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.