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.