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Reading: Improving Long-Term Care Facilities' Crisis Response: Lessons From the COVID-19 in Chile
Special Collection: COVID-19 and Long-Term Care Policy
Improving Long-Term Care Facilities' Crisis Response: Lessons From the COVID-19 in Chile
Josefa Palacios,
Millennium Institute for Caregiving Research (MICARE), Santiago, CL
Maureen Neckelmann ,
Instituto de Sociología, Pontificia Universidad Católica de Chile, CL
Pablo Villalobos Dintrans,
Universidad de Santiago; Millennium Institute for Caregiving Research (MICARE), CL
Jorge Browne Salas
Sección de geriatría, departamento medicina interna, facultad de medicina, Pontificia Universidad Católica de Chile, CL
Context: The COVID-19 pandemic hit Chile hard and affected older people the most. Through its National Service for Older Adults, the country implemented a strategy to prevent and mitigate infection and spread in long-term care facilities (LTCF), reaching regulated and registered residences and, for the first time, informal and unregistered residences.
Objective: Identify the challenges and lessons from the COVID-19 response in LTCF with respect to the support received, the implementation of infection control measures, workforce challenges experienced and the measures adopted to promote residents' wellbeing.
Methods: An online questionnaire was sent to all LTCF managers (N = 385, Response Rate = 32.4%). Statistical tests compare results to identify differences across LTCF characteristics: residence size, location and management type (private, public or subsidized, or informal).
Findings: Irrespective of their location, size or management, managers highlight common challenges during the crisis. They include limited personal protective equipment (PPE) availability, staff shortages, low quality of replacement staff, reduced staff mental health, and the difficulty to understand and implement protocols. Managers acknowledge receiving institutional support in the form of PPE provision and opportunities for staff training, but managers noted the need to expand this support to cover staffing surge needs, staff psychological needs, and ensure the continuity of clinical support for residents as well. Managers share a common demand for a more coordinated response from public institutions. Managers recognize that the pandemic and the measures implemented to mitigate it negatively affected staff morale and residents' wellbeing. Many noted that peer-to-peer support was a mechanism to support staff.
Limitations: Results might be subject to selection bias. Data collection covered a limited period of time at the early stage of the pandemic.
Implications: Findings are relevant to assess the COVID-19 response and to better prepare for another COVID-19 wave or similar health or environmental threats in the future.
Keywords: COVID-19, SARS-CoV-2, long-term care, nursing homes, aged care, Chile
How to Cite: Palacios, J., Neckelmann, M., Dintrans, P.V. and Salas, J.B., 2021. Improving Long-Term Care Facilities' Crisis Response: Lessons From the COVID-19 in Chile. Journal of Long-Term Care, (2021), pp.365–374. DOI: http://doi.org/10.31389/jltc.93
Accepted on 17 Oct 2021 Submitted on 10 May 2021
The COVID-19 pandemic hit Latin America with unexpected force. By June 2021, the region had the highest regional incidence of COVID-19, with roughly a third of world new cases coming from the continent. Although there was cross-country heterogeneity within the region, the countries in the region were all dealing with high incidence and mortality rates and faced difficulties in increasing to increase vaccine availability (John Hopkins University, 2021). After several months fighting with the disease and following an apparent plateau, Chile experienced a second wave during 2021, reviving the debate on how to deal with the pandemic (Gobierno de Chile, 2021).
As in other countries, in Chile COVID-19 affected older people the most. Although the people aged 60 or over represented a small fraction of the cases, around 85% of deaths came from this age group (Gobierno de Chile, 2021; Onder and Rezza, 2020).
Among the group of peopled aged 60 or older, institutionalized older people were especially vulnerable. Older people living in long-term care facilities (LTCF) were exposed to a higher risk of contagion than other older people and, because of their context and health conditions, were more likely to experience serious negative outcomes if infected (Comas-Herrera et al., 2021; Thompson et al., 2020). Several Latin American countries, including Argentina, Colombia, Panama and Uruguay, implemented specific strategies to deal with COVID-19 in institutional care settings (Banco Interamericano para el Desarrollo, 2021). With some differences across contexts, most strategies included testing, infection prevention and control (IPC) measures, and the development of information and monitoring systems (Chen et at., 2020; WHO, 2020). Overall, COVID-19 brought to light the precarious situation faced by LTCF around the world and the need to rethink institutional long-term care policies (Werner et al., 2020; Fulmer et al., 2020; Villalobos Dintrans et al., 2020).
In Chile, COVID-19's impact on LTCF prompted responses from the government, which developed an intersectoral strategy between the Ministry of Health (MoH), the National Service for Older Adults (SENAMA) and the Chilean Geriatrics and Gerontology Society (SGGCh). By March 16, 2020–less than two weeks after the first COVID-19 case was detected in the country–, LTCF visits were banned, sanitary barriers were implemented around each LTCF, and the entry of new residents was halted (Browne et al., 2020). A set of IPC measures were progressively implemented, including: 1) the free delivery of Personal Protective Equipment (PPE); 2) the development of protocols and guidelines, including on how to use PPE, to clean and disinfect areas, and on how to set up setting isolation areas; 3) the replacement of staff with COVID-19-related sick leave; 4) field testing with rt-PCR; and 5) the transfer of confirmed and/or suspected cases to sanitary houses where they could be isolated (SENAMA, 2020; Browne et al., 2020).
A mass vaccine rollout plan began in February 2021. LTCF residents and staff facilities were prioritized and received free vaccination, only second to health care workers (MINSAL, 2020). By mid-April 2021, 57.5% of residents completed their vaccination scheme (MINSAL, 2021).
According to the most recent Census data, in 2017, 2,003,256 people aged 60 or older were living in Chile. Some 24.4% of them (488,990 people) had some degree of functional ability loss. The large majority of them receive long-term care offered by informal, unpaid, family caregivers (SENAMA, 2020; Villalobos Dintrans, 2019). LTCF provide care to 1.4% of the population aged 65 or older through public, private non-profit, and private for-profit institutions (Villalobos Dintrans, 2018). LTCF are regulated by the Decreto 14 of the MoH which establishes infrastructure standards (e.g. residents per room), as well as staff requirement and residence-to-staff ratios by staff category (MINSAL, 2010). Although the Decreto 14 includes healthcare recommendations (e.g., the availability of a nutritionist and physical therapist in an LTCF) it does not contain health protocols or directives on IPC measures to be implemented in case of contagious diseases within the LTCF. LTCF that do not meet the Decreto 14 standards run informally without MoH's authorization and are subject to fines. The number of these informal facilities operating is uncertain. Using census data, Marin et al. (2004) estimated that for every regulated LTCF there is at least one unregulated, unregistered, informal LTCF. Chilean LTCF's healthcare services rely heavily on the quality of its staff. Before the COVID-19 pandemic, the availability and quality of healthcare services provided by LTCF were heterogeneous.
Like in other countries, LTCF care quality remains an unsolved challenge in Chile (Mor, 2005; Villalobos Dintrans, 2021). Gascón and Redondo (2014) find that although Latin American countries have shown some improvements in the quality of long-term care services provided, they still need to advance in the establishment and enforcement of standards. In Argentina, Lloyd-Sherlock et al. (2019) find similar problems and conclude that quality issues can be more serious in informal LTCF.
COVID-19 brought to light some of these challenges. A lack of information has been a general problem for LTCF in low and middle-income settings, particularly regarding their role during the COVID-19 pandemic (Lloyd-Sherlock et al., 2021). In Chile, Browne et al. (2021) highlights the need to consider factors such as people's beliefs and institutional culture in improving the effectiveness of COVID-19 measures in LTCF in Chile. Reduced technical staff wellbeing and impoverished communication within the LTCF were key barriers for the effective implementation of COVID-19 measures. Though relevant, this study is limited given the reduced number of LTCF surveyed (n=8) and the resulting low coverage of LTCF management type and location.
