Celebrating Assisted Living Week

This week ends National Assisted Living Week. You probably were completely unaware of this week of honoring assisted living, especially since we also honored and remembered events that changed our world with the 9/11 tragedies.

But while most of us missed the party, for millions of seniors and their families throughout the U.S. the celebration took place quietly and in an everyday sort of way. It is a celebration nonetheless of a kind of care that wasn't even available just a few years ago.

Less than a generation ago, seniors who needed care had fewer options. Most either went straight into a nursing home or remained at home with family caregivers.

The family caregiver pool diminished dramatically with the growth of women in the workforce, and nursing homes were clearly not the best environment for many seniors who didn't really have medical needs.

And so a new level of care developed that offered support for daily living tasks but minimal nursing care. It was developed on a model, too, that specifically and intentionally feels and looks more like home (or, in many cases, a nice hotel) than like an institution - another aspect that set it apart from nursing homes.

Today families have options for care that range from in-home care (one of the fastest growing segments of elder care today) to assisted living communities to nursing homes that now incorporate many of the values of person-centered care that assisted living has made the norm.

As a society facing an aging population and a potential crisis in care options, we have many reasons to celebrate assisted living this week. Here's my personal word of thanks for all the folks who provide this care, from the investor and developer to the care staff who give so many families a good night sleep knowing their loved one is in good, caring, compassionate hands.

Sleeping Well at Night

I was touched by the entry written yesterday by a family member who had just moved his loved one into a care center.

He talked of the pain of leaving his wife, but the joy when he came to visit a few days later to see his wife happy - dancing, even.

His closing comment was the most poignant:

This good news has lifted a huge burden from me. I now sleep through the night for the first time in eight years.

This is a comment I've heard countless times over the years. Families agonize about finding care for a loved one. They feel deep angst about moving a mom, dad or spouse out of the family home. Of course there's a little guilt. Of course there's grieving what once was, and is now lost.

After it's all said and done, however, the dominant feeling is relief.

It's all about balance. What works for one family is not the same as what will work for another. In this era, we need to be open, accepting and supportive of the solution that each individual family chooses. Not everyone should move into a care community. Not everyone should stay in his or her own home.

The true beauty of living in the age we do is that we have the choice. It's no longer home or nursing home - many options exist in between.

Here's to finding what works for you, and what lets you sleep well at night.

aQuire Training Prepares to Launch Online CNA course

After a lot of hard work on the part of all the aQuire Training Solutions' team, along with many of the folks at the Oregon Health Care Association, we are finally preparing to launch the first ever online nursing assistant course in the state of Oregon.

Might not sound like a big deal to you, but it IS a big deal to people in this state. Last year the state legislature passed a new law increasing the ratio of CNAs to residents in nursing facilities here; that ratio increases yet again two more times. The bottom line for residents is better care. For facility managers, however, it could present a nightmare scenario when they can't find enough CNAs to fill the jobs they must fund to meet the new staffing ratio.

At the same time, the number of individuals being certified as nursing assistants in the state has been in a steady decline.

At the intersection of increased demand and reduced supply is a crisis.

With this course, we not only utilized every tool at our disposal to create a course that showcases what online learning can be, but we also, in our partnership with OHCA and over 40 member facilities (where students will complete the lab and clinical aspects of training), are breaking some exciting new ground in creating the ideal blended learning environment.

We've got people clamoring to begin the course as quickly as possible - people who simply couldn't access training without the online portion of this course.

It's pretty exciting for us. We'll keep you posted on the results in the weeks and months to come.

Read the whole press release.

e-Training Making a Difference in Senior Care

Last week we had a visit from a person who works in a state office on education. He's got a PhD, and specializes in distance education.

I admit it - I was nervous when I began showing him samples of our online courses, both on our website EasyCEU (for licensed nursing home and assisted living administrators, nurses, social workers and other licensed senior care professionals) and on our aQuire Training Solutions website. We showed him samples of all the ways we've built and designed courses to be delivered online.

Our newest course - the one we're most proud of - is the online nursing assistant course. We've just submitted it for approval, and hope to launch it in the state of Oregon within a month or so.

At the end of the presentation we sat back and waited to hear this expert's opinion. We're not distance learning experts, after all (at least we certainly weren't when we began this journey). We're just passionate about training the next generation of individuals who will care for seniors.

We're passionate in a professional way, meaning we've invested millions of hours and dollars into trying to discover the most effective, efficient ways to train new caregivers.

We're passionate in a personal way, too, since we realize that the people receiving the care are our parents, grandparents - one day (in the rapidly approaching future) ourselves.

We believe we're making a difference. We think, maybe a bit too boldly, that our newest nursing assistant course can contribute to a genuine culture change in the way care is provided in the state of Oregon.

There was a moment of silence, and then the expert commented, "I'm tremendously impressed. Your courses are visually interesting, highly interactive and rich in content. You're doing something that absolutely no one else is doing in this area right now. It will make a difference."

It's an incredibly gratifying way to end the week, believing that what you are doing DOES make a difference in senior care today, and will make a difference in the future, too.

It's exciting, too, because we've only just started out on this journey!

Use Your Brain and Your Heart

Our IT Director wandered into my office the other day and made the general announcement that I send – and receive – the most emails of anyone in the company. While I was feeling a bit smug, my husband reminded everyone that only a few years ago (time goes by fast – it was at least 8 years ago) I refused to use email, telling all my friends and colleagues that if they wanted to talk to me, pick up the @#$%$& phone!

But I digress from the topic I intended to write about, and that’s an April Fool’s email I picked up today - ahhh, that’s how I got to the bit about too many emails – some don’t get read until a week or more has gone by.

