One Hundred

One Hundred by Matt Maupin, HFA

I don’t know what it’s like to be one hundred
Life’s challenging at only thirty-three
But if I ever live to be one hundred
I hope my friends will still remember me.

How’d you ever get to be one hundred?
I sometimes ask our friends with us today
“We never drank or smoked,” they say so proudly
“And ne’er to God did we forget to pray.”

Did you ever think you’d really be one hundred
And are you glad you’ve made it all this way?
“My wife’s one hundred too,” said one good man,
“My love for her grows stronger every day.”

Things get clearer once you turn one hundred
The wisdom starts to overtake your head
The things you know, the things you’ve done
The love that you have spread!

I still don’t know the feeling of one hundred
It’s something only those who’ve been there know
But if I ever live to see one hundred
I’ll cherish every day until I go.

An Open Letter to my Director of Nursing

I’ve worked with my fair share of Directors of Nursing. Each DON has their own unique style – some focus on clinical processes and paperwork and avoid patient care. Other DONs prefer to be with the residents and staff all the time, leaving reports and QA for other managers. Some prefer to let the Administrator set policy, and others prefer to do it all themselves. Many DONs have been in long term care longer than I’ve been alive – for others this is their first try at managing a nursing home. A lot of DONs are experts in certain areas but green in others. I’ve worked with some great nurses, but I’ve also seen a lot of extremes.

You are a wonderful blend of talents. You get super involved without going it alone. You’ve gone out and experienced a wide array of nursing jobs and bring great insight to the team. You’re well spoken, know how to use the computer, and you have great repoir with residents and employees. You’re direct and concise, yet thorough and considerate. You have immense clinical knowledge and use it as a tool rather than a weapon. You have fun with the team, but know when to get serious. You lead by example in terms of work ethic, personal conduct, professionalism, and integrity. You understand not just the job of the DON but also the job of the Administrator. You do whatever it takes to get the job done, but stand back and let people do their own work. You live up to your mistakes and learn from them.

It has taken time for me to adjust to your style, because you have higher expectations of me than any Director of Nursing ever has. It’s great to have a partner rather than an employee, and I couldn’t do it without you. Rather, we couldn’t do it without you. Your contributions of time, talent, and effort have improved our standards, improved our quality of care, and improved our employee morale. You’ve made your nurses better clinicians, your managers better leaders, and our team a more cohesive unit. I know I speak for everyone here, residents and staff alike, when I say, “Thanks for everything you do.”

They say that the best advice you can give any manager is, “Hire people better than you.”

I’ve done just that. 

Stop Calling Me a Tube-Feeder

This morning I received an email from a vendor outlining new procedures for billing enterals and ostomies. A pretty boring topic, even in my world. I've been thinking about it all day though, because this particular vendor referred to our residents as "tube-feeders" five times. And he didn't even use the hyphen.

Tube-feeder? Is that what you become right before you're consider a bottom-feeder?

We're a month away from National Nursing Home Week, and I thought we had all taken a step forward as an industry. I don't even think about calling someone a "Medicaid resident" or "a fractured hip" any more than you would call your neighbor's child with a developmental disability, "retarded."

I am frequently reminded, however, that not everyone we work with understands the importance of language in long term care.

So please, if you are reading this, take a moment to think about the language you use to describe our residents and their needs. Feeders, screamers, assists-of-two, memory-care residents, hip-fractures, hospice residents, and level two's all should have went away with OBRA '87. We don't toilet people anymore than we sink them or exhaust fan them. You walk your dog, but you don't walk a resident. We assist people with their needs; people are Medicaid recipients and in some cases require that level II paperwork is completed before they move into our neighborhood. This isn't a marketing gimmick - it's basic respect for your fellow human beings.

You wouldn't call your own grandma a feeder, would you?

Educate Resident to use Call Light

When assessing a resident fall, sometimes it is apparent that if the resident would have used the call light and waited for help, the fall could have been avoided. Seems obvious, right? So our intervention becomes, “Educate resident to use call light.”

The problem is, we’re supposed to be determining the root cause of the fall. In this case, the question shouldn’t be, “What did the resident do wrong?” Instead we must ask, “What was the resident trying to do? How could we have better anticipated that resident’s needs?”

Suddenly “educate resident to use call light” doesn’t make as much sense. Instead, consider:

“Keep bedside table within reach.”
“Change timing of bathroom schedule to better anticipate resident’s needs.”
“Ask resident if they need to use bathroom after meals and 60 minutes after going to bed.”
“Set sleep timer on resident television to keep him from getting up to turn off.”
“Leave bathroom light on for safer way-finding to bathroom.”

Each of these interventions would have to be specific to the question, “what was the resident trying to do,” but hopefully you understand the rationale behind these examples.

There are other reasons to avoid the “educate on call light use” intervention. The MDS must indicate that the resident has perfect short term and long term memory, has full physical ability to use the call light, and that the same intervention has not been listed previously. It’s a tough battle with surveyors, one I’ve lost in the past.  Finally, resident education should be documented in the record or in the incident report – and usually is not.

Avoid this ineffective intervention and keep your team focused on root cause analysis when analyzing a resident fall or updating their care plan.

Addendum to plan of correction

They ask for the strangest corrections:

1. "Please explain what is meant by persistent non-compliance."
2. "What are the staff expected to do when a resident has a care plan for a seat belt, the seat belt is not used, and the staff are called away?"

I'm afraid I've answered their questions with even more obscure answers than the original POC...

Great residents are so much better than a great commercial

This week we threw a party to celebrate the lives of the eleven centenarians at Lutheran Life Villages, including my 108-year old Scrabble partner. We were fortunate enough to have our local newspaper visit and interview the group.

What I wasn't expecting was this wonderful video montage of the centenarian interviews. I'm so glad that more people are taking the time to utilize technology and document resident stories.

That's Eva Teeters, one of my great neighborhood coordinators, in the picture on the left.

Mrs. Brady

I just about fell off the couch when I looked up and saw Florence Henderson in an American Senior Communities advertisement this morning! This is the first time I have ever seen a celebrity endorsement of a senior living organization, but surely not the last. If you're interested, the commercial was a national 30-second generic spot with a local overlay at the end listing facility locations. Flo looked pretty thrilled to be hanging with the nursing staff at the local ASC facility. Who will endorse next? Imagine Tony Bennett crooning in an Extendicare ad, or Betty White bragging about her favorite Golden Living Center.

Of course, my organization's newest local ad ran during the same Sunday morning commercial break. No Flo, but at least we have the sharpest local ads around, and we use actual residents.

Good Pastime

This note from a resident caught my eye during rounds this morning. Made me smile, so probably worth sharing.

Senior living - also a good pastime.

Privacy Rule of Thumb

It's good practice to have a "no business in the hallways" approach to resident privacy. It's difficult though - you see the social worker you've been looking for all day outside a resident's room, or you catch nurse Jackie on the way out the door, and its your duty to get them that important message.Why can't we talk about bed management in the lobby?