In complement to this literature, this study seeks to identify successful elements in the LTCF COVID-19 response in Chile, contributing to the literature on how to better prepare LTCF for future crises in the medium term and, in the long term, improve the quality of institutional care in Chile and other countries.
SENAMA—the national LTCF governing body–provided the data for this study. With the intention of capturing the challenges faced by LTCF as a result of the COVID-19 crisis and their institutional response, SENAMA adapted Rajan and McKee's (2020) survey. In particular, they sought to measure the positive and negative aspects of SENAMA's IPC measures and LTCF partnership relations. The survey also sought to identify the pandemic's effects on LTCF residents' wellbeing and staff and collect LTCF managers' suggestions regarding opportunities to improve the COVID-19 response by SENAMA. The questionnaire—developed in Spanish—combined single-choice, multiple-choice and open-ended questions. Open-ended responses allowed managers to provide more detail on specific issues. Questionnaire completion took approximately 20 minutes. Appendix 1 provides the English version of the questionnaire.
Between November 16 and November 25, 2020, SENAMA contacted and sent the online questionnaire to all 1,190 LTCF managers in Chile. This included managers from all private-registered LTCF, all publicly subsidized LTCF, and the informal LTCF that took part in the national LTCF COVID-19 strategy. Because SENAMA does not have legal faculties to oversee the compliance of Decreto 14, it keeps contacts with several of these facilities without the need to apply inspections or fines.
At least five members of SENAMA's research department reviewed the questionnaire before data collection began. Participants were informed about the characteristics of the study prior to their engagement. Participation in the survey was voluntary and responses anonymous. Although data collected for this study is property of SENAMA, aggregated information can be accessed upon request.
Three hundred and eighty-five managers completed the questionnaire (32.4% response rate). We checked the representativeness of the sample against SENAMA's registry, evaluating whether the 95% confidence intervals of the observed LTCF characteristics in the sample contain the corresponding registry values.
Throughout the analysis, we classified responses by key LTCF characteristics: LTCF size (very small, small, medium, large and very large LTCF according to the number of residents: 1–15, 15–29, 30–49, 50–79 and 80+, respectively), geographic area (north, center and south), and administrative type (private registered, private informal, and public or subsidized).
We conduct contingency table Chi-squared tests to identify statistically significant differences between LTCF characteristics at the 95% confidence level. Appendix 2 provides the full results by LTCF characteristics.
We analysed open-ended responses in two different ways. On the one hand, we report responses that provide detail on single or multiple-choice responses as examples of the main trends. In analysing all these open-ended responses, we reached consensus on the specific responses that provided complementary details on the issues reported by the managers. On the other hand, for stand-along open-ended responses (not directly related to a previous single or multiple-choice question) we categorize responses through a data-driven process to identify the most common issues or concepts.
Table 1 shows that while most respondents manage facilities with 15 to 29 residents (42.6%), managers from smaller (less than 15 residents) and larger (30 residents and more) LTCF are also represented. The sample covers mainly managers from private registered (60.0%) and public or subsidized facilities (23.1%) LTCF. Managers from private informal facilities are also covered (16.9%) providing information on a type of LTCF that has been scarcely studied before. Most respondents were from the Center region of the country (67.8%), where the majority of the country's population lives. The sample is representative of the registry in terms of LTCF size (number of residents) and management type.
Sample Characteristics.
Surveyed Managers N = 385
LTCF Registry N = 1,190
Number of residents
Less than 15 111 (28.8%) 626 (52.6%)
15 to 29 164 (42.6%) 379 (31.8%)
30 to 49 46 (12%) 87 (7.3%)
50 to 79 35 (9.1%) 56 (4.7%)
80 or more 29 (7.5%) 42 (3.5%)
Private registered 231 (60.0%) 707 (59.4%)
Private informal 65 (16.9%) 301 (25.3%)
Public or subsidized 89 (23.1%) 182 (15.3%)
North 31 (8.1%)* 63 (5.3%)
Center 261 (67.8%)* 997 (83.8%)
South 93 (24.2%)* 130 (10.9%)
Covid-19 cases and deaths
At least one case 174 (45.2%)
At least one death 102 (26.5%)
* Statistically different from the Registry (with a 95% confidence interval).
Note: North includes the regions of Arica and Parinacota, Tarapacá, Atacama, and Coquimbo. Center includes the regions of Valparaíso, Metropolitana de Santiago, O'Higgins, Maule, Ñuble, and Biobío. South includes the regions of Araucanía, Los Ríos, Los Lagos, Aysén, and Magallanes y Antártica Chilena.
Reports show that 45.2% of the LTCF covered in the study had at least one COVID-19 case and 26.5% had at least one death by November 2020 (Table 1).
3.1 Partnerships and Support Received
As Table 2 shows, most managers mentioned SENAMA, the regional health authority (SEREMI), and the primary healthcare centers (CESFAM) as important sources of support during the COVID-19 pandemic. Private businesses, local communities, and residents' relatives were also identified as important. Managers insisted on the need for continuous support and reported a lack of coordination in the support offered by public institutions, especially SENAMA and SEREMI. Guidance and protocols received from these two bodies were not always coherent, generating confusion and delaying decision making.
Partnerships and Support Received.
Total N = 385
The most helpful offers of support from key partners (multiple choice answer)
Provision of emergency PPE 314 (82.0%)
Staff training 233 (61.0%)
Guides and protocols 208 (54.0%)
Support with surge staffing †, Δ 104 (27.0%)
Face to face technical support 98 (25.5%)
Access to psychological support for staff 38 (9.9%)
Other 17 (4.4%)
None 2 (0.5%)
What managers feel they need most from key partners (multiple choice answer)
Continuity of clinical support for residents 216 (56.1%)
Access to psychological support for staff 203 (52.7%)
Support with surge staffing 193 (50.1%)
Face to face technical support 114 (29.6%)
Note: *, † and Δ denote a statistically significant difference at the 95% confidence level with LTCF region, type and number of residents, respectively.
When asked to explain their answers, some managers mentioned that during the pandemic, SEREMI had maintained their supervising and auditing role, but refused to adapt their rules to the critical COVID-19 situation. Managers agreed that SEREMI should have focused more on residents' wellbeing and less on what they called 'unimportant details' like applying fines to informal LTCF.
Managers appreciated the role played by local health facilities (CESFAM), particularly through the provision of medicines and physician visits. As one manager commented: 'When we had non-respiratory health problems among our residents, they [CESFAM] provided quick solutions; we have coordinated well the supply of medicines and other medical goods.'
In terms of the specific help received, the great majority of managers reported that PPE provision was useful (82.0% of managers). Also, 61.0% of managers mentioned staff training opportunities were useful and 54.0% that guidelines and protocols were useful. Some 27.0% of managers appreciated support they received with surge staffing, an opinion more common among managers from public or subsidized LTCF (50.6%) and less common among managers from informal LTCF (12.3%) (specific percentages by LTCF management type not shown in the table). Face-to-face technical support was offered by SENAMA through regular visits which were positively evaluated. Though 25.5% of managers identified this as useful form of support received, one manager noted that 'their compassion and regular presence gave us confidence.'
Residents' relatives played an important role by being understanding of the COVID-19 measures implemented (e.g. visitor restrictions), offering emotional support for residents, and helping with supplies. As one manager explained '"our residents"' families were a fundamental support when we had positive COVID-19 cases. They knew that we had few residents and few resources, so they helped us with food and PPE.'"
3.2 Infection Control Measures
Table 3 shows that regarding infection control measures, managers reported challenges related to PPE, isolation of residents, guidance and testing. Only 4.2% of managers reported that PPE had always been unavailable, with 43.1% reporting that they always had enough (managers from very small LTCF [<15 residents] and very large LTCF [>80 residents] were more likely to report that they always had sufficient PPE). Some managers identified challenges related to PPE price surges and proper PPE use among staff. Adherence to PPE use protocols remained a permanent challenge because awareness about PPE importance was not generalized by November 2020.
