Freedom, What Does it Mean to Our Elderly?

The mention on “The Big War” to many of our clients brings memories of fighting in the rain forests of the Soloman Islands or in the countryside of France. They looked upon this as a responsibility or a commitment – something that just had to be done and they were the ones to do it. Our freedom as a country was at stake. Our very independence was being threatened.

Now most of these men and women are in the 80’s, 90’s, or even 100’s. The word “freedom” has taken on a whole new meaning. Their freedom and independence is at stake every day.

The first freedom that I think about when working with our older clients is freedom to make decisions. Many older individuals really manage quite well – at least until that out of state adult child swoops in off of the plane and starts making plans for Mom and Dad – plans that they really don’t need or want. Priorities may need to be established with Mom and Dad’s participation and agreement, and decisions made together. In other words, adult children need pick the battles that are the most critical, and work on strategies for those, but again, do it together.

Daughter, Angela, and son, John, very much want their 89 year old Dad to sell his home and enter an assisted living facility. Since their Mom died four years earlier, he has become very reclusive in their minds. His house is really too big for him to maintain. After sharing their concerns with their Dad (for several months), he agreed to hire a housekeeping service, he has a handyman on call to fix the leaks and other routine problems, and has a caregiver coming twice a week for 3 hours to take him out for lunch, get groceries, and to bridge games.

Another crucial freedom for our older clients is the freedom from harm. As we get older, one of the biggest fears people have is fear of crime. No one can argue that this is a vulnerable population. Every day we hear of scams going on, particularly those involving the elderly. They trust the nice man who shows up at the door wanting to trim the bushes, or reroof the home. The telemarketer calls and the young lady on the call is so ” kind and concerned”, that a check just has to be written to the cause that they are promoting. And then, of course, there are those horrible situations of physical, emotional or sexual abuse. In Maricopa County, Arizona, Adult Protective Services handles 10,000 cases each year. This number is estimated nationally to be 1.5-1.84 cases of elder abuse and exploitation annually.

Ron’s mother, Sara, was confined to a wheelchair. She lived alone, but had a caregiver to assist her with her daily activities for eight hours every day. Ron lived next door. The caregiver noticed that whenever Ron stopped by during the day, Sara would cower in her chair. She would speak very quietly to him, and always agreed to his demands. The caregiver reported this situation to Adult Protective Services after she noticed several new bruised on Sara’s legs and back. Sara is now living in a safe environment where she does not have to fear for her well-being..

Respect is a really great attribute. We “earn” respect. Our older clients have earned respect and deserve respect from us all. Freedom to be respected and honored is another freedom that our older generation deserves. The life experiences are priceless. How can respect be shown? In our every day conversations. In our decisions. In our body language. Ageism means that we patronize older folks. Unfortunately our society reveres youth. This is not true in other cultures where families come together to care for an older loved one as they move along the continuum of life.

Mary Lou had three grandchildren that she adored. She felt so blessed as they lived nearby. However, Mary Lou’s dementia was progressing. She often got lost in her assisted living community. Her grandchildren became fearful, and didn’t understand why Grandma kept asking the same questions over and over. Mary Lou’s daughter, Janice, found several books to help her children understand what was happening with Grandma. They were able to relate to her in ways that she could handle and they spent many pleasant hours – just being together.

Lastly, we need to address the freedom to fail. Yes, sometimes we need to step back as professionals and as sons and daughters, and let our parents make those decisions that we believe are not the best. We may be surprised, though, when they don’t fail. This WWII generation “made do”. They have developed great ingenuity. They have a “stubborn” streak that no one is going to change. Let’s give them the opportunity to “fail” or maybe even succeed!

Beverly and Jake have many struggles. Beverly has macular degeneration and recently fell and broke her hip. Jake, at age 91, has been her primary caregiver for years. They recently celebrated their 64th wedding anniversary. Jake insisted on getting Beverly home following a 3 week stay in a rehabilitation facility following her hip replacement surgery. Their three children tried and tried to talk with Jake about placing their Mom in an assisted living facility, but Jake would hear none of it. His response was “I want her at home for her last months”. A safety net was set up with Home Health Services and a caregiver to help get Beverly up, bathed and dressed every morning, to help Jake with some of the physical care needs of his wife. Jake and Beverly have since come up with many ingenious ways to keep her safe in their home, and she is actually greatly improved in her strength and mobility. They sit together outside on warm days holding hands.

Freedom and independence. Freedom to make decisions, freedom from harm, freedom to be respected and the freedom to fail are so critical. Let’s all help those older persons in our lives be as free as they can – and as independent as they can be.

Summer Sizzles For Seniors Too

For our caregivers in Peoria, Glendale and Phoenix Arizona it is no surprise that it’s hot, after all we are in the Valley of the Sun. But as our caregivers are providing affordable in home care for seniors not all that care is always in the home.

Many times our caregivers take clients to doctor’s appointments, church functions or just shopping and when we are out of the home and in possibly unfamiliar surroundings we always remind our caregivers to be mindful of environmental conditions that might lead to a heat related event that could cause a fall.

This is a short list of what our caregivers remind our clients of prior to a summertime excursion:

Drink plenty of water prior to the outing.
Apply sunscreen to all exposed skin, at least SPF 50 or higher.
Wear a broad brim hat and loose, light colored clothing.
Limit the time you are in direct sunlight.
Try not to be out in the hottest part of the day.
When walking to the car, don’t touch it…IT’S HOT!