A lot of healthcare professionals struggle with this, particularly in and around the nurses stations and other naturally congregate areas. So while its easy to ask staff to pull their business conversations behind closed doors and to "keep all patient information confidential," it's a good rule of thumb to more specifically designate phone areas as safe communication spots. By telling staff to keep all patient or business sensitive conversation within arm's reach of a phone, it's an easy way for them to hold themselves accountable to bringing conversations back to that safety zone. By building this expectation into the culture, everyone understands to also avoid those areas when a conversation is happening, as it is likely sensitive information being shared.

Nurses stations and other public work spaces in health care come in a lot of forms nowadays, but most if not all have at least one phone stationed at their core. Teach your staff to gravitate towards offices or other phone/communication stations to avoid resident disruption and protect health information.

More Scrabble Stories

From my friend John:

"LOVED the Scrabble playing with the 108 year old. My grandma used to be a nationally ranked player and she still plays every day. I played her at the beach this summer and was sadly crushed. She brutalized and embarrassed me, laughing all the way to victory. Then told me she would play whenever I wanted. SIGH."

Thursday Todo List

Today I'm working on:

  • Finalizing the renovation plans for a shower room
  • Meeting with activities about organizing and increasing outings
  • Setting up the logistics for delivery of goods for our soon-to-open skilled nursing campus
  • Reviewing process for tracking lost referrals
  • Maintenance rounds
Hopefully some resident interaction sprinkled in.

Scrabble versus our eldest resident.

Yesterday she celebrated her 108th birthday.  No way I was letting her lose. 

Her secret? "Lots of walking."

Final score: 273-264.

Direct Supply Trip

Last month I visited Direct Supply (DS) headquarters in Milwaukee, WI, traveling with an associate to evaluate furniture and equipment options for a new SNF. I delayed this trip for several months despite the encouragement from my DS reps. It turns out that I should have taken their advice sooner. The trip was 25% sales pitch but 75% quality professional education. If you have the opportunity in the future, I encourage you to take it. I learned more on this trip than most seminars and conferences I have attended.

First of all, here's what you can expect in terms of trip logistics:

-It takes two days to fully tour the DS headquarters and product lines;
-Direct Supply is the Google of the LTC industry; they have a fun work environment, awesome benefits, and an inspirational story;
-Take two items: comfortable shoes and a camera; you will walk several miles and want to remember a number of specific products you demo; you will see ten buildings and hundreds of innovative FFE offerings;
-DS paid our hotel, food and beverage; they were very hospitable;
-DS asks you to pay your own travel expenses.

More importantly, we learned about so many products. I've purchased a lot of beds, mattresses, lifts, carts, etc. in my lifetime but never really understood the differences between various products lines and models. I'm part of an independent not-for-profit, so I don't have corporate staff advising me on the latest technology and offerings. One example:

We still use the 1.5" blue mats next to resident beds to reduce injury from out-of-bed falls. Turns out those are practically obsolete. Now they offer 1/4" versions that are more effective, don't have to be moved during day, and look like floor rugs. I honestly had no idea. I've already order some replacements. Sales pitch + education is okay if it benefits your residents.

Here are some of the items we had the chance to test and learn about:
-Electric beds
-Pressure-relieving mattresses
-Clinical monitoring equipment
-Lift equipment and assistive devices
-Floor care equipment
-Housekeeping equipment and carts for all areas
-Kitchen equipment from hoods to teaspoons
-Furniture, including living rooms, dining, and resident rooms

Direct Supply also offers several services, notably TELS. You will learn that their TELS product is a web-based maintenance tracking, life safety code scheduling, and inventory management system. TELS is designed to be the centerpiece of your facilities maintenance program, serving as both a maintenance request system as well as scheduling, tracking and documenting your annual regulatory requirements. Here are the facts:

-$97 per month, per facility for unlimited users
-Designed for all facility staff to use as maintenance request system 12-month scheduling system for LSC, PM
-Requires some Direct Supply input of information
-Has iPhone capability for easy entering and receiving of new maintenance requests (great feature)

Many large for-profit organizations use TELS and when considered as a monthly cost $97 seems reasonable. When comparing to a one-time software purchase, however, the fee may be excessive for your organization. The biggest drawback is the built in dependency for DS to scan and upload your key documents and scheduled annual tasks. We plan to trial the system for a few months and will ask our Director of Facilities to determine if this system is worth the input time and associated maintenance costs.

Overall our trip to Direct Supply was well worth the expense and time. You've seen the catalog, but it's only a small portion of what Direct Supply really offers. DS is an employer of choice in Milwaukee, an expert in long term care, and an advocate for quality and process improvement. I highly recommend you make this trip if it is offered to you and your organization. Even if you are not a direct purchaser, chances are your maintenance, environmental, and nursing departments are buying products from DS. I suggest you educate yourself on the latest products to better serve your residents and employees.

Submitted by Matthew G. Maupin, HFA

Happy National Nursing Home Week!

A man's age is something impressive, it sums up his life: maturity reached slowly and against many obstacles, illnesses cured, griefs and despairs overcome, and unconscious risks taken; maturity formed through so many desires, hopes, regrets, forgotten things, loves. A man's age represents a fine cargo of experiences and memories.

~Antoine de Saint-Exupéry, Wartime Writings 1939-1944, translated from French by Norah Purcell

New competency model will benefit long-term care industry

From The Department of Labor has released a competency model for the long-term care industry that officials hope will solve long-standing issues of low wages and a high staff turnover rate.

“The models are an excellent guide to leaders at the operational level for both employee recruitment and identification of continuing education needs,” said Matthew Maupin, administrator of Lutheran Life Villages in Fort Wayne, Ind., and a blogger on the long-term care industry. “Often as leaders we focus solely on technical competencies without consideration of broader foundational principles, leading to increased training costs and ultimately employee turnover. The models support professional development programs geared towards customer service, communication and utilization of technological efficiencies, which is precisely what the long-term care workforce needs for the upcoming influx of Baby Boomers requiring care.”

See the rest of the article here.

National Volunteer Week

During National Volunteer Week (April 10-16, 2011) we honor the individuals and groups that support our organizations in a multitude of ways. On our campus, volunteers run the gift shop, push residents to chapel services, repair furniture, and raise tens of thosands of dollars each year, in addition to so many other things. Our volunteers are amazing and truly improve resident quality of life.

Then why do we make it so difficult to volunteer? I had to laugh last night watching this sketch last night on Jimmy Kimmel Live. It sums up my thoughts on how we drown every good intention in regulation and risk management initiatives. Yes, I acknowledge the operational needs, but Kimmel really hit the nail on the head in a very funny way.

Employee Prayer

Dear Lord,

May we be worthy of the trust that our patients and residents, our administrators, our staff, and our community place in us. May we seek Your wisdom and guidance. Bless each employee; multiply time and energy.

May each and every person here experience Your strength and joy as they complete another day in this journey.


Quality Measures to be Removed from 5-Star Updates Pending MDS 3.0 Data

The individual and overall ratings for the Centers for Medicare and Medicaid Services (CMS) Nursing Home 5-Star Rating System now are based on the three domains of inspections, staffing, and quality measures. Use of all three domains will change at least temporarily while CMS analyzes the new quality measure data gleaned from the MDS 3.0, implemented on Oct. 1. The last MDS 2.0 quality measure update will be published on the Nursing Home Compare Web site in Jan. 2011. This last update will be based on the last quarter of MDS 2.0 data and it will remain posted until April, 2011. After April, CMS anticipates no public reporting of quality measures on Nursing Home Compare until spring, 2012. Effective April, 2011, the quality measures will not be included in the 5-Star calculation process and facility ratings will be based on the two remaining domains, inspections and staffing.

