Monthly Archive

Aug. 29, 2006

As we celebrate Labor Day, we must recognize again the most important dimension of our work together — Respect. Respect embodies all that is good, healthy and holy in what we do.

Respect for people who deliver long-term care to older people in various stages of health and independence. Respect for those who serve mentally and physically challenged people of all ages. Respect for people who perform difficult, noble and essential work for virtually every family in America at some time in their lives.

Myriad studies tell us we face a demographic crisis as our population lives longer and a workforce availability crisis to meet emerging need. Still other studies point to staffing as the best proxy and predictor of quality in nursing homes. Studies define what it takes to attract and retain good people. Studies! Studies! Studies! Fretting! Handwringing! More studies! The Chicken Little syndrome! What ever shall we do? What’s the answer?

It all boils down to one fundamental principle of human psychology and spirituality — Respect. So, I’ll distill decades and volumes of research to the Ten Commandments of Respect. These are derived from countless conversations over cups of coffee with people who serve — like a night nurse from an Atlanta nursing home or a van driver from a New Orleans housing community. The Ten Commandments come from seeing hundreds of you in action in your world. They are inspired by the Better Jobs, Better Care living laboratory project of our own research institute. They are discerned from the learnings from numerous panel discussions held nationally and locally with people who work and volunteer in our great field of service. Here they are:

Ten Commandments of Respect

Commandment #1. Thou shalt recognize every employee as a person motivated to relieve human suffering and enhance the lives of others.

Commandment #2. Thou shalt view all employees’ roles as essential to the health of the people served and to each other.

Commandment #3. Thou shalt pay everyone competitively with livable wage and benefits that reinforce family health and economic stability.

Commandment #4. Thou shalt see every employee’s human development potential and offer programs to stimulate personal growth.

Commandment #5. Thou shalt honor the unique and diverse backgrounds and traditions of all people.

Commandment #6. Thou shalt allocate resources to learn the new and emerging concepts and techniques to improve competence and self-esteem among all team members.

Commandment #7. Thou shalt cultivate and nurture helpful and hopeful attitudes among team members and support each other in times of personal tragedy.

Commandment #8. Thou shalt deal with conflict, incompetence and injustice swiftly.

Commandment #9. Thou shalt have fun and grieve losses together frequently.

Commandment #10. Thou shalt take time to rest and renew.

Respect — for each other; for life as a sacred cycle; for aging and disability as inevitable states of existence. Respect — for human potential through desire to do well and do better. Respect — for the possibility of a better life, for legitimate difference of opinion and for the success and achievements of others. Respect — for commonly held values and diversity of traditions within those values and for the freedom to contribute and grow.

I hypothesize that respect is the single most important thing that will make us successful because it always has.

Anybody want to study that? Or do we want to go ahead and implement it every day because we already know the power of it!

Happy Labor Day to all Who Labor Every Day — regardless of your formal position or title.

Larry

William L. Minnix, Jr., D.Min.
President and CEO

Aug. 25, 2006

We sent each of you a video earlier this year called “Imagine the Future of Aging,” featuring a four generation family whose patriarch is 87-year-old Ernesto, who can stay at home because of sensory ,monitoring and communications technology embedded in his life. This is no “Star Wars” episode. This video features technology that is in some stage of prototype development today. Technology is here. We need to anticipate what it can do to help older people and those who care for them. I encourage each of you to view that video with your staff, board and community leaders. It has a study guide to facilitate technology planning. High tech enables high touch which improves quality.

While the “Imagine” video envisions a futuristic scenario, many of our members are embracing available technologies and developing new ones that make life better. They are helping residents in apartments and home settings with emergency call devices with that notify caregivers of problems. These are becoming commonplace.

Some nursing home members are using hand-held devices for caregivers to document care electronically. There are also medicine carts mounted with wireless devices to record medication deliveries. Organizations like Methodist Senior Services of Mississippi, and Moravian Manor in Pennsylvania are using these types of technologies. Soon, these kinds of devices will also be commonplace and may help define the quality difference between who is excellent and who might not survive in the nursing home sector.

Other members are using technology with sophisticated clinical quality improvement tools to improve clinical care. Some can even predict bad clinical events and make recommendations to staff on how to prevent a negative outcome. Our own members in New York developed a program with software called “Equip for Quality,” as an example. Others like The Kendal Corporation, Erickson Retirement Communities and Rest Haven Christian Services are investing in clinical systems that integrate care and services throughout their communities and beyond to improve quality and health status of all their residents — regardless of level of care or facility in which they live.

