How To Get Your Internet Marketing Business Started

June 18, 2017

Do you have an idea for an internet marketing business but aren’t sure how to set it up or make it successful? Or, do you want to make money on the internet but aren’t sure how? Have you ever wished that you could be one of the people that make their living from internet marketing?

Starting a new online business or taking an existing business online can seem intimidating or overwhelming, but learning how to start an internet business doesn’t have to be complicated.

Like everything else, if you make a plan and take it step by step, you’ll be up and running in no time.

There are just some basic things that you need to consider and actions that you need to take, in order to create a successful online business:

Find out if there is a market for your idea or product.

Find your potential customers.
Build relationships.
Create your product.
Create your website.
Market your product.
Take the payments.

These are the fundamental steps to successful online marketing and you’ll find lots of free information and how to’s on the internet in articles and forums, to help you put each step in place.

Alternatively, you may be someone who likes to have all the information in one place and, again, you’ll find lots of offers for courses and guides on how to start your internet marketing business, on the web.

One of these products, that I’ve recently reviewed. is the Internet Business Start Up Kit, which I’ll use as a basis for what you need to be looking for in a guide to internet marketing.

The Internet Business Start Up Kit, produced by Neil Stafford and Neil Travers of KTS Publishing, is designed to be a one-stop source of information, resources and back-up needed to create your own internet marketing business from scratch and get sales coming in as quickly as posssible.

The manual, reports, DVDs, CDs and online training facilities provided as part of the Kit and its Bonus sections take you through all the steps of creating an online business in a logical and easy to understand manner.

Subjects covered include, market research, listbuilding, product creation, forming a website, copywriting, and marketing techniques. All set out with full details of what to do and how and when to do it.

The information in the manual will enable anyone to:

Find a viable market using the keyword search techniques provided.

Learn the benefits of blogging and set up a blog quickly and easily to create a list of hungry customers.

Discover where to find all the information needed to create a well researched and saleable product.

Save time and set up a product website simply and without specialist knowledge, using the website templates provided.

Easily write sales letters and email copy, without any copywriting experience, using the sales letter templates provided.

Implement a marketing campaign using suitable techniques for your product.

Set up the payment facilities for your online marketing business, and see the cash come flowing in.

All this basic information required to get an internet business up and running is set out in the main printed manual, reinforced by the additional reports and presentations included, with further backup tutorials and advice available online.

Particularly useful is the step by step manual, which is clear and comprehensive and set out in an easy to understand and logical manner, guiding the user through the various stages of creating their business and securing sales.

Neil and Neil have given a wealth of information here, including links to sites and resources that they use themselves, in order to make the process even easier for the user.

This is an important aspect because, although much of the basic information could probably be found by some extensive online searching, just the benefit of having it presented clearly and logically in one place, is well worth the modest outlay, even without all the additional training and backup facilities included.

A part of the manual which deserves a special mention, is the section on creating your website and email campaign sales copy. Maybe a daunting task for most people, this is reduced to a simple fill-in-the-blanks exercise, using the proven and effective sales letter templates provided. Well worth having.

In addition, it’s not necessary to be an expert webmaster to construct your website, as the Resource CD, which accompanies the manual, contains a wide choice of easy to use web templates and many other useful resouces, enabling a website to be set up, without extensive previous experience.

Included with the kit is a trial Gold Membership of the Internet Marketing Review. An invaluable resource to anyone setting up or running an internet business.

On the Internet Marketing Review site, there is a huge amount of useful information in the form of training videos and articles, giving even more advice on all the aspects of getting a business started and profitable, plus the latest tips from the two Neils about new ideas and what’s currently working for them.

The Internet Marketing Review also has a very active members forum, a good place to meet up with and ask advice from other successful marketers, who are very friendly and keen to share what they know.

It’s well worth checking out the public area of the Internet Marketing Review to see what’s available there.

I do have one criticism of this product and that is, there’s no guide to the contents. So you really need go through it all and make your own.

On the plus side, having done that, you’ll have reviewed everything once and know where to go back to, when you really need it.

And, there is a lot of solid information on getting started, provided in the Kit, that is worth reviewing several times to get the most benefit from it. Plus many useful ways to further improve your business once it is running.

Overall, the Internet Business Start Up Kit provides sound, practical step by step guidance, well laid out and explained for anyone without previous internet business experience.

It contains everything needed to get an Internet Business up and running, set out in a clear and comprehensive way and, at £79.95 is definitely worth considering.

Now, if you’re thinking of buying an all-in-one guide to setting up an internet marketing business, use this information to help your comparison.

And whichever one you’re considering, bear these four important points in mind.

1. Check that it covers all the elements you need, including the how, why and when, of what to do at each stage of creating your online business.
2. Check out the people involved. Forums and blogs are a good way to find out what sort of reputation they have.
3. Don’t just believe the sales letter. It’s really good to get a personal recommendation.
4. Check out any guarantees offered. Products often have some form of money back guarantee period, like the Internet Business Start Up Kit.

So, however you choose to find the information you need, I wish you every success with your online marketing business.

And, remember, it all happens when you take that first step!

Commercial Real Estate Agents – Let the Tenants Give You Some Local Leads and Contacts

June 16, 2017

When you work as a salesperson or agent in commercial property sales and leasing, you should always be on the hunt for opportunity and listings. Given that the commercial and retail property market revolves around businesses, the key to creating listing and enquiry ‘churn’ is in keeping in contact with business owners and tenants.

So you ask them questions. You need to know what they are looking for in premises when and if the time comes to move, the time that they will be getting to the end of their current lease, and what budget they may have in making a change.

