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.

Sunday, June 3, 2007

The Answer to the How and Why Questions...

As caregivers in nursing homes; it is inevitable that when we meet people, and they find out "what" we do for a living, we get asked, "how can you stand it"? or "why do you work there"? Some people are more polite and avoid the question, but you can see the look cross their face as they think about what it is that we do.

This discussion topic occurred to me last night as I attended a high school graduation open house. At this particular open house; there were people present that I have not spoken to since my own graduation from high school 22 years ago. Of course, the conversation always turns to "so what do you do for a living"? I used to dread this conversation; because I would feel myself getting defensive with my answer. "I work in a really good nursing home", or "I stay there because the company is a great place to work and they pay well." Those were two of my previous answers that I would use to explain my choice.

In the past 6 months I have come up with a new tactic, I ask a question in response to the inevitable question. Last night, when the comment was made regarding how they couldn't imagine working some place like a nursing home; that it must be very depressing. I stated back, "What part of what I do, would you think would be depressing"? I then explained I am just curious about public opinion, and as someone who wants to work on changing it, I am trying to discover why we think what we do about long term care and aging. The visual effect of this conversation turner is a blank look as they think about what they base their opinion on.

As you can imagine, it is hard for most to come up with where/why they have this opinion of nursing homes. As I have performed this little experiment, another truth has come forward for me; less then 1% of those whom I talk to about this; have had any contact with a nursing home environment in the past 10 years. Most people base their opinion on the "image" in their mind that has been placed there either from visiting a nursing home as a child, (over 20 years ago); or worse the media portrayal and news articles that they read.

The other truth about this tactic, is that it gets a little uncomfortable for the person whom asked the original question. I think the discomfort comes from my questioning their thought process/image development. I push the envelope further, when I tell them I absolutely love what I do. I explain that I am one of those fortunate people who has found their '"purpose". (Those of you who know me; know that I can be fairly exuberant about my work, and the goals my team/building have before us.!)

So what do you base your opinion of long term care on? When you first started in this profession, did you bring baggage of image/opinion with you as well?

Now imagine our younger staff, who get these comments and questions from their peers. I imagine it is not a great self esteem builder for them either. As leaders we need to give them the speaking points, the strength to tell their story and support them in the telling of "why" they have chosen this profession We need to help them explain "how" they can actually do this kind of work and the rewards it brings. Sounds like a great empowerment discussion for my next staff meeting....

Friday, June 1, 2007

A Sense of Purpose

Why is it that we find happiness and a sense of well being when we find ourselves with a purpose? I am speaking on this from a personal point of view, and also from a professional observation of elders, and staff who find "themselves" when they are given a sense of purpose in their daily lives. It really is ironic that in the giving, the nice, the doing the right thing, we can find true happiness and a sense of fulfilled well being. Perhaps this is what Maslow meant by reaching the pinnacle of personal needs, self actualization. Whatever it is; it just feels good to have a purpose and it is especially good when the purpose is directed toward the good for others.

This week found myself and a few staff members at a Habitat for Humanity house that is being built for one of our fellow staff members. As we learned new skills, (who knew a bunch of office girls could learn to use power tools, and install vinyl sofits?), we also discovered something that we forget in the daily grind called work. The doing for someone without a pay reward, without any expectation of recognition or merit; feels really good. Our work had a purpose, and the purpose had a kind giving outcome.

As I reflected on this; it occurred to me that this "purpose" and sense of well being that we all felt, is the same emotion and feeling that our elders have when we allow them to find a purpose in our homes. I see examples every day of elders who attempt to help each other; give back to the staff who care for them; or find "jobs" to do that have meaning. As caregivers, we too often try to "do it all" for the elders we care for. Families also have an expectation that as caregivers we are "paid" to do these tasks for their loved one; and sadly sometimes they do not see the pride in a bed that mom made herself; or the table that dad helped to set for the group meal; instead it is viewed as a possible slacking on the staffs behalf; and subsequently, the "best" of caregivers attempt to do it all for the elders they serve.

Sometimes both families/customers and staff confuse this "doing it all" with customer service. Unfortunately, in our effort to be the best at customer service we sometimes fail the actual customer our resident and elder. In our great customer service we take away from them some of the simple tasks, and behaviors that if they are allowed to do for themselves, give them a sense of purpose; or even better when allowed to help each other provides them with the same emotional sense of fulfillment that we get in our volunteering and doing good for others.

When you think of yourself as an aged adult, who may be dependent for care, what do you think you will need to find personal emotional well being?

We can all make jokes or statements about when we are old we will be waited on; and have people at our beck and call for all tasks. In reality; if you have worked hard for a living; have done volunteer work; raised a family, and been a productive citizen; chances are you have had purpose in everything you have done thus far. So why would it be any different for you as you age?

The reality is that it will not be; and that you too will want a job, something productive to do for yourself or others to find your sense of worth. I think it is in our hard wire as humans that purpose drives our lives; we need it for survival.

As caregivers, we need to recognize the need for purpose and find ways to give all of our elders an opportunity to continue experiencing the sense of self worth they deserve and desire. As family members of elders, we need to allow our loved ones the dignity to continue the things that give them purpose and recognize that their need is no different then our own.