AAHSA members like Ecumen, Eskaton and Front Porch are developing very specific products with technology companies to help older people beyond their walls. Some are doing joint research with companies like Intel or Living Independently. Sears Methodist Center even created a new company called “Senior Safe@Home” to expand their mission of service.

Rogerson House in Massachusetts is using fitness technology to create a wellness program called “Rogerson Fitness First.” A company called “Its Never 2 Late” shared a remarkable system used by Christian Living Campus in Denver. It features video games and art to help severely impaired residents express themselves and communicate with their grandchildren, who use technology as a way of life. I observed a stroke patient being coached through the use of the technology. Watching this severely disabled person engage and enjoy the program could bring tears to your eyes.

Other members are turning to universities to partner on the research and testing of very practical products to improve life quality. Dr. Robyn Stone and I recently visited the lab of Dr. Majd Alwan of the University of Virginia. Dr. Alwan is a founding leader of CAST and chairs our “Pilot Projects” committee, which is charged to help all of us advance member involvement in practical research. Imagine my pleasant surprise to see the logos of Volunteers of America and the Evangelical Lutheran Good Samaritan society in Dr. Alwan’s lab as partners in applied research.

Many members are emphasizing technology as a major part of their strategic plan. I read annual reports and newsletters sent to me that reflect this interest. The annual report from Teresian House, a long-time culture transformation leader through the Pioneer Network, says the “…new long term vision of Teresian House is to evolve as a technical leader in social, medical and spiritual care…” Imagine linking spiritual care and technology. Wow! Sister Pauline is always on the cutting edge.

Wesley Enhanced Living of Philadelphia asks the strategic questions in their 2005 annual report called “Compelling Difference”:

“How Can Wesley Enhanced Living be more efficient and productive with the resources we currently have? How can we enrich life for those who are dedicated to living?… One possible approach to both challenges includes technology-based solutions.”
And Lutheran Homes of Michigan has recognized how technology is “dramatically changing the array of services that seniors need and want.”

The McGregor Home and Pacific Retirement Services are exploring smart housing on a broad scale. CAST member Elite-Care in Oregon now has a smart campus of independent and assisted living. It has been featured world-wide, recently on NBC Nightly News.

There is also technology that can help us in facility and maintenance planning. Our platinum business sponsor zumBrunnen, Inc. has a remarkable program that can help any member with construction and maintenance planning for the future. AAHSA used zumBrunnen’s services for the capital maintenance planning for our headquarters.

A fundamental issue in technology for an aging population is the electronic health record. Peter Kress, a technology guru with ACTS Retirement-Life Communities, has been leading the national charge to standardize a comprehensive and secure health record plan to solve this fundamental problem for the people we serve. This is an enormous undertaking and Peter, along with other CAST members, are leading this policy-making process. Without a portable personal health record, care for the people you and I serve will be fragmented and difficult.

Recently, through member leadership provided by Kathy Bakkenist of Ecumen, a bill has been introduced in Congress to create a focused national agenda to advance aging- services technology. The coming weeks are a crucial time and we will be asking you repeatedly to contact your elected officials and tell them how this legislation can help speed to the marketplace technologies that can transform aging. This legislative initiative is an excellent example of how members and business leaders are working together to transform our field.

Technology. Why should we care? First, technology is here to stay. It’s everywhere. More than some of us want. I don’t like the idea of my car telling me how to drive. I can see how Blueberries, Blackberries or Raspberries facilitate communications, but as I stood for a prayer in church a few weeks ago, I saw a man working his Blackberry with his head bowed. Maybe the Blackberry gave him a high tech spiritual connection to the Almighty I don’t have. I still rely on old fashioned prayer, inspiration, The Bible and advice from people who are better than I am to seek divine guidance. I’m probably out of touch. Maybe a Blackberry in church would give me a divine pipeline.

However, I have seen enough use of technology to know that it can make work life better for staff and quality of life better for the people we serve.

High tech can facilitate high touch. When I visit health care members, I ask nurses how much time they spend on paper work versus patient care. The frequently tell me they spend 50 to 80 percent of their time on paperwork. That’s not why they became caregivers. We can become so obsessed with getting the paperwork right that we forget about the person being served— especially with regulatory pressure we face.

Technology — it can catalyze the transformation of your organization. Sister Pauline and the Teresian House are right. We should all be the technology leaders in social, medical and spiritual care and service delivery.

