Friday, December 21, 2007

Training for Passion

In my work I have the privilege of talking with senior care providers all over the country. One theme is constant: there are not, today, enough trained and skilled workers to meet the caregiving needs in senior care.

We all know that today is the easy stuff; it’s tomorrow and the coming years when we enter into the nightmare scenario for staffing. As one Administrator commented at a work group the other day, “Today’s newspaper has statistics about how many of us will live to 100 – what are we going to do, people?”

As I’m listening to people talk, one thing I hear that surprises me just a little is how many new hires don’t complete their initial training or drop out of the workforce very soon after beginning.

I think what’s been missing in some of our early approaches to training is instilling a “spark” – a seed of the passion that the very best senior care workers have. They may not have it during the first weeks or months of their work, but they may develop it over time if they give themselves that opportunity by staying in the field, and learning to love the people in their care.

I know I didn’t have that spark of passion when I first entered the field. In fact, as my parents were both in senior care, I’d been exposed to nursing homes and residential care as a child. I was determined to do anything BUT work with seniors.

I graduated with a social work degree and began working in the Community Mental Health Center in my town, enjoying my work with a variety of individuals and age groups. When our center was awarded a grant to develop mental health outreach programs in the local nursing homes, no one else wanted to do it.

I said, “I’m comfortable in nursing homes – I’ll take the job!” And I found myself, at the age of 22, developing an entirely new program with staff, policies and procedures, and organizational needs with a large group of individuals.

It was a blast. I loved not only the work but also the people. I discovered that I truly loved the residents, and found that I could make a difference in their lives, every single day.

When I headed off to graduate school a year later my career path was fixed: I was working with seniors, focusing on developing quality programs and services to meet their unique needs.

And here I am, 20+ years later, struggling with how to instill that passion in a whole new workforce of young – and not so young – individuals.

My own daughter, newly graduated from college with a passion and skill in creative photography and communication, has been helping us add “ahhaa” moments into each of our courses – moments that are filled with music, visual images, and inspirational messages, designed not to educate the brain, but to touch the heart of the learner.

Because if we don’t touch the hearts of our newest, freshest employees and help them get a glimpse of the emotional rewards that come from caring for seniors, we may be missing out on the perfect opportunity to build a passionate, capable workforce to meet the needs of the coming years, not to mention the very real needs we have today.

Monday, November 26, 2007

It’s About Your Team

We have a motto at our company, aQuire Training Solutions. We say, repeatedly, that “In senior care, your most valuable asset is not your building, it’s your team.”

We say this based not only on our passionate belief that people make the difference in care, but also on our experience as owners and operators that you can have the most beautiful building in the world but if it is not staffed with people who love their work – and love their residents – it will not be a successful business venture, let alone a valuable contributing force for excellence in senior care.

Not too surprising then, that a company called My InnerView’s recent survey of employees in senior care found that what matters most to senior care employees is having management who cares and listens to them.

This 2006 survey found that, among the 100,000 employees of about 2,000 nursing homes, 45% felt their satisfaction level was “Good” with only 16% feeling it was "Excellent". This appears to be a win, since over 60% of employees apparently are reasonably happy.

If, however, you follow the Disney approach to customer satisfaction, you’re running a pretty dismal show. Disney, according to Fred Lee (If Disney Ran Your Hospital), considers anything less than "Excellent" to be missing the mark.

We’re about to embark on a time in history when our needs for caregivers vastly outnumber our supply of trained and capable individuals. Perhaps this is a time when we, as a profession and as a society, need to be investing far more in building the teams than in building the buildings.

Just a thought.

Wednesday, November 21, 2007

A Time for Reflection and Gratitude

Carrie Ermshar, the President of the Tennesee Association of Homes and Services for the Aging graciously allowed me to share her Thanksgiving message with you today. After reading Carrie's message this morning I realized that I could not have said it one bit better, and so in a spirit of true thanksgiving I am honored to share this with you:

The Thanksgiving season has an uncanny way of always sneaking up on us. As we enter into the holiday season, I am inspired to remind us of the significance of our works and spirit.

Call me a traditionalist, but I am one of those souls who refuse to put out a Christmas decoration until Thanksgiving has passed. The reason being, there is a certain peace from taking this time to reflect with gratitude the blessings life has given, but also realize what opportunities lie ahead. Many of these thanks revolve around the work we do every day. The work of improving aging services for those that walked before us. I challenge us each to ask ourselves not what are we thankful, but why are we thankful?

Perhaps it could be that not only are we thankful for the residents that we serve every day, but we are thankful for the joy they bring as they reflect on their lessons of life. Or, perhaps it is the reminder of the power of human touch when we simply give a hand for them to hold. Or, better yet, it could be the complete sense of fulfillment we experience when we see our children interacting with our elders, and together they have laughter and smiles from a simple experience together.

It is also our workforce who provide the inner strength to do life's hardest work. Instead of simply being thankful for them, let us reflect on what they bring us to provide that gratefulness. The stamina it must take for them to do their work day in and day out. The sense of legacy they must possess to continue to care for our most frail while passing stories to future generations. The struggle they must face every day to maintain their own life and family on minimum wages, while continually persevering with a zest for life many have lost. Yes, the workforce we are privileged to work with exemplify the spirit and pride our forefathers gave us so many years ago.

And, then, let us not forget the work that as leaders in this field we are challenged to provide. Personally, I need to thank you for the leadership and inspiration you provide for us to continue to make a difference for our futures. The land of opportunity is ripe for success. The past years have been filled with perseverance on the message to provide options and dollars for the precious care we provide. We are seeing doors open to this message. For that we are thankful. We will carry that opportunity to continue impact for those that come before us. What a privilege we have been given!

Take this time of year to reflect, be still, find inspiration to move forward; and yes, be thankful. We are blessed to be called to serve our field. We are blessed to share a laugh, a tear, a successful message of change. Let us join together in continuing to make a difference.

Tuesday, November 20, 2007

Tech times at the Senior Citizen Home

One of the things I’ve enjoyed most in my own personal transition from a senior care provider (through the assisted living communities we owned and operated) to an online senior care skills trainer is getting first hand look at the range of technologies that can help us all live fuller, more independent lives as we grow older.

I was fascinated by a news alert that popped into my mailbox today about a new link to a weather satellite that the Hong Kong Observatory is making available to seniors to help them prepare for “extreme weather”. The news report indicated that 10% more seniors experienced health-related problems when the weather dropped below 12 C (that’s a frigid 54 degrees F) than at usual, balmy temperatures. The story indicated that this data was derived from the number of seniors who first used the Personal Emergency Link before going to the hospital.

With just a few minutes of research I discovered that this Link is an emergency call system available throughout the country designed to contact help in case of a physical or emotional crisis. I was hoping to read that it was state-sponsored, at no charge to elderly residents, but that appears not to be the case.

What is cool about this program is the fact that technology is being widely used, monitored, and responded to (by the government, apparently, as indicated in the news story about the weather information) in an effort to keep seniors healthy and independent.

How else can we apply emerging technologies to senior care, both in home and in care settings? Only our imagination – and our determination to live out long, healthy, independent lives – will answer that question.

Monday, November 19, 2007

50 is the new 30 - of course!

I loved watching the Today show staff celebrate Ann Curry's 51st birthday this morning - but I loved even more knowing that Ann and I are only a month apart in age.

Ann makes 51 look fabulous - she's healthy, fit and beautiful. She is all the things that make people think that 51 isn't all that old - heck, it isn't really "old" at all, just ask any of us 51-year-olds!

As a part of Ann's birthday tribute other women who had done remarkable things in their 50s were featured.

What a wonderful time in our world's history to be 51! Thanks, Ann, for showing us how to do it in style!

Friday, November 16, 2007

Online Training is Coming of Age

One of the most interesting professional journeys I’ve been traveling has been learning how to create online courses – my small contribution to the overwhelming need of more well-trained senior care providers – in a way that makes them not just equal to, but much better than classroom education.

I started this journey by studying about teaching in general. It is fascinating to me to learn how educators in past centuries thought that teaching must be done in a one-to-one setting to be truly effective; certainly tutors could only handle just a few pupils at a time. Classrooms were considered a pathetic method to conduct true education.

Of course down the road a pace we know that classrooms are challenging. The brightest students are often bored – and disruptive – while the slower learners can become frustrated – and disruptive.

Translate that to adult learning and you get a room full of people at different skill and knowledge levels, with an instructor doing his or her best to provide each person with something of value. Or maybe just shoving in a video, and leaving the room…

Online training provides an exciting new twist to the journey; one that can utilize the best of technology (a constantly evolving definition) to, in a sense, return to training people one by one, letting the more experienced learners progress quickly, while the slower learner can move at his or her own speed.

But online training must be so much more than producing PowerPoint presentations that have 2 sentences per screen.

It must be more than loading PDFs onto a website, followed by a quiz.

Online training need to show people the “what”, the “why” and the “how”; and then it needs to give people opportunities to learn their own way, using interactive coaching activities.

We can do this quickly and easily with current technology – we simply need to have the focus and the will.

