FutureAge magazine Jan-Feb 2010 issue

Transcription

aahsa
Creating the Future of Aging Services | January/February 2010
Volume 9, No. 1
A Culture of Acceptance
Welcoming, Culturally
Competent Environments
Why Civility Matters
Inner-City Nursing Homes
Serving LGBT Seniors
Can Culture Change and Regulation Coexist?
Understanding Social Media
Boards’ Responsibility to the Future
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Contents
features
8 Building a Culture of Acceptance
Beth Abraham Family of Health Services
Providers are adapting to the people they serve and the people they hire, building a culture of acceptance one day, one client, one employee at a time. BY GENE MITCHELL
12 Civility, Ethics and Building Respectful Communities
Building a culture of acceptance is about more than diversity. It also involves old-fashioned notions of civility and good manners.
BY GENE MITCHELL
14 Resource-Poor, Spirit-Rich
Inner-city nursing homes serve poor, marginalized seniors and struggle daily to keep their doors open, but these providers’ commitment won’t fade. BY DEBRA WOOD, R.N.
20 Building a Culture of Acceptance for LGBT Elders
8
Past Issues:
September/October 2009 issue
November/December 2009 issue
futureAge | January/February 2010
Providers are welcoming lesbian, gay, bisexual and transgender seniors and have made outreach to these seniors an intentional part of their marketing strategy.
BY KEVIN BRADLEY
24 Residents in the Boardroom
Though there is still controversy about having residents on boards, a number of not-for-profit providers have been making it work. Here is a look at their experience.
BY DIANNE MOLVIG
28 Regulation and Culture Change:
A Matter of Perception?
2
Compliance with regulations and culture change efforts need not be mutually exclusive. Collaborative relationships between providers and surveyors are the keys to success.
BY MICHELE HAYUNGA
34 New Media for Aging Services: Twitter
The first in a series on social media and communication tools that providers can use for marketing, communication, shared learning and advocacy.
BY CRAIG COLLINS-YOUNG
38 Embracing Better Governance,
One Board Member at a Time
An engaged board member of an AAHSA-member organization talks about why boards must embrace their responsibility to lead.
BY GENE MITCHELL
14
departments
Mary Scott Nursing Center
4 Vision
Advocacy, Inclusion and Technology
6 From the Editor
Circles of Acquaintance and Care
36 Ideas & Innovations
40 Index of Advertisers
20
futureAge
January/February 2010 Volume 9, No. 1
EDITORIAL
Editor
Gene Mitchell
(202) 508-9424
[email protected]
LAYOUT AND DESIGN
Senior Graphic Designer,
Creative Services
Glenn E. Crenshaw
Contributing Writers
Deborah Cloud
Sarah Mashburn
Alisha Sanders
ADVERTISING
Marketing Production Manager
Keesha Jackson Atkins
(202) 508-9440
[email protected]
ART DIRECTION
Director, Marketing & Creative Services
Eva Quintos Tennant
Director, Sales
Margaret Wanca-Daniels
(202) 508-9479
[email protected]
Associate Director,
Creative Services
Cynthia D. Wokas
CIRCULATION
Manager, Education Operations
Heike Spichal
FutureAge (ISSN 1554-3390) is published bimonthly by the American
Association of Homes and Services for the Aging, 2519 Connecticut Ave.,
N.W.,Washington, DC 20008-1520. The members of the American
Association of Homes and Services for the Aging (www.aahsa.org) help
millions of individuals and their families every day through missiondriven, not-for-profit organizations dedicated to providing the services
that people need, when they need them, in the place they call home.
Our 5,800 member organizations, many of which have served their
communities for generations, offer the continuum of aging services:
adult day services, home health, community services, senior housing,
assisted living residences, continuing care retirement communities
and nursing homes. AAHSA’s commitment is to create the future of
aging services through quality people can trust. AAHSA’s Web site is
www.aahsa.org. © 2010 by AAHSA. All rights reserved. For additional
information on online subscriptions or to add/update reader e-mail
information, send inquiries via e-mail to [email protected].
Editorial and Business Offices
American Association of Homes and Services for the Aging
2519 Connecticut Ave. NW, Washington, DC 20008-1520
Winthrop F. Marshall
Chair
William L. Minnix, Jr.
President and CEO
Deborah A. Cloud
Vice President
and Senior Editor
(202) 508-9458
[email protected]
Add AAHSA to your social network. Visit www.aahsa.org/connect to join
our Facebook, LinkedIn and Twitter communities.
3
San Francisco Towers
40 AAHSA Synergy
Advocacy, Inclusion and Technology
A Talk w i t h W i n t h r o p F . M a r s h a l l
W
vision
vision
with and for AAHSA members to be involved, by connecting
them and informing them via technology to enhance advocacy.
Inclusion is about bringing in the frontline workers at AAHSAmember organizations and the seniors they serve, as well as the
families of those served by AAHSA members. Inclusion is also
about bringing in all employees—including middle and senior
management—and trustees as well.
I want to invite frontline workers to the table to participate in
advocacy. They can tell a more passionate story than anyone in
the front office. If we entrust frontline workers to care for the precious gift of life, how can we not include them in advocacy? From
my perspective, inclusion will be from the CNA to the CEO, from
home and community-based services to nursing homes.
There is also concern about where the future leaders of this
FutureAge: You have stated that your priorities as chair are
field will come from. I think the leaders are already in our
advocacy, inclusion and technology. What do you hope to accom- midst. They just need to be cultivated and exposed, and through
plish with your advocacy agenda?
inclusion, we can [bring them out]. Folks feel a greater sense of
Win Marshall: Our mission is to create the future of aging
connectedness if they are involved. These frontline workers and
services. To cremiddle managers
ate means what
[may] have been
you’re creating
engaged for 20
isn’t currently
years but [were]
My goal is inclusion, to try to get everyone
available … or at
never extended
who works with and for AAHSA members to
least that you’re
an invitation to
substantially
participate in
be involved, by connecting them and informing
changing it. State
advocacy.
and national
Barack Obama
them via technology to enhance advocacy.
surveys indicate
would not be
that one of the
president today
primary reasons
if he hadn’t used
organizations are members of AAHSA is for its advocacy. Nettechnology to engage those who wouldn’t normally be in the
working and education are important, but normally advocacy is
political process. From this point forward, the Internet will be utinumber one.
lized to enhance everyone’s campaign.
AAHSA’s 5,800-member aging-services continuum has estabWe’re already using technology in the way we provide services;
lished AAHSA as the preeminent aging-services organization,
I’d like to use that technology to reach frontline workers, middle
as our presence is felt across the spectrum of services. Having
management, even senior management not currently engaged
experts in every segment of aging services enables us to speak
in advocacy. Much of the lower-income population has greater
with one voice.
technology today as well. Any movement that has been successful
What we hope to accomplish with our advocacy agenda is
from the beginning of time has brought all folks to the table, irreultimately to create the future of aging services by expanding and
spective of economic status, irrespective of ethnicity.
enhancing our voice on issues affecting seniors.
FA: In your speech at the recent AAHSA Annual Meeting in
FA: Where do inclusion and technology enter into this?
Chicago, you talked about specific, measurable goals for advocacy
WM: There are about two million employees working for
by AAHSA members. What would you like to see?
AAHSA members, but only the top tier are aware of the imporWM: I believe AAHSA members send about 40,000 messages
tant work AAHSA does in helping to draft and support new laws
[to lawmakers] annually. My goal is to increase that to 250,000
before Congress, state and local bodies—laws that impact the
messages in two years.
lives of people AAHSA members serve. I talk to the assistants of
I want a congressman to call Larry [Minnix] and say “Larry,
the presidents and CEOs, and I have to explain what AAHSA is.
make your folks stop calling us.” Across the country, we have
So you know that the maintenance and other employees don’t
some of the most committed staff, at the state and national level.
know about AAHSA and the effect it has on their daily service to
State associations do tremendous work to organize grass-roots
seniors. My goal is inclusion, to try to get everyone who works
support for policies to help seniors, and that support is what
inthrop F. Marshall, V. P. Finance
& CFO of Christian Church
Homes of Northern California, begins
2010 as AAHSA’s new chair. In a stirring
speech at the AAHSA Annual Meeting in Chicago in November, Marshall
issued a call to action for AAHSA members to advocate for policies in the best
interest of the seniors they serve. See the
video of his speech at AAHSA’s YouWinthrop F. Marshall
Tube Channel.
FutureAge talked with Marshall about
his priorities for the association over the next two years.
4
enables the work AAHSA does at the national level. We must
continue to strengthen our voice, because everyone knows that
as a nation we are not having a genuine discussion about the best
policies for serving all seniors, nor are we prepared to meet the
increased demands of the retiring baby boomers. As we work
to create the future of aging services, it will require advocacy to
change what exists to what could be.
The first time I went to our state capitol to advocate, I stepped
out of it feeling empowered. While I recognize that a lot of the
frontline workers and middle managers will not come to AAHSA
conferences, this message goal can help lift up the state [associations] as well. I think we can reach that 250,000 number [of
advocates].
What I’m asking for is 15 minutes a week, an hour a month,
for each member to participate in advocacy efforts. Just like in a
family you have brothers and sisters, we are part of the AAHSA
family and we have brother and sister agencies that might not all
do the same thing. Still, you can send a message to Congress on
behalf of your brother and sister organizations.
FA: When you look at AAHSA as you begin your term as chair,
what do you believe the association does best, and what should it
be doing better?
WM: I think what is most important to preserve is AAHSA’s
integrity. When AAHSA speaks, it is advocating the right policy
for the right reason, and has become a go-to entity because of
that. It may not be right for all members, but it’s right for the people we serve. It’s not about me or any individual person; it’s about
the people we serve. AAHSA is getting increased recognition on
Capitol Hill, its staff is extremely well-respected, and it puts on
one of the best conferences around.
What needs to be enhanced is not so much what the staff is
doing but what the AAHSA members are doing. If advocacy is
our number one priority, we need to increase that member participation. To spread the word to our respective organizations.
One AAHSA board member, for instance, has weekly meetings
with his frontline staff about advocacy and AAHSA. I’d like to be
able to replicate that.
AAHSA is a very diverse association—our members represent diverse services, religious and fraternal affiliations, ages,
and political views, and this diversity, instead of something that
divides us, can unite us. For instance, AAHSA members do not
all take the same position on health care reform in general. But
AAHSA has taken a definitive position on one particular reform
that benefits the seniors we serve—the CLASS Act.
Our underlying principle is that we advocate for the right
policy for the right reason, to enhance the lives of seniors. We
must do this with sensitivity and appreciation of our respective
diversities. Irrespective of our diversity, each member should be
advocating for the policies that directly affect seniors because a
victory in one area is a victory for the entire AAHSA family, and
ultimately moves the senior services agenda forward.
5
from thefrom
editor
the editor
Circles of Acquaintance and Care
b y G e ne Mitchell
O
ne of the highlights of putting together this issue was my
conversation with P.M. Forni, a professor of literature who
has also taken on the study of civility. I particularly like a phrase
he used to describe one prerequisite for a fulfilling and sane life:
“circles of acquaintance and care.” It’s easy to apply that concept
to many of our articles, which concern human relationships in
many situations—living and working side-by-side with people
of different cultures or orientations, serving seniors with limited
resources, governing organizations, and managing change while
navigating government oversight. The good news, in my opinion,
is that a culture of acceptance isn’t something we need to create;
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it is something we already have but must better understand and
consciously improve.
Speaking of acceptance, this FutureAge—our first digital-only
issue—is a challenge to us all. We realize that it may take a while
to become comfortable with a magazine that you don’t hold in
your hand, and we want to know what you think, and how we can
improve your reading experience. Give the new FutureAge a thorough reading, try out the easy linking, bookmarking and other
new features, and let us know what you think. Please contact me
any time at [email protected] or (202) 508-9424.
In “Building a Culture of Acceptance” (p. 8), you’ll see how providers are working among people of every culture, and serving
and employing immigrants from all over the world, with fewer
problems than a pessimist might imagine. The key is knowledge,
open hearts, and enabling human beings to build their own
circles of acquaintance and care.
See p. 12 for “Civility, Ethics and Building Respectful Communities,” our interview with Dr. Forni. You’ll understand why
someone with a deep understanding of incivility is nonetheless
an optimist about our ability to create more harmonious workplaces, and a better society as well.
Serving the poorest and in many cases sickest of seniors with
few resources is not just a career, it’s a calling. In “Resource-Poor,
Spirit-Rich” (p. 14), read about the stiff challenges inner-city
nursing homes face every day, and how their burden might be
ameliorated.
Elderly lesbian, gay, bisexual and transgender people have
spent lifetimes navigating a world that only recently has begun
to accept them. In “Building a Culture of Acceptance for LGBT
Elders” (p. 20), see how providers are working to create inclusive
environments.
Students of governance have long debated whether retirementcommunity residents can serve on those organizations’ boards
without creating uncomfortable conflicts of interest. See “Residents in the Boardroom” (p. 24) for a look at the experience of
providers with residents on their boards, and what resident trustees themselves think about their responsibilities.
In a system that all-too-easily generates adversarial relationships, can regulators and culture-change advocates find ways to
reconcile compliance and creativity? “Regulation and Culture
Change: A Matter of Perception?” (p. 30), inspired by the work of
AAHSA’s Institute for the Future of Aging Services (IFAS), suggests that the answer is yes.
A correction: The November/December 2009 FutureAge, in
a Synergy Dept. story about Evangelical Homes of Michigan,
incorrectly stated that the organization’s CEO, Denise Rabidoux,
does not use e-mail. Evangelical Homes of Michigan was also
misidentified as “Evangelical Lutheran Home.” We regret the errors.
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Building a Culture of Acceptance
From multicultural California to the heart of
Texas, from central Ohio to the melting pot
of New York City, providers are adapting to
the people they serve and the people they
hire, building a culture of acceptance one
day, one client, one employee at a time.
The keys to success are research and
understanding of others’ cultural norms
and beliefs, willingness to go the extra mile
to accommodate a client’s or employee’s
needs, proactively addressing conflicts,
and allowing people—social creatures that
they are—to do what comes naturally.
