In our youth-obsessed culture, it’s not often you hear that a book about aging isn’t focused on preventing it.  That’s why I was excited to read about A Place Called Canterbury on Bill Thomas’ “Changing Aging” blog.

The premise is simple. Dudley Clendinen is a former New York Times reporter who decided to move into Canterbury Tower, a retirement community (and AAHSA member) in Tampa, Fla., where his mother lived, and write about what he saw. What happened next,  isn’t so simple. Clendinen writes that the 400 days spent at Canterbury were an intriguing and inspiring look at how people from all backgrounds handle the realities of growing older. He describes everything from the weekly cocktail hours to interactions with staff and the tough decisions facing Canterbury’s residents and their families as sickness happens and memories start to fade.

Click here to hear Clendinen share his own take on ”Canterbury Tales” on NPR’s Weekend Edition.

Hundreds of providers, consumers and government officials participated in CMS’ Open Door Forum about the proposed nursing home rating system yesterday. On the call, particpants discussed a variety of issues that will impact this system.  Many expressed concerned about the validity of using government survey data, which is based on minimal compliance levels, as the primary factor for determining quality.

Perhaps the most important news is that there’s still time to share your thoughts about this system and how  should be structured and managed. Thomas Hamilton, director of the nursing homes survey and certification group at CMS, is asking that individuals send in their comments by July 23 to  help regulators “make many decisions about the research that needs to be conducted fairly quickly.”

Please send your comments to us and to CMS as soon as possible.

Nursing homes made the front page of today’s Wall Street Journal, but the story wasn’t a scathing expose or a blurb on a new regulation. Rather, this article took an honest look at the possibilities, as well as the challenges, that face nursing homes as they strive to put the “home” in nursing home.

The story’s protagonist was a man named Bill Thomas.  Thomas is a 48-year old physician who is known for developing the Green House  care model.  Unlike other nursing homes, elders in Green Houses live among 10 to 12 of their peers in small, homelike accommodations.  The first Green House was built seven year ago in Tupelo, Miss. Today, there are currently 41 houses in 10 states.

Thanks to the Robert Wood Johnson Foundation, that number may soon be going up. The Foundation recently pledged $15 million dollars over five years to NCB Capital Impact, a not-for-profit organization that is offering technical assistance help to any party interested in operating a Green House.

Money aside, building a Green House isn’t without its challenges. Take regulatory issues.  Nursing homes are some of the most highly-regulated institutions around. There are “life safety” rules intended to keep residents safe, “physical plant” standards that deal with building codes along with health-care rules, food preparation guidelines and general quality of life standards.  Some nursing-home executives argue such rules can make it difficult, if not impossible, to establish a Green House’s homelike environment.

Plus, the concept often faces resistance from nursing home administrators and staff who’ve grown accustomed to the traditional model. I saw this resistance first hand during a screening of Almost Home, a documentary about culture change. In it, a head nurse complained that these kinds of models make it “so much harder” to do everyday tasks like distribute medications or serve meals.

So what is AAHSA’s take? We support the organizations that are  implementing Green House model, but we don’t think there’s a “one size” fits all approach to transforming America’s nursing homes. Eliminating designated meal times, having consistent staffing and making minor modifications to a home’s physical structure can all promote better nursing home care. In fact, our web site features whole section devoted to tips and tools that can help our members offer nursing home residents the services they need in a place they can truly call home.

Today, CMS will host an Open Door Forum at 2 p.m., Eastern Daylight Time about on the new five-star rating system they proposed last week. The ratings will be posted on the agency’s Nursing Home Compare Web site by the end of this year. However, during June and July 2008, the agency is soliciting ideas, comments and suggestions from the public, consumer groups, nursing homes and others.

This call is your opportunity to ask questions and offer suggestions about the system and advocate that  resident satisfaction data, nursing hours and staff turnover rates be included in it.  It is also a chance to ask CMS to detail how survey and certification data will be factored into the ratings. Click here for more information about the call.

To participate, please call (800) 837-1935 by 1:45 EDT and enter the conference ID: 50249977. You can also send your comments to us and to CMS. 

CMS didn’t just announce their nursing home rating system initiative on Wednesday. They also released a fire safety rule that come with a hefty price tag. By 2013, CMS will require all nursing homes to have full automatic sprinkler coverage in their facilities. If a home can’t comply, they will be unable to participate in Medicare.

