What Are the Strengths and Weaknesses of a Flexible Spending Account (FSA)?

Q: My company is considering instituting a Flexible Spending Account (FSA) benefit. While it sounds good, what are the strengths and weaknesses of a FSA? Are there any special benefits to New Jersey residents?

The Problem – Determining if an FSA is Beneficial
New Jersey (NJ) ranks in the top 30% most expensive states in the U.S. for health care costs. Healthcare costs are rising 8%-10% per year and are likely to grow two to three times the rate of inflation for the foreseeable future. NJ ranks in the top 20% most expensive states for child care for pre-schoolers. Employers are shifting more child care, healthcare and insurance costs to the employees – forcing employees to evaluate FSA’s.

The Solution – Flexible Spending Account
Imagine getting over a 40% discount on your healthcare and child care costs. That is essentially what a FSA provides. Contributions to an FSA are made on a pretax basis and can be used to pay for Unreimbursed Medical (URM) and Dependent Day Care (DDC) costs.

Contributions avoid both federal income taxes (top rate 35%) and Federal Insurance Contributions Act (FICA) tax of 7.65%. Employers also avoid paying FICA taxes on employee contributions. The wonderful state of NJ is one of the only states that assess a state income tax on FSA contributions.

Unreimbursed Medical (URM) Costs
There are a wide range of items covered, including: prescribed and over-the-counter medication, eye glasses and contact lenses, crutches and hearing aids, and nicotine patches. We all know we should visit the dentist twice year for a checkup.

Unfortunately, many employers offer modest dental insurance plans, leaving employees with large out of pocket costs. Many dental insurance plans have $1,000 or $2,000 family limits and cover only “reasonable and customary” charges. In NJ, that could leave you paying $600 for a $1,000 procedure.

Dental examinations, cleanings and fillings are all covered medical costs through an FSA. While paying $600 out of pocket for a dental procedure is not easy to swallow, at least getting a 40% discount is palatable. Often overlooked FSA items include: insurance co-payments and deductibles, in vitro fertilization, and physician-prescribed weight loss programs. There is no federal limit on contributions to FSAs for URM costs.

Dependent Day Care (DDC) Costs
Two groups of dependents are permitted under DDC:
1) a dependent age 12 or under who entitles you to a personal tax exemption and
2) a spouse or other dependent that is physically or mentally unable to care for herself/himself. Qualifying expenses include: care outside of the home, dependent care center and payments to relatives (as long as they are not your dependent). One often overlooked FSA item is summer day camp that is primarily custodial versus educational. The federal limit on contributions to FSAs for DDC costs is $5,000 per year.

Use it or Lose It
Take the time to determine the qualifying expenses you expect to incur throughout the year when establishing your contribution amount. Over estimate and your unused contributions will be forfeited if you do not utilize them by the end of your employer’s plan year. Even if it means running out to the pharmacy on New Years Eve to stock up on aspirin, do not let your hard earned money go to waste. With a change in laws, starting in 2005, some employer plans allow for purchases through March 15th of the following year.

Action Steps – Utilize Your FSA
If your employer offers an FSA take the time to estimate your URM and DDC costs and contribute to your FSA. If your employer does not offer an FSA encourage them to consider one. Not only will it be viewed as a valuable benefit to attract and retain employees, but it can also save the employer taxes.

How To Become An LPN

An LPN (Licensed Practical Nurse) is a nurse who collects the medical details (blood pressure, weight, height, etc.) of a patient who enters a medical facility. In some states, they are called LVNs (Licensed Vocational Nurse). Because the details they collect are used to help diagnosis of patients, LPNs are important members of health teams.

Learning how to become an LPN is now simpler than ever. The internet, and articles like these, make it easy to learn the process.

The process to become an LPN is not very complicated. For example, if you are looking into becoming an LPN in New Jersey, you will see that the process is very straightforward; take some classes, take a test, get your license!

However, before you get started, it is important you understand that the roles of an LPN vary with states. For example, an LPN can prescribe medication in Florida, but not in Massachusetts.

The requirements will vary from state to state, as well. In most states, you must have a high school diploma before you apply for any LPN program. Technical and vocational schools offer the LVN program for a period of one year and award the successful nurses diplomas.

But in all states, demand for LPNs is high. As such, the restrictions to practice as an LPN have been greatly reduced because of the shortage of LPNs in states like Pennsylvania, Maryland and New Jersey.

The training requirements for LPNs do vary from state to state, though. Even though different states have different training requirements for LPNs, the National League for Nursing Accrediting Commission accredits programs to show that the curriculum produces adequately trained students.

Before an LVN program is accredited, the trainers must be qualified and the course must satisfy all relevant requirements fully. Most of the LPN programs in the US are advanced with both online and offline (classroom) teaching sessions.

The courses usually include instruction in the fields of biology and pharmacy. LPN programs are mostly carried out in medical centers like rehabilitation centers and nursing homes. The training process is normally supervised by a registered nurse. However, another LPN can supervise such a program, too.

An LVN program usually lasts for around 12 months based on the educational program’s guideline. In other words, it is possible to start working and get a job as an LPN 12 months after you enroll for the program.

LPNs advance their professional qualifications with ease because of their medical field experience. If you have an interest in getting a job as an LPN, it is necessary to start with an LPN program. If this is the right job for you, you will definitely not have any regrets!

Once you finish your training, the process ends with licensing. LPNs are licensed by the state after passing a special exam called the NCLEX-PN. In most states, you will need to renew this license every few years.

As part of the renewal process, it is compulsory to produce a written proof that shows nursing employment.

Anyone interested in becoming an LPN is advised to find an accredited LPN program right away. Becoming an LPN is a great opportunity to work in the medical field. Becoming an LPN gives you the responsibilities of a registered nurse, without the legal liability. It’s a great entry-way into a lucrative healthcare career!

If you’re interested in learning more about becoming an LPN, check out LPN Programs HQ [http://lpnprogramshq.com] to learn more about the process and find training in your area. If you are in MA, you should check out the page on LPN programs in MA [http://lpnprogramshq.com/lpn-programs-massachusetts-ma/].

Giving Yourself A Competitive Edge

When I was seventeen, I remember going to the “new” Cherry Hill Mall in New Jersey when it opened in 1962. Many teenagers used to go there often – then and now. Today, I sit on one of the benches while my wife shops. I look for anyone passing by older than I am. I rarely see anyone. Time passes – and a lot faster than you might expect – so the time to act in improving your future is now, not later. Here’s some of what I’ve learned that I pass on to help you or to help your sons, daughters, or grandchildren:

Focus and Specialize

While having general knowledge in your field can be useful, today is the day of the specialist. Find what interests you and laser focus on it. It’s very easy to get distracted. I made a career of doing that: customer service manager, convenience store franchisee, Congressional campaign manager, real estate broker, NJ approved real estate school director and instructor, adjunct college professor at six colleges, full time business administration faculty at Atlantic-Cape, Stockton and Camden County College, and author of seven books. Not always unrelated, but certainly not as related and as focused as it could have been – and that has consequences.