It is also interesting to note that many tenants will tell you about the local area and the other nearby businesses. Given that they know their area so well, they are likely to read the change and pressures of the area better than you do.

This tenant contact process takes a systemised approach and requires meaningful content that the tenants value each time they talk to you. In most cases that will be something like the following:

1. A list of vacant premises in the local area that match the industry type for the tenant

2. Details of recent asking rentals and achieved rents from new leases, and also the rents from existing lease relationships (renewals)

3. Details of new property developments that will impact the supply and demand for business premises

4. Comparable property detail in the local area. This will include area, proximity, and improvements.

5. Movements of other major businesses or competitors coming and going through the precinct

6. Prices of property in the local area given the usage and improvements.

7. Levels of incentives being offered to new tenants in the current market

In giving a tenant this helpful information about the local area, the exchange of information you require and seek back from them is quite simple and takes the following form:

1. Who is moving in the local area?

2. What businesses are under pressures of space or relocation?

3. What or who is the landlord for the property and how can they be contacted?

4. When will you need to look for the alternatives of relocation?

5. When will your lease come up for review?

6. What are the neighbouring tenants like and who runs the business?

Asking these questions will give you so much information to build your ongoing prospecting and cold calling model around. Making the fullest use of the local information that abounds is just so simple if you ask the questions and make it part of your meetings and connections with clients or prospects. Every business person knows someone that occupies or owns a commercial property; get the names and build on the facts.

Finding the Right Travel Nursing Placement Agency

June 14, 2017

Travel nursing is becoming one of our nation’s fastest growing professions, and it’s no surprise. If you love seeing new places and enjoy exciting new experiences that evoke the feeling of taking an extended vacation, then the career of a traveling nurse might be just what the doctor ordered! Travel nursing enables many people to stay on vacation for two to six months in free luxury accommodations while earning high hourly wages at the same time.

Yet despite all these advantages, many nurses describe to me that they’ve shied away from the traveling profession. Why? Because bad experiences with placement agencies have left them with nothing but a negative impression. They’ve been underpaid or lacked benefits, and I can’t tell you how many nurses have complained to me about inadequate housing or recruiters who were unkind, uncaring, and just plain unavailable. The sad result is that nurses end up jumping from one agency to the next, always in search of the perfect package that’s never there.

In this light, choosing the right staffing agency requires a nurse to consider everything that is offered. Some nurses emphasize pay as their top priority. Others require an excellent benefits package. Many travel RNs are location-specific and want to experience the lifestyle in the country’s hot spots. Career flexibility is often a pivotal factor, along with customer service. The bottom line is, your agency choice depends largely upon one of the four following criteria.

SALARY

No question about it, there are some agencies that offer more money than others. So the first thing to remember is that agencies may base salaries upon things like location availability, need-to-fill assignments, and cost of living.

Some agencies must offer noticeably higher rates if they expect to fill certain assignments where nurse-to-patient ratios are very low, or where a facility has extreme patient needs. If you’re a nurse who is attracted by very high dollars, be alert for a potentially desperate situation you might be entering, and the workload it could bring. You may make more money, but you’ll earn every dollar and more.

Location also factors into salary. The California bay area and many larger east coast cities definitely offer more lucrative pay rates. It’s also much more expensive to live in those places, so recognize the relationship that exists between salary dollars and cost of living. I’ve seen nurses return from Hawaii saying they had a great vacation and made a lot of friends–but their purses were lighter, not heavier from the experience. You might get less money in an exotic location and come back with more money from a not-so-exotic location. My point is, your criteria will determine your priorities.

BENEFITS

What some companies may lack in salary, they make up for with benefits. Many agencies offer benefits programs that revolve around monetary bonuses or discounted luxury housing; and I have even observed a trend with several newer companies that offer entirely free housing to all their nurses. Take note, however, that those agencies may not ante up the really high salaries. It’s a trade-off, so they compensate you with benefits to save you daily, monthly, and annual expenses. Every nurse should be aware of what benefits they need the most, and then ask their recruiters to assist in developing a package that is tailored to their individual needs.

CUSTOMER SERVICE

To many traveling nurses, customer service and aid are the most important attributes a placement agency possesses. If you called ten agencies and only talked with one live recruiter, it’s probably best to narrow it down to the agency where individual placement specialists were easily available. After all, if you’re ready to proceed with a new assignment you’ll want an agency that can make it happen fast and has recruiters available who already understand your criteria. In fact, your criteria may change from one assignment to another, so customer service is paramount. Determine what you want and then find out which agencies can make it happen.

FEATURED LOCATIONS AND HOT SPOTS

While for some nurses, salary, benefits, and career flexibility might be the number-one interest, many others just want the obvious–to travel and see the world. If you’re an adventurer who cares more about the travel experience than the money, then you’ll need an agency that can offer you the locations you want.

Not every agency can send you just anywhere. Figure out where you want to go, and then call around to discover who can send you there.

A travel nursing career is absolutely one of the best, most rewarding choices any nurse can make, but it’s important to select a company who will partner with you every step of the way. Before you jump in, do your homework and research all the best placement agencies. Finding the agency that fits your unique wants and needs will drastically increase your chances of success and happiness in your career.

The Pros and Cons of a Career in Commercial Real Estate Today

June 23, 2017

When it comes to a career in commercial real estate, there are many advantages, and quite a few challenges. When taken in balance, the career and industry offers significant opportunity. The level of success that you can achieve is driven from your commitment to various knowledge processes and taking the right personal action.