I
magine you are a 70-year-old Chinese, Russian or Columbian whose
son or granddaughter gets a job
working for a high-tech company in
the United States. After a lifetime in your
native country, with little or no English
proficiency, you suddenly find yourself
in a HUD-subsidized apartment in the
United States.
The Beth Abraham Family of Health
Services in New York City is one of many
providers figuring out how to serve people
in just that situation. Beth Abraham has a
lot of experience in serving a vast variety
of seniors—with an equally diverse workforce of nearly 3,000 who speak, at last
count, 72 languages. The organization’s
full continuum of services comes with an
by Gene Mitchell
(PACE) in the motherhouse of an order
of Dominican Sisters to allow them to age
in place; and matching HCBS clients with
home-health aides who speak their native
languages.
Beth Abraham’s Comprehensive Care
Management (CCM) program started in
the Bronx, serving white, African American and Latino seniors. (CCM offers a
PACE, a Medicaid managed long-term
care program and a Medicare Advantage
special needs plan.) When CCM founded
a new site in Manhattan, it had to expand
its cultural competencies.
“At Grand Street we assumed we would
be serving Orthodox Jewish elders, but
[that site] turned out to [have] a lot of
Asian seniors, Chinese, mostly,” says Mia
The Beth Abraham Family of Health Services works hard to build a culture of acceptance—and
gets a lot of help from its residents and clients. Pictured: a music and movement exercise
class at Beth Abraham’s Margaret Tietz Adult Day Health Care Program.
active commitment to inclusion and giving
people what they want and need.
Those efforts include bringing in Chinese, Indian vegetarian or Russian kosher
food to make skilled-nursing residents feel
at home; offering Rosetta Stone languagelearning software to staff members who
want to communicate better with Spanishspeaking residents; setting up a Program
of All-Inclusive Care for the Elderly
8
Etienne, vice president, clinical operations for CCM. Staff had to come up to
speed quickly on the nuances of Chinese
culture—the status of white roses as symbols of death, why putting the number “4”
on a door is a no-no, and understanding
Chinese attitudes toward health care and
respecting family norms.
“We started hiring staff of the same
culture because there are at least seven
[Chinese] dialects we are serving now,”
says Etienne. “We had to have translators
in our center, but [translators] also had to
go out to appointments, to serve people at
home.”
Understanding seniors’ food choices is a
big part of the job. CCM got help from the
kitchens at New York University to bring
in authentic Chinese cuisine. A popular field trip for the Korean elders CCM
serves in Westchester County is a ride
to Queens, where there is a huge Korean
vegetable market. For Latino elders, serving favorite foods isn’t a problem, except
when traditional cooking styles are contraindicated for diabetes or hypertension;
Beth Abraham dieticians work to identify
healthier substitutes.
Health care attitudes among immigrants
also require listening and learning.
“Many [Chinese immigrants] believe
in alternative medicine, and we wanted
to have a balance, so they asked for acupuncture, and we offer that at some sites,”
says Etienne. “We’re also monitoring their
use of various herbal remedies. They are
unregulated, so we don’t advocate them,
but we monitor their use.”
Almost 1,400 miles southwest, Plano
Community Homes, Plano, Texas, also
serves seniors from many nations trying
to build new lives in the U.S. Executive
Director Lee Ann Hubanks manages seven
HUD-subsidized affordable senior housing
buildings that are home to 450 residents.
“We have quite a blend,” Hubanks says.
“Our residents are Chinese, Japanese,
Korean, Pakistani, Iranian, Iraqi, Indian,
Russian and Eastern European.” Though a
challenge in some cases, she is recruiting
staff who speak the community residents’
languages. When necessary, laminated
cards with pictures help communicate
some subjects.
Brought here by family members doing
high-tech jobs in the Plano/Dallas area,
many of these seniors go back home yearly
for up to two months at a time. Plano
Community Homes offers ESL classes in
several languages and helps seniors study
for their citizenship tests.
The seniors help each other as well.
Seniors in the organization’s Cultural
Ambassadors program get together for
group activities: lunch once a month, each
time at a different ethnic restaurant, and
events such as health fairs or bake sales
with homemade dishes reflecting residents’
cultures. Service coordinators arrange for
newsletter and memo translations and
recruit local Asian and Hispanic church
groups to offer programs.
“For aged immigrants, our service
coordinators are absolutely invaluable,”
says Hubanks. “They bring programs and
services into the building and try, no matter what the culture, to bring things in for
them. We have translators at our resident
meetings, so they take forever!”
Similar challenges face Administrator
Joyce Wilson at The Hellenic Tower in
suburban Atlanta, Ga. More than half of
the community’s 150 residents were born
overseas, with a large contingent from
Russia and Eastern Europe.
Typically, language is the biggest challenge. Outside groups come to offer
English and citizenship classes. A local
home-health agency run by a Russianspeaking doctor has staff that can cover
more than a dozen languages. Most
immigrant residents have strong family
relationships. Family members communi-
cate and relate well with the staff.
The Hellenic Tower has one full-timer
who fills the role of activities director and
service coordinator. “One side of her job
helps the other,” says Wilson. “If she hooks
them up with food stamps, it’s easier for
her to go back to them and pull them into
an activity.”
“We try to design the activities to get
people together,” says Wilson. “We think
[of] music and food—everyone has these
in common. That’s slow going, but if you
keep it on the front burner you get brainstorms from residents and staff about new
activities to try.”
We Shall Overcome (Conflict)
Whether an organization’s conceptual
framework is to try to build a “melting
pot” or a “diversity salad,” prejudices are
bound to crop up in any setting. These
providers don’t deny the potential for
misunderstandings or unpleasantness, but
all agree that a proactive approach is best.
BJBC Resources on Cultural Competency
The Better Jobs Better Care program, a four-year research and demonstration program
administered by AAHSA’s Institute for the Future of Aging Services and the Paraprofessional
Healthcare Institute to support the training and status of frontline workers, put a strong
emphasis on cultural competency for aging-services providers. Several useful resources
resulted:
•• “Getting Ready: Focusing on Cultural Competence in Long-Term Care Organizations,”
a guide based on the results of a cultural competence research study, includes:
lessons learned from an assessment of cultural competence at 10 nursing homes
and subsequent interventions; discussions of the meaning of diversity, culture and
cultural competence and the experiences of workers and seniors; the importance of
assessing staff’s attitudes, behaviors and policies toward diversity; and a resource
directory. Click here to download the tool.
•• “Creating Solutions: Handling Culturally Complex Situations in a Long-Term Care
Setting” is a training guide that assists nursing home staff in discussing culturally
complex situations that may arise in the facility. It uses the BJBC video, Stand Up
and Tell Them: Views from the Frontline in Long-Term Care, and the accompanying
discussion guide as part of the training. This guide is available from the Boston
University School of Public Health. For more information, e-mail Ryann Engle.
•• “Developing Cultural Competence” is a one-page chart, developed by Dr. Victoria
Parker of Boston University, that distills what BJBC researchers learned about
cultural competence and what those findings suggest about creating a more
welcoming workplace.
•• A BJBC Issue Brief, “Respectful Relationships: The Heart of Better Jobs Better
Care,” addresses how to develop a respectful and accepting workplace.
•• The March/April 2007 FutureAge was devoted exclusively to Better Jobs Better Care.
9
Heritage Day Health Centers, Columbus, Ohio, is the state’s largest adult day
program, serving 530 seniors in five centers.
“We serve people from [age] 21 to 102,
predominantly African American, with
whites the next largest group,” says Erica
Drewry, Heritage’s executive director.
“Columbus is not terribly diverse—there
is a growing Mexican population but not
so much among the older folks. In the
centers racial tensions come up occasion-
openly as a way to handle issues quickly
and set a tone of civility.
The mental status of seniors complicates
the issue, she says: “There have been a
couple times where you hear a client say
something, especially folks with dementia,
and sometimes those are not their true
beliefs. We don’t fear it, we’ll address it
kindly and we will move forward.”
Drewry says it’s also important not to
pre-judge people’s attitudes, as when Heritage took over a day center in an affluent,
Retirement Housing Foundation
Angelus Plaza’s many programs for residents and the community include cultural festivals with
crossover appeal.
ally. Because of where we’ve chosen to
serve, we’re in lower-income neighborhoods and serving predominantly African
Americans. Sometimes someone wants to
tour the center and you can see some of
them have a reaction. As with any folks,
there are stereotypes and prejudices that
lie underneath and sometimes those things
come out.”
Unwelcome remarks or actions are
handled straightforwardly: “We monitor it
and we just explain that ‘we don’t say those
things here, we are here to serve everybody,’” says Drewry. “Some clients respond
to the diversity of our staff, or we might
even get a request that a certain person
not care for me, and sometimes that’s a
perceived sexual orientation thing.” Drewry encourages staff to discuss such issues
10
nearly all-white area.
“One of the big issues we kept hearing
was that these clients were prejudiced—the
old staff was forewarning us,” she says.
“We walked into it saying that if we lose
clients because of that, so be it. We don’t
want to restrict the people who work in
that center. But frankly, we have found
that not to be the case. Sometimes uncomfortable beliefs begin to get worked out.
We’re a diverse staff, we forge ahead like
[our diversity] will be accepted because we
accept it.”
In Los Angeles, Calif., the nation’s largest affordable senior housing community
serves a vast variety of elders from many
nations. Angelus Plaza, part of the Retirement Housing Foundation family, offers
many programs and activities not only for
its 1,300 residents, but for seniors from the
surrounding community.
“Diversity is our greatest strength, but
it’s our greatest challenge, too,” says Jeffrey
Winston, Angelus’ community relations
coordinator. “It calls for creativity. We try
to avoid favoritism, and sometimes there is
tension within a given group, generational
differences. When there are problems, we
intervene. We try to talk to everyone, quell
and diffuse problems before [they] get
worse.”
Intergenerational activities help both
seniors and young people, some of them
troubled. Angelus Plaza houses a college
preparatory high school for at-risk youth,
and the community’s Senior Activity
Center puts seniors and high-schoolers
together. “The seniors volunteer,” says
Winston. “They avoid isolation and in
turn impart wisdom. A lot of these kids go
on to college or trade school. Some have
family problems, gang problems, but do
well in a nurturing environment.”
The Hellenic Tower’s Wilson says, “Differences in culture and language make it
hard [for some people] to mingle—there
is some ‘us-versus-them’ among residents.
Some of the American folks ask why do
[immigrants] get to come over here and
get benefits? There are stereotypes, but as
seniors get to know each other that goes
away.”
Wilson recalls one resident, very
vocal with divisive rhetoric, who had
a 180-degree change of heart when a
friendly Russian immigrant neighbor
began helping her when she developed
health problems. She cites another example of a Chinese couple who, with the help
of a hand-held translator, became fast
friends with a couple from South Carolina.
Staff can have a tremendous effect, says
Wilson: “We just work a lot with people
one-on-one.”
At Beth Abraham, some activities can
build bonds between seniors without a
word being spoken. Etienne notes how
quilting and sewing groups have helped
Latino and Asian women become friends
even though they can’t speak each other’s
languages.
“Of course, we do have flare-ups among
human beings,” says Etienne. “Sometimes
continued on page 22
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11
Civility, Ethics and Building
Respectful Communities
by Gene Mitchell
Building a “culture of acceptance” need
not rely only on building diversity, a high
priority for 21st-century society. It also
involves old-fashioned notions of civility
and good manners.
In an era of polarized politics, crass
media and a recession-stressed populace,
headlines like the following have been
appearing in newspapers and magazines
all over the country:
FutureAge discussed civility and ethics
with an expert who studies the subject and
has helped civility initiatives across the
country. Here is a look at:
•• “What Happened to Civility?”
•• “US Lacking In Civility”
•• “Incivility Is Heard ’Round the Nation”
•• “There’s Been a Real Shortage of Civility
Lately”
•• “If Civility Isn’t Dead, It’s Definitely on
a Respirator”
■
■
■
■
Why civility matters—its ethical,
practical and health benefits.
Why creating a culture of civility in a
high-stress setting, such as a nursing
home, must be a priority for leaders.
Why today’s level of incivility might not
be as bad as we think.
How civility brings out the best features
of a democratic, egalitarian society.
12
Expecting courtly manners from political figures and others in the public eye
might be expecting too much (and students of history can easily point to earlier
periods of incivility in American history
that would curl your hair).
It is unfair to attribute the sins of public
figures to the mass of ordinary people who
still desire—and practice—civility in their
day-to-day lives. Even so, in stressful times
everyone can use a little help in promoting
greater civility, especially in the workplace.
In aging services, unique stresses arise
because of the nature of the work providers do.
Dr. P.M. Forni, a professor of romance
languages and literature at Johns Hopkins
University in Baltimore, Md., has adopted
the study of civility as a second emphasis
of his career. Forni is the director of the
Civility Initiative at Johns Hopkins, which
he co-founded in 1997. He is the author of
two books on the subject: Choosing Civility: The Twenty-Five Rules of Considerate
Conduct (2002) and The Civility Solution:
What to Do When People Are Rude (2008).
Forni has inspired or consulted with
civility projects around the country: in
Cleveland Heights, Ohio, Duluth, Minn.,
Hershey, Pa., Howard County, Md., and
elsewhere, and he has been featured in
print and broadcast media in the U.S. and
Europe.
FutureAge talked with Forni about why
civility is so important, how it might be
instilled in the workplace, and why the
state of civility isn’t necessarily as bad as
we think.
FutureAge: Let’s start with a question
about civility’s importance. People value
civility, manners or good etiquette, but
most probably do not view them as central
to building a better life and a better world.
In other words, many people view civility
as a useful but perhaps minor concern.
Clearly, you believe it is central to building a better life and a better world. How
do you make the case for civility as such a
potentially world-changing force?
P.M. Forni: We can argue that civility,
good manners and politeness need to be
part of our cognitive and emotional kits
from three different points of view.
First, there is the connection between
civility and ethics. When we are civil, in
a small but significant way we are ethical
agents. Philosophers across the centuries
have contributed to a principle of respect
for persons which says that others should
be treated as ends in themselves rather
than means for the satisfaction of our own
needs and desires. It is when we follow this
principle that we are civil and therefore
ethical.
Refraining from taking someone’s spot
in the parking lot; giving credit where
it is due; being fair selecting people for
an ambitious project; or welcoming a
new coworker from a different country.
