Living Will-Living Will Forms

In the year 2003, through the VueTech platform, the world was introduced to the first live dealer casino based out of a land casino in Dublin, Ireland. This monumental invention introduced a whole new meaning to online gambling. Not only could you play real casino games in real-time, but you could enjoy the company of live dealers (croupiers) while playing your favorite casino game. The live dealer casinos set forth the next generation for online gaming experiences. Now when you decide to have some fun you are not only looking for a highly recommended online casino, rather a highly recommended online casino that offers the live dealer feature.

Why would someone prefer a live croupier casino over an average online casino? Well, it’s a simple and direct reason. They are at the top of the online gaming entertainment pyramid. You can experience real live casino games taking place in real-time with real people, real dealers. You can find your favorite casino games offered at a live dealer casino. You can play live Roulette, live Blackjack, live Baccarat, live Texas Hold´em Poker and live Sic Bo. Now, keep in mind that not all live croupier casinos offer all of these live casino games, but there are a handful of webcam casinos that do offer them all.

The most popular casino games of the webcam casinos are Blackjack, Roulette and Baccarat. Most live online casinos offer these three live dealer games. Live Roulette is offered in both the American Roulette wheel version and the European Roulette wheel version. Blackjack is available in many different strategies, including one strategy offered (early payout) which was soley made for the live dealer casino.

It does not matter which webcam game you prefer to play, you will definitely notice the difference in the entertainment quality compared to the simple online casinos. Apart from the fact that you can enjoy the live games from wherever you desire and whenever you desire, you can also be sure to receive the same adrenaline rush you would get at a real land casino. However, for most it is a better environment since you can control your surroundings. You do not have to deal with crowds, uncomfortable positions, cigarette smoke, and noisy people and music (if that’s not your thing). You can choose your environment, but at the same time you can see and hear the live dealers do their job.

You will notice the difference concerning your surroundings, but while you play with the live webcam casino you will feel that the game is the same as if you were at a land casino. The games are just as exciting and they are played the same way as if you were at the bricks and mortar casino. You can hear the love dealer make calls. You can see the real game happening in real-time. You can be assured that the results are legitimate.

It doesn’t matter if you are a high roller or if you are an inexperienced online player. The live croupier casino can provide you with what you need in order to have a fulfilled gaming experience. All webcam casinos offer great bonuses and promotions you can only take advantage of by playing online. The table limits are also very competitive compared to land casinos. So there is nothing that can keep you from having a memorable time playing with a live dealer casino. I bet you will go back for more fun and excitement.



By: Sofia Hill

About the Author:

Augustine Rivers

I am sure you have heard of online casinos before. The question is, have you ever heard of a live online casino? If not, then you are missing out on the next generation of online casino gaming. There are so many reasons why live casinos are the new leaders of the pack so to speak. The live webcam feed definitely closes the gap between online casinos and bricks and mortar (land) casinos. For many gamblers, the webcam feature will provide a good reason why you should play live casinos and not play with the simple online casinos or even go to the land casinos.

An obvious reason why a live casino is so special is due to the live webcam feature. This means that the online players actually play with real live dealers (croupiers). What does this mean you may ask? Well, it means that you can see, hear and chat with the live dealers in the live online casino. As the old saying goes, “seeing believes”. This is so true! Many players may not even think of playing online because they may think that the results of the games are not real. This means that the results are fixed and not random. This is something that is very easy to believe when you have no idea where the results come from. Well, when playing with a live online casino you can be sure to actually see the live dealers dealing the cards or throwing the ball or dice. Most live webcam casinos give you not only one webcam view, but two or even three different webcam views. In other words, you can not only see the live dealer doing his or her job, but you can also see close up shots of the cards, ball or dice the live dealer handles. You can also see different angles of the playing table.

The live webcam casino technology gives the opportunity to hear the live dealer doing his or her duty. Not only can you hear the dealer, but you can hear the cards, ball or dice being placed in their position. This can be considered an extra security measure for us online players since the sounds occur at the same time the action takes place. It gives you a so called back-up to the fact that the game is for real and in real time. You can also hear the background noise of the land casino where the real live internet casinos are based out of. How much better can a live online casino get? How about being able to chat with the dealers as well! Yes, I am serious! How is this possible? Well, it is very simple. The live chat highlight is integrated into the gaming software and the live game window where the video feed is presented. Below the webcam window you will find a small space committed for the live chat feature.

You may be thinking that with all of these great features a live online casino offers us it will take a decade to download the webcam games. Not at all. Playing with a live webcam feed is very easy and convenient way to play your favorite casino game. All you will need is an Internet connection in order to download the software and install the software or you may simply need to download the software, but not install it, or for some casinos you don’t even need to download at all. Using this last version you can simply play live online by instant play versions of the live games. The way you go about it all depends on the live webcam casino you decide to play with.

So go out and try a live online casino if you haven’t already. You will definitely see why this is the next generation of online gaming.



By: Sofia Hill

About the Author:

Tanja Legallo

Should it be online casinos or live casino TVs? Ever since the new method of playing emerges, there are already a lot of people who believe that the latter is a far better one than the former. But if you are wondering why, perhaps these can help enlighten you:

1. You can play more games here than in online casinos. Okay, an online casino may have hundreds of games that you can choose from. However, if you are going to get serious with it, there are only few that can really rake in money. We are talking about card and table games, as well as slot machines. In live casino, you can have a lot of rounds for roulette and blackjack, where you can win prizes that can be credited directly into your account. Because of too many chances given to you, there is always the possibility that you can win at least once.

2. It is definitely more exciting and real. In online casinos, what you are going to have are simulated games. These are the ones with cool graphics and real-sounding sounds, in an effort to mimic the typical atmosphere in a brick-and-mortar casino. However, no matter what type of technology is going to be used, it will always remain a simulation. Live casino TV is the closest thing you will ever have in a land-based casino. There are dealers, who are sometimes called presenters, and you have opponents. The rules of the game are almost the same, but the only difference is that you can see the games in **** tube. Of course, the sounds and expressions that you see are authentic, so the emotions you convey are also natural.

3. You do not need to travel to get into real casinos. Though online casinos and live casino TV can be enjoyed at the comforts of your own home, we can still trace to the previous benefit that the latter is a lot more real than the former. If you are going to compare both, you will realize that even if they share the same characteristics-that they are both home-based games-live casino TV still has an edge over online casinos.

4. Most live casino TVs have their own website. Typical online casinos do not have their own cable channel and broadcast schedules. When you are going to log in, you can directly open your account and then play the online games of your choice. Surely, you can join roulettes and blackjacks with live dealers, but you may eventually meet some problems with live streaming, especially if your PC or laptop is not capable of playing long videos. With live casinos, you have the option to watch the games into your own television. What’s more, most of these organizers have their own website, where you can continue playing the game just in case you need more.