New Kid In Town

This week I toured a new "facility" in another state. God forbid you call it a facility, because there's nothing institutional about it. It's completely out of your realm, yet so close. I've toured nearly 100 properties in the past 10 years, and this is the only one I could actually picture myself living at. And I'm 30.

Wait until a few of these pop up in every state. Don't worry, it doesn't replace your property. It doesn't even necessarily complement your property. But you aren't offering it, I'm positive. Is it a threat to your census? What isn't?

This time you should be worried.

They aren't doing short-term rehab. They don't have home health. Dementia care isn't their specialty, either. But if they are in your market, you can bet that everyone else will compare your product to theirs. It's not fair, it's not congruent, but it's reality. The new reality is a face off between your traditional facility model and a host of unique new options. Senior living is no longer need-based.

Senior living is no longer need-based.


I get a lot of messages from others that have placed a link to The Nursing Home Administrator on their own resource. This list below is not an endorsement from me, just an organized list (in no particular order) of some other people out there writing about care for the aging.

Get Hospice Nursing Jobs - A hospice job aggregator
The Learning Advisor - On online educational advisor - Consumer Research Site
Becoming A Life Change Artist - Wonderful book on creativity in later life

The Days are Numbered

We've had great weather this year.

I was leaving work and a group of residents, as always, was sitting on the porch enjoying the sun and a nice breeze. One gentleman, sitting away from everyone else, looked especially relaxed - eyes closed, smile on his face, reclined in his chair. I know he's in renal failure and has chosen to spend his time on Earth peacefully rather than going through extensive treatments.

"Enjoying the sun?" I asked as I approached him.

"I sure am," he said without opening his eyes. "The days are numbered though."

"Oh, Mr. Baldwin, I'm sorry to hear that. You're not feeling well, huh?"

We've had a few of these deep conversations and I know that he's been to the hospital recently. He reads the obits pretty religiously and is some ways I'm sure he is counting his own days. I wasn't surprised at all to hear him comment on his own mortality.

"No, I meant the weather," he replied.

A Disappointing Response from the Governor

Here is the response I received from Governor Mitch Daniel's office regarding my recent letter requesting his refusal of a bill that will now allow employees to keep guns in their cars while at work. Unfortunately this bill does not specifically exclude nursing homes or assisted living facilities and will now go into affect July 1, 2010:

Dear Mr. Maupin,

Thank you for your letter and for sharing your thoughts with the Governor. He appreciates the time you took to share your views on this subject.

House Bill 1065, various provisions concerning firearms, passed the Indiana General Assembly and was signed by Governor Daniels. This bill will go into effect on July 1, 2010.

Governor Daniels statement regarding HEA 1065:
"Considering the clear language of the Second Amendment of the U.S. Constitution, and the even stronger language of Article 1 Section Thirty-Two of the Indiana Constitution, protecting these rights as provided in HEA 1065 is appropriate. I also am compelled to give great weight to the overwhelming consensus of both Houses of the General Assembly as they passed this bipartisan statute. The law does contain ambiguities that the General Assembly may wish to refine at some future date, to avoid unnecessary litigation, but the understandable concerns raised against the bill do not suffice to justify a trespass on a fundamental right so expressly protected by our founding documents."

The 2010 Bill Watch on the governor's website has been established. We will continue to update the website as bills are received and/or action is taken by the governor. You may view this webpage at

Please be assured that Governor Daniels monitors all legislation very closely as it proceeds through the legislative process and thoroughly reviews all bills that are brought to him for approval or veto.

Thank you for your citizenship.

Sebilius Suggests Possible Changes to Five-Star Rating System

"The last thing we want to do is have an arbitrary bell curve just for the sake of having a system," Sebilius was quoted this week as saying at McKnight's LTC News. The Health and Human Services Secretary was commenting on the lacklaster five-star consumer system imposed by CMS in 2008. It has received less than shining reviews from providers.

Sebilius should be aware how strongly providers feel about her statement. The fault of the system is that it forces all provides into a single pre-determined quintile, arbitrarily moving individual facility scores around during the year as other providers complete survey cycles. Rather than measuring quality improvement, it is strictly comparative, and certainly not on a real-time basis. Additionally, many facilities and organizations usie their survey as a true quality improvement process tool, and make significant improvements 3-6 months after a health survey. The system forces a single score on providers for up to 17 months at a time, quality measures component aside.

The Secretary seems to agree with providers that an improved system would include all three componets, namely better measurement and explanation of quality measures. "If everyone ends up being excellent or everyone ends up being failing, so be it,” continues Sebilius. We couldn't agree more. While CMS is unlikely to open up to most provider recommendations, we can continue hope and lobby for reform in this area. Until then, just know that a facility in another state could bump you from a three-star community to a two-star community with one good survey.

National Nursing Home Administrator's Week

A lot of you landed here this week because you were Googling (or Binging, I suppose) the term, 'National Nursing Home Admininstrator Week."  In case you missed it last year, I wrote briefly during the week of March 2009 on how this particulcar recognition day should not be included in your community's celebration calendar - and certainly not at your suggestion. 

I can't find any proof of its existence or declaration in 2010.

So from me to you, in the most unofficial of terms, Happy Nursing Home Administrator Week! 

Don't tell your staff.

Ideas for National Nursing Home Week

Community Historic Trivia Contest with Silverchair online in-service

Group photograph of everyone on campus by Professional

Family photography giveaways through Professional – Have your family photo taken in the same style as the Annual Report photos (plus we could use some of the shots for advertising), we could easily do 5-10 of these packages

Banner with every employee’s name on it in front lobby

Letter of recognition to editorial of local paper, mayor’s office, state representatives, etc.

More general “Thank You for what you do” banner to employees outside on main Blvd.

Addition and dedication of new employee wellness equipment, ie. New treadmills, bikes, etc.

Special limited edition Community branded pen – one time run only of 500 for both employees at both campuses

Employee Wellness walk to raise money for Employee Assistance fund

Arrange for 2nd shift nursing staff to work over so that we can throw a 3rd shift party at 10:30 p.m.

Recognize National Nurses Day by purchasing a print media ad

Letter to families of employees thanking them for their support of Community

Community T-shirts…

Make a video of employees saying positive things about other employees and show at Town Hall Meeting

Daily Employee Spotlight Profiles on Facebook every day during National Nursing Home Week

Employee dog show with residents as judges

Themed dress days that will have more than 50% appeal – breast cancer (pink) day, Alzheimer’s (Purple) Awareness day, etc.

Your Employees Should be Begging to Do This

This afternoon I had the pleasure of delivering an impressive Valentine's Day arrangement to a resident. She had been quietly enjoying her Saturday, which consisted mostly of sitting in her recliner watching television and waiting for dinner. Suddenly, though, I popped around the corner holding a lovely bouquet from the local florist. It was an event, and one we both enjoyed.