Whenever we do these things we are good,
decent persons. Civility is not trivial,
because it does the everyday work of
goodness.
Dr. P.M. Forni
The second argument is about civility
and violence. There are about 1.8 million
acts of violence every year in U.S. workplaces. If we [consider instead] slights, acts
of rudeness, how many are there? Probably
billions. We don’t know because they are
not reported. But we do know that many
of those acts of physical violence for which
we do have a figure have origins in an act
of disrespect or rudeness. It happens in
the workplace and on the road. We have a
driver who shows the infamous finger to
another driver, who responds in kind, and
things escalate from rudeness to violence.
The third major argument concerns the
connection between civility and our overall health and well-being. We know from
longitudinal studies that in order to have a
long, serene, fulfilling, sane life, we need to
be part of circles of acquaintance and care.
Part of a nurturing workplace, a supporting family, a group of friends, a book club,
etc. In other words, in order to survive and
thrive we need social support. However,
to gain and maintain that support we need
social skills. We need to behave toward
others in ways that make them want to
keep us around them. Isolation is a predictor of early death in the later part of our
lives. Good manners, civility and politeness are time-proven codes of social skills.
Social intelligence is a better predictor
of success in life than IQ. IQ is important.
You are smart, you get the job. Ten years
down the line, the person who will have
made the most strides is not necessarily
the person with the best IQ, but it may
be the one able to maintain harmonious
relations with coworkers. Everyone in
the workplace and in the schools should
know this. Managers in the business world
keep sending the same message: We need
people with people skills. It is hard to find
good communicators and good team players.
Recent surveys of opinion tell us
something very interesting: that the
number-one stressor in the lives of many
American workers is other people. It used
to be, a few years ago, the answer was
workload. A major part of stress comes
from bruised and broken relationships, at
work or at home. If we can create a new
generation of workers trained in civilitybased competency, the bill we pay for
stress in America will go down. We know
the price tag of stress is about $300 billion per year in days lost, medical and
legal expenses, attrition, etc. If we could
lower stress by making people work harmoniously with one another, we could
invest much of this money much better.
Intensive-care units that have a culture
of incivility also have a higher mortality rate than the average. Civility can be
a matter of life and death. We are talking
about something that is anything but soft,
though we often talk about soft skills.
FA: In nursing homes and assisted living
communities, there are a lot of potential
stressors—ways human relationships can
be strained. No matter how well-run a
home might be, most of the frail older
people there would much rather still be
living at home. The direct-care workers
who have the most contact with residents
do difficult jobs for low pay. Added to
that, the residents, their families and staff
may come from a wide array of different
backgrounds, races and ethnicities. For
these reasons, providers are concerned
with how to create a culture of civility in
the workplace. How should they approach
a challenge like this?
PF: There are four major causes of incivility that ruin the work experience for
many people: stress, anonymity, lack of
time and lack of restraint.
We are very goal-oriented, very taskdirected today. In a society of equals we
want to assert our identity. As we engage
in what is often a mad rush for the attainment of our goals, we don’t think we have
the luxury to slow down to make time for
others. A lack of restraint is also a major
source. As a society we are very successful in teaching our children self-esteem,
maybe too successful. We have not been as
successful in instilling self-restraint.
When we are in an anonymous environment we have little incentive to behave
thoughtfully because those around us are
not really part of our lives. We have to add
workload to this. It is always a source of
tension and stress, and job insecurity.
Catherine Pearson and other researchers
found that one of the causes of incivility
is a diverse environment at work. When
there are workers from different cultures—and the American workplace is the
most diverse in the world—we can try to
leverage diversity, but sometimes there are
[residues] of hostility, of prejudice that create tensions.
FA: Is instilling civility ultimately the
responsibility of the people at the top of an
organization?
PF: It is difficult to change the culture if
there is not an earnest involvement of the
higher rungs of the hierarchy. We know
that [in] programs to foster respect for
diversity, failure occurs when the workers
perceive that the company is not doing this
in earnest—that it is doing it in a perfunctory way, perhaps to avoid legal problems.
It is important that leaders and managers embody the ideal of civility. It very
often is a matter of one or two leaders
changing their way of dealing with everyday situations that changes completely
the feeling of what it is like to work in
that place. Sometimes it may be as simple
as smiling a little more. We are often
reluctant to smile because we fear to be
perceived as weak. But smiling has great
positive effects in all kinds of human
interaction. It may be as simple as saying
please and thank you and smiling that can
change the feeling of a workplace, that
can lessen the burden. Laughter releases
endorphins and other hormones and neurotransmitters in our system, and slows
down our heart rate. At the opposite end
of the spectrum, people who are miserable
because they believe they are being treated
unjustly have a higher degree of cardiovascular problems.
FA: What is being done about civility in
other fields?
PF: One kind of workplace where I’m
Continued on page 39
13
Resource-Poor, Spirit-Rich
Inner-city nursing homes serve poor, marginalized seniors
and struggle daily to keep their doors open, but these providers’
commitment won’t fade.
by Debra Wood, R.N.
Inner-city nursing homes face poor reimbursement, have few if any alternative
funding sources and operate in struggling
neighborhoods. Here is a look at the challenges these resource-poor homes face:
■
■
■
■
■
■
They serve poor residents who may
have had lifetimes of substandard
health care and for whom family
support may be lacking.
They employ staff who have few
personal or family resources and who
may have stress-filled private lives.
They rely primarily on Medicaid
reimbursement, with little chance to add
Medicare or private-pay revenues to
offset shortfalls.
They have difficulty recruiting
professional staff, often having to
pay them more than more affluent
organizations would because of
transportation costs and safety
concerns.
They have difficulty recruiting promising
new board members, who are in
great demand among higher-profile
organizations.
They have greater security costs due to
their locations.
14
W
ith roots deep in the
communities they serve,
inner-city nursing homes
face myriad challenges as
they strive to provide quality care with
limited resources—while maintaining an
unwavering commitment to do the right
thing.
“They have taken on a tough niche that
other people have gotten out of,” says Cory
Kallheim, AAHSA senior attorney.
Yet many operators of inner-city homes
would have it no other way. Richard
Binenfeld knew when he started his career
he wanted to do something meaningful,
and he has found satisfaction in his role
as executive director of the 118-bed Mary
Scott Nursing Center in Dayton, Ohio.
“I remember how struck I was the first
time a resident told me that they had never
lived as well as they have in our facility,”
Binenfeld says. “It’s the nicest place they
have lived, and we do not have a fancy
facility. I felt very gratified.”
Mary Scott saw a need to help homeless,
elderly African American women and, in
the early 1900s, began taking them into
her home. She established the donationsupported Mary Scott Home in 1914. The
home moved several times over the years,
and it closed from 1975 until 1983. Today,
the Mary Scott Nursing Center operates as
a skilled nursing facility and still receives
support from churches and the community.
“We are solving real problems that affect
the lifestyle of residents, families of the
residents and staff members,” Binenfeld
says. “We have a real effect, and it matters
how well the facility does to the stakeholders and the community.”
Patricia Mullins, president/CEO of the
Isabelle Ridgway Care Center in Columbus, Ohio, explains that inner-city homes
tend to serve poor, minority individuals
and members of the dominant culture who
are marginalized. Residents typically earn
less than the poverty level, and families
may depend on that income to live, creating conflicts when their loved ones need
skilled care.
“Serving people, especially those who
need me the most, drives my passion,”
Mullins says. “The rewards are numerous.
I am challenged every day. I learn something new every day about the human
condition. How I view the world changes
frequently. It keeps me open to new experiences and continued personal growth.”
For Jeanine Reilly, executive director of
Broadway House for Continuing Care in
Newark, N.J., moments when she knows
the home has made a difference in someone’s life keep her at her inner-city facility.
“People come by for a daily hug,” Reilly
says.
AAHSA convened the Inner-City Brain
Trust (ICBT) in 2008 to identify issues
facing these and other inner-city facilities
and to come up with strategies to help
them continue their missions in the future.
Brain trust members struggled to define
an inner-city home, but settled on “Homes
serving America’s chronically indigent who
need long-term care services in medically
underserved areas.” The group could not
quantify how many facilities this encompasses or how many residents they may
have, says Neil Roberts, moderator of the
ICBT. Roberts is board president at Fort
Hudson Health System in Fort Edward,
N.Y.
“The density of their problems was
huge,” Roberts says. “These homes are taking care of a lot of people, but they are also
what AAHSA is all about. Turning our
back on these homes is like turning our
back on our roots.”
Evidence Supports Change
A study by researchers at Temple University in Philadelphia, published in the
September/October 2007 issue of Health
Affairs, concluded that African American
nursing home residents are more likely
than whites to live in nursing homes with
significant deficiencies, staffing shortages
and financial vulnerability—homes that
house predominantly Medicaid residents.
A University of Chicago/University of
Pennsylvania study, reported in the journal Medical Care Research and Review in
October 2009, concluded that quality of
care, racial, ethnic and class disparities
exist and are well-documented in longterm care, but they appear related to racial
and socioeconomic segregation of nursing
homes, as opposed to provider discrimination.
However, a study conducted by the
Inner-City Brain Trust, reviewing data for
the 12 original brain trust members and
reported to the Centers for Medicare &
Medicaid Services (CMS) Nursing Home
Compare Web site, found that the level
of deficiencies and staffing ratios in the
inner-city homes are comparable to those
found in other, similar-sized AAHSAmember facilities. The ICBT concluded
that it is “inaccurate and unfair to characterize all Inner-City Brain Trust facilities
as places of poor care and discrimination.”
Rich Histories and Rewarding Outcomes
Most of these inner-city homes have
served their communities for decades, and
the people who live nearby comprise the
resident and employee base.
Eliza Bryant Village in Cleveland, Ohio,
began in 1896 when Eliza Bryant, an
African American woman, established
the Cleveland Home of Aged Colored
People, a modest home lacking a furnace
or bathrooms. She moved her home to a
larger house in 1901, and that grew into
Eliza Bryant Village, which now includes a
175-bed skilled nursing facility, 140 senior
apartments, and a variety of primary
health and community-based service programs.
Eliza Bryant Village is located in a poor
area on the east side of Cleveland. Half
of the population lives below the poverty
level, and among those working, twothirds earn less than $35,000 annually, says
Harvey Shankman, executive director of
Eliza Bryant. Twenty percent of the houses
in the area are vacant. Crime is a concern.
“We’re in an environment that is
demanding and stressful, and this is where
many of our residents and staff come
from,” Shankman says.
The 100-bed Isabelle Ridgway Care
Center in Columbus is nearly as old as
Eliza Bryant, having been founded in 1912
as the “Old Folks Home” by Isabelle Ridgway.
A parish priest formed Saint Ignatius
Nursing Home in Philadelphia to help
elderly women living in squalor. The home
Mary Scott Nursing Center
Mary Scott Nursing Center resident Doty Stephens works on balancing exercises with Janelle Hattery, certified occupational therapy assistant.
The 118-bed home traces its history back a century, when it was founded to serve homeless, elderly African American women.
15
grew and today is a 176-bed skilled nursing provider.
Broadway House has served an HIV/
AIDS population for the past 10 years.
Most residents arrive very ill, but the
78-bed center discharges about 60 percent
of its residents to the community and a
lower level of care. Many of its residents
also have mental health and addiction
problems. Broadway House helps find
them a place to live—otherwise 80 percent
would be homeless.
Two residents recently married at
Broadway House, wearing wedding
apparel donated by department stores,
and were discharged to a HUD-subsidized
apartment. A young man arrived at Broadway House bedbound from a stroke, but
with rehabilitation is now living on his
own, walking with a cane and giving talks
to young people about making smarter
choices.
Significant Challenges
Inner-city homes exist primarily on Medicaid funds, receiving 90 percent or more
of their revenue from the state/federal
program. Of residents who remain for
long-term care at Eliza Bryant Village, 98
percent are on Medicaid, and at Broadway
House 99.9 percent are on Medicaid. That
compares to 41 percent for all nursing
homes, according to 2007 CMS data.
“[Inner-city homes] are struggling dayto-day to make ends meet, not getting
above ground or just barely holding their
own,” Kallheim says. “Stand-alones have to
make up [Medicaid shortfalls] with Medicare. If they are part of a health system, the
system may help them.”
Binenfeld adds that inner-city homes
do not have the option of altering privatepay pricing to compensate for the losses
on Medicaid. In addition, Medicaid does
not pay for hearing aids and other items
residents may need. Mary Scott and Eliza
Bryant offer Medicare-covered rehabilitation services, but Binenfeld and Shankman
report the competition is fierce for these
admissions.
Broadway House seeks and receives
grants to cover items not reimbursed by
Medicaid.
Often, admission to an inner-city home
represents a resident’s first experience with
regular medical intervention. “The number of comorbidities residents come in
with is greater than our counterparts outside the inner city, because of the lack of
medical care,” says John Meacham, administrator of Saint Ignatius Nursing Home.
“There’s a cost associated with not having
medical care.”
“Psychosocial issues abound,” says Mullins. Residents may be homeless or drug
addicts with no family support, no clothing and no income. They may suffer from
Eliza Bryant Village
Ervin Ruffin, a program participant in Eliza Bryant Village’s Senior Outreach program, works out under the watchful eye of Senior Fitness
Instructor Viola Churn.
16
mental health issues that crop up after
medical treatment progresses.
Even though inner-city homes bring in
less revenue than other providers, they
often must pay professional staff more than
a suburban home to overcome concerns
about working in a place farther from
home or perceived as less safe, Shankman
says.
Eliza Bryant has also experienced difficulty recruiting younger members of the
community to serve on its board, because
up-and-coming professionals have multiple opportunities and often choose to
serve on boards that offer better networking opportunities.
In addition, inner-city homes often must
pay more for security.
“Security is a must throughout the day,
because we must project a quality and
secure environment,” Shankman reports.
Certified nursing assistant, dietary and
housekeeping staff typically live near the
inner-city homes where they work.
“Many staff come from a background
with a lot of turmoil,” Shankman says.
Human resources managers work with
employees to develop life skills—how to
manage finances, deal with child care and
cope with a persistent level of grief, due
1002 Aging ad Jan2009
1/20/09
to the violence that is part of life in these
neighborhoods.