Sometimes not focusing won’t all be on you. Your job may force it on you. In law practices, attorneys can get pulled into a variety of different areas, making it more difficult to stay focused. That’s a situation not isolated to the practice of law either. While it may make focusing more difficult in these circumstances, try to identify what you want to focus on, then make any extra effort you can to do it. Time constraints can make this difficult, but otherwise the tail is going to keep wagging the dog. Just take as much control as you can to put the focus where you want it to be.

While money shouldn’t be the focus of a successful life, it surely can be an important component of it. One of my high school classmates knew he wanted to be a pharmacist. He worked in a Gloucester City pharmacy while we were at Gloucester Catholic. He graduated, went to pharmacy school, and later became the Chief Pharmacist at one of Philadelphia’s leading hospitals. He knew early on – a big advantage – and he was focused. Even though he went ahead a few years ago, I still admire the focus he had. He also made about two and a half times more annually than I’m making now, near the end of my career. Obviously, his focus paid off.

Another of our classmates was a student of “modest accomplishment”, like I was. We both would be the first to admit it. However, when he graduated he went to a fine college where he became highly motivated, subsequently went on to a lengthy post-graduate program and became a highly successful professional. It would be very safe to say he’s far exceeded the two and a half times figure above. He wasn’t focused early, any more than I was, but he surely turned that around – big time. He made the necessary changes. It made all the difference. So find something you can truly focus on, specialize as much as you are able to and go for it.

Get An Advanced Degree and/or Certifications – Or Maybe You Don’t Even Have Your Bachelor’s Yet?

If you’re talented, you may not have too much difficulty finding a good position. The question though is how far are you going to be able to go with it in the intermediate and long term?

I tell my Management students that in order to get a job, they need to create significant differential advantages over other candidates to get hired. Just saying, “I’m Jack or Jill and I have a Bachelor’s degree” isn’t going to cut it. (Especially when over 35% of NJ adults already hold Bachelor’s degrees.) I recommend that they learn to speak other languages, maintain an exceptional GPA, take foreign study programs, experience foreign travel, take online courses for improved flexibility and time management, gain relevant experience in the field they are planning to enter, and build their contacts, especially in fields and organizations they aspire to. LinkedIn is designed to help do that, but professionals should become well-versed in all major social media, to facilitate properly promoting themselves and their organizations.

(But what if you don’t even have your Bachelor’s degree or training in a skill that’s in demand? Maybe you think there isn’t any rush. You’re wrong. There is. I told you already how fast time went for me – from seventeen to seventy-three in no time. It’s not going to go any slower for you. You’ll be forty before you know it! And how much extra income are you sacrificing every year by just working at odd jobs or in a job that’s taking you nowhere? Income that could make you more independent – instead of having to just slink through life depending on your parents or others. Everyone has a valuable talent in something. You do too. Get started and find out what it is and focus on it until you’ve started your own road to success. Make an appointment at a local community college’s Advising Office. Take an interest test and listen to the advice you get. There are many options for you. You might be a late starter, but you can still be a strong finisher!)

For anyone who already has his/her Bachelor’s degree and a position, the same “distinguishing characteristics” logic above applies, except that you need to do some different things:

Getting a Ph.D can be one of them. Opportunities for promotion, the ability to teach on the university level, to do research, to get published, and to have greater credence in your field are all benefits that can emanate from this. I wish someone had told me this a long time ago. Wait… Someone did. When I was in my thirties, I thought that just by being recognized as a highly rated teacher and writing books, it would make me a tenure candidate at a four year school. Someone even told me flat out, “You’ll never go anywhere in education without a doctorate.” But I knew more, of course, just like you might think you do now with the limited knowledge you have. I never got a doctorate. While I may not have ever been promoted beyond my current modest academic rank, I ensured it by not getting one. That could be you if you don’t do what you might need to do.

This isn’t a gripe or crying over spilled milk. I made my choices. We’re bound by all the ones we made. After all, who was the one who was always there when the decisions were made?

I’m very fortunate to have the position I have and I appreciate it. This is just an attempt to get you to think about your future and to do something about it now, not when you’re past fifty, when it might be too late to make a substantive difference. Many of my colleagues have gotten their doctorates, even in their fifties. I really applaud them for it. Better late than never. But I’m sure all of them would tell you, it would have been far better to have done it sooner than later.

Obtaining a JD, a law degree, is another path. It is very true that even excellent law school graduates often have difficulty finding a position in the law, especially if they are seeking a position in private practice. However, a law degree can add prestige to a resume, and provide valuable legal, analytical and writing skills. It can also be a real plus when applying for a higher level position in your current field, or in another one. A law degree can be used in the military, business, human resources, educational administration, college teaching, and federal and state government administrative, research and analytical positions, among others.

It is almost a knee-jerk reaction for business administration majors to go for an MBA as a higher degree. If I were in that position again, I would get a JD instead. It’s a doctorate. That enables the holder to teach at the university level. It is also a more prestigious degree. MBA’s might be able to teach as adjunct university instructors, but almost never as full time faculty.

A “doctoral equivalent” for accounting majors, after a Master’s, can be to obtain a CPA. That is considered by a number of universities as the equivalent of a terminal degree in that field.

Sometimes a Master’s may do the trick. It’s very important in fields such as physical therapy, speech therapy and nursing. Similarly in nursing, it can be very wise to obtain an advanced credential as a Physician’s Assistant or Nurse Practitioner. These are what I call “intermediate professional positions”, between being a nurse and a physician. They have a strong future. Analogous to this is becoming a Paralegal, between being an attorney and a legal secretary. Just ask yourself this. If you managed a law practice or a hospital and could hire two or three of these employees for what it would cost to hire one attorney or one physician – when they perform some of the same functions – what would you do? That’s why there is only going to be continued growth in these professions.

One Master’s modification may be necessary when applying for an elementary or high school teaching position. It can often be better to get the job first with your Bachelor’s. Then after you get it, get your Master’s to make more money and have a more substantive professional credential, one that may also enable you to teach in a community college later. Normally, I would suggest getting a Master’s as soon as possible in any field, but school districts often don’t want to hire candidates with Master’s up front and strain their limited budgets. One caution: Some positions do require a Master’s to get hired, so check the job announcement carefully to determine if there is any such requirement.

Other avenues for creating strong “differentials” include obtaining fellowships, judicial clerkships, Board Certifications in the medical field, and certifications in other fields, both professional and technical. There are hundreds of computer,manufacturing and technical certifications that can be investigated too. Speak to professors in respective academic departments to advise you. It can all help. They can give you an edge in hiring, promotion and salary improvement.