I work with a great Director who sometimes laments that she misses the days when she was able to work more directly with the residents. You've heard your managers voice similar concerns, reflecting on their former roles in direct care positions and supervisory roles. As a department leader or Administrator in a CCRC setting though, these daily opportunities are rarely included in your job description. You must seek them out; they probably won't just come to you. Even as a leader, as a manager, as a Director, you must connect with the residents you serve. Especially as a leader.

So I grab these flowers from the reception desk as I scoot in this morning. Sure, they probably already called down to the nurses station when the flowers arrived, and someone on the other end said they'd be down when they had a moment. I may even pass them on the way down. But c'mon, this is no chore! I'm heading that way anyways, so I'll just take those flowers, Nancy!

It's a ten-minute walk across campus as I snake through the buildings, and though I sometimes exaggerate, I'm sure no less than 15 people made some comment about these flowers. What a hit! This will definitely be a feel-good moment for Ms. R. As I finally reach her room, I hear one last person down the hall saying, "Awwwww, for me?" I knock and thrust the roses in front of the awed resident for her inspection.

For the next 15 minutes, this lovely resident tells me all about her family as I help her unpack the carefully cellophaned arrangement. I make sure to ask her permission each time I pull anything away, and I am careful not to look at the contents of the card. I don't throw anything away without her permission either, and I make sure that the flowers are left in a place that is a) sturdy, b) where she can see them, and c) in a place where other people can see them and ask her about them.

So what, you ask? Well, I find that I often miss these opportunities with both my own Grandmother and other people's Grandmothers, and now I'm reminded of the little things in life. So, if you have a Grandma, send her flowers for Valentine's Day - it really DOES make her feel good. And if you're an employee, grab the flowers when you walk past them at the reception desk.

It's your perfect opportunity to connect.

Captain Phil Harris, 1956-2010

I was saddened this morning when I received word that Captain Phil Harris passed away.  He suffered a stroke in January and had undergone serious treatment.  Captain Phil will be missed by his fans and friends, but especially his own family:

"It is with great sadness that we say goodbye to our dad - Captain Phil Harris. Dad has always been a fighter and continued to be until the end. For us and the crew, he was someone who never backed down. We will remember and celebrate that strength. Thanks to everyone for their thoughts and prayers.

- Jake and Josh Harris

Here is Captain Phil with me and the pumpkin portrait of him that I carved in 2009.  Phil befriended our staff here and was very kind to our residents the day he visited.  He was a very gracious guest and geniuinely engaged during his visit. 

Rest in peace, Captain.

The Relief of Annual Survey Completion

Today our campus finished the re-visit to our annual survey.  Fortunately our survey findings were limited this year and their follow-up took less than two days.  The sense of relief that completion of the survey cycle brings is indescribable for me as an Adminsitrator.  Regardless of how you feel about the survey process, knowing it's over should leave you and your staff with a sense of accomplishment and excitement. 

From start to finish, you and your team will spend 2.5 months from day one of a survey to the completion of an average re-visit.  Once the survey cycle is closed, find ways to continue quality assurance monitoring of survey deficiencies per your plan of correction.  Remember, though, your core group has spent a lot of extra time auditing records, checking ted hose, reconciling labs, in-servicing staff, conducting return demonstrations, etc.  Don't fall back from approaches that are exhibting value, but re-tool other parts that aren't working.  Don't be afraid to amend your plan of correction if it becomes irrelevant.

Finally, go back through your notes from the surveyors.  Those "FYI's" they give you aren't just small talk.  Expect close scutiny of those very topics during your next survey.  Re-organize all of the copies that you collected during the survey, type up the most relevant of your own notes, and put a cover sheet on top with the dates of the survey and any other significant information.  Leave something that's easy to comprehend for the next person in your seat.

National Nursing Home Week 2010

AHCA is proud to announce the 2010 National Nursing Home Week® (NNHW) theme: "Enriching Every Day." NNHW will be celebrated in nursing and rehabilitation facilities nationwide, beginning Mother’s Day, May 9, and continuing through May 15, 2010. This year’s theme was selected to honor those who are “Enriching Every Day” for others, thus adding value to life and overcoming many of the infirmities of age and disability.

I encourage you to start planning now.  These events sneak up on you, and before you know it, you are throwing something together - and your staff don't feel appreciated, like they should.  Watch for more posts here regarding ideas for celebrating the week with staff, families, and residents.

Medicare State Operations Manual

The Internet continues to become more interactive and user-friendly. The latest online version of the Medicare State Operations Manual is one speedy PDF! It is organized in a manner that provides instant access to rules governing everything from hospitals and long term care facilities to life safety code and laboratory services.

Wondering how the swing-bed unit in your local hospital works? How about the vendors you work with? It's all included, and so easy to reference. I recommend saving the table of contents PDF and your organization's applicable guidelines to your desktop for quick reference.

101 Blog Posts Every New Nurse Should Read

Nurses Practitioner Schools has a new list of "101 Blog Posts Every New Nurse Should Read." And while my post on conducting a good investigation did not make the list, their list is certainly worth perusing. Even if you don't realte to all of the posts, it is a pretty exhaustive resource to find some great health care blogs.

Additionally, the Health Herald is currently featuring it's Top 50 Hospice Care Blogs. Between the two lists, we have a pretty nice compendium of currrent "resources."

Healthcare-Associated Infections (HAI)

One thing everyone can agree on, no matter where they come down on the current health care debates, is that no one should get sick as a result of visiting the doctor.

Healthcare facilities are rightfully expected to protect you from infection but that's just not always the case. Sometimes people are picking up infections, from pneumonia to antibiotic-resistant staph (MRSA), while under treatment for other health problems, or even while just in the hospital having a baby. That's a situation that could, and should, be completely avoidable.

Kimberly-Clark Health Care is on the forefront of protecting patients from Healthcare-Associated Infections (HAI) and has put together a site dedicated to that prevention called HAI Watch: Not on My Watch. The site has information for both healthcare professionals and healthcare consumers.

Click on the link above to access their resource.

AAHSA Sunday: The weather, event reporting, and the shuttles

Welcome to AAHSA Chicago. It was gorgeous here today, 64 degrees as I write this after dinner. I'm here this week with a group of eight and traveled today with our Director of Nursing and Director of Wellness. The great weather and our wonderful families led us to get a late start from the Fort, so I can't comment much on today's opening speakers. I spotted Mr. Minnix outside of the Marriott but did not have the opportunity to hear his comments this afternoon, which was very disappointing for me. I consider him a bit of a celeb in my world and regretted not stopping him and saying hello and thanks when I saw him tonight.

For the afternoon session I attended (85-A) "Effective Event Reporting in a Risky Environment." This session highlighted the cost benefits of successful risk management in the long term care environment. Speakers made interesting points on unavoidable statements (compare your unavoidable statement verbiage to CMS interpretive guideline language) and the legal benefits of the family notification process. They really did stress the importance of family notification at the time of an incident and talked about methods for educating families on both community policies and the aging process in general. Education in risk management techniques is encouraged now at all levels of the organization, in many different forms. By educating staff on risk management policies, caregivers should not feel as threatened by a facility's investigation procedures and their own involvement.