So many people enter the industry without due regard for the hard work that needs to be done. As with any sales related career, commercial real estate is very challenging and yet very rewarding. When the market gets tough, you find a number of salespeople leave the industry because they have not established the right systems in their personal business.

If commercial real estate is for you, then get organized and systemized. You need to plan for the future and take consistent action every day to build your market share and obtain quality listings. Talk to more people; it is a people based property market and those people need to know you as the expert. Over time you can become the agent of choice.

Here are some of the key factors required to consolidate your personal focus and action in your career. Consider how these key issues apply to you and how they can be improved. Consider also how they apply within your marketplace and your property specialty.

  1. Sales skills are required on a number of levels. You are effectively selling yourself in the first instance, and then you are pitching and presenting across a number of topics. To be an expert in this property market, personal confidence and local knowledge are important factors. The property market is changing on a regular basis with new pressures within selling, leasing, and property management. Understand how to sell your services across these three disciplines as they change and shift.
  2. Prospecting will always be the most important thing that you do every day. Everything else in your diary ranks a clear second when it comes to prospecting. Cold calling and prospecting must occur on a daily basis with new people and with those people that you have spoken to before. You need a business model to sustain regular ongoing contact with qualified prospects at least once every 90 days.
  3. Commissions will vary depending on the pressures of the market place, the client, the property, and the services provided. Importantly the commissions you charge should not be discounted to any great degree. It takes significant effort to achieve results in commercial real estate today. The clients that ask for discounts could receive a discounted service if that is what makes them happy. They soon understand that results are more important than discounts.
  4. Quality listings should be the focus of your prospecting and networking. It is the quality listings that will bring you good levels of enquiry. Some low quality listings will distract you from the quality properties that you should be working on. You work as a salesperson and your commissions are driven from results. Results are much easier to obtain from quality listings. It should also be said that quality listings should be optimized to exclusive agency appointments. In this way you will gain the sufficient time that you require to comprehensively cover the market place.
  5. Property specialty is a good thing. When you focus on one particular property type it is far easier for you to become the expert in the local area. Many agents focus on industrial property initially given the simplicity of the property type. Over time you can move to Office Property and eventually Retail Property. They are more complex when it comes to selling and leasing.
  6. Competitive agents exist in every marketplace. You need to know who they are and what they’re doing. It may be that they already successfully service a segment of the market that is similar to yours and therefore you will be pitching and presenting against them frequently. Understand these competitors and the pressures they will apply on your business and sales processes. Be better than the other agents that are out there. This is a skills and knowledge based process that you can work on.
  7. Systemize your business day and career as much as possible. At least 50% of your day should be devoted to market growth and prospecting. It is very easy for this to be overlooked or postponed given the pressures of your existing clients, listings, and current deals. Self-discipline and focus will get you through the problem.

Those salespeople that choose to improve their actions and systems soon rise to the top of the market. It is a deliberate choice that should be made early in your career.

Unintended Consequences of DMEPOS Competitive Bidding

June 14, 2017

Medicare’s DMEPOS Competitive Bidding Program has been in the public eye before its implementation in January 1, 2011 with lots of clamor on its possible negative impact on the Medicare population. DMEPOS or durable medical equipment, prosthetics, orthotics, and supplies include wheelchairs, oxygen concentrators, pacemakers, hospital beds, prosthetic limbs and other medical equipment intended for typical elderly and/or disabled.

The Centers for Medicare and Medicaid Services (CMS) competitive bidding program for durable medical equipment give emphasis on price competition among suppliers and providers. The innovation made on DMEPOS competitive bidding program greatly affects vulnerable medical beneficiaries of Medicare specifically on their freedom of choice, access and avail quality DME supplies. During the testing phase of the competitive bidding program, major problems were encountered by patients and beneficiaries that include additional costs to Medicare for numerous emergency room visits and longer hospital confinement, unfamiliar DME providers, and inaccessibility to vital equipment and services.

The CMS Medicare program will also take its toll on the marketplace with DME suppliers and providers engage in cutthroat economic competition to get their bid approved. Reduction in the cost of durable medical supplies will lead to inferior product quality and service for Medicare beneficiaries. Most DME bidders will resort to “predatory” and “suicide” bidding that result to unrealistically low bid prices. Small players in the bidding market such as Dallas medical supplies companies will have a hard time competing with large firms. The DMEPOS Competitive Bidding Program could take out most trusted and preferred DME suppliers of Medicare beneficiaries.

Various Home Medical Equipment (HME) organizations and advocacy groups are lobbying for the repeal of the competitive bidding program from influential members of the House of Representative. Certain bills for its repeal or modification are already sponsored for deliberation in the US Congress. Toll-free numbers are set up by HME groups for queries, feedbacks and updates of the program. The competitive bidding will affect nine major metropolitan areas of Charlotte, N.C.; Cleveleand, Dallas-Fort Worth, Cincinnati, Kansas City, Orlando, Miami, Pittsburgh and Riverside, CA. The unintended consequences of DMEPOS Competitive Bidding have yet to come and change the culture of the United States Medicare program.

Electric Cigarettes (cigarros electronicos )- Could They Be For You Personally?

June 14, 2017

E-cigarette will make it easy for you to definitely unwind WITHOUT health problems.