Thursday, November 15, 2007

Aging Tsunami Coming

In September a group of individuals came together for an “Aging Revolution Summit” – a look at how aging services providers will begin to address the coming changes in needs that the aging baby boomers will bring.

According to a story in the FutureAge magazine, the summit was kicked off by Wesley Enhanced Living’s president and CEO Jeff Petty, who said, “As ‘revolutionaries,’ we need not answer traditional questions, but begin questioning traditional answers.”

Keynote speaker David Walker, comptroller general of the US, shared a detailed analysis of coming costs and trends that the seismic demographic shift will bring. (See report.)

Walker notes that just the government liability for Social Security and Medicare benefits alone increased 197% between 2000 and 2006. In his presentation he notes that “GAO’s simulations show that balancing the budget in 2040 could require actions as large as 1) Cutting total federal spending by 60 percent or 2) Raising federal taxes to 2 times today's level.”

Clearly, we have not only a clue, but solid facts about what the future of this country will be with the dramatic increase in the aging population.

As senior care and services providers, our responses will need to be not just “more of the same,” but we will truly need to “question traditional answers” and explore ways to move beyond the current service and delivery method.

One traditional answer that we’ve been working hard to turn on its head is the traditional approach to training. More and more individuals will need to be trained to provide services to seniors in their homes, in assisted living and residential care settings and in skilled care settings.

Fewer and fewer resources will be available to train them. Introducing quality online training can not only increase the number of individuals that can be simultaneously trained, but it can also increase our output of trained individuals.

Once they’re trained, we need to figure out how to keep the goods ones in senior care. We know that ongoing training is a key element, but what other sorts of questions of traditional answers do we need to be asking?

Walker closes his presentation with a statement about the “Five Leadership Attributes that are needed for these Changing and Challenging Times: Courage, Creativity, Integrity, Stewardship and Partnership.”

It is time for real leadership. And that leadership will come through partnership as we work together, creatively, to solve these challenges.

Wednesday, November 14, 2007

Sandra Day O’Connor’s Love Story

The O’Connor family shared a unique love story with the world this week.

The story begins as so many heartbreaking family stories start: with a diagnosis of Alzheimer’s disease, and the family’s decision to find an appropriate care setting.

The O’Connor family chose to have John, Supreme Court Justice Sandra Day O’Connor’s husband of more than 50 years, cared for in an assisted living community that specializes in memory care. Justice O’Connor could not provide the care her husband needed herself (although she apparently did bring him to work with her several times before her retirement in 2005). So she chose the best alternative possible – an experience thousands of families face each day.

The beauty of this love story is that the decision, while challenging, has worked for this family – but certainly in a way none of them could have anticipated.

Mr. O’Connor fell in love. He fell for another resident, and, in the words of the family, “became like a teenager in love.”

Here’s the dilemma I find in this story: both the family and the assisted living community have chosen to place increased public awareness over the confidentiality rights of the individual (John and his new friend, in this case) to shine light on a very little known or accepted part of the process of memory loss.

Both John and his new sweetheart are identified and shown on network television. The camera follows them around the building and grounds, holding hands and sitting close to each other.

The family is not only fully aware, but supports the comfort and joy that this new relationship has brought Mr. O’Connor.

I have somewhat mixed feelings about this story. One the one hand, I remember too well incidents in our own communities where a married resident would form an attachment to another resident, and would suddenly “bloom” (like a teenager in love) as he sat next to his new friend, holding hands or with arms entwined.

And the spouse would be stopped at the door while staff members quickly ran back to separate the resident from his new love.

Most of the time this happened because the spouse would demand that her husband (it was invariably a wife who was still functional and independent) be kept away from “that woman.”

Staff nonetheless realized that the resident had a right to companionship of his choosing, too, setting up a very uncomfortable situation for everyone involved.

Then there was the situation of the female resident who was an early onset Alzheimer's patient, physically healthy and robust but mentally very impaired. This woman would literally go bed to bed, varying partners as the whim seemed to strike her. Staff would try desperately to intervene and divert her, but she succeeded in making many male residents very happy before we finally stumbled on a solution: help her bond with just one male resident who was available and eager to have a partner, too.

Throughout this process we had many red-faced conversations with the resident’s daughters, with the families of the participating male residents, and with staff, some of whom were determined to prevent what they considered to be immoral and unacceptable behavior. We had to provide many training sessions for staff, and help them understand that they simply could not force their own moral standards on anyone, especially on residents in their care.

Throughout it all, however, we fiercely protected the privacy of everyone involved. Even for the education of the public, I don’t believe we would have shared this resident’s story.

And that leaves me somewhat ambivalent about the O’Connor family’s decision to share their own story.

While I applaud the openness and acceptance of the family and staff, I’m concerned for the individuals who are on display. Many people with memory loss have moments of clarity – will those moments cause these individuals to become anxious, concerned or fearful about their behavior, perhaps without understanding why?

It is my hope that the love, compassion and understanding of the family and the staff will compensate for the loss of privacy that the individuals are experiencing by making their story a public event. But I can’t help but wonder if this were my husband – or my father – what choice would I make?

Wednesday, November 7, 2007

Focusing on ALL our Caregivers

This month - November - is National Family Caregiver Month, according to the Family Caregiver Alliance.

The FCA estimates about 44 million family members are caregivers in the US; over 80% of all caregivers are family members, as opposed to paid caregivers.

That 80% mark is something to pay attention to, however, I think we need to recognize those who have devoted their careers to being paid caregivers. They are the nurses aids, the in-home caregivers and the other people, men and women, who support families in providing hands' on care to those who need it most. Without them many families could not continue to provide care, or would become so exhausted with their caregiving tasks that they themselves would be at risk.

The paid caregivers - the professionals - are the ones who come to work every day at low paying jobs, with little societal respect, to perform the most intimate tasks on people who often hit at them, yell at them, or verbally wish they weren't there.

These are the people that, in the structure of senior care, are at the lowest point on the staff payroll. That often, unfortunately, translates into the lowest position of respect as well.

Let's take this month to celebrate all of these individuals, too. Let's thank those who do this work for their efforts and dedication, and maybe provide them with some support in their own lives (do I hear a rallying call for MORE TRAINING?!).

If you're a family caregiver you know first hand how very hard this job is. You also know the profound gratitude one feels when a dedicated, loving professional chooses to make a difference by being a paid caregiver.

Join me in saying "thanks" this month.

Friday, November 2, 2007


Our local newspaper arrived in the mail yesterday - it comes weekly on Thursdays, and is full of news about our community's kids' sports activities, from pre-school soccer through high school sports.

It's also the vehicle for a monthly insert that has always been titled "Senior Lifestyles."

Yesterday the insert had a new title: "Boom!"

Clearly, we boomers are now the "senior lifestyles" target audience, as all of us are approaching those lovely Medicare years, and some have even arrived. Tellingly, while content inside dealt with issues we face - caring for our parents, figuring out when and how to start drawing Social Security - the full back cover was an ad from a plastic surgery center.

While I’m a little (OK, a LOT) disconcerted about now being both a boomer and a “senior” (I’m not, though – really, I’m not!), it is telling that as WE age, the language will change.

It will change because we’re demanding changes in the way we’re viewed, and in the way we’re treated.

And as senior care professionals, we’d better be tuned into those changes and be ready and prepared to change OUR language of caregiving, too.

Because the language, the expectations and the outcomes will change, whether we’re in the lead, or frantically trying to keep up.

Thursday, November 1, 2007

A Fear Greater than Death

Last weekend my father-in-law decided to get out in the delightfully sunny fall air and rake up some leaves in the yard. A few minutes later, he was flat on his back, unconscious, with an ambulance on the way.

At the hospital, the ER physician asked my dad-in-law, “What the hell were you doing raking the leaves at age 93?”

Both the physician and my husband’s family used this as an opportunity to encourage my in-laws to proceed with their long-discussed – and postponed – move into a retirement center.

My in-laws are no different than most older persons: according to several recent studies, leaving home and losing independence are the biggest fears most seniors have. According to “Aging in Place in America,” commissioned by Clarity and The EAR Foundation (as reported in last week’s Senior only 3% of seniors feared death, compared with 26% of seniors who most feared losing their independence.

From our perspective, and, to be perfectly honest from my father-in-law’s perspective, too, moving out of a home environment into a retirement center is an opportunity to increase companionship, social stimulation and activities, as well as a chance to let someone else do the leaf-raking. It’s my mother-in-law that fears losing her things that have such meaning and sentimental value, the things she’s surrounded herself with throughout her adulthood.

Interestingly the study found that the children of seniors worry most about their parents being mistreated in nursing homes (82%); 89% worry about their parents being sad. Certainly that reflects the media attention that abuse or mistreatment in nursing homes receives; it also reflects our fears as boomers that we won’t personally be able to balance everything – our work, our kids and our parents. If we can’t have confidence in the care they’ll receive in a nursing home – or any other senior care setting – we’ll continue to worry about them and continue to feel the “Sandwich” squeeze.