Your competitors are going to have one or more of the above. You should think seriously about being more competitive yourself. Do what needs to be done. Not just what you feel like doing. Keep in mind that even successful people don’t want to do some of these things, but they do them anyway.

One of my cousins, who is the Vice-President of the Board of Directors of well known national company, previously served as CEO there and at several other national corporations. This necessitated a number of moves to Baltimore, New England, Wisconsin, Canada and many other locations for decades, as well as his having to travel throughout the world frequently. He, and his wife, knew what these jobs entailed when he took them and did what had to be done – and they did it well. That’s why he’s successful. That might not be for you, but whatever you choose to do, you have to be prepared to get the job done, whether if it’s operating an auto body shop, running a restaurant, operating a heavy rental equipment business or running a funeral home.

I’ve been a full time college professor for thirty-two years, an adjunct professor for seven years before that, and an approved real estate instructor for twenty years. I cost myself a great deal of money by not getting a law degree or Ph.D. as an educational credential. Probably at a minimum average of about $20,000 per year for thirty years – well over a half a million dollars. Do you want to lose that kind of money and lose the opportunities for promotions in your career because you lack the proper credentials? The same goes for more credence being given to much of what you might say or write. At my age, I’m not going to be making many changes. But it’s not too late for you.

Make A Change If You Need To

Its not uncommon today for workers to change positions a number of times and even career fields two or three times. This can be next to impossible for those who don’t have high level credentials and certifications. They give you flexibility. I can’t do much about that now, but you can. Please don’t think – “poor him”. Think instead “possibly poor me”, if I don’t do something about this while I’m still able to.

Sometimes when progress is stymied in a particular organization, or in your field, because a promotional path seems likely to be blocked for a long time, or there is serious difference of opinion on organizational matters or a disconnect with personalities, it might be best to make a change. Speak with some reliable mentors to get the pros and cons of doing so. Sometimes making a change can lead you to where you would do a lot better. It can make all the difference.

Finding True Happiness and Success

My Management lecture and online courses are about 70% Management and about 30% self-help in finding happiness and personal success. “Self-Management” is a necessary prerequisite to being a good manager in any field. And all fields, not just business, require management. It would benefit any student to take a Principles of Management course. I offer it, principally online. Anyone from anywhere in the world can take it through Camden County College, registering through CamdenCC.edu WebAdvisor, or through the College’s Registrar’s Office.

Success is something you need to define for yourself – and it’s not just about money. That’s one thing positive psychologists agree on.

I read a superior post on LinkedIn about a grade school teacher who sent home a message to Thomas Edison’s mother about him. His wise mother took a very negative portrayal and turned it into encouragement that produced a genius. I commented on it:

“This is an outstanding short – with a huge message. What people say to someone can provide the encouragement to discovery and success. Similarly, how many of you have heard of someone being told, “You’re not college material.” Perhaps sometimes they were right. But what about all those who got discouraged because some supposedly knowledgeable, but not too prescience or tactful “superior”, defined for them what was going to be possible in their life. Believe in yourself and possibilities. Thomas Edison’s mother did. It worked out well for him – and the rest of us too.”

We can all be Edisons in our own special way. Start building bridges to your own potential – no matter how old you are or what your station in life is now. George Bernard Shaw was asked near the end of his life, “Who would you have chosen to be if you could have been anyone else. He said, “I would be the man George Bernard Shaw could have been, but never was.” It is never too late for you to become that person.

That’s the version of yourself you should strive for every day, so you have fewer regrets at the end.”Of all the words of tongue or pen, the saddest are these: It might have been” – Rudyard Kipling. Now’s the time.

Need motivation yourself? Visit my extensive “Happiness and Success ” website at Camden County College. It will encourage you and it will help you:

Finding Happiness and Well-Being, Success, Motivation, Innovation, Reinvention and Becoming A Better You

It’s not just for college students. It’s for anyone of any age and any occupation or profession seeking real gratification, peace and contentment in their lives.

I guarantee that it will improve perspective for anyone who takes the time to read the over one hundred and ten positive psychology and self-help topics it contains. Read a few each day or at night before going to bed. I would encourage any employers to point their employees toward taking a look at it or to use the topical summaries in their own professional development courses. It’s the type of material that Chief Happiness Officers (CHO) would use. The website log-in appears below:

Happiness and Success Course Log-in:

– Go to: ccc.webstudy.com

– User Name: happiness

– Password: success

– Click Happiness, Success and Motivation Course

– Then “Timeline” on left

– Then “Expand All” at the top

– and You’re In! Scroll down to view the fifteen website segments and the many readings that can be clicked on, including two of my books. One is Your Unfinished Life. If you’re still breathing, you have one.

You don’t have to reinvent the wheel to be successful. Just pay better attention to some of the good advice you might be getting – and choosing to ignore. Far better to ignore those who tell you that you don’t have the right stuff. Be the best of what you are capable of becoming. Don’t sit rocking in a chair on a porch someday far in the future with regrets about what you could have done. Do something about it now.

Danger! Fungal Infections in Arthritis Joints From Contaminated Steroids!

The ongoing epidemic of fungal infections from contaminated steroid injections is going beyond the brain and spinal cord to include the many joints injected by arthritis specialists. The medicine, methylprednisolone acetate, is a commonly used prescription steroid for the treatment of inflamed joints. Since rheumatologists often inject joints in patients with arthritis, this presents a potential problem.

While infections in the spinal cord and central nervous system present fairly quickly following injection, it is apparent that joints injected with contaminated steroids may take several months to produce symptoms. According to Dr. Kevin McKown of the University of Wisconsin Medical Center, new cases of fungal infections in joints may present for the next six months… or even longer!

Unlike the brain, joint infections can remain indolent which leads to delay in diagnosis.

There have been at least two cases of joint infections from contaminated steroids reported to the FDA as of November 1, 2012.

Symptoms suggestive of infection include, fever, pain, increased redness, warmth, and swelling in the joint that received the injection. Since this is also a sign of a joint flare from arthritis, an infected joint may not be easy to identify.

If the infection is not recognized, the fungus can spread and lead to osteonecrosis (dead bone), a destroyed joint, and also spread to other joints via the blood stream. In its most virulent form, it may cause death.

The compounding pharmacy responsible for this outbreak is the New England Compounding Center located in Framingham, Massachusetts. It was found guilty of selling large amounts of the medication across state lines. The New England Compounding Pharmacy sold lots of their drugs to clinics in more than 23 states before being shut down by the Federal Food and Drug Administration.

So far, the two species of fungus isolated have been Aspergillus and Exserohilum.

The major problem in identifying cases is that fungal infections are slow to develop and symptoms are not always recognizable after such a long period between symptom presentation and joint injection. For example, cases of meningitis often take anywhere from one to four weeks before presentation. Joints that have been injected can take much longer.

Of the many states reported to have received the contaminated steroid preparations, there are California, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, Nevada, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia, and West Virginia.