Maybe you’ve heard with regards to electronic cigarette(cigarro electronico) smoking still? Electronic cigarette smoking include many rewards within the standard smoking cigarettes. We ought to start by way of revealing just what a electronic cigarettes(cigarros electronicos) smoking really is — a digital camera typically fashioned much like a smoking cigarette(cigarro) which can help you inhale nicotine by utilizing water smoke. These products tend to be fumes cost-free and don’t demand lighting, meaning that you might relaxation almost everywhere you want. Nowadays it is possible to relax in the bar, at the office, on college and possibly with planes!
Seeing you will probably have discovered, you’ll uncover a number of forms additionally to brands of e-cigarette(elektronines Cigaretes) smoking offered. There is available this cigar, electronic, minuscule smoking cigarettes and perhaps some kind of conduit you can choose.

What kind you at long last choose relies your own preferred manner of cigarettes. Nevertheless the designs will vary, most electronic cigarette(sigaretta elettronica) smoking work similarly. Lots of people incorporate a cartridge, atomizer additionally to energy supply that really help this ecigarette smoking work. This cartridge will most likely incorporate a juice nicotine concoction together with a atomizer. This atomizer will most likely warm-up this juice having a cartridge, creating some kind of vapor including smoke, that’s breathed in in the smoker. Numerous will most likely have the ability to consider other immediate advantages.

You do not have inappropriate reason to acquire electronic cigarette(sigarette elettroniche) smoking. Lots of people include no harmful toxins, you are able to really fumes everywhere and additionally they’re a lot more affordable compared to regular cigarettes. People also won’t have to assist take into account smelling including fumes additionally to trashing ones clothes, house or possibly vehicle inside. Let us face the product, customary cigarettes can easily have numerous cost, specially when people consider each of the disguised . prices including such. At this time people can actually certainly take advantage of the pleasure associated with cigarette free from a few of the extended unwanted effects. Just in case you’re sole additionally to looking for someone up to now, using the electronic cigarette smoking people should not get judged to become a smoking afficionado. This collection associated with benefits goes so on and you’ll probably consider numerous yourself.

People may be considering trying electronic cigarette(elektroniskas cigaretes) smoking with the first time or you might have previously a few. In either case, it is possible to save money by way of finding this right ecigarette smoking website. I wound up saving nearly 40 dollars upon the main starter set by way of having to pay for that item around the internet additionally to After I will start to trading within the ecigarette(elektroniske cigaretter) smoking supplies at this time around there, much like refills additionally to eLiquid.

Gathering some frequently questions about electronic ecigarette

June 22, 2017

Recently, we are heard many people are intereted in the hot electronic cigarette and have doubts about it. Here, we are gathering some frequently questions about electronic cigarette to help all Recognize it and choose it. Please view it and find the answer that you may want to know:

Ask:
Has anyone tried it? i need to know how it tastes!?
provide me some recommendations please
Answer:
I prefer it because of the excellent taste.The taste of electronic cigarettes cannot be explain it fees like flying in the air.Provide the more great taste than normal smoking.it come in cool packaging, and the refills are always delivered fast.Try it and taste your self.

Ask:
Which is the best one?
I want to quit smoking and i’m looking for a good one. By good i mean the one where you can get the most smoke with less effort. I bought an e-cigarette that totally suck, almost no smoke comes out. Has anyone here tried a good one?
Answer:
I appreciate your desire to quit smoking. Certainly, it is not good for health. But, it is hard to quit instantly. So, select one from the site in the source(s) box. It has excellent features. I prefer Culala.com electronic cigarettes because of the excellent taste. And there is no best, only suitable one.

Ask:
How do it save money?
it is of free price
Answer:
Electronic cigaret helps the people to save money who smoke cigaret.This is cheap and can use many time. This can be recycle again and again to use.Although i don’t smoke but also know the benefit of the electronic cigarette value.

Ask:
Where can I buy it in Mumbai, in America?
Answer:
In Mumbai??? Why not buy one online???? No matter where you are and no mater what time, you could shopping online.

Ask:
Electronic cigaretes dangerous?
I’m going to buy e cigarettes for my dad. Is it safe!?
Answer:
No duoult that it is safer than traditional cigarette. I have bought one for my father two monthss ago. He loves it

Ask:
it harmful to pregnant women?
My cousin recently found out that she is pregnant. She used to smoke about a pack a day, and is having trouble fighting her cravings…she’s been able to cut down but not totally stop. I’ve heard a lot about it being a safer alternative, but I know that they still have nicotine which is not good for the unborn child.
Answer:
You must know electronic cigarettes is also harm to ourself. It is water vapor and nicotine. Nicotine is bad for your heart, it is a poison to your heart, but electronic cigs are better for you than regular smoking and it wont stain your teeth. Stop smoking as soon as possible.

Ask:
Best Electronic Cigarette Brand?
Im thinking of buying one of these and I noticed that there are hundreds of brands on the internet. Which one would be the best for me? I consider myself a heavy smoker and prefer something strong.
Answer:
Once you have search on google, you’ll find many electronic cigarette. They make you dizzy disorderly. And I just got an eletronic cigarette from Culala.com

Ask:
Electronic Cigarette not working well?
I purchased e-cigarette yesterday. Whenever i put it in my mouth the first 2-3 puffs feels like cigarette and after that i do not feel anything. I try to puff it hard but still it does not feel like i am smoking. Very little vapour comes out.
What can i do ? I have changed cartridge but still it does not work. Battery is fully charged. Is there any problem with problem with atomitizer ?
Answer:
In this way, electronic cigarette is relative to our health, you must choose a professional Electronic Cigarette. Highly quality ecig is different.

All the questions and answers are from the people that around us, give it to all as a reference.