Some of the signs for heat exhaustion are:

Increased sweating
Quick onset of headaches.
Rapid and shallow breathing
Flushed face and moist skin

It’s best to treat for heat exhaustion by cooling the body slowly, getting into a cooler environment and wrap a cool wet towel around the neck.

Some signs of heat stroke are:

Altered mental status and confusion
Very hot skin
Very rapid and shallow breathing

Treatment for heat stroke will be to remove the person to a cooler environment and use ice packs wrapped in a cloth and place them around the neck, ankles and wrists. It is important to note that heat stroke is a serious medical emergency and the caregiver should call 911 if a heat stroke is suspected. It also should be mentioned that for non-medical personnel the difference between heat exhaustion and heat stroke could be unrecognizable and that a call to 911 should be placed.

Heat related events don’t always occur outside. Our elders don’t feel the heat and cold the way younger folks do and many times they will not turn on the AC trying to save on utility expenses. Then they become overheated and under hydrated which could lead to dizziness and a fall.

It is important to keep an eye on our loved ones during the summer. Just a short phone call can give the family caregiver peace of mind and the senior a feeling of still be connected to the world.

Step Two in Understanding Dementia

For me, one of the most profound and surprising processes we witness in the person with dementia is the profound journey towards finding peace.

Yet, it is also often totally misunderstood, misinterpreted or — amazingly — not even noticed by family and caregivers. So, let’s all notice from now on. Watch out for these examples of the process at work.

Your Mom or your favorite resident doesn’t seem to be very present at all. She is absent, as if absorbed somewhere else. Is this her illness or what? I choose “what”.

This person really is somewhere else. My guess, childhood or youth years, parental home, in whatever geographical place that was. So, for example, here you are. Arizona, 2010. Your resident, also Arizona 2010 to all appearances. In reality, however, she’s living in 1926 South Dakota, with Mama and Daddy. She’s ten years old.

Uh oh, you think medically to yourself, “She’s deluded, hallucinating, crazy, disturbed, psychotic.”

To which I reply, somewhat sharply, “Get a grip, will you?”

Firstly, how on earth do you think a person with short-term memory could get this day, date and time right anyway? They can’t. They indeed do not remember what day, date and time this is and therefore they don’t know the geography either. All of this is merely a natural and rational result of short-term memory loss.

Meanwhile, what are they doing? They are doing the great life review, silly. They’re examining life with Mama and Daddy. Re-experiencing, re-examining, making sense of all that happened.

Why would they feel they really WERE there? Two reasons. One, short-term memory loss means they have no cue for day, date and place. Two, the intensity of their memory experiences creates a flashback.

You never read about this, so pay attention. Elders experience an intensification of memory which starts in the late 50s and deepens as they age. The emotional deepening of memory work makes it profound and real.

We know about this from trauma. Trauma often creates flashback moments. But flashback is not necessarily only associated with trauma. Flashback experience happens to remind us to revisit that which requires our attention. People overwhelmed with trauma — solders from wartime, woman from rape — experience this.

However, not all flashback is trauma-related. Flashback is merely intensification from memory which asks for our attention. That is why elders working on the understanding of their lives experience this. And it is also why people with dementia experience it — because they have lives too. Living within them. Asking for that same deep attention so few of us give our lives until we reach old age.

In therapy maybe. In creativity. In old age — absolutely. In old age with or without dementia, absolutely.
That’s why our elders with dementia seem absorbed and far away sometimes. They have just been dwelling in the very distant past.

Go easy and welcome them back respectfully. And ask questions. We have had so little respect for people with dementia, alas, that we have not even considered asking them about their own thoughts, feelings or wishes.

But we could. We could say, “You seemed very far away just now. Where were you?”

You might get some wonderful answers.

Hope for Mesothelioma Patients Via the Valley of the Sun

Results were very positive from the Oncology Nursing Society’s 6th Annual Institutes of Learning (ONS) meeting in Phoenix, Arizona.

There were several clinical studies and several ongoing studies presented formally at the Oncology Nursing Society’s 6th Annual Institutes of Learning (ONS) meeting in the valley of the sun Phoenix, Arizona.

Mesothelioma treatment options provide a longer life expectancy with less debilitating symptoms related to treatment. Some of these recent developments and their impact on helping patients and families cope the challenges of this type of cancer were presented to practitioners by oncology nursing specialists.

The rate of occurrence in the US remains about 2,000-3,000 new cases each year, it continues to increase worldwide. Third world countries where asbestos industry regulations are less stringent are experiencing an increase in this aggressive form of cancer.

The quick acting nature of Mesothelioma requires family members and support groups of the victims scrambling for resources. Patients with various symptoms that require close medical management and an extreme care and support from family members. Dehabilitating cough, shortness of breath and depression are common and painful symptoms. Almost all patients develop pleural effusions that severely limit the ability to breathe; most will need chest tubes, shunts or pleural catheters for relief.

The most important tasks for the nursing team is instructing patients and their caregivers on how to alleviate discomfort at home. To manage pain and breathing difficulty, caregivers need to be taught how to use oxygen delivery systems, steroids and narcotic medications.

Mesothelioma cases are projected to increase yearly until 2020. This combined with medical advances gives us a ray of hope to battle the scourge.

Stroke Camp: Rest, Relaxation and Renewal

S’mores. Sleeping bags in pup tents. Fireside stories and songs. Brave souls going “polar bear” swimming in a freezing lake at dawn. These are the memories I have of going to camp. But the camp I recently attended was different. At this camp, I was surrounded by survivors: stroke and spinal cord injury survivors. The July 2005 Stroke Camp at Chapel Rock Church Conference Center in Prescott, AZ allowed stroke survivors and their caregivers, as well as spinal cord injury survivors, a weekend of rest, relaxation…and play time. Kay Wing, owner and founder of Swan Rehab, which specializes in stroke and brain injury rehabilitation, wanted to host a camp that was “No work, just fun.”