Taking the Pulse of Med Management, Clinical Execs Must Review Systems and Ensure Staff Engagement

Medication management may be one of the greatest clinical challenges in senior living, where the average resident may take four to six medications a day, or more. Yet the assisted living business has earned a reputation for consistent positive performance in this arena.

“A major reason people move into assisted living is that they need help with medications, so it is a service we take very seriously,” says Maribeth Bersani, ALFA’s senior vice president for public policy. “We are training people, we are monitoring them, we are doing it safely and doing it well.”

The numbers bear it out. Looking at all medication mistakes with the exception of time errors, assisted living shows an error rate of 8.2 percent versus 10 percent in hospitals, according to Heather M. Young, Ph.D. and GNP, et al. in their paper, Types, Prevalence, and Potential Clinical Significance of Medication Administration Errors in Assisted Living.

It takes a range of best practices for assisted living providers to score consistently high in the realm of medication management.

Internal Vigilance

Some 1.5 million people receive the wrong medication or the incorrect dose each year, according to the Institute of Medicine, part of the National Academies of Science. Yet assisted living has a history of positive procedures that help ensure accurate dosing, of-ten in response to systemic causes that originate outside assisted living.

Sandi Flores, RN points to poly-pharmacy as one example. “One of the major factors is the sheer number of meds our residents are taking,” says Flores, director of clinical services for Senior Resource Group.

To keep a handle on poly-pharmacy, assisted living communities implement a range of protocols, according to a survey conducted recently for the Center for Excellence in Assisted Living (CEAL). The survey found that 74 percent of assisted living providers make sure doctors or registered nurses review lab data for residents; 68 percent use consultant pharmacists, and 67 percent use blister cards or pillow packs from primary pharmacies. This type of packaging is a safeguard to ensure residents receive correct medication dosage.

Transitions also may be an issue, a time when drugs or orders can get mishandled on their way to the assisted living community. “The biggest problem we have found is when a resident is transferred [into assisted living],” says Loretta Kaes, RN , vice president of health services for Chelsea Senior Living.

Safeguards begin with a vigilant nursing staff, Kaes says. “I want the nurses to question the orders. If you see a resident on 23 medications, I want the nurse to ask which of these drugs possibly are overmedicating,” she says. Nurses likewise make it a point to reconcile the medications as delivered against those as prescribed.

New models also are emerging. Kaes has served with the Health Care Association of New Jersey, which has developed an even more streamlined system. The group has urged doctors to communicate directly with pharmacies, reducing the possibility of error and saving the nurse one step. “Otherwise, you spend 18 hours a day trying to chase the doctor down” in search of clarification, Kaes says.

Rise of the Med Tech

One of the most promising, and most effective, evolutions in medication management has been the rise of the medication technician, or med tech for short. Also known as trained, unlicensed assistive personnel (UAP), these individuals are authorized to deliver medications, freeing nurses to pursue other tasks. The use of UAPs is allowed in virtually every state. These valuable personnel are enabled to do a variety of tasks depending on the state, and are required to attain certain types and levels of training, again varying by state.

In the realm of medication management, “UAPs generally do remarkably well with this complex task. The bulk of the medications are low risk and routine, and the risks appear to be minimal,” Young writes.

While some states are questioning the use of UAPs, a growing body of evidence suggests med techs are an effective means for assisted living to maintain its high level of medical management assurance. “Where it is allowed, which is in most states, it is working very effectively,” Bersani says.

Success lies in training, not merely an introduction to “how” things are done, but also a view toward why. “These are intelligent people, you can’t just teach them a task. You teach them the rationale behind things, and that is when you see an increase in performance,” Flores says. With an understanding of not just how but why, “people are much more understanding of proper dosing, proper timing, and so on.”

To ensure information sticks, Flores issues hands-on testing in multiple topics. The student also must make three perfect passes under supervision before being allowed to fly solo. Delivering training throughout this nationwide organization relies in part on quarterly webinars, which Flores creates.

One more winning strategy for utilizing med techs: Dress the part. Many will think it is a small point, but Flores insists that uniforms for medication aids lead directly to fewer errors. “They are recognized as being something special, and so they act like something special,” she says.

Systemic Strategies

Underlying all these basic strategies, successful administrators demonstrate a commitment to a systematic approach to medication management. To get the right drugs and dosages into the right hands at the right time, appropriate systems must be in place and safety protocols must always be consistent and repeatable.

Best systemic practices in medication management cover a lot of ground. Strategies can be incredibly detailed. A few that are absolutely worth implementing include the following:

Get stakeholders involved. Staff, physicians, and pharmacists all should have a chance to offer input into the plan, since they will be the ones to put it in practice. Transfers are crucial. Check the labels of everything coming from home or from the hospital. Read back phone orders and don’t hang up without verbal verification. If a resident is self-administering, confirm every quarter that the resident is still capable of the task. “Success comes from having the right systems and protocols in place,” Kaes says. “By constantly reviewing and observing those who dispense medications, it allows us to ensure that people are getting the right medications in the right manner.”

The biggest and broadest effort has to do with handling procedures among the staff: where and how medicine is received, stored, and dispensed. Every residence will do this differently. So long as the procedure is easy to understand and simple to implement, the “how” will matter less than the assurance that the internal system is solid. It must be repeatable, and must be repeated consistently time after time.

Some add a further step: Ongoing auditing. It’s just one more way to ensure accuracy, says Patricia Foran, president of C.O.R. Services, a consultancy to the senior housing industry.

Foran has been on the front lines, having served as a vice president at Benchmark Assisted Living prior to becoming a consultant to multiple assistant living communities. Looking at the situation from all sides, she says auditing is a significant tool in keeping errors in check.

Given the possibility of human error, “you need to have somebody to physically monitor what is going on,” she says. In Virginia and elsewhere, the executive director has to be certified in medication management, so there’s a built-in auditor. Outside consultants also can play that role.

In a typical audit, “we are literally asking people to go on a med pass, and watching how the practice is being performed. Then you finetune it each time,” Foran says. “You need to do this no less than quarterly.”

For Further Assistance…

In the best examples, assisted living residences have looked beyond their own internal resources, getting families involved for cooperative efforts in such realms as co-pays and drug availability.

“I think the families have to be really aware that their family member is in a plan that covers all their drugs,” says Jody Silva Falk, vice president of client services at Chem Rx, a pharmacy serving about 30 assisted living residences. “They need to know their formulary changes every year and they need to stay on top of that. They need to take a proactive role in what’s going on with mom’s coverage.”

In addition to family participation, combined with skillful management of the human elements within the community, technological aids can simplify and safeguard various tasks on the way from prescription to administration.

Automated medication dispensing carts secure medications and track dosing regardless of where the resident may be at the time.

Web-based prescribing facilitates the electronic creation and transmission of orders from desktop to pharmacy. Multi-alarm reminders and watches alert users when it’s time to take medications. Multi-alarm pill boxes likewise deliver an alarm while also storing pills.