Infection Control Measure.
Infection Control challenges: Concerns providing PPE
Always had enough 166 (43.1%)
Yes, less than 7 days' supply at times 171 (44.4%)
Yes, less than 24 hrs supply at times 32 (8.3%)
Yes, completely unavailable at times 16 (4.2%)
Infection Control challenges: Isolation of residents with confirmed or suspected COVID-19*,†,∆
Not able to 37 (9.6%)
Able but didn't 89 (23.1%)
Able to and did but not always possible 69 (17.9%)
Able to and always did 190 (49.3%)
Infection Control challenges: Challenges implementing infection control guidance
PPE supply 296 (76.9%)
Staff shortages 237 (61.6%)
Understanding and applying guidance 224 (58.2%)
Applying sanitary barrier 208 (54.0%)
Isolation of confirmed and suspected cases 191 (49.6%)
Access to COVID-19 testing 177 (45.9%)
Keeping residence's hygiene 160 (41.6%)
Transfer to transitory residences 32 (8.3%)
Note: *, † and Δ denote a statistically significant difference at the 95% confidence level with LTCF region, type, and number of residents, respectively. Table A-1 in the appendix provides the full table by LTCF region, type, and number of residents.
Roughly half of managers reported they were able to isolate residents with confirmed or suspected COVID-19 infection. Some 23.1% of managers reported being able to implement isolation measures but decided not to do it. Implementing isolation seemed more challenging for managers in the North with 32.3% reported not being able to do it, compared to fewer than 15% in the other regions (results by location not shown in the table). Managers from informal or smaller LTCF were also more likely to report not isolating people despite being able to do it. Difficulties with isolating residents were related to infrastructure limitations, as many managers indicated not having individual rooms, and having negative outcomes associated with these changes. These challenges were particularly difficult for residents with dementia or cognitive impairment.
As for the guidelines and protocols, 58.2% of managers found them challenging to understand and apply. In their opinion, the guides included too many indications and implementation was difficult due to their numerous and frequent changes and updates. This turned into a significant effort to ensure that staff, residents, and residents' relatives followed the guidelines. One of the most complex tasks was informing residents' families about the ban on visits.
Access to COVID-19 testing was a challenge for 45.9% of the managers. Preventive testing for residents and staff was not always possible. Managers also reported delays in receiving the results. Additionally, staff training and staff shortages were important challenges, as reported by over 60% of the managers. Respondents identified the lack of commitment among the replacement staff as critical, an issue that resulted in lower LTCF staff performance.
When asked what had worked well to control the infection, managers highlighted that, despite the challenges, they had a good evaluation of official guidelines, especially preventive measures such as control of the facilities' entry, cleaning directives, PPE use, limitation of visitors, and lockdowns.
Managers mentioned that guidelines worked better when adapted to local conditions, highlighting that simple and didactic messages—preferably using audiovisual materials— worked better for staff training, and that promoting self-care outside the facility was also key in preventing infections. Infection control worked better when LTCF adopted cohorting measures (i.e. separating positive, suspected and negative cases and staff accordingly) and when there was internal coordination, achieved through better communication between workers, managers, and residents' relatives and when implementing measures to avoid excessive personnel turnover.
3.3 Workforce Challenges
As Table 4 shows, more than 40% of managers reported that morale, mental health, and wellbeing were the greatest workforce challenges they faced, followed by staffing shortages (28.6%) and staff training (18.7%). Only 6.8% of managers reported that access to and interpretation of COVID-19 tests was their greatest workforce challenge.
Workforce Challenges.
Greatest workforce challenge
Morale, mental health and wellbeing 163 (42.3%)
Staffing shortages 110 (28.6%)
Staff training 72 (18.7%)
Access to and interpretation of COVID-19 tests 26 (6.8%)
Workforce challenges: what worked best to address staff morale
Peer to peer support e.g. WhatsApp groups and staff engagement 213 (55.3%)
Support from national or municipal bodies 84 (21.8%)
Psychological services for COVID-19 34 (8.8%)
Good communications 19 (4.9%)
Recreational and relaxation activities 10 (2.6%)
None 13 (3.4%)
Staff morale, mental health and wellbeing was primarily affected by staff's fear of contracting the virus, taking it to or from their homes and the facility. Managers also mentioned exhaustion and stress in staff due to longer working hours, lockdowns, the use of PPE, the implementation of new protocols, as well as the uncertainty that resulted from the lack of knowledge about the disease and the existence of confusing messages from authorities and the media. As described by one manager, dealing with frequent and tense encounters with residents' families contributed to deteriorating the staff's mental health, morale, and wellbeing.
Managers commented that transportation restrictions and lockdowns, workers quitting or being absent due to fear of contagion and the difficulty to attract qualified new personnel with current wages explained the staff shortages they faced during the pandemic.
Regarding staff training, managers pointed out that staff's educational level was usually low, which made it more difficult to train them in the new context. This was especially the case for replacement staff. Managers also noted that training was generally less effective in promoting behavioral change among the more experienced staff.
Most managers identified peer-to-peer support (e.g. WhatsApp groups and staff engagement activities) as the most effective tool to address staff morale (55.3%). They noted that these platforms provided the opportunity to create formal and informal instances to talk about work issues, solve any issue quickly, stay up to date, and foster and strengthen ties within the staff. Some managers organized formal, scheduled and regular meetings, while others promoted informal spaces (e.g. staff gathered to play video games when out-of-shift or commuted together). Only 8.8% of managers declared psychological services as an effective measure, complaining about their low coverage or low quality when available.
3.4 Wellbeing of Residents
As shown in Table 5, managers observed that residents experienced low mood and agitation (51.4%) and reduced mobility (22.9%) following the COVID-19 pandemic and the prevention and mitigation measures. Managers reported that these observed changes in residents' wellbeing were the result of fewer social interactions from visitors and other residents (67.8%), and, to a lesser extent, the impact of PPE's use on the relationships between staff and residents, affecting the residents' wellbeing (17.1%) and the reduced access to clinical support (8.6%). Managers noted that, because of visiting restrictions and distance measures adopted in the residence, residents felt abandoned by their outside contacts and that, as residents in some residences did not have access to common spaces, they had to remain in their rooms practically all day, which reduced their activity and mobility. Some managers noted that residents did not recognize caregivers with PPE, negatively affecting their mood.
Wellbeing of Residents.
Main observed change in residents following isolation
Low mood and agitation 198 (51.4%)
Reduced mobility 88 (22.9%)
Increased falls 18 (4.7%)
Reduced oral intake/weight loss 6 (1.6%)
All 15 (3.9%)
None 56 (14.5%)
Other 4 (1%)
Factors that influenced resident's wellbeing during the COVID-19 pandemic
Fewer social interactions from visitors and other residents 261 (67.8%)
Impacts of PPE on relationships with care staff 66 (17.1%)
Reduced access to clinical support for residents 33 (8.6%)
Disrupted routines e.g. mealtimes 11 (2.9%)
All 8 (2.1%)
Other 1 (0.3%)
Figure 1 summarizes these results. The four domains studied present multiple policy challenges, which can be addressed at a macro (central government institutions) or micro (LTCF) level. This highlights the need for a comprehensive response to crisis management in these facilities that includes coordination between both levels. For example, in response to the workforce challenges identified above, support and training policies for caregivers require actions from the macro-level (e.g. establishing standards, policies, and providing resources) and the micro-level (e.g. generating internal communication channels, peer-to-peer support).
Summary of policy challenges and responses: Examples at macro and micro level.
