs every single day. Tech bloggers are quite ardent with the recent updates:

Tech bloggers give least importance for money. What they look for is only the technology stuff and the latest releases from the same. Things like latest software, hardware vendors, latest invention, and issues in gadgets, technology discovery, technical difficulties and so on attract them the most. Blogs may sometimes act as a discussion forum, where tech bloggers can start sharing their new innovation, thereby gaining trust from other blog readers, building a community and what not.

Free Advice:

Novice Internet users having middle level computing skill read these blogs to gain advice from expert tech bloggers. They are people who are ardent about enriching their computer knowledge. They tend to learn something new everyday. Amusingly, technology and gadgets blog paves way for things to be learnt quite easily, because the blog owners update technical information that is quite understandable. Novice computer users love to evade harmful mistakes:

It can give us a big headache if something goes wrong with our PC. Being a newbie to computer usage, we tend to learn what’s new. That’s why, people read technology blogs because of the abundant information available out there, including, PC security, virus alert and so on.

Be thankful for the invention of Internet. Now, you can learn anything you wish online.

5 Additional Computer and Laptop Gadgets For Your Travel

With the invention and advancement in technology, there are lots of requirements that have become the basic mandate in our present lives. To be more precise, unlike earlier days, we have a blended life of work and vacation together now. We carry our laptops even during vacation and club both work and vacation. This practice has become unavoidable in the present market conditions. When we carry laptops to every other place, it is important to carry few basic gadgets along with it in order to ensure smooth running of the laptop and also to use the laptop to its best.

Laptop Security Cable: During travel, it becomes mandatory to safeguard your laptop. Security cable is one of the most important among all computer gadgets in order to ensure safety to your laptop. These computer gadgets or security cables come with password operations that are very easy to use. The average cost of the security cable is around 6 dollars and is very effective for its price. The length of these computer gadgets are good and comes with a good finish. You just need to enter the password to lock and unlock the cable. The security cable is made out of alloy and weights about 168 grams only. Mini Laptop Optical Mouse: Optical mouse, one other important computer gadgets that comes handy for convenient usage. The size of these computer gadgets are very small and hence easy portable. This mini optical mouse is capable of capturing every motion with amazing digital accuracy. You need not connect these computer gadgets with that of a cord and hence unrestricted motion space for the optical mouse. If you have children who love playing games or surf net, these are the ideal laptop gadgets that you must have.

USB 3D Sound Adapter: These computer gadgets are capable of transferring analog signals to digital sound signals and there is no manual installation required for the set up. The sound quality is very good and you can enjoy listening to music anywhere you go. The size of these computer gadgets are just 12mm thick and fits easily in the USB port of the laptop. These are simple and cost effective computer gadgets.

Mini Wireless Keyboard: These wireless keyboards work fine with batteries. These laptop gadgets are very sturdy and can be used the normal way any keyboard is used at home. Due to the mini size, it is very convenient and very soft. Ideal for traveling purposes where your kids can have uninterrupted usage of the laptop. The weight of these laptop gadgets are just 5.5 oz. Flexible Keyboard Light: These laptop gadgets are a mandate when you travel as you can access the keyboard even in a dark room. The light is bright and it is very useful with a good range. The cost of these laptop gadgets are around 5 dollars. Even when you have to be awake in the night due to work requirement, you can use the keyboard light without disturbing anyone around you.

Are You in the Right Business for You?

Do you love going into your business every morning and spending time with your clients?

This may seem a strange question to ask. If you know your life purpose, you will find the answer comes easily. Your business will become your drug initially and maybe continue to be for a very long time. So, we aware of the sacrifices that you may have to make in being a business owner.

I often wonder if solo or micro business people really know if they are in the right business or not. I do believe that if you know your WHY (your purpose) you will know if you are in the right place for you and your growth. Being in business is not something that you can do half-heartedly. It needs to be something that you want so badly that you will do whatever to make it work.

All too often I meet with people and clients who really have not thought about their WHY or the Vision and Mission of their business. To get real clarity you need to firstly know your ‘why’ for your life and only then can you really be aware if the vision is correct for you and your future.

To be in business on your own you need to be an entrepreneur who has a dream to create something extraordinary. You have to be prepared to go to whatever lengths to make sure it happens, understanding that initially there may be no money, long hours and ups and downs. It takes COURAGE to be in your own business, especially in the early days.