Automated crushers and splitters ease dosing by reducing pills to the appropriate size.

In barcoded medication administration, a handheld device is used to scan a barcode on the resident’s wristband ID and match it against coding on the package of the medication to be dispensed.

RFID (radio frequency identification) assists with accurate medication tracking and inventory management. “[Electronic medication management tools] can be a real help if, internally, you have a good computerized system already in place-if you have electronic file maintenance and other internal systems,” says Silva K.M. Gerety, corporate director of health and wellness at Brightview Senior Living.

No one would say medication management is a walk in the park. Certainly, there are potential challenges with polypharmacy, human error, and the long chain of involvement from doctor to pharmacy to nurses or assistant. Yet assisted living continues to demonstrate its ability to rise to the challenge.

“People who come to assisted living generally are getting their medication the way they are supposed to, on time, in the right dose. This is a huge benefit to our residents,” Kaes says.

Physician Medication Dispensing – A Healthy Choice for Primary Care Practices and Patients Alike

Working on the front lines of modern health care, the primary care physician is arguably the most important physician any patient comes in contact with throughout life. Yet, more than half of primary care physicians feel they aren’t getting credit where credit is due. According to a 2007 survey done by Merritt Hawkins & Associates, 53 percent of primary care physicians said they felt like second-class citizens in the medical hierarchy.

Why? Too much work and not enough pay. The same survey showed while 83.1 percent of primary care physicians considered their practices to be very busy or even too busy, 58.6 percent of those surveyed were disappointed in their income. Many struggled with the cost of overhead, and 22 percent worried they could not sustain that overhead in the next five years.

How can primary care physicians generate more income and manage overhead more efficiently without shortchanging the patients who rely on them? The solution is physician medication dispensing.

Out with the new, in with the old

Abandoning the pharmacy concept may seem new. However, historically physicians dispensed the medications while pharmacists manufactured them. In the early to mid 20th century, things changed. Pharmaceutical companies began manufacturing and distributing medications, pharmacists began dispensing medications, and physicians prescribed medications.

Most primary care physicians currently dispense medications in the form of samples, infusions and injections. In-office dispensing allows physicians to dispense all the medications they prescribe while increasing their practice revenue.

Increased revenue

The most obvious pro for primary care practices is the opening of a new revenue stream. Physicians usually fail to realize how much time is spent each day dealing with pharmacy issues.

Each pharmacy callback costs the physician on average $5-$7 per call. A typical practice can spend $30,000 a year handling these pharmacy-related issues, all for no revenue. These issues consume 6-12 percent of physicians’ time. In-office dispensing can also improve the cost and management of overhead.

There is, of course, an initial learning curve and time investment. The process of training staff and implementing physician dispensing can be difficult, but the training process is essential for success. Successful training and implementation + time + physician leadership = increased revenue for a practice.

Space requirements for dispensing vary according to practice or clinic size. Medications must be kept in locked cabinets; typically, a five- or six-foot locked tool cabinet is sufficient for a solo practice. Medications should be kept out of patient-accessible areas. Larger practices may find it more efficient to dedicate a room entirely to dispensing.

These start-up costs are nominal. With successful training, implementation and continued use, those costs can be recouped within a few months.

Improved patient care

A simple reason for physician dispensing of medications is improved patient care. Two more compelling reasons are: 1) writing and dispensing errors are nearly eliminated and, 2) compliance rates (patients getting their prescriptions filled and taking all the medication as directed) are increased by more than 60 percent. An increased compliance rate means lower overall health care costs.

According to the Institute of Safe Medicine Practices, more than 3 million of the adverse drug events that occur each year in ambulatory care are preventable. These adverse drug events (i.e., illegible writing of prescriptions, unclear telephone/verbal orders, unclear abbreviations, unclear or inappropriate dosages, etc.) cost primary care practices thousands of dollars in overhead.

The pharmacy has to call the physician to clarify, and the physician must take the time to call the pharmacy back. More importantly, these errors cause a decrease in patients’ overall health, and a decrease in the confidence they have in their provider.

Convenience is another benefit of physician dispensing. A typical pharmacy wait time can be upwards of one hour, not including the time it takes for the patient to drive to the pharmacy after their physician visit.

The pharmacy visit time is due in large part by design. The pharmacy is oriented more for sales rather than health care Extra time in their store means more dollars and profits from the patient. Physician dispensing allows the patient to receive their medications at the point-of-care and eliminate this additional pharmacy wait time. All patients, including the elderly, disabled, and parents with sick children, are appreciative of this convenience.

Physicians who dispense are also more aware of the costs of medications. With physician dispensing, they can make the lower-cost generic and therapeutic substitutions on the spot. Traditionally, a pharmacist has to call the physician’s office to get the change made, then wait for the physician to call back to approve the change. This additional wait time (often the patient must leave and return) means the patient is not getting the medication they need when they need it. Therefore, their medication treatment is postponed.

Legal and ethical implications

Physician dispensing is fully legal in 44 of the 50 states. The states of Texas, New York, and New Jersey have placed restrictions on physician dispensing. Only three states have prohibited physician dispensing: Massachusetts, Montana, and Utah. These restrictive laws when dissected serve only one purpose: isolate the profit to the pharmacy. These laws and regulations would probably be held an illegal restraint of trade if challenged under federal law.

Each state is different in their dispensing guidelines. Some states also require an additional dispensing license, which can be obtained for a nominal fee. A qualified and reputable physician dispensing provider can assist you in these areas.

Some physicians are also concerned physician dispensing is a conflict of interest. This could be a conflict of interest, but so is a physician scheduling an office visit, ordering X-rays, lab tests, a hospital stay for a patient and surgery.

The American Medical Association (AMA) endorses the concept of physician dispensing, provided the physicians follow state and federal guidelines, and still allow their patients a choice of where to get their medications.

The overall goal of X-rays, lab tests, surgery and physician dispensing is improved patient health. Physician dispensing is clearly a necessary tool for better patient health.

A choice for your practice

Physician dispensing improves patients’ health. It increases a physician’s practice revenue. It creates higher compliance rates, which in turn lowers overall health care costs for patients and payers. It is completely safe, legal, and endorsed by the AMA. All of these benefits rally on the side of the physician. Medication dispensing is a service that should be in your practice.

The Warren County Winery Train

A single, seasonally-aged leaf, carried by the mid-September billow, floated toward the main and side tracks paralleling the Delaware River at Phillipsburg’s Lehigh Junction Station-a sign of the time, and a sign that it was time for wine-one of the many products of autumn’s harvest. But, before I reveled in the oak-hinted vintages the latest grapes had produced, I first had to access a local winery-specifically, the Villa Milagro Vineyards, located some eight miles from here in Finnesville. That experience, combined with the rails, would result in what was dubbed the “Warren County Winery Train.” But why the rails?