These changes don’t come cheap. According to a McKnight’s Long-Term Care News article, retrofitting the thousands of homes that to install or improve their sprinkler systems will cost approximately $850 million. And CMS wants each facility to foot their own bill.

There’s no question that making sprinkler systems in nursing homes mandatory in nursing homes is the right thing to do. But the government provide grants or loans that can help nursing homes pay for these expensive systems. The Nursing Facility Fire Safety Act of 2007 proposes a framework for providing low-interest loans to nursing homes that needed financial assistance with this expense. When it comes to fire safety in nursing homes, we at AAHSA believe that the best thing policy makers could do is encourage passage of this bill or other legislation to promote fire safety in nursing homes.

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

To the Editor:

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

Questions and concerns  nursing home quality throughout Tennessee is making the news. But it isn’t all one sided.

Recently, The Tennessean published an editorial that AAHSA CEO Larry Minnix and the  Tennessee Association of Homes and Services for the Aging’s Exeuctive Director, Carrie Ermshar, wrote together about transforming the fears about nursing homes into hope. I think it’s a great example of why providers must address today’s crises and challenges head on  to ensure a better  for tomorrow.  Here’s what they had to say:

We must move from fear to hope on elderly care

By LARRY MINNIX
and CARRIE ERMSHAR

Recent events at McKendree Village have fueled double-edged fear about nursing homes. The public fears bad care. Nursing homes fear unfair inspections. Fear is a reckless driver.

Experts agree that nursing care needs transformation. “Quality” is inadequately defined and, too often, the caregivers who deliver it are inadequately supported. The inspection process is geared toward rigid compliance with myriad regulations, and enforcement is inconsistent. Reimbursement payment to providers is woefully low — roughly $6 an hour in Tennessee. (Try hiring a babysitter or finding a good hotel for that.) Policy changes are too often driven by ignorance, Band-Aid planning, self-interest and political expediency. The needs of residents and caregivers are often lost.

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So, how do we move from fear to hope?

Providers need to manage better. While all nursing homes face challenges, many achieve strong staff retention, good inspections and high consumer satisfaction.

We must embrace continuous quality improvement as a management practice. Providers must also acknowledge that staffing is the best proxy for quality and concentrate on human resource retention and development.

Policy-makers should use the National Commission for Quality Long-Term Care’s recent report as an honest appraisal and visionary guide to a new era of quality we can trust. Year-to-year planning on how to cut Medicaid or create more regulation does not work. Gov. Phil Bredesen served on the commission, which was led by Bob Kerrey and Newt Gingrich.

The commission believes long-term care should be based on consumer needs and choice; support of family caregivers; respect, livable compensation and contemporary training for staff; use of technology to maximize the independence of older consumers; make provision of care more efficient; and a financing system that ensures access to long-term care.

McKendree Village has a history of community respect, a status that they will earn again. But because of McKendree’s strong track record and the difficulties even they experienced, we must wonder if the whole system of nursing home care and regulation needs attention.

There should be two kinds of nursing homes: the excellent and the non-existent. It is time to transform fear into hope. All of us have a role to play in getting there.

Remember the New York Times story about private equity nursing homes? Well, members of Congress didn’t take it lightly. In fact, they held two hearings about the issue addressed in it last week.

At a Ways and Means Health Subcomittee hearing, scrutiny was the name of the game. Chairman Pete Stark (D-Calif.) even called for a Government Accountability Office report on nursing home ownership’s impact on the critical elements of quality: adequate staffing and transparency. And none of nursing-home-chain owners were there to argue against it.

Then came an analysis on the Senate side. That’s where the support comes in.  Don’t get me wrong, there was some scrutiny, but Committee members also talked about the work nursing homes were already doing to make their facilities more transparent and accountable to the public.

That work includes participating in the Advancing Excellence in America’s Nursing Homes., which hundreds of AAHSA members are doing now.  Sen.  Charles Grassley (R-Iowa) even said it was “vital” that more nursing homes participate in the campaign.

The Committee also hear from Denise Zabel. She’s an AAHSA member, and the  daughter of a nursing home resident, who spoke about her experiences on “both sides” of the situation.