Firstly, ask yourself why you are in business? What is your reason? It is because you love what it is or are you there purely to make money?Choosing the correct business is important. We are all different so there is no one size fits all. Ask yourself what type of business attracts you? If you understand who you are and where your innate gifts are you will find it easy to know the type of business that suits you best.

Are you a people person or someone who likes to be behind closed doors? Once you understand this part of your personality and what it is that you love to do, then, and only then, will you know who you need to put around you to support you to grow your vision.

Knowing the industry you wish to be part of is important as well as understanding the target/ customer market that suits your service or product. The demographics are important too, for example gender, age, background, knowledge etc. Having an idea of what you want in the way of size and of staffing or if you want to do it alone needs to be considered too.

Is your business to be a quick get in and get out type of business or a hobby type business? Do you know how much you want to earn? Have you considered an Exit plan for the future also? All important questions initially.

It is also a good idea to find out what your customers/clients want that they are not getting elsewhere. What can you create that will fill the need? How can you solve their problems? What is their greatest criticism of where the marketplace is letting them down or not meeting the demand?

Has your business come from a hobby or personal interest that has heart and mind in it? Or, is it what you have been trained to do and can’t think of anything else that would suit you? Do you love what you are doing now and is it what gets you out of bed in the morning?

Is your business home-based or needing to have it’s own premises as it grows? What are you looking to create size-wise in the future? Are you considering an international, national or city business?

Is your business a service or product orientated business? This will make a difference into outlay too. A service business can be run as a home-based business without costly inventor, theft problems, product spoilage or premises.

The opportunities the internet gives us today to search, profile and gather information that will support one to create a good business is outstanding. There is so much support and knowledge that has no cost to it to work out how and what you want your business to look like. So do your research and be discerning with what you find out and learn. Find people who you can trust to discuss your ideas with who will help support you and your business to move forward.

We often have great ideas with a sound theory when in reality it just won’t or can’t work. It may be lacking skills or certain personality types, so make sure you reduce all the risk possible before you get too deep into your business creation. Make sure that you do your market research and that there are people out there wanting what you are creating! To own and run a business that will be successful takes an enormous effort. You must be willing to work the long hours, invest everything you have financially as well as physically in the dream to bring it to fruition. You need to commit and listen only to the people who you know are able to give good sound advice. Family and friends are often not the right people to do this as they will say what they can to protect you. Not everyone is an entrepreneur. Many people I come across are really the technician and are without the personality or management skills necessary to be successful long-term.

I have found that by self-understanding both personality and thinking wise you will make many less mistakes and be more successful. I then come to the question of what is SUCCESS to you as the business owner? This can vary dependent on what you want from your life, your experience, your contacts and how much you want to earn from your hard work.

Understanding your WHY for being in business in the first place is what will be the maker or breaker of your business in the long-run.

Enjoy the process and ASK for help and support whenever you can.

Best Deals On New Computer Gadgets

If you’re thinking of getting one of the new gadgets on the market, you will probably accept that you will be spending some money in order to get it. But you don’t necessarily have to be spending every penny you have in order to get hold of the latest technology.

There are many ways which you can use to help you get hold of these new gadgets that can actually save you money, so you shouldn’t have to pay full price for these fantastic pieces of technology.

Store cards

While for most purchases that you make, this will not be a particularly useful card, but every now and again, the stores will give you a discount incentive on your purchases if you sign up for one of their store cards. So if you’re able to get 10 or even 20 per cent off your new gadgets by using these discounts, then it might be valuable to sign up. However, to make sure it is a good thing to do, make sure you go over the charging structures that such store cards will take, whether there is a monthly fee or if interest is charged. If you factor in all the costs, and then compare it with the savings on your new gadgets; if it works out cheaper, then go ahead, as long as you make sure that you close the card once you’ve paid it off, and that you don’t let any balances on the
card earn interest.

Online Voucher Codes And Cashback Sites

Of course, shopping around when you’re looking for your new gadgets is one thing you will certainly be doing. But you should also have a look online to find the best prices, and to see if there are any vouchers you can find which can further discount the price of your new gadgets.

Another type of website you will want to consider using when you’re purchasing your new gadgets are the online cashback sites. The main one among these is Quidco, but there are many actually available. Once you’ve found the site which offers the best price for your new gadgets, check on the cashback sites to see if you can get any further savings on your purchase.

