Category Archive

When it comes to controversial conversation topics between people and their aging loved ones, driving tops the list. At least that’s what researchers from the National Safety Council (NSC) and Caring.com found in a recent survey about topic.

According to the survey, baby boomers were more comfortable talking to aging relatives about selling their home or making funeral plans than about putting away the keys. However, seven in ten believe that someone else should have that conversation with them.

Why the hesitation? Caring.com’s Andy Cohen believes that many seniors see taking away the car as a ”symbolic step towards end-of-life, and it also marks the beginning of the adult child stepping into a caretaker role.”

But it’s not just about today’s seniors. Over the next 20 years, the elderly popluation is expected to reach 31 million. U.S. Census Bureau experts believe that means the number of elderly driving fatalities could surge to 100,000 over the same time period.

How can you prevent one of these tragedies? There’s several resources that can help. Ask your aging loved one to complete the AAA’s self-rating form for senior drivers. Or, share these tips from AARP:

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

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

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

It features the following questions:

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

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

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

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

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

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

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

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

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

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

Aug. 29, 2006

As we celebrate Labor Day, we must recognize again the most important dimension of our work together — Respect. Respect embodies all that is good, healthy and holy in what we do.

Respect for people who deliver long-term care to older people in various stages of health and independence. Respect for those who serve mentally and physically challenged people of all ages. Respect for people who perform difficult, noble and essential work for virtually every family in America at some time in their lives.

Myriad studies tell us we face a demographic crisis as our population lives longer and a workforce availability crisis to meet emerging need. Still other studies point to staffing as the best proxy and predictor of quality in nursing homes. Studies define what it takes to attract and retain good people. Studies! Studies! Studies! Fretting! Handwringing! More studies! The Chicken Little syndrome! What ever shall we do? What’s the answer?

It all boils down to one fundamental principle of human psychology and spirituality — Respect. So, I’ll distill decades and volumes of research to the Ten Commandments of Respect. These are derived from countless conversations over cups of coffee with people who serve — like a night nurse from an Atlanta nursing home or a van driver from a New Orleans housing community. The Ten Commandments come from seeing hundreds of you in action in your world. They are inspired by the Better Jobs, Better Care living laboratory project of our own research institute. They are discerned from the learnings from numerous panel discussions held nationally and locally with people who work and volunteer in our great field of service. Here they are:

Ten Commandments of Respect

Commandment #1. Thou shalt recognize every employee as a person motivated to relieve human suffering and enhance the lives of others.

Commandment #2. Thou shalt view all employees’ roles as essential to the health of the people served and to each other.

Commandment #3. Thou shalt pay everyone competitively with livable wage and benefits that reinforce family health and economic stability.

Commandment #4. Thou shalt see every employee’s human development potential and offer programs to stimulate personal growth.

Commandment #5. Thou shalt honor the unique and diverse backgrounds and traditions of all people.

Commandment #6. Thou shalt allocate resources to learn the new and emerging concepts and techniques to improve competence and self-esteem among all team members.

Commandment #7. Thou shalt cultivate and nurture helpful and hopeful attitudes among team members and support each other in times of personal tragedy.

Commandment #8. Thou shalt deal with conflict, incompetence and injustice swiftly.

Commandment #9. Thou shalt have fun and grieve losses together frequently.

Commandment #10. Thou shalt take time to rest and renew.

Respect — for each other; for life as a sacred cycle; for aging and disability as inevitable states of existence. Respect — for human potential through desire to do well and do better. Respect — for the possibility of a better life, for legitimate difference of opinion and for the success and achievements of others. Respect — for commonly held values and diversity of traditions within those values and for the freedom to contribute and grow.

I hypothesize that respect is the single most important thing that will make us successful because it always has.

Anybody want to study that? Or do we want to go ahead and implement it every day because we already know the power of it!

Happy Labor Day to all Who Labor Every Day — regardless of your formal position or title.

Larry

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

June 20, 2006

I have three quotes that can transform your organization. Two came from a study that our Institute for the Future of Aging Services did for the Department of Health and Human Services (HHS) and the Department of Labor (DOL). The other is from a study by CNA, AAHSA’s affinity insurance carrier.

The HHS/DOL study is entitled “Measuring Long-term Care Work.” It’s filled with a variety of validated tools — many developed by and with AAHSA members — on how to measure things like job satisfaction, worker-client relationships and organizational culture.

The CNA study, “Comparison of Claims Data in Long-term Care — January 1996 through March 2005 — Not-for-Profit, For-Profit” (a catchy title, don’t you think?), contains an excellent analysis of the major reasons we suffer liability claims and a detailed guide that can fit nicely into your Quality First tool belt on what to do to prevent liability.

The HHS/DOL study is about 400 pages. The CNA study is about 30 pages. Both belong on your bookshelf and are worth operational planning time with your staff. They ain’t sexy, but are essential resources for all of us.

Here are the three quotes—
“In a study of nursing home assistants, worker-resident relationships were identified as the most important work issue, and the major reason for worker retention.”
“The importance of considering worker-supervisor relationships when attempting to maximize retention and limit turnover cannot be overstated… Supervision has been cited as a primary reason for leaving an organization…”
“Effective communication among providers, residents and families can foster realistic expectations related to resident care and services. The quality of the relationships and the ability to freely address concerns is the single most effective deterrent to litigation.”