Electronic Smoke – Get Rid of Vapour

July 24, 2017

Nicotine Pad and Electronic Cigarette – Hunt For Depart Respiration. Should Fag Vaporization be Illegal in Cars? Ventilation in cars is bad for wellbeing for the non-smokers, children. The aerosol remains inside when the windows are enclosed and can drive intellectual illnesses afterwards on in lifespan. Those against vaporisation see the prohibition of smoke in cars.

electronic cigarettes rely on a sensor that detects airflow via the emblem. Whenever you breathe into the e-cigarette, a vapor gas is triggered, and this vaporizes the liquidness whitener stored within the of the twist. In most electronic cigarettes, this clear might comprise nicotine, tho’ there are both models that dont comprise any nicotine at all. A regular E-cigarette is comprised of a representative, vapour substance, rechargeable shelling, and a few electronic components. All these and competent brass of the eruptive fixings contained therein.

Resistless Vapor and Add Link – Look For The Soul E Fag on The . Ventilation and Weight Amount – Electronic Cigarette. Most people create that butt vaporisation accelerates metric exit peculiarly in the senior. But did you pair that prolonged smoke smoking could also cause weight benefit. This is because there is a considerable assets of edulcorate in apiece cigarett? that you respiration.

An E-cigarette is a manoeuvre that offers small doses of nicotine every moment you suspire. for work, an electronic cigaret provides a often safer alternative to conventional baccy items specified as cigarettes, cigars, and wind. Regularise an inexpensive electronic smoke is created this way, and you get all of the taste and somatogenetic sensations with really smoking. Nevertheless, no smoke is actually haggard into your group, and no breathing is inhaled either.

Perception for promiscuous, secured unaffected slipway to plosive – BLU electronic . Are you whacked of methods that dont apply for you? So simply alikeness assorted methods free for you – from nicotine gums and patches, to shots, pills, laser communication, and so some solon. Then hitch out this peltate ventilation checklist to name which act smoking method is advisable for you…

Later Denaturised and Innovation Techniques – Blu Electronic Butt. The Faculty Cigaret Vapor Is Prejudicial To Upbeat – BLU electronic cigaret. What is the represent smoke is to ? Wellspring, there are reasons, and any of the most applicable bonk to be that respiration has been proven to be the effort or suspected effort of few heinous diseases that cloud Humans, much as bronchitis, emphysema, few forms of ulcers, hunch disease, and the big one, person.

River Tobacco, Blu Electronic Fag, Joy cig and Tightened cig are few manufacturers which be easily obtainable on the Mankind wide web. All electronic cigarettes offered underneath aforementioned names have a wonderful texture and looks equivalent to apodeictic cigarettes. These possess a red floaty LED tip that glows equal an factual cigaret, as a lead gift you the perceive of vapour an novel smoke. Whenever you e to the , youre no human below the danger of getting to be prone to creation threatening ailments, much as individual and pump issues. Moreover, privileged the nightlong hale, a preeminent electronic smoke saves you hundreds of bucks that you pay otherwise for cigarettes.

Vegetable Smoke, Blu Electronic Cigarette, Joy cig and Assured cig are few manufacturers which mightiness be easily obtainable on the Earth comprehensive web. All electronic cigarettes offered underneath said calumny individual a wonderful texture and looks equal to faithful cigarettes. These possess a red land LED tip that glows suchlike an real smoke, as a you the undergo of an daring butt. Whenever you select large e butt to the business, youre no mortal beneath the danger of effort to be unerect to creation threatening ailments, as someone and temperament issues. Moreover, inside the bimestrial haul, a greatest electronic butt saves you hundreds of bucks that you drop otherwise for conventional cigarettes.

Planning and Design of Behavioral Healthcare Facilities

July 6, 2017

Behavioral Healthcare Facilities: The Current State of Design

In keeping with most districts of healthcare, the marketplace has seen a boom in the construction of Behavioral Healthcare facilities. Contributing to this increase is the paradigm shift in the way society views mental illness. Society is placing a heavier value on the need to treat people with serious addictions such as alcohol, prescription and elicit drugs. A large percentage of people suffering from behavioral disorders are afflicted with both mental and addictive behaviors, and most will re-enter communities and either become contributors or violators.

These very specialized facilities do not typically yield the attention from today’s top healthcare designers and their quantity accounts for a small fraction of healthcare construction. However, Behavioral Healthcare projects are increasing in number and are being designed by some very prominent architectural firms such as Cannon Design and Architecture Plus. Many are creating state-of-the-art, award-winning contemporary facilities that defy what most of us believe Behavioral Healthcare design to be.

Changing the Way We Design Behavioral Healthcare Facilities

As with all good planners and designers, A+D (along with facility experts) are reviewing the direct needs of patient and staff while reflecting on how new medicine and modern design can foster patient healing rates, reduce environmental stress, and increase safety. This is changing the face of treatment and outcome by giving the practitioner more time to treat because they require less time and resources to “manage” disruptive patient populations.

The face of Behavioral Healthcare is quickly changing. No longer are these facilities designed to warehouse patients indefinitely. And society’s expectations have changed. Patients are often treated with the belief that they can return to their community and be a contributor to society. According to the National Association of Psychiatric Health Systems (NAPHS), depending on the severity of illness, the average length of stay in a Behavioral Healthcare facility is only 9.6 days.

What has changed?

Jaques Laurence Black, AIA, president and principal of New York City-based daSILVA Architects, states that there are two primary reasons for the shortened admission period:

1. Introduction of modern psychotropic drugs that greatly speed recovery

2. Pressures from insurance companies to get patients out of expensive modes of care

To meet these challenges, healthcare professionals are finding it very difficult to effectively treat patients within the walls of antiquated, rapidly deteriorating mental facilities. A great percentage of these facilities were built between 1908 and 1928 and were designed for psychiatric needs that were principled in the belief to “store” not to “rehabilitate.”