I hate to mention the shuttles, but coming and going may be a bit difficult this week! The city traffic and unbalanced ebb and flow of conference traffic extended some shuttle waits to 45+ minutes tonight. Fighting a disappointed Bears crowd, thousands of sunny-day bikers and runners, and a reported crowd of 9,000+ (unverified), the buses just had some difficulty pushing all of these type A personalities from McCormick to the hotels and back.

This hotel charges $14.95 a day for internet. Shameful. Good night.

Captain Phil Harris and his Pumpkin

I had the pleasure of spending the day with Captain Phil Harris from Discovery Channel's "Deadliest Catch." Phil graciously visited with Lutheran Life Villages residents and was the V.I.P. at our first annual Foundation Crabfest.

As a hobby I carve portraits into pumpkins. Stupid human tricks. I carved Captain Phil into a pumpkin the night before and gave it to him. He and his agent were so pumped about it! It was on display for the Crabfest and Phil made it the screen saver on his phone.

Thanks to Captain Phil, his agent Russ, and the whole Lutheran Life Villages crew that made it possible.

Making Rounds Just Got Easier

I'm a real sucker for creating a new form. For all of you form-makers out there, this is usually a bad habit and a poor use of your time. While I haven't found any great resources for long term care forms, the fact is, most of the tools you make have already been created a thousand times over - good, bad, and ugly.

You know who you are.

So last month when Apple came out with the iPhone's newest operating software, I was excited to find a new feature: Voice Memos.

Now when making rounds, there is no audit form needed. No pen, no clipboard. No sitting your materials down to intervene and then forgetting where they are. It's as easy as 1-2-3.

1. As you round, use the Voice Memos application to make notations to yourself, such as, "Peerage Room 363 needs the closet door fixed."

2. Don't push STOP, push PAUSE in between notations. By pausing, you can keep the rounds to just one file. Otherwise, you may end up with 50 separate audio files at the end of the rounds.

3. When rounds are completed, go back to your computer and transcribe your Voice Memos. Because you created a single file using pause, it is easy to stop the recording in between notations or rewind if you missed something.

The Voice Memos application works well enough that it allows the Administrator to be discreet - you can talk softly into the mic and still easily capture your thoughts. And the transcription process is where the majority of time is saved. Even if you are accustomed to just making lists during rounds, you know that communicating your observations afterward can take a lot of time. Voice Memos eliminates this.

I know that the concept of snippet voice recording is far from new. The iPhone, though, has made making rounds much easier than it was in the past. I appreciate your feedback or tips on using this and other applications to improve your efficiency.

Lutheran Life Villages Goes Live

Hopefully someday I'll have more time to write about how my organization changed its name this week.

For now I'll just share our new website - Lutheran Life Villages: A Better Way of Living.

Happy CNA Week!

If you are a Certified Nursing Assistant, this message is for you.

Thanks for being a caregiver. You are essential to those you care for. Their strength often comes through you, whether through physical help or emotional response. You do something that most people could not do. You have training, experience, patience, and grace. You are there for us 24 hours a day, 365 days a year.

Thanks for all you do.

Seven Residents, One Nurse Killed in Shooting

On Sunday morning a young male walked into Pinelake Nursing and Rehabilitation in Carthage, North Carolina and began shooting.  Seven residents and one nurse were killed.  The relationship between the shooter and the community is unclear.

With our Emergency Preparedness plans due to the Indiana State Department of Health this week, this sure hits home.  What a nightmare - something I just don't know how you would plan for. 

I can't even imagine the counseling that will need to follow in order for this five-star community to rebound.  My team will surely pray for the residents, families, and employees this week.  If anyone reading this is aware of a broader support effort, please contact me so that I may assist.

God bless them all.

Great Housekeeping Idea

During our weekly meeting today, our Director of Environmental Services told me about a wonderful cost-saving idea he implemented. Rather than issue bags to the housekeeping staff by the case (I bet your carts have a case of 6 rolls on top), the supervisor issues one roll to each housekeeper during their morning meet-up each day. The department has seen a 40% reduction in bag purchases! A bag is sufficient for one typical day's rounds, and the staff know they can come back for more if they need them.

That's what we need in this economy. It's not cheap, it's smart.

What similar ideas have your employees brought forward in the past quarter?

These People Could Be Your Family

Today we opened a new 15-room Memory Care neighborhood for residents with early-stage Alzheimer’s disease.  Nestled within another portion of our skilled rooms, the new Memory Care is designed to test new household concepts of care delivery.  Our staff is excited to make it home for our residents (it is), and I can’t give enough thanks to all of the people that helped make it possible.

Which is what makes the next part of this story disappointing.

Last week we left the doors open for on-lookers as we moved furniture, installed fixtures, and inventoried equipment.  It was late afternoon and our Director of Maintenance and I were wrapping up for the day.  A family member from another area of the nursing home wandered in to look around. She had actually followed me in. 

“Can I ask you something?” she said.

“Of course.”  I was acquainted with this particular family member.

“You’re going to cover up the windows or these doors so we don’t have to look at these people, aren’t you?”

“Excuse me?”

“I’ve worked with these people, and we shouldn’t have to look at them.  I don’t want to see these people, I know what they do.”

I know, there are a lot of things I could have said next.  Reading what I wrote, it’s was more offensive than the way it reads.  Anyways, I was speechless.  And just to go on the record, her sentiment is exactly the opposite of how I feel, about not just long term care, but how I try to treat every person on God’s earth.  Even animals and bugs, now that I think about it.  Everything has a purpose, and the right to serve that purpose with dignity.

Our residents with Alzheimer’s disease have the disadvantage of memory loss.  Difficulty remembering their former purpose often leads to frustration and confusion.  Rather than attempt to alter this reality, we now understand that is better to direct residents down the most comfortable path than to redirect or reality-orient.  We will encourage our residents to assist us with the “activities of household living ™” that will help to give them a purpose, even if it is different than the one they remembered in an earlier stage of their life.

We will not let any resident live a life without purpose.  I hope that is the mission of many organizations such as ours.  I believe that we do the right thing by co-habitating these residents so they may receive focused programming and well-intentioned care and attention.  Looking down upon this group or any group of residents, though, is wrong, and I believe that as a resident advocate, a long term care professional, and a good Christian, that I was right in saying...   Well, it doesn’t matter.  I said the right thing.  I received a snide remark in return, but that’s okay – we do it for the residents.

National Nursing Home Week 2009

From the American Health Care Association:

AHCA is proud to announce this year's National Nursing Home Week® (NNHW) theme: "Nurturing a Love that Lasts". NNHW will be held May 10-16, 2009, beginning on Mother's Day. "Nurturing a Love that Lasts" will encourage all to think of generations of parents and grandparents nurturing future generations to carry on life and family traditions. A supportive and caring environment, such as a nursing home, nurtures and enables residents and families to continue growing, learning and teaching through various ways. Nursing home staff, residents and volunteers nurture a caring environment that values communication, relationships and partnership. Be a part of this celebration in May 2009!

Get started now and you can still be "ahead of the curve":

AHCA Planning Guide
Promos on Time: "National Nursing Home Week

This is just start. Plan now so that you can also consider communications to families, recognition of nurses (National Nurses Week), and of all staff. Some communities prefer to focus on aging, wellness, or community instead of "nursing home" in order to avoid unnecessary stereotyping or generalization of residents.