And if God inspires me through my Blackberry, I’ll write about it. On second thought, maybe not…

Larry

William L. Minnix, Jr., D.Min.
President and CEO

Aug. 1, 2006 

Last Friday, the Centers for Medicare and Medicaid Services (CMS) announced in the Federal Register that it is participating in a two-year campaign called “Advancing Excellence in America’s Nursing Homes.” The campaign was founded and will be implemented by an unprecedented coalition of consumers, providers, foundations, government agencies and other professional leaders. I am privileged to be the initial chair of the steering committee of the groups involved to see that this campaign is successfully implemented.
As stated in the Federal Register notice, “the ultimate objective of this new nursing home quality campaign is to make a real difference in the quality of life and efficiency of care delivery in nursing homes, by accelerating progress in identifying and treating pain and pressure ulcers, by virtually eliminating the use of physical restraints, and by transforming the nursing home work environment to attract and retain nursing and other staff.”

But this campaign is so much more than that. The “Advancing Excellence” campaign is designed to make a great leap in Quality and Trust and is a major enhancement to Quality First for nursing homes. For the first time, numerous ongoing quality initiatives including Quality First and the CMS Nursing Home Quality Initiative (NHQI) are coming together and incorporating the culture change activities of organizations including the Pioneer Network, Eden Alternative and The Wellspring Institute.

The campaign is significant in ways that may not initially be apparent. First, the coalition brings to the table many groups, some of which traditionally have not worked together. Key stakeholders involved in the planning of the “Advancing Excellence in America’s Nursing Homes” campaign include: Alliance for Quality Nursing Home Care; American Association of Homes and Services for the Aging (AAHSA); American Association of Nurse Assessment Coordinators (AANAC); American College of Health Care Administrators (ACHCA); American Health Care Association (AHCA); American Medical Directors Association (AMDA); Centers for Medicare & Medicaid Services (CMS) and its contractors, the Quality Improvement Organizations (QIOs); The Commonwealth Fund; The Evangelical Lutheran Good Samaritan Society; National Association of Health Care Assistants (NAHCA); National Citizens’ Coalition for Nursing Home Reform (NCCNHR) and the National Commission for Quality Long-Term Care.

Second, consistent with Quality First, this campaign gives nursing homes the opportunity to commit openly to specific quality measures so that we can all “stand for” quality and not be defensive about it. The goals that the coalition has identified seek to improve clinical care; incorporate nursing home resident and family satisfaction surveys into continuing quality improvements; and increase staff retention to allow for better, more consistent care for nursing home residents. Nursing homes can volunteer to be measured on these indicators, showing the public we are confident about our commitment to quality.

Third, for the first time, a quality improvement initiative includes in its process measures indicators related to consumer and staff satisfaction. This allows these most important voices of consumers and staff members to speak for themselves. Every serious study of long-term care improvement – including our studies around Wellspring, Pioneer and Better Jobs Better Care point to the health of our workforce as the single biggest key to quality improvement. Caregivers will finally receive the attention they deserve.

Lastly, the campaign will have important synergy with the National Commission for Quality Long-Term Care, the so-called “Quality First Commission.” Chaired by former Sen. Bob Kerrey and former Speaker of the House Newt Gingrich, the commission is one of the founders of this new quality campaign. The Commission is another platform to focus the quality campaign’s results on solutions for our field and for our policies. As it enters a new phase, the Commission will also focus our country’s attention on how long-term care should be financed. It is difficult to talk about quality without addressing the underlying question of how we will pay for the quality we expect and deserve.

Through this campaign, we have a new visible way to tell the story of the quality you’ve provided for decades and our shared commitment to the transformation of our field. For those of you who do not offer nursing care, the campaign’s focus on customer and employee satisfaction can help you focus your own quality first efforts, consistent with Quality First’s 10 Elements of Quality. Some of our most innovative applications of Quality First have come from our housing and home and community-based services members. That’s why I urge you to sign the AAHSA Quality First Covenant and to develop a plan that focuses on these areas of your work.

This campaign will launch at a Quality Summit on Sept. 29 in Washington, D.C. We expect about 400 people to attend to assess quality in today’s nursing homes; the need for public confidence in long-term care; the role of the caregiver workforce in quality improvement and how the campaign will be implemented at the national and local levels. Invited participants include leaders from the consumer, provider, government and philanthropic sectors. Shortly after that, nursing homes will be asked to volunteer to participate.

This campaign is an opportunity for nursing homes to earn their rightful trust in the public’s eye as a care sector that is known for excellence and worthy of the public’s trust. Our mantra is that quality should be an automatic public expectation. We — and you — are helping to fulfill that promise.

Larry

William L. Minnix, Jr., D.Min.
President and CEO