Note: Grey boxes refer to the domains (challenges) used in the analysis; red circles refer to the level of policy response; white boxes show examples of responses for different challenges at each level.
The study identifies several issues regarding Chile's response to COVID-19 in LTCF. In terms of the results, the analysis shows that, according to LTCF managers, PPE availability, quantity and quality of staff, staff mental health, and the ability to understand and implement protocols have been critical challenges during the pandemic. Although support was received in all surveyed LTCF, there are variations in the extent and kind of help received by LTCF location, size, and management type. Despite some observed differences, the study highlights a common demand for permanent and constant support, as well as a more coordinated response from public institutions.
Institutional support covered PPE and staff training, but managers noted the need to expand this support to cover staffing surge needs, staff psychological support, and continuity of clinical support for residents. Besides public institutions, civil organizations were an important source of support for LTCF. Local communities and private companies provided food and other supplies (as observed in other countries, e.g. Rajan and McKee, 2020). Residents' families also contributed with material resources, plus emotional support.
Staff training appears as a key dimension of infection control and a common challenge reported by managers from all LTCF types. Compared to other higher income countries (see, for example, Rajan and McKee, 2020), we observe a specific vulnerability of the Chilean LTCF system, which generally works with non-qualified staff that was unprepared to face a pandemic.
The pandemic and the measures implemented to mitigate it have affected staff morale and residents' wellbeing. Some of these challenges have also been identified as relevant in other countries/settings (Rajan and McKee, 2020). Staff's mental health and wellbeing is especially relevant, considering that evidence from other countries shows that LTCF workers face more health issues than other workers (Rapp et al., 2021). This was a major challenge for managers, an issue also identified in other countries (Rajan and McKee, 2020; Senczyszyn et al., 2020). Peer-to-peer support appears as a mechanism to support staff wellbeing. It is easy and relatively cheap to implement, signalling possible avenues to mitigate the effects of future crises on staff.
Among the different infection control measures put in place to protect residents, fewer social interactions and visitors have particularly affected residents' wellbeing, as also observed in several countries (Bethell et al., 2020; Rajan and McKee, 2020; Van der Roest et al., 2020). We expect many of these results to apply in different contexts, especially in the Latin American region where community COVID-19 incidence and mortality rates remained high well into 2021. Non-pharmacological interventions such as PPE availability and staff training needs are key to control and prevent infections in general and to prepare for eventual new COVID-19 surges around the world. Recommendations should be applied, mutatis mutandis, in each case. Results also highlight the need to take a broader approach to understand the relevance of implementation factors in improving the interventions effectiveness (Browne et al., 2021).
An important contribution of this study is its scale and representativeness. The information presented covers different LTCF characteristics, including heterogeneity by geographical areas, number of residents and management type. From a public policy perspective, this is crucial to design and implement effective measures to solve particular problems taking into account the different concerns and needs of different LTCF.
Our findings that observed challenges by managers are mostly shared across regions and LTCF types—with some differences—signal the importance of giving immediate and cross-cutting attention to these issues by monitoring how they play out across these settings. As highlighted before, this is a challenge Chile shares with other countries (Lloyd-Sherlock et al., 2021).
Although we acknowledge that informal LTCF might be still underrepresented in this study, the inclusion of this traditionally ignored group constitutes a milestone in terms of making them visible as part of the network of institutional care. The lack of knowledge about these facilities and their label as 'illegal' push them out from the public policy action.
This study's results are subject to certain limitations. Data collection covered an early stage of the pandemic and given its dynamic evolution, results may change as PPE supply chains stabilized throughout 2020, mobility and visiting restrictions eased towards the end of 2020, and mass vaccination began in 2021. Also, results are subject to selection bias, as we report results from managers who replied to the questionnaire. Though it is possible that non-respondents have similar views to respondents, it is also possible that non-respondents were particularly burdened by COVID-19 measures or that they did not consider it relevant as COVID-19 did not affect their operations.
Future research could explore how these results evolved with the pandemic or how it invited long-term processes and activities within the LTCF or with other institutions. In addition, a deeper understanding of the differences between different groups of LTCF is needed. Finally, it is important to explore how these experiences can shape the development of protocols for other emergencies or identify particular interventions that were successful in dealing with residents' wellbeing and staff morale, and mental health.
We hope these results contribute to fostering the debate around institutionalized care among different stakeholders—policymakers, LTCF managers, and families—to generate changes to improve the quality of life of the current and future care recipients in institutions.
Regarding the lessons from the study, findings are relevant to assess the past processes but also to better prepare for another COVID-19 wave or similar health or environmental threat in the future. Although the information collected was COVID-specific, many lessons can be applied to future non-related crises and can be used to identify spaces of improvement for LTCF in Chile (e.g. need to improve regulation, infrastructure, and human resources policies) in the medium and long run (Villalobos Dintrans et al., 2020). In this line, it is important to note that, although we observed some differences across LTCF (by geographical area, size, and management type), an important result is that all facilities report problems related to the preparedness to face crises. The LTCF debate generally operates under the assumption that informal facilities are vulnerable less prepared, and offer a low-quality service. Though we cannot reject this hypothesis, it seems that other facilities (including private for-profit and public ones) are not necessarily better off when it comes to crisis preparedness and quality, inviting to advance structural changes regarding LTCF crisis preparedness and management policies (Villalobos Dintrans et al., 2020). The cross-cutting nature of the challenges raises concerns, particularly considering that one of the main initiatives to improve institutional care is the formalization of informal facilities. Formality does not guarantee preparedness. Other measures—such as setting and enforcing standards, implementing a certification or reporting process—can contribute to improving preparedness in these facilities.
The additional files for this article can be found as follows:
Supplementary Tables 1–4
Open-ended questions. DOI: https://doi.org/10.31389/jltc.93.s1
Questionnare English version. DOI: https://doi.org/10.31389/jltc.93.s2
Full Tables. DOI: https://doi.org/10.31389/jltc.93.s3
Josefa Palacios and Maureen Neckelmann completed paid consultancy work from SENAMA as part of the data acquisition for this study.
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Bethell, J, Aelick, K, Babineau, J, Bretzlaff, M, Edwards, C, Gibson, JL, Hewitt, D, Iaboni, A, Lender, D and McGilton, K. 2020. 'Social connection in long-term care homes: A scoping review of published research on the mental health impacts and potential strategies during COVID-19'. Journal of the American Medical Directors Association, 22(2): 228–237. DOI: https://doi.org/10.1016/j.jamda.2020.11.025
Browne, J, Fasce, G, Pineda, I and Villalobos, P. 2020. Policy responses to COVID-19 in Long-Term Care facilities in Chile. Available at: https://ltccovid.org/wp-content/uploads/2020/07/The-COVID-19-Long-Term-Care-situation-in-Chile-24-July-2020-3.pdf.
Browne, J, Palacios, J, Madero-Cabib, I, Villalobos Dintrans, P, Quilodrán, R, Ceriani, A and Meza, D. 2021. 'Enablers and Barriers to Implement COVID-19 Measures in Long-Term Care Facilities: A Mixed Methods Implementation Science Assessment in Chile'. Journal of Long-Term Care, 2020: 114–123. DOI: https://doi.org/10.31389/jltc.72