5. Live casino TVs can be enjoyed by many. You can only invite friends and families to be with you if they also decide to sign up in the online casino. Otherwise, you are going to be on your own. Live casino TVs, on the other hand, can be seen by those who have access to the cable channel-even by those who are not official members of the casino website. You can even choose not to bet at all and simply take delight in the fast-paced rounds of live casino TVs.

Live casino TVs offer a whole new way in enjoying your favorite all-time games. If you wish to join, you can use the free phone number or register at the online casino and bet through there.



By: Dan Roberts II

About the Author:

Nathaniel Royce

Assisted living facilities are rapidly becoming the nursing homes of the future. According to the National Center for Assisted Living, there are over 36,000 licensed assisted living facilities nationwide with an estimated 1 million residents.[1] However, because there is no common definition for assisted living facilities, this number may not adequately reflect the prevalence of these facilities. In fact, in 2002 the National Conference of State Legislatures hailed the assisted living market as one of the fastest growing long-term care options for senior citizens; the number of seniors in assisted living facilities receiving Medicaid benefits has grown nearly 50% over the past few years.[2]

These facilities tend to aggressively market and recruit residents, many times promising staffing levels or services that, in reality, are not available.[3] In an attempt to compete with nursing homes, assisted living facilities are accepting patients with higher acuity. Most major chains promote special Alzheimer’s Disease Units, and are accepting patients with significant cognitive impairment. The reality is that many of these facilities have staffing that is inferior to the staffing levels present in nursing homes and simply cannot meet the needs of the higher acuity residents. The end result is that residents throughout the county are suffering from serious injuries due to the neglect and abuse that is taking place in these facilities.

A. Assisted Living v. Nursing Home Care

Assist living abuse and neglect cases and nursing home abuse and neglect cases are similar in some respects, i.e., both involve supervision and care of the elderly, but evaluating the assisted living case involves a greater perception of the differences in the two types of facilities.

1. Standards of Care. The litigation of assisted living abuse and neglect cases, like the litigation of nursing home abuse and neglect cases, can be an effective tool in forcing the industry to comply with proper standards. However, since most states have weak regulations, it often becomes difficult to establish the legal standard of care for a particular facility. Many times a plaintiff may have to fall back on basic community practice nursing standards that will apply when an assisted living facility contracts to provide more than just room and board.

Nursing homes are highly regulated and must comply with the regulations set forth in the Omnibus Budget Reconciliation Act (“OBRA”) of 1987[4] (otherwise known as the federal Nursing Home Reform Act) which set minimum standards of care for long term care facilities that receive federal funding. Unlike nursing homes, assisted living facilities are not regulated by the federal government, and the state regulations that do exist are inconsistent and, for the most part, not aggressively enforced.

When considering the basis for liability, one must consider whether the assisted living facility breached regulatory or community practice standards in admitting the resident whose needs may have been too great to be met by the assisted living facility. Many assisted living facilities, especially those with “Specialized Alzheimer’s Units” are accepting residents with advanced dementia who would normally be admitted to a nursing home, and possibly even a skilled wing of the nursing home. In such cases, it would be advisable to obtain an expert who will evaluate the resident’s condition and the relevant admission criteria. Such an evaluation will likely be beyond the abilities of a lay person, although many admissions decisions in assisted living facilities are being made by non-medical personnel.

Almost all states prescribe some limitation on who can be admitted into an assisted living facility. For example, Virginia regulations prohibit adult care facilities from admitting or retaining patients with a variety of conditions, including ventilator dependency, dermal ulcers stages III and IV, those requiring intravenous therapy or injections directly into the vein, nasogastric tubes, and those who require continuous licensed nursing care. 22 VA. ADMIN. CODE § 40-71-150 (West 2003). Other states contain similar limitations with prohibitions aimed at excluding patients with a demonstrated need for skilled or specialized care.[5] Assisted living facilities do not provide skilled care; consequently, they are uniformly required to screen patients to determine the level of care needed and reject patients whose needs exceed their capacity. State regulation of assisted living facilities is lax and, for the most part, ineffective. Only a few facilities in the Commonwealth of Virginia have been denied a license for regulatory noncompliance. It is the opinion of this author that weak regulatory enforcement is in part due to inadequate regulations that do not adequately specify industry standards.

2. Experts. To litigate a nursing home abuse and neglect case it almost always requires the use of medical experts who will define the standard of care and address breaches in the standards. As assisted living facilities are generally not considered health care providers, one may question whether an expert is necessary. This will obviously depend on the facts of your case. But in almost every case, at the very least, you will require an expert to establish causation and damages. Since many times injuries in assisted living facilities result in the patient requiring long term care in a nursing home, you may also want to consider obtaining a life care plan from a qualified expert.

Once you have obtained records, you should have the case reviewed by a nursing expert you can rely upon. Unlike nursing homes where there DON and Administrators are RNs, many of the nurses who work in the assisted living arena are LPNs and lack the background that you may be looking for in an expert. Finding talented nurse experts who are actively involved in assisted living care is a challenging task. This author has used the ATLA list serve, and random calling of facilities to locate qualified experts.

B. Evaluating the Assisted Living Case

1. Facility Records. The first step in assessing liability against an assisted living facility will be to obtain the records from the facility and the contract that was signed. The contract will likely define the duties undertaken by the facility. Most assisted living facilities have various levels of service. Level one might be the basic service which would include only room, board, meals and activities. Level four, or the highest level of service, might include resident assessment, care or service planning, medication administration, and dementia and nursing care. The standards applied by these facilities could be analogized to standards of care applied by a nursing home that was not providing skilled care.

2. Freedom of Information Act. In addition to obtaining the records, you will need to do a Freedom of Information Act request. This will help you identify the corporate entity that actually owns and operates the facility and may also allow you to see surveys or inspections that were done on this facility. The license should always be available, and may include information about the scope of services that the defendant facility is authorized to provide. Do not expect the surveys or inspection reports to contain the wealth of information that are available for nursing homes. Many times surveys are performed by the local Department of Social Services and do not include assessments of whether or not these facilities are complying with regulatory standards of care.