It’s time to start a new perspective on aging options, whether retirement community, assisted living or skilled nursing. It’s time to think of these as options to ADD to our live, and to the lives of our parents, rather than options for TAKING AWAY: independence, freedoms and decent and honorable treatment.

It’s time, as members of an already too-stressed generation of people caring for parents (and grandparents), children (and grand-children) to see the advantages of getting help in providing care and services to our parents.

It’s time, from the professional perspective, to put into place methods and systems for family members to consider these options worry-free, and guilt-free.

Maybe it's even time for my father-in-law to put down his rake - but only if that's what he really wants to do (one can rake leaves even in a retirement community, dad)!

It’s up to us, as the baby boomer generation with the most challenges and stresses related to this issue our nation has ever experienced, to start making the difference.

Friday, October 26, 2007

Real Caregiving

Did you hear the NPR story about the residents from an LA area nursing home that were evacuated to the Qualcomm Stadium? (Read a related story.)

The NPR reporter, who observed the care given to the residents by staff during an afternoon, shared a story about individuals who provided remarkable care for the residents, even during the most trying of circumstances.

While residents tried to rest in uncomfortable army cots, staff sang “Take me Out to the Ballgame” with them, and joked about coming to Qualcomm Stadium for this, instead of a ballgame.

When a resident’s “diapers” (the reporter’s words) needed to be changed, the staff would hold up blankets in a circle around the person, allowing him/her privacy in a very non-private situation.

I smiled as I listened to this story, thinking, “Here are folks who really get it – who understand that caring for elders is not simply making sure the right medicines are given at the right time, and that the body is well cared for.”

Caring – the right way – for seniors means using creativity and knowing that whatever the circumstances, caring for the PERSON is the most important part of the job.

That’s why when we’re training new caregivers we need to start with the basics: not bathing, dressing and grooming, but rather WHY we do what we do, and how to preserve the person’s dignity, privacy and promote independence in every single aspect of care we provide.

Those are the kinds of caregivers that I want caring for my mother – and ultimately, for me.

Wednesday, October 24, 2007

'Round the world view

Yesterday was my first day back in the office following three weeks on the other side of the globe.

What an experience it was, to see first hand how people live in Singapore, Indonesia and Australia. The cultural differences couldn’t be more dramatic, especially between the remote islands of Indonesia (we spent 10 days on a small island group 600 miles east of Bali), the bustle of Singapore and the quiet beauty of South Australia.

We saw families transporting cows on the cabin roof of their small boat, visited a family’s home on stilts, carefully walking on the floor joists so we wouldn’t crash through the grass mats covering the floor, and stayed on a winery in picturesque McLaren Vale.

In one of the most remote villages we visited, age 50 looked ancient and the average life expectancy was very short.

In Singapore the government has recently decided to allow people a third day off each week, in addition to the weekend, in the hopes that they will procreate more freely and help offset the aging population. There, with the third oldest population in the world, the health and social needs of an aging population are at near crisis. With too few young workers, migrant laborers, mainly from India, are imported to provide the needed labor, raising cultural and social challenges of their own.

It’s always interesting to see how the rest of the world lives, and how they tackle some of the very problems we’ll soon be facing here.

On the other hand, it’s always good to be back home, too.

Thursday, September 27, 2007

An Insider's View

I love a good story. I particularly love those stories that make me think, over and over, for a good, long time.

Celia Berdes, a researcher and author, reviewed the new book "Dancing with Rose" with such enthusiasm that I'm going directly to Amazon and ordering it:

Dancing with Rose: Finding Life in the Land of Alzheimer's (York: Viking, 2007), a new book by Lauren Kessler, is the best book yet written on the lives of old people in residential care and the people who care for them,
Celia writes in today's Quality Jobs/Quality Care e-newsletter.

Here's more of her review:

Dancing with Rose leads us to this inescapable conclusion: that caring aptitudes and attitudes of skilled direct care workers are the most important components of high quality care. In a call for systemic reform, Kessler asks us to think about our own aging: ''If I do need help when I get older, if it becomes impossible for me to live independently, how do I want to live? Do I want to be cared for by an overworked, underpaid woman with so many chores to accomplish on her shift that she can barely spare a minute to talk to me? The important question is whether I--whether any of us--have the gumption, foresight, creativity, fearlessness, imagination, whatever it takes to do something about eldercare before it's our turn.''

Let me echo this. My theme, and I'll repeat it every chance I get, is to simply say that this is a personal issue for all of us. Who will care for my mother - for yours - when the day comes? Who will, eventually, be caring for you and me?

That's about as personal as it gets.

Wednesday, September 26, 2007

For Caregivers, It's All About the People

I shared with you earlier my memories of my first job as a nursing home caregiver. I was just 17, living away from home at a distant college, needing a job I could fit around my class schedule. Working swing shift seemed perfect – except for one small problem: my supervisor never once, during the entire semester I worked there, gave me a Friday night off – my one and only request when I started work.

I was trained by following an experienced caregiver for one shift. After that, I was responsible for feeding, bathing and assisting to bed 10-12 residents each evening.

Here’s the part that actually surprises me when I think about those days: I still remember the people. I remember the two young women with severe cerebral palsy, for whom we provided total care, including peri-care during their menstrual cycles. I remember the gentleman who became one of my favorites. I remember the people who really needed a two person assist, but whom I usually had to assist by myself.

This was over 30 years ago, and I still remember the people.

This reflects a lot of what we now know about caregivers in general: they’re in it for the people in their care. They’re not in it for the money, the respect or the leadership shown to them. It’s the people.

Imagine if we could enhance the money, increase the respect, offer multiple training opportunities and provide strong leadership?

What kind of a powerful workforce could we build?

Given the tools to excel, caregivers will be able to focus even more on the part of the job that defines them: genuinely caring for people.

Thursday, September 20, 2007

Don't be a Technology Dinosaur

Let’s face it: most of us running companies providing care to seniors today didn’t grow up with a PDA or a mouse in our hands.

We probably don’t have Facebook or MySpace accounts, let alone thousands and thousands of “friends.”

If you’re like me, you may not even know how to load a video onto YouTube, although you have watched one or two.

But please don’t call us technology dinosaurs! We like to think we’ll adopt technology as soon as it’s tested and can be demonstrated to be of benefit – that very minute, we’ll be on board.

But just listen to what U.S. Senator Whitehouse (D-R.I.) said about us just recently at the Senate “idea exchange” sponsored by Sen. Harry Reid and Sen. Debbie Stabenow: “"the use of technology is worse in this industry [long term care] than any other industry except mining."[1]

Yikes! That’s not a flattering review of our profession.

Just to show you that I know how to do some cool things using technology, here’s a YouTube video of what one company, Ecumen, is doing to utilize technology:

Pretty cool stuff – and great press that gets the attention of seniors today whose number one concern is losing their mental functioning and consequently their independence.

But what about technology as it relates to training? What’s wrong with the old “stand-up-in-front-of-the-entire-staff-on-payday” approach?

Just a few things: using the same schpele for everyone, regardless if they are a week one or year 10 employee, missing those folks who are sick, sleeping or simply don’t show up, and checking how well your training worked by using a sign-in sheet for verification.

Why not dip your toes into the murky water of technology and check out online training? Like other aspects of technology, the cost is increasingly affordable, the implementation is quick and simple. And the results? One independent study found that game-based online learning was over 7 times more effective than traditional forms of training.

That’s something to think about when you’re ready to make the move away from the old way – the dinosaur way – to the new, modern way of providing senior care!
[1] As reported by Larry Minnix, AAHSA President and CEO in his message dated 9/13/07.

Wednesday, September 19, 2007


Here's one advantage to our jumbled system of senior care: we have a lot more choices now. Less than 50 years ago seniors either moved in with family or moved into a nursing home. There were no other options available.

Today, in-home care is readily available in almost every community in the US. Assisted Living has added another level of care to the mix, allowing seniors to live in an independent, residential environment while accessing support services. Granted, the level and type of support varies widely - from state to state and even from building to building - but no longer does a person needing care have to move into a skilled nursing community to receive assistance.

Barbara Quirk, a geriatric nurse practitioner, writes about yet another option that boomers may well choose in the future: shared housing arrangements.
The fact is that it is not a bad idea to consider moving in together with lifelong friends and hire whom you choose for your helpers. This may be a far better option than the traditional assisted living. For starters, you would be with people you know and enjoy, rather than strangers.
My immediate response is, "Yes, but then I'd still have to cook and clean!" I like the idea of someday moving into a senior living community where I simply show up at the dining room when I wish, and leave the day-to-day worries to someone else.

My mom has been living in a cottage in a retirement village now for over 6 months. She was sharing her experience with friends who had come to visit her for the first time - and who were speechless at how friendly everyone there was to them.

"We were just walking down the sidewalk and people would stop to talk. Come to find out, we have friends in common with more than one person living here!"

My mom is happy, has tons of new friends, and says she truly feels like this is now "home" for her.

My friend, on the other hand, receives calls daily from her mom who, recently widowed, is alone and lonely on her countryside home.