I recently had the opportunity to hear an inaugural presentation by Ed Kinney, the new CEO of Life Care Services. LCS is based in Iowa, but serves in 29 states as owners, managers and developers. Ed said to the assembled group, “you know, in the final analysis, we’re fundamentally in the relationship business, aren’t we?”

John Outler, a human resources guru I worked with, said many times, “you have to go through relationships to get to the work.” Then he’d add, “people have been known to hang high-voltage wire in a hurricane if they have trusting relationships.”

Mike Moore, AAHSA board member and CEO of the United Presbyterian Home in Iowa, wrote me last week about a resident who died recently. A deathbed conversation with her son included her gratitude for the home’s staff. Her son quoted her at the funeral, “they were more than my caregivers. They became my friends.”

A medical study a couple of years ago concluded that the relationship between certified nursing assistants (CNAs) and residents is often so close that they are the most likely folks to pick up on subtle changes that result in a health crisis. Observations of a resident like, “she doesn’t seem like herself today…” can make all the difference.

I wonder how deeply we really understand the depth, power and quality of the relationships between staff and residents. Mike Moore said he sat in the pew at that funeral, beamed inside, and teared up as he shared this individual’s perception of her relationships with staff members. If we asked, we might be amazed at staff’s level of knowledge about resident needs, disappointments, hopes, fears and joys … yes, the relationship context of deep friendships.

The resident-staff relationship is a sacred experience when it’s done right. How does that happen? It happens by selecting the right people. Making sure that every staff member is in care-team meetings. Developing consistent staffing patterns and vigilance about burn-out or unusual stress in the lives of staff. Using staff satisfaction surveys. Hosting fun events. Being accessible to staff. Managing by walking around. Creating policies and programs that allow staff to spend quality time with residents.

Research from our Better Jobs, Better Care program has also given us some hard evidence on what works: Things like cultural competency training that focuses not just on teaching staff English, but on understanding the customs and cultures of those being served and those doing the serving. Dedicated staff retention specialists whose job goal is to reduce turnover. Direct care worker peer-mentoring programs and organizations that budget for the time required for them to participate in training and to support each other.

Early in my career as administrator of the Wesley Woods Health Center, an old Hill-Burton nursing home, we participated in one of the Great Society job training programs. Though a success, I remember a young CNA who was unusually gifted. She was bright, warm and had a good work ethic, and a lot of promise. Well, one day, she slapped a resident, out of the blue. Stunning; naturally, we had to discharge her immediately.

The person who cried most was Doris Kittle, a registered nurse who was a gifted mentor, among her other talents. One of the greatest nurses I’ve ever known. She thought she’d failed one of her residents and this young woman terribly. When we rooted out the cause of the behavior, the young CNA had just found out she was pregnant and had a sexually transmitted disease. She had gone home from work the afternoon before to find all of her belongings piled out on the street, and her boyfriend had left her. She came to work the next day and took it out on a resident. If we’d only known …

The care and feeding of the resident-staff relationship and the staff-supervisor relationship within the context of healthy teamwork is the crucible from which a successful human resources culture is forged. That’s what the Pioneer Network, Eden Alternative and Wellspring are all about. And there are people like Anna Ortigara of LEAP, Michelle Holleran, Clint Maun, Fran Battisti and Robyn Stone—and many of our members who are successful culture keepers—who can help us develop such a culture.

The aging-services airwaves will be increasingly filled with the concept of “person-centered” or “resident-directed” care. I can’t prove it, but I’d bet that far too much of what we do is provider-centered care done for our convenience, or to mollify surveyors, or because “that’s the way we’ve always done it.” Order the video “Stand Up and Tell Them” and view it with your staff. It realistically addresses where we are and where we need to go in terms of person-centered care.

Genuine person-centered care isn’t new. Hospice developed on that core principle for almost two generations. It is based on open communications with the patient about their condition, keeping family in the loop, tailored approaches to treatment that the patient wants to try and flexible schedules of basic services like meals and sleep and bathings and visitors.

Just ask some of our business friends like Aramark, Morrison Senior Dining or Sodexho about the effect of replacing a tray line assembly approach to meals with a dining experience with cafés, buffets and flexible hours. Resident satisfaction is up and weight loss is down.

Why? Choice. Control. Variety. Ambience. Relationships.

What do the people we serve and those who serve them expect of us? A good place to start is to make sure you ask them. Drew Gackenheimer of Joseph L. Morse Geriatric Care Center in Florida has a well-thought-out approach to family expectations from the early stages of the relationship. If families expect a cure or a return to health that is impossible, the Morse people help families honestly deal with the reality.

The science behind jury decisions in liability cases reflects that the key to favorable outcomes is the perception that we’ve done the best we know how to do, that we have a positive relationship with residents and families about expectations. And, yes, even when we make mistakes, we aggressively try to respond to problems when they arise, and honor requests when we can. People are less likely to sue people they know, like and respect. Mark Thomas of the Ebenezer Society in Minneapolis told a group of AAHSA leaders, “Culture eats strategy for lunch.” Relationships should be the number one responsibility and concern of leadership.

The key to a future of health and viability for our organizations, and the improved quality of life the elders in our communities deserve, is Relationships! Relationships! Relationships! In the final analysis, Ed Kinney and Mike Moore are right. We’re in the relationship business, and we enable deep friendships through caregiving.

Larry

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

Learn more about Better Jobs, Better Care.
Learn more about the Aon risk management training.
Read the ASPE/DOL Report.