Winning market positioning strategies for long term care facilities

The decision to develop an aggressive marketing strategy for its long term care facility has become a priority for the management of a one-hundred bed facility in the Rocky Mountain West. Financial success and lasting competitiveness require that the facility in question (Deer Haven) establish itself as the preferred provider of long term care for its target market. By performing a marketing communications audit, Deer Haven evaluated its present market position and created a strategy for solidifying and dramatizing this position. After an overview of present conditions in the industry, we offer a seven step process that provides practical guidance for positioning a long term care facility. We conclude by providing an example application.     

Sustained measles elimination in Australia and priorities for long term maintenance

We used the 2002 national serosurvey to evaluate a primary care-based young adult vaccination campaign, measure the reproductive number (R) and, together with vaccination coverage estimates, predict R until 2012. The campaign had no impact on immunity in young adults. R was estimated to be 0.69 and predicted to stay well below the epidemic threshold of 1 until at least 2012, indicating that Australia should remain free of endemic measles in the medium term. To maintain elimination in the longer term, the timeliness and coverage of childhood vaccinations must improve and innovative strategies will be required to improve measles immunity among young adults. This experience is likely to apply to developed countries that have achieved or are approaching measles elimination.     

State strategies to support community based long term care for the elderly

States play a principal role in designing and implementing publicly funded long term care programs. They are in a key position to determine what setting, from whom, and under what philosophy of care individuals can access long term care. State long term care systems have evolved over the past 25 years to support increased availability of community based care for older individuals. States have pursued three broad strategies to increase availability. One set of strategies aims to increase capacity through expanding the supply, public funding and eligibility for a wide array of home and community based services (HCBS). A second set of strategies seeks to constrain institutional growth in order to increase the dollars available for HCBS. Managed/capitated long term care is a third strategy that is a hybrid of the other two approaches. Empirically, increased capacity through use of Medicaid and Medicare resources and growth in the supply of community based care providers, combined with moderation of institutional bed supply, are associated with enhanced access and expenditures for community based long term care. The effectiveness of capitated or managed systems of care varies by model and in some cases is still under study. State fiscal resources are key to the ability to support community based care for the elderly. Targeted federal support may be critical to the continued expansion of community based care, given heterogeneity in state resources, coupled with an increasing demand for long term care.     

The use of group dynamics strategies to enhance cohesion in a lifestyle intervention program for obese children

Background  

Most research pertaining to childhood obesity has assessed the effectiveness of preventative interventions, while relatively little has been done to advance knowledge in the treatment of obesity. Thus, a 4-week family- and group-based intervention utilizing group dynamics strategies designed to increase cohesion was implemented to influence the lifestyles and physical activity levels of obese children.     

A search for strategies to engage women in substance abuse treatment

Retention is a well-documented predictor of favorable outcome of substance abuse treatment. In order to remain in treatment, clients must initially engage in the treatment process. This issue is a particular challenge for clinicians who continually seek motivational strategies that will draw each individual into the treatment process. Few engagement strategies have been specifically tested to determine their efficacy. The results of this study indicate that outpatient clients who received engagement services during the intake period showed increased use of these services, relative to a comparison group, throughout the treatment process. In addition, tangible engagement services provided to women during the intake period for outpatient substance abuse treatment had no significant effect on the rates of admission, discharge, and service utilization.     

Improving maintenance of lost weight following a commercial liquid meal replacement program: A preliminary study