3. Case Review. The following are some factors to consider early on in deciding whether or not to prosecute an assisted living facility for negligence or abuse:

a. The nature of the resident’s condition upon admission. If she was mentally competent and independent with acts of daily living, you will confront significant problems with contributory negligence and comparative fault defenses.

b. The nature of the contract and duties assumed by the facility. If they only agreed to provide room, board, and meals, the defense will argue their duties are analogous to that of a landlord in an apartment building.

c. The quality of the relationship between the personal representative and the victim. If the victim is deceased, this may take on a greater importance as the nature of that relationship may define your damages under the applicable wrongful death act.

d. Whether the family members make good fact witnesses, appear genuinely outraged by the facility’s conduct, and complained and/or removed their loved one from the facility.

e. Whether the facility had serious staffing shortages or a pattern of neglecting their residents.

f. Did the victim suffer a significant injury in the facility that adversely affected the quality of her life for the future, or caused her death?

g. Do you have strong witnesses and powerful exhibits? Do you have an insider who is willing to blow the whistle on rampant staffing shortages? Do you have color photos of that pressure?

h. Do you have significant economic specials that are not encumbered by a Medicare or Medicaid lien?

i. Is the defendant a charitable organization, religious affiliate, or part of a large assisted living chain?

C. Theories of Liability

With weaker regulation, variety in industry standards, and market competition, it is not surprising that the U.S. General Accounting Administration, in 1999, identified problems in assisted living facilities that included inadequate or insufficient resident care, insufficient trained staff, improper medication administration, and not following admission and discharge policies required by state regulation. A 2000 study by the U.S. Department of Health and Human services found that a high percentage of the staff at assisted living facilities were not knowledgeable about the normal aging process and at least 60% of the staff did not know how to properly manage difficult behavior among assisted living residents.

Liability: Improper Admission. Many times, liability based upon an improper admission results when someone is admitted into a facility that is not locked down or enclosed. Many residents with dementia have a tendency to wander and they should simply not be admitted into facilities that are not locked down or do not have appropriate wander guard systems and/or alarms on the doors.

In Selvin v. DMC Regency Residence, Ltd., 807 So. 2d 676 (Fla. Dist. Ct. App. 4th Dist. 2001) a resident of an assisted living facility wandered off and was found dead in a nearby canal. Plaintiff’s complaint alleged two different theories of liability: the first was a statutory wrongful death action and the second was based on alleged violations of statutes relating to assisted living facilities. Plaintiff alleged that the facility had a common law and statutory duty to supply at least the level of services and care that all licensed assisted living facilities generally furnish elderly patients of the plaintiff’s decedent’s classification and condition. At the time of trial, plaintiff sought to introduce expert testimony about specific safety precautions that were the industry standard and further sought to show that the facility should have built a fence to prevent elders from wandering near the dangerous area of the canal. The trial court precluded this testimony, finding that the facility had no legal duty to fence off the canal to the general public. The Appellate Court reversed, finding that the facility undertook to furnish certain services of care and security which created such a duty of protection. The Appellate Court also held it was an error to exclude testimony regarding industry standards of what could have been done to protect these impaired residents from falling into the canal.

1. Liability: Falls. Another common area of liability in assisted living facilities involves falls. Expert testimony may not be required in such cases. See, Walker v. Southeast Alabama Med. Ctr., 545 So. 2d 769 (Ala. 1989).[6] However, fall assessment and fall prevention planning is usually done by a nurse or other medical provider and it may be advisable to have an expert address this issue. In large part, the need for an expert will be determined by the facts of your particular fall. If the staff simply dropped the resident during a transfer, an expert may not be necessary. However, if the resident came in to the facility with multiple risk factors for falling[7] which were never assessed or care planned and he fell one day while wandering the hallway, you should retain an expert to discuss how the standard of care for fall prevention was breached. To establish causation, she will have to testify that if appropriate standards were followed, it would have, more likely than not, prevented the particular fall which caused injury to plaintiff. As this is an area of first impression in many jurisdictions, it is advisable to educate the court with a trial memorandum addressing experts and other issues prior to trial.

D. Other Theories of Liability

Attorneys who prosecute assisted living facilities have an opportunity to be far more creative in the prosecution of these claims, given the broad range of theories that are available. Below are some typical theories that can be advanced against an assisted living facility.

1. Common Law Negligence. This is probably the most common theory of liability advanced in assisted living cases. Make sure you do not plead breaches in medical or nursing standards of care, or you may face the argument that you have pled a traditional malpractice case. You can plead the breach of regulatory standards and/or industry standards which proximately caused injury to your client. As assisted living facilities are not health care providers, they should not be subject to caps or other discovery limitations (i.e., quality assurance privileges) that apply to traditional health care providers.

2. Violations of the Consumer Protection Act. Make sure to inquire of your client what representations were made as an inducement to enter the facility. Obtain the brochures that were handed out by the marketing representative. Most consumer protection statutes provide relief for misrepresentations which were made as an inducement to enter into the consumer transaction. Case law has allowed such theories to be advanced even against health care providers, so there should be no reason that this theory could not be advanced against an assisted living facility.[8] The advantage is that many states’ consumer statutes allow for the recovery of costs and attorney’s fees.

3. Adult Protection Act. Most states have statutes that have been specifically enacted to protect the rights of elder Americans.[9] Some states, like Tennessee, specifically exempt health care providers from the application of such statutes.[10] As assisted living facilities are not health care providers, these exemptions should not apply.

4. Breach of Contract. Almost all assisted living facilities will make their residents sign a contract as a condition of admission. Scrutinize the contract carefully, as it may contain waivers of liability or waivers of the resident’s right to a jury trial. Such waivers can be asserted irrespective of whether one pleads a separate breach of contract claim. Under the laws of most states, contract damages will be limited to foreseeable economic damages, so it would be disadvantageous to plead this as your only theory of liability. However, the contract may have required that certain services be delivered to the resident (i.e., activities, assistance with acts of daily living, 24 hour supervision) which were not, in fact, provided. The resident may have suffered no physical injury from the failure to deliver such services and the defense will argue that such evidence should be excluded at the time of trial. With the contract theory properly pled, plaintiff can argue that such evidence is admissible to prove contract damages and recover monies for services which were not provided.

Be wary that the defense may argue that since plaintiff failed to quantify the extent of services that were not provided, any award of contract damages would be based on speculation. As such, you should make an attempt to have your client provide a good faith estimate in percentage terms as to what services were not provided. However, if you have a strong negligence claim based on a discreet event (i.e., a fall causing a hip fracture) you may not want to confuse the jury with a lot of collateral facts and issues that may not have a strong bearing on your damages.

5. Negligent Hiring and/or Retention. Consider this claim where you have intentional torts committed by an employee and some evidence that the defendants knew or should have known that this was a troubled employee. Many assisted living facilities don’t adequately screen their employees. This evidence may not be revealed until the discovery process begins and it is essential that you obtain the employee’s personnel file early on in litigation so you can amend your complaint if necessary. Depending on the tolling provisions of your individual claim, the cause of action may still relate back because it arguably arises out of the same set of operative facts. It is also a good idea to sue the employee individually. The same defense firm may represent both the employee and corporation, making it impossible to argue that the employee was not operating within the scope of his employment.