Chen, AT, Ryskina, KL and Jung, HY. 2020. 'Long-term care, residential facilities, and COVID-19: an overview of federal and state policy responses'. Journal of the American Medical Directors Association, 21(9): 1186–1190. DOI: https://doi.org/10.1016/j.jamda.2020.07.001
Fulmer, TT, Koller, CF and Rowe, JW. 2020. Reimagining Nursing Homes in the Wake of COVID-19. Available at: https://nam.edu/reimagining-nursing-homes-in-the-wake-of-covid-19/. DOI: https://doi.org/10.31478/202009a
Gobierno de Chile. 2021. Cifras Oficiales COVID-19. Available at: https://www.gob.cl/coronavirus/cifrasoficiales/ (Accessed 21 June 2021).
Lloyd-Sherlock, P, Penhale, B and Redondo, N. 2021. 'Evaluating the quality of long-term care services in the city of La Plata, Argentina'. Ageing and Society, 41(1): 208–230. DOI: https://doi.org/10.1017/S0144686X1900103X
Lloyd-Sherlock, P, Sempe, L, McKee, M and Guntupalli, A. 2021. 'Problems of Data Availability and Quality for COVID-19 and Older People in Low- and Middle-Income Countries'. The Gerontologist, 61(2): 141–144. DOI: https://doi.org/10.1093/geront/gnaa153
Marin, PP, Guzmán, JM and Araya, A. 2004. 'Adultos Mayores institucionalizados en Chile: ¿Cómo saber cuántos son?'. Revista Médica Chile, 132(7): 832–838. DOI: https://doi.org/10.4067/S0034-98872004000700007
Ministerio de Salud. 2010. Aprueba reglamento de establecimientos de larga estadía para adultos mayores. Available at: https://www.minsal.cl/sites/default/files/files/DTO-14_05-AGO-2010_ELEAM.pdf.
Ministerio de Salud. 2020. Recomendación provisoria del CAVEI para la priorización inicial de grupos a vacunar contra SARS-CoV-2 en contexto de suministro limitado de vacunas. Retrieved from: https://www.minsal.cl/wp-content/uploads/2020/12/CAVEI-Priorizacion-grupos-vacuna-COVID19_ENMIENDA-22dic2020.pdf.
Ministerio de Salud. 2021. Vacunación Campaña SARS-CoV-2. Total País. Retrieved from: https://informesdeis.minsal.cl/SASVisualAnalytics/?reportUri=%2Freports%2Freports%2F9037e283-1278-422c-84c4-16e42a7026c8&sectionIndex=0&sso_guest=true&reportViewOnly=true&reportContextBar=false&sas-welcome=false.
Mor, V. 2005. 'Improving the quality of long-term care with better information'. The Milbank Quarterly, 83(3): 333–364. DOI: https://doi.org/10.1111/j.1468-0009.2005.00405.x
Onder, G, Rezza, G and Brusaferro, S. 2020. 'Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy'. JAMA, 323(18): 1775–1776. DOI: https://doi.org/10.1001/jama.2020.4683
Rajan, S and McKee, M. 2020. Learning from the impacts of COVID-19 on care homes: a pilot survey. Available at: https://ltccovid.org/2020/06/09/learning-from-the-impacts-of-covid-19-on-care-homes-in-england-a-pilot-survey/.
Rapp, T, Ronchetti, J and Sicsic, J. 2021. 'Are long-term care jobs harmful? Evidence from Germany'. The European Journal of Health Economics. DOI: https://doi.org/10.1007/s10198-021-01288-y
Senczyszyn, A, Lion, KM, Szcześniak, D, Trypka, E, Mazurek, J, Ciułkowicz, M, Mackowiak, M, Duda-Sikula, M and Rymaszewska, J. 2020. 'Mental health impact of SARS-COV-2 pandemic on long-term care facility personnel in Poland'. Journal of the American Medical Directors Association, 21(11): 1576–1577. DOI: https://doi.org/10.1016/j.jamda.2020.09.020
Servicio Nacional del Adulto Mayor [SENAMA]. 2020. Protocolos COVID-19. Available at: http://www.senama.gob.cl/protocolos-covid-19.
Thompson, DC, Barbu, MG, Beiu, C, Popa, LG, Mihai, MM, Berteanu, M and Popescu, MN. 2020. 'The Impact of COVID-19 Pandemic on Long-Term Care Facilities Worldwide: An Overview on International Issues'. BioMed Research International, 2020: 1–7. DOI: https://doi.org/10.1155/2020/8870249
Van der Roest, HG, Prins, M, van der Velden, C, Steinmetz, S, Stolte, E, van Tilburg, TG and de Vries, DH. 2020. 'The impact of COVID-19 measures on well-being of older long-term care facility residents in the Netherlands'. Journal of the American Medical Directors Association, 21(11): 1569–1570. DOI: https://doi.org/10.1016/j.jamda.2020.09.007
Villalobos Dintrans, P. 2018. 'Do long-term care services match population needs? A spatial analysis of nursing homes in Chile'. PLoS ONE, 13(6): 1–15. DOI: https://doi.org/10.1371/journal.pone.0199522
Villalobos Dintrans, P. 2019. 'Informal caregivers in Chile: the equity dimension of an invisible burden'. Health Policy and Planning, 34: 792–799. DOI: https://doi.org/10.1093/heapol/czz120
Villalobos Dintrans, P. 2021. The Future of Long-Term Care. New York: Nova Science Publishers.
Villalobos Dintrans, P, Browne, J and Madero-Cabib, I. 2020. 'It Is Not Just Mortality: A Call From Chile for Comprehensive COVID-19 Policy Responses Among Older People'. Journals of Gerontology: Social Sciences, 20(20): 1–6. DOI: https://doi.org/10.1093/geronb/gbaa092
Werner, RM, Hoffman, AK and Coe, NB. 2020. 'Long-Term Care Policy after Covid-19 – Solving the Nursing Home Crisis'. The New England Journal of Medicine, 383(10): 903–905. DOI: https://doi.org/10.1056/NEJMp2014811
World Health Organization. 2020. Preventing and managing COVID-19 across long-term care services: Policy brief, 24 July 2020. Available at: https://www.who.int/publications/i/item/WHO-2019-nCoV-Policy_Brief-Long-term_Care-2020.1
Palacios, J., Neckelmann, M., Dintrans, P.V. and Salas, J.B., 2021. Improving Long-Term Care Facilities' Crisis Response: Lessons From the COVID-19 in Chile. Journal of Long-Term Care, (2021), pp.365–374. DOI: http://doi.org/10.31389/jltc.93
Palacios J, Neckelmann M, Dintrans PV, Salas JB. Improving Long-Term Care Facilities' Crisis Response: Lessons From the COVID-19 in Chile. Journal of Long-Term Care. 2021;(2021):365–74. DOI: http://doi.org/10.31389/jltc.93
Palacios, J., Neckelmann, M., Dintrans, P. V., & Salas, J. B. (2021). Improving Long-Term Care Facilities' Crisis Response: Lessons From the COVID-19 in Chile. Journal of Long-term Care, (2021), 365–374. DOI: http://doi.org/10.31389/jltc.93
1. Palacios J, Neckelmann M, Dintrans PV, Salas JB. Improving Long-Term Care Facilities' Crisis Response: Lessons From the COVID-19 in Chile. Journal of Long-Term Care. 2021;(2021):365-374. DOI: http://doi.org/10.31389/jltc.93
Palacios J and others, 'Improving Long-term Care Facilities' Crisis Response: Lessons from the COVID-19 in Chile' (2021) Journal of Long-Term Care 365 DOI: http://doi.org/10.31389/jltc.93
Palacios, Josefa, Maureen Neckelmann, Pablo Villalobos Dintrans, and Jorge Browne Salas. 2021. "Improving Long-term Care Facilities' Crisis Response: Lessons from the COVID-19 in Chile". Journal of Long-term Care (2021): 365–74. DOI: http://doi.org/10.31389/jltc.93
Palacios, Josefa, Maureen Neckelmann, Pablo Villalobos Dintrans, and Jorge Browne Salas. "Improving Long-term Care Facilities' Crisis Response: Lessons from the COVID-19 in Chile". Journal of Long-term Care no. 2021 (2021): 365–74. DOI: http://doi.org/10.31389/jltc.93
Palacios, J, et al.. "Improving Long-Term Care Facilities' Crisis Response: Lessons From the COVID-19 in Chile". Journal of Long-term Care, no. 2021, 2021, pp. 365–74. DOI: http://doi.org/10.31389/jltc.93
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text:
New Music Video Review: VIXX "Chained Up" (South Korea, 2015)
Published on : November 11, 2015 November 11, 2015 Published by : Ghassani Swaryandini
The kings of concept-idol VIXX, have returned with an original single, "Chained Up"! Starlights have been waiting for their concept return and surely they are not disappointed. "Chained Up" is a catchy electro pop track that showcases a more mature side of VIXX after their last youthful comeback, "Love Equation".
From the title and the concept photos, one would expect this music video to be rated 19+ like "Voodoo Doll", but VIXX have chose to go for a more subtle approach with symbolisms throughout the whole music video. As the title suggests, this song tells a story of how they are willing to be chained up and become slaves to the girl's love. This concept of being chained up is portrayed throughout the whole music video with their costumes, which include chokers or neck collars and suits. As usual, VIXX shows in-sync choreography with some great formations and lifts, which will be exciting to see in a full choreography version of the music video.
The visuals for this music video is very appealing while showing a more subtle concept of being trapped. In the music video there are several settings, such as mazes, flower glass box, rainforest, single staircase, room of chains, and flooded room. Every setting in this music video depicts an illusion of escape, however, there is no way out. VIXX were pictured having different collars in different settings, however towards the end, the girl was still holding all six collars. This could mean that even if they try to escape, the girl could still chain them up.
Overall, "Chained Up" didn't disappoint at all. The music video opens up a lot of interpretation and the song is bound to be stuck in your head. If I got you intrigued, please watch the new music video!
Review score: 8 out of 10
"Chained Up" is available now on iTunes Australia
Tagged in : Korea vixx
Categorized in : Album Reviews Music Videos New Music Reviews Video
K-Pop Party 2016 feat. Boyfriend & JJCC to be held at Carriageworks Sydney in February
Singapore DJ-Producer MMXJ scheduled to release debut album on 27th November