Binenfeld was dismayed to learn that
employees took their paychecks to a
check-cashing place that charges $20 per
check—more than $500 per year—and
that they feared banks and wouldn’t open
checking accounts. (The Federal Deposit
Insurance Corp. reports that 43 million
Americans, especially minorities, rely on
alternatives to banks for financial services.)
Mary Scott’s bank also charged noncustomers to cash checks, but Binenfeld
prevailed upon the financial institution
to issue identification cards to all of Mary
Scott’s employees, allowing them to cash
paychecks at no charge.
Successful Strategies and Opportunities
Mary Scott offers employees interest-free
loans, repayable through three payroll
deductions. The facility lends employees
up to $40,000 per year. The employee
decides on an amount and does not need
to tell the home the reason for the note.
Ninety-nine percent repay.
“These are honest people trying to make
it,” Binenfeld says.
9:41 AM
Page 1
When Reilly came to Broadway House
in 2000, the turnover rate was 120 percent. She brought it down to less than
five percent within three years, and it has
held there. She credits listening to the staff
and their concerns outside of work, and
to understanding the challenges of caring
for a population of residents with HIV/
AIDS who often die young. Broadway
House brought in a grief counselor. “You
get attached to the residents, then they
pass away,” Reilly says. “If you cannot talk
about it at work, there’s nothing else to do
but shove it down.”
Reilly also learned that employees sometimes came to work hungry, leaving what
little food they had for their children, and
that they had no money to buy lunch.
As their blood-sugar levels dropped,
people became crabby and tired. Reilly
approached a food bank for donations;
the home now receives chicken and other
fresh foods, which it uses to feed residents.
“The food bank was saving us so much
money, we could feed our employees,”
Reilly says. “Everyone [on staff] here eats
one solid meal a day, even nights.”
The food bank also delivers, each
Wednesday, two bags of dry goods, with
at least enough to make two meals, for
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17
low-income employees. The first week,
were ways we could work together,” Shank- “The fact that it is difficult is part of the
only four people showed up, but then they man says.
attraction. It gives validity to how neceslearned the benefits. Now more than 50 of
Mary Scott presents an annual health
sary this work is.”
the home’s 150 employees participate.
fair and periodic educational programs
AAHSA’s Inner-City Brain Trust pro“It all comes around to job one,” Reilly
geared to people in the community.
duced a report, “Serving the Underserved:
says. “If they are healthier and nourished,
Binenfeld suggests more financially viable
The Case for Supporting and Sustaining a
they are better caregivers.”
providers could cosponsor these events.
Mission of Value,” in fall 2009. To downReilly discovered that many staff memDespite the obstacles, inner-city home
load the report, click here and scroll down
bers had talents, such as massage therapy
operators are determined to do whatever it
to the “Nursing Homes” section.
and Reiki, they could share with each
takes to stay afloat, because they consider
other. Once a month Broadway House
their missions critical to their communities.
offers a spa day for staff.
“If loving what you do is important, this Debra Wood, R.N., is a writer who lives in
The Inner-City Brain Trust suggests
is the place for us to be,” Binenfeld says.
Orlando, Fla.
continuing to work to raise policymakers’ awareness of the challenges that exist
for inner-city homes, perhaps enhancing
reimbursement for serving indigent populations.
Eliza Bryant Village, Cleveland, Ohio
“We have taken on the social responContact: Harvey Shankman, executive director, [email protected] or (216) 361-6141.
sibility to serve the most needy, the most
Mary Scott Nursing Center, Dayton, Ohio
inconvenient patients,” Binenfeld says.
Contact: Richard Binenfeld, executive director, [email protected] or (937) 278-0761.
“In the Medicaid payment formula, there
Isabelle Ridgway Care Center, Columbus, Ohio
ought to be a way for us to get a little more
Contact: Patricia Mullins, president/CEO, [email protected] or (614) 252-4931
money, so we can serve those people better.”
Broadway House for Continuing Care, Newark, N.J.
Many inner-city home operators hope
Contact: Jeanine Reilly, executive director, [email protected] or (973) 268-9797.
to partner with more affluent retirement
Saint Ignatius Nursing Home, Philadelphia, Pa.
communities that are looking for ways to
Contact: John Meacham, administrator, [email protected] or (215) 349-8800.
demonstrate their philanthropic nature
AAHSA Inner-City Brain Trust
and maintain their not-for-profit status.
Contact: Neil Roberts, moderator, [email protected] or (518) 474-9183. Download the Inner-City Brain Trust’s
“Many of those organizations have
AAHSA ad - January 11/23/09 2:34 PM Page 1 November 2009 report here (scroll down to the “Nursing Homes” section).
resources, and it would be nice if there
Resources
Salary & Benefits Reports
Published by Hospital & Healthcare Compensation Service (HCS)
Endorsed by AAHSA
Hospital & Healthcare Compensation Service (HCS), the leader in healthcare salary
and benefits research, now has available these four national compensation studies:
AAHSA Assisted Living Salary & Benefits Report
AAHSA CCRC Salary & Benefits Report
AAHSA Nursing Home Salary & Benefits Report
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X-6895-1109
for LGBT Elders
by Kevin Bradley
Diversity and inclusion are modern-day
extensions of not-for-profit providers’ core
values and tradition of offering quality,
compassionate health care, housing and
supportive services to those who need
them. A genuinely mindful, resident-centered approach to aging services fosters
a culture of acceptance throughout the
organization.
For lesbian, gay, bisexual and transgender (LGBT) seniors, though, acceptance
is sometimes an iffy proposition that can
make choosing services or a place to
live a stressful experience. Here’s a look
at several providers that have welcomed
LGBT seniors and, in some cases, have
made outreach to these seniors an intentional part of their marketing strategy.
These senior communities have found that
a welcoming culture not only expresses
their organizational values but also has a
practical side in today’s competitive marketplace.
20
T
he last national census confirmed that 99.3 percent of U.S.
counties are home to lesbian,
gay, bisexual and transgender
individuals. Seniors in this group confront
the same issues anyone does when choosing aging services: where to live as they
age, how to meet rising housing, health
care and medication costs, and how to
stay connected to community, family and
friends.
These elders, though, face an extra
layer of stress, says Lisa Krinsky, executive
director of the Boston-based LGBT Aging
Project. They often wonder, she says, “Can
I be my full, true self in the community in
which I choose to live or in the services
that I seek?”
Krinsky’s organization strives to help
aging-services providers better understand
how to serve this population. Frequently,
she says, it doesn’t occur to providers to
market to them, nor have they considered
that some of the people they already serve
may identify as LGBT.
When seeking a community or services,
or transitioning between levels of care,
these elders look for signals from staff and
residents as to whether it is an environment in which they can be themselves.
At an administrative level, providers are
welcoming, Krinsky says, but in her experience, “They have not yet figured out the
optimal way to convey to their staff and
residents that they are an inclusive community.”
It is incumbent upon aging-services
leaders to create friendly environments,
she stresses. This happens by implementing and supporting policies that make it
clear that the organization as a whole is
inclusive of LGBT residents, family members and staff.
One such leader is Sandy Douglass,
CEO and administrator at The Methodist
Home of the District of Columbia, who
attributes her organization’s success to a
philosophy of care that embraces diversity
in all its forms. It is, she says, an open
environment “where families of choice
are celebrated and partners of choice are
respected.”
Douglass’ organization advertises in
local LGBT publications and offers diversity and inclusion training to staff. She
also is working with the National Center
for Assisted Living to formalize a packet
of staff training materials that address
LGBT concerns and needs and will be
available to other providers. In addition,
Douglass is co-founder, with Susan Hester,
of Open Circle Communities, an assisted
living community offering LGBT people
a place to live where they feel accepted.
Douglass acknowledges that this kind of
community is not for every LGBT person,
as many prefer to live in heterogeneous
communities. But for others, an exclusive
community that embraces and welcomes
them, with special understanding of their
concerns and service needs, has great
appeal.
Awareness and Outreach
Like The Methodist Home, Episcopal
Senior Communities (ESC) in California
is committed to inclusiveness, both as
a service provider and as an employer.
ESC President Kevin Gerber observes
that while some LGBT residents, family members or staff may not be open
about their orientation, it is important to
be aware that they may be a part of your
organization. He also reinforces that many
LGBT persons may choose not to live in a
senior-living community that caters exclusively to that population. In fact, he says,
the “next generation of LGBT residents
may reject” such an option and that only a
small segment may find it attractive.
One example is a gay resident who
wrote to the San Francisco Chronicle
about living at San Francisco Towers, an
ESC property, and commented that he and
his partner of 50 years did not want to live
in an exclusively LGBT community, preferring a diverse community that represented
the kind of life they lived—filled with a
variety of people from all walks of life. The
couple appeared in a San Francisco Towers ad in 2007, and their story got picked
up by a local radio station, which raised
awareness of both the Towers and the
issue. The couple received an award during
gay pride month for being role models.
San Francisco Towers has been
intentional in marketing to the LGBT
community since opening in 1997. “We
have received lots of positive feedback
from members of the LGBT community
thanking us for our outreach,” says Director of Marketing Kate Hoepke, who runs
a monthly ad in a local LGBT newspaper.
She believes this and other outreach efforts
have benefited ESC, making it a provider
of choice for elders as a whole, including
LGBT seniors.
Selma Burkhom discovered San Francisco Towers through an ad and has lived
there for two years. She had looked at
many retirement communities and crossed
off her list any that were exclusively LGBT
or were evasive when she asked questions
regarding sexual orientation. Kate Heopke,
she said, was “forthcoming and very
appealing” in answering her questions.
At the Towers, Burkhom says, “Everyone
is extraordinarily convivial and civilized,
and I have not met with any overt or
covert sanction. The staff is also extraordinarily trained.” She, too, has allowed her
picture to be used in marketing materials. Heopke says the ads have prompted
compliments and calls not only from
prospective residents but from LGBT family members who are interested in having
their parents live there.
A Welcoming Culture
Robert Taylor and his partner moved to
Kendal at Oberlin in Ohio after living for
many years on the coast of Maine. They
were drawn by Kendal’s setting, amenities
and access to the town and local univer-
San Francisco Towers
Jack Bird (left) and his partner of 50 years, John Darby, were among the first residents at San
Francisco Towers when it opened in 1997. Though San Francisco Towers is intentional in
marketing to the LGBT community, it is not an exclusively LGBT community, a fact that Bird
and Darby value. The couple has appeared in San Francisco Towers advertisements and on
radio programs.
Resources
The Methodist Home of D.C., Washington, D.C.
Contact: Sandy Douglass, CEO, [email protected] or (202) 966-7623.
Episcopal Senior Communities, Walnut Creek, Calif.
Contact: Kevin Gerber, president, [email protected] or (925) 956-7400.
Kendal at Oberlin, Oberlin, Ohio
Contact: Barbara Thomas, CEO, [email protected] or (440) 775-0094.
AAHSA Annual Meeting Presentations
Several sessions at the 2009 AAHSA Annual Meeting covered LGBT issues. Click here to order audio recordings
of the sessions.
• Fostering Cultural Competence in Aging Services (session 42-A)
• Transgender Elders: What Aging-Services Providers Need to Know (session 141-C)
• Making the Case for Lesbian, Gay, Bisexual and Transgender (LGBT) Inclusion (session 76-F)
Forge Transgender Aging Network, Milwaukee, Wis.
LGBT Aging Project, Boston, Mass.
HHS National Resource Center
In October, the Department of Health and Human Services (HHS) announced plans to create, via the
Administration on Aging (AoA), a national resource center for lesbian, gay, bisexual and transgender elders.
The new Resource Center for LGBT Elders will provide information, assistance and resources for both LGBT
organizations and mainstream aging services providers at the state and community level to assist them in the
development and provision of culturally sensitive supports and services. The LGBT Center will also be available
to educate the LGBT community about the importance of planning ahead for future long-term care needs. The
funding announcement for the Resource Center is here.
21
sity. Most importantly, they found the
organization and culture inviting.
Since arriving, Taylor has served as
the president of the residents association and is currently a resident member
of the board of directors. His experience
at Kendal has been “entirely positive,”
he says, adding that his and his partner’s
arrival “helped change the conversation in
interesting ways. Some people thought of
themselves as tolerant before we arrived,
and had to face the fact that they were now
neighbors to two gay men living comfortably as a couple together.” Despite any
initial hesitations, the inclusive culture
has allowed Taylor and his partner to feel
welcomed and a vital part of the Kendal at
Oberlin family.
Taylor said he and his partner enjoy the
“mix of people, different points of view
and diversity of thought” that pervade the
Kendal culture. “We reach out in order to
help build a life for everyone around us
—Kendal residents, staff members, townspeople, students, visitors, all those who
come into contact with us—that is full,
rich, challenging, interesting and, most of
all, rewarding.”
Of LGBT inclusion and diversity in
general, Kendal at Oberlin CEO Barbara
Thomas says, “Those things just emerge;
we meet different people every day and
realize that they have so much to offer and
that is what makes this world so interest-
ing.”
As not-for-profit providers continue to
offer leading-edge care and services for
seniors and other populations across the
country, there are lessons to be learned
from the experiences of leaders such as
Sandy Douglass, Kevin Gerber, Barbara
Thomas and others. Organizations such as
the LGBT Aging Project and the Milwaukee-based Transgender Aging Network
also offer resources to help aging-services
organizations become familiar with the
concerns and needs of the LGBT community.
about the culture of the nurses, what they
wanted.” Fragale says. “We provided them
with housing, gave them help shopping,
and when they came to their apartments
they saw [we had stocked] foods they are
used to.” A preceptor program buddied the
new nurses with experienced staff.
Equal Employment Opportunity (EEO)
discrimination awareness training helps
prepare staff to handle issues with residents.
“We talk about age, religion, race discrimination,” says Fragale. “We also deal
with patients who are physically as well as
mentally impaired. We know that we will
come in contact with those residents and
their behavior may be challenging. However, we have to react in a professional
manner.”
In partnership with unions, Beth Abra-
ham provides ESL classes to help integrate
immigrant staff. A partnership with City
University of New York helps staff take
college courses. Employees with management aspirations can pursue a master’s
program in health care administration,
tuition paid by Beth Abraham; Hofstra
University instructors come on site to
make scheduling easier.
“It’s tied into our talent development
and succession planning program,” says
Fragale. “We are assessing individual skills
and experience and getting them ready for
promotion.”