A glance over my left shoulder up the hill to an imposing brick building, currently painted green, indicated more. Like a full-sized, living history book, it revealed its past. It was once the Phillipsburg Union Station, and the gravel on which I stood fronting the tracks while I awaited my wine-or at least my method of getting to it-represented but a shadow of the town’s former railroad self.

“Never the twain shall meet” goes the saying, but it did here, if “twain” could be defined as “train.” Located in western New Jersey, on the edge of the region’s Lehigh Valley and on the state line (here that line is actually a river) with Pennsylvania, Phillipsburg was incorporated as a town by an Act of the New Jersey Legislature on March 8, 1861, and is today Warren County’s largest city, mirrored by its sister, Easton, across the water.

But that water, perhaps more than anything else, gave it rise. Situated at the confluence of the Delaware and Lehigh rivers, it naturally evolved as a transportation hub, linked, via the Morris Canal, to New York City’s industrial and commercial centers from the 1820s onwards, and to the west, via the Lehigh Canal.

After barge-negotiation of the waterways, products and goods were transferred to one of five major railroads, all of which also converged here: the Central Railroad of New Jersey, the Lehigh and Hudson River Railroad, the Lehigh Valley Railroad, the Delaware, Lackawanna, and Western Railroad, and the Pennsylvania Railroad. Local transportation was facilitated by five streetcar and interurban railways.

All these trains needed more than the splotch of gravel on which I stood to process passengers and products, and part of that deficiency was remedied by Union Station, located at 178 South Main Street and constructed by Frank J. Nies, architect for the Lackawanna, in 1914. It was also used by the Central.

Symbolic of the city’s great railroad era, it was the last vestige of what once encompassed a complex of stations, roundhouses, turntables, interlocking towers, signal bridges, and coal pockets. Having served as a political campaign headquarters, a pharmacy, a bank computer center, and a sporting goods store, it is occupied today by the Friends of the New Jersey Transportation Heritage Center, whose members are restoring it to its turn-of-the-20th-century splendor. Negotiation of its required tools and equipment (and resultant dust), however, still offers a glimpse of its ticket windows and waiting areas, along with an n-gauge model railroad layout and a few artifacts.

Where did all the trains go? Like numerous other US cities served either by main or branch lines, the wheels were either transferred from the rails to the roads or the skies, decreasing demand prompting service reductions until the town had closed its book on the railway era. The Lackawanna, for example, had run its last passenger train to Phillipsburg in 1941 and New Jersey Transit followed suit four decades later, in 1983.

Today, the area is only served by two such rail concerns. The first, the Norfolk and Southern, operated freight trains and accessed Phillipsburg via the former Lehigh Valley Railroad tracks, crossing the river on the Lehigh and Hudson River Railroad Bridge. The second was a tourist railroad, the Belvidere and Delaware River (Bel-Del) Railroad, operating under the Delaware River Railroad Excursions name as far as Riegelsville.

With the sheer thought of it, I could now feel the fermented liquid running down my throat, since it would transport me to the all-important vineyard. But it first had to run on the rails before I could reach that point.


That railroad hardly plied smooth ones to get where it is today. Indeed, its own journey, which was characterized by obstacles and setbacks, was a circuitous one-and often without track and the rolling stock needed to use it. Then again, the situation was not as ironical as envisioned, because establishing a railroad was never its intention from the start.

Its origins lay with the New York Susquehanna and Western Technical and Historical Society, a not-for-profit educational group founded in 1988 with eight members, to restore engines and coaches and preserve New Jersey’s railroad history. With it came the first idea of establishing the previously mentioned New Jersey Transportation Museum.

Wheels first rolled, at least in the direction of its restoration destination, with the lease of a self-propelled, 1950 Budd RDC-1 (M-1) passenger car from the United Railway Historical Society intended for the museum.

Initial train operations were not its own, but paved the way (a long way) toward it. Its members, along with those of another group, staffed those undertaken by New Jersey Transit to Hawthorne for skiing purposes and Vernon in early-1990, thus providing initial hosting experience of rail-facilitated events.

After the United Railway Historical Society signed a lease for the Morris County Central engine house in Newfoundland and four former Morris County Central members themselves began work on the M-1 in July, the need for funding arose and, looking back at the revenue-generating rail rides it had hosted, the New York Susquehanna and Western Technical and Historical Society elected to extend that effort, running trips with full dining service on the Susquehanna line.

Gleaming like a gemstone just polished by a jeweler, the restored M-1, periodically rolled out of the engine house, attracted considerable interest and it operated its trial trip to Sparta on September 12, 1992. While it had only been displayed when it had been rolled out, it was now ready to wear-or, more appropriately, ride-and the public was eager to try it on-so much so, in fact, that the tourist journeys begun later that month in Whippany had culminated with an oversold one at the end of the Christmas season, necessitating an impromptu capacity increase from its existing 88 seats to 117 with temporary folding chairs and the accommodation of five children to a seat bank.

Historic and scenic tourist railroads were hardly novelties, but those operated by single, self-propelled coaches were, and capacity could not be adjusted to meet demand by coupling another car to it, simply because the society did not have one. However, a scouting trip to Tennessee yielded two-as in “two more”-an M-2 acquired by it and an M-4 purchased by some of its members.

Intending to operate its own sightseeing excursions, New York Susquehanna and Western purchased a Mikado SY steam engine from the Valley Railroad.

Despite what appeared to be increasingly green signals, the September 11 terrorist attacks abruptly turned them all red, their resultant-and prohibitive-liability insurance requirements for steam engine operations leaving the Susquehanna little choice but to sell the society the engine it could no longer afford to operate on its own track. Leasing its cars, along with those of another rail concern, it was able to inaugurate its own service, using New Jersey Transit tracks.

Funding now proved its own obstacle. Escalating New Jersey Transit movement and inspection fees left it virtually trackless. Then again, it did not own any coaches to couple to its just-acquired locomotive, even if it had the rails to do so.

The latter problem was solved when it purchased five 1950s-1960s Long Island Railroad 3/2 Pullman coaches and three 1960 ex-Metra (of Chicago) Pullman Galley bi-level ones, and these were added to the vitally important equipment roster, which now included the three 1980 Budd SPV-2000s (M-1 through M-4), the steam engine, and the previously obtained 18-ton, 1938 Plymouth locomotive.

But rail journeys were not always smooth-especially this one-and yet another company seemed imminent to write its history with its wheels in Phillipsburg, chosen location of the state transportation museum. The Black River and Western Railroad, owners of the Belvidere and Delaware River Railway and operators of its own excursion trains between Flemington and Ringoes, acquired a gas-powered Brill Model 55 motor car for this purpose.