6. Wrongful Death. In any case where there is evidence that the facility’s negligence caused or contributed to the resident’s death, a separate wrongful death claim should be asserted. If there is any good faith basis to conclude that the negligence contributed to plaintiff’s death, you should plead both survivorship and wrongful death claims. Any long term care case has greater value if you can argue that defendant’s neglect caused plaintiff’s death. You may also have separate claims for injury that in no way contributed to the resident’s death. Such claims should be pled with your survivorship claims. Research the law in your jurisdiction to determine what forms of damages are recoverable under a wrongful death statute. If you’re in one of those unfortunate jurisdictions that allow only economic damages, you may not want to plead a wrongful death claim.

7. Punitive Damages. As the nature of economic damages in an assisted living case may not be impressive, and as your client will likely have suffered from several preexisting conditions that may weaken your compensatory damage claim, you should, whenever possible, plead punitive damages. Successfully pleading a punitive damage claim will also provide you with the basis for exploring defendant’s conduct with respect to other residents who were neglected in substantially similar ways to that of your client. Cases from around the country have upheld such punitive damage claims against nursing homes, and there is no reason that such precedent would not apply equally to assisted living facilities. [11]

8. Americans with Disabilities Act/Fair Housing Act. The Fair Housing Amendments Act of 1988 (FAA)[12] prohibits discrimination in virtually all housing and related activities, whether such conduct takes place in the private or public sector. This law is complemented by the Americans with Disabilities Act,[13] which, while it specifically does not include entities covered by the FAA, applies to non-housing functions of a facility, such as common areas, meeting rooms, cafeterias, adult day care, or long term care under Title II (state and local) and Title III (public accommodations) programs.

E. Selected Case Results

A survey of reported cases reveals very few published cases throughout the country. This author has litigated fall cases, negligent admission resulting in pressure sores cases, and one case involving an unfortunate resident who caught fire in the recreation room. The manner in which he was ignited was never explained by the facility.

In one assisted living case taken to verdict in Virginia, plaintiff had fallen during the evening and was placed back in bed (with a hip fracture) by a nurse aid who denied the fall ever happened. Plaintiff was alive at the time the case went to verdict and required ongoing nursing care because of her injuries. The jury rendered a verdict of $1.5 million in compensatory damages.

A brief survey of published assisted living cases results and verdicts across the U.S., reveals the following:

1. **** v. Bixby Knowles Towers; No. NC 021 371, verdict date 04/15/1998. Plaintiff was walking through the dining room when she felt hot coffee spill onto her neck, back and shoulder. She turned away from the coffee and stumbled and fell. One employee acknowledged holding two pots of coffee at the time of injury, but denied spilling coffee on the Plaintiff. Plaintiff suffered a fractured distal femur and first and second degree burns. Verdict was $378,990, with medical expenses totaling $128,000.

2. Wiggins v. St. John’s Terrace Homes, Inc. Docket No. 96-2705-CA; FJVR reference No. 98:7-55 (July 1998) Plaintiff, an assisted living resident, was seated at a dining table when a coffee pot burst open, pouring scalding coffee down Plaintiff’s leg. Verdict of $223,893.

3. Weiland, as Personal Representative of Louise Debenack, v. Alexandra & Co. of Boca Raton, Inc., d/b/a/ The Colonnade at Haverhill, Docket NO. CL 99-00066 AE; FJVR reference No. 01:6-54 Pub.(June 2001). Plaintiff found dead after she developed a UTI that became septic. Upon admission to hospital, plaintiff had a large hematoma which was not explained by the defendant. Settlement for plaintiff for $1 million.

4. Estate of John Doe v. Anonymous Assisted Living Facility. (Reported from the Michigan Trial Reporter, JAS Publication) Settlement of $1,350,000 for an elderly assisted living resident who died from burn injuries sustained while showering. Plaintiff’s theory of negligence alleged that defendant was negligent in not having proper temperature controlling devices for their residents.

5. Davis v. Premium Health Care, Inc. Docket No. 98-20263, Reference No. 01:8-12 (August 2001). Settlement of $300,000 for decedent who developed multiple pressures sores (including a stage IV) while in the facility.

6. Casaletto v. Helen Homes Corp., d/b/a The Palace Gardens, Docket NO.: 01-12468 BA 20; FJVR Ference No. 02:9-44 (Miami, September 2002) Defense verdict involving an 86 year old male who was admitted to an assisted living facility in May and suffered a fall in August of the same year. Plaintiff alleged improper admission and failure to properly supervise. Defendant contended that the decedent was a proper admission and that the level of supervision was appropriate in he ambulated independently. Both parties relied on experts in the area of assisted living administration.

7. Pollock v. CCC Investments I. LLC d/b/a Tiffany House by Marriot, Docket No. 01-16746, Ref. No. 05:3-9 (Florida 2005). Defense verdict involving a resident who was murdered by another resident. Defendant’s argued they had no notice of the other resident’s potential violent conduct. The jury found there was no negligence on the part of defendants that caused plaintiff’s death. They also found there was no violation of the assisted living facility’s resident’s rights under Florida statutory law. Defendant’s highest offer was $750,000 with lowest demand at $9,900,000.

II. Conclusion

As this is a new and evolving area of the law, attorneys who litigate these cases should strive to establish favorable precedents for those who follow. If the recent explosion in nursing home litigation is any indication, assisted living facilities could be the nursing homes of the future. As with nursing home litigation, the civil prosecution of these cases provides an important safeguard in protecting the rights of our elderly and assuring that proper standards are followed in the industry.

[1] Mollica, Robert L. State Assisted Living Policy: 2000. Portland: National Academy for State Health Policy, 2000, Executive Summary.

[2] Issue Brief, Health Policy Tracking Service, National Conference of State Legislatures, October 1, 2002.

[3] Based on a study done by AARP that randomly shopped some 80 assisted living facilities, a pattern of discrepancies was found between what representations were made in the marketing materials versus promises made in the admission’s contract. Two previous surveys that compared marketing materials and assisted living contracts, one by the American Bar Association’s Commission on Legal Problems of the Elderly Consumer Reports, and the other by the U.S. General Accounting Office, revealed similar problems. Adrienne Oleck & Bruce Vignery, Nurture or Neglect? Challenging Deceptive Practices in Assisted Living Facilities, CONSUMER ADVOC., Jan. 2001, 7(1).

[4] See, 42 C.F.R. 483.10 et seq.

[5] Montana law prohibits assisted living facilities from admitting patients who, inter alia, are non-ambulatory, in need of physical/chemical restraints, or unable to self-medicate. MONT. CODE ANN. § 50-5-226 (2002); Florida law prohibits admission of residents who are bedridden, those who have stage III or stage IV pressure sores and those residents who may require 24 hour nursing care. FLA. STAT. Ch. 400.407 (2005).

