Category Archive

We’ve unveiled our 2008 Award winners. Each year we honor individuals and organizations for their excellence and innovation in aging services. The awards, which will given during our annual meeting in Philadelphia, Pa., on Oct. 12, 2008, include the Excellence in Leadership Award, the Excellence in the Workplace Award, the Leading-Edge Care and Services Award, the Hobart Jackson Cultural Diversity Award, the Dr. Herbert Shore Outstanding Mentor Award, the Public Trust Award, and the Outstanding Advocacy Award.

This year’s Award of Honor will be bestowed upon Laverne R. Joseph, president and CEO of the Retirement Housing Foundation in Long Beach, Calif. Mr. Joseph has a long-standing record of leadership in aging services, particularly affordable senior housing.

“Our award winners combine leadership, creativity and commitment to make great strides for the people they serve and those who serve them,” AAHSA President & CEO Larry Minnix said. “We honor them for their commitment to quality and more important, the inspiration they offer our members to create the future of aging services.”

On Tuesday, July 15, H.R. 6126, the Fairness in Nursing Home Arbitration Act of 2008, is expected to be marked up.

We at AAHSA oppose this bill, as well as its Senate companion, S. 2838, because the measure would prohibit arbitration clauses in long-term care admissions agreements. Supporters argue that nursing home/assisted living residents and their families should not be asked to waive their right to go to court before a dispute arises. In essence, the bill’s sponsors take the position that this type of waiver can never be done fairly (knowingly and voluntarily). The sponsors are responding to examples of over-reaching by providers that in fact were thrown out by courts (e.g., provisions limiting damages when the state does not have a damages limit, provisions prohibiting the arbitrator from awarding punitive damages when state law allows it, and so forth). The sponsors also appear to be claiming that arbitration agreements have a negative impact on quality.

However, there is no relationship between the forum where a dispute is resolved (arbitration or court) and the requirement to provide quality care. Moreover, a blanket prohibition against arbitration clauses is unnecessary. Courts are already doing their job of policing these agreements to ensure that they are fairly entered into and the provisions are not unconscionable.

There is in the field a rough consensus of best practices which takes a balanced and responsible approach, mirroring case law — for example, not mandating signing an arbitration agreement as a condition of admission but allowing the agreement to be rejected and providing for a period of time to rescind the agreement after it is signed; not changing state law on medical malpractice/negligence; etc.

Click here to watch the House Subcommittee on Commercial and Administrative Law’s hearing on H.R. 6126.

With a vote of 69 to 30, the U.S. Senate on Wednesday approved a cloture motion for H.R. 6331. According to The Hill, Sens. Harry Reid (D-Nev.) and Mitch McConnell (R-Ky.) agreed that if the cloture motion passed, the bill as a whole would be considered approved.

Sen. Edward Kennedy (D-Mass.), recovering from surgery on a malignant brain tumor, was able to return for the vote. The Hill quoted Kennedy as saying, “I return to the Senate today to keep a promise to our senior citizens – and that’s to protect Medicare.”

Kennedy’s presence was important as the previous cloture motion failed by one vote.

The bill, which would extend the Medicare therapy caps exceptions process for 18 months as well as place a moratorium on a 10.6 percent cut to Medicare’s physician payment rates, now heads to President Bush.

The U.S. Senate today is expected to once again consider a cloture motion for H.R. 6331, the Medicare Improvement for Patients and Providers Act of 2008. The bill, which failed to reach cloture by one vote on Jun. 26, needs 60 supporters to proceed.

The bill would extend the Medicare therapy caps exceptions process for 18 months as well as place a moratorium on a 10.6 percent cut to Medicare’s physician payment rates which will begin this month.

Senate GOP members say their main area of contention is how the bill would be funded.

Responding to Republican requests to amend to measure, Senate Majority Leader Harry Reid (D-Nev) on Tuesday said that “75 percent of the Republicans in the House voted for it. And it seems a little unusual to me that this bill, they want to change it now.” Reid added that “every day that it’s not passed, seniors are being affected, doctors are being affected, and veterans are being affected.” Reid said, “If we don’t get 60 votes, the Republicans are going to have to live with that.”

We’ll update you as soon as Congress moves forward.

For those consumers that are a bit more technically inclined, the ability to visit with a physician just got a little easier. On Tuesday, TalktoaDoc.org launched its Web site, which offers “the ability to talk to local physicians online through text, voice or video,” HealthcareITNews reports.

The company says that while other “advice sites require patients to pay a yearly membership fee and a high flat fee up front before they can even talk to a doctor,” TalktoaDoc.org will provide the first minute on consultation for free, with each additional minute costing $2.98.

Each of the online physicians, who are available beyond normal office hours, will be required to be “licensed in the state in which the patient is located.” In addition, each doctor will carry medical malpractice insurance.

Last month, HealthcareITNews reported that American Well launched its Online Healthcare Marketplace, which also allows health care providers to offer consumers “real-time consultations online or by phone.”

Roy Schoenberg M.D., CEO of American Well Systems, said that technology is helping to “bring healthcare to people’s homes, changing the rules of engagement and the convenience that goes with them.”

The launching of the two online services trends with the California HealthCare Foundation’s recent findings that roughly three out of four consumers would like online interaction with a health care provider.

For the latest on the development, evaluation and adoption of emerging technologies that will transform the aging experience, be sure to visit AAHSA’s Center for Aging Services Technologies (CAST) Web site.

A few days ago, The New York Times launched the “New Old Age” blog to promote discussion about the issues facing our aging population and those who care for them.  Jane Gross, a seasoned NYT reporter, is the blog’s primary author. Her experience caring for her aging mother inspired her to cover stories on the topic for the publication.

Already, hundreds of readers have praised the newspaper for starting the blog. Nearly 500 readers commented on the first post alone. Here’s an excerpt from her first blog post. Let us know what you think.

“Jim’s mother-in-law has fallen again. For the fourth time this year.

He and his wife meet the ambulance at the emergency room, then try to keep the frightened, old woman distracted through the long wait. They check her into the hospital with several broken bones and an unsteady heartbeat. They spend days at her side, jolly her through the rigors of rehab and finally take her back to her apartment, as they have so many times before.