“Health care is different from other
[fields] because of what our main priority
is, and that’s caring,” Fragale concludes.
“We hire staff who understand that. As
they work with one another, ultimately
they share that same value of caring.”
Kevin Bradley is AAHSA’s education
development manager.
continued from page 10
it’s just ‘Someone took my seat’; it’s not
about culture.”
Welcoming and Integrating a
Diverse Staff
At Beth Abraham, managing the staff is a
challenge simply because it’s so big. Add
the occasional misunderstanding, resentment or cultural faux pas due to the staff’s
diversity, and there is plenty of potential
for problems.
“Fortunately, we put a lot of work into
this,” says Peter Fragale, corporate vice
president for human resources. The key
is really quite simple—recognition and
appreciation of staff, and finding ways to
encourage all staff to mingle and get to
know one another, cultural differences
aside.
“We don’t see a lot of problems,” says
Fragale. “We educate and welcome staff.
We offer a number of recognition ceremonies, awards throughout the year. We have
a program called Caught in the Act, where
employees nominate one another for
awards for going above and beyond every
day … taking extra time with a depressed
or unhappy patient. We give them gold
stars. Some people say that’s not a big deal,
but that instant gratification is amazing.”
When Beth Abraham recruited a group
of Indian nurses a couple of years ago, it
anticipated the culture shock that would
result.
“We reached out to the recruiter to ask
22
Resources
Beth Abraham Family of Health Services, Bronx, N.Y.
Contacts: Mia Etienne, CCM vice president, clinical operations, [email protected] or (718) 944-4695; Peter
Fragale, corporate vice president for human resources, [email protected] or (718) 519-4231.
Plano Community Homes, Inc., Plano, Texas
Contact: Lee Ann Hubanks, executive director, [email protected] or (972) 423-6058.
The Hellenic Tower, Atlanta, Ga.
Contact: Joyce Wilson, administrator, [email protected] or (770) 992-4393.
Heritage Day Health Centers, Columbus, Ohio.
Contact: Erica Drewry, executive director, [email protected] or (614) 236-0586.
Angelus Plaza, Los Angeles, Calif.
Contact: Jeffrey Winston, community relations coordinator, [email protected] or (213) 623-4352.
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Residents in the Boardroom
by Dianne Molvig
In the governance of aging-services organizations, there has long been controversy
over the addition of residents to provider
organizations’ boards. Proponents believe
that residents, who have substantial financial stakes in CCRCs, should have a say
in how those organizations are governed;
they reason that boards can only gain
from having residents’ perspectives on
important issues. Opponents counter that
residents may have conflicts of interest
because of their financial stakes, or may
see themselves only as representatives of
residents’ interests, rather than considering the long-term viability of the whole
organization.
The debate will continue, but it is worthwhile
to examine the experience of organizations
that have residents on their boards. Here is
a look at several such communities.
G
lenn Brewer is a retired biochemist and pharmaceutical
company executive who,
during his working career,
served on the boards of various not-forprofits in the Princeton, N.J., area. Now
he lives at Meadow Lakes, a continuing
care retirement community (CCRC) in
East Windsor, N.J., operated by Princetonbased PHS Senior Living. He’s again
serving on a board, this time as a resident
board member at his CCRC.
“As residents, we have made a financial
investment in the health of this organization,” Brewer points out. “It’s good for us
to keep an eye on how things are going.”
Across the country, individuals like
Glenn Brewer spent decades being active
in community organizations. Now that
they’re living in CCRCs or other senior
housing, they’re eager to have a role in
overseeing their current communities.
A survey by Ziegler Capital Markets,
released in August 2009, found that among
112 senior-living organizations, 64 percent
lot of buzz about it,” observes Steve Maag,
director of assisted living and continuing
care for AAHSA.
While AAHSA opposes statutory mandates requiring residents on boards, it
encourages organizations to find ways for
residents to be involved in decisions about
their communities’ operations. “Residents
want to have input,” Maag says. “In many
cases, they have a lot of good ideas and
time and energy. Lots of positives can
come of this.”
But some observers warn of pitfalls:
Residents may have conflicts of interest
because they have financial stakes in the
community. They may oppose capital
expenditures for improvements they may
not be around to enjoy. Even with prior
business or organizational experience, they
may be out of touch with today’s business
and legal environment.
Still, amidst the debate, many CCRCs
and other senior housing organizations
have residents on their boards.
“We don’t tie up board meetings talking about the peas being too
squishy. We’re a governance board; we focus on policy.”
had residents on their boards. Of those, 79
percent granted resident board members
voting powers. Though the sample size is
small, the findings may indicate a trend
toward including residents on senior-living
boards.
To date, only New Jersey and Nebraska
have laws requiring CCRCs to have residents on boards as voting members. “I
think more attempts to pass such laws will
be popping up in other states. There’s a
24
Finding Opportunities
Gary Puma, president and CEO of PHS
Senior Living, admits he remains unenthusiastic about New Jersey’s 2007 law
requiring residents on CCRC boards. “We
were already very transparent here,” Puma
says. “We didn’t need this law.”
The initial dilemma was to figure out
how to comply in a way that fit PHS’s
structure. It’s a multisite organization with
26 communities, only five of which are
PHS Senior Living
“As residents, we have made a financial
investment in the health of this organization.
It’s good for us to keep an eye on how things
are going.”
—Glenn Brewer, board member and resident at
Meadow Lakes, East Windsor, N.J.
CCRCs. PHS’ 14-member parent board
oversees all 26 communities. Adding
five CCRC residents to the parent board,
whose responsibilities extend beyond the
CCRCs, would have had no value, Puma
says.
Instead, PHS created five local CCRC
boards that meet all at once. Seven people
sit on each board: two parent board members, four PHS officers and one CCRC
resident. Six members are the same for
all five boards; only the resident member changes. When the five boards meet
together, the appropriate resident member
participates in discussions and voting
pertinent to his or her CCRC. The CCRC
boards have met three times to date; Puma
says it’s too early to know the full effect of
the change.
But he already sees a bright spot. The
five CCRC board members get to know
each other and become advocates on critical issues facing the field. “They can go
back to their resident associations and
discuss those issues in a general forum,”
Puma explains. “We can put out a call to
action asking them to contact legislators.”
While Puma is new to having residents
on boards, Bob Scharmann has worked
with this structure during all of his 11
years as executive director of John Knox
Village of Florida, a Pompano Beach
CCRC. “I must say I have yet to encounter
a situation in which we wished we’d never
let residents under the tent,” he reports.
Three residents serve on the board,
which can have up to 15 members. A
resident senate committee proposes resident candidates to the board’s nominating
committee, which then reviews these
applications just as they would for nonresidents. “It’s definitely not a popularity
contest,” Scharmann emphasizes. Residents
serve one three-year term.
As the senior resident member, Eleanor
Smith automatically serves on the board’s
NaCCRA on Residents on Boards
Charles Paulk is executive director of the National Continuing Care
Residents Association (NaCCRA), which advocates for the interests
of CCRC residents and is a strong supporter of adding residents to
CCRC boards. We asked Paulk to explain his organization’s position.
FutureAge: How did NaCCRA evolve?
Charles Paulk: About four or five years ago, massive renovation
and expansion projects hit the CCRC industry. Communities
started incurring huge debts, without any resident input—and in
some cases without even resident knowledge until a project had
already started. This created a groundswell among residents. We
wanted to be involved in the decision making.
executive committee, plus she’s on the
board’s health care committee. “Without
patting myself on the back,” she says, “I
feel I do contribute. The board president
will say, ‘Eleanor, as a resident, what do
you think?’”
At the same time, she’s acutely aware of
the parameters of her role on the board.
“I feel I walk a tight line,” Smith says. “I
represent the residents, but I vote for the
whole village.”
John Knox Village of Florida
“I feel I walk a tight line. I represent the
residents, but I vote for the whole village.”
– Eleanor Smith, senior resident board member at John
Knox Village of Florida, Pompano Beach, Fla.
FA: Why does NaCCRA support having residents on CCRC
boards?
CP: The biggest reason is that most residents have made a
substantial investment in the community. That gives them a keen
interest in that community’s long-range success.
FA: Do you think we’ll see more state laws, like New Jersey’s,
requiring CCRCs to have voting resident members?
CP: I think there have to be. To give an example, there’s a
community in Pittsburgh that just went bankrupt. It looks like the
residents are going to suffer tremendous financial losses. Most
states have no protection for residents. I am concerned, however,
about national regulation of CCRCs. So far, NaCCRA maintains it’s
better for states to write regulations for their communities.
25
ACTS Retirement-Life Communities
“Hardly a week goes by without a resident
coming to me with a problem and asking me
to fix it. I’ve trained myself not to do that. I
don’t get involved in matters best left to the
professional staff or resident association
committees.”
—Titus Yonker, a resident of Spring House Estates in
Lower Gwynedd, Pa., and an ACTS Retirement-Life
Communities board member.
Selection Is Key
Since opening in 1992, Emerald Heights
in Redmond, Wash., has had residents as
voting board members, with good results,
says Lisa Hardy, who’s been the CCRC’s
president and CEO for two years.
“I can’t stress enough the importance of
choosing the right residents,” Hardy says.
“They have to know that when they walk
into that boardroom, they take off their
resident hat and put on their board member hat. They have to focus on what’s best
for the organization, not what’s best for
them personally.”
Three residents can serve up to two
three-year terms on the board, which
ranges from 12 to 19 members. The resident council chair sits on the board in a
nonvoting capacity. When voting resident
members rotate off the board, they recommend new resident candidates to the
board development committee. That com26
mittee and the departing resident board
members then work together to come up
with a final recommendation.
Marvin Mashner agrees with Hardy
that the selection process is critical. “A lot
depends on the screening you do,” says
Mashner, president and CEO of ACTS
Retirement-Life Communities, West Point,
Pa. ACTS has 19 CCRCs in three regions
covering six states. The board has up to
15 members, including one resident from
each region who’s elected for a three-year
term with no term limits.
“We look for people who are familiar
with what’s expected of a board and what
the duties are,” Mashner explains. “We
don’t tie up board meetings talking about
the peas being too squishy. We’re a governance board; we focus on policy.”
Titus Yonker, a resident of Spring House
Estates in Lower Gwynedd, Pa., and an
ACTS board member, knows resident
members easily could get sidetracked from
their true role. “Hardly a week goes by
without a resident coming to me with a
problem and asking me to fix it,” he says.
“I’ve trained myself not to do that. I don’t
get involved in matters best left to the
professional staff or resident association
committees.”
At Plymouth Harbor on Sarasota Bay
(Fla.), selecting resident board members
follows yet another model. The resident
association’s president, vice president and
immediate past-president automatically
take seats on the CCRC’s board. Plymouth
Harbor president and CEO Harry Hobson
believes it’s not the ideal method.
“We’re going to take a serious look at
this,” he says. “Maybe we’ll change it so
that the resident association puts forth a
list of candidates, who then go through
the same vetting process” as nonresident
board members.
While he believes the current selection
model has shortcomings, Hobson has had
few bad experiences with the results. In
fact, he was CEO at two other CCRCs,
in Ohio and Virginia, that used the same
selection method. In his 25-year career,
he’s worked with nearly 30 residents chosen by this system. “I could count on less
than one hand any situations that became
uncomfortable,” he says. Whenever resident board members needed reminding
about their responsibilities, the chair of the
board or governance committee handled
it. “That’s not a role for the CEO,” Hobson
notes.
Advantages for All
CCRCs aren’t the only types of senior
providers to have residents on boards.
For example, Mt. Carmel Gardens, a
207-apartment HUD community in
Jacksonville, Fla., has three residents on
its 11-member board. Executive Director Linda Rubens sees benefits in having
resident board members. “They bring the
day-to-day experience of living here to the
board,” she says. “I can make reports up
and down, but I don’t live here 24/7.”
Barbara Knopf has served her community’s board in both a nonresident and
resident capacity. She was on the board at
Emerald Heights for seven and one-half
years before she became a resident in 1999.
Emerald Heights
“As a resident board member, I understood
there’s not only governance but also aspects
of living here that the other board members
didn’t really understand. We did a lot to try to
help the board see how their decisions were
perceived by residents.”
—Barbara Knopf, former board member, Emerald
Heights, Redmond, Wash. Knopf served on the board
both before and after she became an Emerald
Heights resident.
Three years later she was reelected to the board, this time as a
resident member. She’s now been off the board for a year.
“As a resident board member, I understood there’s not only
governance,” she says, “but also aspects of living here that the
other board members didn’t really understand. We did a lot to
try to help the board see how their decisions were perceived
by residents.”
On the flip side, she notes that as a resident board member,
she gained an appreciation for what drives board decisions. “I
got a better understanding,” she says, “of what is best for our
community, and why.”
Indeed, boards and residents both stand to gain from having
residents on boards, says Matthew Neeley, president and CEO
of Hillcrest, a CCRC in La Verne, Calif. “The board members
are reminded at every meeting who they’re here to serve,” he
notes.
As for the resident board members, “I’ve found they love
being involved in the bigger picture,” Neeley says. “They’re
part of decisions that will affect the well-being and longevity
of this organization. That’s part of the legacy they’re leaving
for coming generations.”
You care for
Your clients,
we care for
ours.
Dianne Molvig is a writer who lives in Madison, Wis.
Resources
PHS Senior Living, Princeton, N.J.
Contact: Gary Puma, CEO, [email protected] or (609) 987-3976.
John Knox Village of Florida, Pompano Beach, Fla.
Contact: Robert Scharmann, executive director, [email protected]
or (954) 783-4020.
Emerald Heights, Redmond, Wash.
Contact: Lisa Hardy, CEO, [email protected] or (425) 556-8165.
ACTS Retirement-Life Communities, West Point, Pa.
Contact: Marvin Mashner, president/CEO, [email protected]
or (215) 661-8330.
Plymouth Harbor on Sarasota Bay, Sarasota, Fla.
Contact: Harry Hobson, president/CEO, [email protected]
or (941) 361-7514.
with over 35 years of experience
completing over 30,000 units ranging
from small-scale apartments to
expansive resorts, wpc can help you
build communities in which seniors will
be proud and happy to live. wpc is fully
licensed and bonded and knows how
to work with HUD loan facilitators. we
have the financial strength to provide an
exceptional level of accountability. wpc
also provides full 2-year warranties on all
new construction.