redpajama_set_name: RedPajamaCommonCrawl


I had the pleasure of interviewing David Newman, a fantastic marketing consultant, coach, and author of Do It! Marketing: 77 Instant-Action Ideas to Boost Sales, Maximize Profits, and Crush Your Competition. The book is all about taking a tactical approach to marketing and offers actionable ideas that you can implement today. David reveals his reasons for writing the book, what tools are most useful for him, and why you need to make your business a FLOP in order to succeed.
Jay: I see your book over your shoulder, and rightfully so. You are the author of a fantastic book that continues to sell day after day on the Amazons. It is called "Do It! Marketing: 77 Instant-Action Ideas to Boost Sales, Maximize Profits and Crush Your Competition".
The book has been out almost a year. In fact, you're having a book-iversary, so to speak. It is a book birthday this week, right? Is it the book's birthday?
David: It is, yes, yes. June 5.
Jay: I was very delighted to work with you when you put the book together. I'm so happy that it continues to sell so strongly. It absolutely should because it's a barn burner. We talked about 77 sort of instant-action ideas. What do you mean by "instant-action ideas"?
David: Well, there are a lot of books out there that talk marketing theory. They talk about the why, they talk about the how, but they don't talk about the "Okay, now what?" So what I did, and this is similar to both of your fabulous books, by the way, I wrote the book that I myself wanted to read.
It's the action-oriented ideas that I use every day to market my business, sell, develop an audience, etc.
Jay: You talked about the offline and online. I think that's really fascinating. Do you find that people who read the book, or people that you work with on a consulting basis, have more of a struggle with the online tasks or the offline tasks?
David: Well, they probably have a struggle just with sales and marketing. One of the key things that I put into the book is I don't care what kind of executive or entrepreneur you are or what you do or the core of your work. Our job, job number one is to be marketer-in-chief and salesperson-in-chief of our career, of our company, and of our business.
All of a sudden, the marketing and the selling yucky-ness disappears.
Because the reality is, as per the book, there are at least 77 tactical things that you could or should do in terms of sales and marketing. I feel that a lot of people who are entrepreneurs, use the title "entrepreneur" as an excuse to not be good at tactics.
companies can learn from the small companies and the entrepreneurs, and what can the entrepreneurs learn from what the big companies are doing?
but I don't have time for that." I hear that a lot from executives on my side. I don't work with too many entrepreneurs, but a lot of executives.
They say, "Well, I don't have time to be doing all that Twitter. I got a girl to do that." What do you say to them?
raising, development, cause marketing. All this stuff.
Because, obviously, I'm doing it for her. But the point is, as a solo-preneur, I know you're running an empire, so you're not solo anymore.
Jay: I think the answer is, it's hard to say this, but the answer is you got to work harder than you think you do.
You could spam the world. You could send out your 10 million emails. You could paper the wall with your direct mail and your postcards, and your campaign letters. But every single day, those kinds of old-school tactics are getting less and less and less effective. The stuff that you teach and the stuff that I teach with some of the online components is getting more and more and more important.
"Yeah, it's easy, but how is that working for you?" Right?
Imagine five years from now if you don't get on the bandwagon and don't start getting your house in order, now.
So if what you were doing five years ago isn't working, well, why would you wait another five years to do something about that?
David: "Ancient Chinese wisdom is correct," says Confucius.
Jay: What is your advice, both in the book and in person, if somebody comes to you, "David, I really need to get going on all this." What do you tell them is the first step? What is the very first thing you should do?
David: Well, first they should read your books. Second, they should read my book.
My philosophy both in the book and in real life is, number one, focus on the who. You can't boil the ocean. You can't market and sell to the world.
So, figure out who is that sub-niche, who is that slice of the world, who – whatever your product, your service, or your program is. Who needs it more greatly? Who suffers from it more deeply? Who is going to value it more highly? Because that's the slice of the world, that's the slice of the universe that you can own and dominate and penetrate and identify, and start to serve.
problems, heartaches, headaches, challenges, and gaps that your product and your service and your program are brilliant at solving.
Chinese wisdom, "If you're going to sell fire extinguishers, first show the fire".
They're not going to pay money because "Oh, it's a great product, it looks really good." or "Oh it's a great service, it looks really good".
People buy things to solve problems.
They can be emotional problems, intellectual problems, financial problems, problems with my kids, problems with my car, problems with my hair.
I no longer have a lot of hair problems but anyway. It's pretty simple. I wake up, little bit of mousse, little bit of you know, whatever.
But seriously, start to speak in the vocabulary of problem-solving and then resolve those problems. Solve bigger problems, you get bigger checks. That's true whether it's a product, or a service, any sort of business-to-business, business-to-consumer, etc.
If they were starting from square one, the two first things I would do are, identify your "Who?" identify the who, critically important, and then identify those urgent, pervasive, expensive problems, because that's going to open the floodgates to the marketing conversation and the sales conversation. Then, more importantly, you'll never be at a loss for words, for what to say or how to say it, because now we're in a conversation. Now we're just talking. "I need to enter the conversation that is already going on in your mind so that we resonate." The only two purposes of marketing, in my opinion, are to convey two, and only two, ideas.
Jay: It's funny, two things that you mentioned there really resonate with me. I was giving a presentation yesterday in Utah. I was talking about that same principle of understanding what the real need is. The real need is not usually your product. Your product is a means to an end. What I said was that, "Nobody in the history of the world has ever needed socks. But everybody in the history of the world has needed their feet to be warmer." That's the kind of thing that you were talking about. You have to understand what the big picture really is.
There's a great Zig Ziglar premise, which is that the most effective kind of sales and marketing thing ever is the similar situation sale. Right?
Part of the challenge, I think, and I'm sure you see this, is that a lot of business people, especially entrepreneurs, want to try and attack too big of a section of the market.
Figure out who the people are in the world who will say, "That is the best blog. Of the 500 million blogs out there, that's the best one." Who are the people that would say that, and write for those people. Don't write for anybody – you'll get some other people, but only write for those people.
your own dreams. To say, "Here's where I want to be, but to get there I actually have to start here." That is really, really hard to deal with, especially for entrepreneurs.
it's has all been downhill since.
effective social platform for you in your career, and why?
David: Wow, what a great question. Well, I'm also a firm believer, when you say, "Kind of rein it in and be the favorite blog for this kind of thing". I'm not a big believer in "Dominate every social media platform".
So I'm active on a very small handful. I'm active on Facebook. I'm active on Twitter, and then also on LinkedIn. Now, I have a presence on all the rest of them. So, yes, I'm on Instagram. I'm on Tumblr. I'm on Pinterest.
LinkedIn is great for direct prospecting. It's really about targeted prospecting, so I love LinkedIn for that.
Facebook is a humanizer. Anytime I try and do something straight business, like promote a webinar, even if it's free, even if it's free. Promote my blog, promote the webinar, Facebook couldn't care less. It's just like, "Nah, we're not doing that." If I say, "Hey, guys, I'm going to my in-laws in Reading, Pennsylvania and I'm doing a yard sale. Do you have any tips?" I'll get 30 likes and 57 comments. Everyone wants to help David with the yard sale. No one cares about David's webinar or David's coaching program or any of it.
Then so, finally, I find that Twitter is a huge driver of traffic. It's not good for sales. In fact, there is no social media channel that is good for sales. I write about that and you write about that. The most idiotic thing, Jay, that I ever hear is, "Instantly grow sales with social media." It's like "Hmmm, no, no, no." We're not going to instantly grow any sales with social media.
So, Twitter is a great source of traffic, for me. You look at your web stats to see where your traffic is coming from. Some is organic. Some comes from Google. Some is from Twitter. 15 to 20 percent of my traffic on my website, on my blog comes from Twitter. That's because I am just a Twitter machine. I use great tools like Buffer, TweetAdder, and some of these tools to automate. My belief in social media, by the way, is automate and humanize.
Number one, don't be everywhere. It doesn't make sense to invest and spread yourself so thin that you're everywhere. Take your two or three social media platforms and figure out which ones are best for which application.
If you're in a certain niche, if you're going after a certain demographic, yes of course, Pinterest is great. Instagram is great. Tumblr is great. Snapchat, Vine, all that stuff is great. But don't let the tail wag the dog, is the other thing.
Figure out strategically why are you there. What do you hope to accomplish? "Sales" is never a good answer, by the way. Then just figure out, what, as a small business owner, as an entrepreneur even, as a corporate entity, figure out what is the best fit for your goals and that platform and that audience. Because if your audience isn't there, you shouldn't be there if you're hoping to develop business.
I see this a lot. People say, "Well, we're everywhere and none of it is working." Well, do less. Do less marketing, less social media, and you'll get better results if you focus it on where your folks are and you use it more strategically and more programmatically.
Jay: You've been in business for a while. I've been doing this for a while.
Looking back, what do you wish you knew then, that you do know now? What would you tell young David Newman about business and marketing?
David: I just recently figured this out, last two or three years. I'll be totally up front about that, and part of it is us doing this interview.
I'm a huge Tom Peters fan. One of the first things he implemented is a little feature on his blog called "Tom's Cool Friends". I was like, "Oh my God. What a great idea. Tom's Cool Friends." He would specifically and intentionally shine the spotlight on other experts, shine the spotlight on other thought leaders.
I have a blog post out there called "Why your business needs to FLOP". FLOP is an acronym for Feature and Leverage Other People. So, my business FLOPs. Your business FLOPs.
Whether it's a company of one or a company of 10,000. Figure out how can you FLOP, how can you Feature and Leverage Other People, because that's going to raise your profile, raise your expertise, raise your level of trust, and raise your level of Youtility.