Housing Market Update: Growing Impact on Senior Living Providers

The housing market continues to dominate news across the nation, with words like "morbid" and "dire" applied to the topic in news bylines. The release of year-end data from multiple sources demonstrates the impact of this crucial market on move-ins to senior living communities. Particularly CCRC's such as the property I manage have seen their primary feeder, the independent living, go from several move-ins per month to zero. This will turn out to be more than a short-term problem, as our average independent living resident stays in their apartment for several years before needing a change in level of care.

The complete article is fascinating, including hard data and charts. Be sure to check it out.

Be a More Effective Traffic Cop

Consider the traffic cop that pulls someone over after just 30 seconds of clocking speeds. How many drivers does the officer prevent from speeding? Not many because he is busy writing a ticket (punitive).

Now consider the traffic cop that notes some drivers exceeding the speed limit by 8-12 miles per hour, but doesn't issue tickets. Most of these drivers slow down when they see the officer as their adrenaline increases and they realize the potential harm and consequence in speeding.

Sometimes you have to be a traffic cop, and every officer has to pull over the most obvious offenders, but you have a choice.

What kind of traffic cop are you?

Stimulus Package Includes $87 Billion in Medicaid Spending

AAHSA has begun breaking down the stimulus package sitting on President Obama's desk this weekend. Of relevance here it is worth noting that states will receive an additional $87 billion in Medicaid funding. Here is how much your state would receive.

Click here for more information from AAHSA.

Silver Alert System Designed to Aid in Locating Missing Seniors

At least 10 states have implemented their own missing person notification system for people with some form of mental impairment, namely Alzheimer's disease and dementia. Silver Alerts are similar to Amber Alerts, which are issued by police and broadcast by media outlets and put on Web sites when a child is believed to have been abducted and is in danger.

Indiana is currently considering implementation of the Silver Alert system. Click here to read more about Silver Alert systems across the country.

Miss Indiana Crowned Miss America

Congratulations to Indiana's own Katie Stam, who was crowned Miss America 2009. As an Indiana native I'm proud to give her a big shout out from her home state! Katie, email me to schedule a visit to the wonderful residents of Lutheran Home in Fort Wayne!

Here's the news coverage from MSNBC.

Click here to watch the You Tube video of her crowing.

Tainted Peanut Butter - Tainted Words

What Not to Say When the City Newspaper Reporter Calls:

"Residents at Lutheran Home and Concord Village, 6701 S. Anthony Blvd., are not getting all their snack options these days, said administrator Matthew Maupin. Gordon Food Service, which is their food vendor, informed them of the recall. Residents have many other snacks to choose from, Maupin said."

Which is not what I said.

Extendicare and Beverly Healthcare both gave me great training on media response. But they also both had teams. If I recall correctly, I may have had a colorful laminated card with 24-hour PR response - basically, keep your mouth shut. I see that Lutheran Hospital had a "spokesperson" in this article. That's pro.

In this case, I actually explained over the phone that sure, we had received some product related to the recall, but that we were fortunate to have our great national vendor alert us immediately and assist with product replacement.

Why did I say this, even? There was no need. I did not ask to be quoted directly, which would have been responsible, even if it didn't work. I could have offered a quick written response via email, which would have been nice documentation for both parties(what if I had been quoted waaaay out of context).

I just don't gain anything giving some one-liner about peanut butter to my adoring fan base in Fort Wayne. So anyways, just some quick advice: Don't respond off-the-cuff.

If you don't buy my advice, click here for someone else's tips (a nice Powerpoint presentation) for dealing with a media call.

Tools to Connect with the Obama Administration

As our first tech-savvy President is sworn in, a number of new and tradition dot-gov websites are beginning to embrace the latest, most-effective techniques to allow Americans to access to government. Bookmark this article detailing the top resources being run by the new Obama Administration so you can share with employees and residents or check them out yourself.

Are Your Employees Being Abused?

Over the holidays, I purchased a cabinet from Ikea, the low-budget, lots-of-assembly-required furniture and household gadgets store. One of the largest pieces was broken, and my subsequent call to customer service only revealed that Ikea is not interested in my individual satisfaction. Like most twenty-first century, I-want-it-now Americans, I exchanged heated words with the person on the receiving end of that call. I didn't get my way, and I made sure to express my sentiments - loud and rude. Was it abusive? I didn't give this worker the chance to let me know.

You have employees who feel abused by family members and residents. And if you're a member of your community leadership team, many employees blame you for not intervening. There is not a healthcare professional reading this that cannot recall a customer sitting on the other side of their desk, or standing on the other side of the bed, or even in the hallway, vociferously expressing their anger over an actual or perceived breakdown in the delivery of care. I have been sworn at, had fingers pointed in my face, and threatened. I fully understand my responsibility as a community leader, though, and I've benefited from more customer service and crisis management training than most of our employees combined. I know that I have a responsibility to find solutions and prevention through root-cause analysis, and every concern is taken seriously.

When a direct-care employee such as a nurse or a C.N.A. is verbally reprimanded by a family member, it can be perceived as a personal attack on their intelligence, proficiency, or even race and socioeconomic status. The linked article above, from a great C.N.A. forum, describes the frustration felt by many nursing staff members first-hand. I admit experiencing the same feelings as an Administrator, and the helplessness that can accompany them. Patti's article along with the subsequent reader comments, calls for a policy shift in retirement communities that holds customers accountable for their own behvior.

The topic has forced me to examine my own views and approach to conflict resolution, and I agree that families do not have the right to verbally accost employees, regardless of the situation. While difficult to craft an umbrella policy that does not discriminate against residents or breach resident rights, I recommend reviewing your process for prioritizing family and resident concerns. This process must be transparent, accessible to families, and objective. I believe that most communities have some version of this in place, but I also know how uncomfortable the worst of these situations be.

What is alarming about the conversation is that some direct-care employees are searching for their own methods to deal with situations because they feel a lack of support from their Administration. Several commenters promote calling 911 when they have been verbally (even physically) attacked by a family member. Their presumption is that communities pander to families in order to maximize revenue:

"We must stand up for ourselves if the DON won’t. If we lose the job, so what. The job wasn’t worth US. Getting hurt at work isn’t worth it. The management CAN draw the line but usually won’t cause it’s all about money- the paying customer. Mind you, I question if the payment equals the worker comp bills.

When it is family who is abusing staff, that is different. They should be banned from the facility until they are made to take an anger management course. And then they must apologize to the staff. It’s one thing to yell and hoot and scream. It’s quite another to shake and rattle and otherwise manhandle the staff. Limits must be set. Just like with kids."

So how are you going to effectively convey the right message to both employees and customers? No Administrator or Director of Nursing enjoys asking a family member to examine their own actions, but allowing your customers to act out against employees certainly sets the tone for your community. Feelings of resentment will build and employee morale will suffer greatly if leadership fails to address each individual circumstance swiftly. While I still have some introspection to conduct on the topic, I offer three tips to begin your own journey:

1. Include "Addressing Angry Customers" as part of your Abuse Prevention and Reporting In-Service. The resentment created by an angry family member can turn into retaliation - against the resident.

