A few years ago, “Slow Medicine” proponent, Dr. Dennis McCullough was the keynote speaker. He is the author of My Mother, Your Mother: Embracing Slow Medicine, the compassionate approach to caring for your aging loved ones.

Dr. McCullough is a professor at Dartmouth and brings wonderful heart to his exploration of elder care as it should be. In my blogpost from that time, Slow Medicine and Italian Restaurants?, I described his talk about bringing the principles of the Slow Food Movement to the practice of geriatrics (attention to quality, an unrushed process, emphasis on the social interchange…). They say creativity is bringing ideas from one sector and applying them to another. He has done so beautifully. The metaphor is brilliant!

This year my favorite keynote at the conference was Dr. John Sloan, the author of A Bitter Pill: How the medical system is failing the elderly. Like Dr. McCullough, Dr. Sloan is a meta-thinker with a creative bent. (If he ever decides to quit medicine, he could get a job in radio. He has a wonderful baritone and is absolutely hilarious in his impersonations of American vs. Canadian physicians.)

Dr. Sloan teaches at the University of British Columbia, but more importantly, he has spearheaded a practice where he makes house calls to his frail, elderly patients. For even in Canada, they suffer from a tendency toward what Dr. McCullough would call “Fast Medicine” which throws pills and heroic interventions at elders, many of whom suffer from a crisis in support more than the need for more drugs and surgery.

Dr. Sloan defines the “frail elderly” as those who have “irremediable dependence for activities of daily living.” Usually this is due to limitations in cognition or mobility. By definition, there really isn’t a “fix” for their problems (“irremediable”). The antidote is to focus on quality of life and make each day the best day it can be.

Unfortunately, medical practice really has just two strategies for addressing health problems:

• Prevention – usually medication-based
• Rescue medicine -  Crisis interventions for when prevention did not do the job.

Neither of these work well with the frail elderly

Prevention is dubious as an approach because the frail elderly live in an “evidence-free” zone. As Dr Sloan points out:

• Prevention is a prediction that an action will result in a reduced or eliminated health problem. But the elderly are extremely heterogeneous. You have those who are quite healthy in terms of heart and lungs for instance, but they may have cognitive problems. And then you have those who are severely impacted with multiple co-morbidities but who are sharp as a tack. And then there are those with nothing malfunctioning at all. The range of normal within elders is too wide to make for accurate predictions.
• Elders, and frail elders in particular, are not included in clinical trials. They have too many co-morbidities (confounds) to assist in proving or disproving a hypothesis.
• Elders have a limited chance of benefit. It simply takes too long for the preventive drugs to work. The frail elderly do not have a few months or years to wait for results.
• Elders tend to have more adverse reactions. Medications come with side effects. And most elders are taking more than one medication. Adding new meds just compounds the chances of a bad drug interaction. It’s simply not worth the risk.

So when prevention does not work, the alternative is “Rescue Medicine” in which the hospital is the Cathedral of Crisis.

Typically, frail elders do not have much physical reserve for responding to stressors. A relatively small, temporary condition can cause a great reduction in functional capability. (Continence, cognition and mobility might be severely impacted in an elder with the flu, whereas a younger person might just feel icky–that’s a technical term.) And when an elder can’t cope functionally (e.g., continence, cognition and mobility), where does the family have to turn?  The only option right now is 911.

A crisis in function and family ability to cope suddenly shifts and becomes a medical crisis. As Dr. Sloan observed, “The only light on at 3:00 in the morning is the light outside the ER.”

But when a frail elder enters the ER all kinds of alarm bells get set off. Each specialist sees their particular organ system failing and throws in their medicinal solution. Before you know it, the elder is so medicated, problems develop as a result of the fixes. Not good!

Working with the frail elderly, Dr. Sloan has identified a strong sub-population. He and his daughter (a marketer), playfully came up with a moniker for this group, “the Sunshiners.” (I confess I’m not sure the name works well. They were trying to “brand” a philosophy of life with something appealing. I think this part still needs work.)

This group of frail elders have very specific values:

• They don’t want to be a burden
• They care more about comfort than about living longer
• They don’t want medication unless they really need it to feel comfortable
• They don’t want to go to the hospital unless they really need it to feel comfortable

Medications and Rescue Medicine are simply anathema to this group. But their families, their doctors, and society as a whole seem to insist on “drug” or “rescue” options. Dr. Sloan’s call to action is to create a grass roots movement that demands alternatives focused more on quality of life.

Remember at the beginning of this blogpost I talked about Dr. McCullough and Slow Medicine? I think we may be on to something. These two doctors are speaking the same language. I’m not sure “Sunshiners” is the best branding for a social movement. The Slow Food Movement, however, is huge and has spawned other “Slows” such as Slow Travel, Slow Schools, Slow Parenting, Slow Cities…This is branding that resonates.