Along the way, the 60-something couple, friends of mine in Los Angeles, learn which pain medications make an 87-year-old woman delirious and which leave her in a stupor. They learn that Medicare covers orthopedic surgery but not long-term care at home. They learn about stage-three bedsores. They learn that out-of-town siblings can be summoned for a few days respite but don’t fully grasp the relentlessness of the caregiving task.

Nobody wants the old woman to die, but her misery is a heavy blanket muffling many lives. Each mad dash to the ER, each hospitalization, takes a toll. On top of the cost of assisted living, Jim’s mother-in-law needs private duty home care, or else the next fall could be her last. But what happens if and when even 24/7 help isn’t enough? A nursing home? Who pays, at upwards of $100,000 a year? And how long will the money last?

These are the trials many of us face during the final years of our parents’ lives, as we lurch, ignorant, from crisis to crisis. When my brother and I began this journey with my mother, who went from feisty independence to utter reliance on her children in a matter of months, we were making it up as we went along.

We knew nothing about entitlement programs. What do you mean Medicare doesn’t cover the cost of home care or assisted living or a nursing home? We knew nothing about the advantages and disadvantages of hiring companions and aides through agencies or word-of-mouth. What do you mean that the agency aide needs permission from a supervisor before picking my mother off the floor if she falls?

We knew nothing about hospital discharge planning. What do you mean she has to leave tomorrow when we have no place to take her? We knew nothing about geriatric medicine. What do you mean emergency rooms and intensive care units can cause a form of psychosis in the elderly, or that a catheter can lead to an undiagnosed urinary tract infection and even death?

We knew nothing about Medicaid spend-downs, continuing care retirement communities, in-hospital versus out-of-hospital do-not-resuscitate orders, Hoyer lifts, motorized wheelchairs or assistive devices for people who can neither speak nor type. We knew nothing about “pre-need consultants” who handle advance payment for the funerals of people who aren’t dead yet, or “feeders” whose job it is to spoon pureed food into the mouths of once-dignified men and women.

At the time, between 2000 and 2003, my brother and I felt terribly isolated. As leading edge baby boomers and the children of older parents, we were the first of our friends to go through the drawn-out process of watching a mother or father grow more helpless with each passing day until the role reversal put us squarely in charge of everything. Once in charge, we had to rely on each other as never before — sometimes perfectly in synch, other times at each other’s throats.

At work, the assistance available to new parents did not readily extend to our situation, which was as laborious as child care but without the joy or the promise for the future. When I asked for a four-day week here at The New York Times, exhausted from my dual labors, the person in charge of such matters, who readily agreed, noted that I was the first employee to make such a request but surely wouldn’t be the last.

How right he was. Today, in the newsroom at The Times and at places of business everywhere, middle-aged men and women in growing numbers are juggling their jobs, their parents’ increasing needs, frequent emergencies and all the other moving parts of their lives. They look stunned and very tired. I remember it well. Because I chose to write about aging and caregiving in the wake of my mother’s death, gaining a level of expertise I didn’t have when I needed it, they come to me with questions.

How can they find a reliable home health aide? What should they look for in an assisted living community? How long is the waiting list at top-notch nursing homes? How onerous is the paperwork for applying for Medicaid? Is it worth spending money for the guidance of a geriatric case manager? How do you persuade a parent that it is no longer safe to drive, or that the time has come for live-in help at home? What can be done about siblings who won’t carry their weight? Or about siblings who disagree over end-of-life or financial decisions?

The experience of fielding those questions inspired this blog. I intend for it to be a source of information and community for grown children faced with these new responsibilities, for the elderly adjusting to unwelcome limitations and dependency, to employers interested in easing the burden, for professionals in the field and for anyone else who wants to chime in. Whining is permitted. Wisdom, and humor, are especially welcome.

But most of all, I hope you will tell me, and each other, what problems you face and how you have solved them; what changes in American health care policy, in the workplace and in the community would make your lives easier; what has surprised and inspired you; and how your family has changed, for better or worse, as a result of this intergenerational experience.”

On Monday, the Bush administration announced that it would give Congress more time to deliberate on the proposed cut to physician payments by the Centers for Medicare and Medicaid Service (CMS). Originally scheduled to take effect today, CMS spokesman Jeff Nelligan said the agency “will not be making any payments on the 10.6 percent reduction until July 15, at the earliest.”

However, at a meeting with therapy provider groups late yesterday afternoon, the agency’s deputy administrator, Herb Kuhn, advised that the administrative payment relief CMS is providing for physicians does not extend to the Medicare therapy caps exceptions process.

This means that any outpatient therapy claims submitted as of today will begin to count against a beneficiary’s allowance of $1,810 per year for speech and physical therapy combined and another $1,810 for occupational therapy. Therapy provided in a hospital outpatient setting does not count against the caps.

Furthermore, CMS will count any therapy a beneficiary may have received since January 1, 2008 against the cap. This means that many beneficiaries will already have exceeded their annual cap, even though they obtained an exception from the cap at the time they received their therapy.

Kuhn suggested that therapy providers could hold claims and not submit them to CMS for the next 10 days, by which time we can hope that Congress will have reconvened and passed an extension of the therapy caps exceptions process.

At AAHSA, we’re encouraging our members to Contact Congress. You may also call the U.S. Capitol at (202) 224-3121 (not a toll-free call) and ask to be connected to your legislators.

Yesterday, the U.S. Senate rejected a cloture motion on H.R. 6331, a bill that would extend the Medicare therapy caps exceptions process for 18 months. The bill also would place a moratorium on a 10.6 percent cut to Medicare’s physician payment rates which begin on July 1. The motioned failed 58-40, with Sens. John McCain (R-Ariz.) and Edward M. Kennedy (D-Mass.) not voting.

However, the bill is expected to be addressed after Congress returns from its July 4th recess, as Majority Leader Harry Reid (D-Nev.), following a procedural rule, changed his vote to the winning “no” side, allowing the bill to be brought up at a later time, Congressional Quarterly explains.

According to updated Centers for Disease Control and Prevention (CDC) data, in 2007 roughly 23 percent, or 12.2 million, of those aged 60 and over in the U.S. had diabetes. The agency also estimated that about 536,000 new cases appeared among that age group. Over all, 23.6 million Americans live with diabetes, and researchers say the new numbers represent a 15 percent increase from a 2005 report that found about 21 million living with the disease.

