Monthly Archive

AAHSA’s hopping on the Facebook bandwagon, and we want you to join us! Click here to join the AAHSA Facebook group. As a group member, you can connect with your colleagues near and far, watch videos, read the latest news in aging services and find out how AAHSA’s changing the face of aging in America. Send us your contact information and we’ll make you a friend of AAHSA’s too. Let the social networking begin…

When the GAO says something, people listen. That’s why it’s no surprise that their latest report on nursing home quality improvement made the The New York Times.  The reports features a variety of suggestions to make sure America’s nursing homes improve. But there’s one important suggestion missing: tracking staffing. After all, they are the best proxy to quality we have. That’s why AAHSA CEO Larry Minnix wrote a letter to Times in response:

To the Editor:

Sure, hiring a new worker or instituting a training program won’t solve this problem, but it could make the life of a vulnerable person a little better. And that’s what it’s all about.

What makes a nonprofit a nonprofit? This topic has been all over the news lately, most recently in the New York Times. How does an organization demonstrate to the community, and policymakers, that they are provided a public good?

So what exactly is the difference between for-profit and not-for-profit providers? Well, here at AAHSA we see the difference in several areas:

• Mission: Not-for-profit providers meet the needs of older adults because they adapt to the changing aging services landscape while remaining committed to their missions.

• Governance: Community-based volunteers, not corporate investors, govern not-for-profit organizations. These individuals commit to ensuring that an organization remains true to its mission, responds to local needs and serves as an effective steward of its resources.

• Quality: Not-for-profit aging-services organizations consistently use their resources to provide more hands-on care and develop new and creative ways to meet the needs of the people they serve and their families. These approaches help aging-services providers set the standard for quality in the field.

• Resources: Not-for-profit organizations reinvest all resources into their missions. Resources are used not to benefit stockholders or increase company value, but to increase staffing, improve facilities, enhance services, and most importantly, ensure consumer and staff satisfaction.

• Services: Not-for-profit organizations are committed to innovation and continuous quality improvement. These organizations tailor their housing, healthcare and community services to meet individual needs, not profit goals.

• Ethics: Not-for-profit aging-services providers have a moral responsibility as caregivers, employers and members of the community. More specifically, the AAHSA mission, vision and ideals suggest that its members have at least a tri-fold responsibility: to provide high-quality service to those in need; meaningful work for staff, board members and volunteers; and an ethical workplace for employees.

Click here to read more about the not-for-profit difference.

There are many useful resources available on the Quality First Web site to help your organization display all it does for the community. How does your organization spread the word about its good work?

Check out this new Quality First ad to inspire you on your journey:

“Know it, Show it” includes two key pieces for AAHSA members:
(1) Striving for continuous quality improvement;
(2) Promoting consumer understanding and earning the public’s trust.

What are you doing to know and show your quality?

The Villages at Unity, an AAHSA member in New York, is hosting several events in conjunction with AAHSA’s 1st Annual Homecoming. The events will honor the residents of the community and are free and open to the public.

Tuesday, May 27, 10:30 A.M.: YMCA demonstration of Zumba Chair Dancing

Tuesday, May 27, 2:00 P.M.: Reception with Democrat & Chronicle’s Bob Marcott

Wednesday, May 28, 1:30 P.M.: Spring Fling with music by Gateswingers

Thursday, May 29, 2:00 P.M.: Lecture by Margaret Thirtle, former vice president of Sibley’s Department Stores

Friday, May 30, 2:00 P.M.: Talbots Spring and Summer fashion show

AAHSA members all over the country will be celebrating Homecoming next week. What is your community doing?

It’s no secret that adopting culture change principles in a nursing home is the right thing to do. But a new report from the Commonwealth Fund finds that it may be better for business too.

Take staff retention.  Researchers found that 59% of nursing homes who implemented seven or more culture change intiatives, like letting residents determine their daily schedule or asking nursing assistants to participate in care planning, had improved their staff retention rate since they implemented these initiatives.

That’s not all. Occupancy rates went up and operating costs fell as nursing homes adopted more programs that empowered direct care staff and focused on residents’ needs and preferences.

That’s not to say these programs aren’t costly. 31% of nursing homes surveyed reported that cost was the biggest barrier to implmenting more culture change programs in their facility. This survey, however, begs the question: does embracing culture change give nursing homes a better “bang for their buck?”

Attention all caregivers: AAHSA wants to hear from you!

We’re developing a “Tips from the Experts” page of our Web site for consumers looking for guidance on finding and evaluating care and service options for seniors. …and guess who the experts are? Caregivers like you!

Here are the categories we’re considering:

–How to evaluate a CCRC

–How to evaluate an assisted living residence

–How to evaluate a nursing home

–How to evaluate an adult day services provider

–How to evaluate a home health provider

–How to determine what services are best for an older person

–How to find services in your community

We’ll publish your tips on our Web site with your name and photo. Let us know if we’re missing any questions or categories and we’ll add them to our site.

I’m looking forward to reading your responses!

Lutheran Services for the Aging  (LSA) does. In fact, they made the pages of the Salisbury Post because of their efforts to keep the landscape around their new facilities intact.