Whether you scrutnize or support nursing homes, the real question is, will any of this analysis create solutions?

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.

Harvey Shankman is at it again… and this time his commitment to storytelling landed Eliza Bryant Village on the pages of USA Today! Check out his letter to the editor about how not-for-profit organizations are pooling resources and developing innovative programs to offer minority seniors quality nursing home care.

 Let us know if there is an organization in your community that’s doing something similar.

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.

Jan. 23, 2007

You need to know the AAHSA Plan for 2007-2008 and what you can do to advance it. The plan is based on the unprecedented confluence of the following information.

Scenario Planning Process — All AAHSA members are receiving by mail an outstanding publication about the future called the “Long and Winding Road,” our updated 10 year scenario planning report. It identifies “consumer behavior” and “talent and workforce availability” as the biggest uncertainties we face in the next decade. I ask you to read it, download supporting information from our Web site and make it a source of strategic discussions throughout your organization.

Member and Employee Satisfaction Surveys — The 2006 AAHSA Member Value Survey pointed out member diversification and overall satisfaction with AAHSA. More than 75 percent of our members are providing some kind of home-oriented services. Approximately 75 percent conduct a resident/client satisfaction survey, but only 25 percent conduct staff satisfaction surveys. I ask you to keep transforming your organization with an eye toward helping older people stay in a place they call home. And, conduct regular client and employee satisfaction surveys. Those who know most about the people they serve and work with will be tomorrow’s successful organizations.

Quality First — Quality First is our multi-year quality improvement plan to achieve excellence and earn the public trust. At its core are “Tell Your Story” and “Live Your Story.” It is based on a continuous quality improvement management and governance culture. It is for all members. Quality First has begun to change the national discussion from punishing nursing homes to transforming aging services for all Americans.

The National Commission for Quality Long-term Care published an excellent booklet called “Out of Isolation: A Vision for Long-term Care in America.” It is clear, simple and outlines the six major area of systems change that challenge America’s aging services continuum. It is a “must read” for your board and other constituents.

I ask you to advance Quality First and report your results. Our Web site is full of tools, examples and case studies that you can use to be successful.

If you are a nursing home, sign up for the new Nursing Home Quality Campaign, a supplement to Quality First. More than 1,200 nursing homes have signed on to measure new and existing quality measures. This voluntary campaign is an unprecedented collaboration on the part of providers, consumers, professionals and government. The campaign reinforces existing quality measures and it introduces process measures related to resident and employee satisfaction.

With these core priorities outlined, below is a summary of our 2007-2008 business goals to advance our mission of creating the future of aging services.

1. To Tell Our Story More Boldly
Our 2006 Annual Meeting & Exposition in San Francisco was a phenomenal experience of storytelling. We all need to get really good at it through annual reports, media relations, resident life history programs and policy maker visits to your organization. The popular media is still focused on negative stories of personal experiences. Our 2007 Annual Meeting in Orlando, Fla., will follow-up on that storytelling journey. The theme is “Live Your Story.” It will remind us again that storytelling changes lives, reinforces fundamental values and underscores enduring truths. It is up to us to change the perception of our work. Perception is reality until we change it.

2. To Strengthen Our Leadership Position
We must continue to position AAHSA members as transformational leaders. We need to be advocate leaders, thought leaders, innovation leaders and statesperson leaders. We will continue to convene leadership groups like CAST, our Long-term Care Financing Cabinet, our Affordable Housing Cabinet and our Faith-Based Cabinet as national models to be emulated locally. We will continue to offer tailored leadership development programs for you and your team. To paraphrase Jim Collins, greatness is a matter of conscious choice and leadership is the key. Leadership matters.

3. To Develop Innovative Models of Care and Services
Some of our members have organizational histories dating back to post Civil War. Yesterday, they were leaders of widows and orphans homes. Today, they are leaders in comprehensive gerontological centers, non-traditional housing models, geriatric rehabilitation, hospice and much more. These same organizations and newer ones like them will lead us into the future. We have led innovation for two centuries — where human need has arisen, our member ancestors have met it. It requires courage, hard work, vision and commitment. We all need to be innovators, and we all need to learn more from each other. I have not found a problem yet that one member faces that another hasn’t addressed successfully, nor have I seen a need that a great not-for-profit hasn’t figured out how to meet.