The CDC points out that diabetes, which is associated with high levels of blood glucose due to irregular insulin production, is “the seventh leading cause of death in the country and can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations.”

For seniors, diabetes can be particularly detrimental. The CDC reports that in 2004, heart disease contributed to 68 percent of diabetes-related deaths among people

aged 65 years or older. Stroke contributed to about 16 of diabetes-related death for that same age group. The agency also notes that people aged 60 or older with diabetes “are 2 to 3 times more likely to report an inability to walk one-quarter of a mile, climb stairs, do housework, or use a mobility aid compared with persons without diabetes in the same age group.”

The data did have some encouraging news. Over a two year period, the number of people with diabetes that did not know they had the disease decreased from 30 percent to 25 percent, the agency said.

Ann Albright, Ph.D., director of the CDC’s division of diabetes translation, said that while it is “concerning to know that we have more people developing diabetes,” it is good to find that “more people are aware that they have diabetes.” Albright added, “That is an indication that our efforts to increase awareness are working, and more importantly, that more people are better prepared to manage this disease and its complications.”

However, according to the Diabetes Prevention Program, a research study focused on examining the effects of diet and exercise on the prevention or delay of type 2 diabetes, lifestyle intervention reduced the risk of developing diabetes by 71 percent among adults aged 60 years or older.

For more information and tips on prevention, visit the CDC’s Diabetes Web site.

Congressional Quarterly is reporting that Senate negotiators have brokered a deal on a bill that would block the scheduled 10.6 percent cut to Medicare physician reimbursements, but that would not be vetoed by President Bush. According to Sen. Debbie Stabenow (D-Mich.), several concessions were made to Republicans on the issue of Medicare Advantage funding.

Sen. Orrin G. Hatch (R-Utah) “confirmed that a key part of the compromise dropped restrictions on private fee-for-service plans, a subset of the Medicare Advantage plans,” CQ adds.

On Wednesday, the Centers for Medicare & Medicaid Services (CMS) announced that it plans to launch a “five star” ranking system for nursing homes not unlike the way hotels and restaurants are rated. The new system will be part of the agency’s Nursing Home Compare Web site.

According to CMS Acting Administrator Kerry Weems, “The new ‘five-star’ rating system will provide a composite view of the quality and safety information currently on Nursing Home Compare to help beneficiaries, their families, and caregivers compare nursing homes more easily.”

While many in the nursing-home field support a system to rate the quality of a provider, one area of concern about Mr. Weems’ plan is that it is based on inconsistent data taken from state surveys of homes. State surveyors are often underfunded and undermotivated. A GAO report issued in May reflects this fact, finding “approximately 70 percent of federal comparative surveys identified state surveys missing at least one deficiency at the lowest level of noncompliance, and in all but five states the number of state surveys with such missed deficiencies was greater than 40 percent.”

At AAHSA, we believe a rating system that helps consumers identify both high and low performing nursing homes is essential. Consumers deserve nothing less than a reliable seal of approval for the best nursing homes in America.

To be reliable, it’s important that a rating system be based on four essential pillars: resident and family satisfaction, staffing based on resident needs that measures nursing hours and staff satisfaction, clinical quality outcomes, and public oversight. Each of these pillars needs to be based on up-to-date and valid data.

We’re already working with CMS and other stakeholders on the Advancing Excellence in America’s Nursing Homes campaign to strengthen all four of these pillars, enhance quality in nursing homes and increase the public’s trust. We believe there should be two types of nursing homes: the excellent and the non-existent.

A new study by the Harvard School of Public Health and the Universidad Autonoma de Madrid suggests coffee might be a relevant subject when discussing the future of aging. The study, which was published in the Annals of Internal Medicine, found that after accounting for various risk factors, such as smoking and diet, coffee consumers were “less likely to die,” mainly because coffee may decrease the risk of cardiovascular disease (CVD).

According to the researchers, compared with non-consumers, women who imbibed “two to three cups of caffeinated coffee per day” were shown to have “a 25 percent lower risk of death from heart disease during the follow-up period,” and an “18 percent lower risk of death caused by something other than cancer or heart disease.” The research team found no significant connection to either an increase or decrease in death for male coffee drinkers.

As for regular or decaf, Medical News Today reports that “there appeared to be no difference in the link to death rates between caffeinated and decaffeinated coffee, they both appeared to have the same link with lower death rates compared with people who did not drink any coffee at all.”

Still, the study team did not recommend a change in drinking habits. Esther Lopez-Garcia, Ph.D., the study’s lead author, said, “More research is necessary to be able to recommend consuming coffee on a health basis.” Dr. Lopez-Garcia added, “Our study is not enough to make such a statement.”

Sen. Charles Grassley (R-Iowa) on Wednesday introduced the Preserving Access to Medicare Act of 2008, legislation intended to postpone a scheduled 10.6 percent reduction to Medicare physician payments. Sen. Grassley said the cuts would likely affect seniors’ access to physicians.

Under Grassley’s bill, a 0.5 percent physician update would be provided for the rest of 2008. That percentage would increase to 1.1 percent for 2009. To help pay for the plan, the bill would cut over the next five years roughly $12.5 billion from privately run Medicare Advantage plans.

The measure also offers incentive payments to healthcare professionals for using a qualified e-prescribing system. Rural home health agencies would see a five percent home health add-on payment for 2009, and starting Jan. 1, certain skilled nursing facilities would be included as originating sites for the telehealth services initiative.

Sen. Grassley said that unlike similar legislation introduced by Sen. Max Baucus (D-Mont.), his bill was far more likely to be signed into law because it “does not make large, unwarranted cuts to Medicare Advantage.” The Baucus bill, the Patients and Providers Act of 2008 (S. 3101), would cut roughly $13 billion from the private Medicare Advantage plans.

On Monday, Kaiser Permanente, the nation’s largest nonprofit health maintenance organization, announced that it will team with Microsoft Corp. to begin a pilot program that will connect Kaiser’s My Health Manager and Microsoft’s HealthVault, two consumer-controlled personal health record (PHR) platforms.

According to the New York Times, if the pilot program is successful, the new product “will be offered to Kaiser’s 8.7 million members in nine states and the District of Columbia.”