Mt. Carmel Gardens, Inc., Jacksonville, Fla.
Contact: Linda Rubens, executive director, [email protected]
or (904) 733-6696.
Hillcrest, La Verne, Calif.
Contact: Matthew Neeley, president and CEO, [email protected]
or (909) 392-4321.
National Continuing Care Residents Association (NaCCRA),
Lakeland, Fla.
Contact: Charles Paulk, executive director, [email protected]
or 863-816-2065.
Ziegler Capital Markets, Columbia, Md.
Contact: Jeffrey Girardi, research specialist, Senior Living Finance Group,
[email protected] or (410) 884-8311.
407.644.8923 / www.wpc.com
senior HoUsing / mUlti-family
Hospitality / renovations / commercial
HUD financeD projects
27
Regulation and Culture Change:
A Matter of Perception?
by Michele Hayunga
Providers interested in culture change
efforts based on the principles of personcentered care often worry that those efforts
will run afoul of surveyors; meanwhile,
surveyors are not always up to speed on
culture change principles.
AAHSA’s Institute for the Future of Aging
Services has surveyed providers launching culture change efforts and studied the
work of several states that are working
to educate surveyors and providers in
order to create more collaborative relationships. Here is a look at some of the issues
involved, and what CMS and two states
are doing to maintain compliance while
allowing culture change efforts to flourish.
I
nspired by the culture change
movement, a growing number of
providers are looking at how to turn
facilities into homes and schedules
into choices. But many nursing homes
worry that doing things differently could
have consequences come survey time. So
are regulation and culture change destined
to be at odds?
“In many cases, the barriers are more
perceived than real,” explains Robyn Stone,
executive director of the Institute for
the Future of Aging Services (IFAS) and
AAHSA’s senior vice president of research.
While some conflicts exist, there are a lot
of misperceptions by providers and regulators.
Stone suggests these misperceptions are
fueled by a compliance-based approach
to regulation, which, although necessary,
needs to develop more opportunities for
dialogue and shared learning about how to
achieve culture change.
For culture change to flourish, Stone
believes the federal government and states
need a smarter approach to regulation.
This approach would recognize the impor-
toward the same goal,” she says.
Stone and her team recently conducted
a seven-state study of the culture change
initiatives for nursing homes, which was
funded by The Commonwealth Fund. The
study found evidence of a perception by
providers that regulations can impede culture change. It also identified several states
that have developed a more collaborative
relationship between regulators and nursing homes, and highlighted progress at the
national level.
Stone emphasizes this shift in paradigm requires an investment of time and
resources. “This is about more than a
provider who happens to get along with a
surveyor,” she says. “We’re talking about
formalizing a relationship into a partnership.”
Federal Efforts to Remove Barriers
Recently, the Centers for Medicare &
Medicaid Services (CMS) has taken a
larger role in promoting culture change.
In April 2008, CMS and the Pioneer Network cosponsored a one-day symposium.
For culture change to flourish, Stone believes the federal government
and states need a smarter approach to regulation. This approach would
recognize the importance of compliance in weeding out bad apples, while
acknowledging a role for partnership aimed at improving high performance.
tance of compliance in weeding out bad
apples, while acknowledging a role for
partnership aimed at improving high performance. “We need more knowledgeable
providers and surveyors who understand
each other’s worlds and can work together
28
Its purpose was to review how nursing
home design innovations relate to federal
and state regulations and the Life Safety
Code. The following day, stakeholders
worked together to develop recommendations.
As a result of the recommendations,
CMS implemented changes, effective June
2009, to its Guidance to Surveyors for
several Quality of Life and Environment
section F-tags. These changes include
allowing residents to receive visitors 24
hours a day and supporting a home-like
environment through more emphasis in
such areas as encouraging residents to
wear their own clothes and determining
their own activities and schedules. The
changes offer clarification and assistance
to surveyors in determining compliance.
According to the Pioneer Network, “These
revisions have ground-breaking implications for resident choice, environment and
quality of life.”
Another outcome of the symposium
was the creation of a National Life Safety
Task Force, convened by the Pioneer Net-
Resources
Institute for the Future of Aging Services, Washington, D.C.
For an in-depth analysis of each state’s
approach, see the IFAS Issue Brief, “Supporting
Culture Change: Working Toward Smarter State
Regulation.”
For a copy of the seven-state culture change study,
check the IFAS Web site in February 2010.
For a toolkit listing the culture change initiatives in
the seven states, go to the IFAS Web site.
Contact: Linda Barbarotta, senior communications
associate, [email protected]
or (202) 508-1209.
Clatsop Care Center, Astoria, Ore.
Contact: Anita Schacher, CEO,
Marquis Care at Forest Grove, Milwaukie, Ore.
Contact: Leah Brandis, dietary manager,
[email protected]
or (503) 357-7119.
Oregon Department of Human Services,
Salem, Ore.
Contact: Sarah Hout, RD, nursing facility complaint
manager, [email protected]
or (503) 691-6587.
Consultants
Patricia Maben, Culture Change Consultant,
Lynda Crandall, RN, GNP, chair of MOVE Steering
Committee, [email protected]
or (503) 945-5918.
work, which is working to change the Life
Safety Code for 2012 to accommodate
culture change innovations. For example,
the group has proposed allowing residential cooking equipment in small nursing
homes, so residents can see and smell food
being prepared.
CMS and the Pioneer Network are
planning a second symposium Feb. 11 in
Baltimore. This one will focus on how dining initiatives interact with regulations.
Proponents of culture change have
a champion at the Administration on
Aging: Assistant Secretary for Aging
Kathy Greenlee. Since coming to Washington, Greenlee has met with the Pioneer
Network and with CMS. She spoke at
AAHSA’s 2009 annual meeting and will be
a key speaker at February’s symposium.
“In the culture change nursing homes
I’ve visited, it’s clear that residents are living well and have a good reason to get up
in the morning,” she says. “I believe these
facilities create a more positive and holistic
environment.”
A Unified Approach in Kansas
Greenlee’s home state, Kansas, is known
for advancing culture change while
maintaining a strict survey process. The
state is unusual because, since 2003, the
responsibilities for funding and regulating
nursing homes have been located in the
same department—the Kansas Department on Aging (KDOA). The department
also houses a Long-Term Care Division
with separate staff, who provide technical
assistance to providers and education for
surveyors.
“The survey itself is about compliance,”
emphasizes Greenlee, who was secretary
of KDOA before joining the Administration on Aging. “However, we wanted to be
available as an agency to provide guidance
and answer questions, so we set up this
separate consultative unit. Administrators
can even call in anonymously.”
The department’s structure has resulted
in a more unified approach to culture
change. For example, KDOA’s Promoting
Excellent Alternatives in Kansas (PEAK)
initiative uses civil monetary penalty funds
to provide cash awards to facilities recognized for culture change.
Few people are more familiar with
KDOA’s unique model than Patricia
Maben. As former director of the LongTerm Care Division, she wrote and
interpreted many of the state’s long-term
care regulations.
While Maben found few problems with
the actual regulations, she acknowledges
there was a need to educate surveyors.
“They had been trained in a certain mindset, and some had difficulty making the
change,” she says.
During KDOA’s quarterly meetings with
surveyors, representatives from culture
change facilities were invited periodically
to give presentations. This provided an
opportunity for surveyors and providers to
discuss issues related to the survey process
and culture change. For example, there was
confusion around whether staff should
wake residents up for medications. This is
not necessary unless there is a clinical reason for the resident to take a medicine at a
specific time.
Summaries of the issues discussed
were published in KDOA’s newsletter.
“Consistency and transparency were very
important,” says Maben.
She also worked to create an atmosphere
where providers felt comfortable asking for
help. “As director of long-term care, I averaged 50 calls a day from providers seeking
advice,” Maben says. “After we talked, I
encouraged them to call their regional
survey manager so there wouldn’t be any
surprises come survey time. Keeping them
in the loop was important.”
Oregon’s Surveyor-
Provider Teams
Oregon offers another example of how
providers and regulators can work
together to further culture change. In
2005, the state created six culture change
teams—each composed of one surveyor
and several staff from a nursing home.
The surveyor on the team had to be someone who would not actually inspect the
home.
Oregon contracted with Lynda Crandall, a Pioneer Network board member, to
provide technical assistance to the teams.
Using resources from the civil monetary
penalties fund, the state also paid for the
surveyor and one nursing home staff
member to attend a culture change institute in Portland sponsored by the Pioneer
Network. In addition, providers had access
29
to a $2,500 matching grant to work with
their team on a specific culture change
activity. Oregon expanded the program in
2008 to include six additional teams.
Clatsop Care Center, in Astoria, Ore.,
was one of the initial providers chosen.
Its leadership wanted to transition from
traditional dining to buffet style, but was
concerned about being cited for not monitoring meals.
As CEO Anita Schacher began holding
regular meetings with her counterpart,
she discovered the regulations didn’t really
present a barrier. “One of the biggest surprises was that we’re not actually required
to record how much a resident eats at each
meal,” she says. “However, the surveyor
did recommend weighing residents once
a week for the first six weeks, so we would
be able to pinpoint anyone who needed
closer monitoring.”
Marquis Care at Forest Grove was
another provider that wanted to reinvent
its dining program. The residents’ council
had expressed a preference for family-style
dining.
One of the home’s big concerns was that
surveyors would perceive residents serving
themselves as a violation of food-safety
regulations. However, after brainstorming
with her team’s counterpart, dietary
manager Leah Brandis felt confident they
could head off any problems.
“We trained all of our staff to be
observant and take responsibility for safe
food-handling,” she says. “If a resident
isn’t using good judgment, we’ll discreetly
replace the serving spoon before anyone
else uses it.” Since making the transition,
the nursing home has not had any
deficiencies relating to its dining program.
Former lead surveyor Sarah Hout, who
worked with Marquis Care, believes a
lot can be accomplished when providers
and regulators talk openly. “I always tell
providers, if you’re doing something
unusual, be upfront about it when the
surveyor walks in the door,” she says. Hout
is currently the nursing facility complaint
manager for Oregon’s Department of
Human Services.
Even better, says Hout, talk to the state
before making changes. “When you have
a new idea, don’t be afraid to call us,” she
says. “Our surveyors are willing to work
with you on how to get it done while
meeting the regulations.”
Of course, for this approach to work,
both providers and surveyors must be
educated about culture change. Oregon’s
orientation for surveyors includes a
presentation on culture change and how
it interacts with regulations. Surveyors
are also encouraged to attend quarterly
meetings of Oregon’s culture change
coalition, Making Oregon Vital for Elders
(MOVE).
Lessons for Other States
Oregon and Kansas demonstrate how
a regulatory approach that combines
compliance and technical assistance can
further culture change. Both states reveal
how structure plays a key role in striking
the right balance. They highlight the
importance of educating and engaging
stakeholders, from the leadership to the
front lines. Stone believes that if other
states can learn from their example,
culture change will eventually become the
norm.
Michele Hayunga is a writer who lives in
Eldersburg, Md.
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31
Four days. Three conferences. One
Register
NOW!
Top-notch speakers, leadershi
advocacy insiders come togeth
Monday, February 2
On Monday, Jeff Jarvis, auth
it off with a presentation on how
has the potential to transform t
aahsa
future of aging
services conference
& leadership summit
and support their families.
Watch this video to get a previe
his book and how Google’s pri
organization.
Tuesday, February 2
For the insider perspective, hea
Brazile. She is an adjunct prof
of the best-selling autobiograph
Pots in American Politics. To aff
heard, AAHSA members must h
with the tools to share their stor
february 22-24, 2010
Washington, DC
knowledge of national politics a
grassroots efforts and the confi
Wednesday, Februa
Join nationally recognized com
Sheehan for this once-in-a-life
communication strategies to fo
your organization at the local, s
CEMO Annual Winter Retreat
art and science of expressing o
concise, authentic and convinc
february 25, 2010
(exclusively for CEOs of multi-site
provider organizations)
Visit www.aahsa.org/futur
to find out more information
e location.
ip experts and
her like never before.
Future of Aging Services Conference
Sunday, February 21
9:00 a.m. – 5:00 p.m.
Pre-conference Seminar*
1:00 – 5:00 p.m.
House of Delegates
Monday, February 22
8:00 – 10:00 a.m.
Opening General Session
10:00 a.m. – 1:00 p.m.
Exhibit Hall Open/Boxed Lunch
1:00 – 3:00 p.m.
Concurrent Sessions (A)
3:15 – 4:45 p.m.
Concurrent Sessions (B)
5:00 p.m.
Exhibit Hall Open/Welcome Reception
Tuesday, February 23
7:00 a.m.
Morning Coffee
8:00 – 10:30 a.m.
Advocacy General Session and State Caucus
w the emerging world of social media
10:45 a.m. – 12:15 p.m.
Concurrent Sessions (C)
the way we relate to and serve seniors
12:15 p.m.
Boxed Lunch
1:00 – 5:00 p.m.
Congressional Briefing Visits
4:00 p.m.
Capitol Hill Reception
22
hor of What Would Google Do?, will kick
ew of some of Jeff Jarvis’ thoughts from
inciples for success can apply to your
Wednesday, February 24
7:30 a.m.
Networking Breakfast
8:30 – 10:00 a.m.
General Session
10:15 a.m. – 12:15 p.m.
Concurrent Sessions (D)
23
12:15 p.m.
Boxed Lunch
ar from political strategist Donna
12:30 – 2:00 p.m.
Concurrent Sessions (E)
fessor, syndicated columnist, and author
hy Cooking with Grease: Stirring the
Leadership Summit
fect positive change and have our voices
have a clear direction and be equipped
7:30 a.m.
Networking Breakfast
ry. Donna Brazile will share her insider
8:30 – 10:00 a.m.
General Session
10:15 a.m. – 12:15 p.m.
Workshop, Part I
12:15 p.m.
Networking Lunch
1:15 – 5:15 p.m.
Workshop, Part II
and congressional leaders, hometown
fidence to boldly tell it like it is.
ary 24
mmunications expert, Michael
CEMO Annual Winter Retreat*
etime opportunity to learn
oster greater influence and distinguish
6:00 p.m.