Trade-In Sites

If you are anything like me, you will have a large number of gadgets which you no longer use, but they don’t necessarily have to spend the rest of their lives unused at the back of the cupboard. There are some stores which will offer a trade-in facility for your old gadgets, and will allow you a store voucher which you can use against the cost of your new gadgets. Unfortunately, the prices you receive can vary from store to store, so if you can’t get the discount you want off your new gadgets using this method, then you can also consider selling the old items on an auction site such as eBay.

Conclusion

Whatever the type of new gadgets that you are looking for, it is important that you don’t jump in at the first sight of the technology, and pay the full price immediately. While negotiation might be an option in some independent retailers, for most major stores, you will need to look at alternatives if you really want to get the best deals on new gadgets.

Retro Vacationing in the Great Midwest Dustbowl Recession of 2012

With recently financial difficulties Nationwide, Many Americans (myself included), have found it difficult to go anywhere and do anything. Let’s face it, without a job, you can’t even afford the overpriced gasoline to go anywhere-much less, do anything.

I did manage to find a few gems that I would like to pass along, that may be an affordable break from the awful conditions that we are all experiencing. Chiefly, the relentless 110 degree Midwest temperatures and the lack of financial ability.

I have a family of 4; which consists of one boy (age 5), and one girl (age 12). We reside in the Greater Louisville Kentucky/Southern Indiana area; “Pert Near the middle of the Great Midwest Dustbowl”.

It has been my family’s long goal to go to Disneyland, The Smithsonian, The Grand Canyon, and well you get the idea. Our finances have gone from Bad to worse over the years, making it difficult to do anything. Employers are offering lesser salaries; while prices are still going up. I guess, I am probably preaching to the choir, so I will get on with the gist of my article.

Some folks view that vacations are a waste of money and a poor investment. I believe that vacations are an investment in a family’s memories. You should do your level best, to provide at least some form of morale boosting recreation, especially in these trying times.

I wanted to give my family a Happy July 4th this year. My larger extended Family wasn’t planning anything reunion related; which would have consisted of back-yard fireworks and burgers anyway. So, it was my chance to do something different.

I decided to take my family to Deam’s Lake for the 4th; for a day of hiking, fishing, lake swimming, watermelon and yeah the same burgers. I invited along my Dad’s family and a family friend. Park admission is $5.00 per car-load. Everything else we brought with us, except in that there was no hand-soap in the rest-rooms. I had to pay $2.50, for a small size pump that normally would have cost $1.25, but that was all.

We found a great place near the lake with shade trees and picnic tables and a grill, all for our $5.00 admission (for the whole car-load)! I had spent some time there as a boy with my family. I remember when the open grass was full of bikini clad women working on their tans, when I was about 7 or 8 yrs old in 1970 something.

My uncle, who shall remain nameless, was 5 years older than me. He used to have me chase him with a bucket of water. The goal was to miss him, and hit the young ladies with the water so, that they would jump up, and with their tops un-done for tan line issues; they would expose heavenly morsels to sunlight-or something of the sort. So, the amount and type of folks at the lake are forever burned in my memoirs.

I later spent time there as a 12 year old Boy Scout, and then again as a 1980s teenager with my Pals from High School. During my teen years, I can assure you that I noticed the young ladies that were there. Not quite as many as age 8, but it was about quality, not quantity.

I noticed something unusual, about our 2012 July 4th. First off, there were no sun-bathers at all. The open grass was a dessert wasteland. The type of folks there was different as well. The amount of Hispanics was overwhelming. I minored in Spanish in college, and like the culture, Food and Sangria very much. While there were a few Senoritas there that were strikingly attractive; I couldn’t help but wonder if Arizona had lost, it’s border battle.

All kidding aside, the Caucasian population doesn’t go outdoors anymore. And when they do, they shouldn’t be wearing Bikinis. It appeared that my red bandana and I had time travelled back-all alone.

My kids had an absolute blast. My 5 year old led us on an adventure hike. My daughter caught a fish. We all swam in the lake, and no one drowned. We ate watermelon and had a very “Retro” July 4th that will be emblazoned in the minds for eternity.

I strongly suggest getting your family to the lake, or “A Lake” in the near future. The physical activity will do your family well in the waistline, and the close knit morale that comes from being a “Shope” or a “Thomas” or a Whatever you are, will be priceless.

Another Retro alternative for “The Great Midwest Dustbowl of 2012” was a personal favorite of mine… King’s Island.