Currently, nearly 2 million users of the Kaiser PHR are able to access clinical information and health management tools, including the ability to order prescription refills and to schedule appointments online. However, Kaiser says linking with Microsoft’s system will offer users an even wider array of “health and wellness management applications.”

HealthVault allows patients to store all of their health information, “from prescriptions to X-rays and lab reports,” the San Jose Mercury News explains. Although many of the major insurers, including Kaiser, Aetna and WellPoint, offer their own online databases, Microsoft’s HealthVault enables users to cull all their data in one independent location. The company explains it as being more of a “hub of a network of Web sites, personal health devices, and other services.”

Peter Neupert, corporate vice president of Microsoft’s Health Solutions Group, said, “As the universe of online health applications continues to grow, people will learn how technology can empower them and their trusted providers to make the most informed decisions about their health and care.”

But while the electronic health management tools are meant to make accessing information easier for both health-care professionals and patients, some experts are concerned about privacy issues because, according to the Cleveland Plain Dealer, information aggregation and sharing sites are not covered by the Health Insurance Portability and Accountability Act, or HIPAA, a regulation that govern medical information privacy.

Kaiser and Microsoft have responded to privacy concerns by explaining that their tools and Web sites “adhere to federal standards for data exchange and include advanced safeguards to protect members’ personal information,” Reuters points out.

For infants and their parents, it’s Dr. Spock.  For future financiers it’s Donald Trump or Suze Orman.  Now, there’s a whole list of another type of experts: the leaders and experts who are changing the way Americans age.

Yesterday, The Wall Street Journal published this list of the 12 people who are “changing aging.”

It’s no surprise that three of these famous faces have AAHSA roots. Eric Dishman is the chairman of our Center for Aging Services Technologies.  John Erickson is an AAHSA member, a former AAHSA board member and works with AAHSA CEO Larry Minnix on his Erickson School of Aging Studies at the University of Maryland.

Many AAHSA members have worked with their fellow member and colleague Dr. Bill Thomas to transform the culture in their organizations.

 We know that these people can do great things. Now it’s time for them to take our “graying nation” by storm!

Thanks to advances in medicine and scientific discoveries, millions of Americans with AIDS are living longer than ever before.

That leaves just one question: How can  providers help these individuals face their unique health challenges as they age?

An article considering this very question made the front page of yesterday’s New York Times.  The article investigates how housing and health care providers across New York City are tackling these challenges while keeping in mind the needs and preferences of the people they serve. These include people like Jeff, a 56-year old who struggles with AIDS-induced osteoporsis and Parkinson’s Disease simultaneously. Or another who, in addition to several AIDS-related hospitalization, has had several heart attacks and triple-bypass surgery.

The article also features insights from medical experts at the Rivington House. This AAHSA member is one of the country’s only nursing homes exclusively for AIDS patients. There, support groups and drug trials bring hope that individuals with AIDS can age with more dignity and independence, but the stressors of today make it difficult to see the promise tomorrow may hold.

Some people call it the age wave. Others say it’s a silver tsunami. Whatever you like to call it, the fact of the matter is that our society is aging, and it’s going to affect all of us. Especially the businesses with aging employees and caregivers in their midst. That just leaves one question: are these companies going to ride the age wave, or fall beneath it?

That’s the question Kathryn Roberts asked in a recent editorial in the Minneapolis Star-Tribune. Kathryn is the CEO of Ecumen, a large aging-service provider in the Midwest. But she’s also the daughter of an 86-year-old mother. She knows that businesses are losing valuable time and money (to the tune of $33 billion each year) when they don’t help people like her access the help they need for themselves or their loved ones. To her, doing nothing it’s just bad business. And I feel the same way.

It’s official: the holiday season is upon us.

For many, it’s a time for reconnecting with family and reuniting with loved ones.  But often during this season, individuals realize that their older loved ones are having more difficulty living alone than they thought. It’s also a time when many people realize that Dad’s trouble walking or Aunt Mary’s forgetfulness can’t be ignored anymore.

That’s why we developed a short questionnaire that individuals can use with their older loved ones to understand their preferences and choices for care. It’s designed to help them start an important discussion about why planning for their future needs and preferences should be their priority today.

It features the following questions:

1. If I begin to have difficulty with cooking, cleaning and other household
responsibilities, I would like to:

__ move to an independent living community
__ move in with family
__ remain in my home with home-based services to help me
__ other (specify _______________________________________)

2. If I become unable to bathe myself or take my own medicine, I want to:
 __ move to a residential care facility
__ move in with family
__ remain in my home with home-based services to help me
__ other (specify ____________________________________)

3. To pay for services I might need, I want to:
__ use only the services that my pension, Social Security and other regular income
  can cover
__ use some of my savings as well as my pension, Social Security and regular income
  to cover my expenses
__ use my savings to ensure my preferences can be met
__ use my long-term care insurance benefits
__ other (specify ________________________________________)

4. If I need to move out of my home, the place I would most like to move is:

5. If I need to move into a residential care facility, the three features that are most
important to me are:

__ a place where I can have a private room
__ a place that is close to my family
__ a place where my friends live
__ a place with good food
__ a place with a good reputation in my community
__ a place with a wide range of activities
__ a place with easy access to the outdoors
__ a place with a friendly staff
__ a place affiliated with my faith tradition
__ other (specify _______________________________________________)

6. As I age, the person I will depend on for support is:

7. The one thing I want my loved ones to remember about my preferences is:

Got more questions? Visit the “consumer information” section of AAHSA’s Web site to find the answers.

Sometimes,  all it takes is something happening to a famous person to make more of us wonder: “What would I do?”

That’s just what happened when the media reported on Sandra Day O’Connor’s husband and his “girlfriend” at a nursing home here in Washington. Millions of Americans and their families are affected by Alzheimer’s Disease, and many are facing similar situations. Yet, this Supreme Court Justice’s sitution presented an opportunity for the media to highlight this issue and more important, how people can handle it in their own families.

Check out this article from the Sunday Chicago Tribune.  It starts out talking about Sandra and her story, but quickly turns to the “What would I do?” question with expert insights and personal ancedotes. Maybe you’ll find the answer you are looking for.