“I teach a week long class at NAU every year for the Physical Therapy students,” says Kay. “We have stroke survivor volunteers for the students to treat. The patients are there all day long, and rotate between various therapeutic activities. Everyone has such a good time that it’s like camp. It made me realize how hopeless a permanent disability can seem to both the survivor and the caregiver. Just the week of this class gave people new hope, a change of scenery, and the caregivers a rest from the constant responsibility. I thought this type of hope needed to be available to a wider community of stroke survivors and their caregivers. Only, I wanted it to be just a fun camp.”

Jim Koeneman, President of Kinetic Muscles and co-sponsor of the event, agrees. “Through Kay Wing and our customers, we became aware of the tremendous need that stroke survivors and their caregivers have for recreational opportunities.” Spinal cord injury survivors were included for the first time after a serendipitous encounter with Amy Rocker, Community Relations Director for the Arizona Spinal Cord Injury Association. The woodsy, rustic atmosphere and hotel-like accommodations offered Camp attendees a multitude of activities to choose from: nature walk, arts and crafts, bingo, yoga, a lecture on fishing, indoor volleyball, and a massage or acupuncture. The group attended a mixer and learned about meteorites from guest speaker John Salza on Friday night; and was allowed to sit in during the Phoenix Boys Choir music rehearsal Saturday morning.

It was here, at this special camp, where I learned what it meant to be a survivor:

1) Change is gonna come. Some of the simplest daily activities we take for granted are the first things a stroke and spinal cord survivor have to re-learn. Not only is the survivor affected, but loved ones are, too. For the first year after his wife, Susan, got home from the hospital, Jack Fuhrer’s daily routine was simply to ‘get through the day’ and observe her daily therapy sessions. “Tending to Susan’s basic needs was hard physical work because she was so profoundly paralyzed,” he states. Chang Bae and his wife, Kim, who were invited to the camp through the American Heart Association, still cope with difficulties like not being able to communicate well and rapidly. And the physical impairment prohibits certain activities that they’re trying hard to get back. Ron and Nancy Wheelen’s 14-year-old daughter is handling the new routine, but is frustrated and tends to be short-tempered at times.

2) It really does pay to have insurance. Insurance companies have gotten a bad rap for years. So much so that a couple of movies have been made to drive the point home that they have a habit of leaving their members twisting in the wind. Like a coin, there’s going to be two sides with insurance companies: the bad and the good. Jack Fuhrer feels he and Susan are among the fortunate few who have had good, hassle-free insurance coverage for a several million dollar illness. They were assigned a “supportive and helpful” case manager courtesy of Cigna. And an uninsured friends’ tragedy a few years earlier caused him to buy long term care insurance. Consequently, there are still a lot of deductibles. Ron Wheelen, whose wife, Nancy, suffered a stroke in a hospital in June 2004, states that “overall, there was $3,000 to $4,000 not covered by insurance. The hospital visit was $500 out of pocket.” Although he didn’t have to pay it, Ron said that the helicopter ride from one hospital to another was almost $12,000. Taxi, please.

3) Remember when?… Family members birthdays. The day my boyfriend popped the question. The day I got married. These are the special occasions I’m going to remember for the rest of my life. For a stroke and spinal cord injury survivor, the day their life changed forever is something they’re not bound to forget. Kim Bae, February 5, 1999; Susan Fuhrer, Sunday June 23, 2002, 9:15 a.m.; Kenny Baker, August 13, 1999; Terrible Tom O’Brien (who’s not terrible at all, but a shameless flirt), Monday May 27, 1996-Memorial Day; Susan Wheelen, June 2, 2004, 6:30 p.m.

4) There’s no such thing as limitations. Just because someone walks with a limp, wears a brace on their leg, or gets around by wheelchair, doesn’t mean they’re completely helpless. Diana Partain is an occupational therapist whose methods of therapy include driving rehabilitation and expressive art. “You don’t have to give up your hobbies or your life after having a stroke,” she says. “You just have to find another way to do them.” And in the words of Terrible Tom O’Brien: “I have two eyes, two nostrils, two arms and two legs. If one doesn’t work, I still have the other one.” Amen.

5) Support, support…and did I mention, support? The dream of seeing my work published has been a goal of mine ever since I started writing in the seventh grade. I not only had to believe it for myself, but I needed to have someone else believe in me, too. Don Price broke his neck and sustained a spinal cord injury in a diving accident in 1982. He was 18-years-old. “It was a difficult adjustment,” he says. “I had great family and friend support, but the best help in adapting to my disability came through peer mentorship–meeting others who had a similar disability, and learning from them. Once I spent time with other quads, I realized that they were out in the community working, playing, dating, driving, traveling and having fun. So I knew I could, too. They supported me; we supported each other.”

6) Celebrate the victories. Sixteen stroke survivors and two spinal cord injury survivors attended the Stroke Camp this year. The most inspirational person I spoke to was the youngest of the group, and was neither one of those. 24-year-old Laurel Murray survived an encounter with a drunk driver. She was pronounced dead at the scene for ten minutes. The doctor’s told her she would never walk again. “What do they know,” she scoffs. The brain damage she suffered is comparable to that of a stroke, her speech is slow and meticulous, her gait is even slower, and she’s determined to do things without help. But she’s walking. So stick THAT in your stethoscope and smoke it, you overpriced, pessimistic doctor!