I vote we use social media to start a Slow Medicine movement. With its roots in geriatrics and palliative medicine, it would focus on the bio-psycho-social-spiritual components of elder health and well-being. GCMs and hospice already practice with this holistic approach. ePatient Dave and the folks at the Society for Participatory Medicine are doing for chronic care what family caregivers (if they had the time) could do for elder care. Dr. Sloan and Dr. McCullough could get together and start an online community of professionals and lay people.

What do you think? Would you participate? Who else is a thought leader and should be part of the group?

As a behavioral scientist the data were clear: People listen more to folks like themselves than they do to folks not like themselves. This was before social networking. So, we included video to convey the information and help viewers realize they weren’t alone.

Our initial programs were interventions that assisted with reducing fat in the diet, increasing physical activity, quitting smoking…

It was very effective for someone trying to quit smoking to view a video of someone else who had been in a similar situation and had found a strategy that helped them break the habit. We called these testimonials our “joining statements” and they worked by increasing the viewers’ confidence that they too could employ similar strategies and eventually quit. Understanding that they were not alone with their struggles helped our subjects overcome cravings, environmental cues, etc. Our quit rates were twice what the control group (and average smoking cessation intervention) was achieving at the time.

But the technology was painful. Broadband Internet connection was barely available and mp4 files did not exist, so we couldn’t have more than tiny, postage stamp video clips. Sigh…

Fast forward 15 years and now we have YouTube and Netflix, all kinds of technology that not only allows for Internet playback of a full length movie, but you can even watch on your mobile phone while riding the bus home from work. Wowzer!

But what does this have to do with hospice and elder care?

Well, many of the things we know about helping people overcome bad health habits can be applied to helping families address difficult family situations. Family caregivers often are overwhelmed and stuck in a quagmire of a family system that has them stressed out yet unable to change their behaviors and make different (wiser?) choices. Family caregivers are often shocked to realize they are not the only ones feeling or experiencing difficulties with the elder care journey… Starting to sound familiar?

Video testimonials or joining statements can go a long way toward creating an environment of empathy and building confidence for making needed changes in attitudes (e.g., recognizing that Dad is going to die) or trying something new (e.g., getting help).

But separate from the health/education benefits, there are some very good business reasons to be thinking about online video:

• Video keeps viewers on your site for longer. When we go over the analytics, many of my clients are anxious to have very high traffic to their websites. Traffic is good, but the more important statistic is quality: how long people actually stay on your site. The Internet is something of an ADHD medium. I’ll take 10 people staying 3 minutes over 100 staying 30 seconds. (Two minutes of a viewer’s attention is considered nirvana on the Internet.) The longer viewers stay on your site, the more they are bonding with you. These are the high quality viewers. (Imagine having to pay for 2 minutes of a TV infomercial that was targeted only to persons already interested in elder care. That would be expensive indeed!) A 2010 Forbes study showed that text-only business sites average 42 seconds per visit, while those business sites with video average 5 minutes and 50 seconds (an eightfold increase).
• Online video outperforms TV ads. Precisely for the reasons noted above, a video on a website will yield far more response than a video broadcast to the general public because a website viewer is someone who is already interested in your area of expertise. Dollar-for-dollar, online video is considered the better investment.
• Nearly 60% of people said they would watch a video before they would read the text. I have observed hundreds of family caregivers interact with our National Institute on Aging multimedia interventions and I would say this is true. I’d put the statistic at closer to 80% for family caregivers. Page after page during our clinical trials, they went first to click the video. If they were interested in the topic, they went on to read the text. Otherwise, they clicked to the next page and watched that video. We simply are social animals. We see a face and we want to know what the person has to say. The video can’t go on too long. (People’s interest begins to fade quickly. As a rule of thumb, the optimal length of a video is 30 seconds.) Obviously, you can’t go into great depth with a 30-second video. But you can create that sense of “I’m not alone.” That joining moment of, “These people really understand me and my concerns.”
• Video boosts memory retention by 50% vs. 28% for sites with only text and graphics. Advertising is about creating a memorable event such that viewers remember/recognize your name, and eventually develop a sense of your business’ personality and a feeling of loyalty to your brand. A video communicates much more than text and still graphics can on their own. With video you can convey empathy and warmth as it makes your pages and the content come alive.
• Video appears to stimulate more requests for information than text-only sites. The Forbes study was geared more to general business websites than one focusing on health care, let alone our special audience of the elder care market. Still, this finding of the Forbes’ research is worth noting. As I mentioned earlier, hearing from someone else who was in a similar situation can often provide the boost of confidence needed to try something new and different, such as reaching out for services.
• Video on your website sets you apart as an industry leader. Online video is equated with state-of-the-art practice. One day, of course, everyone will have video on their websites. But for now, fair or unfair, those that do have video are considered to be more professionally on top of it and “in the know” than their competitors who do not have video. (That’s like the study that found that the patients of doctors whose waiting room had old magazines in it were more likely to feel that their doctor was behind the times in terms of keeping current with his/her medical knowledge. These are completely unrelated skills and areas of expertise—waiting room tidiness vs. continuing medical education—but sometimes perception is everything!)