4. To Advance Advocacy Activism
We know all too well that if we don’t actively advocate for the right policies for the right reasons, bad things will happen through ill-conceived law, regulation or litigation. All of us — including residents, families, staff and boards — must tell our story to policy makers. They listen to somebody’s story every waking hour of every day. That’s how bridges to nowhere get funded and housing and Medicaid don’t. Activism. You must personally and organizationally get involved in advocacy. AAHSA makes it easy for each of you to “Contact Congress” through our Web site. You can express an opinion in less than a minute. You no doubt remember “minute men” from American history class. Today we need “minute people” to get Congress’ attention on key issues.

5. To Reinforce Membership Value
You value AAHSA membership. Thank you. Those who use our Group Purchasing program have collectively saved more than the amount AAHSA receives in dues from all members. Many of you who use our affinity insurance program have similar results. But more important, as one of our members leaders put it, “Every major innovative idea my organization has implemented has come by way of AAHSA.” Our member survey reflects that those who get involved feel more value. It’s called the Power of Community.

6. To Strengthen Relationships with State Associations
Gone are the days when there were clear lines between state and national issues — and between states themselves. We are all in this era of transformation together. While each state has its local dynamics, character, economy and demographics, one thing binds all of us: our aging parents and friends deserve consistent, secure and competent care and services through policies that make quality an automatic public expectation.

Therefore, AAHSA—which is you, our members—is a state and national team. “Think global, act local” and “standing alone together” are two guideposts I use to describe the great relationship we have with state partners. It is incumbent on members and professional staff to see that we synergize and energize our advocacy, shared and storytelling. Together.

7. To Advance a Culture of Discipline
Jim Collins’ Good to Great paradigm includes developing a Culture of Discipline. Like each of you, AAHSA needs to continuously improve our planning and management processes to help you do your job more effectively. Simply put, our job is to help you help the people you serve and those who care for them. To lead you requires that we be the best we can be based on your ever-changing needs. To help us continuously improve, we want your feedback and participation at state and national levels.

A new era is emerging. AAHSA has a responsibility to lead and serve through the Power of Community.

That’s the plan. Let us know how we’re doing — and how you’re doing.

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

Oct. 5, 2006

Last Friday, we participated in an unprecedented quality summit. The purposes of the summit were to draw a baseline on where quality stands in nursing homes, model a new relationship paradigm with stakeholders — some with whom providers have had adversarial relationships — and to take an experimental step in the Quality First journey. The experiment is a campaign called “Advancing Excellence in America’s Nursing Homes” and its mission to improve quality of life for nursing home residents and staff. It is a focused, voluntary, two-year initiative. To clarify up front, this campaign does not replace Quality First. If successful, the campaign and the processes used to advance it will enhance Quality First.

So this is a report on where quality stands today and how we plan to move forward.

Context and History

Four years ago, we, the American Health Care Association (AHCA) and the Alliance for Quality Nursing Home Care publicly committed to Quality First, a national quality improvement plan to demonstrate excellence and earn public trust. While Quality First covers the total aging services continuum, it was widely recognized that the nursing home sector had been embattled for years and we found ourselves in a “crime and punishment” approach to public oversight. After pointed feedback from policy and consumer leaders, we reasoned that the only way out of this awful dilemma was to take responsibility for quality based on continuous quality improvement (CQI) principles. Quality First was born.

While our members have traditionally delivered quality, good works were overshadowed by isolated bad incidents and bad care or deceptive business practices by a few. Yet, it was evident that quality is achievable, measurable and worthy of public good will. And it is my experience there’s more good care available than we’ve been given credit for. Quality First would enable good providers to shine and the chronically incompetent and ill-motivated to be run out of business. Quality First was designed to build on other quality initiatives like Pioneer Network, Eden and Wellspring, and to complement the Centers for Medicare and Medicaid Services’ (CMS) Nursing Home Quality Initiative of 2001.