But, unlike the many derailing events that had characterized its historical journey, this one resulted in a synergistic car-coupling and not in the hitherto-expected competitive impact. That car coupling, representing its partnership, saw it inaugurate weekend steam train service on May 1, 2004 over an initial 3.5 miles of Belvidere and Delaware River Pennsylvania Railroad branch tracks laid in 1854 and these were extended by two miles in 2006 and by another 900 feet two years after that. Society members, for the first time, graduated from coach attendants to full-fledged conductors and engineers in the process.

The sooner the train glided into the Lehigh Junction Station today, the sooner the wine would glide over my tongue.


The brisk day, sending the scent of autumn to the senses, was suddenly assaulted by soot. Emerging from the natural tunnel of foliage surrounding the track and ducking under the trestle that had, only moments before, supported an elongated Norfolk and Southern freight train, a red caboose and four “Susquehanna” coaches were nudged into Lehigh Junction Station by the Belvidere and Delaware River Railroad’s signature 13-ton Mikado 2-8-2 coal-burning steam engine, #142, built by the Tang Shen Locomotive Works of the People’s Republic of China in 1989 and dubbed the Walter G. Rich after the late-CEO of the New York Susquehanna and Western.

A brief brake snag, signaled by a screech, caused the collected crowd to approach and then funnel its way through the opened door. I settled into the last car, #533-one of the Long Island Railroad coaches with walkover seats and a blue interior, and reserved for winery passengers. Only half-full, it assuredly offered sufficient space for what would be full-full-that is, the bottles of wine purchased at the vineyard.

Once again releasing a bulbous gray belch from its stack and a whistle that tore the morning’s fabric, the locomotive gave a gentle nudge to its cars, as they glided back under the trestle and settled into a rhythmic sway and clack abreast of the Mica-glinting surface of the Delaware River now visible through the right-hand windows.

Across the river, at the site of Williamsport, was the so-called “Forks of the Delaware”-or the junction of the Lehigh and Delavare rivers, itself the funneling point of the Lehigh, Delaware, and Morris canals.

At the southern edge of Raubsville, which was also on the Pennsylvania side, was the Delaware Canal’s double Ground Hog Lock–and its deepest, at 17 feet–next to which was the hydroelectric powerplant whose turbine was powered by canal-harnessed water.

Subjected to constant soot and smoke onslaughts from the locomotive, the coaches and single caboose bored their way through the arboreal tunnel, whose trees seemed equally coated in early-fall’s brown embers. Despite their lack of glitter, a rare nougat of autumn-brushed gold occasionally highlighted the collage.

Passing under the bridge that carried Interstate 78 from New Jersey to Pennsylvania, the train sliced through Carpentersville, once the location of a Bel-Del station and now little more than a hamlet formed by a scatter of vintage homes. A narrow road, as if compressed by a vice, thread its way between the tracks and the cliffs.

Rising, like two medieval monoliths beyond the third grade crossing, were two limestone kilns, once part of the almost two dozen which had graced the area and were fueled by coal, which itself had been transported by these very tracks. After locally quarried limestone had been ground into powder suitable for soil preparation and mixture with mortar, it had once again been rail-transported by the bushelful to Flemington, Trenton, and Monmouth County.

The coaches continued to sway-the very perception I expected to have after my wine, even if the train had not been in motion.

After a final burst of coal-created soot and cinders, and a last screech of the brakes, the train ceased motion, still immersed in dense foliage, now short of Riegelsville, one-time site of another Bel-Del station.

My dry throat, anticipating a vineyard oasis in what externally resembled nothing like a desert, prepared itself for lubrication, but the last mile or so of the journey, unable to be completed by the train because of still unrehabilitated tracks, required transfer to a yellow school bus. (Of course, I had forgotten to do my homework.)

Riegelsville itself was the location of one of the country’s few remaining, multi-span highway suspension bridges with continuous cables. Designed by John A. Roebling and Sons of Trenton-who themselves were the architects of the Brooklyn and Golden Gate spans-it connected Pohatcong Township with Riegelsville, Pennsylvania, and replaced the tri-span, wood-covered artery constructed in 1837 and used by foot, horse, and wagon traffic. Destroyed by a flood in 1903, it lent its piers to the current bridge, which opened on April 18 of the proceeding year.

Following the narrow, track-paralleling road and skimming the edge of the historic town, the bus shifted its way up a steep hill past a ceramic silo and threaded its way through tall cornstalks to the 104-acre Villa Milagro Vineyards, located in the Warren Hills Appellation and owned by Steve and Audrey Gambino.

Noted for its use of organic and sustainable practices to provide a protective habitat for native species of birds and plants, it produced ten varieties of grapes blended in the traditional European style to create complex wines.

An escorted tour of the fields, grapes, fermenting, and wine–making processes at last led to the tasting room, and the half-dozen varieties-from Merlots to Cabernet Sauvignons to Shirazes-accompanied by hot hors d’oeuvres finally enabled me to reach my physical and culinary destination.

Like the clinking of two glasses, my rail car, to which I had subsequently returned, seemed to toast the one ahead of it as their tensing couplings caused a momentary jolt and the smoke- and steam-emitting locomotive pushed them along the river-paralleling track for their journey to Phillipsburg in a backwards direction. With the wine I had had, at least it felt that way.

Where Are Drug Company Profits Really Going?

The leading trade organization for U.S. drug companies, Pharmaceutical Research and Manufacturers of America, or PhRMA, keeps telling American consumers that the high cost of drugs is due to pricey research and development costs, but what the organization fails to mention is skyrocketing salary payouts to its own directors and record high marketing and lobbying expenditures, which translate to crippling-high prices of drugs to the American consumer.

New drug development is often funded by private sources. In 2001, Donald Light, a economics professor at the New Jersey School of Medicine specializing in drug economics, released a study finding that more than 84 percent of drug research money around the world comes from public and charitable sources, not deep-pocketed drug companies who claim to be getting the hit.

The proof is in the pudding with the case of Thalidomide, a drug that was banned for decades before being brought back with publicly funded research. In the mid-1990s, Dr. Bart Barlogie, who runs the Myeloma Institute for Research and Therapy in Little Rock, Arkansas, found that Thalidomide could dramatically reverse the course of multiple myeloma, a life-threatening blood disorder. In 1999, he published his study results in the New England Journal of Medicine. Shortly thereafter, use of the drug was expanded from being completely banned to being used to treat leprosy and childhood leukemia. Dr. Barlogie’s study was primarily funded by the National Cancer Institute and American government grants. But the drug company was the one to profit.

In response to Dr. Barlogie’s groundbreaking research, Celgene, the manufacturer of Thalidomide, dramatically hiked prices. Before the research was published, Celgene was charging $400 for a month’s supply of the drug. Within six years, it was charging $3,600 per month, an increase of 900 percent!

Russell Williams, the president of the leading trade organization for Canadian drug companies Research-Based Pharmaceutical Companies, Rx&D, insists that drug development costs fall to the companies. Williams says it costs drug companies more than $1 billion to discover and develop a new drug.