It was a post from my very favorite e-learning blogger, Tom Kuhlmann at the Rapid E-Learning Blog. Here’s the link – it’s worth 5 minutes of your time: April Fool’s E-Learning Example.

While it’s a spoof on e-learning tips, one message stuck with me, because I believe this one message alone would change the face of training, especially for senior care staff in assisted living communities, nursing homes and home care settings:

“Use your brains and your heart to make your training smart.” (It’s actually part of a rap that’s on the demo.)

Although in my company we often refer to the flash-card approach to e-learning; that is, the repetition of key concepts through stories, games, quizzes and illustrations, we aren’t really teaching multiplication tables.

We’re teaching people to be compassionate, caring, observant individuals – to notice something that is unusual before it becomes a crisis.

We’re teaching people to be on the lookout for ways to brighten the days of the seniors they work with; to add smiles, hugs, laughter and playfulness to the daily dose of doctor-prescribed medication.

We’re teaching staff to understanding how to create an environment of caring and to avoid anything that might harm a resident, no matter how unintentional.

We’ve got to teach the heart and the mind to truly train people to be the kind of caregivers that we want caring for our mothers – our fathers – someday, ourselves.

Risk Management in Senior Care: the Case for e-Training

I was talking with a client of ours the other day and she shared a story that I can relate to all too well. She was asking staff for their feedback on the new e-training system that they have been using – just happened to be our system, aQuire Training Solutions.
“Believe it or not,” she said, “I kept hearing comments like this: ‘I learned so many new things’ from my staff. The most eye-opening thing for me was that this is content I’ve been teaching in inservices for years – it’s not really new!”

What Debbie was commenting on – and what I’ve experienced first hand – is that staff don’t remember. They don’t remember what you said during an inservice – or a dozen inservices. Maybe it’s because we tend to schedule inservices on pay-day, and staff could be just a little tiny bit preoccupied with how badly they need that check.

Maybe it’s because staff are either on their way out the door for the day (mentally clocked out), not really checked in yet - or not quite awake (quality training for night staff probably doesn’t happen during their regular sleeping hours).

Whatever the case, it seems like a lot of the time staff just aren’t listening. And in my experience, that’s troubling.

Troubling because training topics are things that staff really need to know. It’s not “hey – here’s a fun idea to do with your family this weekend” kind of stuff. It’s the kind of information and skill development that means the difference between quality care and just eeking by.

It is also the training that makes the difference during survey or when litigation is threatened.

Did you train staff on this? When? Where’s the documentation?

And then when someone asks the employee, “Have you had training on this specific topic?” and the employee says “No – I don’t remember ever being trained on that!”

Your sign-in for the inservice training isn’t going to carry much weight. You can say, “I know we covered that information,” but if your staff doesn’t remember it, and say they have never been trained on it, guess what – you’re in trouble.

And that’s where e-training can save the day. Not only do you have documentation of training, you have the EXACT content that the training included, a test that the employee had to pass to earn a certificate, and validation that the person was tuned in and trained on the topic.

And if you, like most companies, have a blended approach to training – some stuff you still have to cover in inservices or seminars – our newest module, the Training Tracker will let you document that training on the same page as the e-training. One click of the “Print” key and you’ll be able to document full training compliance for every employee.

And if you’re like me, one of the things that keeps you up at night is managing the balancing act of meeting increasingly rigorous licensing requirements and avoiding threatened lawsuits. Lose your balance on either one, and you’ll pay in time, money, and reputation.

Sort of makes implementing an e-training system a no-brainer.

The Ethics of Truth

The past couple of weeks have been ones in which truth-telling has taken a bath. One of my personal “good guys,” Eliot Spitzer, was found – well, you know where.

And while my local newspaper endorsed Barak Obama in large black editorial typeface, my periodical of choice, Time Magazine, ran its own editorial about why newspapers should never write an endorsement of a candidate (makes them look less objective, was the reasoning).

Then in this week’s Time, a columnist shared his day’s tasks: run, eat, drop off kids, vote for Barak.

It makes me think about an issue of ethics that I’ve believed in for some time: transparency.

I remember precious little else from my undergraduate education, but this one bit of extemporaneous advice from a professor stuck with me and rang true: as people setting ourselves up to help and guide other people, the most honest thing we should do is post, for everyone to see, our own personal guiding beliefs. Then, people who chose to accept our help would know what they were getting into.

It rang true to me then, and it rings true to me today. What guides me, as a person, will deeply affect the advice and assistance I give you.

As an educator, dedicating this phase of my career to training the next generation of senior care providers, my personal beliefs profoundly affect how I craft the learning experience.

My staff has been immersed in the creation of the first online course to train Certified Nursing Assistants in the state of Oregon, a project jointly sponsored by my company, aQuire Training Solutions, and the Oregon Health Care Association.

Part of what every nursing assistant must know to pass the state exam is a set of procedures for providing specific care tasks to individuals; things like transferring from bed to wheelchair, and assisting with a shower.

The state posts these procedures, step by 101-step, on their website. Instructors must teach the steps exactly as the state sets out.

As we were creating learning activities to help students learn these steps easier I felt myself getting more and more agitated – couldn’t figure out why, until I realized – and shouted, “These steps sound like we’re moving pieces of furniture!”

We’re teaching students the steps, but we’re adding in, for every step, a sample quote of what the student might say to the individual as the step is being taken.

We’re not caring for pieces of furniture. We’re caring for individuals – with losses, with needs, with real human lives.

My own beliefs show through in every aspect of this course. I think that the course will be better for it – but that’s for you to judge. My beliefs are pretty much out there for everyone to see…

Watch the movie…you’ll get it!

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.

Boom?

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.

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 Journal.com) 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.

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.

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.

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.

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.

Choices

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.

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.

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.

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.

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.

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.