If you would like to see how online video can be incorporated into your Internet marketing plans, check out the video versions of our e-libraries:

• For hospice: seriousillness.org/demo
• For geriatric care managers: elderpages.com/GCM
• For home care agencies: elderpages.com/HomeHealth

In that light, my blogpost is a recap of a superb session by Transcend Hospice Marketing: Rx for Increasing Physician Referrals.

Enjoy!

If you have a Personal Profile, you may be familiar with the new header. It essentially has a very large/long rectangular banner across the top (called the “Cover Photo”), and then a little square graphic (“Profile Picture”) inset in the lower left. Your business page will be converted to the same format. Here are some tips:

The Cover Photo

• Make this a graphic with roughly a 6:1 aspect ratio (six parts wide by one part high). Facebook states that the ideal dimensions are 851 pixels x 315 pixels.
• The smallest graphic can be 399 pixels wide, but recognize it could be very blurry when they expand it.
• You can change the Cover Photo at any time. Since it is the first thing that people see, due to its size, make the photo something that will be appealing to a large segment of your target audience. But if you want to rotate out to emphasize different aspects or audiences, there is no harm in doing so.

Items you may NOT have on your Cover Photo. Facebook is in the business of selling ads (my personal commentary) so they are restricting what you can say on the Cover Photo. Things that are not allowed include:

• Price or purchase information (e.g., Actual prices or advertising of sales, such as 40% off)
• Contact information (your company web address, email address, phone number…). They want you to put this in the About section
• Reference to Facebook activities such as “Like” and “Share”
• Calls to action, such as “Get it now,” “Download it at our website”, “Tell your friends.”

The Profile Picture
In addition to its place in the header, the Profile Picture is what serves as the source graphic for the “thumbnail” image that gets put beside any status updates on your Wall, any comments on other business’ pages, etc.

• The Profile Picture is square. Facebook states that the ideal dimension is 180 pixels x 180 pixels.
• For the thumbnails, the Profile Picture needs to look good at 32 pixels x 32 pixels.
• Your logo is the best option here. Especially since this is what will show when you comment and post on the Walls of allied business pages, you want people to know who you are.
• Do not change your profile picture often. This is your branding piece, so consistency is best. Pick a graphic that indentifies you well and then stick with it.

The other big change is your Wall.
Whereas before you had a tickertape, stream-of-consciousness set of postings in a single column, now your status updates will alternate left and right sides of a central timeline.

• To anchor a post at the top for 7 days, you will want to “Pin it.” (Shades of Pinterest?) Hover over the pencil icon at the top right of the post and select “Pin to Top” from the pull down menu. You only get one “pinned” post at a time.
• To make a post wider, you click on the star icon. This will make a post cover two columns instead of residing on just the left or the right of the central vertical timeline.
• To make a post stand out as a key moment in your business, enter the update as a Milestone. A Milestone must include a photo (optimally 843 pixels x 403 pixels). Like a starred entry, Milestones will display across both columns. Facebook will also ask for more information on Milestone posts, and the posts will be made to stand out on a more graphical history of your business over months and years.

A few other notes:

• Navigation has moved. What used to be the list of pages and apps on the left hand side (Wall, Info, Photos, Events…) has now been moved center right, underneath the Cover Photo. There are 4 that show up immediately (Photo and LIKES by default) plus 2 others of your choosing. Anything more will only be accessible via a pulldown arrow beside the 4th app. Be sure your top priority calls-to-action appear in positions 3 and 4 (Probably “Join My Email List” and “Events.” A superb study by Idealware revealed that Facebook is best at supporting these two endeavors.)
• “Info” is now “About”. This is available right under the Profile Picture on the lower left. As before, it is VITALLY important that you fill out this page completely, using lots of the keywords you have targeted for your business, and linking generously to different pages in your company website. This is how Google and the other search engines, not to mention Facebook’s own search engine, find and catalogue you so you will appear appropriately on a search result.

Have you upgraded to the new format yet? Any tips? Things you like about it? Things you hate?

The last blogpost was on the first 2 C’s: Customers and Convenience.

This one is on Cost, Competitors and my personal addition: Contribution. Since the impetus for this article was to teach new entrepreneurs in the field of geriatric care management, the “Cost” section is geared for the private pay sector (e.g., private duty home care, GCMs, etc.). But the other two C’s (Competitors and Contribution) apply to anyone in the elder care industry.

Cost
Fortunately, elder care is not subject to “blue light specials” or “end-of-year sales.” That does not mean that the cost of services does not matter in the purchasing decision. It does. But using cost as an element in your marketing materials is much more difficult for the service sector than it is for retail businesses.

