Thursday, November 22, 2007


Today represents not only a national holiday but a turning point in my life. I am officially 40 years old today. I am still thinking about where my life has been, and how quickly the time has gone by. Wow..I really understand what my residents speak of when they talk about how quickly their lives were spent.. On that note; I have taken much of their saged wisdom to heart and am living my life with a purpose and intent instead of simply living. (thank you to my two female elder mentors!) I am so ever thankful for the elders who have crossed into my path on this journey of living.

With that said today represents so very many things to people. Many spend it with family, many spend it at home watching football and resting. Others get out and do things like run a 5K in the snow, (Detroit today has 6 inches of snow on the ground, and it is freezing drizzle/snowing still. Not exactly great running weather!) There are also people who get out and do for others today; working at homeless shelters, handing out meals to shut ins and those in need.

The people I am most thankful for are the employees and care providers who right now across America, are working to take care of our frail, forgotten, and neediest of Americans. Yes they are getting paid to do this..However, on any Holiday they are there working to assure that these individuals are cared for and remembered. In my facility like all across America, a big Thanksgiving meal is being prepared for noon. The dietary staff in any given facility is prepping for that meal as we speak.

I am sure in most buildings, the staff and residents spend this day enjoying the day together. Holidays in a nursing home are chaotic for staff; yet rewarding. Families come into visit in large numbers; many have not been in all year and they will have questions and concerns about how their loved one is. The staff will take the time to respond to every one. Many elders will have a sad day; as their families fail to visit or worse; they have no one to visit and observing the many visitors it reminds them of their all alone in the world status. Again, the staff will recognize this; and offer comfort and empathy; in return the elder will smile, say thank you or give a great hug and both may shed some tears in silent understanding of the emotional connection that occurs.

It is this spontaneous nurturing and giving that occurs that I am so ever thankful for. Outsiders - those who have no inkling of what really happens in care facilities; do not know of the symbiotic relationship that exists between elder and staff. It is a giving/receiving/giving cycle that occurs when true care exists.

As I have focused my life; it is this very element of care that I strive to teach, role model and educate others on. We can create beautiful structures; we can give outstanding clinical care; but without the humanness of giving selflessly; we fail as care givers. It is perhaps the most difficult element to teach, and grasp; it is not visual, nor tangible; it must be felt. Yet, once understood and recognized, it becomes an intrinsic part of the heart and soul of every great caregiver. It is this giving that outsiders "feel" when they come into homes that practice this.

Happy Thanksgiving to each of you. May you recognize the gifts you have given, and those that you receive. Continue to share and allow others to share with you. Be thankful for the simple things..they matter the most in the end..

Wednesday, November 21, 2007

Life Lessons Can Not Be Risk Managed...

I received a great article yesterday from a colleague regarding children's authors in England being "censored" for writing about risky behaviors. According to this article, authors are being told to re-write scenarios in their books that may encourage children to engage in behaviors that could lead to harm. The scenarios? Simple things that we did as climbing trees... Yes you read that correctly, according to this article these types of books could lead to children engaging in behaviors that could lead to harm..

I guess this puzzles me. As a child, we did all sorts of stupid things that could have lead to our impending doom; yet by the grace of God we survived with minimal damage; and great stories for our children. None of the incidents were premeditated or directed by something we read. In fact they were usually spontaneous actions brought about from three creative female imaginations deciding that some activity would be fun. The three female minds were myself and accomplices of at least two of my three sisters. One would come up with an idea, and the others would follow or add additional embellishment to the original thought. For example the time we had a significant snow fall; and the drifts were so high that we could climb to the top of the wood piled against our garage and then slide down the roof of the garage, over the wood pile and get significant distance into the yard...Needless to say the neighbor ruined our fun by calling attention to our mother that we were on the roof...Lesson learned? Mom indicated we could break our neck from falling off the roof, or worse at least a limb; and that the neighbor was in on her anxiety.

So why do we feel the need to "protect" our children from all risks? There are inherent lessons to be learned from taking on risk. Stifling a creative story will not stifle risk. Giving parents false hope that by eliminating any "idea stimulator" will decrease the risk to their children is wrong. We are human beings; and like any animal we learn from attempting behaviors; and our minds work so that ideas and decisions can be made spontaneously.

As a parent I always hoped that I had done my best to teach my child how to way decisions and make responsible choices. Yet, he has had some significant learning from taking on risks and then dealing with the consequences. I believe he will be a better adult and person because of it. As a parent it hurts to see them suffer from their consequences. It is natural to want to protect and eliminate; but the learning is lost in overzealous protection. Ironically, the lesson takes longer to then learn.

Why was this story sent to someone who works with elders? Because, it is the same thought process that care providers deal with every single day. We are to manage/control risk for our elders; and in some cases their rights be damned. The regulations are conflicting in this case. Yes you have rights; but I also am required to protect you from all harm. Even that harm which you could cause to yourself from (gasp!) being human and having an inquisitive determined mind. For example, walking. If we (your care provider) feel you are not safe to ambulate by yourself, we must do everything possible from allowing you to ambulate unassisted. Imagine sitting in your room; and seeing your roommate drop her Kleenex box on the floor. Your mind and spontaneous thoughts tell you to "get up and hand it to her". Wrong! your thoughts are no longer allowed to govern your own behavior... Welcome to a new life lesson....

Sunday, November 11, 2007

Social Responsibility...

Does a company, or it's leaders have a moral/ethical responsiblity to educate, develop or offer personal growth for their employees?

This was the topic of discussion last week in my organizational leadership class. The further discussion centered on where are the leaders of the future going to come from, and are we facing a critical shortage of great leadership in America? One answer that resonated with me from a class peer was the perspective of social responsibiity of corporations and business to create and grow their own next generation of leaders.

As we shared our own personal journey's into leadership roles; it was evident that some companies are getting this idea better then others. I have thought about this topic all week as I face a "change" in my own leadership role and take on a new challenge. I have thought about how we/I as a leader, view development of future leaders.

I also have researched and looked for information regarding developing good leadership programs for future administrators and nursing managers. What I find is very good resources; with limited applications throughout our industry. A sad testament to what we view as important.

Yet, we espouse conversations about quality, we talk about driving down costs, increasing productivity while maintaining high staff satisfaction rates. None of this can be accomplished without some very basic leadership skill and development.

It is as if we "assume" that persons in leadership roles have a skill basket filled with the necessary ingredients to create the recipe for success. The reality, is that most leaders in health care are in these positions perhaps based on some in born ability or talent and personal drive. They may/may not have actually recieved good hands on training and knowledge of the nuances of leadership it takes to reach the level of excellence we are seeking.

I again am fortunate to work for someone who recognizes this as an area of growth to be developed on an individual basis. Yet as I start to think of our industry on a global realm; I realize how truly lucrative it could be for me/my building and my company if we develop a phenomonal talent pool of future leaders. It is something our competition has not even begun to address or focus time and resources on.

Growing our own leaders comes at a cost. In fact, the cost may be losing some of those that you develop. I sit in my office at work today; cleaning out my desk. On my desk is the list of the upcoming nursing graduates that we will sponsor an event for. I have two of my own employees on this list. Both are part of our tuition reimbursment program. Both will make phenomenal nurses and have bothpersonal drive for quality and a passion for customer service. As a leader to have had a hand in developing these two young women and watching their personal growth is a reward unmatched. Yet, the dilemma is where are we going to place them? I have no nursing positions in my building. Discussion with sister facilities will have to take place to find a place for them to continue their journey. Perhaps they will even leave our company.

So is it worth growing future leaders if you have no place for them once ready? My answer to this question is a resounding yes. I feel as a care provider it is my social obligation to create excellence for all care givers. If this means over development of potential leaders then so be it. Imagine the possibilities if all companies felt this responsibility. We would not be facing a leadership drought, and health care would be so much better for it...

Sunday, November 4, 2007

Hello and Goodbye...

Ok, so i can talk about embracing change, and my need for constant flux in my life..But when it hits you out of the blue are we ever really ready for it? For those of you newly reading; welcome to my blog. For my current readers, a little update. I am leaving my nest, the comfort of home and the known that I have retreated back to from time/time in my life. I have been offerred, and accepted a position in another building, located 100 miles from my home.

I did not expect this quite so quickly, I have come to learn to be careful what you wish for; in my life it seems to be if I speak it, write it, or even think about change, it happens.. With that said I am thrilled by the opportunity, sad for what I am leaving unfinished, and remorseful about leaving my elders.

For my new building, staff and elders we are about to embark on a new path. I am so very excited to be working with a great team. Your reputation for great care and outstanding compliance precedes you all. You should be very proud of what you have accomplished, and I am honored to be able to work with you as we take this building to a level of remarkability that will be a model of care, customer service and what aging should and will look like in the future. Given your expert abilities at care, we are going to transition well to the next level. As your leader on this journey I am committed to giving my heart and soul to working with you as we create the new vision of care.