The park opened in 1970. That’s me with my Mother in about 1973 or 1974, I am guessing 5 years old. Yes, I am sporting “Herb Tarlic” pants and a Bowl-cut, Mom was as beautiful as ever, may she rest in piece (Don’t Smoke).

At any rate, I remember the park had the most wonderful shops, with Family Crests and knick-knacks that you couldn’t find anywhere else. I remember that the flowers were always beautiful and thick everywhere impatiens galore. You used to be able to play in the fountains at the front entrance.

I expected the park to me more packed than it was, especially with the closing of 6 Flags over Kentucky Kingdom, just 90 minutes away. There was a decent turn out, however there was a break in the heat from 105 degree temperatures down to a more comfortable 88 degrees on the day that we went.

The flowers aren’t quite as impressive as they used to be, and the fountain is now fenced off; but they have added a new water park in 1989 now called Soak City. I haven’t been to it since 1993 or so, and it hasn’t changed much, except for some of the names. Soak City is triple the fountain fun and is included with park admission for free. You can even ride the train to it.

The park has dozens of roller coasters, and the old Hannah Barbara land is now “Planet Snoopy”. Since, I’m another “Joe Cool”, I’m good with most of the changes, except for the antique cars; which are now a tombstone in the graveyard of dead rides-literally they have a graveyard! My Antique cars are now a smoking park, where you can apparently walk your smoker (again-Don’t Smoke).

My family and I decided to go, and try not to spend a dime in the park. Except for admission (we got free media passes). General park admission costs $36.99 per person.

We brought in a bottle of water each, with generic propel fitness packet for electrolytes and a granola bar-non chocolate “Retro” type. We got to the park at opening 10am. The kids were wide-eyed. They were intimidated by many rides, but soon began having a blast.

Most of the rides are included with park admission, and free. We did not purchase fast line cutting passes, and avoided all shops and pay games.

We had a blast in Planet Snoopy. We shot Zombies in the Haunted Hill, and did not pay $8.99 for our picture. We also, did not pay $8.99 for an Icee/Slurpy frozen drink. We ate our granola bar and drank our fitness water, and spent nothing. We had a small backpack to put our drinks, granola bars and camera in. This is necessary for some rides, that ask-do you have any fluids with you.

We got our hand stamped, and ate lunch in the car. We had packet a cooler with sandwich fixins, Veggi sticks and drinks waiting for us. We did not spend $29.99 for 1 pizza.

After lunch, we carried in a second water, packet, and granola bar for another pit stop snack for later in the day. We did not spend $6.00 for popcorn, and $5.00 for a coke.

We did attend a free concert, called of all things, The Retro 1970’s. They played that Funky music White-Boy! Did the Disco Duck, and Freaked-Out to “Freak-Out”. We all thoroughly enjoyed it, and after walking 20 miles through the park, it was a welcome change to sit for 30 minutes in the shade.

The disco ball dancing was in tune with my 1970s expenses. I spent $12.00 to park, and $15.00 for a large locker at soak city, to hold 4 pair of shoes and a bag. I let the kids play 1 game to try to win a 4′ tall red dragon; they spent $1 each-and basically threw those dollar bills away. (stay away from all shops and pay games).

Basically, we spent $29.00 for a family of 4, for a full day of activity, rides, water park fun and even got in a show. Of course the park admission would have cost us $147.69 had I not received my Eagle Eye Productions Freelance Media passes.

We also got drive through on the way home, with a 90+ minute car ride from Ohio at 9pm, it was the only real option. The moral of the story, for under $200.00 you can have a Disney style day trip on a recession budget, and beat the Dustbowl Heat at the same time.

On both occasions, I got to feel like a good parent for taking care of my kids, as best I could, and did not spend a fortune. Their spirits were renewed somewhat, in the midst of “Dust-Bowl fever”.

Real Estate Agents and the Internet – How to Buy and Sell Real Estate Today

Then and Now

Ten years ago, a search for real estate would have started in the office of a local real estate agent or by just driving around town. At the agent’s office, you would spend an afternoon flipping through pages of active property listings from the local Multiple Listing Service (MLS). After choosing properties of interest, you would spend many weeks touring each property until you found the right one. Finding market data to enable you to assess the asking price would take more time and a lot more driving, and you still might not be able to find all of the information you needed to get really comfortable with a fair market value.