Congratulations to Morningside Ministries of San Antonio, for some wonderful media coverage in the San Antonio Express-News about their advances in design for the aging.  Though senior-friendly design and home-like environments are old news to most people working in aging services, we have a ways to go before the media and the public understand  that living in a senior housing community doesn’t mean living in a hospital. Every story like this one helps break down old stereotypes  of what growing old means for where you live and how you think. We like to see all the coverage like this that’s out there.

What are you doing to tell your story through the media?

In my letters to you, I usually tell the stories of how AAHSA members are working hard to create the future of aging services. Today is different. This letter is about how AAHSA member organizations are showing, and telling, their story in a new way.

Eliza Bryant Village began in 1896 as the first nursing home for Cleveland’s African-American seniors. Today, the organizations continueto live that mission under the leadership of their CEO Harvey Shankman. He and his dedicated staff work hard to ensure that residents like Mary Lou Williams can enjoy her daily walk and the “good food” in the dining room. But there I go storytelling again. Watch and hear from Mary Lou herself.

Take seven minutes out of your day and YouTube with Harvey (http://www.youtube.com/watch?v=OJ5CQiUOzns).

In our increasingly complex media world, YouTube is a fantastic way for non-profit providers of aging services to tell how you live your story. Let me know if you already have a “YouTube story” of your own to share.

Larry

For the past two years, we’ve been all about storytelling here at AAHSA. Why? Because telling stories turns numbers into names and facts into faces about our members mission-driven work for older adults. And it makes a difference for members like Del Zook. Here’s an e-mail he recently wrote to Larry about a story in our FutureAge magazine he shared with his county’s tax appraiser.

What’s the “bottom line?” That telling your story can mean a happy ending in your community, on the front page of the newsletter, at the statehouse and even on your organization’s tax return.

Dear Larry,
Just an interesting happening to share with you. First, I appreciate so much AAHSA’s emphasis on the “mission” and “not-for-profit” focus. I sense a real connection with AAHSA to our mission where I don’t with other other organizations such as the local Chamber and other organization where I serve on the board.

I have been dealing with the Yamhill County tax appraiser on placing our new care center on the books the last few months. It seems when new appraisers are hired it is a whole new cycle of training about what “not-for-profit” really mean to a community.

Frustated after several visits from a new appraiser around the discussion of a 501-c-3 having “nothing” to do whether the care center is tax exempt, I picked up the July/ August issue of AAHSA’s Future Age. I turned to the short article “Home’s Focus on Community Ensures Public Trust” written about Rock of Ages regarding our fire suppresent system, walkways, and fundraising. I asked him to read the article and walked out of my office to regroup. When I returned in a few minutes it was as if a light had went on. A well paid tax attorney could not have said it better. He seemed far more sympathetic towards what Rock of Ages is all about and that there is a force (AAHSA) bigger than just us working to help communities just like Rock of Ages. The next morning I received a call from the elected Tax Assessor who said I need not worry about his position on the new care center’s tax exempt status. Thanks to Larry and crew for helping with our position. You, or at least I never know how AAHSA and it’s work may help school communities, including appraisers, what a mission focused, not-for-profit, organization can do for community.

Thanks Larry and hats off to the AAHSA staff for all your work and support for us “little guys” out here serving our communities.

Del Zook, CEO
Rock of Ages Mennonite Home

Sharing your story can also win you a trip to AAHSA’s Annual Meeting in Philadelphia! Submit your story online or print out a form to use. We also developed a form that you can share with your residents. Please fax all printed entries to us at (202) 783-2255. All entries from your organization will be entered in a raffle to win either an all-expenses paid trip to AAHSA’s 2008 Annual Meeting & Exposition in Philadelphia or free registration to this event for your entire board of directors. Submissions will be accepted until Sept. 10.

AAHSA’s vision for long-term care is a “healthy, affordable and ethical” system of aging services. Today, those three criteria are far from reality. Few would argue that health care in general, and aging services in particular, reflects well-defined, healthy outcomes. Nor do I know any expert who says what we have today is affordable. Many countries spend far less and have better outcomes. Public outcries related to health care scandals have questioned health care’s ethical underpinnings. And now, Congress and the IRS have their sights focused on not-for-profit ethical behavior and accountability.

Recently, I met with a leading consumer advocate about the state of nursing home care in general and the future of aging services in particular. I asked her what AAHSA’s and the nonprofit role should be in getting beyond where we are today. She said she believes our responsibility is two-fold: continue to create a vision of what the continuum can be for older people in our society and create trust in our work. A provocative perspective succinctly stated.

I submit for your consideration that the vision so badly needed in our field and the trust so hard to earn begins and ends with ethics.

Oh, I’m sure most of us could say with confidence that we are corporately ethical. Our intentions have been noble and honorable for generations. But without a disciplined process of ethical reflection as organized as our processes for financial analysis, it is easy to drift ethically. Ethical lapses lead to crises of trust reflected in headlines that are etched in the public’s mind for decades.

What do ethical lapses look like and how do moral imperatives manifest themselves in difficult times? Let’s use a couple of human resources (HR) examples from real situations. I use human resources because AAHSA’s Ethics Commission, under the leadership of Audrey Weiner from the Jewish Home and Hospital Life Care System in New York, will soon publish a Quality First white paper entitled Our Moral Imperative: Creating an Ethical Workplace. It has guidelines for human resources ethics. It should become part of your corporate ethics tool kit and library, along with corporate compliance, codes of ethical conduct and social accountability material - examples of which AAHSA has available for our members.

In fact, AAHSA’s annual meeting in Orlando this fall is themed “Living Your Story” with daily themes of “A Life of Conscience,” “A Life of Community,” “A Life of Integrity” and “A Life of Legacy” - driven by the AAHSA Ethics Commission’s work.

Back to the human resources lapses and imperatives. Years ago, I visited a colleague’s facility to share solutions to common problems. My organization faced a much higher food service cost per meal than others I compared with. The colleague’s facility had a particularly low-cost program, with labor costs less than half of my facility’s costs. I asked the food service director his secret. He smiled and replied, “It’s simple. Our community has lots of immigrants who need work, so I don’t have to pay more than minimum and I don’t have to offer vacation and other benefits. And if they don’t like it, I can replace them immediately.” Stunning! I wonder: was that an HR policy sanctioned by the board? Did the board even know? Was this an ethical lapse under the board’s radar or corporate intent?