“I lied to my mom for the first time yesterday when I told her I was busy and couldn’t go with her on an errand,” she said. “I was simply worn out from daily calls for help – but mostly for companionship.”

Caregiver stress and the medical ramifications are well documented today. This stress affects families who are trying to balance it all, as well as paid caregivers who don’t have access to the training or support that they need to do a demanding, often thankless job.

I like what Barbara Quirk says in her comments about shared housing and other options we have now:

With all of the housing options available today, plus a few that haven't even been thought of, it pays to at least consider what would be acceptable to you.
And, perhaps even more importantly, consider – and discuss - what would be acceptable to your loved ones. Giving that some attention now may take some of the stress off all of us when needs arise in the future.

Tuesday, September 18, 2007

Working Together for Change

This Sunday is the annual Race for the Cure event in my home town (Portland, Oregon). It’s an event I’ve been participating in for several years, and one I’ve encouraged my daughters to attend with me year after year.

The first time I attended the Race I spent the entire time in tears – what an emotional experience to see so many women, moving together with a force that only comes from joining together for one purpose and one goal. At the time, I wondered what incredible things we could achieve if we put that kind of effort into other needed changes in society.

I often reflect on this experience as I work with senior care providers, training the next generation of senior care administrators, managers and caregivers. What a force we can be when we join together to achieve a goal!

Too often in this profession, however, we tend to want to protect our turf, and focus only inward. Instead of tapping into each others’ skills and services, we try to “reinvent the wheel” by doing everything in house. We miss the tremendous benefits we can gain by going outside our own circle and sharing our expertise, asking advice, or standing together for a cause.

The folks in Hendersonville, NC know the power of joining together to solve a problem. Instead of protecting turf and hording resources, they’re joining forces to reach out to impoverished seniors who cannot afford to purchase medical equipment – equipment that may make the difference, for many, between the ability to live independent lives or becoming dependant, increasingly frail seniors.

Carillon Assisted Living (1550 Charles Rd Shelby, NC 28152) is at the head of the pack, collecting donated items 7 days a week and working together with the Salvation Army and other area non-profit organizations.

Associations like the American Association of Homes and Services for the Aging and the American Health Care Association provide a vehicle for providers to join forces for change on a national scale, and in that manner those organizations have achieved amazing things.

As those of us who are both senior care professionals and aging boomers know, however, change starts right here at home, in my town, in our state. Working to improve the quality of care provided to seniors right here is a cause we can support – together.

Monday, September 17, 2007

A New Message for Senior Care Communities

The other day I had to stop by my physician’s office for a few inoculations before I take off on our upcoming trip to Indonesia. My plan was to run in, get my shots and run back out. My plan, as often happens, got waylaid – but this time for a very good reason.

Occupying a good share of the sidewalk in front of the clinic was a table loaded with fresh fruits and vegetables. A banner above the stand identified it as being from a local produce farm. The fruits and veggies looked fresh and fabulous. So I stopped – and I shopped. I brought home fresh corn on the cob, salad greens and nectarines – the best I’ve eaten all summer.

Since that day, the idea of stopping at the doctor’s office and picking up some fresh, wholesome produce on my way out has stuck with me. What an incredibly creative way to live your point: eat healthy, take care of yourself and you’ll need to see less of us! This was Kaiser Permanente, who is clearly living their new motto, “Thrive!”

Last week in Dodge City, Kansas, Kathy Greenlee, the Secretary of the Kansas Department on Aging spoke to a group of seniors about healthy aging. As reported in the Dodge City Daily Globe, the first question Ms. Greenlee asked the seniors in attendance was, “How many of you plan to go to a nursing home?”

Not surprisingly, no hand was raised. Ms. Greenlee went on to talk about the importance of taking responsibility of our own health, and eating well – lots of fresh fruits and vegetables being a key component of that advice – as one of the best ways to avoid needing long term care services.

Researchers have found that we can prevent many of the disease processes that cause long term disabilities and dependencies. The two most important things we can do to live long, healthy lives are getting regular exercise and good nutrition.

I have been wondering, as I reflect on the best produce I’ve had all summer, how we can incorporate this message in a meaningful way in our senior care communities.

What about sponsoring a walking club for residents, and inviting seniors in the general public to join in?

How about offering space inside our spacious lobbies or activity areas for local farmers to sell their produce?

What other ways can we creatively say to the public, “We’re here to help when you need us, but in the meantime, we’ll help you stay healthy, active and independent”?

This may be a message that helps move senior care from the dreaded place (“I’d rather die than move there”) to the mainstream (“I’m sure glad they were there when I needed them!”). It’s a message we need to be giving today, as we prepare for the needs – and the options – of tomorrow.

Friday, September 14, 2007

Honoring Those who Share Their Talents

Last evening I had the pleasure to share stories with John Wakeman, the Administrator of the Life Care Center of McMinnville, a skilled nursing center operated by Life Care Centers of America.

John and I talked about how managing a nursing home is a challenge, while being at the same time an honor and a privilege. I shared with John a beautiful story I had read earlier that day about one woman’s experience in the Alzheimer’s center where her mother lived: how her young daughter, experiencing the boredom common to kids visiting grandparents in a care setting, had wandered over to the piano and started playing the few songs she knew. Shortly she was joined by a group of residents who started singing along, over and over, the familiar songs the young girl was playing.

John shared how he played the guitar and enjoyed singing with his residents as well. He and I talked about how music seems to be such a universal, deeply rooted language, and how residents who can’t remember how to perform simple daily care functions could remember every word to a beloved song.

John also shared with me his upcoming weekend plan to hold a barbeque and picnic, and invited me to attend. John says he’ll be participating in all the activities – maybe even wearing a clown suit and sitting in the dunk tank.

As I was driving home I reflected that nursing homes are a lot like hospitals: places we all hope never to have to stay, but places we’re incredibly thankful exist if we need them. I also was thankful that people like John have chosen, as their profession, the challenging and often thankless job of running these centers, and daily put their hearts, souls and talent – from guitar playing and hamburger flipping to managing staff and dreaming up new ways to better serve the community – into their jobs.

Oh, and if you’re in the small, rural town of McMinnville, Oregon, nestled in the heart of Oregon’s great wine country, stop by the Life Care Center this Saturday afternoon for a little heartwarming fun.

Thursday, September 13, 2007

Honoring the PROFESSIONAL Caregiver

Yesterday I shared some of my memories on the last time the staffing shortage in senior care was truly a crisis. Looking ahead, the aging of our society – and all of us boomers approaching our senior years – means that the shortage of the early 90’s could be a fond memory of times that really weren’t all that bad.

The other area that, I believe, ties in directly with this issue is our need to elevate the caregiver perception in the eyes of the general public to that of a profession, not just a lowly minimum wage job.

In practical terms this means not only talking about the profession of caregiver in our daily conversations with other professionals, but it also means honoring those individuals with the kinds of perks – and requirements – associated with other professionals.

Training, for example. Physicians have CMEs; nurses, attorneys and teachers have professional continuing education requirements. Many states have continuing education requirements for caregivers, but some of those requirements are so loosely enforced that simply reading a posting and signing that you’ve read it counts. Other states don’t address continuing education at all. Initial caregiver certification varies widely from state to state as well, with many states requiring no certification or licensure at all.

When I talk with owners and operators I often mention the need to offer extra training opportunities for all staff, especially caregivers, to give them the tools to become the best at their profession that they can be.

After all, for the most dedicated among them this is not simply a job, it’s their profession. It’s our duty - and our privilege - to begin to raise the respect for these individuals to a new level.

Wednesday, September 12, 2007

Caregiver Crisis Memories

I've been talking to a lot of people lately about two issues that are on my mind: The coming caregiver workforce crisis and the need for caregiver respect as a profession.

The projections on the coming caregiver crisis are dire; they make the shortage we experienced in the 1990s seem insignificant. I recall only too clearly what those days were actually like for an owner and operator of several senior care communities, which was my work at that time.

Before that time we had policies against hiring multiple persons from one family. During the shortage, we began asking every employee if he or she had a brother, sister, aunt or mother who would be interested in this work.

Before that time, we could keep our staff roster full with only periodic advertising. During that time, we put sandwich boards on the sidewalks that said “Now Hiring Caring People” – and left them there week after week.

Before that time we’d put two-line ads in the local newspaper and actually have applicants to interview and choose from. During the shortage, we got creative in our descriptions (“seeking people with a sense of humor only”) and ran ads in everything from the daily paper to the Nickel Ad sheets.

While we were trying everything we could to find people to fill positions, we were working every staff member overtime – lots of overtime. I worried constantly about fatigue and the results on the quality of care that a caregiver provided, not to mention the increase in abuse potential when a caregiver was exhausted.

And I have to admit we hired a few doozies, too. I remember a couple of people with tattoos from head to toe - neatly covered during the interview - that had colorful language and questionable motives for applying in the first place. Some got hired, and almost always we regretted the hiring choice.