Today, most property searches start on the Internet. A quick keyword search on Google by location will likely get you thousands of results. If you spot a property of interest on a real estate web site, you can typically view photos online and maybe even take a virtual tour. You can then check other Web sites, such as the local county assessor, to get an idea of the property’s value, see what the current owner paid for the property, check the real estate taxes, get census data, school information, and even check out what shops are within walking distance-all without leaving your house!

While the resources on the Internet are convenient and helpful, using them properly can be a challenge because of the volume of information and the difficulty in verifying its accuracy. At the time of writing, a search of “Denver real estate” returned 2,670,000 Web sites. Even a neighborhood specific search for real estate can easily return thousands of Web sites. With so many resources online how does an investor effectively use them without getting bogged down or winding up with incomplete or bad information? Believe it or not, understanding how the business of real estate works offline makes it easier to understand online real estate information and strategies.

The Business of Real Estate

Real estate is typically bought and sold either through a licensed real estate agent or directly by the owner. The vast majority is bought and sold through real estate brokers. (We use “agent” and “broker” to refer to the same professional.) This is due to their real estate knowledge and experience and, at least historically, their exclusive access to a database of active properties for sale. Access to this database of property listings provided the most efficient way to search for properties.

The MLS (and CIE)

The database of residential, land, and smaller income producing properties (including some commercial properties) is commonly referred to as a multiple listing service (MLS). In most cases, only properties listed by member real estate agents can be added to an MLS. The primary purpose of an MLS is to enable the member real estate agents to make offers of compensation to other member agents if they find a buyer for a property.

This purposes did not include enabling the direct publishing of the MLS information to the public; times change. Today, most MLS information is directly accessible to the public over the Internet in many different forms.

Commercial property listings are also displayed online but aggregated commercial property information is more elusive. Larger MLSs often operate a commercial information exchange (CIE). A CIE is similar to an MLS but the agents adding the listings to the database are not required to offer any specific type of compensation to the other members. Compensation is negotiated outside the CIE.

In most cases, for-sale-by-owner properties cannot be directly added to an MLS and CIE, which are typically maintained by REALTOR associations. The lack of a managed centralized database can make these properties more difficult to locate. Traditionally, these properties are found by driving around or looking for ads in the local newspaper’s real estate listings. A more efficient way to locate for-sale-by-owner properties is to search for a for-sale-by-owner Web site in the geographic area.

What is a REALTOR? Sometimes the terms real estate agent and REALTOR are used interchangeably; however, they are not the same. A REALTOR is a licensed real estate agent who is also a member of the NATIONAL ASSOCIATION OF REALTORS. REALTORS are required to comply with a strict code of ethics and conduct.

MLS and CIE property listing information was historically only available in hard copy, and as we mentioned, only directly available to real estate agents members of an MLS or CIE. About ten years ago, this valuable property information started to trickle out to the Internet. This trickle is now a flood!

One reason is that most of the 1 million or so REALTORS have Web sites, and most of those Web sites have varying amounts of the local MLS or CIE property information displayed on them. Another reason is that there are many non-real estate agent Web sites that also offer real estate information, including, for-sale-by-owner sites, foreclosure sites, regional and international listing sites, County assessor sites, and valuation and market information sites. The flood of real estate information to the Internet definitely makes the information more accessible but also more confusing and subject to misunderstanding and misuse. Despite the flood of real estate information on the Internet, most properties are still sold directly through real estate agents listing properties in the local MLS or CIE. However, those property listings do not stay local anymore. By its nature, the Internet is a global marketplace and local MLS and CIE listings are normally disseminated for display on many different Web sites. For example, many go to the NATIONAL ASSOCIATION OF REALTORS Web site, http://www.realtor.com, and to the local real estate agent’s Web site. In addition, the listing may be displayed on the Web site of a local newspaper. In essence, the Internet is just another form of marketing offered by today’s real estate agent, but it has a much broader reach than the old print advertising.

In addition to Internet marketing, listing agents may also help the seller establish a price, hold open houses, keep the seller informed of interested buyers and offers, negotiate the contract and help with closing. When an agent provides all of these services it is referred to as being a full service listing arrangement. While full service listing arrangements are the most common type of listing arrangement, they are not the only option anymore.