The best part of this camp was the boys. All of our meals were blessed by the angelic voices of the Phoenix Boys Choir. I still get chills thinking about those young boys, some as young as eight, opening their mouths and hearing this almost supernatural sound emerge. I think about 12-year-old Collin, a member of the choir, who was born with no arms (stumps) and no legs (stumps fitted with suction-cup type prosthetics). And yet he was still wholly accepted by his peers. Those boys will grow up and never look twice at someone with a physical disability because of Collin. Get’em while they’re young, that’s what I say.

I’ve been in the medical field for several years now, but only in the form of a desk job. As a medical biller, I sit at a computer all day and register members. I have no contact with the member and have never had much contact with the physically disabled. After spending a day and a half with these eighteen survivors, I am simultaneously humbled and inspired. My life, my daily complaints, seem so small compared to what they’ve suffered and what they still struggle to accomplish. For a moment in time, I was allowed a sneak peek into their world. We rested, we relaxed, we had fun. We have been renewed. I recently attended a camp. At this camp, I was surrounded by survivors.


~ On average, every 45 seconds someone in the United States has a stroke.

~ Stroke is our nation’s No. 3 killer and a leading cause of severe, long-term disability.

~ African-Americans, American Indians or Alaska Natives, and Mexican Americans have a higher than average risk of getting a stroke.

~ Recent studies indicate that the risk of stroke may be higher in women during pregnancy and the six weeks following childbirth.

~ Each year, about 700,000 people experience a new or recurrent stroke. About 500,000 are first attacks and 200,000 are recurrent attacks.

~ Each year, about 40,000 more women than men have a stroke.

~ African-Americans have almost twice the risk of first-ever stroke compared to Caucasians. The age-adjusted stroke incidence rates (per 100,000) for first-ever strokes are 167 for Caucasian males, 138 for Caucasian females, 323 for African-American males, and 260 for African-American females.

Is it Rude to Boss Your Mom and Dad?

Each generation thinks it knows best. Now that you have elderly parents, you think you know best.

How’s that going for you? Have you been successful in getting them to eat better? No, I didn’t think so. You’re now going through what you put your parents through when you were adolescent. Now they’re doing it to you. And it’s making you as crazed and anxious as you made them.

See, now that’s God’s plan for you all.

I had a phone call the other day from man whose wife I knew. She urged him to he talk to me about his parents. Nice man, sincerely troubled because he just couldn’t get them to exercise. They wouldn’t take brisk healthy walks. They refused to join the gym.

“I’m at my wit’s end.”

“So, how old ARE your parents?” I said.

“Well, my mother is 89 and my father is 90,” he told me.

Eventually I stopped laughing.

“Okay,” I said, “Here’s the thing. They don’t want to do those things. And you can’t make them. And, to be honest, I’m not sure they’d be such healthy things for two very elderly, largely un-exercised people at this point in their lives.”

“You really think so?” he said sadly.

“Well, yes. You’re never even going to find out, because they aren’t going to do it. Congratulations, you’ve become the father of two elderly teenagers!”

It’s very hard to stand by when old parents seems to be doing the wrong things. And not doing the right things. However, it really is also true that people’s ability and energy to do things varies a lot according to age.

Our most useful ability as the caregivers is to figure out realistic priorities. Those must concern issues of real danger, food deprivation and medication messes.

You can add to that list your special choices of intolerable things you won’t put up with. I only concede that, because I know you’ll try anyway.

Most of the oldest old, those from mid-80s up, won’t be taking up exercise, unless it’s doctor-ordered physical therapy. They also won’t be changing their diet much either.

You can forget your seaweed salads, sashimi and good strong organic coffee. And I speak as someone who likes those things. Even if you order your parents to like them, they won’t. They want to eat what they want. At that age, you want them to keep eating, even if their choice is not your choice.

So, to answer your question, is it rude boss your Mom and Dad? Well, you know it is. But, even more important, you and I both know you won’t win. In reality, it’s not even a viable option.

You really want them to feel you’re on their side. With a strong relationship of trust. Able to talk with you. When they really need help.

You don’t want them to be like that late-80s couple I met in Arizona. They told met they ran away from home, in Nebraska, without leaving a forwarding address.

“Really, why did you do that?” I asked this pleasant frail old couple.

“It was our kids,” they said. “They never stopped bossing us around.”

There you have it.

Do Parenting Classes Benefit Your Family?

Connecticut, Arizona, and Utah divorce courts require parents to take parenting classes before granting a divorce. This applies also to some counties in some other states. Mandated classes for divorces with children can be attended separately or together.

These classes are important because parents need to be made aware of how their divorce might affect their children. Children react differently at varied stages of development, but they all react emotionally. Parents need to learn what is appropriate developmentally and what is not.

The kids may be acting angry, but the underlying emotions are sadness, disappointment, and fear. Adults will need to learn to get to the real issue at hand. It would be very easy to burn bridges and build walls that lead to destructive behavior if parents do not learn how to respond to a child struggling with their family breakup. Good parenting courses help parents to avoid this parenting mistake.

There are highly accredited online parenting courses available that satisfy court requirements for probation or divorce. These courses are great because they allow parents to put their kids first and complete the course on their own schedule. There is no time limit, but there can be a four to ten hour course requirement. Parents are very busy all the time when they have children. Online participation gives parents individualized 24/7 flexibility.

Online parenting studies are recognized by courts in most states. Just check with the organizer of the class and verify with your attorney or mediator.

