Category Archive

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

The fragmented care system in the US, particularly with respect to payment, has often been cited by field experts as one of the hindrances to a better quality healthcare, while single payer systems, similar to those available in Europe, are seen as conducive to “investing” in programs that reduce the cost of care and generally improve the quality of care for the majority of care recipients, including preventive health programs and technologies.  This comparison is sometimes perceived as advocating single payer healthcare system.  I have recently come across this very interesting article that offers a more balanced multi-faceted comparison between the US and the European healthcare systems, which I thought of sharing with the readers of this blog; enjoy!

- Majd Alwan

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

Jan. 26, 2007

Dear Mr. President:

Your State of the Union message surely highlighted fundamental and enduring American ideals reflected in our “commitment of conscience,” so eloquently stated. Our members, mission-driven care and services providers who serve the elderly and disabled, support your assertion that a “future of hope and opportunity requires that all our citizens have affordable and available health care,”… and that “government has an obligation to care for the elderly, the disabled, and poor children.” Well said, sir!

You then mentioned the challenge of “entitlements.” Please understand that remarks like that have become code for cutting Medicaid, social programs and senior housing for the very same populations that commitments of conscience should be faithful to. So, lest we all talk of commitments in one breath and cuts in another, perhaps this is the time for you and Congress to clarify what you believe all Americans are entitled to.

America’s early historical principles say we are entitled to life, liberty and the pursuit of happiness. Noble, universal, enduring umbrella ideals forged in the crucible of the great American experiment of self-governance, freedom and promotion of the general welfare. Our existing entitlements did not come easy. A century after the Civil War, it took major national unrest to assure equal access to the ballot box for all Americans.

Over time, other apparent entitlements have evolved. For example, we now require all children to attend school and receive immunizations, and we afford them universal protections from abuse, neglect and exploitation. It is safe to say that we as Americans believe they are entitled to be educated and protected, as we decided that seniors are entitled to prescription medication two years ago — a long overdue benefit.

But we quickly reach the limits of entitlements for children because not all of them have health care. Are not our children entitled to health care? You made that a priority in your speech. I suspect virtually every American would support that as an entitlement. Mr. President, you and Congress, as the elected representatives of our commitments of conscience must make it so.

What of other vulnerable populations? Are they not entitled to basic health care as part of Americans commitment of conscience? As a matter of practice, do we turn them away at our emergency rooms and public health clinics? No, usually not, but we often don’t make it easy for them. In fact, we often channel them through a two-tiered great divide system of inner-city mega-facilities and the blue chip insurance hospitals. The former is chronically under-funded and take in our difficult, uninsured and Medicaid populations. Then, some politicians complain that the tax burden to support them is too great, so we cut their funding. Yet, no major city or rural community can survive without these large and small oases of health for all citizens. Are these services an optional commodity or a basic entitlement? Our collective conscience would say the latter, I would wager.

So, why not recognize what we, in our hearts, already know and believe — that all Americans are entitled to basic health care as a right? It took 400 years for people of different races in America to agree that we all are entitled to vote, socialize, shop, worship, dine, ride and be educated. So, is not the time long overdue that we should all finance, support and have equal access to the considerable, miraculous and advanced health resources of America? Let’s do it in two years—not another 400.

Mr. President, do you, your family, members of Congress and federal employees have immediate access to excellent health care? Of course—and you deserve it. The American people have a moral obligation to see that you have it. But, how then do you differ in status from a convenience store worker, a nursing assistant, a domestic worker, a teacher’s aide, a new graduate looking for job, a homeless person or a family down on its luck? I’d bet your upbringing would say we are all equal in the eyes of the Almighty. If so, isn’t it time to declare that all Americans are entitled to health care?

Health care feasible as an entitlement, pundits might ask? The money to cover the cost might be found in a surprising place: the restructuring of long-term care financing. Many American families face the cost of practical obligations of a family or friend chronically impaired. The demographics say that the majority of this growing group of American citizens are elderly, but one third are younger. They all need care and support.

The conventional wisdom is that Medicaid’s problem is greedy families wanting to hide assets and the solution is tax breaks to buy long-term care insurance. Neither conclusion reflects but a minuscule amount of truth. Yet, there are existing long-term care financing models in Europe and successful experiments in the United States that could create a sound and viable long-term care financing model that could save Medicaid and help us fund health care as an entitlement. Mr. President, there are solutions to financing of health care beyond the current, and narrow, scope of inquiry and the protection of special interests health care businesses. Yes, health care in general, and long-term care in particular, can be affordable entitlements!

Mr. President, you made no mention of Katrina and Rita recovery. A surprise for many who listened to you. Are the people of the Gulf Coast region entitled to funds and support to restart their lives? We made them a promise to rebuild their community, and money was committed. Yet, efforts are slow and priority of national interest seems weak. While your attention is focused on unimaginably complex issues, surely there must be a surge plan to catalyze the Gulf Coast recovery. Are not all Americans entitled to the opportunity to recover from great tragedies? Surely we are.

And, Mr. President, you made no mention of housing policy. Not surprising with the press of other issues. Isn’t housing, either rented or owned, a basic entitlement for all Americans? Certainly your leadership has made it easier for more people to own their homes, and the economic climate you have created has made it easier to obtain affordable loans. Both great achievements. But what about low-income elderly people unable by personal circumstances of health or pocket book to live alone in a home? Two generations ago, the U.S. Department of Housing and Urban Development created subsidized housing to address this emerging need for senior housing assistance and low interest capital to stimulate construction. A very successful program. Now, there are 10 low-income seniors on a waiting list for every unit that becomes available. Yet, funds are continually squeezed, the bureaucratic barriers to new construction and renovation daunting and the mechanisms to coordinate housing with services to keep older people out of nursing homes and emergency rooms are limited — all of which have negative impact on health and the cost of health care. The loop circles back to health care.

So, Mr. President, isn’t it time we decided that all Americans are entitled to health care, housing and recovery from catastrophe as the new era manifestations of enduring and hard-earned, assured American ideals of life, liberty and the pursuit of happiness? None of us can feel secure at home without these essentials. To deny them sears our souls and masks the real costs of inevitable conditions and untreated sickness. A moral failure and bad business. Not what makes America great.

We’d support your leadership on these matters the last two years of your Administration. That would be quite a legacy. You could be remembered for your “commitments of conscience.” I like that phrase a lot.

Thank you, Mr. President. AAHSA will help you fulfill these commitments. We believe that Americans are entitled to them.

Sincerely,

William L. Minnix

President & CEO
The American Association of Homes and Services for the Aging