I look good in orange...

Busy..can you say it like a four letter word? My life has been a ball of chaos, but the storm is in full force now and the momentum of change is taking over...so..life is grand..right where I enjoy it the most....on that note..I am a tad fired up about a bit of information that was given to me last week, and the more I have had time to digest,dwell and ponder, the more irritated and angry I have become. So, in typical fashion I am going to vent. Enjoy..Jana

I wonder how many of my esteemed collegues, like I; wake up mid night drenched in a panic/nightmare sweat of being arrested for something that happened while their building was under their watch? Yes America, we have criminalized care and you all have not only allowed it but condone and encourage it. I have decided that if something bad is going to happen, a mistake getting made, a rule broken, and I am ultimately responsible for anothers actions, my only saving grace is that orange is a good color for me. No longer is it just my personal actions that come under scrutiny, it is any action, mistake,regulation not followed that could lead me to hand cuffs and the orange jumpsuit..and quite frankly I have asked myself after every nightmare why do you do this to yourself? What is worth this personal torture? I have decided that either I am a glutton for punishment, or I am a fighter and am willing to put myself out there for what is right and worthy; damned be the consequences....

Up until last week, fighting against a known entitiy, unneccesary regulations that are subjectively imposed; and attorney generals who enjoy using nursing homes as a back bone for campaign strategy...Those were my two known potential handcuff wielders..Now? Our own physicians have entered into the "punishment" arena as a means of obtaining notice for their agendas. Apparently, we, nursing home administrators make nice targets for public scrutiny and out cry. Yes we are a criminal bunch; the whole lot of us.

Currently in Michigan there is legislation proposed that will offer up some form of "punishment" for nursing home administrators of homes that have too many patient/elder discharges back to hospitals. Confused? So am I. As an administrator, I do not wield the pen/phone/fax that sends people to the hospital; the Dr. does. So how does criminalizing me, (by the way, I have been told that the original legislative proposal has been watered down to eliminate criminal action against my type, it is now simply fines and money penalties to be levied against us/our buildings.) make this stop residents from going to the hospital uneccessarily? As an elder advocate, this legislation frightens me on several accounts..

First, as an elder I should have the right to demand hospitalization when I feel it is needed...It is my right as a patient/resident. Second; the Dr. should retain his medical judgment to determine the need/necessity of hospitalization. Third, few administrators are clinical based individuals, why would you want them to determine who goes and who doesn't?

I understand somewhat the need to stop unneccessary hospital admissions and discharges from nursing homes. It is costly; it can be cumbersome. But companies who benefit from keeping residents in care facilities, (check with your managed care/HMO provider..they tout this as a selling point) are pushing this agenda, as it benefits them in the long run..My uneducated but rational mind tends to wonder if this legislation isn't a tad self serving to these companies that make money by keeping people in the nursing home; and avoiding hospital stays? It is their reward/payment system set up by our government.

So in my mind, by using us, Administrators; they are hoping to put fear in our hearts to keep residents in our building, and money in their pockets. Nice..and it should scare you that the HMO/Managed care organizations behind this proposed legislation has partnerships with physicians who provide services in many Michigan nursing homes. Do the pieces of this puzzle fit for you now? They certainly do for me..and the entire story is leaving me more then a tad ill. To think that the very Dr.'s who provide services in many of our homes; would bite this hand that feeds them; to gain a tad more in the other hand.

Huh, and we wonder why american's are apathetic about their government really representing the best interests of all.....

Goals Realized...

Just a short congratulations to my previous building..WAY TO GO! I am incredibly proud of every member of the team at Yale..wow..you are a highly successful, highly trained and most importantly great people who get customer service and the impact it has on each other, your company and the people you serve..


I hope each of you wear this honor with pride..Your abilities and dedication continue to amaze and impress...I am so very proud to have been your leader for a brief but incredibly fun moment in time...

Awesome job!


jana

Thankful

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..

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 children...like 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....

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...

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..

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.