[6] In Walker, there was evidence that a patient had a history of falls and further that the patient’s doctor had instructed the nurse to leave the bed rails up at all times. A nurse lowered the bed rails and the patient fell. The court held that the plaintiffs were not required to present expert testimony because the breach of care alleged by the plaintiffs, leaving the bed rail down contrary to doctor’s orders, was so apparent as to be understood by a layman.

[7] Risk factors for falling could include dementia, confusion, unstable gait, prior stroke, arthritis, medications usage, history of falls, history of agitated behaviors, vision problems, and weakness or muscle atrophy.

[8] Dorn v. McTigue, 157 F. Supp. 2d 37 (D.D.C. 2001) (holding that District of Columbia Consumer Protection Act applied to the medical profession); Chalfin v. Beverly Enters., Inc., 741 F.Supp. 1162 (E.D. Pa. 1989), reconsideration den., 745 F.Supp. 1117 (E.D. Pa. 1990) (health care services provided by a nursing home were within the scope of “trade or commerce” provisions of Pennsylvania consumer protection laws); Winkler v. Interim Servs., Inc., 36 F. Supp. 2d 1026 (M.D. Tenn. 1999) (Disabled Medicare beneficiaries’ claims against home health care provider for violation of Tennessee Consumer Protection Act were not exempt on the grounds that the provider’s termination of services was regulated by the Medicare Act, given the alleged claims did not arise under the Medicare Act).

[9] According to the National Center of Elder Abuse, www.Elderabusecenter.org/laws, all fifty states and the District of Columbia have enacted legislation authorizing the provision of adult protection services in cases of elder abuse. The statutes vary widely on definitions of abuse, investigation responsibility, and remedies for such abuse.

[10] The Tennessee Adult Protection Act, TENN. CODE ANN. § 71-6-101 et. seq. (2002) does not apply to actions against “health care providers,” as defined in the TENN. CODE ANN. § 63-6-228 et. seq. Alternatively, Tennessee’s Medical Malpractice Act provides the statutory authority to suits against health care providers.

[11] See, Texas Health Enters. V. Geisler, 9 S.W.3d 163 (Tex. App. Fort Worth 1999) (repeated shortages of staffing and other acts of negligence supported punitive damage award against defendant); Estate of McIntyer by & Through Ex’r v. Transitional Health Servs., 1998 U.S. Dist. LEXIS 13965 (M.D.N.C. May 1998) (holding that defendant’s knowledge that it was operating in serious violation of several health codes and that it took very little, if any, action to remedy those violations might reasonably be found to constitute reckless indifference to the rights of their elderly residents with varying medical and non-medical needs); Beverly Enters. – Florida v. Spilman, 661 So. 2d 867 (Fla. Dist. Ct. App. 5th Dist. 1995) (testimony that expert was “outraged” at poor level of care of resident who developed and died from an infected decubitus ulcer supported punitive damage award against corporation and management company). See also, Christopher Vaeth, Allowance of Punitive Damages in Medical Malpractice Action, 35 A.L.R. 5th 145 (1996).

[12] Fair Housing Amendments Act, 42 U.S.C. § 3601 et. seq. (2000).

[13] Americans with Disabilities Act, 42 U.S.C. § 12101 et. seq. (2000).



By: Jeffrey Downey

About the Author:

Victor

Assisted living facilities are rapidly becoming the nursing homes of the future. According to the National Academy for State Health Policy, more than 36,000 licensed facilities are operating nationwide.[1] Because there is no common definition for these facilities, however, this number may not adequately reflect their prevalence.

Although most litigation in the long-term-care field over the last 10 years has involved nursing homes, suits against assisted living facilities are mounting. One reason is that these facilities are not regulated by the federal government, and the state regulations that exist are inconsistent and, for the most part, lax in enforcing industry standards.

In an attempt to compete with nursing homes, assisted living facilities are accepting residents with greater medical needs or significant cognitive impairment. Most major chains promote special Alzheimer’s disease units, but the reality is that staffing in many of these facilities is inferior to that in nursing homes and simply cannot meet the needs of these residents.

Neglect in assisted living facilities can result in falls, fractures, sexual or physical abuse, pressure sores or other skin breakdown, malnutrition, depression, immobility, and even death. For example, one assisted living facility admitted an elderly alcoholic undergoing detoxification who required close supervision and care. An employee allegedly provided him with a lighter and cigarettes, then left him unsupervised. The resident set himself on fire.[2]

In other cases where supervision was severely lacking, people who tended to wander were admitted into facilities that were not set up to prevent this behavior. Wanderers mostly suffer falls and fractures, but some who have ventured out during winter months have died from hypothermia. One unfortunate resident wandered into the path of a moving train and was killed.

In several cases, assisted living facilities accepted severely ill patients who either had or were at severe risk for developing pressure sores, even though these facilities are not equipped to provide the skilled care—including tube feeding, catheterization, and daily turning and positioning—necessary to prevent or treat them. These residents developed severe pressure sores as a result of improper care.

These scenarios are not uncommon, but a lack of reporting requirements, state investigation, and active litigation has allowed assisted living facilities to continue operating under far less scrutiny than the nursing home industry.

Admission criteria

When a facility accepts residents whose needs or acuity levels exceed the staff’s skill or training, it opens itself up to legal liability. In most jurisdictions, liability can be determined by the state’s admission criteria.

For example, Virginia regulations prohibit assisted-living facilities from admitting or retaining patients who have stage III and IV pressure sores; who are ventilator dependent; who require nasogastric tubes, intravenous therapy, or injections directly into the vein; and who need continuous licensed nursing care.[3] Other states have similar limitations.[4]

These are some common state law criteria that would preclude a person’s admission to assisted living facilities:

1. is a threat to self or others[5]

2. has a contagious or an infectious disease[6]

3. requires care beyond the facilities’ skill[7]

4. requires physical and/or chemical restraints[8]

5. requires 24-hour nursing or other care[9]

6. is bedridden[10]

7. requires specialized long-term care[11]

8. has stage III and/or IV pressure sores[12]

9. requires more than minimal assistance in moving to a safe area during an emergency[13]

10. is less than 18 years old[14]

11. requires help with tube feeding[15]

State regulations that set forth specific admission criteria can be used to set the standard of care in your jurisdiction. Even in states that have no criteria, the community-practice standard would dictate that an assisted living facility may not accept a patient whose needs it cannot meet. However, the lack of case precedent and strong regulatory standards poses significant—although not insurmountable—obstacles to successful litigation.

Case selection

The first step in evaluating your case will be to get the records from the facility, including the signed contract, which should define the duties the facility agreed to undertake.