“It would have been easy and less costly just to level everything to build our parking lot, but we really wanted to be good stewards of the land and preserve the natural surroundings,” Keesha Smith, LSA’s director of special projects, said in the article.

Smith’s words say it all. Our not-for-profit members have an obligation to be effective stewards of all resources, including natural ones.

How can your organization start “going green?” The “Environmental Stewardship” section of the AAHSA Quality First Web site features a variety of tips and tools you can use to get started.

Lutheran Services for the Aging, an AAHSA member, included environmental protections in their recent renovation project. They designed their parking lot around the existing trees on the property to protect the old growth - protecting the environment and adding to the beauty of the campus.

“Environmentalism is part of being a good citizen in the community,” said Lutheran Services President Ted W. Goins Jr. “… We take that responsibility very seriously. We were advised that it would be easier to just cut the trees down, but sometimes the easy solution is not always best.”

Even though they could have saved the money, they opted to help the earth and beautify the campus. What types of things has your organization been doing to protect the environment?

Our CEO’s communications to AAHSA members, known better as “Larry Letters,” are the most popular publication we produce. Why? I think it’s because Larry’s got a knack for telling stories that inspire us to make a difference.

Take a look at his latest letter. It starts with a simple story, but by the end, you’ll be ready to contact your member of Congress with a simple message: make it easier, and more affordable, to care.
May 7, 2008
Recently, I was invited to teach a class at George Mason University’s masters in public administration program. The regular faculty member is Frank Shafroth, my good neighbor and chief of staff of our Congressman Moran (D-Va.).

Frank represents the best of public service. A distinguished career in the Peace Corps, House of Representatives, U.S. Senate, National Governors Association and county government. Frank is a lawyer by training and a teacher-gardener by constitution.

Frank is intrigued by AAHSA’s Long-term Care Solution, so he invited me to teach his class one evening and share the framework with his students. There were 11 students, ages 20-something to 60-something. Mixed backgrounds, employed in a variety of businesses from government intelligence to the funeral industry.

I asked the class how many had experiences in their lives as caregivers. Seven of eleven hands went up. I asked who would mind sharing their situation. One young woman had experience early in life as a kid. An older Caucasian man had been a long-distance caregiver for his mother. An African-American woman said her family tradition is that the caregiving falls to her because her mother says that caregiving is a daughter’s responsibility (her two brothers agree). There were multiple ethnic backgrounds represented in this small class - and there seemed to be ethnic traditions that differ quite a bit when it comes to expectations about caregiving.

One woman’s story caught my attention. She is 32, a newlywed of three months. She and her husband agreed to move her 97-year-old great-grandmother into their two-bedroom townhouse. They love her a lot. She and new hubby became the caregivers because the grandparents can no longer do the job due to health problems of their own. Her mother and aunt now have responsibility for grandparents and great aunt. I asked her about the “burdens” of caregiving. “My great-grandmother isn’t a burden. It’s just what you do as a family,” she said. “Finding the community resources to help us see about her during the day while my husband and I work is the real burden.” She’s also worried about her parents, so she pays for long-term care insurance for them.

Several in the group could identify with the maze of what I call “yellow pages” assistance with confusing options and no guidance to help make good choices. Several could identify with the hospital discharge crisis of not knowing where to turn when an older person has their Medicare coverage terminated. Getting help in another state with programs that differ from state to state is a common theme. No one to help make choices, make decisions and pursue options. Transferring assets, what’s covered by Medicare or Medicaid or long term care insurance - a mish-mash of financial issues.

Recently, a former member of Congress was referred to me by a Congressional staff member. Her mother almost died a few months back from an infection. The mother suffers from a neurological disease, may also be depressed, can’t go home but may not need the nursing home she’s in and she’s bounced around the acute and long-term care system in a large city.

I asked the former Congresswoman if her mother had received a comprehensive geriatric assessment. “No,” she said, “I didn’t know a comprehensive assessment was even an option.” So, we offered to help her set that up. The Congresswoman loves her parents very much. She just doesn’t know what to do.

The class at George Mason and the former Congresswoman are among 34 million families today that need our help beyond the boundaries of our traditional services. And policy leaders offer few answers. One state seems to believe heavy fines for nursing homes should be a priority in long-term care. Others believe almost everybody can be cared for at home, so let’s close down the nursing homes. Still others are slow to support home-and community-based services because people will come out of the woodwork to take advantage of government programs. Many believe we can regulate good care and services. Others believe the marketplace will sort all of this out, whatever that means. Some think tax breaks are the financial answer while others believe a universal plan is in order. Others even say that long-term care is such an overwhelming issue that we can’t address it politically.

It is my belief that few policy makers really know what they are talking about because they don’t connect their own families’ caregiving experiences with an opportunity to change policies or a chance to win voters’ hearts. I heard of one member of Congress with a “graying” district who wants to avoid the aging agenda because of appearances to his constituents. Perhaps he’s denying his own aging.