Our managers worked night shifts, then came in the next day to do their own jobs bleary eyed and fatigued. We had residents who simply needed 24 hour care, and we had committed to providing that care to them, whatever it took.

Looking at the demographics, that experience was nothing compared to what is coming just ahead. Better Jobs Better Care reports:
Shortages of qualified, committed paraprofessionals are likely to worsen. In the coming years, the U.S. will experience a tremendous increase in the size of its­ elderly population as baby boomers age. At the same time, the number of middle-aged women who have traditionally filled these jobs is not growing fast enough to meet the increased demand for services. The result of these demographic shifts is an emerging "care gap" that could severely curtail our nation's ability to provide long-term care.
Tomorrow I’ll address the second part of my recent conversations: how to enhance the role of caregivers as professional. I can’t help thinking that these two subjects are directly linked, and are essential to our understanding if we’re going to make a real difference in the care we provide – and the care we receive.

Friday, September 7, 2007

Needed: Bold Leadership

Thanks, Larry Wenger (Workforce Performance Group) for your feedback on yesterday’s blog about the crisis of staff turnover.

Larry says, “In my 40 years of experience as a human services exec., I have come to believe that a large % of turnover is due to inadequate and poorly focused supervision...'people don’t leave jobs, they leave supervisors'.”

I agree, Larry. What’s needed in senior care today is true leadership.

Leaders who will make reduction in turnover – and the improvements in quality care – a priority.

Leaders who will be bold, and will make leadership decisions in implementing whatever technology is available to achieve bigger goals.

Leaders who won’t say, “I can’t require my staff to do anything – they’ll just quit” – but who will set up requirements along with incentives and rewards, and create a culture of going above and beyond the minimums.

Larry’s latest newsletter contains a quote that I needed today, as it’s the end of a week that held some frustrations and challenges for our team:
“We are all faced with a series of great opportunities brilliantly described as impossible situations.” - Charles R. Swindoll
Today, reducing staff turnover in senior care feels like an impossible situation. Perhaps, in reality, it is simply a great opportunity.

Thursday, September 6, 2007

Caregiver Turnover - an Expense We Cannot Ignore

Do you realize that the turnover rate for CNAs in nursing homes today stands at over 70%? That means in a given year 7 out of 10 caregivers will leave their jobs – and the people in their care. That’s incredible – and an issue none of us can afford to ignore.

During my mother’s stay in a nursing home following her auto accident last fall she came to know her caregivers well. She listened as they told her stories about their kids and personal lives, and she shared her own stories with them. They got to know her as a person, and got to know her individual care needs and wishes.

My mother, mind you, is not only a lactose intolerant vegetarian but she is also a retired RN who worked her entire career in long term care. Meeting her needs in a way that met her standards was challenging, to say the least. Imagine the increased challenge to discover, just when she had one trained, he/she left only to be replaced by a “caregiver in training.”

Families rely on caregivers to notice when something changes in their loved one; when something seems a little “off” or when behaviors can signal a problem.

To the brand new caregiver, agitation might mean the doctor gets called and an order for an anti-anxiety medication gets added. For the experienced caregiver, this may simply have been an alert to a medical problem like a bladder infection that needs diagnosed and treated.

In fact, reduced caregiver turnover is directly tied to the quality of resident care and to client/resident satisfaction, according to Better Jobs Better Care, an organization focuses on improving the turnover rate among direct care staff and “contribut[ing] to improved workforce quality.”

BJBC found that, among other things, turnover costs the organization an average of $2,500 per person, racking up millions of dollars of costs that get passed to the consumer either directly, as a portion of the cost of care, or indirectly, as governmental programs reimburse care services.

In a recent article published in FutureAge (“The Business Case for Investing in Staff Retention”, March/April, 2007) David Farrell of Medical Hill Rehabilitation Center shared what happened when his community began to seriously invest in proven staff retention strategies (things like increased staff training – near to my heart – seniority wage increases, peer mentoring and more): “Over the past six months, as staffing stabilized, the results have been dramatic: Our annualized CNA turnover rate has dropped from 94 percent to 29 percent, representing significant savings.”

As the result of this savings, Medical Hill was able to increase staff wages (one significant factor in high turnover) without adding to overall expenses.

Investing in improved staff training and other turnover-reducing measures pays off financially, but it also pays off in a more significant way to those of us who need the services of a care community: it pays off in better care for our loved ones. And that’s a payoff we all have a stake in.

Wednesday, September 5, 2007

Challenges In Training Staff for Today's Caregiving Needs

My friend and colleague Keren Brown Wilson and I were recently discussing some of the most challenging aspects of preparing a work force to meet the caregiving needs of seniors today and into the future. As Keren pointed out, it's not like we're training people to do highly repetitive, step by step assembly-line tasks.

We're actually teaching people "complex judgment and decision-making skills", as Keren phrased it. Each task that involves another person, especially an elder adult, must be respectful of that person and responsive to his or her needs and rights.

That's why teaching someone to help give a shower isn't simply a "Step 1 - Step 2" process. I like to say that as soon as we complete the "Here's how to assist with a shower" lesson and send a new caregiver off to do just that, he or she will encounter something we never covered in this lesson.

What happens if the person refuses to shower? Prefers a bath? Wants a helper of another gender? Finds the experience frightening or overwhelming? As often is the case, the person sent to assist with the shower and the person being helped may have entirely different needs and agendas.

Clearly, we need to teach caregivers some more basic skills before we begin the lesson on bathing assistance.

We need to teach about basic resident rights - but more importantly, we need to give caregivers the tools to understand those rights. Although it may seem simple from the outside, when you're actually in caregiving situations there are many shades of gray; rarely is anything simply black and white.

The person who is being assisted with bathing has a right to refuse to bathe - but what about the rights of the other people who must share a table with him/her at mealtime? Do we then have the right to make the person who will not bathe regularly sit at a table all by him/herself, essentially isolating him/her from social interaction? How do we meet the health care needs of the person who is refusing to bathe, resulting in skin breakdowns or other problems? When does the person no longer have the right to refuse to bathe?

Trying to boil down caregiving training to simple assembly-line-style procedures results in some of the abuse situations currently making news, situations where the person did what he/she was taught, but didn't take into account the unique individual needs of the resident. (Here's an example where the caregiver may have simply been doing what she was taught - and now is facing the next 6 years in prison.)

How do we teach complex judgment and decision-making skills? Join us as we continue to explore that question, using all of the incredible tools we now have available. Through our team, we're using stories (helping caregivers understand the PEOPLE behind the tasks), situational decision making and games. We're exploring approaches using interactive multi-generational games to allow people to experience, in a safe but realistic environment, the options and choices that come with every task related to caregiving.

It's an exciting challenge - but such a necessary one if we're going to prepare the next wave of caregivers to provide the kind of care that we'd want for our loved ones - or for that matter, for ourselves!

Tuesday, September 4, 2007

Caregiver's Language of Caring

Clearly the topic of the words we use in talking about caregiving is a concern to many. Roy G. Gedat wrote,
This came up as a priority at the recent Direct Care Alliance national convention of direct care worker associations. 18 states were represented and our goal is "to help determine universal terms for DCW issues."
The words we use do reflect how we feel about people and about tasks. One of the words I've struggled with in the past is "resident" to reflect people who live in our care communities.

Although moving to "resident" is an improvement from "patient", I used to teach my staff to refer to the folks living in our assisted living communities as "the people who call this their home." It helped remind us that this WAS their home, and to communicate that to others, especially guests and prospective families.

The problem, of course, is that we've replaced one short word with 7 words - not an easy solution. As I look at many word suggestions for replacing other words that don't reflect our current view on caregiving, I see the same pattern. A challenge, clearly, if we are to replace words with new terms that gain broad usage.

I have to chuckle, speaking of words, at the creative language people use to talk about their experiences as members of the "sandwich generation." Colorful language - all in an effort to help communicate how truly challenging this role is for many of us.

Some have referred to feeling like an open-faced salami sandwich, lying face-down on the sidewalk. Others have talked about feeling like a smushed flat PB&J. Judy Steininger describes the feelings of living your life when, out of the blue, you get a phone call that a parent has suffered a serious mishap. Meanwhile, you're busy balancing your kid's soccer game and dinner for the family.
Just like that, you’ve become the newest member of the Sandwich Generation. If you’ve always liked your lunch served on wheat or rye, in the months or years ahead, you’ll learn to appreciate sourdough.

I think this generation is perfectly equipped to handle the task of creating a new language of caregiving. We're talking the Baby Boomers, Sandwich Generation - or whatever term you want to use - but we're talking about people who are all about creating a new language!

Friday, August 31, 2007

A little fun for Friday (Swinging Seniors)

Eric Christianson from the Waterford Retirement Community in Vancouver, Washington, sent me his most recent newsletter. Here's my favorite part...and a great way to end the week!

Eric says that these two women are part of their community's walking group who go out every week for a walk - and a swing!

Thanks for sharing this, Eric. Helps me remember the most important fact of all: it's possible to live healthy, joyful lives to the very end of our lives. Swinging with friends who share our interests doesn't hurt, either!