Happy National Nutrition Month! This March, make a new goal to live healthy. This resource provides simple and healthy tips to improve your diet and lifestyle.
Eat breakfast every day. Skipping breakfast may seem smart, but it can make you tired and unable to focus throughout the day. Start the morning with a healthy breakfast like oatmeal, yogurt, or eggs.
Cut back on foods with added sugar. Foods with lots of added sugar can make kids jittery and leave them with empty calories. Try to eat foods with natural or low sugar instead.
Drink plenty of water. If you're dehydrated, you might feel tired or even lethargic. Keep a water bottle with you at all times and drink from it whenever you feel thirsty.
Exercise at least three times a week. Exercise is important to keep your heart healthy and strong! Try to get at least 30-45 minutes of moderate exercise three or more times a week.
Don't give up. Real lifestyle changes don't happen overnight. Even if these habits are hard to pick up at first, they'll get easier in time.
Make springtime a season of transformation and add these healthy tips to your lifestyle!


About Us – Pollock Planning Associates, Inc.
Pollock Planning Associates was founded in 1985. The firm has served a broad variety of clients on a fee-only basis for over thirty years. We believe that continuing guidance and education are essential building blocks for a sound financial plan. Being compensated on a fee-only basis allows us to be accessible, objective and to make decisions with only your best interests in mind. Our raison d'être is to help you realize your life-long financial goals.
As members of The National Association of Personal Financial Advisors (NAPFA), we are required to meet rigorous Continuing Education requirements. In fact, NAPFA has imposed requirements that are more stringent than those of the Board of Certified Financial Planners. NAPFA requires adherence to a strict Code of Ethics. Members maintain a fiduciary responsibility to their clients…a relationship of utmost trust and confidence.
Our mission is to achieve an unequaled standard of excellence in our profession by providing personalized value-added services. We endeavor to become indispensable to our clients by assisting them in making educated, intelligent financial decisions. We deliver this to our clients through comprehensive financial planning and investment management. We will continually develop new services and planning techniques to maintain our position on the cutting-edge of the wealth advisory process. We consistently strive to go beyond our client's expectations. Our greatest reward is our client's peace of mind.
We have felt strongly from the start that the fee-only model stands alone in allowing an advisor to act with an unmatched level of objectivity. We believe that an inherent conflict of interest exists should we stand to gain financially from any course of action or product that we recommend to you. We charge a fee for our services that is based primarily on the time involved to provide the service. Many advisors and salesmen who sell products use the term "fee-based" to describe their method of compensation. What this actually means is that, in addition to a commission received, they are also charging a fee for some of the services that they provide. While this may seem like a subtle distinction, in practice, when one has a hammer in their hands, everything starts looking like a nail. For example, a life insurance salesman is in a position to offer a range of products to solve just about any financial need be it retirement income, a savings vehicle or education funding. As a guard against an untimely demise, pure life insurance is unrivaled…in many other circumstances, there are far more elegant solutions.
We perceive financial planning as an on-going, dynamic process, as opposed to an event. As we identify specific financial goals or objectives, we will, in concert with you, develop planned steps to achieve them. Our services are provided on either a fixed-fee, retainer basis or as a percentage of assets under management. We would prefer that you feel free to call or meet with us for any reason as opposed to being forced to make a cost-benefit analysis with respect to each and every issue. Whether your goal is to put the children through college, buy that condo on the golf course or retire in the comfort that you've always envisioned, a consistent, methodical and proven approach will allow you to realize your objectives.


text:
package org.apache.sling.scripting.xproc.xpl.api;

import java.util.Map;

import javax.xml.namespace.QName;

public interface XplElementFactory {

	XplElement createXplElement(QName type, Map<String, String> parameters);