Classes online should teach subjects like parental communication, anger and stress management, parenting styles and teamwork, rewards and discipline for children, conflict resolution, and avoiding parenting mistakes. Courses should deal with the new blended family in America. Over fifty per cent (50%) of the families in this nation are comprised of step-family members.

Some parents may desire to improve their parenting skills without a court order. Observing the behavior of parents and children in any public place, anyone can see the need for improved parenting skills in America. Many times it is not readily apparent who is the parent and who is the child. This can also occur in a divorce when a parent and a child reverse roles and the child becomes the caregiver. This is not fair to the child. Children deserve a happy, carefree childhood.

Parents will want to be sure they are getting information from licensed practicing professionals. Any quality online parenting course should offer a Certificate of Completion. A full refund should be guaranteed if the court does not accept the Certificate of Completion.

Lil Lyon is on fire for kids caught in the middle of family breakup. She knows that they are the innocent victims of parental conflict.

The Extended Enterprise in Action

This paper is a companion to “Widening Your Sphere of Influence: An Introduction to the Extended Enterprise,” which laid out in detail the concept of the Extended Enterprise platform, its key elements, features and general benefits. Building on that foundation, the purpose of this paper is to demonstrate how the Extended Enterprise platform can help specific verticals to promote and sell their products to external audiences. In particular, it investigates the value of the Extended Enterprise solution in financial services/insurance, government, retail, manufacturing, healthcare and associations. Feel free to read ahead to the section that is most applicable to your own organization.

Financial Services and Insurance

The regulatory arena has expanded considerably over the past decade, placing an enormous compliance burden on the insurance and financial services industries. Meeting Sarbanes-Oxley regulatory requirements alone involves a tremendous amount of management complexity. The result is a communication tangle spanning the various employee categories across multiple locations. And that’s only one of many regulations affecting this sector.

Now, factor in the strategic management of workforce knowledge in the financial and insurance markets. In many organizations, this comprises a central headquarters and perhaps a few regional offices servicing a large external network of remote offices, brokerages, agents, financial advisors and customers. In such an environment, it is critical to consistently deliver a superior managed service in order to achieve profitable growth.

Traditional Learning Management Systems (LMS) are aimed mainly at head office personnel. They provide great value in terms of managing performance, aligning goals, facilitating training and development, and proactively managing succession planning. However, their limitations are exposed when it comes to federating knowledge and information to external reps, tracking the status of development initiatives and verifying compliance to ongoing programs.

Armed with the Extended Enterprise solution, insurance companies and financial services organizations can gain control over their far-reaching networks of brokers, dealers, advisors and customers. Knowledge and information can be made available to them online as an effective means of managing certifications and upcoming expirations to avoid lapses in licensing. Additionally, workforce productivity can be maximized by accelerating delivery of knowledge on key skills, policies and mandated instruction.

A well-designed Extended Enterprise solution can often pay for itself or even directly generate revenue. In a financial services organization, for example, training puts your company’s message and value proposition front and center. While brokers may have dozens of packages to choose from, the addition of a relevant knowledge nugget or the right training element (either free or available for a small fee) as a value-add for the broker or potential customers can tempt many to select you as opposed to one of many alternative vendors. By aligning a simple content item to a sales or business goal, customer retention and acquisition can be boosted.

Similarly, existing customers can be kept up to date on the latest offerings in an interactive manner. They can be encouraged to view short pieces of online content to increase their knowledge of a specific field and to keep them actively involved with your company.

Remote employees and independent agents can also be comprehensively serviced online without the need to mail a piece of information, wait for knowledge transfer to occur in a non-structured format or bring everyone to the head office once a year for a week-long course. In those cases where a trip to headquarters is desired, the Extended Enterprise solution can greatly reduce costs by slashing the annual stay to a day or two with the balance of the knowledge and information delivered online.

These are just a few of the ways that the Extended Enterprise solution can enhance the value of human capital. As everything is managed within one system, it is easy to track compliance and certification. Training programs can be assessed against organizational programs at a global, national, regional and individual level while promotional activities intended to generate new business can be evaluated against measurable results.

Organizations already taking advantage of the Extended Enterprise solution include BankAtlantic, First Niagara Financial Group, PHH Mortgage, Wellmark Blue Cross Blue Shield and Utica National Insurance Group.


Manufacturers, of course, have unique business challenges. They must compete in a global economy and find lean and cost-effective processes to bring their products to market and manage their supply chains. At the same time, they must deal with corporate policies and strategies, and a seemingly endless stream of government regulations. To make matters worse, many manufacturers have to compete in a retail sector overrun by competing brands, each one attempting to capture the hearts and minds of retail sales staff. As these staff work for the retailers and not the manufacturers, how do you ensure your message is front and center and your goods are the ones they instinctively reach for?

The answer lies in the Extended Enterprise solution. Providing a platform for the creation of a sustainable and scalable knowledge network, such a network helps manufacturers to efficiently sell and support their products. How? Let’s take a look at business as usual.

Each manufacturer has probably prepared sales literature to ship out to all retail outlets. While the intention is to have sales reps read, understand and appreciate the nuances of specific products, what happens to these materials when they are distributed is anyone’s guess. Some are diligently handed out to employees who then sit down and study them. Others are distributed but merely glanced at. In a few cases, the literature sits in a storeroom never to see the light of day.

Some companies attempt to circumvent this outcome by a variety of means. They post materials online and hope to entice staff to view them. They sometimes send their own personnel out into the field to train sales reps on the peculiarities and fine points of their product lines. They perhaps send out newsletters and e-mail in an attempt to engage external audiences. The issue, though, is that competitors are conducting similar efforts. Without the Extended Enterprise solution, it is impossible to gauge success and bring your goods to the front of the line.