Changes in the technology behind the real estate business have caused many agents to change the way they do business. In large part, this is due to the instant access most consumers now have to property listings and other real estate information. In addition, the Internet and other technologies have automated much of the marketing and initial searching process for real estate. For example, consumers can view properties online and make inquires via email. Brokers can use automated programs to send listings to consumers that match their property criteria. So, some agents now limit the services they offer and change their fees accordingly. An agent may offer to advertise the property in the MLS but only provide limited additional services. In the future, some real estate agents may offer services in more of an ala carte fashion.

Because of the volume of real estate information on the Internet, when people hire a real estate agent today they should look at the particular services offered by the agent and the depth of their experience and knowledge in the relevant property sector. It is no longer just about access to property listing information. Buyers and sellers historically found agents by referrals from friends and family. The Internet now provides ways to directly find qualified agents or to research the biography of an agent referred to you offline. One such site, AgentWorld.com, is quickly becoming the LinkedIn or Facebook for real estate agents. On this site an agent can personalize their profile, start a blog, post photos and videos and even create a link to their web site for free. Once unique content is added to their profile page the search engines notice!

Some have argued that the Internet makes REALTORS and the MLS less relevant. We believe this will be false in the long run. It may change the role of the agent but will make knowledgeable, qualified, and professional REALTORS more relevant than ever. In fact, the number of real estate agents has risen significantly in recent years. No wonder, the Internet has made local real estate a global business. Besides, Internet or not, the simple fact remains that the purchase of real property is the largest single purchase most people make in their life (or, for many investors, the largest multiple purchases over a lifetime) and they want expert help. As for the MLS, it remains the most reliable source of real estate listing and sold information available and continues to enable efficient marketing of properties. So, what is the function of all the online real estate information?

Online real estate information is a great research tool for buyers and sellers and a marketing tool for sellers. When used properly, buyers can save time by quickly researching properties and, ultimately, make better investment decisions. Sellers can efficiently research the market and make informed decisions about hiring an agent and marketing their properties online. The next step is to know where to look online for some of the best resources.
Internet Strategies

In the sections that follow, we provide strategies and tips on how to use the Internet to locate properties for sale and research information relevant to your decision to purchase the property. There are many real estate Web sites from which to choose and although we do not mean to endorse any particular Web site, we have found the ones listed here to be good resources in most cases or to be so popular that they need mention. One way to test a Web site’s accuracy is to search for information about a property you already own.

Finding Real Estate for Sale

Despite the widely available access to real estate listings, many believe that MLS databases continue to offer the most complete and accurate source of real estate information. Most MLSs now distribute content to other Web sites (primarily operated by real estate agents). An excellent starting point for MLS originated content is the national NAR Web site, realtor.com, which is also the most popular web site for searching real estate listings. Virtually all local and regional MLSs have an agreement with realtor.com to display much of their active listing inventory.

Some local and regional MLS systems also have a publicly accessible Web site. However, to get complete information you will most likely still need to find a qualified local REALTOR. Many local real estate agents will also provide their customers (via email) new listings that are input into the MLS that match their predefined criteria. This can be very helpful to a busy buyer.

There are also many Web sites that display both real estate agent listed and for-sale-by-owner properties. Some of the more popular Web sites include zillow.com and trulia.com. These sites offer other services too. For example, zillow.com is best known for its instantaneous property valuation function and trulia.com for providing historical information. Another source of properties for sale is the state, regional, and local Web sites associated with brokerage companies; for example, remax.com or prudential.com. Search engines like yahoo.com and classified advertising sites like craigslist.com also have a large number of active real estate listings.

One key difference between these sites is how much information you can access anonymously. For example, at trulia.com you can shop anonymously up to a point but then you will need to click through to the agent’s Web site for more information. Many new real estate search engines allow you to sift through listings without having to fill out a form. The best strategy is to browse a few of the sites listed above to find geographic areas or price ranges that are interesting. Once you get serious about a property, then that is the time to find a qualified REALTOR of your choice to conduct a complete search in the local MLS.

It also never hurts to search the old-fashioned way by driving through the neighborhoods that interest you. There is no substitute for physically, not virtually, walking the block when you are making a serious investment decision. In this sense, real estate is still a very local business and standing in front of the property can lead to a much different decision than viewing a Web page printout.