In the ensuing four years, we’ve had the opportunity to discuss Quality First with numerous groups — including the Founders of the new campaign. These interactions have led me to six major conclusions about quality:

1. Quality is getting better, though more must be done. Quality measures and process improvements are in their infancy for many of us.
2. Workforce is the key to quality and we must address caregiver needs.
3. We need to understand consumer perceptions and enlist consumer groups to help us fulfill Quality First.
4. We have more collective knowledge than we are effectively using.
5. Many key policy makers don’t really understand the complex issues we face and, therefore, are not making the most constructive policy decisions.
6. All interested parties: consumers, government, providers, professionals and business, must work together better if quality nursing home care is to become the automatic public expectation it should be.

A Definition of Quality

To pursue nursing home quality, we must define it. The Founders of the new campaign drafted the following definition:

We’ll see how well this definition wears over time.

Where Quality Stands

Here are the summary bottom lines from various sources, much of which was expressed at the quality summit.

1. Improvement in nursing homes is evident in several CMS quality measures. Use of restraints and pain management are two examples. No progress is evident in pressure ulcers for a variety of reasons. Refinement of measures will be an ongoing concern.
2. Culture change initiatives are proving successful in improving staff retention, with correlations to quality and cost-effectiveness. While studies are relatively small in scale, it is abundantly clear that respect and effective human resource management can make a major dent in the 70 percent average turnover rate nationally for certified nursing assistants (CNAs). One study reports a rate of 10 percent staff turnover based on culture change. We know that staff turnover rates will never be zero and shouldn’t be because a certain amount of turnover is healthy. But a national average of 70 percent is too high, and culture change helps bring that number down.
3. No one really knows in a collective and disciplined way, how residents and families evaluate the services we offer. Our recent AAHSA Member Value Survey found that two-thirds of our members perform resident satisfaction surveys, but little is known about how those results get reported and used to improve quality. There is no national profile for resident satisfaction. Approximately one-third of our members conduct employee satisfaction surveys, but again, little is known about what changes these surveys generate.
4. The momentum behind Quality First is growing. Two-thirds of AAHSA members have signed the Quality First Covenant. In AAHSA’s recent member survey, approximately half of our members report they are using Quality First to help them improve. Interestingly, approximately one-fourth of those who have not signed the covenant say they, nevertheless, are using Quality First to improve. We have strong anecdotal information about how Quality First is helping to transform organizations. Our Web site is full of Quality First member success stories.
5. National leaders who spoke at last week’s summit are recognizing that quality care is a national responsibility, and that the financing of it needs to be revamped. While no one promised more money, there is general acknowledgment that quality should be defined and paid for adequately, with financial incentives for good care. Emerging themes at the meeting were changes that allow people to stay at home longer, redirection of dollars to follow clients and the potential for technology to improve care and cost.
6. Sen. Charles Grassley (R-Iowa) addressed the summit. He is a skeptic about voluntary self-responsibility initiatives, and stressed his support for strong survey and certification oversight. He reported that there are several hundred chronically bad providers who should be shut down but are not. Sen. Grassley, and those groups who reinforce his view, are our acid test critics. While we disagree with his conclusions about the effectiveness of voluntary initiatives, we have much work to do to prove him wrong. And we agree that the bad apples should be discarded. The issue becomes how to support CMS and the state agencies in accomplishing that objective.

What Should We Do Next?

1. Full steam ahead with Quality First! I believe we are close to the tipping point in its effectiveness. The Quality First Elements need to be embedded in every member’s culture. There is plenty of evidence that this is occurring. Quality First is taking root.
2. Implement consumer and staff satisfaction surveys, use the results for improvement and report findings through annual reports and newsletters.
3. Embrace culture transformation. It is our salvation.
4. If you are a nursing home, sign up for the “Advancing Excellence” campaign. This is a way to show that voluntary efforts can be successful. Your participation will give us reliable, collective national data on improvement.
5. Learn to tell our story better locally and nationally.

At the close of the “Advacing Excellence” summit, I asked one of the dozen or so nursing home residents in attendance how he would “bottom line” the day. He replied, “It looks like if residents and staff are given the respect they deserve, and the people that run these places will train people well and have better communication, we shouldn’t have too many problems.”

Yes, let’s ask the consumer what he or she thinks. It could be enlightening and helpful on this next phase of the Quality First journey. And let’s see what this campaign can teach us about quality improvement, working more collaboratively with other groups and the effects we can have on policy makers. We have a big opportunity and responsibility to lead permanent transformational change. Yes, we are close to a tipping point!

Larry

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

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