Most assisted living facilities offer various levels of service. Basic service might include only room, board, and activities. The highest service level might include assessment of physical and mental health, care or service planning (a multidisciplinary process in which various providers come up with a unified plan to address the resident’s physical, mental, and psychosocial needs), medication administration, and nursing care (assistance with bathing, feeding, and grooming). These facilities are like nursing homes that do not provide skilled care, and arguably they should be held to the same standard of care.

You will also need to submit a Freedom of Information Act (FOIA) request to identify the corporate entity that owns and operates the facility. The license should always be available from the local regulatory agency in charge of licensing and inspecting the facility; it may include information about the scope of services that the facility is authorized to provide.

In your FOIA request, also seek access to results of surveys and inspections of the facility conducted by the local department of social services. Do not expect these reports to contain the wealth of information typically included in such reports on nursing homes: Often they do not include assessments of whether the facility is complying with regulatory standards.

Once you have obtained these records, have a reliable nursing expert review the case. Because many nurses who work in the assisted living industry are licensed practical nurses, not registered nurses, they may lack the background you need, so you may need to retain an expert from outside the field. If a case involves a relatively simple issue like a fall, you may not need a liability expert.

Working with your expert, consider these factors when deciding whether to accept a case:

1. The nature of the resident’s condition upon admission. If he or she was mentally competent and living independently, contributory negligence and comparative fault defenses will pose significant hurdles.

2. The nature of the contract and duties the facility assumed. If the facility agreed to provide only room and board, the defense will argue that its duties are comparable to those of a landlord in an apartment building.

3. The quality of the relationship between the resident and his or her personal representative. If the resident is deceased, this issue may take on a greater importance: The nature of that relationship may determine what damages are available under the applicable wrongful death act.

4. Whether the family members make good fact witnesses, appear genuinely outraged by the facility’s conduct, and complained and/or removed their loved one from the facility.

Whether the facility had serious staffing shortages or a pattern of neglecting its residents.

5. Whether the resident suffered a significant injury in the facility that will adversely affect the quality of his or her life in the future, or that caused his or her death.

6. Whether you have strong witnesses and powerful exhibits. Do you have an insider who is willing to blow the whistle on rampant staffing shortages? Do you have color photos of the resident’s pressure sores or compound fracture?

7. Whether the client has significant economic damages that are not encumbered by a Medicare or Medicaid lien.

8. Whether the defendant is a charitable organization, religious affiliate, or part of a large assisted living chain. Charitable organizations tend to be more sympathetic defendants, and some states have statutory limits on their liability.

Liability theories

Attorneys who file claims against assisted living facilities can be creative in developing liability theories. However, don’t complicate your case with unnecessary theories, and remember that the scope of discovery may be affected by the ones you advance.

Common law negligence. This is probably the most common liability theory in assisted living cases. Make sure you do not plead breaches in medical or nursing standards of care, or you may face the argument that you have pleaded a traditional medical malpractice case.

Instead, plead the breach of regulatory and/or industry standards that proximately caused your client’s injury. Because assisted living facilities are not traditional health care providers, these cases should not be subject to damages caps or discovery limitations such as quality assurance privileges that would apply to medical negligence claims. A quality-assurance or peer-review privilege is typically asserted over any documents created to improve the quality of care in that facility—such documents can include incident reports, meeting minutes, or internal memos addressing any problems.

Violations of the state consumer protection or “adult protection” act. Many states have statutes that allow a private right of action for neglect committed in assisted living facilities.[16] Plaintiffs have advanced consumer protection theories even against health care providers,[17] so there should be no reason why such theories can’t be applied against an assisted living facility.

For example, one U.S. district court upheld consumer-protection and fraud-based claims against Manor Care, Inc., an assisted living provider that allegedly persuaded a resident to enter the facility with misrepresentations about staff ratios and training.[18] Ask your client what representations the facility made, and obtain any marketing brochures.

One advantage to filing under state consumer- and adult-protection statutes is that they allow for recovery of costs and attorney fees. While some states specifically exempt health care providers from such statutes,[19] these exemptions should not apply to assisted living facilities.

Breach of contract. Almost all assisted living facilities require prospective residents to sign a contract as a condition of admission. Scrutinize the contract for waivers of liability or of the resident’s right to a jury trial. Facilities can assert such waivers whether or not a plaintiff pleads a separate breach of contract claim. Usually such waivers impose mandatory arbitration of all claims, including tort and contract claims.

Most states limit contract damages to foreseeable economic damages, so don’t plead this as your only liability theory. However, the contract may have required that certain services be delivered to the resident—activities, assistance with daily living, 24-hour supervision—that were not provided. If the resident did not suffer physical injury from the facility’s failure to deliver services, the defense will argue that evidence of such failures should be excluded at trial. You can argue that this evidence is admissible to prove contract damages and to recover monies for services that were not provided.

The defense may respond that contract damages would be based on speculation, since the plaintiff failed to quantify the services that were not provided. To preempt this argument, have your client provide a good-faith estimate of the percentage of services that he or she did not receive.

If you have a strong negligence claim based on a discrete event, such as a fall that caused a hip fracture, you may prefer to omit the contract claim to avoid confusing the jury with collateral facts and issues unrelated to your client’s damages.

Negligent hiring and/or retention. Consider this claim when the case involves intentional torts, such as assault, committed by an employee who the defendants knew or should have known was a potential danger to residents. Obtain the employee’s personnel file early in litigation; if you discover evidence of the defendant’s knowledge, amend the complaint to include this claim before the statute of limitations expires.

Also consider suing the employee individually. If the same defense firm represents both the employee and the corporation, it will be difficult for the defense to argue that the employee was not operating within the scope of his or her employment.

When the case involves an intentional tort, always check the terms of the facility’s insurance coverage to determine whether any exclusions apply. If the policy excludes coverage for intentional torts, you may want to dismiss the claim against the employee after you have obtained a ruling that he or she acted within the scope of employment. Then, if you recover damages against the facility under a general negligence theory, this ruling will make it difficult for the defense to argue in a subsequent declaratory judgment action that liability insurance coverage for torts does not apply.

Wrongful death. When there is evidence that the facility’s negligence caused or contributed to the resident’s death, you should assert wrongful death and survivorship claims. Also plead any claims for injury that did not contribute to the death with your survivorship claims.

Determine what damages you can recover under the wrongful death statute in your jurisdiction. If the law allows only economic damages, you may decide to forgo a wrongful death claim.