Also impacting the need for Behavioral Healthcare construction is the reluctance of acute-care facilities to provide mental health level services for psychiatric or addiction patients. They recognize that patient groups suffering from behavioral disorders have unique health needs, all of which need to be handled and treated only by very experienced healthcare professionals. This patient population also requires a heightened level of security. Self-harm and injuring staff and other patients are major concerns.

The Report of the Surgeon General: “Epidemiology of Mental Illness” also reports that within a given year about 20% of Americans suffer from a diagnosable mental disorder and 5.4% suffer from a serious mental illness (SMI ) – defined as bipolar, panic, obsessive-compulsive, personality, and depression disorders and schizophrenia. It is also believed 6% of Americans suffer from addiction disorders, a statistic that is separate from individuals who suffer from both mental and addiction disorders. Within a given year it is believed that over one-quarter of America’s population warrants levels of mental clinical care. Even if these statistics were cut in half, it cannot be denied as a serious societal issue.

With a growing population, effectively designing in accordance with such measures is at the heart of public health.

Understanding the Complexity of Behavioral Healthcare Design

Therefore, like Corrections, leading planners and designers specializing in Behavioral Healthcare are delving deeper to better understand the complexity of issues and to be the activist to design facilities that promote treatment and healing – and a safer community.

The following is a list of key design variables that are being studied and implemented:

1. Right Sizing

2. Humanizing Materials and Color

3. Staff-Focused Amneties and Happiness

4. Security and Safety

5. Therapeutic Design Tenants

Right-sizing

Today’s Behavioral Healthcare facilities are often one-story single buildings within a campus size. Often debated by Clients due to costs, this design preference is driven by the demand for Uncategorized light, window views to nature for all patient areas, and outdoor open-air gardens “wrapped” within. All of this provides soothing qualities to the patient, reduces their anxieties, counteracts disruptive conduct and helps to reduce staff stress.

“When you look at the program mix in these buildings, there’s a high demand for perimeter because there are a lot of rooms that need Uncategorized light. Offices, classrooms, dining areas, community rooms, and patient rooms all demand Uncategorized light, so you end up with a tremendous amount of exterior wall, and it forces the building to have a very large footprint.” – James Kent Muirhead, AIA, associate principal at Cannon Design in Baltimore

These design principles are also believed to improve staff work conditions. Unlike a multi-story complex, at any moment staff can walk outdoors and access nature, free from visual barriers, and within a building that more accurately reflects building types that both patients and staff would encounter in their communities.

In addition to right-sizing for the overall building footprint, is right-sizing for internal patient and staff support area. Similar to the move we have seen in Corrections to de-centralize support spaces, Behavioral Healthcare is moving to decentralized nursing/patient units called “neighborhoods.” With mental health facilities there is a large concern with distances and space adjacencies in relation to the patient room and patient support areas such as treatment and social spaces. Frank Pitts, AIA, FACHA, OAA president of Architecture Plus, Troy, NY, advocates neighborhoods that average 24-30 beds arranged in sub-clusters, called “houses”, of 8-10 beds. Thus, each neighborhood consists of three houses. Often these layouts will include a common area where patients congregate and socialize, with a separate quiet room so patients can elect to avoid active, crowded areas. In addition Pitts states, “There’s a move away from central dining facilities. So, while facilities will still have a central kitchen, it’s a whole lot easier moving food than it is patients.” However, it is important for the facility to mimic normal outside daily life routines, so patients are encouraged to frequently leave their neighborhoods to attend treatment sessions, and outdoor courtyards.

Humanizing Materials & Color

In all facilities that play a role in rehabilitation, design strives to create spaces that humanize, calm, and relax. Behavioral Healthcare patients need to feel that they are in familiar surroundings; therefore, the architectural vocabulary should feel comfortable and normal. Since these facilities are about rehabilitation (when possible) and encouraging patients to merge back into society, the facility should feel like an extension of the community. Their spaces should reflect the nature and architecture of the surrounding region and thus so, no two facilities should look too much alike.

“Our a
pproach to designing these facilities is to view the facility as an extension of the community where patients will end up when they’re released. Interior finishes also depend on geography because you want to replicate the environment patients are used to. You want to de-stigmatize the facility as much as possible.” – Tim Rommel, AIA, ACHA, OAA, principal with Cannon Design in Buffalo, NY.

Therefore, materials and colors within these spaces want to feel familiar to one’s region and everyday life. To soothe the psyche and rehabilitate, they want to feel soft and comfortable, yet visually stimulating. An interior that is overly neutral or hard in appearance is not appropriate. Materials should reduce noise, and colors should lift the spirit. This can help to create an environment in which the patient can learn, socialize, and be productive while easing anxieties, delivering dignity, and modifying behavior. As stated previously, behavioral studies advise the use of softer interior materials-like carpeting, wood doors and tile. Doing so translates directly to both patient and staff well-being, particularly staff safety, and makes for a nicer place to work. In addition, staff have more resources to “treat” instead of manage heated situations. When staff experiences are eased and satisfied, morale is boosted and life-saving rules and policies are more likely to be enforced.

Staff-Focused Amenities & Happiness

While reducing staff stress and fatigue through a healing supportive environment seems like an obvious goal, there are relatively few studies that have dealt with this issue in any detail. More attention has been given to patient outcomes. However, many leading hospitals that have adopted therapeutic tenants into their newly built environments have seen vast improvement through their “business matrixes” and financial reporting.