I’d like to ask each and every one of you to convene a community forum that helps people understand and access community resources and brings to light why we must demand that policy makers create a better system that empowers consumers instead of burdening them. We can help you structure the forum and ask the right questions.

Real people are willing to take responsibility for their elders, but they often find the current system a nightmare to navigate. Even people who make laws don’t know the options. Let’s get the really good public servants like Frank Shafroth to help create the policy story that addresses the critical policy problems that make it difficult to care.

If AAHSA members don’t help families make connections and don’t help policy makers make connections to get the help they need, and if we don’t help policy makers create policy and programs based on the needs of real people, then who will?

Caring for our loved ones and friends is our personal responsibility. Making it not a burden is ours. Hopefully, we will all live long enough to be somebody’s great-grandparent, and hopefully, a great-grandchild is there to care. Let’s make it easier.

William L. Minnix, Jr.
AAHSA President & CEO

When I think of the New England Journal of Medicine, my first thought isn’t long-term care. New medication for a disease? Yes. A study linking my favorite food with some kind of unpleasant health condition? Possible. But long-term care? Not so much.

That’s why I was surprised to see this article about LTC and the 2008 election in this month’s issue. In it, Dr. David Stevenson analyzes a variety economic, social and political factors that all come down to one conclusion: long-term care is here to stay, and candidates for political office have to start talking about it. Steveson said it best here:

“If the upcoming election truly is about creating sustainable change, then presenting an efficient and humane plan for the reform of long-term care should be viewed as an important test of the candidates’ vision for our country. ^”  

Then it came to me: like a new medication or research study, our long-term care crisis isn’t a stagnant situation. It’s dynamic and our politicians, like medicial researchers, must discover how can we can make  long-term care affordable in America.

I think investigating AAHSA’s Long-term Care Solution would be a good start. Do you have any suggsetions to share?

First there was the slow food movement, now there is a push for slow medicine.

“Grounded in research at the Dartmouth Medical School, slow medicine encourages physicians to put on the brakes when considering care that may have high risks and limited rewards for the elderly, and it educates patients and families how to push back against emergency room trips and hospitalizations designed for those with treatable illnesses, not the inevitable erosion of advanced age.”

Slow medicine helps older adults make decisions for themselves when it comes to treatment. According to the article quoted above, this mission is much more easily accomplished when a person lives in a retirement community. Healthcare communities, like Kendal at Hanover, develop a relationship with the patient that includes finding out their wishes for their end of life care. The example below demonstrates how slow medicine works.

…at Kendal — which offers a continuum of care, from independent living apartments to a nursing home — death and dying is central to the conversation from Day 1.

So it was natural for Ms. Gieg to stay in touch with Joanne Sandberg-Cook, a nurse practitioner there, during her husband’s out-of-town consultation.

“I think that it is imperative that none of this be rushed!” Ms. Sandberg-Cook wrote in an e-mail message to Ms. Gieg. The doctor the Giegs had chosen, the nurse explained, “tends to be a ‘do-it-now’ kind of guy.” But the Giegs’ circumstances “demand the time to think about all the what-ifs.”

Ms. Sandberg-Cook asked whether Mr. Gieg would want treatment if he was found to have cancer. If not, why go through a biopsy, which might further weaken his voice? Or risk anesthesia, which could accelerate her husband’s dementia?

“Those are the very questions on my mind, too,” Ms. Gieg replied. The Giegs took their time, opted for no further tests or treatment, and Charley came back to the retirement community to die.

Conversely, many people who rely on home and community based health care or use no services at all, may not have the luxury to use the slow medicine movement. They are much more likely to call 911 when having a medical emergency which makes it more difficult for them to use less invasive procedures.

With so many life extending medicines and procedures, our culture can become fixated on living as long as possible without looking at the quality of life of the individual and their wishes. How does your organization balance the wants of the individual with potentially conflicting wants of family members? Does your organization subscribe to the slow medicine movement?

That old saying isn’t just lip service. Consider the facts: Ruth Bader Ginsberg became a Supreme Court Justice at 75. B.B. King’s still singing the blues for audiences worldwide at age 82. Who knew?!?

Want to know more? Check out the videos our California affiliate, Aging Services of California, produced as part of their “Aging is an Active Verb” campaign. Their message? Aging is all about living… and whatever the number, it’s time to start living today. Sounds like a plan to me.

[youtube=http://www.youtube.com/watch?v=YrL8WYwt6hs}

The Pioneer Network has posted the presentations from their Culture Change symposium online. The presentations are on the following topics:

• Private vs. Shared bedrooms in Nursing Homes
• Lighting: Partner in Quality Care Environments
• Nothing is Traditional about Environments in a Traditional Nursing Home
• Low Cost Practical Strategies
• Creating Home in a Nursing Home: Fantasy or Reality?
• National Fire Protection Association: Codes and Standards Making System
• History, Use and Application of NFPA 101®, Life Safety Code®
• Strategies to Encourage and Nurture Culture Change
• Culture Change Initiative in Oregon
• Individualized Care Pilot for Nursing Homes
• CMS and Culture Change

Click here to see all of the presentations. Use them in developing your culture change initiatives.