Thursday, August 30, 2007

Moving to Home - Let's start with two words

Several news items caught my attention today:

  1. The Canadian government announced a $700 million dollar investment in developing a nation-wide "Aging at Home" strategy: "aging at home is much less costly than long-term care and helps preserve a senior's dignity," says Health Minister George Smitherman.

  2. A news story out of San Antonio that describes a new senior living community that "breaks the mold of the institutional and moves to the residential," says Carlos Moreno, an architect at Marmon Mok LLP, who is designing the community. In addition to being designed like a traditional small apartment, the doors are wide enough to accommodate walkers and wheelchairs, the outlets are higher and all the units are fully wired for computers. The community also offers courses and programs for the community at large, bridging the gap between a senior residence and the rest of the community. Administrator Steve Fuller comments, "They [residents] want to stay connected with the broader community."

  3. Then there's Aging Maven who titled her blog "The Great Diaspora: Moving Seniors" and shared how, at one location in her city condo developer were courting seniors while at another neighbors were protesting a new assisted living project..."You’d think we were talking about sex offenders."

What's going on here is a discussion about "home" and what that means - a discussion that will only intensify as more and more of us become seniors.

I won't want to live in a big house by myself, counting the minutes until my mailman comes by (he'll be the only other human I'll see all day).

I'll want to find a vibrant community of people I can share meals with, take a walk with, discuss the news with. Maybe I'll forget to pick up my mail for days at a time since I'll be so busy!

And how on earth can we meaningfully - and economically - provide the same services to people in their homes - spread out all over a city - as we can to those living in close proximity?

Here are two words for today: choice and community. What I will want may be quite different from what you will want. What both of us will need, however, to support us into our elder years, is a community.

Wednesday, August 29, 2007

Words DO Matter - Let's create a new caring language

Russ Hughes from SC made the following insightful comment:

In reading your post regarding efforts to unionize Atria, I was stricken by the impact of language on our culture of care and its implications for how we view what we do. My reference is to the use of the word "front-line" in referring to staff who provide direct care to elders. While innocuous in and of itself, it conjures up images of World War II (as depicted in movies) of forces squared off against one another with a clearly defined "front-line" that places us (the good guys) and them (the bad guys) on opposite sides of that line. When we in the nursing care programs use such a term, it implies that the good guys are the staff and the bad guys are the elders.

Of course there are numerous terms we use that to those outside the industry similarly connote an adversarial relationship between care givers and elders. Too often we hear such of those as "in the trenches," "non-compliant," or "uncooperative" (or numerous others) that suggest we are on opposite sides from those we serve.

As a major source of education, aQuire is in an excellent position to provide leadership in awareness and this culture change effort.
Thank you, Russ Hughes, Ph.D., N.H.A. SC Department of Mental Health

Russ goes on to say,

I would welcome opening the discussion to others including through your blog. Perspectives would be most interesting I would think. I have always wondered at the use of the word "facility." Outside of our "industry" facility tends to conjure up the image of a warehouse and "skilled nursing facility" suggests something very highly technical (skilled). How about "wards" and "units?" Those certainly do not connote something "homelike" but harkens back to the days of nursing homes as sterile mini-hospitals.

I'm with you, Russ. Let's take this opportunity to work together to craft a language of caring that moves us into the new millennium. I mentioned earlier my conviction that we have the ability to train staff to view care communities (NOT facilities) as true communities: homes of the people who live there, with services provided to them as they WANT and need them, not just as we see fit.

In our company we are indeed privileged to be training the next generation of senior care providers. I'm very excited about the ability to affect the language we use and to teach a new language that more accurately reflects the caregiving model we want - for our parents and ultimately for ourselves - into the future.

Please join the conversation. Whether you're a senior, a family member, a senior care professional or just a future consumer - let us know what you think. We have an opportunity to shape at least a part of the future of care together!

Tuesday, August 28, 2007

Sandwiched Baby Boomer Sticking Together

At least there are a lot of us! Thanks, friends at the blog Nourishing Relationships, for sharing your comments about my blog:

I want to applaud you on your terrific posts about the Sandwich Generation. Your storytelling, blending professional wisdom and personal humor, is charming - a refreshing and informative read for those struggling with the challenges of a family in flux.
I've been googling a few new contacts and read so much negative press about just about every company out there that it feels good to read nice, positive comments!

Here are just a few other comments from recent news items or posts that struck me as interesting:
I was not ready for my energy to be sapped by giving dating advice to both my daughter and my mother at the same time. (By Susan Brooks-Thoman, on the Victoria Habelrih blog).

That comment made me smile - and made me just a little nervous about my own newly widowed mom (and my three unmarried daughters...will this be me someday?)

Tim from Michigan emailed me:

I have searched low and high and have yet to find info specifically for the male caregiver. I guess I'm in a very small minority or maybe it's just that most men won't or can't share their experiences.
While Tim IS in the minority, he's not alone. The Caregiver Resource Center in Kalamazoo, MI, provides a much needed service to all caregivers, young and old, male and female, according to a recent article in the Kalamazoo Gazette. Director Colleen Simpson comments,

...more and more men are taking on the role of caregiver, and teens and preteens caring for the needs of an elderly relative while their parents work are also on the rise.

The center provides education resources as well as support for caregivers.

While there's no doubt more and more of us are assuming caregiving roles, at the same time it is comforting to know that we are not alone. In fact more resources exist now than at any previous time in history to support family caregivers.

So from that perspective, it's a great time to be a sandwiched boomer!

Monday, August 27, 2007

Innovation and Technology Applications in Senior Care

“Mom, lay back down and push your call button. Someone will help you get up. Lay back down now, mom!”

That’s the voice recording my friend Lane put on the fall alert device he recently purchased for his mother. She has been getting increasingly forgetful, and has been experiencing some falls. After a nasty fall last Christmas, Lane found an assisted living community near his home and was delighted to be able to secure a unit for his mom.

No matter how many times Lane and the staff there have instructed her she simply can’t remember to use the call system before getting out of bed. When she attempts this by herself, she falls. So far she has not suffered any injuries, but a few months ago while Lane was traveling out of the country, his mom fell again. To make sure she didn’t have any injuries the assisted living staff sent her to the hospital for a check-up and X-rays. At the hospital, staff became alarmed and determined that she wasn’t appropriate for assisted living – she was too great of a fall risk.

What happened next was a nightmare for Lane’s mom: admission to a skilled nursing center where, to prevent her falling, she was immediately put into a wheelchair and taken to the dining room, pushed up against the table and wheels locked in place.

She was accompanied on walks a couple of times a day, but other than that she was in the wheelchair, unable to get out.

When Lane returned from his trip, he was horrified to discover his mom unhappy, depressed and significantly weaker than when he left. Lane immediately moved her back into the assisted living community and started looking at options to keep her safe – and independently mobile. She uses a walker, and she wants to walk. While she seems to be able to walk relatively safely now, getting out of bed unassisted is her trouble spot.

Lane looked at alarm systems; by the time staff was alerted, however, his mom was out of bed and on the floor.

So he discovered the voice alarm alert. Now, he goes to visit his mom and she’ll say, “It was the strangest thing: I heard your voice in the middle of the night last night telling me to get back into bed!”

So far, mom has had no further falls. For Lane – and more importantly, for his mom – the risk of falling is not the worst thing that can happen. The worst thing, by far, is losing the independence and mobility she has left.

Do you know some innovative devices currently available to promote independence? Share them!

Friday, August 24, 2007

Innovation is the Word of the Day

While many are busy criticizing senior care providers for perceived problems – and certainly, there are companies and communities that do have significant problems – what isn’t getting as much attention is the innovation in services that many providers are implementing. These innovations are designed not only to meet the expressed needs of today’s seniors (mental stimulation, life-long learning are at the top of the list) but also to improve the public’s perception of senior care and improve overall services.

Consider what Atria, subject of many negative news stories (and my last blog) is doing in its Burlington assisted living community, incorporating Nintendo’s Wii video game into community activities:

The Nintendo Wii is not only for the young, but the young at heart," said Zappala [the community’s Executive Director] via e-mail. "Those who participate are not only staying physically active, but mentally active as well. The Wii stimulates their mind by incorporating a significant level of hand and eye coordination.

Then there’s the community in Canada that is actually growing grass on the roof:

Shalom Manor and Shalom Gardens, a linked Dutch-Christian nursing home and assisted-living facility, is going green, with a rooftop revamp. The facility has decided to transform its bland grey asphalt roof into a lush, year-round scenic piece of nature, with more than 3,000 square metres of garden.”

The point is both esthetic (more than half of the resident’s view was of the old, flat roof) as well as environmental. Both management and residents like the idea of doing something that enhances the environment in many respects.

Ecumen is in the news again with a program especially designed to promote senior wellness – both in the residential community and in the community at large. More importantly, staff are also welcome to use the fitness equipment, mingling with residents and guests as they improve their own physical wellbeing.