In one example, the Mayo Clinic, a national leader in implementing healing design in its facilities, has reported a reduction of nursing turnover from a national annual average of 20% to an annual 3%-4%. In another example, when Bronson Methodist Hospital incorporated evidence-based design into its new 343-bed hospital, they cited their 19%-20% nurse turnover rate dramatically dropped to 5%.

Now, both the Mayo Clinic and Bronson Methodist Hospital have had to initiate a waiting list for nursing staff seeking positions. This converts to better-trained and qualified staff, and a reduced error rate. Therefore, more health facilities are investing in staff support areas such as lounges, changing rooms, and temporary sleep rooms. Within these staff spaces and in the hospital throughout, facilities are also recognizing the need for upgrade materials, better day lighting, and an interesting use of color: One soon realizes that the need of patients and staff are interwoven, each impacting positively or negatively the other.

Security & Safety

Without debate, self harm and harm to staff is one of the biggest concerns mental health facilities manage. Often the biggest safety and security concern is the damage patients can do to themselves. “There are three rules I had drummed in me,” says Mark Hanchar; Director of Preconstruction Services for Gilbane Building Company, Providence, R.I. “First, there can’t be any way for people to hang themselves. Second, there can be no way for them to create weapons. Third, you must eliminate things that can be thrown.” Hanchar says that the typical facility is, “a hospital with medium-security prison construction.” This means shatter proof glass, solid surface countertops (laminate can be peeled apart), stainless steel toilets and sinks (porcelain can shatter), push pull door latches and furniture that cannot be pulled apart and used as a weapon. These are just to name a few.

Additionally, removing barriers between patients and nursing staff is a safety consideration. Frank Pitts, AIA, FACHA, OAA president of Architecture Plus, says what may be counter-intuitive for safety precautions, “Glass walls around nursing stations just aggravate the patients.” Removing glass or lowering it at nursing stations so patients can feel a more human connection to nurses often calms patients. There is also discussion of removing nursing stations altogether; decentralizing and placing these care needs directly into the clinical neighborhoods and community spaces. Pitt says, “The view is that [nursing staff] need to be out there treating their patients.”

Therapeutic Design Tenants

As medicine is increasingly moving towards “evidence-based” medicine, where clinical choices are informed by research, healthcare design is increasingly guided by research linking the physical environment directly to patient and staff outcomes. Research teams from Texas A&M and Georgia Tech sifted through thousands of scientific articles and identified more than 600 – most from top peer-reviewed journals – to quantify how hospital design can play a direct role in clinical outcomes.

The research teams uncovered a large body of evidence that demonstrates design features such as increased day-lighting, access to nature, reduced noise and increased patient control helped reduce stress, improve sleep, and increase staff effectiveness – all of which promote healing rates and save facilities cost. Therefore, improving physical settings can be a critical tool in making hospitals more safe, more healing, and better places to work.

Today’s therapeutic spaces have been defined to excel in 3 categories:

1. Provide clinical excellence in the treatment of the body

2. Meet the psycho-social needs of patients, families, and staff

3. Produce measurable positive patient outcomes and staff effectiveness

Considering the cost of treating mental illness, which is exceedingly high, and wanting facilities to have effective outcomes, a further practice of incorporating therapeutic design is increasing. The National Institute of Mental Health (NIM H) approximated in 2008 that serious mental illnesses (SMI ), costs the nation $193 billion annually in lost wages. The indirect costs are impossible to estimate.

The estimated direct cost to clinically treat is approximately $70 billion annually and another $12 billion spent towards substance abuse disorders. In addition to the increased need of care and the boom in Behavioral Healthcare construction, it becomes an obligation to make certain that we as facility managers, architects, designers and manufacturers therapeutically plan and design these facilities.

Notably, in 2004, “The Role of the Physical Environment in the Hospital for the 21st Century: A Once-in-a-Lifetime Opportunity,” published by Roger Ulrich P.H.D., of Texas A&M University, was released. In a culmination of evidence-based research, research teams found five design principles that contributed significantly to achieving therapeutic design goals.

The report indicates five key factors that are essential for the psychological well-being of patients, families and staff, including:

1. Access to Nature

2. Provide Positive Distractions

3. Provide Social Support Spaces

4. Give a Sense of Control

5. Reduce or eliminate environmental stress

Access to Nature

Studies indicate that nature might have the most powerful impact to help patient outcomes and staff effectiveness. Nature can be literal or figurative – Uncategorized light, water walls, views to nature, large prints of botanicals and geography, materials that indicate nature and most importantly, stimulating color that evokes nature. Several studies strongly support that access to nature such as day-lighting and appropriate colorations can improve health outcomes such as depression, agitation, sleep, circadian rest-activity rhythms, as well as length of stay in demented patients and persons with seasonal affective disorders (SAD).

These and related studies continue to affirm the powerful impact of Uncategorized elements on patient recovery and stress reduction. Thus, it is clea
r that interior designs which integrate Uncategorized elements can create a more relaxing, therapeutic environment that benefits both patients and staff.

Positive Distractions

These are a small set of environmental features that provide the patient and family a positive diversion from “the difficult” and, in doing so, also negate an institutional feel. These can be views to nature, water walls, artwork, super imposed graphics, sculpture, music – and ideally all of these want to be focused on nature and, when applicable, an interesting use of color. Therapeutic environments that provide such patient-centered features can empower patients and families, but also increase their confidence in the facility and staff. This helps with open lines of communication between patient and caregiver.