Welcome Reception
state and national levels. Discover the
7:00 p.m.
Networking Dinner
organizational information and goals in a
cing message.
reconference
n and to register.
Thursday, February 25
7:00 a.m.
Continental Breakfast
8:00 a.m. – 12:00 p.m.
Keynote Workshop featuring Erik Peterson
12:00 p.m.
Networking Lunch
1:00 – 4:30 p.m.
Featured Sessions
*Separate registration fee required.
New Media for Aging Services:
Twitter
by Craig Collins-Young
As we enjoy the flowering of social networking tools, organizations are learning
that these media can have strong benefits
for not only the way we live our private
lives, but also how we work.
Here is the first in a series of articles on
social media and communication tools
that providers can use for marketing, communication, shared learning and advocacy.
34
W
hen I’m asked by AAHSA
members about why they
should use social networking tools, my response is
simple: You have expertise, and you should
share your wealth of information.
If you think back to that first history
class in elementary school, you might
remember learning about the conventions
of society: a group of people who interact for their mutual benefit. Individually,
we offer our services or information in
exchange for others’ services or information. We specialize and then we share.
These interactions provide the individual
or community with the ability to achieve
something they might not have been
able to achieve on their own. What social
media tools, especially Twitter, have done
is provide our communities with an easier
way to create and maintain these interactions.
Within my community on Twitter, I may
on any given day see what news articles
are being read, what videos or movies are
popular, or what my friends are planning
for the weekend—all from the convenience
of my phone or computer. I’m able to keep
up with the many topics and trends I may
not find in a timely manner on my own.
Now, imagine what a group of interconnected aging-services providers could
share: marketing ideas, money-saving
procedures, information about regulations,
up-to-date news about advocacy projects
or upcoming events, or ways to solve
workforce retention problems.
Clay Shirky, a noted thinker and
writer on social media, sums it up this
way: “Once one person solves the problem once, the problem stays solved for
everybody.” With tools like Twitter, vital
information has the ability to pervade our
communities in real time.
What Is This Twitter You Speak Of?
Twitter is a communication tool that
blends instant messaging with blogging.
Messages are called tweets, and are limited
to 140 characters (not words), which may,
at first, seem too short. But, as I’ve used
Twitter more and more at home and for
work, I’ve come to realize that the character limit is a good thing; it forces me
to consider my message in a way that is
devoid of superfluity. Short and sweet, if
you will.
While Twitter is easy to use, there are a
few things you’ll need to know about the
Twitter community. Below are a few concepts to familiarize yourself with:
•• Following: Following simply means you
are receiving a user’s updates, or vice
versa.
•• @Reply: Sending a public tweet with the
@ symbol in front of another username
denotes that you are sending a message
as a reply to that user rather than a
normal tweet.
•• Hashtags: Using # in front of a word or
phrase denotes a hashtag. It’s a way to
categorize. During our Annual Meeting
in Chicago, we used #AAHSA09 so that
we and our followers could easily track
what was being said during the event.
•• Direct Messages: Messages sent from
other users that are not visible to the
public. Only the person sending and
the person receiving are able to see the
tweet.
•• Retweet: Using the letters RT before an
@reply means you are reposting another
user’s tweet to your followers. It’s like
saying, “Hey, check out what Roger just
said.”
Twitter is also a great research tool.
American Association of Homes and Services for the Aging
Social Networking
“Social media is best with people who were experts in something else first.
Today more than ever the power of the Internet is its ability to connect like-minded people and provide an easy way to share
information andJust
resources.
Social networking
such as Facebook,
Twitter should
and YouTube,
offer users
a variety tools to do just
as form
followssites,
function,
marketing
follow
content.”
that. And these social networking sites are not only for kids.
— Leo Laporte, host of This Week in Technology
Get Connected
At AAHSA, we believe that harnessing the power of social media will help generate
great conversations about the future of aging. That's why we've created communities
on the
following
sites:
Because it is a large network of people
“The largest
growing
group
of users is
interface. For example, at AAHSA, I use
communicating, Twitter is a great place
women in their 40s and 50s,” says Shute.
Tweetdeck to manage company tweets.
to see what’s popular beyond your com“This isn’t justFacebook
for kids.” Shute points out
It enables users to use multiple accounts,
munity. Twitter has a search feature similar that while social networking may have
and allows for more than one search at
to Google that allows a user to search all
started with teenagers, there is now huge
a time.
of Twitter for the latest trends. You might
growth in the number of adults using these
Twitter is also accessible by phone.
also look into these other search platforms:
tools
both personally
professionally.
If you’re
on a smartphone
or PDA, see
Facebook
is designed
to giveand
people
the power to make
the world
more
open and That
connected.
Users
can
photos
connect
tracks well
with
theshare
overall
trendand information,
if your phone
has an application store
with friends
andpeople
colleagues,
updates,
join apps
groups
thatApple’s iPhone and
•• Trendistic provides a graphical interface
of more
over 65post
usingstatus
the Web
and and(a.k.a.
store).
reflect
their
interests
or
areas
of
expertise.
AAHSA
has
a
Profile
Page
of trends and keywords.
staying on the Web longer. Recent data from Google’s Androidand
phones have a variety
Group. We encourage you to join both. If you've never used Facebook
•• Monnitter uses keywords to track
Nielsen’s found that in the last five years,
of Twitter apps. If you’re on a Microsoft
Twitter trends.
seniors actively using the Internet increased
Windows-based phone, you might try
•• Tweetmeme tracks most popular links
by more than 55 percent, from 11.3 million
PocketTwit.
on Twitter.
in 2004 to 17.5 million in 2009.
•• Hashtag.org shows most popular
“The new future of old age is about stayWhat’s Next?
hashtags being used on Twitter.
ing in society, staying in the workplace and
Try it. As an expert in aging services,
YouTube
staying very connected,
” Joseph F. Coughlin, you have thoughts people will want to
Who’s on Twitter?
director of the AgeLab at the Massachusetts
read. The great thing about Twitter is
More and more AAHSA members and
Institute of Technology, told The New York
the cost: free. If you decide it’s not for
businesses in the aging-services field.
Times. “And technology is going to be a very you, fine. But I think you’ll figure out
YouTube,
owned
by Google,
a Webis,site that
users
to
More and more older adults.
bigwhich
part ofisthat,
because
the newisreality
whyallows
millions
of people
are using this
upload
and
share
videos.
It's
a
great
resource
for
individuals
and
increasingly,
a
virtual
reality.
It
provides
a
Doug Fusella, president and COO of
tool. It’s easy. It’s informative. It’s fun.
don't
the bandwidth
to store It’s
andnew
stream
videos
way tothat
make
newhave
connections,
new friends
New Lifestyles, which helps consumersorganizations
media
for aging services.
on their own sites. Many AAHSA members already use YouTube to share
and
new
senses
of
purpose.
”
find information about senior housing
and
If
you’
d
like
more
videos about their organizations with the world. Why not join them? Visitinformation, visit
services, says his organization joined TwitAAHSA’s social networking page, or
AAHSA's YouTube Channel.
ter because it saw the numerous groups
Where Is Twitter?
e-mail me.
that were potential users of its services and Twitter is global and there are a variety of
wanted to engage and communicate with
ways to access it, the simplest being Twitter.
Listen to the full interview with Nancy
them in their chosen medium.
com. Here you can set up an account, sign
Shute.
Twitter
Increasingly, that chosen medium is a
in to read and send
tweets, and search the
social networking platform like Twitter.
world of Twitter.
According to Nancy Shute, a contributIn addition, there are products that
Craig Collins-Young is a manager of
ing editor at U.S. News and World Report,
allow users to interface with Twitter via
Internet content and social networking at
there has been a noticeable shift in the use their desktop. Many of these products have
AAHSA, and a contributor to the Future of
of social networking.
more robust features than the Twitter.com
Aging blog.
http://www.aahsa.org/connect.aspx/[1/6/2010 12:29:16 PM]
35
ideas & innovations
ideas & innovations
Cash Award Honors Affordable Senior Housing
Pre-K Classroom Connects the Generations
2009 MetLife Foundation Award of Excellence
The Commons, Enid, Okla.
Contact: Scott Wegmiller, [email protected]
or (580) 237-6164.
Three AAHSA-member senior housing communities are
recipients of the 2009 MetLife Foundation Award of Excellence
in Affordable Housing: Lytton Gardens I, Palo Alto, Calif.; The
Marvin, Norwalk, Conn.; and Mission Creek Senior Community
in San Francisco.
Enterprise Community Partners, Inc., and MetLife Foundation
have given the awards for the past 14 years to honor exemplary
models of affordable housing. Each winner receives a $50,000
unrestricted award to further its mission. This year, the competition focused on best practices with special consideration for
properties that incorporate green components.
Lytton Gardens I, a 35-year-old property that is home to 417
low-income seniors, takes a creative approach to green rehabilitation that includes extensive improvements for energy efficiency
and water conservation.
The Marvin, which recently celebrated its 12th anniversary,
serves 52 senior residents and offers three- and four-year-olds
affordable early childhood education at its children’s center. The
Marvin fosters strong connections between generations and provides a breadth of supportive services to promote independent
living and aging in place.
Mission Creek Senior Community offers 139 affordable apartments for seniors, including some who were once homeless, those
living with HIV/AIDS and others with special needs, and operates an adult day health center. The building was constructed on a
former industrial site using green building techniques.
A fourth winner, Station Place Tower in Portland, Ore., offers
active seniors affordable apartments near downtown and features
rooftop gardens, a rainwater harvesting system and other energyefficient technologies.
Otterbein Site Chosen for New Arts Center
Otterbein Retirement Living Communities, Lebanon, Ohio
Contact: Rosemary Cicak, [email protected]
or (513) 933-5448.
The Warren County, Ohio, Arts and Cultural Center will build
its new 350-seat regional performing arts center on Otterbein
Retirement Living Communities property in Lebanon, Ohio.
Over the past two years, Otterbein has developed a master plan
for providing an innovative, memorable sense of place and special
life experience for all ages in a life-long community. President
and CEO Jill Hreben is excited by the arts center decision, which
Otterbein had sought through a proposal it submitted to the center’s board.
“It really fits beautifully with our plans,” she says. “Part of the
reason we wanted to develop this master land plan was so that
when opportunities like this came along, we would be prepared to
respond to them. I think that’s really paying off right now.”
By working together as partners, Otterbein and the Arts and
Culture Center say they will be better able to reach, engage and
serve residents in the region at all stages of life from young to old.
36
It’s not unusual to see preschoolers in homes for the aging, but
it’s comparatively rare for a public school classroom to be located
there. This school year, The Commons, a senior-living community of the United Methodist Home of Enid, Okla., became the
site of an Enid Public Schools classroom for four-year-olds, focusing on an intergenerational approach to learning.
The pre-kindergarten classroom is located in the heart of the
community’s nursing center. Residents and staff look forward
to the students’ arrival in the lobby each morning. Playground
equipment newly installed in a courtyard next to the main dining
room has enlivened the view for residents, families and staff.
The intergenerational classroom resulted from the collaboration of Enid Public Schools, The Commons and an organization
called Smart Start Northwest Oklahoma/CDSA. In 2007, Smart
Start staff applied for and received a grant from the Inasmuch
Foundation that led to the intergenerational pre-K classroom.
Grant funds have supported the purchase of classroom furnishings and playground equipment and have assisted The Commons
with remodeling costs. The classroom is modeled after a similar
program at Grace Living Center in Jenks, Okla.
Home Health Agency, Fire Dept. Team Up for Senior Services
National Church Residences, Columbus, Ohio
Contact: Patrick Higgins, [email protected] or (614) 273-3514.
National Church Residences’ InCare senior home health care
agency has teamed with the Chillicothe, Ohio, fire department
in a pilot program to link seniors with the services they need.
The pilot, cooperative Community 911 Service Coordination
Program, launched in November, enables a service coordinator to
follow up on a senior’s needs, even though the situation may not
be deemed a 911 emergency.
“We know that first responders, such as fire fighters and EMS
professionals, are often the first point of contact with seniors who
live alone or perhaps don’t have family members to help them
out,” says InCare Vice President Terry Allton. “When a call comes
in from a senior who is not in imminent danger, an InCare service coordinator will work with the EMS first-responders to meet
that senior at the point of need, whether it’s linking them with a
Meals-on-Wheels program, offering home care assistance or connecting them with health care services.”
An assistant fire chief oversees the program for the fire department, and a service coordinator has been assigned full-time to the
department for one year. An InCare housing manager oversees
coordination at the corporate level. Program organizers hope to
duplicate the success of a similar effort in Upper Arlington, Ohio,
which saw the average number of non-emergency 911 calls from
seniors plummet within a six-month period.
A contract between the City of Chillicothe and National
Church Residences enables the service coordinator to act on
behalf of the city so that HIPAA laws are followed and each citizen’s privacy is protected.
Wii Bowlers Stage All-City Tourney
Lilac Plaza, Spokane, Wash.
Contact: Kris Martin, IT Services, [email protected]
or (509) 489-7612.
Video-game bowling has caught on in retirement communities
from coast to coast, but in Spokane, Wash., the game is so popular that seven senior-living communities organized an all-day,
all-city Wii bowling smackdown in 2009.
As reported in Spokane’s daily, The Spokesman-Review, the
tournament came “complete with projection consoles set side by
side and an online link to a retirement center in Omak, where
another eight bowlers wanted in on the tourney.”
Family and friends came to root for bowlers identified by their
colorful t-shirts and team names, such as Holman Gardens’ “Holman Hotties” and Lilac Plaza’s “Wii Lilacs.” High scores were
announced by loudspeaker and trophies were presented after
lunch.
Citing the health and social benefits for residents, staff of the
participating retirement centers vowed to hold more such tournaments in the future. True to their word, there have been Wii
tourneys every couple of months since that first one last spring,
with some 15 retirement connunities and senior centers now participating.
Glen Pierce, CEO of Spokane Baptist Association Homes,
whose Lilac Plaza retirement center has organized and hosted the
Wii events, believes they are well worth continuing. So does Kris
Martin, who directs the organization’s IT services and sees to the
tournament equipment.
As for the residents, many have fond memories of bowling
when they were younger but may now lack the strength to lift a
heavy ball. In Wii bowling, all they have to do is move an arm,
and they can play again—and compete.