For my current staff, friends, peers and elders; I am sad that our journey this time around was only a year. But what a journey, and look at what you have accomplished! The communication levels, the team work, the focus on customer satisfaction and community involvment are all off the chart successes you should be very proud of! You are all responsible for taking a facility and making it part of the community. A place that everyone recognizes for not only great care, but greatness period. When people in our area talk about our building, they talk about the environment, culture and feeling that you have all worked very hard to create for the elders whom you serve. I hope you realize how very special each of you are; and that every individual has played a role in this achievement. I am honored to have played a small role in your success, and cannot wait to see what you accomplish next. I am forever grateful for the opportunities, support and lessons I have learned working with you over the past 14 years.

As I told someone last week, no I will not be back, unless it is to live in about 35 years... and yes I would be proud to allow you to care for not only me, but any of my family. That in itself should speak volumes to the level of trust and respect that you have earned.

What a crazy week this has been...I return from a great training where ironically the focus was on the implications of change. Only to come back to a phone call first thing on Monday with a change being offered. The implications of this change? Huge for all involved.. I have spent the last 48 hours thinking about it all..planning for the future, getting a little organized and adjusting my mind to the past memories; and future possibiities..

Hello to the unknown future, and Good Bye to the comfort and known of my past... All at the eve of my 40th birthday...I apparently enjoy the drama of it all..

Sunday, October 21, 2007

Goal Realized...

As I sit here; my feet, legs and back are screaming in agony...But it is a good agony. Yours truly finished her first half marathon(13.1 miles!) today at the age of 39.11 months...Yes it is a goal realized.

No I did not run it, I walked it with the encouragement/companionship of a peer/coworker who has completed several of these as a walker. When I say walk, do not picture a leisurely stroll..No it is a timed event, and we averaged a 16.38 mile. It does not seem like much, but to me, it is a goal that I never thought would be met..

As I reflect on the past 10 years of change and growth in my life, exercise and getting healthy were not high on the list until the past two/three years. As I have lost weight, and started exercising, the thought about doing something like this was in the back of my mind, but it took someone to be persistently annoying and encouraging to first adopt it as a goal, and then to continue encouraging me to seek and desire it for myself.

Now I have not only pain, but I also have the medal proving "I did it" and knowledge that I completed an idea from start to finish and can cross this goal off my list of things to get done in my lifetime. The other interesting thought that comes from this; is that I don't think it will be my last...I think the experience is something I will seek out/train for harder next time. The other irony of goals realized..."So I did this now how can I do it better?"

I think these personal principles apply so aptly to what I am desiring as a leader for my staff, peers and elders. It is time for some personal pain, sweat and tears to get the goals we have, achieved.

Another analogy to use as a talking point for my managers and staff. What goals do they have, personal/professional that they would like me or someone to be persistently annoying and encouraging about for them? Personal goals will remain a secret personal goal until you share it with others..The cool thing about sharing is that now you are held to level of accountability to see your goal come to fruition. The downside is that you are now held to a level of accountability to see your goal come to fruition. There is a risk in the sharing...the paradox of sharing as I call it.

Is it worth the risk to share? Yes, it makes us human, and it makes us stronger achievers...If I had just listened to this specific peer talk about her walking, instead of saying, "you know,I think I would like to try that" one time; my Sunday would have been spent not in pain! But isn't the emotional pain of having goals and ideas that you don't share, more difficult then the physical pain of seeing your goal/idea realized?

Think about that..I am now off to pack for a week of training in Texas. Another goal that I have wanted for two years...I am sure it will make great discussion for my next blog.

Tuesday, October 16, 2007

The Gift of Potential.. A Thank You on Bosses Day..!

As a leader, I think the best gift I have ever been given is having someone who leads me; recognize my potential. Not only was the potential recognized, it was developed through opportunities, education, and some well deserved kicks in the seat of my pants when needed. Now, as I reflect on my relationship with my own "boss" whom I view as a mentor and role model, I find myself thinking about what she could possibly have recognized in me close to 8 years ago when I was first given the opportunity to become a leader.

It is an interesting self retrospective; I have undergone dramatic personal growth during the past 8 years; most who know me view the change as occurring in the past 18 months. The reality is that once I understood that it was okay to have ideas; and then to try implementing those ideas, I found confidence in both the success and the failures. A recognition of self potential was the gift she gave me and I now recognize this for what a true gift it is.

So on bosses day, I give a sincere thank you to my boss, mentor and leader; for recognizing my potential and then giving me the tools and opportunity to recognize it for myself to develop new skills and confidence.

I only hope that as I develop my own leadership style and see ideas come to fruition; that I too can help develop the potential of those I lead. There is no greater gift to be given; or perhaps receive as a leader....

Wednesday, October 10, 2007

Vigilante Regulators...

Wow...Who wants to duck and run from long term care in Michigan today after yesterdays frightening "joint provider" training?

For those of you who are not fortunate enough to work in long term care, let me share with you that yesterday we (providers from all over Michigan) and our survey agency staff, affectionately called the "state" by providers sat thru the most vigilante/out to get you with a vengeance seminar/training that I have ever experienced. "The underlying theme I felt was that we, (providers) cause harm, have the potential to cause harm, and that we are going to be "caught" irregardless of what we do for our elders.. When I define caught, I am referring to the use of the surveyors new weapon against nursing facilities; the Immediate Jeopardy tag that strikes fear in the heart of every Nursing Home Owner, Administrator and staff care giver.... Read on for the highlights of yesterdays events.

The original purpose of these training seminars was to bring providers and the oversight agency from the State of Michigan together for training on best practices, new regulations and to create an environment that focused on collaborative visionary care thinking... Well the training continues but what originally was started as a collaborative "good will" event has quickly become a "here are the new rules and best practices as we see them; and by the way; tough about what you think is really important/priority for your elders"... Common sense and practical thinking about what elders really need and want be damned....

Maybe I am biased, maybe I am way off base, but when I sat and listened to the surveyors from the CMS regional office share "great stories" about facilities that have been closed, or suffered from an IJ tag with such relished enthusiasm I felt an illness in my stomach. Where is the elder in their enthusiasm? Where is the resident opinion and right in the citations that they quoted so joyously? As an advocate for elders I fear that our regulators are jumping to judgement without considering the resident point of view and their rights are being forgotten..

Let me share the story that made me the most ill and frightened for my elders..During a presentation about how an immediate jeopardy citation can be cited for the potential to cause harm, the CMS regulator spoke with great enthusiasm about a small facility in rural Wisconsin that had received four perfect, zero citation surveys during the past four years; only to get an IJ on the last day of survey for delivering a resident a birthday cupcake with a lit candle on it. The surveyor even described the scene, "the dining room was full of staff, families and residents; all there to celebrate this residents birthday and they were singing to her and it was her special day".

The problem? the resident had a nasal cannula in her nose with oxygen to it. NO she did not blow up, no fire, no injury no harm. Yet, they(the surveyors) ruin the excitement for this elder/staff and give them(the facility) an immediate jeopardy for the potential for a fire due to oxygen in her nose, and the small lit birthday candle....Could she have been hurt, possibly. Should they have known better, probably. Did the facility deserve to be fined, nearly closed, lose it's ability to admit residents, get placed on a "bad facility listing" and lose it's nurse aide training because of it? Not to mention the "label" and Internet label of poor performer; hardly.

As an Administrator this type of story is not only infuriating it is devastating. This facility has to be one of the best facilities you could encounter. Knowing the type of care/resident and staff interactions that must exist for a perfect survey to occur; I know that this facility has to have real person centered care relationships and outcomes in existence. I would bet this facility has great family, community, resident and staff support and enthusiasm. How do I know this? I use my own facility as a gauge and my peers who also have had the great fortune of a "perfect survey". To attain this you have to have reached beyond the regulations to create the remarkable person center nirvana that is the pinnacle of the elder care experience.
I can only imagine how crushed/damaged the dietary aide who delivered the cupcake would be. I think of my own enthusiastic, caring young people who work in my kitchen. I see them deliver the snacks in the hallway, in fact as I type this I am hearing them singing to one of my elders a rap song...there is laughter and a real relationship occurring spontaneously.

I think of the emotional damage to the elder. In our building, the elders are outspoken about their needs and wants. This is good! To me that says, "hey, I trust you to fix this, and I know it is o.k. to say what I think because I trust you, you will not harm me, you love me and want what is best for me when you care for me." They demand real relationships and the unconditional love that is given and received in a person centered care model.

I think about some of my elders and how devastated they would be if they knew that their special day and the love from the staff resulted in devastation for the very same caregivers who love and care for them. They would feel such guilt and be emotionally harmed by the knowledge that their event caused this. (No, my staff would not share, but trust me they would know, we exist as a community and family; that is why our great buildings remain great...)

So where was the elder in this citation? Yes, I agree we must protect our elders from actual harm. But to try and prevent every "possible harm outcome" is ludicrous. Every environment, every person has the ability to be a victim of potential harm. I think about when I fill up at a gas station, and see the person next to me smoking a cigarette or filling a gas can in the back of their pick up. I think about my own bad behavior of using my cell phone while driving. I think of the countless times I have spilled hot coffee on myself in my car; or while wearing ridiculously high heels I have tripped or stumbled.

I think of my parenting and how I raised my son. If you were to look at my environment when he was young, using this model of "potential for harm" you should have taken him from me early on...He broke his collar bone three times before he was 12 years old. I was present at only one of the fracturing events. Yet, he had actual harm from his own volition, and my apparent lack of keeping him from harm. Using the surveyor model, I should have been eliminated from the mother model.

Apparently, because "we" accept money to care for elders, "we" are now held to the light that we must eliminate every "potential for harm" that could exist for the person/elder we are being reimbursed to care for. Resident choice be damned; if your care is being funded by the government I am obligated to give you lukewarm coffee, and wrap you in bubble wrap...Your right to the dignity of making poor choices such as falling from trying to ambulate as long as possible,or smoking a cigarette with poor reflexes, or eating sugar while diabetic could get me an immediate jeopardy, and can no longer be tolerated if I am to exist as a provider of care.

I wonder how many great caregivers went home yesterday and pulled out the resume...This quest for culture change and person centered care is definitely not for the faint of heart.

Sunday, October 7, 2007

Defining Culture...

Ok, I have been called on the carpet this week for speaking to "culture change" but not defining what culture it is we want to change in long term care. This came to me from a new reader via email.

So after receiving said email; I sat back and observed, thought and experienced my communities culture full throttle this week. If you have never done so; the next time you find yourself in a public setting that involves members of your community, I encourage you to sit back and observe the people and what they are doing, saying and the interactive behaviors that occur. Trust me this can be a fun yet frightening experience.

I spent Friday night in full bologna queen regalia, (crown, sash, fancy dress and heels) to be part of the high school homecoming parade in Yale. Needless to say, this cultural event was wrought with great observation about the culture of our town, its people and the rituals that have existed for many years...My next opportunity came today as I went with my parents to a small town dinner fundraiser at a local township hall for the fire department. Picture a simple wooden building where indoor plumbing was an after thought; situated 25 miles from any main city/town with services. The food is always phenomenal at these small town events; always served family style on mismatched donated dishes with home made pie for dessert..The culture of middle small town America at it's finest. In comparison to last week where I attended a black tie social event for a main religious community of metro Detroit. Different cultures, different rituals, different norms.

For those of you not raised in, or having never lived in a small tight knit community the culture may appear/act/feel very different from what the culture you were socialized or live in. To use a tool that my boss uses, (thanks for always having a Webster's handy...) I took the time to research the common definition of culture. Per Wikipedia; "Culture has been called "the way of life for an entire society." As such, it includes codes of manners, dress, language, religion, rituals, norms of behavior such as law and morality, and systems of belief".

As providers of health care, I think we often refer to the culture as the norms that we have come to know inside of our own care communities and provider associations. The culture of care that I seek change for is the pervasive culture of what nursing homes are in America; and the societal norms that people perceive to be true about aging and long term care facilities. How we as providers define our culture of care is vastly different from what society feels our cultural norms are. As the provider we are obligated to create a change for how society and we ourselves view our culture of care. We must not accept the current norms to be continued if we seek to exist in a positive light for society. Care is evolving, and our cultural norms; rituals, and beliefs about what we do must evolve and change with the needs of society.

Further, depending on where your facility is located, what community you draw from will greatly impact the culture of your building and we need to be ever aware of the impact this has on us as providers. Using a one shoe fits all model; does not work for care providers. We must mesh our culture to impact the overall community culture in a positive win/win situation. Nothing is worse then having cultural conflict between a provider and the community it serves. It will not bode well for your reputation or opportunity to become the provider of choice.

So this little lesson on how I perceive culture is brought to you via an email question. I hope this helps you to understand what it is I speak of when I refer to culture and why change is needed.

Tuesday, October 2, 2007

QualityCan Not Be Legislated, It Must Be Lead By Innovation

I have had a full 24 hours of great education this week, and my head is spinning with new thoughts and ideas..

Last night, I had my first organizational leadership class; and I remembered why I loved organizational psychology and sociology so well as an undergrad! The class had a great discussion on leaders within organizations and their defining moments; IE; leading during the non-traditional events that occur within an organization. It got me thinking about the market disruptor's and changes that are looming in health care and the prospect of where the great leaders will emerge from to get us thru the changes as they occur. As health care organizations,we need to start spending significant time on teaching and mentoring innovative leadership. We need to think about how we reward and grow those individuals who have the ability to see the big picture, absorb it and make the critical decisions that will be necessary to stay competitive in a world market of care decisions.

The other part of my education occurred today at a Detroit Economic Club lunch where the president of one of the largest health care companies in America spoke about the future of health care in America. His thoughts put into words what many of us need to hear about our health care choices. I am still thinking about one item that he said and I am going to make it my new mantra for what I do within my organization, and for my leadership model to my staff. To paraphrase the thought: Quality will drive health care in the future. Further, quality can not be legislated, compliance can be legislated. Quality must be lead by innovation. Compliance does not create quality....

As providers, too often we find ourselves seeking "quality" to be defined by meeting the criteria set up by the government regulations. The reality is that quality is driven by creating market disruptive innovation that customers desire and demand. Without creating remarkable quality services and outcomes, we will fail in the future. By allowing the government and other regulatory entities define quality for us; we are missing the critical element; customers. Customer based definition of quality should be our one and only focus. In a true market based economy the customer should drive the success of a health care provider. Subsequently, as health care providers we need to fight for this vision. We need to demand that we are allowed to have the latitude to create customer driven quality care environments where consumers are able to define the quality they want. If the regulators really want to "thin" the poor performers, this system would work quicker, and fiscally more affordable for tax payers.

As an example of a market disruptive innovation, I think of the remarkable one of a kind wellness center that our company just opened at a sister facility. This is a living breathing example that will set the bar on remarkable quality for customers and families. This center will redefine what rehabilitative short term care should look, feel and act like. Kudos to the innovators who designed this, and thank goodness I work for a future sighted company!

As providers it is time to let go of the regulated quality/compliance outcomes that we feel comfortable with. We must allow our customers and market demand define what "quality" should be. It is in this innovative thinking that we can finally break thru the regulatory bureaucracy and achieve a competitive market based organization where the services we offer are worth the price to the consumer.

As a future leader, the times are both frightening but wrought with possibilities...I cannot think of a more exciting time and career to be in for the next 25 years!

Monday, October 1, 2007

The Character of a Community

On Sunday evening I had the pleasure to attend a very touching and inspiring event. This event, celebrated a 100 year anniversary, and the retirement/service of a dedicated individual who has dedicated a great portion of her life to providing care to the elderly of her community.

During this gala, one of the speakers made a simple statement that touched me in a profound manner. The statement? "You can judge the strength and character of a community by how they treat their elders."

As I sat there pondering his words and the rest of the evenings events; the strength and prophetic wisdom of this thought kept reverberating in my head. Several questions came to mind... How does my community treat it's elders? How have I role modeled the expectation of treatment to elders? Would my community members who are not part of my "care giving" environment agree with this statement?

I had never thought of a communities character in this manner. The speaker was referring to a religious based community; however his concept and thought can be applied to several sets of societal communities. Where do my "communities" measure up in comparison to the role model that I observed last night? (picture near 700 people who paid a large sum of money to attend this fundraising/retirement gala, all of whom were supporters of this specific religious community via religious or business affiliation.) Tough assessment and evaluation for myself.

Where have I been as a role model for care in my community sharing the expectation of how elders should be respected and treated? Am I a true advocate in every sense of the word? I would like to think yes; however I find myself thinking I/we could do better, and should do better. As a prospective elder, I would hope someone would advocate for me when I can no longer do so for myself.

As fellow caregivers; I ask you where is your community in the realm of respect and honor toward it's elders? Is it where you would like it to be when you are aged? If not, do we really have a community of value or character that we can be proud of?

Interesting thought, and one that I will share with my management staff...Great discussion topic for our next meeting.

Friday, September 28, 2007

Will We Be Open On Monday?

So, Monday morning, we will either have an operational state government, or we will have none...Wow...nothing like a little group punishment to get every one's attention. So much for a government who really has their constituents best interest at hand. In what way will this help us resolve our continuous overspending, and out of control government programming in the State of Michigan? It is not bad enough that we have the lowest economic forecast of any state in the union, now we can get some more bad press by turning the lights out on our government. Yes, it would make me want to jump on board and move to this great state. I can see the business lining up to get in already...

As a health care provider, I wonder when/if I will get paid for providing care to the state's frail and elderly in need? Will my vendors understand my dilemma?

Will this push back my state survey by days again this year? What kind of mind set will the surveyors be in when they get to my building? If I understand my peers correctly, the survey teams appear directed to find citations that are fineable ie: money making for the state on the providers payroll. If you are a skeptic, than it really is ironic that in the past year Michigan has again gone outside of the federal norm for the number of fineable citations and repeat surveys. (These both cost us as providers fines that are given to the state government). Funny like that...

As a mother of a young soon to be college graduate, I have already expressed my hope that he packs his car and heads south or west where jobs are plentiful and he can actually find productive and meaningful work with his degree...

As I drive to work I now count at least 10 houses that are vacant,foreclosed and for sale by their new owners the mortgage company...A sad testament to our state forecast.. (mind you that I live in an extremely rural area, 10 houses=15% of the houses I actually pass each morning..)

The other sad irony, it is predicted that health care will soon be the biggest industry in Michigan..If this is correct, where will all of the patients come from and where will they be working/earning money to pay for this great health care? As a provider I would prefer to be 3rd of 4th on that list...

Could it be that the same wisdom(or lack there of)' that is being applied to shut down our government for an indefinite period is what got us into this financial conundrum in the first place? A point to ponder isn't it?

Thursday, September 27, 2007

Eating our Young...

The following is based on a recent personal revelation, I call them "aha" moments for lack of an intellectual term. For my female peers, sorry I am sharing about a "female weakness", for my male readers here is a little insight into one of our own gender failures in regard to leadership and achievement.. It is not a politically correct discussion, but those that know me; know that I relish exploring the not so pretty side of humanity. With that said, this topic is a personal discussion and should not be construed as anything but a personal observation of a "careered female" seeking personal growth and development.

Let me know what you think; I know opinions will flourish about this topic..


Okay it is time to take the gloves off and talk about the dark side of female behavior. I am speaking about the behavior that has perpetuated thru the ages, and in looking at it critically could be one of the main reasons we fail to achieve leadership success at the rate of our male counterparts.

I am speaking to the behavior I term,"eating our young". In fact, I have had several women refer to this behavior as such. Ladies, you know what I am talking is the negative, gossip mongering, catty, destructive behavior we enact when one of our gender counterparts does something to get recognized, looks good/better then us and gets compliments, or achieves something worthy of notice.

Perhaps it is the relishing of someones mistake, or other embarrassing moment. We pride ourselves in being the "first" to share the story and continue the destruction of our counterpart female. As if the original embarrassment from the incident was not enough atonement for their sins, we continue to heap the wrath upon them and then sit back and enjoy their utter and total destruction; as if we are a vindicated victim.

Perhaps you are reading this; and saying, "I have never done this; and I am sooo above that behavior. I am a professional educated female, I am impartial and fair", and I hate to tell you; in denial. Every woman at some point in her life has done something to piss off her female peers, and the claws have come out. Or one of your female counterparts have pissed you off, and you sharpen your claws on your emotional response...

Maybe you are a subtle attacker, sitting in the background listening to the gossip, but not stopping it; not disagreeing but secretly thinking, "thank god I am here, they could be talking about me like this." Yet, the darkness of the conversation sucks you in every time and you sit and listen. Perhaps you are an aggressive attacker, the speaker, using great descriptive terms to embellish the story, and make it even more significant. You are a strong woman, people wouldn't dare question you, and this feeds you to continue the behavior. It gives you a power over your female counterparts... Maybe you are a combination of the two; depending on the audience you have mastered both tactics and are the true eater of young. You can master, "this is not appropriate" and direct the conversation away as a leader should do; yet, in your own peer group where your power is limited you are an active participant in the behavior. (I call this passive aggressive to the nth degree.)

What ever your style we (I include myself here, guilty as charged); all have either participated in this behavior toward one of our peers, or have been the victim of such behavior. Either way, there is pain and loss involved. We not only are inflicting pain, but we are giving up significant power in our role modeling of strong leader, strong female.

As the perpetrator, it is a false sense of power and vindication isn't it? Because once we have acted in this manner, it puts us out there at risk for others to do the same to us As the victim, our sense of self, our esteem, our productivity as a leader can be significantly damaged, at times, to the point of no repair.

I know that many of you are probably outraged at this discussion. Good. I would rather have outrage and discussion, then a passive, so what? as a response.

Now let me take it one step further; I know we could sit here and discuss "why" we do this. We could blame society for keeping us "down", we could blame men for not respecting our ability; we could blame our mothers and female role models. The reality? We need to look at our own personal responsibility to this behavior and learn to check ourselves, and check ourselves frequently.

I had a discussion with a fairly educated man about this topic; and he told me that he felt it was part of our genetic make-up to be competitive with other females in an attempt to get the best mate. (I told him leave it to a man to make it about sex). However, his answer to the problem being genetic may not be to far fetched. Perhaps we are innately wired to compete with each other for the best "provider" and "provisions". Perhaps we are the most competitive of the species. Yet, as the most intelligent species in the world, you would think we could have achieved the ability to overcome the hurtful and destructive behavior associated with this genetic coding.

What ever causes it; we (women, females) need to learn to control it better. This behavior is leading to our failure as role models of success. It also is setting up our proteges to falter. If we are to be true female role models, we need to build up our young counterparts, allow them to gain success beyond anything we ever have had or could dream of achieving ourselves, and then relish in their achievement. We need to share honestly and supportive in their failures and provide an environment that is significantly different from what we experienced. We need to quit eating our young, and instead start feeding them to thrive.

Saturday, September 22, 2007

How it all began...

I received an email today from someone I met this week at the conference I attended. Her question? Why did I start my blog? In my first blog entry back in Dec. of 2006 I share my personal life story about change and what I have been seeking/working on for the past two years. What that entry does not tell, is the story of my first ever writing on line. In late August of 2006, I was spending an evening on-line reading a few websites and updates as I usually do instead of T.V. An article caught my eye,it was a response/rant from a female writer in regard to a Forbes Magazine article entitled, "Don't marry a career woman".

As a "career woman" I was curious. After reading the purported offending article, I felt compelled to respond; and respond, and respond.. I posted my response on a (ffaf), free-for-all-Friday on one of my favorite blog sites, slacker manager. Needless to say the response was a little interesting. One reader who really enjoyed my writing, sent me an email and we began talking via email about blogging and what it could do for me personally, professionally and what I could offer up to you; the readers. I pondered his suggestions and encouragement....

The rest is shall we say history....the link to my response on the ffaf is listed below; I apologize for the lack of editing. It was my "first" posting on line. Yet, it still speaks to how my mind works/thinks about life. With that said, the original article on Forbes was pulled, but is now found with a rebuttal article from another Forbes author/editor. To find it; simply type in "don't marry a career woman" in your Google search engine...Enjoy ALL of the articles/responses!

my link: to view this, cut and paste this link into your search bar.

So now you know the rest of the story...and how I found the tag "career female" as my blogging tag name.


Friday, September 21, 2007

I'll take the wealthy Dr. please...

The following is a personal opinion, and should not be misconstrued as the opinion of my company or profession. It is simply a reflection on a thought that revisited me today courtesy of a political discussion held with a physician; and given my attitude at the moment I felt compelled to share...Jana

Why is it that in America we feel compelled to control the income of a certain group of people? Usually that group is anyone who has more, earns more, or we perceive to be more successful then us. I am speaking to a new mind set that I have heard more then once related to the amount of money that physicians earn for their work. This mind set terrifies me...At what point did we as a society decide that our physicians should be price controlled and that given the opportunity we should be able to decide how much they earn?

I for one, want my physician to be the most successful, sought after, wealthiest person in their profession. Why? If we truly had a free competition medical market, I would envision he or she to be the best at what they do. IE: their personal success=success for my care.

Why would I want someone who was paid the same amount of money irregardless of how successful or good they were? Where is the motivation for them to provide me with outstanding care? I would envision my care to be mediocre at best.

Yes, I know care giving is an art; and it should not be about the money. I like to believe I do my job because it is my "passion and calling" however I also like the paycheck, and the benefit package that comes with it. Quite frankly, moving up the ladder into a leadership position was not only a personal draw, but also a financial one for myself and family. Is it not the same for you?

At what point do we decide that someone else makes too much money and therefore should not be able to make any more? Is this not the key component of a jealous or envy driven mind? Quite frankly I can think of many people I am envious of..I wish I had their intellect, their beauty, their charisma, their talent, their business savvy.. Simply because I covet these traits, does it make it right for me to stomp my foot and say not fair, give it up, play fair, you MUST share with me. Hmmmm. I think that lesson is called life is not fair, it never has been, and it never will be on earth..

I know we need health care reform, I know that we need to get a handle on out of control costs for insurance or people who have no coverage; but I believe stopping free market competition is wrong. It will not solve the problem, but in essence exacerbate the quality of care that we receive. Don't believe me? Check out the failing free government insurance and care programs of our European allies. Not good. They too are struggling with care issues mostly related to lack of good services being available and incredible waiting times for services to be rendered. Why? perhaps it has to do with the fact that their physicians are price controlled, and have no motivation to be more productive, or competitive...

Funny thing that competition, we act as if it is politically incorrect to view competition as a standard of American living. Yet in reality, it is the main stay of what has made our nation great and different... Competition drives you to seek success; without the drive it is a rare person who does not become complacent or lose their motivation.

Take the competition out of the medical profession and we risk losing the best, brightest and most driven caregivers. Kind of a scary thought isn't it?

Wednesday, September 19, 2007

The Power in an Idea

I am home from my professional conference, exhausted but exuberant. Why? The exhaustion comes from late nights of networking/conversing/laughing with fellow care professionals. The exuberance? I did my first individual presentation at our annual conference; and the content of what I spoke on created new ideas for those who listened. In essence; the content of what I spoke on was a new concept and idea that many had not known/thought or expended time on. I am in lack of better terms; "geeked" by the feedback and that I had an idea that was new; fresh and different to train and speak on.

As a speaker, my voice was not on my A game. Unfortunate for me, (Murphy's law aside); I have a nasty cold that came home with me from New Orleans. I could not use much inflection or tone change without having a coughing fit..Not pretty...however, the outcome of the content that I presented appeared to be very new ideas for most in the audience, and it caused discussion at the post lunch tables.

Having people talk about what you said indicates that they are thinking about a new idea. I don't care if the conversation is negative or positive; the mere fact that a conversation is happening indicates that they are thinking about something you said and it put a new thought in their head. In essence, your education was successful.

So what new ideas have you triggered in your teams? your consumers, your elders? As I sit here typing; it occurs to me that the power of placing an idea in someones head is incredible. As a provider and leader I am driven to put new thoughts about long term care, our industry, our profession into the minds of society. Imagine the collect power of our voices speaking the same language about who we are; what we do, and why we do it. Imagine the speed at which we could change the culture of care in America, one simple idea or thought at a time spoken to 200 and the rest could be history...

Thank you to those who attended my presentation; and welcome to my blog. I will be working with HCAM to set up a longer/more involved hands on training. Thank you for the feedback and idea to create a more involved training; I am looking forward to getting you all writing, and sharing. Watch the Pulse/HCAM publications for further information and dates.


Thursday, September 13, 2007

The problem with magic mirrors...

Just like the wicked stepmother in snow white, it seems that some in our industry still have a mirror image problem. That is; that when they look into the mirror, they only see the beauty, good and their own perception of what "we" are all about. While in reality the image our public sees is the ugly, evil vision of what "we" are all about...

And herein lies the problem...

As an industry, we need to recognize and embrace the current public image of who we are. Embrace it? Yes, embrace it; live it and think it...The only way to overcome a problem is to get into the heart of it to understand it. This concept comes to me from an excerpt I recently ready where an engineer who designed jets was called by the military with a problem r/t a design flaw in on of his planes that was causing out of control spiraling. What did he do? He got in a plane and put it into a spin; the result? He figured out what the cause of the system failure was. He stated that it was best learning opportunity to create a solution.

Yesterday I did interviews for a professional level position in my building. None of the candidates had long term care experience. As I went thru the paces of questions; I finally asked one last question. "Please honestly tell me your perception about long term care." I was asking this prefaced by a statement that their answer would not weigh on my decision, I simply want information about how we are perceived (especially from potential new hires) and how they came about that perception. Their answers were all brutally honest. Did I hear it? Could you have sat and accepted hearing it?

I like to think that I can hear the criticism from the public...I hope that by being open to this I can figure out how to create a paradigm shift in thinking and imagery that gets into the minds of society. It is probably the most painful part about working in long term care. The constant barrage of negativity that surrounds the profession frequently gets our defense mechanisms racing and the barriers go up.

As the leader, it is imperative that my team has witness to my acceptance of the public image and that I role model discussion on how to change, not how to defend our position.

If we as leaders in long term care really want to create a shift in thinking, we need to start with our own mirror image; and then willingly, painfully, share that with those whom we lead. Until this happens the image that we see will always delude us; and the true image of what we could become will fail to fill the looking glass that we peer into...

Tuesday, September 11, 2007

Negotiating The Medicare Labyrinth

Have you ever had that nightmare where you are stuck in a maze, and you keep hitting the wall only to have to turn around and start over... You wake up exhausted, scared and in a cold panic that you could be stuck in that maze forever...

Welcome to the world of negotiating medicare payment for services, procedures and care.

I recently lived this nightmare in regard to a treatment option that my care team felt would benefit a resident. The problem? We live in the wrong state and our Dr. is assigned the wrong fiscal intermediary to bill for services in our building. If this resident lived in Virgina the treatment would have been done at bedside in her room by her Dr. who could bill for it and receive payment. Unfortunately for my resident the only way she can receive this treatment is to experience a van ride to a clinic 35 miles away where she would have to see a new Dr. and deal with the trauma of leaving her environment, and riding in the back of a health care van for over an hour. By the way, she suffers from dementia, and the transfer trauma would be very painful for her.

I am being told that our Dr.s' fiscal intermediary does not recognize us a "service provider for such treatment", yet they will allow me to bill for transporting this resident, paying a driver and staff member to go with her and the treatment supplies once the treatment is completed. I am not the brightest person with financials, but even I can figure out that this is the more expensive option....

This scenario irks me greatly...First for my resident/elders. Why is there not a par/par coverage system for medicare? Why do the fiscal intermediaries get to determine what services get covered and in what setting? Why is this not a universal service program? Secondly, as a taxpayer and perhaps someday medicare recipient how do I know what services are covered and where I can get these specialized services? As a provider who deals with reimbursement issues daily, this was a new encounter. I can only imagine the lack of consumer awareness of these scenarios that play out daily all over America.

I think of the millions of dollars that companies such as the one who provides this treatment option, Dr.'s, facilities and other providers spend simply negotiating payment for services. I can only imagine the impact this additional cost has on the goods and services that we all provide to Americans.

In fact, obtaining reimbursement for health care has become an occupation in high demand. I would imagine that becoming a reimbursement specialist would be a lot like completing a new sudoku puzzle each day...You finally get the numbers in the right places, and wham...a new puzzle appears for you to figure out.

So we continue to run the maze, occasionally we make it out, but usually we spend thousands of hours and dollars running into walls....Only America could make health care a game..

Monday, September 3, 2007

A toasted marshmallow kind of day...

Every once in a while it is good to just "be". I hope this three day weekend gave you the opportunity to just have a moment or two of relaxation and fun. If not read on...We all need those kind of days to remind of the important things in life. Jana

My list was long going into this weekend....Research paper to be completed, power point slides for class project; power point slides and handouts for upcoming training I am doing, interviews to set up for work, in service schedule to get done...You all know the drill. It is the weekend and you have an "at home" list, but the work list seems to be taking precedence Family needs seem to be the very distant last on both lists, and fun is not a word in your vocabulary..

This weekend, I did something different. I put my family and friend needs first, and guess what? We had a great weekend, and I have no regrets. I spent Saturday taking a nephew, a friend and her daughter,son and a friend(can you say herd of children?) to the rain forest cafe and then to build bears...(Picture two 6 year old boys, two nine year old girls plus extra relatives who met us at bear building).

Considering that I have not spent significant time with this many children in some time I didn't know what to anticipate. But I discovered that when they are not your children, that children's behavior and comments are truly very funny and so inquisitive.

The restaurant fish tanks and animals were amazing to them. To adults, the fish are pretty, and the noise level is a tad annoying. The kids were enthralled..

Listening to the interactions in the car was like opening a window on personality development..As they fought over space in the seat, and who would sit where, (the girls used manipulation, and the boys used brute force...somethings never change).

As I watched them sing and dance to whatever music, and just being silly; it occurred to me that adults forget the need to have those silly moments, and that parents sometimes try to stop the silliness in fear of social embarrassment from their child's behavior.

After we built bears, the girls wanted to "shop" and I knew that the boys would not tolerate sitting in a dressing room..So we did something silly that their moms would never do....We rode the three levels of escalators up and down twice, then we ate ice cream,(I let them get chocolate, with sprinkles and make a HUGE mess)...Then, we threw pennies in the fountain, and of course we decided to wash our hands in the fountain, followed by a small splashing fight...

When my nephew got home; his favorite part of the day was when Aunt Jana let them do the silly stuff they never have time to do...

I created a memory for him that hopefully will trigger something in him when he becomes an adult and has children...

Yesterday, I finished the paper utilizing the college "all nighter" policy; I worked on the power point and it was then off to another family function. This time it was at the in laws...As I sat pool side I realized it was the first time I had used the pool all summer; and it was the first time in many years that everyone was home for a non-significant event, (wedding/funeral). Again a sad testimony to our priorities in life...As we swam, drank, had funny conversations about inane subjects that the intellectual relatives come up with while drinking...I felt relaxed, something that comes very rarely for me.. The laughter was genuine and enjoyable, we were being silly as adults know how to do rarely.

After dinner we did our traditional campfire and marshmallows...As my 5 year old niece proclaimed after her third of such; "I love the toasted marshmallow days aunt Jana, they are my favorite kind of days"...

I simply responded so do I Addy, so do I....

I hope you find time to have this kind of day soon too..

Saturday, August 25, 2007

Even our Sister doesn't love us...

Eee gads...If it isn't enough having advocacy groups, the attorney general, public opinion and regulators who feel it their personal mission and obligation to point our your inadequacies and subpar performance. Now comes the same attack from our "sisters" the hospital associations.

It seems, that the hospitals are a little put out by the proposed medicare rules (labeled the 75% rule) that will limit what/who/when can recieve inpatient rehab care in a hospital setting. So how are they fighting? They are using our industry as the scape goat...Go figure, it appears to work well as a marketing opportunity.

However, I find this a golden opportunity for us to distance ourselves from the hospital settings. We are different, and if investigated via a customer service rating; we "spank" their outcomes. In mere dollar and cents; skilled nursing services come in cheaper, more effective and surprisingly I would venture with better customer service ratings on the experience.

As an industry, this should be the talking point. lets look at the dollar and cent difference between in patient rehab and us; and then compare amenities. It is the time to speak of what we do and do well...Customer service with good healing/wellness outcomes.

Perhaps public awareness that we even offer these services will happen because of the "ads" that are being run by the hospital associations.

Hmmm..I wonder if they thought of that possibility. Do they realize that much of the public does not know of our short term rehab abilities? For if they did; they would be amazed and impressed but what we do, with what we have; and how pleased our customers are when they leave.

I say bring it on; this is one attack that I welcome. We are not only good at rehab; but if you look at our outcomes vs. our cost we produce a phenomenal product.

In fact I have a suggested equalizer; if the inpatient rehabs want to play fair; they will accept a Medicare PPS program for their services; complete with the federally mandated survey process based on the medicare regulations/oversight given to skilled nursing facilites. Once this system came into play; perhaps then the outcomes could be measured via a scientific based research study. This data could be the catalyst to stop the "public opinion and word association model" they are using in their ads to attack "nursing homes".

Either way; It is yet another example of how we as an industry must continue to hold true to the principles of quality outcomes; and ethics as we proceed forward to care for the next generation.

Tuesday, August 21, 2007

The Reward of Having Us in Your Neighborhood

I have heard us referred to as "that home", "the necessary evil", and "the old folks home". It is rare when people are conversing about us; for them to speak with kind epitaphs about the nursing home; elder care center or senior living center down the street or in their town.

Instead, we often hear ourselves referred to with a negative adjective or adverb attached. That is ok; but let me share with you the positives of what "we" bring to your area, community or neighborhood. Yes, you're reading that correctly. Having a nursing facility in your town is a good thing.

I want you to imagine having your parent take ill suddenly and finding yourself with a decision to make about what you are going to do for care. you and your spouse are both working; you have children at home; and you are the only child who lives within 100 miles of mom or dad. You are by default their care choice maker. Believe me when I say that this scenario plays out every day in every nursing home and hospital across America. It is how we as a society come to terms with choosing elder care. It is how "we" meet 95% of our new admissions and families. Bewildered, confused, scared and facing the toughest decision any child has to make for/about their parent. Having a nursing facility in your hometown at that moment can be priceless. We serve a purpose, fulfill a need and do so in a moment's notice for many families every single day. The social and emotional support that we give every day is perhaps the biggest gift many a family has been given during their time of need.

Now think about you. You find yourself the mom of an empty nest. You want a job, but really don't know what you would like to do. Guess what? That "home" down the street, has posted a job for a part time cook. You think to yourself, "I cooked for four kids, plus friends for the last 20 years; I could do this". In our home we have 162 employees. Our starting salary for an entry level cook is 10.00 per hour. Not bad. In fact, in our building last year we paid out over 4 million dollars in wages to our employees. If you're the grocery owner down the street, that is a lot of apples being bought at your store. Not to mention the lunches bought at the local diner; the gas from the local station and beer from the local pub. In our town we are the second largest employer,(number one is the school district). 4 million dollars of salaries being spent in a local economy equals a high success factor for many a small local business.

Hmmmm....Local business, how do we help them? Simple, we do business locally when ever it is possible. Last year our building spent over 1 million dollars in goods and services to businesses within a 50 mile radius of our address. That is one million dollars of small business revenue that helps our local economy, supports local jobs and you.

What about our impact on your schools? Schools? How could we possibly impact your schools? Well it is a little something called property taxes. As a business, we pay them; and we pay them in a big way. In fact our building makes the top 5 list for tax payers in our district. That band uniform your child wears, that football your kid catches, and the book your little one brings home from the library; you should probably send a hug our way, we probably paid for one or more of them.

The financial benefit of having a nursing home in your community cannot be denied.

What about that community service your child needs to serve for graduation? Oh yeah, we help with that too. Every year we get at least 15 youth from various districts that come in and give us a few volunteer hours for their graduation requirements. The surprise to most; is that they enjoy it; and many ask for a job application when they are done. The other thing we do for schools? We seem to generate a large number of children from our employees. For some reason when your industry is female dominated, pregnacy and children seem to follow a close second. Of the 162 current employees, 90 currently have school aged children, and 75 live in our local district. Hmmm, that could mean a lot of fourth Friday heads to be counted! Not to mention the 125 total employees who live in our local district and pay sales or property taxes locally.

Think about it; as industries go; we are quiet, no industrial noises. We generate no hazzardous waste or industrial by products that you need to worry about getting into your water shed or air. (Yes we have dumpsters, and yes I am aware of what goes into them; but when you compare this to an actual by-product like mercury I would take our dumpsters ANY day). Our grounds usually look neat and tidy, with flowers and nice trees. We employe people from all age groups, all educational levels and provide a very good wage and benefit package compared to other opportunities that are available in most small communities. We are a vital part of this community and many like it across America. Plus, when you find yourself in need of our services we are here; right in your back yard your neighbor; ready to take care of our neighbors.

So; the next time you hear someone refer to us as "that home", remember this article and what "that home" does for your community.

Thursday, August 9, 2007

The Power of Action...

Wow...Today I am hosting the last of my "state of the facility" addresses for the year end 2006/2007. For some reason my talk today transcended the norm, and became an empowerment speech...To the point that I had a few staff members in tears..Yikes..These were good tears, but still I apparently touched a nerve, and it created energy to seek action.

I am speaking about the anger that I have related to our current spending in the state of michigan per prisoner vs. what we spend per elder on care. As a tax payer; it makes me very angry and apparently my anger became other's anger as we shared a moment related to the injustice of it all... I shared this information with my staff as a hopeful catalyst to get them involved in voting, having their voice heard and for them to recognize that they "are the government". I spoke openly about the budget crisis we are facing; what it could mean to us as a building, and what it could mean to them individually as tax payers. We talked about options that we have, and my perception related to our government leaderships lack of vision to correct the financial crisis we are in.

Perhaps my passion is a little over the top; and in retrospect, I know I must be careful about sharing my opinion, but as a leader, sometimes we fail when we forget to share. We fail ourselves, and those we serve by not letting them see the human being inside who has real emotionional responses to situations.

I know that sharing my angst, created a need for action in a few people today...Good. The discussion in the break room this evening was about my "speech" and what "we" are going to do...Good.

Allowing my staff to see me angry is something new for them, and for me. I try to remain calm, even in crisis, ( I am sure my boss is rolling her eyes at the thought of me identifying myself as calm). But if you were to ask my staff, I am thought of as kind, fair, energized but never angry. Today they saw my anger for the first time.

Whatever it takes to get people motivated to become involved and help us take action against elder injustices...Whatever it takes to get people out to vote and use their voice. It is empowering, not only for me; but especially for them. There is no doubt in my mind that we will have several individuals who will become involved in this process as it unfolds. To me; creating energy and new thought processes in others is the best reward of leadership I can ever get.

Wednesday, August 8, 2007

Ignorance is bliss until it smacks you in the face....

Todays headlines in Detroit, "woman found floating in a pond behind luxury condominum complex". Ok, so bad things happen in good neighborhoods. The part of the story that disturbed me the most; several people report seeing "something" floating in the pond, but didn't bother to report it. Perhaps it wasn't in their realm of thinking that it could possibly be a body. Not it this neighborhood. Or perhaps they were to "busy" to really think about what it could possibly be. They were "ignorant" to the reality of what they were seeing.

Hmmm.. Remaining ignorant is bliss isn't it? Not knowing the truth, or even a bit of information about something can be heavenly. I liken it to my first taste of calamari and really liking it until I was told what calamari really is...

Another ignorance subject....the aging crisis we will be facing shortly in America. I am speaking to the soon to age baby boomers who will overtake our health care systems starting in the next 10 to 15 years. Perhaps it is because I work in the health care profession that I feel angst about the future of America's health care system. Perhaps it is because I see really poor public policy being implemented currently in my state. Perhaps it is because I watch American's place value on youth, and avoid aging at all costs. Perhaps it is because I see where we as a society are not saving money to be cared for when we are old and in need. Perhaps we are simply ignorant to the facts of aging and the cost, choices and decisions that have to be made to get care for ourselves when we are in need. What ever the reason; the ignorance of American's in totality; those who live here; those whom we elect, and those whom we allow in our borders; frightens the heck out of me.

The lack of focus on this crisis in the making should be the number one topic on everyone's agenda. Yet, we rarely hear anything about it.

So what are we waiting for? Apparently, like most public crises the government is going to wait unit it "smacks" them dead center between the eyes before they start to "deal" with it.

Maybe I am just really cynical about government and their inability to get the "organizational processes" moving. But the example I have been given as a taxpayer to observe, "Michigan" has not given me much hope for the future...

In fact, in our state; the current flavor for elder care is to create an environment where we push "aging in place" as the answer to our health care woes. Nice answer for the 50% of Michigan elders who actually have family support systems and financial ability to choose this. What about the other 50%? So we set them up to be cared for in their own "home" by themselves, dependent upon government appointed/selected care giving services. That sounds like a successful venture to me. Further, what an idealistic approach to care. How many families; especially Michigan families; can handle the emotional, physical and financial burden of caring for a frail elder 24/7? How many elders would chose this option to burden their already burdened children?

Ahh yes...the ignorance factor. We as taxpayers "ignorantly are buying this vision" and the government is ignorantly believing that they have the "solution".

Monday, July 16, 2007


This is a reflection on my thoughts from yesterday, Sunday. For some, Sundays are spent in church; for others it is a day of rest; and for some it is a day spent working/doing but usually with family and friends. However you spend your Sunday/Sundays I hope you take the time to reflect on your personal blessings in life...Jana

Today was a day filled with hope and renewal..

I spent the morning exhausted and a little defeated r/t our less then stellar showing at a fund raiser the night before. I had staff who volunteered to work/help only to have a small crowd show up. I felt that I had failed at something, and had failed them as well by asking for their support, only to have a dismal showing. Those of you who know me; know that defeat and failure are two things that do not bode well in my mind. I will usually respond in retreat and withdrawl mode and become somewhat pissy. (A little personal descriptive word that I have heard more then once from others r/t my moods). In the past I would find a good comfort food, a book and spend the day feeling sorry for myself and "blaming" the world for my failures. Again a bit of personal information, but probably true for many of you as well....

But alas, It was not to be; as I had made a commitment to attend a function in the afternoon. So, I got up, dressed, and off I went to the house dedication of the habitat house we had volunteered hours for. This house, is a home that was purchased/built for a C.N.A. from my staff. I was a few moments late, but arrived in time for the "service" portion of the dedication. This home was a co-sponsored build by Thrivent for Lutherans, a financial/service organziation that coincidentally I am a member of.

As I listened to the Pastor speak to the blessings of giving and receiving and God's grace in both I found a sense of peace. It was a moment of clarity for me as I watched my staff member and her family glow in the joy of their new home and the overwhelming emotion that they were experiencing from the gift of this home. It made me think of my own life and the blessings I have been given, and yet fail to recognize in my "self pity" moments. Sound familiar?

Our lives are abundant with blessings if we take the time to recognize them. Even in the failures, we can find a gift. In fact, the failures are sometimes the best blessings and lessons. Of course as I sat and listened to the sermon, and then when my young staff member was able to say thank you, that I found myself in tears with her. (yes, I know no great surprise again for those who know me). This time my tears were of the happy variety, and a little for my own sense of gratitude that I have been blessed abundantly in this life and have failed to recognize just how blessed I truly am. I have my health, my family is healthy and thriving; we own our own home and are financially stable, I have a great job that I love; and people who love and support even the silliest of my ideas. Yes, I have been blessed.

It was in this moment of watching someone achieve something that many of us take for granted, owning a home; having a place to call our own; that brought the reality of it all back to me. Perhaps it is because we are socialized to always "want more" that we forget to count our blessings. Perhaps it is just our own personal drive; what ever it is; we need to stop and take time to reflect and appreciate.

Tuesday, July 10, 2007

A Safe Peer...

Last night in class, we ended our team discussion; with a tangent discussion about why our class group works well together. This conversation led to the topic of giving and receiving support and feedback to/from "safe" peers. What do I mean by safe peers?

A "safe" peer is someone who usually has no connection to your "company/organziation" work, they are not your competition, your superior, or your subordinate. They are someone who shares professional role equality/or roles with you; but are not necessarily in the same line of business or work. To put it in lay man's terms; they understand your pain.

It was a fascinating discussion; and something that I had really not thought much about. I am fairly fortunate, and an oddity in that I am a pretty straight forward person, and trust my superiors and my subordinates with an abnormal amount of personal "stuff"...However, what about those days when I just feel like an island? You know what I mean...all alone, with no one to share my frustration or paradox with, what do you/I do?

Now imagine...Your behind on your work that is due in; so you don't dare call your boss to vent, (the first thing out of their mouth could be where is it)? You really can't blame them, I am sure they are experiencing their own angst with you.. If you call one of your organizational peers, they will probably empathize, but then nature will take over and they will "share" your story. Competition between company/organizational peers being what it is; nothing feels better or gives more power then "information" about a peer that could become a negative in your collective bosses opinion... (Don't even try to deny that you are always above sharing information about a peer that could make you look one is that perfect).

I started to think about who my "safe" peers were, and what role they have played in my personal development or personal mediocrity. I came up with my list, and it was surprising to find, that I have developed a fairly strong safe peer group over the past four years. The interesting side bar in this; is that I consider two of these individuals to not only be professional peers(both in totally different lines of work but in management), but also people whom I am personal friends with.

I then thought about who am I a safe peer for, and what is my role for them? Can I be a better peer to them with increased honesty and real feedback? What can they learn from me, and what can I gain from them?

As a peer "group" my class is diverse. We represent all age groups, a few religions; we are all over the political spectrum; and we have varied career paths/goals. But the one thing we all agreed on; was the power of group support, discussion and feedback on issues that we face as leaders and managers. Getting someones idea, or view point about your particular issue can be critical in developing your own leadership tool box. Having a group of "safe" peers can help you develop your skill set and broaden your arena of ideas, and solutions to the day to day frustrations or issues we all face as leaders.

We ended our discussion with this thought; if you have not developed a "peer network" are you simply stagnating at your leadership role? Is it not critical to have someone that you can bounce ideas/issues off of; and then take their feedback and put it to work for you? How do you continue to grow without someone to give you feedback and insight into your problems or dilemmas? Perhaps we have stumbled upon a new research topic for a paper; but more importantly, it is a topic worth thinking about if you are a leader, manager or working toward personal growth.

Monday, June 25, 2007

Observations on the Road to Bologna Queen....

By now, many of you are aware that I am running for the illustrious title of "bologna queen". The following is a reprint of something I posted earlier today as a tongue in cheek look at my new found campaign run. It represents me as a person; and not my company or professional associations in any way...If you are offended, I apologize in advance. It is meant to be funny and light hearted...every once in awhile it is good to laugh, especially at ourselves...It reminds us to be human...Jana

The following are observations from my campaign to become bologna queen. Looking at the campaign and the behaviors required to become ingrained in this yet unexplored culture.

1. The title alone, bologna queen; speaks volumes to the intellect and appearance of the candidates.

2. Bologna is not politically correct in all cultures, and some even find it offensive. Further, the idea of wearing it on one's head as a trophy is indigenous to the small culture of which the festival centers.

3. The amount of donations received at a local pub is equivalent to the size/visibility of one's physical attributes; locally referred to as "getting the girls out".

4. Discussing the merits of utilizing your campaign as a market research/data collection tool for your graduate thesis does not endear the locals to your campaign. Getting drunk, half naked and dancing on a pole in the back of a Harley bus and then sharing pictures; you will find yourself the local favorite.

5. telling people to check out your website r/t queen seeking only works in the local area if you exaggerate and tell them you have over 15 mature ladies ready to meet them posted there. Apparently the Internet is used only for viewing specific types of "photographic art" in some cultures.

6. Even clean solicitations for donations makes one feel skanky.. Especially when it is occurring at a local gathering place (hangout) and the bikers sitting next to you explain they will donate only if you rate the quality and size of their bologna...

7. Wearing ones bathing suit with a man's tank top (commonly referred to as a wife beater); with flip flops and cutoffs to a local pub will get you more donations then hanging out at coffee hour after church and discussing the merits to the community for their donations.

8. The above only works if the "girls" are your best attribute and the pub is air conditioned.

9. While visiting local pubs eat food that is pre packaged. Observing the dog licking himself as he walks from the kitchen while you eat the salad that was just prepared there...

10. Eating salad from any local watering hole is an experienment to only be tried once.

11. Never order a drink from a guy wearing an old Harley vest that requires more then two juices or has a big name like cosmopolitan.

12. Stick with something simple like J-A-C-K

13. Drinking JACK gets you more donations and looks of admiration from the locals

14. Especially after the fourth of such....

Utilizing the web for shameless self promotion of my run for bologna queen, and to gander more research data on marketing to a new culture.

Jana 4 Bologna Queen

Wednesday, June 20, 2007

The Taboo Topic

I just finished reading an article by the citizens research council of Michigan r/t the Michigan budget fix for 2007; and what we can expect for 2008. The numbers, prospects and outcomes for next year make we want to pack my bag and head south; or west. I want to be in one of those states where the tax payers are getting money back, due to their state's excess of funds. (Yes, over 40 states have fund excess this year).

As someone who works within the Michigan Medicaid system, I am still scratching my head in wonder as to why Michigan has not looked to asset recovery as one remedy to the medicaid funding crisis. Yes it is a political hot button. Who wants to have their name on legislation that promotes taking assets from the frail and elderly to pay their medical bills? That would/could be career suicide for anyone who would like to continue their pursuit of a political career. As someone who works on the provider side, I recognize the negative of for profit businesses promoting such an item as well. Who wants to be known as the "place" that wants to take all of your money. It could become a corporate "greed" connotation being attached to your logo. Instead, everyone from state leaders, to provider leadership avoid this conversation and never bring it to the table as a solution.

Yet, Michigan remains a renegade state in regard to asset recovery as one way to help fund the medicaid costs of elder care. We allow individuals to qualify for medicaid coverage, and keep their homes. Homes valued way above the norm for the average Michigan resident are still an allowed asset. In most states, if the medicaid applicant does not have a surviving spouse, the home has a medicaid lien placed on it; or a reverse mortgage is set up. Some state's even require the home to be sold and the money to be used for care prior to picking up the medicaid care tab. Yet in other states, even with a surviving spouse, the home may have a lien placed on it; and at the death of the spouse, or the sale of the home; the state recovers their money first.

At what point are we going to recognize that this program is one "good and fair" way to collect or offset the increasing burden of medicaid on the state of Michigan? What special interest group, or need are we protecting by not seeking some recovery of money spent for care? If we want examples of where it works and works well, we should go back to the 40 states with fund excess; review their medicaid policies and programs then adopt the very best for our state.

Think about what good corporations and businesses do when someone has a new idea. In my profession, if someone has a great program with excellent outcomes; we study it; tweak it and make it work for us. But that might be to much like business think for our leadership to do; instead, we would rather debate and maintain hard lines of party rhetoric than to look at policies and programs that work.

Tuesday, June 19, 2007

A Vision

So, I have been asked to post something a little less like a rant...Sorry about that, but sometimes the misrepresentation takes my breath away; and it is hard to get a positive focus back in place.

What is a vision? Is it important to have one? How do you define it? These are all questions that I have heard bantered about as we discuss leadership; changing cultures and creating new process. For me; the vision is fairly straight forward. I desire to create an environment of care that I would chose to live in vs. living alone when I am old; or in need of assistance.

Yes you are reading that correctly; I want to create an environment that people would choose to come live in; instead of staying home alone when they are elderly; or in need of care and assistance.

What does this environment look like? To me it looks like a thriving community filled with people who interact spontaneously, have meaning and purposeful relationships; and a sense of purpose for their day. It would include multiple generations, and places where I could chose to spend my day. I could find laughter, solitude, meaningful conversations; intellectual banter, and maintain the ability to learn something new. The building, setting, location would not be as important to me, as the human contact and relationships would be. However, I would prefer to have my own space, a private room; or a large shared room where I could find some quiet "me" time which I am accustomed too.

As caregivers, we often get wrapped up in the "care" portion of our job. It is the essential portion that we focus on; because it is what we are all about. However, my contention is that without an emotional, intellectual, and spiritual environment, the care will never be totally comprehensive. My vision puts the "person hood" first, and the physical care second. It is my opinion, that if we create this type of environment, our elders would "feel" better, and the care would become less of a focus and easier to accomplish. Over all health and well being would improve.

The other side of this vision, is that the environment can only be created when you have created this same culture for your employees. As an employer, we must value, respect, and give as much as we expect our employees to do for the elders we care for. It is the old adage, "you give what you receive", I believe it holds true for care environments. Have you ever performed care? It is a demanding, stressful job. If we do not recognize the worth and value of what caregivers do, how can we demand that they give worth and value to our elders? This is a hard thing to accomplish. Yet, it is the first thing that must be accomplished if we expect them to in turn give to another human being.

As an administrator I will tell you that creating this type of environment for employees is hard work. At times you feel that every good thing you do is perceived as a negative. However, I have learned that the negative comments, and statements come from individuals who by and large have never had anything positive in their lives; and have a low trust factor when you give them something or do something nice for them. It takes time and consistent positives to change a personality. Sometimes, it takes the difficult conversation of adopt change, or leave. (That conversation is one I am still working on perfecting).

Role modeling this consistent vision can be exhausting. But, when I was given the opportunity to go "away" from my building for two years and then return; I was able to recognize that "the vision" we had planted over 6 years ago was still there; and still being nurtured by the positive members of the team who had adopted it as their vision. Now, I see it coming to fruition and it gives me such a lift every day when I hear an interaction, watch a spontaneous activity occurring; and see real quality of life happening before my eyes.

We still have a long way to go; but now when I speak of vision; the team speaks it with me. They have adopted their own personal vision of what our environment should look and feel like, and by and large we are on the same path. Nothing gives me a thrill like having a front line staff member with an "idea" for bettering our environment for staff and elders. We are finally speaking the same language; and it is a language of care for the future.

Perhaps our vision and culture is why people chose our building over the prettier and newer buildings down the road. Our physical care is good, our food is good, but our culture is phenomenal; you can feel it; see it; and hear it every where you walk in our building. It is a culture of person hood and it is being grown before my eyes. How nifty is that? It is this culture that brings me back when I am confronted with negative press; or comments about long term care/nursing homes. We are creating a place that "we" all want to live in someday.

Sunday, June 10, 2007

Media Misrepresentation....

Check out Sunday's edition of the Detroit Free Press,; (June 10, 2007). The article written by Ruby Bailey on the front page references the strain our aging population is putting on our care system.

The article, contained so many ill researched facts, that I don't know where to begin. Other then by saying, did she call anyone who knew about nursing homes to verify her data? The fact that the article states medicare covers 90 days of care in a nursing home. (Where did she get this piece of information, and now imagine the misconceptions the public has about this fact?)

I am most concerned about the political spin on the single point of entry program, and the perception that the general public will have about this service as the new "fix it" for the medicaid program. This article did not speak of the real problem; Michigan is top heavy with management, regulatory oversight, and people involved in the process. The actual purpose of our medicaid dollar is to provide care; not government agency employment.

She( Ms. Bailey); obviously did not speak to providers about their perception on how the program is working. Nor did she find the elders who need nursing home services; but are being kept in hospital hiatus, awaiting the "one to one" visit and assessment to assure that they really do need a nursing home placement. It is being reported that this program has rolled out like any other Michigan government initiative; top heavy with management, very little training for personnel, and the services are less then stellar to the actual end user, our elders and medicaid recipients.

The reality as I see it about our system; Yes, the medicaid system is a huge cost for our state. The actual cost of care is the not the largest burden. The regulatory oversight; administration, and levels of beauacracy are the costs that could be down sized and quality care would continue.

When you consider it costs less the 7.00 per hour to pay for a nursing home resident to be cared for; it is less then most people pay for day care services for their children.

Yes, you are reading that correctly. Another misnomer; Medicaid, does not reimburse actual cost. It reimburses for skilled nursing services at a rate level that is based on the nursing facility expenses from a period of time that occurred 2 years prior to the year we are being reimbursed in; and with a capped level of reimbursement. How many businesses would accept a payment for services rendered now, only to be reimbursed based on your cost from two years prior?

For a skilled nursing facility; irregardless of the skilling need, ie: how much care needs to be rendered for the elder, we are reimbursed at the same level. There is not a graduated system of payment based on need; (I am a huge fan of this idea; maybe would could finally actually break even on some of the care we provided to extremely skilled care needing residents).

For elders who are dependent on others for care, have no one that lives with them, or family whom can help; this new single point of entry system is going to represent a decline in their well being and care. The state, will now dictate when, how and where their care giving will occur; and if it is to be in their home, they will be totally dependent on this new agency to assure for their safety and services to be provided. Yes, it keeps people in their homes; but does it really provide a quality of life that is worth living? Or is it simply a cheaper option for us as taxpayers, and quality of life be damned...

As a professional in elder care, I will argue that quality of life is not simply met by being able to stay in one's home as long as possible. That is only one factor in a multitude of factors that must be weighed when it comes to quality of life, and quality of care. Being isolated, alone, having limited social opportunities; and being dependent/reliant that the caregiver will be there to meet their needs is a tremendous risk to quality of life. Especially if the caregiver is someone who must drive to their home; and someone that they are trusting to enter their home and with their possessions. Whom will provide oversight to this program? As taxpayers are we going to demand yet another level of oversight and regulation? As a elder care advocate, i am most concerned about whom is performing these assessments of need? Do they have experience in elder care, and dementia?

As a Michigan resident, taxpayer and someone who actually works in our medicaid system; this new program is yet another example of how and why our state is failing us. Yes indeed, this is yet another politically motivated, and positively spun "program" that spews rhetoric, cost millions, and will save us nothing. But hey, they get an A for getting the media to sell it...

Milestones, Memory and Insight...

So it is Sunday; I have just finished a major life accomplishment, (checked it off the list of things to do before I turn 40); I walked a 12 mile walk today with a group of Catholic parishoners from one small burb, (translate that to a dot on the map that includes a quaint Catholic church, and a bar...) to another burb, (larger dot, with a stop light and a larger Catholic parish!). It was a great morning, I am a little sore, but the cool thing is that I could not have done this at 30 and I am ready to take on the next walk later this summer.

The only irony in this; is that I no longer consider myself Catholic. I converted to Lutheran upon my marriage, and have been very involved in our church; we have raised our son Lutheran, and I consider Martin Luther to be one of my personal heroes...

So why am I sharing? As we walked, mass was performed intermittenly with what I will call Catholic rituals. I found myself in an odd place of comfort/discomfort and I wonder if it is what someone with Alzheimer's feels when they remember things from their past, but cannot grasp why they are remembering them... I found myself speaking along the rosary, the words flowing from my long term memory. There was a sense of loss that I really can't describe in that moment as I started to recite from memory, without even thinking as to the "why". I felt a need to recall the moments spent in church with my family; at catechism; and a few treasured moments with my grandmother.

This odd sense of memory and reflection, gave me a new insight into the mind; and how our elders whom suffer from memory loss; must feel when something clicks and they can recall. Without being able to tell us the how and what of the dementia process; as caregivers we should grasp our own "ah-ha" moments and use them as our guide to what the experience must be like. I know that in my training of new staff; I will share this personal experience with them; and ask them to spend some time being "aware" of what their mind does for them; and how at times it leads us on an unexpected path of memory.

So as I sit here and write; I am still spending some moments thinking about the childhood church memories; and where/how I learned the rituals that are apparently still deeply embedded in the grey matter.