Social Support Spaces

These are spaces designed partially for the patient but mainly for the comfort and socialization of family members and friends of the patient; therefore, family lounges, resource libraries, chapels, sleep rooms and consult rooms all play a role. When family and friends play a key role in a patient’s healing, these spaces encourage families to play an active role in the rehabilitation process.

Sense of Control

In times when patients and family feel out of control, it is very healing for the facility design and staff to provide it back when appropriate. Although, this cannot always be done suitably in mental healthcare facilities. However, when applicable, these design features include optional lighting choices, architectural way-finding, resource libraries, enhanced food menus, private patient rooms and

optional areas to reside in. A few well-appointed studies in psychiatric wards and nursing homes have found that optional choices of moveable seating in dining areas enhanced social interaction and improved eating disorders. When patients feel partially in control of their healing program and that the building features are focused to them, an increased confidence of the quality of care enters and tensions lower.

As with all therapeutic design, this allows the caregiver to use their resources healing in lieu of “managing” patient populations.

Reduce or Eliminate Environmental Stress

Noise level measurements show that hospital wards can be excessively noisy places resulting in negative effects on patient outcomes. The continuous background noise produced by medical equipment and staff voices often exceeds the level of a busy restaurant. Peak noise periods (shift changes, equipment alarms, paging systems, telephones, bedrails, trolleys, and certain medical equipment like portable xray machines are comparable to walking next to a busy highway when a motorcycle or large truck passes.

Several studies have focused on infants in NIC Us, finding that higher noise levels, for example, decrease oxygen saturation (increasing need for oxygen support therapy), elevate blood pressure, increase heart and respiration rate, and worsen sleep. Research on adults and children show that noise is a major cause of awakening and sleep loss.

In addition to worsening sleep, there is strong evidence that noise increases stress in adult patients, for example, heightening blood pressure and heart rate. Environmental surfaces in hospitals are usually hard and sound-reflecting, not sound-absorbing causing noise to travel down corridors and into patient rooms. Sounds tend to echo, overlap and linger longer.

Interventions that reduce noise have been found to improve sleep and reduce patient stress. Of these, the environmental or design interventions such as changing to sound-absorbing ceiling tiles, are more successful than organizational interventions like establishing “quiet hours.”

Conclusion and Additional Information

The information contained in this excerpted report is intended as a guide for architects, specifiers, designers, facility planners, medical directors, procurers, psychologists and social workers which have a stake in providing improved facilities for behavioral healthcare patients. It is a portion of a report entitled “The Contributions of Color” authored by Tara Hill, of Little Fish Think Tank. Ms. Hill was commissioned by Norix Group Inc., in 2010 to research the role color plays in the safe operation of correctional facilities and behavioral health centers. More in-depth information specifically about the psychological influence of color and behavioral healthcare facility design can be found by reading the full report.

3 Quick Cash Loan Myths Exposed

June 12, 2017

If you are considering a Quick cash loan (payday loan, fast cash loan, payday advance etc…) to get you through a tough financial time, you may be making a smart decision. Despite the ridiculously high APR that loan providers charge, a payday loan is many times a lower cost option than paying fees stemming from bounced checks, credit card late fees, re-connect fees etc…

Here are 3 myths that are commonly and erroneously associated with a payday advance loan.

MYTH: Quick Cash Loan providers charge outrageous rates

TRUTH: You’ve got to compare. A payday loan is typically cheaper than other customer alternatives.

Here’s a scenario: Did you forget you didn’t have any cash in your checking account but bought stuff anyway with your debit card? Maybe you did that 4 times in one day.

It’s amazing how we can lose track of our finances, but we all do it..

Guess what…

Each occurrence just cost you $35 in NSF fees from your bank. Those 4 withdrawals of $10 just cost you $140 dollars in fees! Ouch! The cost of borrowing $100 from a payday cash loan provider is $15 – $20 per $100. The APR on this transaction is 391%, which seems sky high but compared to the overdraft fees at your bank it makes good sense.

The remedy here is if you know you’re going to be short of cash but need to use checks or debit card, weigh the costs. It may be better to set up a fast cash account and use it only when you know you’ll be potentially incurring late fees.

MYTH: Quick cash loans always create a spiral of debt for the customer

TRUTH:Most users are responsible borrowers and have no trouble managing the short payback period.

These loans are short term solutions and most borrowers realize the danger of being over extended. About 60% are one time users – meaning they don’t renew the loan or have to extend the payback period.

Studies have also revealed that:

66% of payday loan users utilize the service to cover only unexpected expenses

34% use payday advance loans for a planned expense

70% of fast cash loan users only use the service 1 time per month.

MYTH: Emergency loans prey on unsuspecting customers

TRUTH: There are solid laws in place to protect customers from being taken advantage of.

The overwhelming popularity of these loans as a discreet and dignified way to solve temporary cash flow problems speaks for itself.

70% utilize fast cash loans because of the convenience (fast, easiest…)

96% are fully aware of the charges they will incur. Most state they were quoted the fee as an APR. Most believe that quick cash loans are useful ( 92%) and only about 12% state they were dissatisfied with the service.

Also, 33 states and D.C. provide balanced, responsible regulation of payday advance companies.

Summary

Why not consider a quick cash loan when you know you are going to be short on cash and will face fines or fees? As a temporary solution you may save a lot of money despite the high APR. It’s easy to find a reputable quick payday loan provider (see links below) and set up and approval takes only minutes.

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