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...

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..

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..

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.

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.

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.

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".