In Denver, Center Promotes Self-Sufficiency
Seniors’ Resource Center, Denver, Colo.
Contact: Mark Smiley, director, public relations and marketing,
Seniors’ Resource Center will use an economic sustainability
grant from the Xcel Energy Foundation to help fund the center’s
program to promote economic self-sufficiency through job training and placement for low-income seniors and to make minor
home repairs for people with special needs.
“Given the current economic climate, it is becoming imperative for low-income seniors to work,” says the center’s CEO, John
Zabawa. “Many adults ages 55 and older are out of work, and
some of our current senior clients on a four-month waiting list for
services are homeless.”
The Seniors’ Resource Center job training program assists
seniors in preparing for employment, including resume writing
and understanding the current workplace, and provides help in
finding and maintaining employment.
The grant money will also be applied to the center’s volunteerdriven home repair program. Volunteers go to seniors’ and
disabled individuals’ homes to perform minor repairs such as
installing handrails, ramps and grab bars and weatherizing homes
to conserve energy and lower utility bills.
In keeping with the center’s mission, these simple but necessary
services give individuals the knowledge that their homes are safe,
and in turn promotes continued independence and quality of life.
Editor’s Note: The SAS Strikers from ACTS/St. Andrews Estates South in Boca
Raton, Fla., rolled their way to the National Senior League Wii Bowl™ crown on
Dec. 15. The league plans to host multiple national Wii Bowl and Wii Golf matches
this year, as well as fundraising events to benefit organizations supporting
dementia research. Click here for registration details.
37
Embracing Better Governance,
One Board Member at a Time
A
s the operating environment of not-for-profit organizations
gets more complex, and as government scrutiny of not-forprofit governance grows, the responsibilities of board members
are growing as well. Long-established organizations are moving
out of their comfort zones and embracing new models for delivering services to a rapidly differentiating consumer marketplace.
Internally, many boards are adopting governance models that ask
trustees to take on more creative—even visionary—roles, and are
making efforts to recruit from a more diverse group.
AAHSA has increased its governance resources and boosted
its programming for trustee education. The number of board
members who attend the AAHSA Annual Meeting each fall is
growing; attendance by trustees has grown by at least 40 percent
this decade.
Wes Teague was one of some 500 board members who attended
the 2009 AAHSA Annual Meeting in Chicago. Teague, vice chair
of Goodwin House Inc., Alexandria, Va., reported back to his
board about his attendance, and why the meeting was a valuable
experience.
Changing Lives—the theme for this year’s [AAHSA]meeting—is more than just a tag line. For many attending the
event, it is a daily occurrence in their jobs. For others, such as
me, it is a reminder of the work that our organizations do and
the mission behind those organizations, in one way or another.
My intention in attending this meeting [was] to learn something (or several somethings) that I [could] bring back to GHI
and put into practice that will help us with our mission, our
vision, and our goals as an organization.
Outside of specific sessions I attended, there were three overall trends that I saw, or heard about loud and clear.
First, technology is here to stay, and will become (or even
has become) a staple of any offering by any organization striving to remain successful in today’s market. The particular type
of technology, how it will be used, and the cost of implementing it is yet unclear. But it is going to be a force, and a must
for any successful product offering.
Secondly, single-location organizations are at risk of becoming dinosaurs in the senior living field. Well-managed and
well-governed multiple-location organizations will be much
more likely to be able to find financing … in the foreseeable
future. Economies of scale, in buying power and in management expertise, will become increasingly important.
Lastly, the trend toward providing more and different services to people in their own homes will continue, as “aging in
place” becomes more and more the norm. Our current model
will continue to attract some people, but many, many more
will look for alternative services in their senior years. The
intersection of this trend with technology will be an exciting
one to watch.
FutureAge talked with Teague, who is senior vice president of
Capstone Strategic, Inc., a mergers and acquisitions advisory firm
in Washington, D.C., about his experience on a not-for-profit
38
wisdom
wisdom
board and why good governance is becoming so important in
aging services.
FutureAge: You wrote something interesting in your report to
the GHI board, based on a presentation in Chicago:
The characteristics of a right board for the times: one that
is engaged; that questions, discusses, and refuses to accept
things at face value without investigation and contribution;
and one that is willing to look ahead, and not be bound to
the past. Example after example was given of organizations
that have failed, completely or in part, because their boards
were closed-thinkers; were not comprised of members with a
variety of skill sets, experiences and opinions; allowed life-time
terms which discouraged new thoughts and thinking; and that
become struck still as a deer in headlights in the face of changing, challenging conditions.
What do you believe about board members’ responsibility to
lead a not-for-profit organization?
Wes Teague: If a board member isn’t up-to-date, they are driving blind. How can they properly guide an organization? Kathy
[Anderson, CEO of Goodwin House] is as impressive a CEO as
I’ve met in any field. Yet we as a board don’t always listen to her
and nod our heads. We ask questions, we throw out alternatives,
we sometimes say no. If a board is comprised of individuals who
are there a long time, and who automatically rubber-stamp what
a strong CEO wants to do, they are not doing their job. The board
is supposed to direct the organization, the CEO executes on the
direction.
FA: In your work, you see a lot of boards in action. How do the
not-for-profit boards differ from business boards?
WT: We work with other not-for-profit organizations. A lot of
[their boards] don’t have a strong business background. They are
led by people with good hearts and are passionate about the work
they do, but are not necessarily good business people. We like to
say that if you’re on the board of a not-for-profit, you think of it
as a business or it won’t survive. At GHI, all of our actions and
activities must not hurt the business aspect; we must keep the
organization solvent.
Business boards tend to be much smaller and more nimble,
and it’s my experience that they tend to be a little more focused.
Goodwin House’s board is large, and work is done primarily
by committees that meet frequently. Governance—we take that
responsibility very seriously. It seems we spend a lot more time on
that at GHI than business boards do.
FA: What has GHI’s board done to “create the future” for the
organization?
WT: Three years ago, we held a strategic planning session, with
trustees. We needed a strategy. Taking care of older people is our
mission but isn’t a strategy. We have followed the guidelines that
came out of that session and will repeat it again. It does permeate
everything we do.
Our strategic direction—we’d like to
expand it a couple of different ways. We
think we have an excellent leadership
team, which has capacity to manage other
organizations under management contracts. Can we market our management
capabilities?
We also want to be open to, alert to,
other acquisition or even greenfield opportunities. This direction was developed
about three years ago, before the current
economic climate. We’re building 106 new
units at Bailey’s Crossroads—The Pointe—
connected with our existing facility.
Goodwin House was founded about 42
years ago. One of the continuing questions the board is asking, and especially
the Mission and Strategy Committee, is
what will we look like at our half-century
mark. We are convinced, to a person, that
it will be different, perhaps not markedly,
but there will be changes in how we do
what we do, how we offer our services, and
who we offer them to. We have a guiding
set of questions that the executive leadership team, especially Kathy, always keep in
mind: What are we doing that we shouldn’t
be (stop and get rid of it)? What are we
doing that we should (continue doing it)?
What are we not doing that we should
(here is where we significantly change ourselves)?
These three questions drive the board
and the organization, and are setting the
scene for that 50th year celebration.
People see endless, ugly conflict in the
media, and perhaps are swayed to believe
that the whole world is going crazy even
though it is not. What is your take on that?
PF: I think you are right. About 75 to
80 percent of Americans think incivility is
a major problem. About the same percent
think the situation has gotten worse in the
last 20 years. They see the glass half-empty,
but not half-full, because of the highprofile cases of incivility in the media. For
every three of those there are millions of
people who behave in a civil way that we
never hear about.
But what do we mean when we say civility is in decline? There are certain forms of
deference and respect that are becoming
obsolete. But every era creates new forms
of civility, and that means the situation is
not so bad.
Take my example of a pregnant woman
on the bus, who has to stand because no
one will give up a seat for her. This is a
sign of a decline in civility. But when that
woman steps into the workplace, the number of men who see her as an intellectual
and a professional peer is higher than
in my father’s generation. And that is an
increase in civility.
Today we are more respectful of people
who have a different skin color from our
own. We have higher consciousness of
environmental protection than we had
several generations ago. The glass is halffull. The high-profile cases of rudeness
tend to eclipse the good things, but they
are there too.
PF: For the first half of my career I
was a straight scholar working in medieval Italian literature. About 10 years
ago something changed. That was not
enough anymore, I needed to dedicate
myself in part to something with a more
direct relevance to everyday life. It was my
middle-age crisis—the middle-age crisis of
a professor of the Middle Ages. My crisis
came in the form of falling in love with
this notion of civility.
It seemed to me a much underused,
crucial resource and I decided to make an
attempt at changing that. It all was born
or coalesced when one day I was teaching my students Dante’s Inferno, and I
looked at them and a thought occurred to
me that stayed with me. Here are my students, I thought, and I would be delighted
if they knew everything there is to know
about Dante, but even if they did, if they
went out and were unkind to an old lady
on a bus, I would think I had failed as a
teacher. I had spent my life under the sway
of aesthetics, but at this point ethics was
knocking at my door.
Now the time is right to discover that
civility is the most egalitarian way of living
because the rules of good manners require
you to treat everyone the same: the president of the United States and the person
who cleans his office. I want to disabuse
people of the notion that good manners
are a façade. They are just tools and are as
good as the use we make of them. If we
use good manners to discriminate to each
other, to keep people from having access to
the halls of power, to keep people divided,
to keep them out of the golden circles of
privilege … that is the appearance of good
manners but not the substance.
Civility, Ethics and Building Respectful Communities
continued from page 13
asked to speak about ameliorating the
quality of life of the workers is in the
medical profession—hospitals and medical
institutions. More and more medical institutions are making their personnel aware
of the advantages of a culture of civility
and of the costs of incivility.
At the NASA Goddard Space Flight
Center, in the Washington, D.C., area,
they have started permanent civility
committees. They have a “civility collaborative”—regular meetings of workers at
all levels who have a great personal investment in the notion of civility. They try to
capture the imagination of their coworkers
and foster talks on civility and diversity.
They are one of the most active employers
that have embraced this notion and have
permanent initiatives.
Also, one thing I do is go to communities around the country that want to
create civility initiatives, that want to rally
around the notion of civility. There are
dozens of civility projects and programs
around the country. Some of the things
done are, for instance, going to the local
school district to persuade them to teach
good manners in the schools, involving
the police department, talking about the
notion of community policing.
FA: AAHSA and its members put great
emphasis on public-policy advocacy. We
have been concerned with the general lack
of civility within political life, and want to
be sure that we and our members keep our
eyes on the important issues and not get
sidetracked. The bitterness that appears
in our leaders and the media is misleading because it does not necessarily extend
down to the ranks of ordinary people.
FA: How did you, a professor of
romance languages and literature, become
interested in civility?
39
aahsa synergy
aahsa synergy
AAHSA’s Live Learning Center Brings Annual Meeting Magic Into Your Organization
With more than 250 education sessions on topics ranging from
staff retention to environmental stewardship, it’s hard to make
the most of an AAHSA Annual Meeting—even if you come to
the conference.
Thanks to AAHSA’s Live Learning Center, all members have
the chance to share in this educational event, and more. This site
offers access to session presentations from AAHSA’s conference as
well as recordings of audio conferences and Webinars.
Want to find more information on a particular topic? You can
search the center for resources throughout the site. Take staff
satisfaction. The site features information on best practices for
hiring to ensure staff satisfaction, a presentation on coaching and
a study of CNA retention.
Visit the AAHSA Live Learning Center to stop wondering and
start discovering how your organization can make the most of
this opportunity.
Advancing Excellence: Nursing Home Quality Version 2.0
As you know, quality improvement isn’t just a project. It’s a journey. And the Advancing Excellence in America’s Nursing Homes
Campaign is moving forward on its journey with the launch of
its second phase.
To start, the campaign reordered its eight original goals to
accommodate nursing homes’ needs. Staff satisfaction became the
first new goal because as we all know, a stable workforce is essential for quality improvement. Other goals, like managing pain
for long-term residents and short-stay residents, were combined
to streamline work and help homes achieve similar goals faster.
Advance Care Planning is also a new campaign goal.
What’s more, the campaign developed resources that can help
nursing homes address these goals more efficiently and effectively.
For example, a fact sheet on pain management for staff features a
list of tips for minimizing pain, a link to a pain management tool-
kit and a list of organizations that address this important issue.
Just as Advancing Excellence began a new phase of quality
improvement, so should your organization’s nursing home. Visit
the Advancing Excellence Web site to register or update your profile and set new goals and targets. Registration ends January 31,
2010.
Advocacy and Learning Take the Stage at AAHSA’s Futures Conference
The weather in Washington, D.C. during February may be cold,
but the policy climate is just heating up. Congress is coming
together to make decisions on issues affecting your work, like
housing funding and Medicare regulations. And they need to hear
from you. That’s why we are hosting our Future of Aging Services
Conference, Feb. 22-24 in our nation’s capital.
At this conference, you’ll discover ideas and inspiration to
enhance your organization’s service and advocacy for older adults.
Take our advocacy caucus. There, our experts will arm you with
tips and tools you need to tell your federal legislators how they
can help their older constituents and those care for them.
But it’s not just about Capitol Hill. There are also dozens of education sessions where you can learn about everything from home
and community-based services expansion to financial stability.
The conference will conclude with AAHSA’s Leadership Summit. Michael Sheehan, a Harvard University lecturer and message
development expert, will join us to share his insights on how notfor-profit organizations can create messages that resonate from
the inside out. He will also guide attendees through an exercise
that results in a framework for highlighting an organization’s notfor-profit leadership in its community.
Leadership. Advocacy. They are words you’ve heard before. At
this conference, you’ll learn effective strategies for putting them
into practice for the people you serve. To learn more, click here.
Visit AAHSA’s Conferences and Education page here.
Written by Sarah Mashburn, AAHSA communications manager.
index of advertisers
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40
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Ziegler Capital Markets............................................................................................. 11
AAHSA Savings & Solutions Center................................................................... Cover 4
AAHSA Futures Conference..................................................................................32-33
AAHSA 2010 Partners....................................................................................... Cover 3
AAHSA recognizes its
2010 Partners
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FutureAge magazine Jan-Feb 2010 issue

Transcription

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