The best way to boost brand image in this situation is to initiate an Extended Enterprise program. Captivating Webcasts and presentations can be made available online to rapidly take sales personnel through the key points of your pitch. They can be briefed on why your goods are superior. Further, progress can be tracked right down to how many reps have accessed or completed the content asset on a per store basis, how many have started, how far they have gotten, their feedback and even how this is related to sales performance in that area.

Consequently, programs can be adjusted to ensure maximum success through integration with incentive and award programs, using certifications to vest sales people in your offering, and providing a consistent and accurate message that can be evaluated for effectiveness. This ultimately leads to sales personnel at a retail level that will push your products instead of those of a rival. Why? Because you have gained mind-share.

Manufacturers already enjoying the benefits of the Extended Enterprise solution include Black & Decker, Harris Corporation, International Rectifier, United Technologies Corporation, ZLB Behring and Anixter International.


The medical world is probably one of the most dynamic sectors of the modern economy. Constant changes are the norm as new technologies, procedures, and compliance requirements are introduced. Combine this with the complexities and pressures of healthcare staffing shortages, a constant demand for cost containment and ongoing efforts at reform and you have an industry like no other.

What isn’t so well appreciated, though, is the fact that many healthcare organizations typically service an area that consists of smaller clinics, outpatient facilities, field caregivers and other external workers whose livelihood is dependent upon the primary facility. Delivering knowledge and information to these individuals on health, safety, hygiene and organizational protocols can be a nightmare given the busy schedules of most of these personnel. As a result, the critical exchange of information often takes a back seat.

Enter the Extended Enterprise solution. Federating knowledge and information online allows doctors, nurses, technicians and support personnel in the field to work their way through the content they need during the small windows available to them. Whether it is a few minutes or a couple of hours, the Extended Enterprise solution keeps track of where each individual is at and makes it easy for them to return and complete their activity when time allows.

This is also important when it comes to continuing education and certification. Staff needs to put in a certain number of hours annually to maintain their accreditations and stay up to date. The Extended Enterprise solution facilitates such activities, often bypassing the need to transport individuals with skill sets in short supply to a seminar on the other coast or, worst-case scenario, another continent.

When it comes to regulations such as HIPAA, FDA, The Joint Commission, OSHA, and those of the EPA as well as state and local authorities, keeping track of compliance is a simple matter with the Extended Enterprise solution. All Web-based assets within the solution can be tracked for external staff progress and completion. This can be vital when it comes to defending the organization against legal actions – success or failure in court can depend upon being able to prove that one person completed specific requirements of a given program at a specific date.

Additionally, the Extended Enterprise solution is of great value in the area of customer acquisition and retention. Prospective patients, for instance, can view presentations online about the facility, their specific condition and available procedures to help them gain confidence in commencing treatment. Existing patients can be offered value-added information and knowledge on such topics as preventive medicine, or how diet and fitness can play a role in their recovery.

Healthcare customers currently taking advantage of the Extended Enterprise solution include HealthQuest, Kaiser Permanente, Sisters of Mercy Health System, SwedishAmerican Health System, US Oncology, Association of periOperative Registered Nurses and MedAssets, Inc.


Employers in the highly competitive retail sector are challenged to disperse knowledge and information to employees on a wide range of skills, including detailed product knowledge, how to sell, complaint handling, price products and services, objection handling and much more. To make it even more challenging, sales associates, clerks, floor managers, distributors and dealers comprise a geographically dispersed population, many of whom are not direct company employees. Nevertheless, how they represent your organization to customers directly impacts revenue and customer satisfaction. It takes the right methodology and system to maintain your brand image while improving business performance.

This is made difficult due to the high turnover rates experienced in the retail sector. Under these circumstances, it can be difficult to maintain any consistency of brand. That’s where Extended Enterprise solution comes in. It provides the right vehicle for updates to product information, training, sales programs and service management information to those on the front lines.

Take the case of education about a new product line. Short online courses can be accessed by personnel as time permits and managers can keep track of everything to ensure everyone completes in a timely manner without impacting productivity and ensuring consistency of the message.

It gets even more interesting when you deal with more complex goods such as personal electronics. In many cases these goods are so sophisticated that the general consumer requires formal initiation to gain proficiency. One retailer, for instance, was experiencing a heavy rate of returns for its latest phone. Many customers complained that their products were faulty. Analysis showed almost all of them to be working correctly, and that customers simply didn’t know how to utilize them. An Extended Enterprise solution was introduced to train sales associates on how to use the phones, quickly making them experts in its use.

When customers came into the store with the latest wave of returns, sales associates were able to educate customers on these products resulting in a tremendous drop in the rate of return, adding millions to the bottom line in a short period. Such courses can also be made available to customers as a means of improving their purchasing experience. Furthermore, by capturing customer-support-related data, small media-based snippets on “how to” can be pushed to the mobile device in order to reduce call-in rates for similar knowledge deficiencies.

Finally, there is the aspect of harnessing the External Enterprise solution as a direct revenue generation engine. Some organizations are so dominant in their field that agents, dealers, service technicians and other professionals are clamoring to be associated with them. By requiring these individuals and groups to complete paid certification programs and maintain their credentials annually, significant amounts of income can be generated. And by taking the burden of this training off the organization and positioning it online, resources can be freed up for more pressing matters.