2. Take ownership of the concern process. I receive all written concerns in order to ensure timely, objective follow-up, and review all concerns from the previous 7 days with our Concerns Committee. The Director of Nursing and I take time each week to sit down and call several families that have expressed concern or frustration.

3. Educate employees on involuntary discharge. The average employee believes that a nursing home resident can be "kicked out" at the whim of management. Involuntary relocation is an extremely cumbersome process, and rarely executed. Why? Because forced discharges are almost never to the benefit of the resident.

OH, the resident! We almost forgot about the resident. And that is what concerns me the most about this conversation. When employees become embroiled in family onflict, the resident almost always loses. By dealing quickly and honestly with family outbursts, leadership can minimize resident stress and undue harm. Focus difficult family conversations on how actions are impacting the resident's best interests, rather than scolding or threatening discharge. A successful Administrator or Director of Nursing can advocate for both residents and employees simultaneously - and should do so every time.

I look forward to hearing from you on this topic.

Healthcare or Business Internship Opportunity

I am hosting a summer internship for a qualified Business Administration or Health Policy & Administration student. While I do not have an available Administrator-In-Training position open at this time, the opportunity to complete a Bachelor's degree internship experience with a large retirement community will be vital to graduating students hoping to earn their licenses post-graduation.

Lutheran Home is the largest not-for-profit retirement community in Fort Wayne, Indiana. Also the headquarters for Lutheran Homes, Inc., our well-established community takes a different approach to delivery of care, focusing heavily on holistic wellness programming and empowerment of all community residents. Considered home to more than 350 Fort Wayne residents, Lutheran Home offers many levels of care and endless learning opportunities for students.

Interested, qualified students should forward their resumes, in Word or PDF format, to by March 31, 2009.

ABC News Highlights C-Diff Prevalence in Healthcare

Tonight ABC News ran a feature on the prevalence and impact of C-Diff on hospitals and nursing homes. While the focus was more on hospitals, the most interesting segment featured a clinical study on the effectiveness of bleach decontamination in the post-sub-acute setting.

Bottom Line: Consumers demand and deserve your respect, rightfully so, regarding the prevention of this infectious disease. Here are several tools for you to use when communicating to employees, residents, and families:

Mayo Clinic Guidelines on Hand Washing

Center for Disease Control (CDC) Facts on Seasonal Flu

Blogging Live from AAHSA

I'm here at my first AAHSA Annual Convention in Philadelphia, PA. It's Monday night and the crowd has filed out of the Dana Carvey show and into any number of downtown Philly joints. Of course you've already enjoyed a Philly cheese steak off the street and a good night at the Fieldhouse, and no matter where you are staying there's some historic sight of epic proportion within walking distance - we've got city hall out the window and the liberty bell within walking distance. On Saturday night I literally ran into Chris Matthews outside the Loew's hotel. A trio of high class weddings and an international media dinner drew the best-of-the-best to our part of town this convention weekend.

Dana Carvey was sub-par, an equal but disappointing replacement for the absent Aretha Franklin. Anybody that respects music would have preferred Aretha, but overall the crowd seemed to enjoy the impressions that were either Carvey circa 1994 (Swartzenager, Bush Senior, Church lady, Ross Perot) or Carvey circa 2008, which is an "impression" of every current political newsmaker, half of which require a serious stretch of the imagination.

The attendance is estimated at over 6,000, though I don't see quite that many people - as a first timer I'm still very impressed. The current presidential race and economic crisis are an intrinsic theme of the whole show, whether presented by a comedian or a nun. The audience here is the type that was abuzz today over the 900+ day the Dow had - you could feel the value of everyone's accounts rise as Monday passed. I wasn't the only one staring at my Blackberryhalf the day.

Great sessions, at least for me at this point. The speakers are experienced presenters, which is one key difference from smaller conventions. It's one thing to be a success or an expert - it's another thing to be able to tell your story really well. The educational sessions that I have attended all included multiple, related speakers. Fortunately, I chose presentations that will really help me pull some projects together, with best practice ideas presented that neither my team nor I had thought of. I am not 100% sure that all presentation materials are accessible online, but you can tell that AAHSA is at least on the way to being a green organization. You should've heard the audience clap at the opening address when it was announced that this was the last year they would be distributing tote bags.

I chose to sleep in for the John Glenn talk, but I can say that Whoopi Goldberg was decent. Her message was a bit of a stretch, and she was one up'd by Larry Minnix, AAHSA President. Minnex's discussion on the impending leadership void and the state of our government and economy was right on point and was also in line with the convention theme of "One Voice." The nun stole the show from both when she confessed to being a sinner by embracing Goldberg during the end of the opening session.

Overall, I'm excited to discover such a large, high quality convention dedicated to our profession. The polish that this convention has trulyturns the cost of sending your leadership into an investment in your organization's success.

On Hiatus...For Awhile

It's so pleasing to see the number of great resources available for professionals in long term care to turn to online. As much as I enjoy being a part of that family, I am again planning to go "on hiatus" in an attempt to simplify both my work and personal life. I prefer to keep my blood pressure at healthy levels.

Please feel free to send me an email message, but please understand if I do not respond timely.

Thanks for reading.

Welcome Peabody Retirement Community!

I kept getting visitors from the internal website that I set up for Peabody Retirement Community last year...So I visited the page (which is being kept up to date!) and there's a link back to "The Nursing Home Administrator."

So, if you're from Peabody, thanks for visiting! Please leave a message in the comments section - It will be great to hear from you.


Occasionally I am contacted by a professional that is searching for an Administrator-In-Training position. While I am not in a position to host an AIT at the present time, I felt compelled to post the resume of Phil Eccles. Below is a brief bio on Mr. Eccles, and if you are interested, his resume can be downloaded by following the link at the bottom.

Please contact Mr. Eccles directly to arrange an interview.

Thank you for your consideration in looking at my bio and resume. As I anticipate my final career transition, it is one that is taking me onto the track that I nearly took when completing graduate school – administration of residential care of the infirm and elderly. I am in search of a seasoned administrator as an AIT preceptor who is in excellent standing with their corporation, also has an incessant curiosity and desire to improve operations and financials, is willing to be a true mentor beyond an AIT program, provides leadership in the industry in some capacity (writes articles, provides seminar sessions, serves on committees, serves as an officer, or is a regular AIT preceptor), is able to pay a stipend, and can assure me that their corporation will have a place for me upon completion of the program in good standing. I currently reside in Plainfield, IN, and would like to find a preceptor within a forty-five minute driving radius from here so that a temporary move would not be necessary until full-time placement.

As a brief bio, I have a background in sales, consultation, customer relations, and work within the healthcare industry. I completed my graduate studies at Indiana University in Health Administration, including coursework in nursing home administration. My adjunct professor was the administrator for Hooverwood in Indianapolis. The majority of my career has been in patient financial services.