But Dr. Marcia Angell, former editor in chief of the New England Journal of Medicine puts the price tag on R&D for a new drug at $100 million, which she calls “a charitable guess.”

So where is Williams getting his billion-dollar number?

Williams was likely using a 2002 study by researchers at Tufts University in Boston who put the figure for new drug R&D at $802 million. But the study was performed using data from the drug companies themselves by economists that were funded by the drug industry, evidence that the drug industry was interested in massively inflating research and development costs to justify extremely high prices.

In Forbes’ list of the world’s leading companies, pharmaceutical companies have profit margins averaging 20 percent, whereas the average profit margin for the 2,000 leading companies worldwide is 8 percent.

Where is the money in the gap going then, if not to drug development?

Probably to the drug industry execs themselves.

Billy Tauzin made $4.48 million in 2008 as the top lobbyist for drugmakers in his position as CEO of PhRMA.

While PhRMA and drug company execs say huge R&D costs justify the high price of medication, are they really looking to justify their high salaries?

Drug companies seem to be benefiting by exploiting the very people they claim to be trying to help.

When will these profits start being redirected into drugs that can help consumers themselves?

The Best Medical Clinics and Doctors in Jersey

Jersey, the largest of the islands in the English Channel, is an offshore financial hub with a booming tourist industry. Though widely reported to be, Jersey is not, in fact, part of the United Kingdom, but a British Crown dependency. Jersey’s economy, finances and healthcare are topics of frequent discussion, and residents of Jersey must be aware of the current health policies. While the island does have its own health insurance scheme, having international health insurance as well is recommended, as some conditions must be treated elsewhere. The following is a list of the best medical clinics and doctors in Jersey.

Cleveland Clinic

Jersey’s Cleveland Clinic has been in operation for more than 40 years, and is the island’s second largest practice. With a staff of 13 doctors, this clinic has several surgery locations. The Town Surgery is located in St. Helier at 12 Cleveland Road. Open Mondays and Thursdays from 8am to 7pm, Tuesdays from 8am to 8pm, Wednesdays from 820am to 715pm, Fridays from 8am to 6pm and Saturdays from 9am to 12pm, this location was renovated in 2009. The second surgery is located in St. Brelade, on the first floor of Unit B Millenium Properties in Arcade; this surgery opens at 9am Monday through Saturday, and closes at varying times between 330 and 1130pm. The final Cleveland Clinic location is on the Route du Marais in St. Ouen. A small branch, the St. Ouen Surgery is open from 9am to between 440 and 545pm during the week, and from 9am to 1130pm on Saturdays. The services provided by Jersey’s Cleveland Clinic include antenatal care, well checks, minor operations, sports medicine, screening procedures and more. The St. Helier Surgery has an attached Cleveland Pharmacy for patients to utilize, making filling prescriptions quick and easy, and the Cleveland Clinic also offers after hours service to their clients.

Island Medical Centre

The Island Medical Centre on Jersey island has four clinics, located in St. John, Grouville, St. Helier and St. Brelade. The practices’ extensive team of doctors and nurses conduct appointments between 8am and 6pm Mondays through Fridays, and from 8am to 12pm on Saturdays. The centre’s innovative website design allows patients to book appointments and request prescription refills online, as well as print out new client forms for easy registration. The Island Medical Centre offers urgent appointments, telephone advice and home visits, as well as treatment for temporary residents, or visitors to the island. An on-site pharmacy is available to fill prescriptions and provide medication-related advice.

Meridian Clinic

The Meridian Clinic is a holistic Jersey practice that specializes in colonic hydrotherapy, osteopathy, herbal medicine and acupuncture. Located in central St. Helier on Nelson Street, this Jersey practice is open from 9am to 6pm Monday through Friday, and between 9am and 1pm on Saturdays. The Meridian Clinic offers 24-hour emergency service to their patients when the office is not open. This clinic is run by Mr. Badrul Huda, who is extensively trained in osteopathy, colonic hydrotherapy and acupuncture; he also extends his osteopathic services to both canines and equines.

Many of these Jersey medical clinics accept many forms of payment, such as debit and credit card, as well as many different types of insurance. With the medical centres and surgeries in Jersey ranging from traditional to holistic, there is no doubt that island residents and visitors will be able to find the particular care they are looking for. If you are looking to find the best Doctor in Jersey, the ones listed above are some of the best available.

How the New Federal Minimum Wage Will Affect You

The Federal Minimum Wage increased on July 24, 2008 to $6.55. This raised the minimum wage by $.70. Approximately 2 million Americans make minimum wage. This results in approximately an additional $5.60 a day, $28 a week and $112 a month for a 5 day work week. An additional increase will occur next year and raise the minimum wage to $7.25 an hour.

Twenty-three states including the District of Columbia have a minimum wage higher than the new federal requirement which affects approximately 60% of American worker and are: Alaska, Arizona, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Illinois, Iowa, Maine, Massachusetts, Michigan, Missouri, Nevada, New Jersey, New York, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, Washington and West Virginia.

The low-income and middle class are greatly affected by the current recession. The minimum wage increase unfortunately is not enough. Many Americans are struggling just to make end meet and to buy basic necessities and have to use credit cards just to buy food and gas.

The average family is spending approximately $4,655 more on basic necessities such as food, housing and gas. Child care costs have also increased for those with children under age 5 to $1,508 a month and for after-care with older children to $622 a month.

Food prices rose more than 4% from last year. According to Money Magazine the cost of prescriptions drugs has increased, pharmacy co-pay prices have increased 25%, the cost of milk has increased by 14%, the cost of college tuition by 6%, the cost of eggs by 31%, the cost of bread by 14% and the cost of gas by 21% since last year.

Americans will have to find additional ways to reduce expenses and make their dollar stretch further. If you like to eat steak for dinner substitute it for chicken or fish, beans and rice for dinner or breakfast food for dinner. Fix tuna casserole, or other types of casseroles, stews or soups for dinner to save money on food costs. You can also shop at wholesale stores, buy items or sale, use coupons, carpool to work, shop at thrift stores or discounts stores such as Costco, Walmart, Ross, Marshalls or J.C. Penny.

Cut expenses in every area you can. You will have to make sacrifices to make ends meet but it is possible. Think of creative ways to save money by reusing items, holding a yard sale or bartering services with others who have businesses. It will take a lot of hard work and discipline to make it through these tough times but if you make it through you will know that you are a survivor. Good luck to you.

Harrine Freeman is owner of H.E. Freeman Enterprises, a speaker, personal finance expert and the author of, “How to Get Out of Debt: Get an “A” Credit Rating for Free Using the System I’ve Used Successfully with Thousands of Clients.

H.E. Freeman Enterprises is a personal finance services company that helps clients restore their credit and learn how to manage their finances. She is a member of Credit Professionals International, the American Association of Daily Money Managers, SPAWN, Toastmasters, AAUW, National Association of Women Writers, and the Women Network.