Vitalize! Wellness Centre, opening this fall , will have all the bells and whistles . . . TechnoGym weights and TechnoGym aerobic fitness equipment that digitally measure one’s personal progress, a warm-water lap pool, a warm water pool with a treadmill, herbal teas and great food, exercise rooms, massage, plus classrooms for lifelong learning that helps people explore, personalize and enhance dimensions of successful aging.
The point of all of this innovation is to keep pace with what seniors are looking for in their aging experience – a chance to keep living vital, involved lives right through the end of their days.

Senior care communities that want to stay in the news in a good way – and more importantly, meet the rapidly changing needs of their target market – should listen, learn and innovate!

Wednesday, August 22, 2007

An Offer to Atria and Assisted Living Communities

Atria is still making news as the target for unionizing efforts by SEIU, who is now focusing on yet another Atria community, this one located Riverdale, NY. SEIU, presenting itself as “Senior-care advocates from the Campaign to Improve Assisted Living”, has been zeroing in on the national company’s 121 facilities in 27 states as a prime target for unionizing caregivers throughout the US.

SEIU has issued press releases on Atria beginning some months ago, with the most recent ones coming in a one-two punch August 19 and 21st. In each press release the union focuses on a community with infractions, and their “advocacy” work on behalf of residents. Here’s a paragraph from the press release dated August 19, 2007:
Advocates will deliver an over-sized "Get- Well" card to residents, and ask to meet with facility administrators to discuss the recent viral outbreak that drove residents to their rooms and closed down the communal dining room.
No mention, of course, that over the past few years viral outbreaks like this have occurred in many communal living/dining environments. Some, including one in the state of Washington, resulted in multiple hospitalizations of residents as well as hospitalization of staff and even some emergency workers responding to the situation (these are nasty bugs indeed). Clearly Atria is not alone in experiencing this admittedly dangerous, distressing situation.

And while I’m all for advocacy, I’m truly for advocacy that supports all the needs of the consumer – in this case the senior and his or her family – both in improving care and in increasing accessibility. Explain to me how putting an organized labor union layer between owners, management and caregiver is going to truly achieve either one. As unions siphon off their dues, someone will pay that cost. And the possibility of a labor strike as a tool to increase wages certainly won’t benefit the residents.

So to John Moore, CEO of Atria Senior Living Group and all the other assisted living communities who are interested in genuinely improving care and services, I have an offer for you. We’ll provide to you – at no charge (other than set-up fee) for up to 6 months – our online staff training system, aQuire Training Solutions, to help you demonstrate your commitment to increasing staff training.

Even the SEIU knows that a better trained workforce is a workforce that will provide better quality care. Here’s their press releases’ closing line:
The Campaign to Improve Assisted Living is calling for Atria to make a real investment in front-line care by staffing-up, increasing worker training, and lowering worker turnover.

Atria – we’ll help you achieve this without unionization. Any other assisted living company – the offer stands for you, too. Contact me and I’ll personally sign you up.

Tuesday, August 21, 2007

Engaging Caregivers' Minds

Today's news is an interesting mix of topics:

  • People traveling to Mexico for more affordable long term care (see past comments on the need for creative, affordable options right here at home);
  • New program and services designed to better support family caregivers:
    Sen. Amy Klobuchar,U.S. Senator from Minnesota has a new proposal:

"Most caregivers report taking time out of the work force, cutting back on hours and turning down promotion opportunities. One recent study found that women who provide care to an aging parent suffer about $8,600 per year in lost wages and benefits.

"Family caregiving also has a significant impact on our economy,costing businesses an estimated $33 billion annually in lost productivity.

"For all of these reasons, I am introducing federal legislation to assist our family caregivers."

I applaud this attention to the needs of the family caregiver – and the effort to do something to support these dedicated individuals.

  • A comment by Carol O’Dell (Mothering Mother, Kunati Press) “Engaging the caregiver’s mind is a challenge” as she goes on to share her experiences of depression, isolation, and the mind-numbing repetition of caregiving tasks. Carol describes her challenge to stay mentally engaged, active and growing as a person, and to fight the apathy that threatens to overwhelm.

    As I read today’s news and comments I am again convinced that, as a profession, we need to do two things: listen – carefully and hard – to family caregivers. Hear what they are saying. They need our services; they WANT our services. We need to listen and support them.

    Secondly, we need to engage the mind of the caregiver. Not just the family caregiver but the professional caregiver as well. Imagine the daily mind-numbing repetition of caring for many individuals, then going home to care for your own family and personal needs. Engaging these individuals’ minds – giving them challenges, new skills and opportunities for personal and professional growth – is one of the greatest gifts we can present to the caregivers we encounter and employ.

Monday, August 20, 2007

Someone to Watch Over ME!

Call us the Sandwich Generation - Baby Boomers - whatever you want. The truth is, we're tired! We're working to put kids through college (one down, 2 to go); we're helping our folks managing their lives, sometimes on a day to day basis. We still have a mortgage, and that private college tuition increase is putting us over the edge.

Last week as our middle daughter was heading back to college (the $40K+ a year expense item) she talked about how nice it was to be able to just run over to the school cafeteria and pick up some hot, home-made food without having to take the time or effort to cook it herself. Even though she'll be living in an off campus apartment, she'll still take advantage of the cafeteria from time to time.

I laughingly told her I was looking forward to moving into a retirement community myself someday and having someone cook for me, too. I like the idea of someone planning social outings and cleaning my home, too, on a regular basis.

While so much attention in the news focuses on people trying to stay out of retirement or assisted living housing, there is certainly a segment of us boomer population who are anxiously looking forward to the days when we can just run to the dining room and pick up a hot, fresh meal – prepared by someone else.

In our community (Portland, Oregon) a new senior high rise on the city waterfront, the Mirabella, being developed by Pacific Retirement Services is already sold out with a waiting list - and it's not scheduled to open until 2010. Some friends of ours have signed up, and they can’t wait to move in. Other friends are signing their parents up for this opportunity to live in a downtown, waterfront location with all the amenities of luxury retirement living. One sales representative recently told me that they were getting questions they’d never gotten from retirement living prospects before – questions like, “Will there be space to store my kayak?”

As I not-so-laughing said to my daughter, at either ends of your life you get someone to cook for you; in the middle, you’re busting your toosh cooking – and everything else – for yourself and your family!

Tuesday, August 14, 2007

AAHSA's Ethical Imperative is an Imperative for us all

Larry Minnix, President and CEO of AAHSA (American Association of Homes and Services for the Aging) sent his regular message out to members today. Minnix is an articulate, passionate advocate for seniors and the non-profit providers who are his constituency within AAHSA. Implicit in his messages of late is the need to fight hard for the profession, to preserve our ability to communicate directly to our frontline workers without going through union reps, and the real possibility that unionization throughout the profession may not only affect affordability for the consumer, but may have consequences throughout our society – it may, ultimately, bring this industry to its knees. (See AAHSA’s website in response, The Long-Term Care Solution.)

Today’s message from Minnix is titled, “Our Ethical Imperative”; in it Minnix addresses the need for non-profit senior care communities to look first and foremost at ethical behavior and interaction with staff – the human resources ethical standards that, unfortunately, some providers have forgotten. Minnix says, “Our ethical imperative is the leadership dynamic of transformation needed in long-term care.”

He goes on to relate two stories: one about an administrator who paid his immigrant work force minimum wage with no benefits, saying, “If they don’t like it, I can replace them immediately.”

The second story is about a community in Boston, Mary Immaculate Health Care, who chose to continue to pay wages to employees even after a flood left them without a facility in which to provide care.

Our ethical responsibility to our frontline staff has long been a passion of mine. Several years ago I was asked to speak at a state conference on the subject of ethics, and prepared a passionate presentation about the need for ethical pay and treatment of the lowest paid employees, who typically provide the most direct resident care.

I was part of a panel of presenters, including one woman who was the marketing director for a large, national company. Her portion of the presentation briefly mentioned ethics needed in the marketing process, and went on to discuss marketing incentive programs, benchmarks, and ways to increase census.

During the question and answer period, not one person commented on my portion of the presentation, some of which was, I thought, fairly controversial (my intention being to create discussion, debate and provoke some thinking in new areas). Hands went up all over the room, asking the marketing director specific questions all relating to how to get more results from marketing and sales staff.

I left the session wondering if I was talking to the wrong group or just a bit ahead of the curve in thinking about issues surrounding ethical treatment of staff. Here are just a few of the thoughts I presented at this conference:

A corporate executive stopping in at a community facility, dressed in a custom-tailored suit and driving a Lexus, communicates to the staff something that goes like this: “If you work hard enough, keep costs within the low, low budget parameters we’ve set, I’ll be able to continue driving my Lexus and taking my luxury vacations – and you’ll keep your minimum wage jobs!”

Wow! How exciting! I work hard, and for that work I get to earn $10 an hour (if I’m lucky; I realize that’s quite a bit above minimum wage), while the average Administrator earns several multiples of this amount and corporate staff earn even more.

And I’m pretty much OK with that as long as management respects me, listens to me and treats me as a valuable person, not just a commodity.