While sales and coupons would be unseemly, there are things you can do to soften the blow of the price. As a home care provider or geriatric care manager, you might consider the following:

• Package some of your services into a fixed price. Quoting an hourly rate opens the door to comparisons to the customer’s own wages. Not an auspicious beginning. The customer does not understand your overhead expenses and you don’t want to have to explain them. It will sound too defensive. In addition, with an hourly rate, there are too many unknowns. The customer doesn’t really have a way of evaluating your quality ahead of time. It’s not like purchasing a product where they can pick it up, feel the weight of it, get a sense of its durability, etc. Purchasing a service is a bit of a gamble. With a package (e.g., an initial assessment), you take some of that vagueness out of the equation. You can list the things you do, and any deliverables (a written summary, a meeting with the family…). People will have a better, less abstract concept of the purchase and whether the price is worth the end result (usually peace of mind). They also have the security of knowing the cost won’t go any higher. Humans are generally risk averse. It might actually be cheaper for them to hire you by the hour, but the known is easier to embrace than the unknown.
• Offer a discount to your referrer’s clients. This makes your referrer look good as you have provided a “value add” to his/her service. Very likely you will get more in goodwill and collaboration from the referrer than you will lose in revenue. (Be sure to check with your attorney first, though, to determine if there is anything legally inappropriate. Kickback revenue to your referrer would need to be disclosed, for instance, and in some states would be illegal. But this is not a kickback. Offering 10% off an initial assessment for clients of ABC Financial Planning is a benefit for the client and might be very appropriate in your community.)
• Emphasize how you can help save money. For instance, in my own family, we had a very real experience of the geriatric care manager identifying that my grandfather was over-insured. He had purchased a Medicare Advantage program that was unnecessary as he was a WWII veteran and fully covered by TriCare. This saved the family several hundred dollars a month. Sharing stories like this, while not applicable to everyone, can highlight ways that the expense of your service may in many cases be offset by your deep professional knowledge base.

Competitors
While we all would like to be colleagues and mutually supportive, it is simply true that in tight times, there may only be a limited number of customers to go around. This doesn’t mean you want to go “dys-ing” your competition. But it helps to be clear about who they are and what their strengths are.

For each of your competitors, create a profile:

• What geographic area do they serve?
• What is their specialty?
• Who seems to be their referral base? Attorneys? Trust officers? Financial Planners?

Since such a large percentage of your customers will likely come from referrers, it’s an awkward truth that growing your business will likely be the result of woo-ing a referrer who currently works with one of your competitors.

If you know your competitor’s strong suit, then don’t go toe-to-toe on that specialty. Unless you have heard inklings of dissatisfaction, you will be swimming upstream.

Instead, ask a potential new referrer what cases keep them up at night. Then ask them to take a chance on you and give you their hardest nut to crack.  If you can prove your convenience for them (how you save them time, energy, perhaps money, and how you make them look good to their clients), you will be a long way toward building a rapport that could lead to more referrals.

The best way to do that, however, is to be very clear about…

Your Unique Contribution
This is a 5th “C” that I have added, and it is the pot of gold at the end of your professional rainbow. Some people call it your niche, your positioning statement, or your value proposition. Whatever term you use, it’s a critical concept for your business success. You need to be clear yourself, and make sure others understand the areas where you truly shine.

Marketing is and always will be about how to make yourself memorable, how to stand out from the crowd. Identifying your unique contribution, and being able to communicate it quickly is your best marketing strategy.

Create a list with a quick description of 1-2 areas that are your specialty. Consider possibilities such as these:

• Dementia care
• Technology in the home
• Family meetings
• Guardianship
• Communication with long-distance family members
• Knowledge of local resources and eligibility requirements

Whatever your unique contribution, that is what you want to emphasize in your marketing materials, be it brochures, presentations, or that chat with the new referral source.

Know your strengths so you can distinguish yourself from your competitors. It doesn’t mean that you aren’t good at the broad range of skills required in your profession. But people need some way to remember you as different from the others. This is your unique contribution.

How have you used the 4 C’s (plus 1) in your own marketing materials?

When I first took marketing classes, the standard was “The 4 P’s”: Product, Place, Price and Promotion. While these are still relevant, they are more geared to manufacturing and selling products than they are to marketing a service.

A newer version has been evolving called the 4 C’s. I’ve seen several permutations, but the four that strike me as most relevant for elder care providers are:

• Customers
• Convenience
• Cost
• Competitors

And to this, I would add

• Contribution

In this blogpost, I will be looking at the first two: Customers and Convenience.

Customers are always King
Customers are the people who make the buying decision; clients are the ones who receive the service. Sometimes they are the same person and sometimes they are not. For instance, in elder care, the client is often a senior who may or may not even identify that there are problems that need addressing. The decision-maker (and in the case of geriatric care management often the person who pays for the service) tends to be an adult daughter or son.

In the 4 C’s model, be very familiar with the characteristics of your customers and, separately, of your clients.