Valuing Real Estate

As we mentioned, one of the most popular real estate tools is zillow.com’s instant property valuation. Just type in an address and in and you get a property value. It even charts the price ups and downs, and shows the last date sold (including price) and the property taxes. There are other sites that provide similar tools such as housevalues.com and homegain.com. Unfortunately, many people use these estimated values alone to justify sales prices, offers and counteroffers. However, these are only rough estimates based on a formula that incorporates the local county sales information. These estimates can swing wildly over a short period of time and do not appear to always track actual market changes, which are normally more gradual. In addition, these estimates do not automatically take into account property remodels or renovations or other property specific or local changes. This is not to say these sites are not useful. In fact, they are great starting points and can provide a good ball-park value in many cases.

When it comes to getting a more accurate value for a particular property, there are other strategies that are more trustworthy. One is to go directly to your county’s Web site. More often than not the county assessor’s area of the Web site provides sales and tax information for all properties in the county. If you want to research a particular property or compare sales prices of comparable properties, the local assessor’s sites are really helpful. When you visit a county’s Web site you are getting information straight from the source. Most counties today publish property information on their Web sites. Many times you cannot only see the price a previous owner paid, but the assessed value, property taxes, and maps. Some county assessors are now adding a market and property valuation tools too.

Given the importance of valuation to investing, we are also going to remind you of the two most important (non-Internet) valuation methods: real estate agents and appraisers. Working with a local REALTOR is an accurate and efficient way to get value information for a property. While one of the primary purposes of the MLS is to market the active property listings of its members, the system also collects sales information for those listings. REALTOR members can pull this sales information and produce comparable market analyses (sometimes called CMAs) that provide an excellent snapshot of a particular property’s value for the market in a particular area. Finally, the most accurate way to value a property is by having a certified appraiser produce an appraisal. An appraiser will typically review both the sold information in the MLS system as well as county information and then analyze the information to produce a valuation for the property based on one or more approved methods of valuation. These methods of valuation can include a comparison of similar properties adjusted for differences between the properties, determine the cost to replace the property, or, with an income producing property, determine a value based on the income generated from the property.

The Neighborhood

There are many ways the Internet can help you get the scoop on a particular neighborhood. For example, census data can be found at census.gov. You can also check out the neighborhood scoop at sites like outside.in or review local blogs. A blog is a Web site where people discuss topics by posting and responding to messages. Start by looking at placeblogger.com and kcnn.org/citymediasites.com for a directory of blogs. Trulia.com has a “Heat Map” that shows how hot or cold each neighborhood is based on prices, sales, or popularity among the sites users.

Schools

When it comes to selling residential property or rental properties that cater to families, the quality of the area school district makes a huge difference. There are many Web sites devoted to school information. Check out greatschools.net or schoolmatters.com. Most local school districts also have their own Web site. These sites contain a variety of information about the public schools and the school district, including its district demographics, test scores, and parent reviews.

Finding the Right Real Estate Agent

A recent addition to the Internet boom in real estate information is Web sites that let real estate agents market their expertise and local knowledge by displaying their professional profiles and socially networking with blogs. You can search to find an agent with a particular expertise, geographic area of specialization, or an agent offering specific services. The web site AgentWorld.com lets users quickly and easily find an agent with the right expertise using keyword searches and clean and simple agent profiles. AgentWorld.com also enables agents to post personalized blogs, photos and videos to help consumers find the best agent for their needs. Plus, many agent profiles include a direct link to the agent’s web site where you will likely find the local MLS listings.

Maps and Other Tools

The Internet has made mapping and locating properties much easier. To get an aerial view or satellite image of a property or neighborhood, go to maps.live.com or maps.google.com or visit walkscore.com to see how walk-able a particular property is. These sites can give you an idea of the neighborhood characteristics and the types of entertainment, restaurants, and other facilities that are within walking distance of the property. Maps.Live.com provides a view at an angle so you can see the sides of houses and Maps.Google even gives you a 360 degree street-level view for certain neighborhoods. If you have not tried one of these satellite map Web sites, you really should if only for amusement.

Final Thoughts on Internet Strategies

The Internet is a very effective research and marketing tool for real estate investors but is not a replacement for a knowledgeable experienced real estate professional. The Internet can save you time and money by enabling quick and easy property research and marketing options. Sites like AgentWorld.com also help you efficiently find a REALTOR who fits your buying or selling needs.

Always remember, when it comes to Internet strategies for real estate: More knowledge is better. You need to use the Internet to build your knowledge base on a target property or to find a real estate agent with expertise you need. However, the big caution here is that the Internet should not replace human judgment and perspective, expert advice or physical due diligence-keys to successful investing.