My own early exposure to this world was working as a nurses aide in a skilled nursing home my first year in college. I was hired on the spot, before my interview was even completed, and, while I was willing to work hard, I asked the supervisor if I could please have Friday evenings off at least a couple of times each month. This was the one accommodation I requested.

I stayed at that job for only one term. During that time, I received not one Friday evening off. I was given 10 – 12 residents to feed, bathe and “put to bed” every shift. I received no training, and spent ½ of one shift shadowing another aide. At no time did the person who hired me – the Director of Nursing – ever check in with me to see how my work was going, or to ask if I needed any additional training or tools.

Throughout my own career I have looked back on this personal experience and vowed never to treat any of my own employees in this way, but rather to listen to them, to really hear them and know them as people, and to treat each person in a fair, ethical manner.

Here’s an Ethics Policy I believe every senior care provider should embrace, adopted from Levi-Strauss’ policy:

Honesty: We will not say things that are false. We will never deliberately mislead.

Promise-keeping: We will go to great lengths to keep our commitments. We will not make promises that we cannot keep.

Fairness: We will create and follow a process and achieve outcomes that a reasonable person would call just, evenhanded and nonarbitrary.

Respect for Others: We will be open and direct in our communication, and receptive to influence. We will honor and value the abilities and contributions of others, [especially the lowest paid employees] embracing the responsibility and accountability for our actions in this regard.

Compassion: We will maintain an awareness of the needs of others and act to meet those needs whenever possible. We will act in ways that are consistent with our commitment to social responsibility.

As Minnix concludes: “We have an ethical imperative…It is the key to transformational leadership to change a broken system of inadequate quality, despite the resources thrown at it and the competition for them. Ethical thinking is the foundation for change. And it needs to happen every day, in every community.”

Non-profit or for-profit, if we are going to continue to achieve our mission – and our margin of profitability – in this vital profession of senior care, we cannot afford to evade this imperative.

Friday, August 10, 2007

Let's not make nursing homes and assisted living Home-Like - let's make them home!

Yesterday I attended a presentation designed to promote Avamere Health Services' newest community, an up-scale retirement residence called the Stafford to open next year in Lake Oswego, Oregon.

The presenter, talking about the meals, said that they won't be "restaurant-like" but will be authentic restaurant style dining. He said in an off-the-cuff manner, “People say their places are home-like, or their meals are restaurant-like; we’re not going to be ‘like’ anything; we’re going to be genuine.”

I thought, “What an appropriate concept for senior living!”

Too often we focus on being home-like, when what we really offer is a home environment that is simply different from the home one lived in before. If we truly believe that our communities are our residents’ homes, why are we describing them as “home-like?”

Several years ago I wrote an essay titled “Changing Home” in which I described our challenge in introducing my in-laws to moving from their long-time house into a retirement community (read it at the end of this blog). What I was trying to convince my in-laws was that they were not leaving home, but simply changing home.

Somehow we don’t seem all that convincing when we describe our communities, assisted living or nursing home, as “home-like.” Let’s start calling them our residents’ home, and training staff to think of them in exactly that way. We’re then guests and employees in our residents’ home, rather than them being visitors in our “facility.”

Maybe changing our mindset, and the way we orient our staff to think about residents and the building will help us achieve a true culture change that will genuinely make a difference in the quality of life and the quality of care.

Changing Home
(Essay written in June, 2005)

A few weeks ago I shared with you our family's story of helping BOTH sets of parents choose to move into a retirement community.

We spent weeks scheduling the first retirement community visit - weeks during which the negotiation went like this, "Mom, Dad, I know YOU aren't ready for a retirement center, but you know how much it would help the other set of parents."

And the reply invariably went like this, "You're right, we're not ready yet, but the other set of parents sure is!"

Finally, we got to the retirement center and spend hours - literally - getting through both sets of parents' anxieties and resistances.When we left, all four parents were talking about how nice this would be - "4 or 5 years in the future" (that's a 92- year-old speaking)!

Now, two months later, MY parents have their name on two waiting lists, and are actively cleaning out their very formidable collection of stuff; my husband's parents are still talking about the "where" and the "when."

My mother-in-law keeps bringing up this refrain, "I never thought I'd have to give up my home."

And I've been thinking we've been missing the mark here, both in our conversations with the folks, and in the marketing within our profession. We're not asking people to "give up their home" - we're simply asking them to change their address.

Because ANYWHERE can be home - whether you own, rent, or stay free. HOME is that place where you feel comfortable being just "you."

Where, if you're lucky (Mom, Dad, are you listening?) you're surrounded by people who make you laugh, who give you something to talk about, and who share meals, good times and bad times with you - and who are there to help you when you need help.
Because a house is just a house...but a home is absolutely wherever your heart happens to land.

Wednesday, August 8, 2007

Are You a Learning Leader? Lessons from MetLife

Every day I'm immersed in training issues for senior care providers: writing and editing CEU courses for administrators, discussing new, creative ways to train caregivers, working with our learning partners to develop online courses to reach out to even more care providers, especially those located in rural, remote areas with limited access to big-city training opportunities.

I love the example of MetLife, and the recent article that came to my attention recognizing this company as a "Learning Leader." Doris Fritz, the VP of learning and development, identifies the company's need to go beyond basic training and to address learning as a vehicle for corporate development in a fast-paced, changing business environment (sounds a lot like senior care, doesn't it?).

MetLife chose three main focuses of training:

1) Centralization and systemization to increase efficiencies;
2) Using technology and a design team to gather resources into the central distribution source;
3) Focusing on learning needs that advanced the company as a whole, including new employee orientation, customer sales and service, and in-depth product knowledge.

MetLife had been offering training as instructor-led, but determined that, to meet their goals, they would need to develop a robust e-learning approach. MetLife chose to hire an in-house team and spent significant resources developing their own e-learning solution.

The result? Quicker and more effective skill building in new employees immediately evident, with anticipation of strong, long-term results from this approach.

The application for senior care is clear:

1) Focus on building a community or company training approach that goes further than simply compliance;
2) Look to technology to help systematize the approach and delivery (and we don't need to build it from the ground up, with those high costs and time delays);
3) Expect increased skill development, at a quicker time-line, than traditional instructor-led approaches.

Improved training is accessible to almost every senior care community and company. Not going the extra mile to provide all the training, resources and support to our caregivers and other staff is a mistake that we cannot afford to make as we build excellence in service.

Monday, August 6, 2007

Outsourcing to India the answer to caregiving costs?

Imagine my surprise to open the Sunday newspaper and read the story of the man who moved with his parents - a 93 year old dad with Alzheimer's and an 89 year old mom with Parkinson's - to India for care that cost him less than $20 a day!

So here's the solution to those high costs of care: move to India. Seriously, though, it's a sobering story. Actually, it's quite heartwarming to read about their 1:1 nursing services, daily massages, and hour long physical therapy sessions. The parents are able to live at "home" - a house they share with their son and round-the-clock care staff.

And it's all affordable, with money left over. Their monthly bill for rent, utilities, food, medications AND 24 hour staffing is less than $2,000 a month. That's compared to the typical cost of about $4,000 a month for each of them.

The son in the story looks at his monthly bill and feels happy with the decision he has made, as now his parents get the care and services they need and can afford easily from their own income.

It's sobering to me to wonder if this is what we've come to as a country: the need to move to India - or Mexico - or Canada - to be able to afford medication and care that we will increasing need as we, and our parents, age.

Are there better solutions? Will we be a part in creating them - or just responding as people like us seek and find their own solutions?

Tuesday, July 24, 2007

Glad I'm not Atria Today

Today I received an email alert from Oregon Health Care Association that included this:

"Union Campaign to Improve Assisted Living's Report ReleasedOn July 9, the Campaign to Improve Assisted Living, "Assisted Living's Broken Promises: A Case Study of the Atria Senior Living Group." ...This report signals what we may expect from this group in the future as we anticipate that they may issue similar reports on other assisted living providers in a fashion similar to efforts targeting nursing homes nearly a decade ago. "

Check out this information and you'll also be glad you're not Atria today. This site is sponsored by the SEIU Healthcare, whose implicit goals are to recruit new union members from the vast pool of assisted living employees, many of whom are admittedly living at very low wages, doing very challenging jobs.

But creating bus stop ads, newspaper ads, and displaying postcards from family members on their website - all in relation to the poor job Atria is supposedly doing...I'm just glad I'm not Atria today!

I must say, however, that I got a smile out of the postcard note displayed on the site that, while indicating that a few changes would be nice, also said,

"The employees are caring and compassionate."

That pretty much sums it up, in my opinion. Assisted living employees ARE, by and large, caring and compassionate.

It's up to us to provide them the training, resources and support they need to continue to care. Without negative ads, please!

Finally, thanks to ALFA for creating this new website in response: Chose Assisted Living. It is a beautiful tribute to those individuals who have dedicated their lives and careers to providing care to seniors, and a great tool for professionals to use to help seniors and their families understand assisted living even better as a cost effective solutions to support seniors who wish to remain as independent as possible.