Clinic-based liquid meal replacement (800 kcals/day) programs produce substantial weight loss. Nevertheless, long-term maintenance remains a challenge. A limitation of maintenance programs is that they continue to promote large behavior changes that are initially required to induce weight loss which may be unsustainable long-term. The study aims were to conduct a preliminary assessment of the feasibility, acceptability, and effectiveness of a small changes maintenance intervention (SCM) for 30 patients who completed liquid meal replacement program (LMR). The 20-session SCM delivered over 52 weeks offered no preset goals for maintenance behaviors and all changes in behavior were self-selected. Participants had a median BMI of 40.9 kg/m² and weight of 111 kg at the start of LMR. At LMR completion, they lost 18% (21 kg) of body weight. The SCM was completed by 22 patients (73%); 19 completers (86%) attended ≥ 17 of 20 sessions with a median satisfaction rating of 9 (on a scale of 1 to 9). Completers were asked to record self-selected maintenance behaviors daily (median 351 days recorded). The most commonly reported daily behaviors were self-weighing, use of meal replacements and step counting. Median percent regain at week 52 was 14% (2.8 kg) of lost weight (range, − 42 to 74%), significantly less than a median of 56% (11 kg) percent regain of lost weight (range, − 78 to 110%) in a demographically similar historical control group with no maintenance intervention after LMR completion (P < 0.001). Thus, SCM holds promise for improving weight maintenance. Future research should compare SCM to standard maintenance programs that promote large program-directed changes.     

Effects of cardiac stress during a very-low-calorie diet and exercise program in obese women

To assess the safety of very-low-calorie diets (VLCDs), stress tests known to induce arrhythmias in susceptible patients were performed in 24 obese women on a VLCD (660-720 kcal/d) for 6 wk. Half of the subjects had diet only (DO) and half underwent supervised exercise (DE) four times weekly. Five control subjects ate a balanced, moderately low-calorie diet (approximately 1400 kcal/d). Stress tests included maximal and submaximal (85%) exercise, psychological stress, and isometric handgrip tests, all with constant electrocardiogram (ECG) monitoring. Twenty-four-hour Holter monitors at weeks 0 and 6 and weekly resting ECGs were obtained. DO and DE lost similar amounts of weight. There were no changes in QT intervals or in voltage or width of the QRS complex on resting ECG and no arrhythmias on Holter monitoring. These data support the safety of VLCDs containing greater than or equal to 650 kcal/d and adequate amounts of high-quality protein, vitamins, and minerals for use for periods of at least 6 wk in normal, healthy obese women.     

Eating disorder inventory in the assessment of psychosocial status in the obese patients prior to and at long term following biliopancreatic diversion for obesity

Psychological traits of obese patients, assessed with the Eating Disorder Inventory (EDI), were compared to those of subjects in the long term following biliopancreatic diversion for obesity (BPD), when body weight has been steadily normal for over 1 year and any preoccupation with dieting and weight has been completely abandoned. The overall results suggest that the stable body weight normalization on a completely free diet does confer considerable psychological benefit on obese individuals. On the basis of the EDI results, post-BPD subjects were divided into weight-preoccupied and not-weight-preoccupied individuals. In the not-weight-preoccupied subjects, the psychosocial status and emotional rectivity were closely similar to those observed in lean control persons, whereas the few weight-preoccupied subjects, in spite of completely normal body weight, showed residual body dissatisfaction and personality traits very similar to those of eating-disordered patients. © 1994 by John Wiley & Sons, Inc.     

Changes in self-efficacy and decisional balance for exercise among obese women in a weight management program.

OBJECTIVE: To assess changes in eating and exercise self-efficacy and decisional balance for exercise in an obese population enrolled in a multi-disciplinary weight management program. RESEARCH METHOD AND PROCEDURES: Thirty-two obese women were assessed at entry and after 12 weeks of treatment. RESULTS: Participants showed 15% mean weight loss after 12 weeks of treatment. Mean minutes of self-reported exercise increased by 229%. Participants demonstrated significant improvements in self-efficacy for both eating and exercise and health parameters but not in decisional balance for exercise adoption. DISCUSSION: These results may have implications for the practitioner in that self-efficacy changes occur during successful weight loss, but decisional balance for exercise may not change until individuals enter maintenance. These results imply that practitioners may be advised to shift from confidence building to relapse prevention early on in treatment, and that focusing on strengthening the pros of exercise and reducing the cons of exercise may need to remain constant during treatment.