• Age
• Gender
• Location (Your service area? Same as elder, or lives far away)
• Education level
• Income level
• Degree of tech savviness
• Problems that keep them up at night
• Buying/spending habits

Seniors, for example, do not generally spend money for assistance, especially if it’s something someone in the family can do for free. (Never mind that the family member may have to take time off work, and lose income, in order to provide the service!)

Boomers, on the other hand, generally understand that paying someone to help is one way to “purchase” time, less stress and less worry. Provided they have the resources, Boomers tend to be more accepting than their parents when it comes to paying someone to help with care management.

If you are new to elder care and are not sure about how to describe family caregivers, I have a blogpost on family caregiver demographics that can help you with national level data.

Don’t forget your referrers when you think of Customers. Keeping referrers happy is part of your sales process. You need to know them as intimately as you know your customers and clients. Make a similar description of them. You may want to substitute “Billing pattern” or “Revenue source” for “Buying/spending habits.” Professionals who bill public agencies, such as Medicare and Medicaid, have very different approaches (and clientele) from those whose business is private pay, fee-for-service (e.g., an elder law attorney).

Convenience
The motto of Staples Office Supply is “That was easy.” ‘Easy’ should be your intent as well. With our extreme societal emphasis on multi-tasking, you need to describe and demonstrate how your services will be the most convenient for your clients, customers and referrers.

Convenience can be defined by several means:

• Saves time
• Saves money
• Saves energy (emotional stress and strain)

And in the case of your referrers, I would add

• Makes them look better to their clients

What are you doing to express the ways working with you adds convenience to your customer/client/referrer’s life? How does your sales process demonstrate that convenience?

In our next blogpost we’ll look at the remaining C’s: Cost, Competition and (my bonus “C”) Contribution.

In spending a last visit with her, I took my cues from my training as a hospice volunteer. A favorite author, Dr. Ira Byock, has suggested that closure of a relationship involves these simple phrases:

• Please forgive me
• I forgive you
• Thank you
• I love you
• Good-bye

With her dementia, the forgiveness piece was best handled non-verbally, by beaming our love and acceptance through our eyes. My brother, half-sister and I had long ago made our peace with the usual bumps and bruises that happen in family life.

For Christopher and me, our stepmother was our mom for a quarter of the year when we spent summers with our dad. She was a fun-loving counterpart to our very intellectual parents. She brought music and silliness and an earthy charm that had her making mud pies with us out in the backyard. She taught me to play the piano as a child, and bought me my first radio as a teenager. She became known to my son, very affectionately, as “Grandma Quack” because she spent an afternoon on a boat with him as a toddler, teaching him to talk to the ducklings swimming by.

Laura’s last hours were filled with stories of appreciation, with tender caresses to her head, and her hands held by one child or another. We said our thank yous, expressed our love, and then said good-bye as they removed her life support. It was a sweet and peaceful passing.

I am grateful for the structure of Dr. Byock’s simple formula. It helped my siblings and I to create closure and give my stepmom the send-off she deserved. They are simple words, but very big concepts. If you haven’t taught your volunteers and staff this approach, I highly recommend it.

Let’s start with a few acknowledgements:

• People may be saying bad things about your business on the Web already, you just don’t know about it. This is not as likely for elder care providers as it is for Comcast, AT&T or Microsoft, but still… Have you done a Google search lately? You may be surprised. To borrow a line from the Godfather, “Keep your friends close and your enemies closer.” Better to have people post negatives about you where you can easily find them (on your own Web presence) and respond than to have negative comments floating out there on the Internet with no redress at all.
• When you do a public presentation, you risk someone publicly saying something negative. Part of live interaction with the public is taking the risk that you may have to deal with an uncomfortable bit of criticism. No one would say you shouldn’t do presentations, or shouldn’t be interviewed on a radio call-in show. Why run away from social media for this reason? The solution is to be prepared with a reasonable way to respond.
• In elder care, the overwhelming amount of comments are positive. I have taught workshops where some of the early adopters of social media were in attendance. After several YEARS of blogging and doing Facebook, one said that she literally had 300 positive comments before anyone posted a negative comment. I’ll take those odds!
• You do have the ability to delete negative comments. While it is not in the spirit of the open dialogue and engagement inherent in social media, it is always your prerogative to get rid of a posting that you think is completely off-base or inappropriate.

What are the comments you can/should just delete?
Some people are just grouchy. They like to pick fights. (Called “Internet Trolls”.) They may be offensive or abusive. They may use profanity. (Called “Ragers.”) They may have forgotten to take their meds for a few days… You meet all kinds.

Publishing an inclusion/deletion policy helps. Some items you might decide to categorically delete would include comments that are:

• Abusive, unlawful, threatening, harassing, embarrassing or hateful (racist, sexist, ageist…)
• Obscene or offensive, using profane language
• Defamatory or libelous
• Infringements on the copyrights of others
• Advertisements or solicitations for business (aka spam)
• Impersonations of someone else
• Off-topic to the discussion
• Of a private, medical nature (although this is not negative per se, think HIPAA)

You not only have the ability to delete these posts, you can also block them from posting again. (You may wish to do this for the more obstreperous ones. Deleting a comment can anger a poster and inspire them to comment again and again. If they are irrational, this is even more likely.)