Contrast that with the ethical imperative loudly stated in the actions of Boston member Mary Immaculate Health Care, whose CEO is Barbara Grant. Mary Immaculate experienced a river flood that could have been an even worse disaster. Fire and rescue, local hospitals and nursing homes all responded nobly and quickly, resulting in no injury, no loss of life as the facility succumbed to the river. Perhaps most inspiring was the employee response. Employees on site stayed, others came in to help. All followed their residents to various facilities that took them in. Immediately post evacuation, with a now uncertain future for the facility, the board of Mary Immaculate reassured the staff that no employee would miss a paycheck! A moral imperative, from their perspective.

Our ethical imperative is the leadership dynamic of transformation needed in long-term care. Recently retired CEO Dick Lamden from Wexner Heritage Village in Ohio testified at a state legislative hearing in which conflict about a public policy objective was apparent. Dick’s recommendation to this committee contrasted significantly with the profit sector’s recommendation. After discussion, a prominent elected official stated that he trusted Dick’s recommendation because of Wexner’s history of quality and doing the right things for the right reasons. Unanimous approval.

The Kendal organization in Pennsylvania calls it “One Common Interest” on the cover of its 2006 annual report, which quotes John Woodman, who, in 1763, said:

“Here we face the prospect of one common interest from which our own is inseparable, that to turn all the treasures we possess into the channel of universal love becomes the business of our lives…”

Yes, we have an ethical imperative. It begins with corporate leadership, including the board. It should pervade all aspects of our work. It should encompass all groups of people with whom we have relationships. It is the key to transformational leadership to change a broken system of inadequate quality, despite the resources thrown at it and the competition for them. Ethical thinking is the foundation for change. And it needs to happen every day, in every community.

Larry

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

P.S. Be sure to watch for the September/October issue of AAHSA’s FutureAge magazine, where you’ll find articles that profile members who take ethics and quality to heart, examine the characteristics of a just society, look at what determines an ethical corporate culture and more.

The Good Lord didn’t make a more loyal AAHSA member or more credible elder advocate than Shirley Barnes from Minneapolis. On July 31, I asked all of you to flood your Congressman and Senators during their August recess at home about your concerns — even outrage — about freezes on Medicare cost–of–living increases, about the continuing problem with therapy caps, about user fees, about a broken Medicaid system, about inadequate housing funding, and the need for technology planning.

We asked you to flood your elected officials with appointments to meet with your boards, residents and staff about the effects of some of the Congressional actions or a predicted veto of the State Children’s Health Insurance Program (SCHIP) bill, which contains provisions for Medicare and nursing home payment. We also asked you to flood them with thanks for their interest and concern.

Typical of her leadership, Shirley Barnes contacted Congressman Keith Ellison (D–Minn.) even before we asked. The Congressman’s staff met with Shirley’s staff and residents at the Boulevard and sent a letter of thanks. He said,

“The feedback I received has given me a better perspective of how the legislative proposals in Congress affect Minnesotans. The residents of the Boulevard and their personal situations will remain with me as I cast my votes for health care and senior issues in the U.S. House of Representatives.”

Yes, we must change the perspectives of an elected official. And yes we must help them make it personal. If you watch much political discussion on television these days, you can see and hear how politicians can lose perspective on the personal problems families face every day.

Let the August flood continue. Make it personal about how Medicare and Medicaid freezes impact employees who may not get a raise and the quality of care that your residents and clients receive. Make it personal about how a veto of an SCHIP bill will jeopardize the health of your employees’ children. Tell them how user fees take away money from direct care services. Help them understand how badly seniors need affordable housing.

Shirley Barnes knew what to do. Don’t take no for an answer about a visit, a response to a letter or a petition from residents, families or employees. Don’t let them say no to a letter from your board.

Flood them with perspective and the reality about people and real situations. We have tools and contact to help you flood their offices with your perspective on the personal problems that your residents, clients and staff face. And let us know what you’re doing.

Larry

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

Contact Congress on SCHIP, appropriations and housing.

We had better know how to connect with consumers. Our scenario planning document, “The Long and Winding Road,” shows that consumer behavior is one of the two biggest uncertainties for the next decade. (The other is talent availability, which will be addressed in another letter.) What will consumers need? Want? Expect? Will the people be available to provide the services the market needs?

I’d like to comment on consumer connections in two dimensions: the science and the art of understanding and responding to basic human needs in our work. I’ll spend more time on the art because there is an abundance of resources on the science.

Of course, market studies are now an essential part of strategic planning and day-to-day management of current and future service. Regular, daily consumer feedback and response are rapidly becoming the norm, and the ability to analyze that information to generate effective and satisfying consumer service may be the most important management work we can do. There are numerous tools and business friends that can help with the most important driver of our work: understanding perceptions of the people we serve and those who serve them. The science of marketing is complex, but we must master it.

While the razzle-dazzle of marketing science is increasingly critical in our increasingly sophisticated work, I hope we can remember the fundamentals of the art because the fundamentals continue throughout our ongoing service relationship with the people who call on us to help them. This hit home to me recently through a colleague with a mother in crisis. Demented, frail, combative, falling apart, this elder went through a saga that began in an assisted living facility and continued through hospitals, nursing homes, a mental health unit, a rehab facility and a home health agency. My friend and her sister went with her. You know from your own experience that this typical family predicament is difficult in the best of conditions.

As my friend reflected on the situation, she said, “Maybe I’m expecting too much…” I picked up on that statement, perhaps thinking she and her sister were unrealistic—wanting cure where there could be none, wanting an idealistic relationship with their mother that will never exist again, wanting restoration to health where irreversible damage has taken its toll. So I asked her, “What did you expect?” She had no trouble in responding — these are mostly her words—so listen carefully—it is the market speaking through this daughter, who is YOUR colleague—and they apply regardless of the types of service you offer.