The Extended Enterprise solution, therefore, helps retailers to reinforce their brand and heighten the customer experience by providing consistent information for thousands of employees across multiple franchises, geographic regions and languages. This directly drives revenue by providing associates with the knowledge and skills to cross- and up-sell to meet customer needs and boost repeat purchases. In addition, it reduces turnover and supports career planning initiatives, as well as streamlining new employee orientation and on-boarding for full-time, part-time and seasonal employees.

By targeting sales personnel in a retail chain, it is possible to incentivize them to access and complete specific content focused on helping them become better informed about specific products. By aligning these types of programs to a distinct business purpose such as the improvement of sales, a small investment can pay substantial dividends. In a world where a multitude of brands are vying for attention, a professionally produced program is an excellent way to reinforce brand recognition. Done correctly, it cleverly differentiates a brand in the eyes of external audiences.

Another critical factor: In many verticals, speed to market is a major component of success. Particularly in industries such as computer hardware, software, durable goods and telecommunications, rapid development of products is rarely enough. It takes velocity and agility on the marketing side to ensure results.

Take the example of a security software release. In many cases, multiple vendors come to market at the same time with their latest offerings. Extended Enterprise solutions can help differentiate products by educating channel partners and resellers about your new release. The speed with which that knowledge gets out, as well as the ease of access and management, can make or break a marketing campaign. This doesn’t mean that formal training has to be involved. Distribution of a webcast, PDF or PowerPoint in conjunction with accurate tracking of viewing patterns might be enough to move your product to top of mind in the target audience.

Another way to become more nimble in an evolving marketplace is in the area of centralized training. Many companies require external sales personnel to come in to the head office for one week every year for an update on products, pricing and policy. This represents a hefty annual expense for all concerned when you take airfares, hotels, food and lost productivity into account. What if that week could be either eliminated entirely or reduced to only two days, with the rest of the training done online? The Extended Enterprise solution is a way to facilitate the transition.

Organizations currently using the Extended Enterprise solution include AMC Entertainment, Cabela’s, Hudson’s Bay Company, Pilot Travel Centers and Oreck.

The Extended Enterprise solution is especially suited to federal, state and local government organizations. In the federal arena, There’s a wealth of knowledge and experience in developing premier human capital management and development solutions for federal agencies- systems that raise workforce productivity, improve employee retention, aid regulatory compliance, cut expenses and reduce training time (GSA Contract Number GS-02F-0114R).

This depth of experience has been used to full advantage in the Extended Enterprise solution. Agencies that sell services to the public can deliver knowledge, information, training and certification, harnessing the platform to improve time to market and increase customer satisfaction. The system can also be used to provide solutions to a geographically dispersed employee base. With many agencies having offices in all 50 states, it can be daunting to maintain control and accountability for the individual progress of thousands of employees. Failure to keep track of No FEAR Act, ethics, sexual harassment and other mandated training and information initiatives can have serious consequences.

Federal agencies deploying the Extended Enterprise solution have saved taxpayers millions of dollars by reducing expenses associated with the exchange of information, knowledge and formal training to remote employees. In terms of cost avoidance, the Learning Center alone saved taxpayers approximately $20 million in expenses related to travel, lodging and time away from work in just the first 20 weeks of operation.

Smaller agencies provide one-stop access to high quality knowledge, learning & performance products and services by unifying initiatives across departments, thereby eliminating redundant procurement and licensing costs. The platform is compliant with Section 508 of the Workforce Investment Act of 1998, which requires all public institutions to use information technology accessible to persons with disabilities. Further, world-class security infrastructure has been audited by independent organizations on behalf of the U.S. Office of Personnel Management. The hosting environment utilized by the Extended Enterprise solution meets OPM Baseline Security Requirements, for a certified and accredited host for the e-government learning initiative.

More than 50 agencies, including OPM/GoLearn, the Departments of Education and Interior, U.S. Agency for International Development, U.S. Department of the Interior, U.S. Office of Personnel Management/GoLearn and the U.S. Securities & Exchange Commission, have implemented the Extended Enterprise solution.

In the state and local category, the Extended Enterprise solution is used in local agencies such as Loudon Water as well as state agencies such as State of Arizona Department of Health Services, State of Washington, State of South Carolina, NY State Police Academy, State of North Dakota and Florida Department of Highway Safety and Motor Vehicles. Agency administrators are able to track compliance to vital initiatives around the country and create content tailored to their needs. A searchable catalog provides all the information and knowledge required by a diverse community.

Is There a Parkinson’s Personality?

This Saturday morning I found myself making a huge arrow-linked diagram of projects, goals, objectives, outstanding mundane tasks, basically my whole life for the next three months on a 14×20 inch art pad. I have been doing this sort of diagramming since probably high school. These big-picture highly-detailed diagrams have served me well in all aspects of my life from career to personal decisions. I even use a Bic classic 4-color pen. Things undecided appear in red. The larger size helps me with writing which has become rather slow and difficult. I think I own more of these type pens than anyone in the world.

When I used to work in an intensive care unit, I made similar diagrams for each patient organized by organ system, lab tests and therapeutic regimens. I would write very small. One might say I had “micrographia” years before developing early-onset PD at age 44. Yes I was compulsive with my work and it benefited my patients. One day a resident saw me writing in my notebook and started to jokingly refer to me as “the scrivener” after the character Bartleby in the classic Herman Melville novel of the same name.

Still one would never accuse me of OCD or any other form of obsessive neurosis. In fact I was always rather balanced, and even known for being calm in the worst of situations. I could even be rather impulsive. Before 9/11 when airport security was beefed up, I went to Newark Airport on several occasions when I needed space for important decisions, carrying a small kit of overnight essentials and a credit card. I would then browse the gates for an impromptu trip to places like Sedona Arizona and New Orleans or Boston. Rather impulsive.