Comments that have a rational tone to them should be kept and responded to. Not only because the individual deserves a reply, but also because your Fans will want to know what you have to say. If they see you have deleted a rational albeit negative comment, you will lose credibility in the Internet crowd. Kremlin-esque policies are frowned upon on the Web, especially in social media.

Monitor frequently (once a day at least). If someone does put a negative comment up, you want to begin putting your policy/response in motion as soon as possible. For platforms such as Facebook, you can have comments forwarded to your email so you can immediately see (or as often as you check email) who has said what.

A blog is the “safest” social media platform as you can set it so all comments have to go through an approval process before they are posted publicly. If your leadership team is especially squeamish about negative comments, start with a blog rather than Facebook. The greater control on this platform will ease anxieties. It also allows you to hold “borderline posts” until you have a reply ready to release right after you “publish” the negative comment.

A difference of opinion is a good thing. Community engagement is a primary goal of social media and by its nature implies a certain amount of debate. While a lovefest is lovely (all positive comments), if people care enough to challenge something you have said or done, part of building community and building relationships is to respect their opinions and participate in the conversation.

The Air Force, of all agencies, has an infographic for its comment response policy. It provides a handy flowchart that might help you decide how to respond.

Some people suggest leaving non-abusive but obviously irrational posts alone. Your Fans will likely recognize the person as off-base and discount their comments. Or one of your Fans may even step in and come to your defense.

I tend to think this is more relevant advice for larger companies with very large Fan bases (in the thousands range) as the number of Fans who actually post on a business page tends to be less than 2%. If you have 100 or fewer Fans (the average small business has 65), the chances of one of them defending your honor gets pretty slim. Don’t forget, our client base tends to be of a generation that is not as active in terms of posting comments. They may even feel that you are being treated unfairly, but that doesn’t mean they will jump in on your behalf.

It’s not a good idea to let negative comments linger unaddressed. Depending on the intensity of the comment, if your Fan base has not stepped forward within half a day, it would be good for you to reply. The more balanced and rational the comment, even if it is misguided, the more quickly it deserves a response. To that end:

• Take a deep breathe. Count to 10. Don’t take it personally.
• Resist the temptation to defend your company or yourself. Defensiveness is considered poor “Netiquette.” Take your cue from the editorial replies in the “Letters to the Editor” section of the local paper, or a suggestion bulletin board at a local store. The “goal,” if you will, is to demonstrate your openness and responsiveness.
• Gather the facts. Connect with anyone who had contact with this individual. Recheck your sources if it’s a disagreement about an article.
• Respond politely and concisely. This is a public conversation, but other readers will not wade through paragraphs of text. You want your Fans to see that you are responsive. If you can’t do justice in a paragraph, summarize your response and then post a link to a FAQ page or some other venue where those who are interested can read further details.
• Have a negative comments committee in place. It’s difficult for one person to retain perspective. Optimally, you would have several people who are on tap to quickly vet a response before it gets posted. Having several sets of eyes review the response is the best way to be sure that it accurately reflects your company tone.

What if there is truth in the comment?

• Thank the commenter and apologize. There is a very strong ethic of transparency and honest relationship-building on social media. In this culture, defensive smoke-and-mirrors is worse than any error you could have committed. Be humble. Admit your humanity. Work with integrity to address the issue.
• Describe what you will do to prevent a recurrence in the future. If there is a policy problem, an internal communication glitch, something that can be changed systemically, great! Let the person, and your audience, know about your intended changes. It’s not only the right thing to do, but it also demonstrates to all your followers that you listen and respond.
• Do what you can to publicly address the problem now (within bounds of privacy). Certainly if there was an inaccuracy in one of your posts, rectify it right away.
• Offer contact information, if appropriate, to help resolve private issues offline. Posting a name and phone number is the best way to show your eagerness to address the situation and make things right. One hospice workshop attendee said they invited the commenter to talk with them offline so they could rectify the situation. When they had, the hospice then asked the commenter to post about that experience. It worked out well for everyone.

If you would like to see sample Comments Policies, check out the policies of other health care organizations (e.g., Mayo Clinic, Kaiser Permanente) that are shared on the Social Media Governance website.

How have you handled negative comments?

For this entry, we’re going to look at defamation, libel and false light. To be honest, when I started researching this, I didn’t think it was much of an issue for elder care professionals.

• But then I started thinking about the comments followers leave. Are we liable for their libel?
• And then I learned about “false light,” an easy mistake to make.
• I also started thinking about advocacy roles. I realized that there may be times when we need to speak up, against unfair laws or dangerous or abusive practices.

Hmmm.

