CMS Regulations, Dementia Care and More: American College of Health Care Administrators Winter Conference

Annual conferences are an opportunity to stay abreast of changes in the industry and creative programs to enhance practice and outcomes in long term care.  It is an opportunity to meet other colleagues in the industry who can serve as future resources and mentors.  This year’s ACHCA Winter Marketplace will be hosted at Bally’s in Las Vegas, Nevada December 4 – 6, 2015.

I will be presenting information on the current state of dementia care practice, pending regulatory changes and ways to prepare as well as ”best practice” in memory care.   My session, “Dementia Care and CMS: Are You Ready?” will be presented on Sunday, 12/6 at 8:30 am.

As we all know, memory care is exploding and predicted to increase, yet many programs lack a strategy for ensuring positive outcomes and compliance with upcoming CMS demands.   This session will define essential components of an exemplary program, competitive advantages, the CMS pilot, and projections for future regulations.  Topics include: leadership role in addressing consumer desires; staff recruitment, retention, orientation and training; consistent assignments; ongoing communication, integrating families; admission processes; safety; and importance of developing a continuum of care.

Click HERE to register or to learn more on scheduling of events for the conference.



Change AGEnts: Building Momentum for Change, Improving Care of Older Adults

The 2015 John A Hartford Foundation Change AGEnts Conference, “Making Connections, Building Momentum for Change,” will be held on December 1 – 3, in Philadelphia.   Robert Schreiber, MD of Harvard, Hebrew Senior Life, and I will be facilitating a course on Leadership and Culture Change, as well as a session on Kotter’s Eight Step Process for Leading Change.

The Change AGEnts Conference will bring together approximately 120 selected leaders in aging and health striving to improve the lives of older adults through new connections, building skills critical to practice and policy change and facilitating change through collaboration.

The Gerontological Society of America (GSA) manages the Hartford Change AGEnts initiative guided by leaders from both the John A. Hartford Foundation and GSA and Strategic Communications and Planning.

More can be found about the Change AGEnts program at or





Elders and Seasonal Affective Disorder (SAD)

We have all been touched by a bit of the winter blues at one time or another.  The early sunset makes most of us want to put on our pajamas and settle in by the fire or the television much earlier than usual!  However, while it isn’t unusual to suffer some minor episodes of the winter blues – there are those who will be affected by a more serious version – Seasonal Affective Disorder, appropriately referred to as SAD.

Though SAD is thought to affect mostly females prior to the age of 55, it can occur later in life.  Because of the cold temperatures and chances for snow and ice, older adults are more likely to stay indoors which may increase the incidence of SAD.  Older adults are also at risk for social isolation during the winter months, as family and friends will stay home more often as well.

SAD is more common in areas that experience the changes of the winter season more prominently.  It is thought that the decrease in sunlight is a primary cause of SAD.  Less sunshine and more overcast skies, as well as shorter periods of daylight in early fall to late spring have an impact on developing SAD.

Signs of SAD are very similar to depression in general and it is important to be evaluated by your physician if you are concerned. Physicians will determine if there are other causes for your symptoms and look for patterns to determine if you are one of the many who suffer from SAD.  Symptoms of SAD include loss of energy, mood swings and/or feeling anxious and sad, social isolation, sleepiness and lethargy.  People affected with SAD will also show little interest in normal activities, and often experience an increase in appetite and weight gain.

Dependent upon the effects of the symptoms in your daily life your physician will determine a course of therapy if needed.  Medication is available and has been found to help, more so if started prior to the onset of symptoms.  A form of Light Therapy has also been found to be beneficial.  Your physician may also prescribe Vitamin D.  Older adults are at risk for Vitamin D deficiency in general, and the decrease in sunlight during the winter months may warrant adding this important supplement.  For others, a physician may recommend counseling as an alternative to medication.

Whether it’s SAD of just a case of the blues, there are steps we all benefit from to lessen the effects of winter weather.  Try to get some form of natural sunlight each day.  If possible, take a few brief walks outside when weather permits.  Physical exercise is always beneficial, and can be an effective way to increase energy levels.  Exercise will lift both the mind and the spirit which may help decrease the symptoms.  Eat a healthy diet and stick to a regular sleep schedule.  Make a point to stay active, find some fun hobbies or things to do and visit with friends or family – which may be the most effective treatment of all.


Memory Care Programs – Misleading Advertising Leads to Lawsuits

Why Staff Training is a Must

Memory care providers take note – misleading memory care advertising is becoming a focus for a number of advocates and state executives who are now pursuing (and suing) facilities who promise well trained staff and specialized memory care programs, yet are not delivering as promised.

Most, if not all who provide memory care programs market and sell their programs on well trained staff, specialized programs and activities, and individualized and person-centered care. But how many facilities are true to the spirit of such advertising? Are they actually providing staff training, and delivering such unique environments, activities, programs, expertise and the specialized care that they proclaim?

Recent news stories focus on nursing facilities, however advocates and state executives are acutely aware of consumer concerns in the assisted living memory care industry. Despite less regulation and oversight in assisted living, advocates and state executives are cognizant of the need to protect consumers in this predominately private pay environment as well.

Staff training is essential for providing specialized memory care. Yet training is often infrequent, inadequate and ineffective. Unless required by the state, some facilities do not provide any dementia training despite caring for a large percentage of residents with a dementia diagnosis. Often for those who do provide training, education on dementia is exclusively online and they rely on staff to access training on their own. Many organizations do not even require a specific online curriculum be completed before they begin providing care for a resident with dementia, and seem to believe that staff will access the online training when needed. While online and computer training is beneficial, online training alone does not give staff all that they need when caring for a person with dementia – an opportunity to ask questions, share strategies and brainstorm on potential techniques and solutions with leadership and one another.

Leadership teams who provide initial and ongoing training “in person” better equip staff to manage residents with dementia, but also demonstrate that staff are valued and worth the time and effort. This in turn enhances staff satisfaction and retention, so critical to memory care programs. And the “learning” for staff should never end; new residents, new situations and new strategies are worth exploring with staff, face to face.

Staff training, ongoing education, communication and support enhance the staff’s ability to provide the type of care, enjoyable programs and experiences we would want for someone we love. Ask yourself if you are prepared or able to develop programs internally or if you would be better served to seek external experts. If the answer is no, find a consultant who does know and can help.

Don’t promise what you cannot and do not deliver. It is not only detrimental to the resident, family and staff but will cost a great deal in the end; reputation, financially and now potentially in a lawsuit and damaging press.

CMS Regulations and Person-Centered Dementia Care: Are You Ready?

Change is coming. CMS has introduced multiple changes to nursing home regulations that will impact the industry, especially those facilities providing dementia care. Even though the comment period was extended, organizations need to take these potential changes seriously and begin to implement strategies and programs now. Doing so will not be quick or easy. It is clear that it will require an organizational approach with effective and consistent staff communication, thus organizations with high turnover will have the greatest difficulty.

I will not attempt to tackle all of the proposed initiatives, but two major areas of focus with new emphasis should not be a surprise to anyone in the industry; person-centered care and dementia care. For many years numerous advocacy groups, associations, and organizations as well as CMS have advocated for person-centered care and dementia training as a means to improving life for older adults with dementia in long-term care. Facilities should have already implemented much of what is going to be expected, not simply because it will be regulated but because much of what is proposed is actually “best practice.” