Saturday, May 26, 2007

Dodging the Budget Bullet

For all intents and purpose, it appears that Michigan's frailest citizens are out of harms way for the next 4 months. After reading the legislative update web pages, it appears that Michigan is on it's way to a budget agreement that will not include medicaid payment cuts to health care providers.

But don't get excited. This was just the warning wave before the tsunami....Next year, 2008, Michigan is looking at a much larger deficit, and cuts of some type will have to be made. Not only cuts but some type of revenue generating formula will have to be agreed upon.

The irony for me as a taxpayer, is the lack of vision that our state leadership has; and the lack luster performance that the health care providers did with educating the public about this crisis, the impact it would have on our state, and the citizens we serve. The teachers, educational providers and colleges all did their media campaign loudly. It was so loud that when the agreement was made; education was the forefront of all news articles, and one had to "dig" to find the outcome for the medicaid budget.

We as providers need to heed this as a wake up call for the next round of budget action. If we want to preserve the quality of care we provide; the services to our communities; the livelihood for our staff we must become active. We also must agree on a few talking points that send home the message; we need to be funded adequately. Further, we need to remember that we are the voices for the citizens we serve, and we are doing them great harm if we do not become loud, vocal advocates on their behalf. We need to become the discussion topic at the water coolers, we need to push the agenda of quality of life; quality of care and what it takes to achieve both.

I for one want to stay in Michigan as a citizen, taxpayer and care advocate. I will not however; become a hypocrite and speak about providing good care when the care we are able to provide (due to funding cuts); is less then what I feel our elders deserve. Nor will I speak against tax increases if they are linked to sound, rational public policy that will impact the long term future and growth of our state.

So, get out there and start talking; planning and creating. We need to send a message to Lansing that we have an opportunity on the horizon to create a new and different Michigan; but it will take our voices unified to send a strong message; are you up to the challenge?

Friday, May 18, 2007

The Michigan Paradigm

It is Friday, at the end of a joy filled week for my building as we wrap up nursing home week. However, it has been a week of apprehension and "what ifs" for those of us who are fiscally responsible to adjust our budgets as the June 1st deadline comes closer, bringing the 6 percent cut in our medicaid reimbursement as a potential reality.

So what does 6 percent really represent to our industry? To some buildings, and elders, it means closing a business and losing your home. For some communities it will mean a devastating decrease in economic growth and spending as the only profitable entities left standing become profit neutral, or worse; profit deficit. It will mean lay-offs, an increase in unemployment; and a lack of jobs in the one area Michigan was still hiring labor. It will represent another hit to the construction market as companies who were planning on remodels, or upgrades put project plans away for a better day. It will represent a decline in quality as we are faced to make choices about labor, service costs, and budget cuts with the smallest elder impact; yet they will have an impact.

Word out of Lansing today is that we are looking at a budget deficit of over 800,000 million dollars for 2007. (by the way, it is May, and the budget year ends in September). So what do we do?

Historically, we would raise taxes, or seek other types of revenue generating proposals that would place the cost burden on the residents of the entire state. Given the already stressed economic climate, the citizens, (those who still reside here and have not fled to healthier economic states); will not tolerate any type of tax increase that affects their already stretched dollar.

I can think of several critical questions that if answered, we could find solutions to the problem that exists in Michigan. Unfortunately, they are tough questions, some of which we may be resistive too; however, if we consider our sister states who are thriving we can find the answers; whether we agree with them or not; they are demonstrating fiscal growth and opportunity; and their citizens are experiencing financial well being, not strife.

The list of critical questions as I see them...

What services could we privatize, contract out, or eliminate without causing harm to the frailest and most dependent of our citizens?

Why are we still allowed to not be compliant with asset recovery for medicaid?

What about right to work laws, and the reality of their economic potential for our state?

What about barriers to free economics; especially those that are antiquated and out of sync with our current reality? (For example the certificate of need that is required to build new nursing homes).

Why would we spend millions to create another layer of bureaucracy that when fully implemented will not be cost neutral? (Single point of entry program).

Why do we provide medicaid and financial support to people who enter our country/state illegally, yet deny it for citizens without insurance who are faced with catastrophic events?

What about privatizing all travel venues that the state currently holds? (State historical museum, parks, and travel services).

Why isn't there an across the board decrease in payment to all state employees, including all state elected officials?

What about real cost sharing for state employee medical and benefit programs?

What about a cap on the years/amount of retiree benefits, to cut on legacy costs for the state?

Why do we have a state pension fund that includes health benefits, when the majority of the state's citizens are not afford this type of retirement plan any longer?

Where is the vision of our state? Are we so wrapped up in the rhetoric of tax increase, and cutting options, that we have lost sight of the large picture?

Perhaps it is the loss of vision that bothers me the most; and perhaps it is this lack of vision that is giving many Michiganders the vision of a new horizon, outside of the Michigan border.

But the biggest irony for me; is that we as providers can create new paradigms of care; change our culture and do it with very little change in our revenue. Look at what we have done in 10 years. While our government; who "speaks" of the need for change; cannot look beyond the same rhetoric, same "box" that Michigan has always operated in.

Thursday, May 17, 2007

Transcending Leader and Becoming a Mentor

I consider myself blessed. As I reflect on my life today; I think of the positive influences that others have been for me. But I specifically think about someone who has been not only my boss, a friend and confidant; but truly a mentor. I wonder if our mentor's ever really know the impact they have on our lives, and that by their willingness to share their expertise, wisdom and advice how they have molded our direction.

I feel that perhaps if I share a little of my personal journey, you may reflect on where you are in your career development and how you could transcend your leadership into becoming a mentor.

The reason for this reflection? Several of my peers have commented on my driven attitude, and passion to create change, and how "intense" I have become about using and adapting ideas to create the change I envision. In my attempt to answer the "why" of this personal change for myself it occurred to me I owe the change to an incredible mentor. My mentor is someone who sets me up for success, allows me to learn from my failures; walks me thru my frustrations and has made me face my personal demons. For the past seven years, I have worked for the same company as an Administrator. The experience alone though, does not account for my personal development. I give credit for my personal development to a true leader, my mentor.

So what did she do? You need to first know, that when I first started working for her I was deathly afraid of her. I had heard stories of her cutting tongue, her sarcasm and general attitude. Little did I know, that by opening myself to her comments, and style, I would learn not only how to lead, but also about myself and how to help others on their own journey. As our relationship developed, we would have conversations that left me with ah ha moments about how to handle problems, and think for myself.

Being given the opportunity to have success, and failure, and how to deal with both has been the biggest skill I have learned from her. This skill has now transcended into how I share success with my staff, and allowed them to learn from failed attempts. I think that as leaders, we too often find fault with the failed attempts, instead of finding a new skill or insight. As a true mentor and leader she has allowed me to learn both, and likewise it is a pattern I hope to develop for others as well.

As part of my personal development, she has given me the opportunity (many painful discussions); to think about how my past "stuff" has limited, or created road blocks to my personal development. Again, an area that as leaders we are apprehensive about going down with our staff; perhaps it has to do with our own insecurities, but as leaders being real, sharing and taking the risk of putting our "stuff" out there can be a cathartic experience that gives other insight into their own growth.

Observing her style, and absorbing her style has left me with a new found appreciation of leadership and what skill sets it requires. We are two very different people; I exhaust her with my constant idea chatter, and she perplexes me with her silent, slow response to it. I drive her crazy with my lack of appreciation for deadlines, and her need for systematic approach to problem solving makes my ADD go full tilt. Yet, because as a leader she recognizes that I am different, she has adapted her style, and her vision for me to fit me, not her needs.

How many of us as leaders have said to ourselves it they would just "act like me" it would work. The reality of this statement is that it takes all types of styles to create a functional team. Unfortunately the ability to recognize the needs of our teams, and peers can be a difficult task and reality to accept. A true mentor, is able to get beyond the differences and adapt for the needs of the individual.

For the past two years, I have been working hard on my own personal development. Most of the hard work has come with conversation with my mentor along the way. Questions about why, how, what and where have become more clear as I have progressed. Again, these questions were not answered alone; but rather with reflections from her about things along the way. As leaders, it can be quite frightening when our "leadees" become more confident, inspired and have the audacity to question our wisdom. Yet, as a mentor, she has recognized this as a sign of growth, and not weakness on her part. As leaders, we can make the mistake to perceive the new found confidence as a threat or something that must be thwarted. True mentorship takes this as a sign of their influence and it is good.

So what does it cost to transcend from being a leader to mentor? If you desire to leave a legacy, become a mentor. If you want to be known by your style and approach; stay as a leader. If you hope to find and train your replacement, become a mentor. If you want to be irreplaceable, stay a leader. If you want people to talk of the wisdom and where they learned it, be a mentor. If you want them to talk about how they learned what not to do; be a leader. If you want to create change, be a mentor; allow people to see who you are, share with them; help them find out who they are and what they are capable of. The results could be changing for you; but more importantly for them.

Happy Nursing Home Week, and a sincere thanks to the people who have given me the opportunity to celebrate it with my elders, staff, peers and families. Thank you to the owner and leadership of our company who continue to inspire our journey to creating a culture of care that we all want to live and work in. A special thank you to the mentor who has driven me to look at where I am, and what I am intended to do with the rest of this journey!

Tuesday, May 15, 2007

Little Moments...

Today has been one of those great days as an Administrator. Everywhere I went in my building, I observed evidence of person centered care in action. It is the simple things like today that make me desire to create this environment for all elders. As you read, I hope I can convey the warm feelings I have had today about our calling to this profession and I hope it inspires you on your journey into culture change.

I started the day being greeted by one of our newer elders who has joined our community and has quickly become an icon. He is one of our resident volunteers, and he has a job; yes a job. I know, there are laws about putting resident's to work; and for some of you the fear of the regulations, keep you from giving residents a job to do. He loves it. His job has given him a purpose to get up every morning, and he does it with panache. He sells stuff; and I bet if he had a car to sell; he could convince you to buy it. His office, is the front lobby, and he currently is selling items to raise money for the American Cancer Society. He has raised over 500.00 dollars by selling cookies, wood crafts, and t-shirts over the past three weeks. He does his own announcements, and everyone in the building looks forward to his detailed advertising lingo.

My next stop was the beauty shop, where my ladies were commenting on their hairdo's for tomorrows senior prom; and what they were wearing. I then encountered the social service director who informed we her presence was requested on the shopping trip next week; because she had promised a resident coney island, if she would leave her room and go. Both are occurring next week; in fact this particular elder, found a cohort in the dining room during breakfast, and informed the social worker that they both were going, and she was buying them both lunch.

I then overheard a phone call from a special resident who I have bonded with; she was hospitalized this week, and she called to tell us she wants her hearing aides and glasses because apparently they are going to keep her; but to tell the office gals to keep her purse hidden, because she does not trust them with it there. My admissions director was off to do her marketing visits, which today consisted of taking the glasses and hearing aides; along with a special bear and a get well card from me to this resident telling her to not give the nurses to much trouble, only enough to keep them on their toes. Per my director, when she read this she got a good chuckle, and told the lab person, "look, even the boss lady wants me cut loose".

I needed a break in the late morning to stretch my legs, and walked out onto the patio. The sight was so incredibly calming and uplifting. I had three residents digging in the flower pots planting tomatoes, two planting flowers; one sitting in the sun, getting her face tan, and two visiting with their families. As I walked about checking out the flowers I was given a directive to get a bigger garden box, and one that was higher so they could work in it better; from the two ladies planting tomatoes; and one asked me if we could grow our own yellow beans for the dining room; they are her favorite. The garden, has been tended under the watchful creative eye of an activity aide who has taken it under her wing, and the elders who join her daily love every moment they are together.

At lunch, as I toured the dining rooms I overheard a restorative aide using a neat technique to get a resident to try her food, " the kitchen called and you are the official temperature tester, can you tell me if this is the right temperature"? next he asked now what about this,how does it taste, too sweet or just right"? His promise to my elders, is to not have weight loss on his watch.

All of this and lunch wasn't even done yet. I then fielded a phone call from someone who is writing an article about staff satisfaction, and resident satisfaction, and what approaches do we use to gain both. I was fairly geeked about our building at that point, and after I had told this young lady everything we have done; I finally summarized it with this, creating a culture of person hood hinges on real meaningful relationships between staff, staff and residents, and staff and families.

As a leader we must develop, role model and live these real relationships 24/7 if we expect our staff to follow; a simple statement with a large amount of personal stuff invested.
But isn't the outcome worth the effort, and personal pain along the way? After all; if I get to be 80 plus, and I am in the hospital, I hope there is someone I can call on to get me my things, to trust my purse with, and to bring me a message of real caring. If I get dementia I hope someone encourages me to keep trying; and I hope that if I need a friend, someone will seek me out to do something fun with like a personal shopping trip and lunch.

It is the little moments that give us hope, and guide us on this journey. It is the spontaneous interactions between staff, residents and families that I hear, see and feel every day. It is the creation of a culture of community and person that inspires. Find these examples in your day, and use them as your energy on a journey to creating the culture of care your elders deserve.

Wednesday, May 9, 2007

Afraid of Change?

The rhetoric of culture change has become the catch phrase of all who work in long term care. As an Administrator, the thought of changing the environment and life style for the elders we serve can be a very exciting topic of which we have many ideas. However, the thought of changing our style of leadership can be frightening. Giving up our "control", even adopting new values can be an exhausting endeavor.

However, the argument exists, with proven outcomes; that changing the culture of the building begins with the leadership first adopting personal change from the inside out. For a culture change to occur, the leadership must not only speak of the change, but also role model the change beginning with themselves. Self evaluation is a scary process. Accepting that our current style needs tweaking can leave even the strongest leaders feeling a little vulnerable. It could be argued that this resistance to self evaluate, and change styles could be the reason our industry is faltering with the voluntary adoption of change.

It seems that anytime you get more then three leaders from long term care together; the conversation inevitably turns to the negatives we feel we cannot overcome. Over regulation; unfair process of regulation; inadequate reimbursement; poor public perception; and of course liability. The list is endless. If you ask the same group about positives, they will talk about the "change" the industry has undertaken in the past 20 years, the increased quality outcomes, the change in environments, increased resident and family satisfaction.

When forced, we are able to not only adopt change, but it appears embrace it and make it a positive. I reflect on the change in side rails and restraints that every nursing facility has undergone in the past 15 years; this was an issue where we were given a mandate to change, and we have pretty much accomplished it nationwide. From an outsider's view, it would appear that collectively when we are "forced to change" via a regulatory, financially based negative outcome we respond, and we respond quite well. So why would we expect the public to be sympathetic to us for being over regulated, when the regulations gander an outcome, that by most opinions is a very positive outcome for the lives of millions of American elders?

Please don't misinterpret this; I too feel the extreme frustration of regulations that at times appear unfairly applied, and over used. However, I also feel the frustration of watching many in our industry resist changes to the way we do business, and use the regulations, financing, or other limiting external forces as the reason to avoid even an attempt at change. Perhaps if we were honest with ourselves, the real limiting factor comes from within, it is our own "fear".

Fear? Yes fear. What could we be afraid of? Change. Change in the primal sense of change. I am speaking of doing that deep soul searching self analysis that tells us we could do something different, yet we avoid it because of the "stuff" we fear and wish to avoid at all costs. Could it be that as leaders, we have adopted the "fear change" model because we have observed the perceived failures of others who have attempted change? Or could it be that we fear personal growth and change because it is an overwhelming task and painful?

Either way; our lessons from past history should tell us that avoiding change, is only going to prolong the agony; or worse; the change will be dictated to us via a new regulation or rule. Worse case scenario? Our competition will pass us by and our skills, services or environment will be come obsolete; making that which we fear most an unfortunate reality.

Tuesday, May 1, 2007

Culture Change Agents

So, I have returned from four days of networking with peers and regulators at the SORIM-ltc conference. it was enlightening to say the least, and now I am fired up with ideas and inspirations to create change. It is a little unsettling to not be able to sleep at night as the ideas and process change thoughts spin in my head.
What I do know, is that the current regulatory and provider environments need to realize that recreating the same product we have is not an option. Yes, we can tweak our current environments, and make them "home like". We can use fancy terms, and create "teams" and care givers who are empowered. But if we forget about the consumer who will be using our product, the same consumer who currently distrusts us, and is fearful of "nursing home" we will do nothing to improve the image or opinion of the general masses.
It is this consumer view that we need to focus on as we create culture change. Where in the models are the consumer opinion, and test group studies? It is interesting that I am not finding much information about the outcomes from this perspective.
What I do find, is the pervasive belief that nursing homes cause harm, are viewed as warehouses where care is not good, the food is terrible and abuse occurs. Nursing homes are to be avoided at all costs in the general public opinion poll. If you don't believe me, sit down and visit with strangers on an airplane, at a bar, or any public place that you can interact with complete strangers. The reaction by and large is not a favorable one.

So what do we do? Well in my sleeplessness, I often get up and get on line. I recently stumbled across two different discussion thread groups geared toward caregivers of elderly parents. These sites were designed as sounding boards for individuals who take care of an elder in their home as a family member. They basically are on line support groups. I could not resist responding to a few comments that were wrought with significant misinformation about medicare eligibility and dementia, and giving the correct response. It was after reading several posts; and a few heart failing moments; when I felt like my culture change vision was at a dead end; that it dawned on me...We are not spreading our message beyond our box. What do I mean by this? Think about it, what was the last article you read about a culture change nursing home that was not in a trade publication? When was the last positive news report about nursing homes on your TV?

The realization that we are good at patting ourselves on the back in our peer group, but are horribly deficient in spreading the good word beyond our new culture buildings hit me as a significant ah ha moment. How do we fix this? How do we get the message out about culture change, how do we get consumers to embrace the change we know we are about? And how do we as providers accept the public opinion as the hard truth when it is true and fix it? These are the really tough questions that we must answer if we are really going to create culture change in elder care, financial support of elder care and public opinion toward caring for elders.

My suggestion? Simple grassroots response. If each provider who reads this were to log onto message boards, give straight forward information, and talk about how we need culture change; it would create a new thought about what we; (providers) are all about to consumers. Write stories for your local paper, get busy and advocate for change. Yes it is time consuming,exhausting and overwhelming; but what do you really want for your future; what do you want for your own elder hood? The results of our effort could be breathtakingly phenomenal.

My own personal experience is that by opening dialogue with a few home caregivers via a caregiver website, I was able to share the culture change theory, and application; talk about medicare, dementia and offer supportive information to consumers who really did not know about our industry. Their opinion was based on that of another, and very little first level experience. Very similar to our own behavior as consumers. Think about this; if we experience bad customer service; we share that story with our friends and contacts. The same holds true for our customers. Yet for some reason, we as providers have a somewhat smug belief that we "are better" then what people think we are and that they are simply uneducated about our services.

If we are going to create a culture of care that our society can embrace, we need to get the message to the masses; and it needs to be a real story, not simply what we think they should know, but the story behind what we have now; and how we together can create environments that every elder would love to call home.

Get out there and share your story, give support, and agree; that care as we know needs to change, and we are the leaders with the knowledge to lead consumers to a new paradigm of social norms regarding elder care, formerly known as nursing care.