And even if you don’t define yourself as an advocate (not that you should), the weird thing about the Internet is that even one obscure little blogpost could end up being seen by millions. Double hmmm. That puts the stakes a little higher than your average brochure or flyer and makes it wise to understand how to say what you need to say AND protect yourself.
Recognizing that I am not a lawyer, here is a thumbnail set of definitions and guidelines I gleaned from the Citizen Media Law Project of Harvard University:

• “Defamation” is “a legal claim involving injury to reputation caused by false statements of fact.”
• “Libel” is written defamation, while “slander” is the spoken variety.
• “False light” is like defamation, but has to do with untrue implications rather than direct statements of false information. For instance, posting a picture of someone who is gaunt by an article about cancer, might imply that the person had cancer. This is the type of error I think is most likely to happen in the field of elder care.

As a rule, we tend to shy away from controversy. Harsh, critical commentary is not usually the style with elder care professionals. But if there is something you just have to let fly on, it appears that as long as you are extremely clear that this is your opinion, and your facts are true, your legal liability is limited.

Again, I am not a lawyer.

The Citizen Media Law Project recommends some guidelines to consider:

• Would you be upset if these things were said about you? The Golden Rule may not be the gold standard of legal liability, but it’s a good first step. The phrases that seem most upsetting are those that you need to inspect and edit extra carefully.
• How sure are you of your facts? Follow good journalistic practices and only use reliable sources. Especially in light of those sensitive phrases, you want to be sure that you are publishing only truthful information. A truthful statement that harms another’s reputation is not libel. However, you may be open to other suits if the information is especially private (e.g., private financial records of an individual or business. We already know you would not publish medical information!)
• Seek comment from the person/organization in question. Fair is fair. And there may be an explanation you hadn’t thought of.
• Document your sources. In the unhappy event that you go to trial, you will have a record of where you learned what.
• Clarify what is fact and what is opinion. Words like “in my opinion” and “I believe” will help. But context as well as the language needs to draw the line clearly. False implications often occur when the context is blurry, such as the innocent mistake of poor picture placement described above.
• Avoid inflammatory language. Passionate rhetoric can be really fun. I LOVED writing it when I was in college. But it also tends to fan the flames. Give your staff guidelines. Unless it is your intent to rile things up (e.g., you are doing community advocacy about a piece of legislation that you feel is patently unfair or biased), you may want to have a second set of cooler eyes read through the text before you click “Publish.”
• Beware of conflict of interest. If your remarks impact a competitor, you could be liable for a fair trade lawsuit.
• Retract or correct inaccurate statements. The horse may be out of the barn, but if you give your corrections the same prominence as your initial statements, you are at least demonstrating your intent to be fair.

But what if your followers are the ones who post something defamatory?

It turns out, you are not liable. The Communications Decency Act legally protects you from liability for user-submitted communication. As long as the posting was submitted by someone outside your organization, you are not legally on the hook. That said, talk to your business liability insurance carrier. They may have some opinions on the matter.

Regardless of liability, however, what is the tone you wish to set? Controversy is popular. You will get a lot of traffic, especially with spicey headlines. (My most popular blogpost so far was a somewhat feisty anti-ageism piece entitled “Don’t call me ’senior’!“)  But is the traffic you receive going to come away with an accurate sense of your business’ personality?

Perhaps being a strident advocate is part of your professional image. (I do get pretty feisty about ageism.) By all means, then, have at it with the above precautions. But if you ask yourself, “What adjectives do I want potential clients to associate with my business?” and you come up with softer ones, such as “warm, caring and compassionate” then statements that might lead to defamation or false light might not be in your best interest.

It’s perfectly fine to remove defamatory comments, although it is considered best practice to publish an inclusion/deletion policy.  This will help your staff understand your guidelines, and provide public warning/disclosure/justification for any comments you choose to delete.

For samples of inclusion and deletion policies other healthcare companies use in social media, I recommend the Social Media Governance website.

You need to be sure they do not violate HIPAA nor say things even in their personal posts that reflect poorly on your company.

In the next few blog entries, I am turning my attention to the legal risks of publishing online. After HIPAA, I would say the next most likely transgression has to do with intellectual property violations.

Intellectual property rights apply to anything you publish (in print, or on your website, blog or Facebook page). Many companies, rightfully so, encourage employees to Like, Share and Comment on the company Facebook page or blog. And certainly your official “post-ers” are employees. In that light, be sure you are clear with everyone about what can and can’t be posted from a legal point of view. You don’t want a lawsuit!

Before we go much further, I am not a lawyer. I am drawing my information from two sources:
•    Citizen Media Law Project of Harvard University
•    Legal Guide for Bloggers from the Electronic Frontier Foundation

“Intellectual property” is a fancy way of describing “products of the mind.” It is in our country’s interest to encourage innovation, thus the federal government has set up laws designed to protect the rights of innovators. It takes skill (and time and money to develop skill), not to mention talent and creativity to come up with new ideas.