}

redpajama_set_name: RedPajamaGithub


text:
SANTA FE – New Mexico state health officials on Friday announced 1,266 additional COVID-19 cases. Per the state Department of Health, the most recent cases are: 291 new cases in Bernalillo County 77 new cases in Chaves County 9 new cases in Cibola County 7 new cases...
SANTA FE – New Mexico state health officials on Thursday announced 1,434 additional COVID-19 cases. Per the state Department of Health, the most recent cases are: 344 new cases in Bernalillo County 1 new case in Catron County 73 new cases in Chaves County 9 new cases...
SANTA FE – New Mexico state health officials on Wednesday announced 1,151 additional COVID-19 cases. Per the state Department of Health, the most recent cases are: 352 new cases in Bernalillo County 1 new case in Catron County 17 new cases in Chaves County 8 new cases...
SANTA FE – The New Mexico Department of Health on Wednesday announced the updated statewide COVID-19 map for the two-week period beginning Jan. 13, with 30 counties at the Red Level. Twenty counties saw a higher average daily per-capita rate of new cases in the last...
SANTA FE – Gov. Michelle Lujan Grisham on Wednesday announced her agenda for the first session of the 55th New Mexico Legislature, a series of proposals that will advance meaningful investments and new policy in public education, early childhood well-being,...
New Mexico COVID-19 update: 893 new cases, totaling 157,974 – thirty additional deaths
SANTA FE – New Mexico state health officials on Tuesday announced 893 additional COVID-19 cases. Per the state Department of Health, the most recent cases are: 231 new cases in Bernalillo County 2 new cases in Catron County 35 new cases in Chaves County 7 new cases in...
New Mexico COVID-19 update: 933 new cases, totaling 157,087 – fifteen additional deaths
SANTA FE – New Mexico state health officials on Monday announced 933 additional COVID-19 cases. Per the state Department of Health, the most recent cases are: 261 new cases in Bernalillo County 19 new cases in Chaves County 17 new cases in Cibola County 5 new cases in...
Department of Finance and Administration releases FY22 Executive Budget Recommendation
SANTA FE – The New Mexico Department of Finance and Administration on Monday released the FY22 Executive Budget Recommendation from the administration of Gov. Michelle Lujan Grisham, totaling $7.3B in recurring spending with a 3.3% increase. The executive...
New Mexico COVID-19 update: 1,208 new cases, totaling 156,157 – seventeen additional deaths
SANTA FE – New Mexico state health officials on Sunday announced 1,208 additional COVID-19 cases. Per the state Department of Health, the most recent cases are: 270 new cases in Bernalillo County 58 new cases in Chaves County 1 new case in Cibola County 3 new cases in...
New Mexico COVID-19 update: 1,507 new cases, totaling 154,954 – twenty-two additional deaths
SANTA FE – New Mexico state health officials on Saturday announced 1,507 additional COVID-19 cases. Per the state Department of Health, the most recent cases are: 374 new cases in Bernalillo County 2 new cases in Catron County 60 new cases in Chaves County 18 new...
Get in touch with the Governor
Governor Michelle Lujan Grisham and her staff welcome your comments and concerns.
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· Who should be the first to know that I'm resigning? An associate should inform the senior pastor or immediate supervisor before spreading the word among other staff members or friends in the congregation. I know a pastor who felt betrayed when he was one of the last persons to learn of his associate's resignation. If you're the senior pastor, talk to your elders or deacons before church members find out.
· How can I facilitate a smooth transition to my successor? Pose the following questions to other staff members, to the church board, and to key lay leaders whom you supervise: What do you need from me during these last weeks? What information or training will keep things running smoothly until my successor arrives? Prepare a notebook or electronic file for your successor, chockfull of program information, office procedures, and policies integral to the job description. Leave a record of key persons and their contact information. Ponder ways to save this person's time once he or she comes on board.
Bubna also cautions against frequent visits to the previous congregation, particularly during the first couple years. He says it's "professional courtesy" to return only with the prior awareness and blessing of your replacement. "Whether or not the split was on friendly terms, any return to the parish needs to be instigated by the new shepherd without pressure from either the prior pastor or his supporters." Limiting your visits allows for a bonding to occur between the people and the new staff member. A close friend who pastored our church for 18 years recently visited on a Sunday for the first time in six years. But first, he phoned the current pastor to inquire about a possible visit.
How we leave a position says a lot about our character!
What additional questions should be addressed by a staff member who's planning leave?


Life is just odd sometimes. I'm not sure what to think of it. Alex is great in so many amazing ways, but then he's bad in these not-really-big-but-i-don't-know-if-i-can-handle-it kinda ways. Like the drinking. It's never-ending. He's always drinking beer. Granted he never gets so drunk that he's mean or anything. I don't think he would ever get mean while he's drinking. At least, not the kind of mean that pops into my head when I think of mean drunks. But I can't stand the alcohol just the same. Now he's got this breathalyzer device installed in his truck, so he really can't drink. It will go off if he was even drinking the night before. It's really kinda funny in a mean way.
Anyways, so we've got this new little 16 yr old that's coming over to pick stuff up now. A friend of a friend of Alex's. He's cool, but that's just so young. It kinda weirds me out. I know it's no big deal, I just never hang out with anyone that young. I've been smoking since he was 1. It's slightly creepy for me and makes me feel very old.
So, I'm sitting up here at Borders drinking a coffee slushee. Mmm I love them. I really need a cigarette, though. I'll wait a little longer. I have to pack up all my crap to go outside. I got a new book, The Host by Stephanie Meyer. I loved the Twilight series, so I figured I should try her other book. I also need to pick up the other books by Charlaine Harris. I just finished the new Sookie Stackhouse novel. It was really, really good. Well, I guess I should go smoke my cig and then do my test for Nutrition class.


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Plug micro USB connector of the USB cable into your AnyCast dongle. Use paper pin to short pin 7 and pin 8 (count the pin number from bottom up) of the NAND Flash memory. Keep 2 pins shorted and plug USB type A connector of the USB cable to PC at the same time.


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Tories will be 'toast' if they do not deliver on Brexit, says Raab
Tory leadership contender Dominic Raab has warned the party will be "toast" unless it takes Britain out of the EU by the October 31 deadline.
Ahead of the second round of voting on Tuesday, Mr Raab hit out at those in Parliament who he accused of trying to "steal" Brexit from the voters.
He defended his controversial refusal to rule out suspending Parliament to prevent it blocking a no-deal saying he did not want to weaken his negotiating position with the EU.
However, fellow leadership contender International Development Secretary Rory Stewart accused rivals pledging to leave by October 31 of making promises they could not deliver on.
Foreign Secretary Jeremy Hunt said that committing to a "hard stop" at the end of October would be to ensure a no-deal Brexit.
He said he believed he could negotiate a new deal with the EU which would avoid the need for the Northern Ireland backstop, which led to Theresa May's deal being defeated three time in the Commons.
Mr Raab, who, like Boris Johnson, is committed to leaving by October 31 with or without a deal, insisted there could be no more delay to Brexit.
"The Tory Party will be toast unless we are out by the end of October. The Conservatives cannot win an election unless we have delivered Brexit," the former Brexit secretary told Sky News's Ridge On Sunday programme.
He again refused to rule out proroguing Parliament if it was necessary to ensure that MPs could not "sabotage" the will of the people.
"The big mistake we made in these negotiations was taking no-deal off the table. When we start ruling things out we only weaken our chances of getting a deal," he said.
Rory Stewart has accused rivals of making promises they cannot deliver on (Jeff Overs/BBC/PA)
"All those candidates that are going weak at the knees and saying 'I'm not sure about this and that', they are sending a message to the EU that they can take us for a ride.
"We gave people a decision. Now Parliament is trying to steal it back away from them. When people voted, they voted to leave."
Tory leadership