My skills and achievements include:

  • Ability to quickly garner trust and rapport.
  • Experience working closely with medical providers, insurance carriers, and healthcare business offices.
  • Knowledge of the continuum of elder care available.
  • Coaching and personal development
  • Interdepartmental communications and teamwork building
  • Process flow analysis and recommendations, and implementation of subsequent policies and procedures
  • Management by direct observation and talking with/helping employees
  • Financial analysis, flexible budget determination, expense reduction, and price setting to obtain net profit goal

Thank you for reviewing my biography and attached resume. Please contact me with any questions, or to simply discuss your thoughts in directions that I may take. Even if you do not have a place for me now, I enjoy meeting people and building relationships, so I would enjoy hearing from you.


Philip A. Eccles

Click here to download the resume.

Senate Fails to Pass Medicare Bill; Therapy Caps to Go Into Effect

Last Thursday, the Senate failed to act on HR 6331, the Medicare bill that passed overwhelmingly in the House. This Medicare bill would stave off a 10.6% rate cut for physicians beginning on July 1st. This cut was part of a 1997 balanced budget deal to trim the money going to Medicare, but physicians have been able to regularly postpone the cuts. The 1997 bill also included the Medicare Part B therapy caps that have also been either postponed or have been rendered harmless through an exceptions process. The caps would also go into effect on July 1st without this legislation.

HR 6331 would “pay” for the postponement of the physician rate cut by cutting the subsidy given to the private Medicare Advantage plans. President Bush has threatened to veto the bill if it includes this cut to the insurance plans. The administration would pay for the postponed physician rate cut by cutting other provider group reimbursement, such as eliminating the market basket rate adjustment for skilled nursing facilities and home care agencies.

The original Senate vote was 59-39 (Sen. Ted Kennedy and Sen. John McCain absent). Sen. Harry Reid changed his vote to No (final vote 58-40) so that he can bring the bill up again when the Senate returns on July 7th. Both the Senate and House are now on 4th of July recess (known as “District Work Period”).

The Bush administration gave a reprieve to the physician rate cut on Sunday. The Department of Health and Human Services will essentially freeze the current pricing system until Congress returns. Congressional aides said the freeze could last 10 days. If the legislative dispute lasts beyond the new deadline, HHS Secretary Leavitt said he hopes to retroactively pay doctors once the dispute is resolved.

The therapy caps were not included in this reprieve and will go into effect on July 1st. Congress is expected back on July 7 and it is anticipated that a vote will be taken that week.

Residents with Alzheimers Benefit from Volunteering

As Alzheimer's disease begins to wear away the memory and cognitive functioning of an older adult, caregivers are sometimes so distracted by the disease process that they fail to recognize the inner struggle of the resident. One key aspect of this struggle is the loss of contribution to society, represented as the occupational component of the six dimensions of wellness. Residents who once defined themselves by their service to their country, their community, and their family recognize their inability to perform in these roles and subsequent depression sets in.

This morning National Public Radio aired an intriguing, at least reassuring, story on a study that was pairing these residents with intergenerational volunteer opportunities. The story highlighted several assisted living residents, including a woman (with Alzheimer's disease) that was such a great volunteer that last year she won her city's volunteer of the year award - and didn't know why.

This story is a wonderful way to illustrate to caregivers the inner turmoil faced by those they love and take care of - and poses at least one solution to improving their lives, even if it's forgotten five minutes later.

National Administrative Professionals Week

Yes, it IS National Administrative Professionals Week. No, it is not National Nursing Home Administrators Week (as a few of you have Googled).

Here's the information you're looking for regarding what started as "National Secretaries Week."

Here's my brief aside on National Nursing Home Administrator's Week.

If you're looking for ideas (Wednesday is the "Day"), consider taking in something that the entire office may share. You always run the risk of leaving someone out that felt they were classified as an Administrative Professional.

Hey, these things happen all the time.

I'm going with "Business Office Donuts" plus individual thank you cards for the key Administrative staff. If I had an assistant I would go flowers, not roses, lunch sometime during the week.

But, I don't have an assistant (and wouldn't know what to do if I did).

One hundred fifteen. Don't you forget it.

I would be remiss in my duties if I did not highlight Ms. Edna Parker, from Shelbyville, Indiana, who turns 115 on Sunday. There are only 75 people alive — 64 women and 11 men — that are 110 or older.

At 115, Ms. Parker is the officially the oldest, according to Guinness.

Boomers to Flood Medical Care System

From today's MSNBC Article:
  • There aren’t enough specialists in geriatric medicine.
  • Insufficient training is available.
  • The specialists that do exist are underpaid.
  • Medicare fails to provide for team care that many elderly patients need.
Everybody start running around and screaming.

The Star Program

Goal: To create and sustain a culture that actively shares positive feedback within the organization.


  1. Make asking for positive feedback regarding other employees a part of day-to-day conversation. Find this information by talking with managers, direct care staff, residents, families, and even vendors.
  1. Award a small gold star pin to employees that are recognized. Include a thank you note quoting the positive feedback you received about them.
  1. Start by handing out pins and thank-yous privately versus at a public forum. eventually, enough staff will receive pins that employees will realize the meaning.
  1. Begin awarding some pins at monthly employee meetings. Tell a small story about the employee and make a small to-do in front of other employees.
  1. Buy more pins.


  1. Keep it simple. Don’t make a tracking system, don’t trend anything, don’t MAKE anybody do it. It’s just a fun employee morale exercise.
  1. Keep it up. If you do it for six weeks and then stop doing it, you’re being one of those guys.
  1. Keep it interesting. Simple doesn’t mean you can’t be creative. Occasionally pass one out with a random gathering of employees, attach an additional gift card for really great efforts, etc. again, just don’t get bogged down with it or you’ll stop doing it.

A Good Investigation

When confronted with an off-color situation between a staff member and a resident, the effort that a manager puts into investigating the facts is more than just a good customer service gesture. The community must ensure that there is immediate action around the occurrence and that it is addressed systemically for the future. The charge nurse can play a very effective role in collecting facts and minimizing exposure.

Recently, a weekend nurse debriefed me on an abuse allegation that had been made just several hours earlier in the morning. The nurse had immediately assessed the resident situation and systematically clicked off a number of key facts regarding the incident:

  • The assessment and status of the resident
  • The immediate actions taken, including meeting with and immediately suspending an employee
  • The staff involved, including other employees secondary to the incident
  • Brief history and status of the resident and family
  • Brief history and status of the employee
  • Documentation, including witness statements, from above mentioned employees
  • Educated conclusion to the allegation
  • Action steps still needed

In addition to her consideration of these key steps, this licensed nurse minimized the disruption of employees and residents not directly involved. This maintained privacy for the resident and staff involved, and will hopefully enable leadership to conduct root cause analysis that can in the future identify abuse before it happens.

Successful communities will be those that have an outwardly positive culture. By consistently reinforcing not just positive outcomes but also positive behaviors, employees begin to find job satisfaction and success in just being happy. Employees who fail to embrace this culture standout more quickly and can be evaluated prior to an abuse situation.

Good investigation techniques often translate into good assessment skills, and similar strategies should be encouraged when dealing with other problems or diagnoses in the community. Leadership must build constructive questioning into daily processes. Nurses that use their senses to answer the questions of who, where , why, and how eliminate negative outcomes by considering the root cause of an issue. This includes an assessment of staffing, environment, emotions and morale. Often something happens in the course of a day or even week that sets off a chain of events, and employees should be able to identify when those situations are escalating.