Punitive damages. Economic damages in an assisted living case usually are not impressive because most residents are too old or infirm to hold jobs, and any preexisting conditions that your client has may weaken the compensatory damages claim. Therefore, plead punitive damages whenever possible. Making a punitive damages claim will also provide a basis for exploring the defendant’s conduct toward other residents who experienced neglect similar to your client’s. Courts around the country have upheld such claims against nursing homes,[20] and these precedents should apply to assisted living facilities.

Essential experts

In almost every assisted living case, you will need experts to establish causation and damages. Since many residents injured in assisted living facilities require long-term care in a nursing home, consider obtaining a life-care plan from a qualified expert. In most cases, you will need a medical expert to establish causation, support the life-care plan, and testify to life expectancy. When determining whether the facility breached regulatory or community-practice standards in admitting a resident whose needs exceeded its capabilities, have an expert evaluate the resident’s condition and the relevant admission criteria.

Be prepared for a battle over the admissibility of your experts’ testimony. Selvin v. DMC Regency Residence, Ltd., a Florida case, is a good example.[21] In Selvin, an elderly resident of an assisted living facility wandered off and was found dead in a nearby canal. The plaintiff alleged two separate theories of liability: The first was a statutory wrongful death action, and the second was based on alleged violations of statutes relating to assisted living facilities.

The plaintiff claimed that the facility had a common law and statutory duty to supply at least the level of services and care that all licensed assisted living facilities generally furnish residents of the decedent’s age and health condition.

The plaintiff sought to introduce expert testimony that specific safety precautions that the defendant had not taken were the industry standard, including building a fence to prevent elderly residents from wandering near a dangerous area of the canal. The trial court excluded this testimony, finding that the facility had no legal duty to fence off the canal to the general public.

The appellate court reversed, finding that the facility’s undertaking to furnish certain services created a legal duty to protect residents. The court also held that the trial court had erred in excluding the expert’s testimony regarding industry standards.

Experts may also be helpful in cases involving falls, depending on the facts of the case. If the facility’s staff simply dropped the resident during a transfer or made some other obvious mistake, an expert may not be necessary.[22] In more complex cases, an expert will help the jury understand the facility’s negligence in failing to implement adequate fall-prevention measures.

For example, if the resident came to the facility with multiple risk factors for falling—such as dementia, unstable gait, arthritis, or a history of falls—that were never assessed or planned for, and fell while wandering the hallway, retain an expert to discuss how the standard of care for fall prevention was breached. To establish causation, the expert will testify that if the facility had followed appropriate standards, the fall, more likely than not, would have been prevented.

As the use of experts in assisted living cases is an area of first impression in many jurisdictions, educate the court with a trial memorandum addressing your expert’s testimony before trial.

Liability for negligence by assisted living facilities is a new and evolving area of the law, and attorneys who litigate these cases should strive to establish favorable precedent for those who follow. These claims, like those involving nursing homes, help protect the rights of elderly Americans by ensuring that the industry follows standards to keep facility residents safe.

Notes

[1]ROBERT L. MOLLICA, STATE ASSISTED LIVING POLICY: 2000, at 3 (Nat’l Acad. for State Health Pol’y (Portland, Maine) Nov. 2000).

[2] Holt v. Clarksville Residential Care Ctr., No. 50300430 (Tenn., Montgomery Cir. Ct. filed Nov. 11, 2002).

[3] 22 VA. ADMIN. CODE §40-71-150(F) (West 2003 & Supp. 2004).

[4] For example, Montana law prohibits assisted living facilities from admitting patients who are a danger to self or others (aside from being at risk of leaving the facility), in need of physical or chemical restraints, or have severe cognitive impairments rendering them incapable of expressing needs or making basic care decisions. MONT. CODE ANN. §50-5-226 (2002). Florida law prohibits admission of residents who require 24-hour nursing care. FLA. STAT. ch. 400.426(12) (2003).

[5] See, e.g., IOWA ADMIN. CODE r. 321- 25.23(3)(c)(231C) (2004); TENN. COMP. R. & REGS. 1200-8-11-.05(6) (2004).

[6] See, e.g., FLA. ADMIN. CODE ANN. r. 58A-5.0181(1)(b) (2003); UTAH ADMIN. CODE 432-270-10(5)(b) (2003).

[7] See, e.g., IDAHO CODE §16.03.22- 422.07.a (Michie 2003); OR. ADMIN. R. 411-056-0020(1)(a)(A) (2004).

[8] See, e.g., ARIZ. ADMIN. CODE R9-10-705.1 & .2 (1998); MISS. REGS. pt. I §A-122.1.b(1) & (2) (2003); MONT. CODE ANN. §50-5-226 (2003); TENN. COMP. R. & REGS. 1200-8-11-.05(8) (2004).

[9] See, e.g., N.M. ADMIN. CODE ***. 7, §8.2.19 (B) (2004); S.D. ADMIN. R. 44:04:04:12.01.(1) (2000); WIS. ADMIN. CODE §HFS83.06(1)(a) 4.a (2000).

[10] See, e.g., MO. REV. STAT. §198.073.1 (2003).

[11] See, e.g., N.J. ADMIN. CODE ***. 8, §36- 4.1(f) (2004).

[12] See, e.g., D.C. CODE ANN. §44- 106.01(e) (2) (2004); MISS. REGS. pt I §L-122.1.b(1) & (2) (2003).

[13] See, e.g., 210 ILL. COMP. STAT. 9/75(c)(5) (2003).

[14] See, e.g., D.C. CODE ANN. §44-106.01.(c) (2004); N.M. ADMIN. CODE ***. 7, §8.2.19 (2004).

[15] See, e.g., FLA. ADMIN. CODE ANN. r. 58A-5.0181(1)(k)(2) (2003); MISS. REGS. pt. I §L-122.1.b(4) (2003).

[16] See, e.g., ARK. CODE ANN. §20-10-1209 (Michie 2004); CAL. HEALTH & SAFETY CODE §1430(b) (West 2003); CONN. GEN. STAT. §19a-550(e) (2003); see also D.C. CODE ANN. §44- 105.05 (2004).

[17] See, e.g., Winkler v. Interim Servs., Inc., 36 F. Supp. 2d 1026 (M.D. Tenn. 1999); Chalfin v. Beverly Enters., Inc., 741 F. Supp. 1162 (E.D. Pa. 1989), reconsideration denied, 745 F. Supp. 1117 (E.D. Pa. 1990). But see Dorn v. McTigue, 157 F. Supp. 2d 37 (D.D.C. 2001).

[18] Beaty v. Manor Care, Inc., No. 02-1720-A, 2003 U.S. Dist. LEXIS 25044 (E.D. Va. Feb. 10, 2003). The case gave rise to a detailed memorandum opinion that upheld liability theories based on actual and constructive fraud, violations of the Virginia Consumer Protection Act, and false advertising.

[19] See, e.g., TENN. CODE ANN. §§ 71-6-101 to 71-6-120 (2002).