However when it came to my work I was always a person of absolute precision. Even during on-the-spot medical emergencies, as I was managing the crunch, inside, I was always formulating an alternative plan in case my current strategy failed.

One day, maybe on my second visit to the neurologist after my diagnosis, I needed him to fill out a questionnaire for the insurance company. I made a copy of the form and gave him two copies: a blank original and another filled in with all relevant personal data to save him the trouble of needing to search my chart to answer the questions. As I handed him the array of sheets neatly paper-clipped together with instructive post-it’s he smiled and said, “You’ve certainly got the personality for Parkinson’s.”

After that I did some reading and observing. Most of the people I had met with early-onset PD were good at their jobs and great at getting back to you when you tried to contact them. Two were engineers and another a quantum physicist. And right now I can’t think of any famous slackers who have it. MJ Fox is no slouch, nor is Janet Reno, and even Muhammed Ali, whose Parkinsonism was likely more from head trauma than of ‘idiopathic’ causes was one hell of a wit in his prime, and known as well for being a very smart strategic boxer.

Well it would seem that we who suffer from early-onset Parkinson’s are in very good company. So much so that actual studies have been done based on these stereotypes originally noted anecdotally by neurologists, other caregivers and family members.

To my surprise, in perusing the studies done to confirm this hypothesis, in 1993 a research group of psychiatrists at Robert Wood Johnson School of Medicine in NJ suggested that these seemingly admirable traits were the result of early brain damage, to quote:

With relative uniformity, PD patients are described as industrious, rigidly moral, stoic, serious, and nonimpulsive…that these personality traits are behavioural manifestations of damaged dopaminergic pleasure and reward systems.

Their results published in the journal Neurology said that “parkies” scored lower on the “novelty-seeking behavior” part of the evaluation. Does that suggest we are a risk-aversive boring bunch, who cage-in ourselves before the disease does it for us?

I have to disagree. Other studies have also disputed this claim as well. I have travelled all over the world, and partaken in many endeavors. The people I’ve encountered personally with early-onset PD are just not the keep-it-safe Walter Mitty types.

If anything, I see these traits as making us into very fit explorers: like Vikings who don’t leave port before checking out that the boat is intact and all the oarsmen are well-prepared for the adventure that awaits. Whatever it might be that predisposes us to become “careful explorers” if I may (and ignoring whatever chicken vs. egg debates exist on neurological causation), might also just happen to be a serendipitous gift. That extra something, maybe even manifest as an ability to keep a strong perspective, confers upon many of us an insatiable drive to make the most of post-diagnosis life. As a doctor I’ve seen many different reactions to the news of a terrible diagnosis. There is something unique about us. Rather than retreat in anguish (oh there are bad days), most early-onset sufferers I’ve met in person or online seem to face this plight head on, and more often with a thankful smile.

5 Ways to Ease the Stress of Caring For an Aging Parent

It’s hard enough managing the to-do’s in our own lives. Add to that the responsibility of in home care – managing every aspect of someone else’s life too – and it can be overwhelming. Yet that is exactly what millions of people do each year providing senior services for their aging parents, and it is taking its toll. According to a study by the National Alliance for Caregiving, more than 50 percent of those providing assisted living services for their parents experience increased levels of stress and strain, often to the point of being detrimental to their health.

In other words, it does your aging parent little good if you run yourself down to the point of exhaustion while providing for their personal care, companionship or homemaking needs. It is critical that while looking after the mental, emotional and physical health of your loved one that you take precautionary steps to preserve your own.

Follow these 5 steps to ease the stress of caregiving in your life:

1. Maintain a healthy diet. You know how important eating well is to your aging parent. Well, it is equally important to you, so do yourself and your loved one a favor – make it a habit of eating at least three balanced meals a day.

2. Exercise. You need all the strength you can get when caring for an aging parent, especially if they need assistance moving around, so staying physically fit is critical. Equally important, physical activity is a great stress reliever – the perfect way to re-energize yourself so you can be at your best, for your loved one and for yourself.

3. Get plenty of sleep. As exhausted as your body may be from running around all day caring for yourself and caring for your loved one, that often doesn’t stop your mind from working overtime, especially at night. Worry is inevitable, but find a routine that helps ensure you get plenty of rest, whether that means a hot cup of chamomile tea before bed or taking naps throughout the day whenever you have an opportunity.

4. Go in for regular medical checkups. When you’re caring for someone else, it can be easy to dismiss signs of your own ill health. Or there may be things going on that you’re not even aware of. Just to be safe, it’s important that you see a doctor on a regular basis, as stress is one of the number one causes of physical illness.

5. Consider professional in home care. Whether you’re helping your aging parent just a few days a week or 24/7, you and your loved one can benefit from in home care with a professional caregiver. For instance, Synergy HomeCare is widely known as the most trusted name in home care, providing senior services throughout Arizona, including:

– Personal care services
– Homemaking services
– Companionship services

In home care can be especially beneficial to those whose aging parents are living with Alzheimer’s or dementia, as helping a loved one with these conditions can be particularly challenging. You not only need help for them, but respite care for you so you can get away for a while to avoid burn-out.

My name is Patrick Tourian and here at Synergy HomeCare We share in this sense of pride and accomplishment as our Arizona senior caregiver organization is the most trusted name in home care. Since 1999, every Phoenix caregiver, Scottsdale senior caregiver – and other Arizona caregivers throughout the state – have been trained to provide the best in elder care senior services.