Category Archive

As the saying goes, hindsight is 20/20. And in the case of Jane Gross from The New York Times’ “New Old Age” blog, there are many things Gross would’ve done differently when it came to caring for aging mother.

Her latest post  features a personal analysis of these decisions while providing readers with information about how to avoid similar situations in their own caregiving responsibilities.

Among other topics, Gross advises readers to find a geriatrician for their elderly loved ones and investigating home care options rather than just traditional nursing homes or assisted living residences.

Two of her tips were particularly interesting to the folks at AAHSA. The first: stick to the not-for-profit sector. In her blog, Gross writes:  ”If I had it to do all over again, I would plan for the worst and seek out a not-for-profit nursing home that met my standards.” Obviously, that’s music to our ears.

The other is Gross’ wish that she had understood the limits of her mother’s long-term care insurance policy. Here’s what she had to say:

“The policy cost us about $7,000 a year because of my mother’s advanced age when we purchased it. It would have paid for retrofitting her own home, or even mine. It would have paid for 24/7 home health attendants. But it was virtually useless in an assisted-living apartment, and once my mother was in a nursing home, the policy benefit wasn’t ours to spend.

As long as my mother still had assets and could pay for her $14,000 a month room, the insurance benefit went to the nursing home and reduced her bill accordingly. When she ran out of money, in fairly short order, she was eligible for Medicaid, not because she was old but because she was impoverished. Then the insurance benefit went to the federal government.”

Gross isn’t alone. Across the country, thousands of individuals find that even with LTC insurance, their loved ones end up in unfavorable situations where it is simply unaffordable to care for them. That’s why we are advocating for a national insurance trust that provides cash benefits that individuals who need long-term care can use to pay for the services they need in a place they call home. 

Now that you’ve heard from Jane, we want to know you  caregiving “woulda, coulda, shouldas.” How would you help a new caregiving make the most of their options while avoiding the pitfalls many caregivers face?

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?

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.

As a communications professional, seeing a front page story in The New York Times only means two things: it’s time to celebrate or fight a fire. Unfortunately, this story meant I had to get out the ladder and hose.

 The story is true, but leaves readers questioning the quality and integrity of all nursing homes, not just those mentioned in the article.  And it also begs for suggestions about how we can make sure that there only excellent and non-existent nursing homes in America.

That’s why AAHSA’s CEO Larry Minnix responded with a letter that does both. Take a read. It may not be front-page news, but it certainly shows how telling your side of the story can make the media take notice.

I’ve been watching with interest TIAA-CREF’s new advertising campaign, the powerof.org.  TIAA-CREF is leveraging its status as a not-for-profit provider of financial services to draw a distinction for customers.  Their point is that because they are a .org, people should trust their motives and mission.  I think this is an excellent model for aging services providers to embrace.  Over the last couple of months, I have asked several AAHSA members how they use their not-for-profit status in their marketing, and the answer often comes back that they just haven’t figured out how to do so.  Some who have done market research find that potential residents and clients like the values that being not-for-profit convey, like being focused on people over profits, dedicated to staff, and stable for the long-term.  Do you accentuate your not-for-profit status in your marketing materials?  If so, I’d love to hear about it.  I’m leading a session at our Annual Meeting on this topic and would be delighted to feature your efforts.

 Check out TIAA-CREF’s Web site at www.powerof.org. 

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.

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.