1. I expected my mother to be offered a good quality of life for the condition she was in. I expected that she not be avoided because she is unpleasant.
2. I expected her to be clean, well-fed, have interaction and receive the attention the facilities said she would be given and that we paid for.
3. I expected her to be treated with dignity even if she is beyond understanding her condition.
4. I expected staff to let me and my sister take the time to tell them what a wonderful person my mother used to be because all they see now is a crotchety, difficult demented woman.
5. I expected them to believe us when my sister and I said something was wrong.
6. I expected the long-term care facility to know my mother’s medical problems well enough to know that there was a developing crisis.
7. I expected the hospitals where she was transferred to diagnose and fix what they could—not discharge her with an infection she didn’t enter with.
8. I expected my mother to be released from the hospital when her medical problems were resolved, not when she ran out of coverage.
9. I expected professional guidance from professional staff, with a doctor who takes leadership responsibility for coordinating medical care and nurse leaders who would advise me and my sister on what we should do.
10. I expected nursing staff to recognize that cleaning my mother or giving her a treatment and putting her back into a soiled bed isn’t good. Simply saying another department didn’t do its job is not acceptable.
11. I expected on-site advocates—not 1-800 numbers.
12. I expected someone to empathize with me when I sobbed about my mother’s obvious state of affairs—not ask me what’s wrong.
13. I expected to be able to trust the people and institutions to provide good professional care and support my sister and me through all of this.

Too much to expect? Maybe all of our marketing, hospitality, sales and consumer relations programs should begin and end with asking people like my colleague and her sister what they expect throughout the service delivery process… Is that too much?

The great organizations stay closely connected to expectations and needs of the people we serve—connected most closely and intimately in the midst of crisis, not just through the perspective and distance of sophisticated science, though both are essential. No, that’s not too much to expect of us, is it?

Larry

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

In 1973, my mentor and boss, the late Scott Houston, sent me to visit the late Dr. Herb Shore of University of North Texas long-term care leadership fame. Truth be known, Dr. Shore probably has more disciples in long-term care administration than anyone.

My objective in the visit with Dr. Shore was a report on “philosophies of administration” as part of my own administrative internship experience. As we began a tour of Golden Acres, where Dr. Shore served as CEO, I asked him to define his fundamental philosophy. “Very simple,” he said. “If I take care of the staff, they’ll take care of the residents.”

An enduring truth! Now, 34 years later, AAHSA’s Institute for the Future of Aging Services just completed a multi-year grant called Better Jobs Better Care (BJBC) funded by the Robert Wood Johnson Foundation and The Atlantic Philanthropies. Our March/April issue of futureAge summarizes the experience of the multiple BJBC sites and projects throughout the country. I urge each of you read that issue cover-to-cover and make a human resources plan based on it.

I was also struck by a speech I read from an event at Phoebe Ministries in Allentown, Pa. Though the President and CEO, Rev. Rodney Wells, is an eloquent clergyman, the speech actually came from Louise Santee, a certified nursing assistant (CNA) at Phoebe. Ms. Santee delivered the speech at a celebration of Phoebe’s success with Better Jobs Better Care.

In that speech, she said: “A CNA must have love in her heart for the residents, because it is more than just a job. When you leave work, you think about it all the way home, and then some. If, after you have done your care, the resident is smiling or has a twinkle in the eye, that is all the thanks you need. ” She says BJBC helped her “make things better” by “working together as a team,” which she says is “the Phoebe way.”

So, here’s what we can learn from Dr. Shore, Better Jobs Better Care and Louise Santee:

1. Nurture the love in your heart.
2. Conduct employee satisfaction surveys, act on the findings and measure employee recruitment and retention.
3. Discuss what respect means to everyone in the workplace.
4. Offer competitive wages, family-friendly benefits and career ladders and lattices.
5. Teach and mentor people on leadership.
6. Create a multi-cultural sharing program.
7. Create an ongoing team-building program and teach continuous quality improvement-TOGETHER-at all levels!
8. Invite policy leaders into your setting and let them hear from employees about the importance of the role of the care and service professions.
9. Have fun, celebrate events and share sorrows.
10. Oh, yeah… remember to nurture the love in your heart — because it’s not just a job.

All these have stood the test of time. If we take care of employees, they’ll take care of the people we serve. Or, better jobs generate better care. It’s the right thing to do. And remember what Louise Santee says about the unique rewards of a great day’s work. Bigger hearts, better jobs, better care!

LarryWilliam L. Minnix, Jr., D.Min.
AAHSA President and CEO

Learn more about Better Jobs Better Care.

John Picken, board chair of AAHSA member Kendal at Oberlin, and Benjamin Franklin think alike about not-for-profits.

Franklin established the Leather Apron Society in 1727 based on the premise that “The good that men do separately is small compared with what they do collectively.”

Thus, the birth of the American not-for-profit organization. Our own publication, The Not-for-Profit Responsibility — Changing Lives, Enlarging the Hearts of Communities, quotes Franklin’s belief that benevolence is the binding virtue of society. A century later, Alexis de Tocqueville commented that community action for the public good was honorable and uniquely American.

Fast forward a century. Peter Drucker discerned three fundamental sectors of American society that make it vibrant: business, government and not-for-profits. Each sector has a unique responsibility. Government’s is to protect and oversee. Business’ role is to generate an economy. Not-for-profits’ responsibility is to change lives. More recently, Dr. Lester Salamon, director of the Johns Hopkins Center for Civil Society Studies, defines four major duties of the not-for-profit sector:

• Guardians of values
• Service providers to meet emerging and often difficult societal needs
• Advocates for those often without public voice
• Creators of community (or social capital)

Salamon, in his must-read book for not-for-profit boards, The Resilient Sector, offers facts and figures on the size, scope and impact of this sector on the American economy and our way of life.

Even more recently, Dr. Claire Gaudiani of Yale University, in another must-read book for boards, The Greater Good, discusses how American generosity is the economic engine that drives capitalism as an essential dynamic of democracy. Dr. Gaudiani, who will be a keynote speaker at our 2007 Annual Meeting & Exposition in Orlando, says, “The ultimate form of generosity is the investment in people, property, and ideas.” She reflects on Maimonides, who wrote centuries earlier about the eight states of Tsedakah (which means “generosity that acknowledges the dignity of the receiver”):

“The highest level of Tsedakah is to enter into a partnership with the person in need so that he will become productive and eventually independent.”

Gaudiani has a chapter in her book on the fragile balance between democracy, capitalism and generosity, in which she writes, “Most people think Americans are generous because we are rich. The truth is we are rich because we are generous.”