[20] See, e.g., Tex. Health Enters., Inc. v. Geisler, 9 S.W.3d 163 (Tex. App. 1999) (repeated staffing shortages and other acts of negligence supported punitive damages); Estate of McIntyre v. Transitional Health Servs., Inc., No. 2:96CV00424, 1998 U.S. Dist. LEXIS 13965, at *17-18 (M.D.N.C. May 20, 1998) (defendant’s knowledge that it was violating several health codes and its failure to remedy those violations might reasonably be found to constitute reckless indifference to residents’ rights); see also Christopher Vaeth, Allowance of Punitive Damages in Medical Malpractice Action, 35 A.L.R. 5th 145 (1996).

[21] 807 So. 2d 676 (Fla. Dist. Ct. App. 2001).

[22] See, e.g., Walker v. S.E. Ala. Med. Ctr., 545 So. 2d 769, 771 (Ala. 1989) (not requiring plaintiffs to present expert testimony because the alleged breach of care—leaving the bed rail down contrary to doctor’s orders—was so apparent as to be understood by a layperson).



By: Jeffrey Downey

About the Author:

Jeffery Kushlan

Every cricket fan fervently desires to view live cricket match . Nothing can replace the excitement, thrills and enthusiasm of live cricket match. Live cricket match is of much concern for a fan during any ongoing series or tournaments. Every cricket fan manages to connect with the medium which enables them in viewing live cricket match. The commencement of any series or tournaments compels fan to acquire sources for viewing cricket live. Whatever the medium occur to a fan, but he can’t miss the chance of viewing live cricket.

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By: Ella Wilson

About the Author:

Chance Gutterman

If you are among those persons who are addicted or let’s just say extremely passionate to Watch Live Football matches, now, thanks to technological advancement you have the possibility to access the best live football matches broadcasted over the Internet. You also have the opportunity to take pleasure in watching all the major football events played anywhere in the whole world even if you don’t have a satellite connection or a cable one.

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We are all aware that football is one of the most popular sports in the world. It is highly appreciated by the audience, but football fans don’t have the time or the money to manage to pay for the tickets of every live football game there is (not to mention the costs of the trips in all the countries in which live football games are being played). Taking all this information into account you should choose a cheaper and more enjoyable way to watch live football. You can watch live football from your office or from home anytime with the help of the Internet and for just for a very small fee. It’s a luxury that the modern world offers us and we shouldn’t say no to it.



By: Mr Walker

About the Author:

Lance Freidhof

When you want to know what is going on in a live football match, but simply can’t watch the game yourself, then you will want to have access to live match scores online. Whether you are at work or at home, you can find live scores and even live football games on your PC. You can also find other fans to talk to about the game by accessing a community forum dedicated to the sport.

Live Games

To access live football on PC, you will need to find a website that offer the service. Typically, you will need to have a paid membership to the website to access the live coverage, especially if you want to have access to any game twenty four hours a day, seven days a week. Luckily, you can find special discounts online that give you access to live football matches for around ten pounds- far less than you would expect to pay for cable service or to go the game in person.

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Live Scores



Live match scores are excellent when you do not have time to watch the entire game. You can find a website that will update the scores throughout the game, giving you access to the most up to the minute scores of all playing teams, any day of the week. This feature is the perfect addition if you need to check the scores while at work, or when you have other obligations that do not leave you time to watch the game. Premiership league is one of the most popular, but there are also other leagues represented, as well.

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Online Community

If you are the only person at work or in your community that enjoys watching live football, then you know how important it is to have someone around who enjoys the sport as much as you do. You will find that several of the best football websites offer an online forum for football fans to discuss all aspects of the game, including new players, favorite teams, coaches and recent games. There is nothing about live football that is boring, so there is plenty to discuss with your new online community. Since the online forum is free to anyone who wants to join in the conversation, there is never a dull moment in the community.

Joining a website is simple when you find the right one. The first thing that you may want to know is whether or not all of the features that you are interested in are being offered. For example, you will want access to live games, an online community, football news, Premiership information and live football results. You can find all this, and more, online.



By: Sourav Sarkar

About the Author:

Bethany Nowicki

Have you considered starting your own online casino, but you don’t know where to begin? The recent popularity of online casinos makes it a lucrative industry, if you know what you’re doing. The only decision you have to make before finding your casino software is; do you want a live casino, or a computer-generated casino? Once you have decided, you can begin researching different live casino software providers. The success or failure of your online casino will depend on the quality of your live casino software, so make sure you know what you want before you make a final decision.

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By: John Johnson

About the Author:

Fumiko Blouir

The new Fisher Price Elmo Live Doll has already become one of the HOTTEST Christmas gifts of the year 2008 for kids and tots. If you are lucky as me to preorder Elmo Live previously, you don’t have to worry about “sold out” anymore. There is rumor spreading now that the Sesame Street Elmo Live Toy has been sold out in some local retail stores already (Remember what happened to Tickle Me Elmo and other HOTTEST toys by Fisher Price in the previous years?)

So I received my preordered new Elmo Live toy last week, and I have to say I am really impressed by this furry red doll. Fisher Price includes 6 AA batteries in the package, I immediately played with him after pulling out the “Try Me” strap near the battery compartment. Similar to the beloved Tickle Me Elmo (a.k.a.T.M.X Elmo), this Elmo Live toy tickles if you touch his tummy, foot and back (sensors will be activated when you touch the right part of Elmo’s body). He Moves, Talks, Dances, Tells jokes, and even Sneezes! When he tells stories or jokes, he actually moves his mouth in nearly perfectly sync with the voice. And you know what, he even acts out during his story-telling. For instance, he moves his cute hands up to show he is shocked. If he reads to some part that’s really funny, he laughs out which is really hilarious. This new Elmo Live doll is capable of so many life-like movements, that he looks like the real Elmo alive from the Sesame Street.

Another difference that sets Elmo Live apart from other “talking” toys is that he is quite interactive in a way. For instance, he asks you for a hug and then says “thank you” if he receives one. Interactive features like this make Elmo Live an alive friend rather than a toy for kids, as if he or she is playing with a live creature.

I did notice that sometimes the Elmo Live toy can fall over if he doesn’t stand on a hard, flat surface (He will ask you to help him back up again and says “Thank You” if you do so. This could be a good way to teach good manners towards young tots). Also you can hear the mechanical sound when he moves sometimes, but I found this noise is not that loud and quickly forgotten since you see so many wonderful features from Elmo Live.

I have a good website to recommend for someone who wants to buy an Elmo Live toy before it’s gone. Visit ElmoShop.com to shop for Elmo Live or other Elmo related products.



By: Wilson Snyder

About the Author:

Emilee Lane