There is also a certain amount of risk (also involving time and money) to perfect new ideas and get them ready for market. Legally, then, the creators deserve to have protection so they can control their “products of the mind” and reap any monetary or social rewards.

How does this relate to social media? Well, you’d be amazed how many blogs I see, or Facebook pages with a Notes section that has out-and-out lifts of other people’s materials. Or graphics that have simply been “borrowed” from another website.

People often type in whole articles and think that by listing the name of the author, they are covered. Not so! (One hospice even copied my whole e-library and entered all 60 pages of it (!) into their company website. They were not intending to break the law. They just didn’t realize that writing on the Internet was not up for grabs!)

Because the Internet has a basic ethic of “sharing,” it’s easy to forget that all the laws of copyright, trademarks and trade secrets apply just as they do in print.

• Copyright: The Citizen’s Media Project aptly describe copyright as “protecting the fruits of creative efforts.” The owner of a copyright has the exclusive right to manage how, when and by whom their work is displayed, reproduced or distributed. Copyright ownership lasts, as a general rule, for about 70 years and can be transferred to heirs or whomever the copyright owner wishes. Writing, photos, drawings, videos, photographs, music, coding for software, all of these are products of the mind that can be copyrighted.
• Trademarks: Your branding is your trademark. It’s usually your name, perhaps a slogan, and often has a symbol (i.e., logo) attached. The idea of a trademark is to keep others from appearing to be you and gaining business advantages that they have not earned. Trademarks can be owned locally by simply having used them in a specific region for a number of years (common law). But for trademarks to be protected nationally, they must be registered with the U.S. government.
• Trade secrets: Confidential customer lists, vendor lists, billing or staffing policies…anything that might provide a competitive edge is considered a trade secret.

When you think of policies to guide employees in their posts, you must think not only about protecting what you have created, but also about preventing your employees from inadvertently infringing on the intellectual property rights of others.

• Using text written by others: As a rule of thumb, you may quote from others as long as you use only a few lines, quote verbatim, and distinguish the passage as a quote (with quotation marks and an acknowledgement of the author). If you want to use more than a few lines of text, contact the author and get written permission. Note any copyrights and declare beside them that the materials have been “Reproduced with permission.” With Internet materials, it is considered polite to include a link to where you found the material originally. (Or use the “Share” feature on Facebook, or “Retweet” on Twitter.) Many authors are very happy to let you reprint their entire article for free as long as you link to their blog, website, or other online presence. The exception to this general permissions rule is that articles published by a government entity are considered “public domain.” Your tax payer dollars paid for them so you can use as much of them as you want and do not need to ask permission.
• Writing your own text:  Although there is an official copyright protection procedure with the federal government, simply noting the copyright symbol, the year and the name of your company puts a stake in the ground alerting others to the fact that you consider this copyrighted material. If you are telling the story of a volunteer, or patient or family, you also need get their permission, in writing as their story is their “asset.” This is true not only for intellectual property reasons, but in the case of patients and families, extremely important for HIPAA compliance.
• Using graphics, photos, music or videos created by others: You need to get permission of the artist/creator in writing. It is best to also note their copyright for the material and “Reproduced  with permission” somewhere close to the artwork. You can also consider using stock photography sites that offer royalty-free graphics for a nominal fee. You generally do not need to give written credit in this instance, unless you have specifically licensed the materials as “editorial content.” Check with the terms and conditions of the stock photography company.
• Graphics, photos, music or videos that you create: As with written materials, a copyright symbol with the year and name of your company is generally adequate to protect your rights. If you have a fancy graphics company helping you, these works of art can even be digitally branded so if someone lifts it, you can easily identify it as yours. (Like a chip in a stray cat.) It’s always safest to keep written permission on file, even from staff members who have participated in the creation of the work, or are the subject of the photograph, video, etc. If you are using images or voice recordings of individuals in your community, you absolutely need to get their permission, especially if they are patients or clients as this invokes HIPAA privacy protections.
• Use of logos (trademarks): You should have a clear style sheet available to all employees that delineates how, when and who can post your logo. Similarly, caution your employees to never lift the logo of another company and post it on your social media account. Even if the company is an allied business or strategic partner, they need to be consulted before their trademark is published in your context. (It’s theirs to share, not yours…Do unto others…)
• Precautions regarding trade secrets. Certainly in elder care, it’s different than for retail or manufacturing. You don’t have 13 specially selected herbs and spices as part of your secret sauce. Still, it does not hurt to be clear about the kinds of things you think are inappropriate to share. You have competitive advantages, and your employees may have access to those. An employee could inadvertently reveal something that is very strategic. Sadly, a disgruntled employee can also make potentially damaging revelations. (And if they are no longer in your employ, you don’t have the most obvious options.) Consult your attorney about including a passage regarding confidentiality of trade secrets as part of a hiring document. It may not stop the revelation from being made after a termination, but it may give you some teeth for a cease and desist order.

What have you done to help your employees avoid intellectual property infringements?