I submit to you that the “fragile balance” that makes America great rests on the broad shoulders of not-for-profit governing bodies: yes, the volunteers who are generous with time, commitment, money and influence; people who see need and are not afraid to take risks and work hard to meet it.

Most AAHSA members have boards that are bedrock keepers of this fragile balance. Our largest 100 members have average life spans of three generations, compared to our counterparts in the investor-owned sector, which have only a third of that. I’m not making a value judgment with that comparison, but I mention the difference because the not-for-profit sector is expected to fulfill a unique and enduring role: to change lives, enlarge the hearts of communities, guard values, advocate and meet changing needs when it isn’t profitable to do so.

Therefore, governing bodies need to know their jobs. In these complex times, many of our boards are asking that very question: “What is our responsibility?” Public pressure from Congress and the media, spurred by high-profile scandal, raises another question, “How do not-for-profits stand accountable for the recognition American society affords us through tradition and law?”

Salamon concludes that the not-for-profit sector is in danger of “losing its soul” because we act too much like businesses. Jim Collins of Good to Great fame also wrote a monograph, Good to Great and the Social Sectors: Why Business Thinking is Not the Answer (another must-read for our boards), in which he details special characteristics of mission-driven versus profit-driven enterprises.

Which brings me back to John Picken, who put the issue to me like this (I’m paraphrasing): Can our members and their boards “cite the good they do?” Do they “know the difference between doing good and doing well?”

Our boards must answer Picken’s question! But how? There are numerous experts and tools to guide a thoughtful reflection process. Quality First offers an excellent framework for essential board talk. We have a social accountability guide we developed with the Catholic Health Association. We even published a resource that your organization can use to establish a social accountability program in 60 minutes. Experts like Richard Chait, William Ryan and Barbara Taylor are also helping members through their book Governance as Leadership and presentations at national and state meetings. Accreditation through CARF-CCAC is an excellent process that stimulates reflection about effective governance.

This year, AAHSA will hold town hall meetings all over the country about our not-for-profit responsibility and how we must stand accountable for our actions. You’ll find the questions we’ll be asking on our Web site. You can use them to hold a town hall meeting in your organization. I invite you to share your results with me.

The health of American society depends on such dialogue to maintain that essential yet fragile balance of democracy, capitalism and generosity. A key outcome of that dialogue is John Picken’s challenge to know the difference between doing good and doing well. Not-for-profits must do both, or we will not fulfill our unique responsibility.

LarryWilliam L. Minnix, Jr., D.Min.
AAHSA President and CEO

Find more governance resources from AAHSA.

March 28, 2007

Yesterday, my friends Sydney, Colline and Susan moved their mother, Frances, to an assisted living facility. I’ve know them for years. They’re like family to me. I came to know the family through Frances, who cared for her own mother at home for years. Frances helped to start a support group at Decatur First United Methodist Church 30 years ago. They asked me to lead it because of my experience at Wesley Woods. The founders were five women who, like Frances, had the responsibility of caring for mothers at home. They laughingly and lovingly called themselves “Dutiful Daughters.”

The group grew over the years, served hundreds of “daughters,” and later, a few sons and couples. It met monthly, and I was privileged to meet with them. The group was open to anyone. Word of mouth channeled new people to the group. The original five “Dutiful Daughters” became expert supporters as they lived through the deaths of the mothers they so responsibly served. They found themselves comforting others in aisles at the grocery store, over the back fence and in Sunday school. They were naturally therapeutic people who’d “been there.”

As Frances aged, you could begin to see signs of the ravages of brain disease. Sydney and her husband, Bill, began to coordinate shared responsibilities with the other sisters all doing their part as they were able. This phase lasted several years until yesterday — when the time had come. Frances’ condition was irreversible; it was affecting the health and well-being of the family. It had caused clear and present dangers for herself. And she didn’t really know anybody anymore.

Sydney wrote me last night —

“This is too hard!!! Make it stop! I guess today went ok. Colline was ready to bolt and run with her, and Susan almost threw up. They led her away and then led us away. The lunch time report was that she was talking and laughing with her table mates and that she’s a dear. My head knows she’s ok. My heart is broken.”

The irony in all of this is that Frances faced these same issues 25 years ago with her mother, Sydney’s grandmother. Frances wrote about it in a booklet entitled “Dutiful Daughters” that the support group produced. Frances’ story was called “…loved me the most.” Here’s what Frances — a generation ago — had to say:

At age 87 my mother came to make her home with my husband and me.We had felt that keeping her in her own home as long as possible was best, and we did that with help for a number of years. As her health failed and symptoms of Alzheimer’s disease increased, we chose to bring her into our home to live.She was gentle, quiet, loveable and as easy to care for as a person in her condition could be. However, we were not prepared for the changes in our lives that having her with us made.

My husband and I had just retired from our jobs and we had looked forward to having time to travel and pursue other interests. Of course this was impossible now, because Mother could not be left alone. Consequently, we both became frustrated and I began to feel conflicting emotions. I wanted to take care of my mother, and at the same time I felt resentment for having the responsibility.

My sister and two brothers helped with her care for a time but as her condition worsened I was not given the help or support I needed. This was very discouraging to me.

In retrospect I realize this conflict with my family was as much my fault as theirs. I had chosen to care for Mother — thus they saw it as my responsibility. I failed to expect or require enough help from them.

If, in the beginning, the decision for Mother’s care had been ours, rather than mine, and a plan made with all of us contributing and sharing, I think we could have avoided much misunderstanding and heartache later.

I cared for Mother because I really wanted to, even though I was drained physically and emotionally with her constant needs night and day. I felt tenderness and love for her and received a great deal of satisfaction in caring for her. I kept her clean, dressed her in pretty clothes, put a ribbon in her hair and made her room attractive with pretty sheets. I used lots of color, plants and flowers and potpourri for a nice fragrance.

It was particularly frustrating not to be able to communicate with Mother. There was so much she could not understand. But even in her confusion she never lost her gentle and cooperative spirit. She lived in a time long past, and I discovered if I took her seriously and entered her world too, I could often relieve her anxiety and give her comfort.

If Mother was worried about her mother (long deceased) we would talk about what we could do for her. If she concerned herself with some job in the past she thought she hadn’t done, we would plan (pretend) to do it together, etc.

It was a challenge to cook and provide nourishing meals for her. I felt tremendous satisfa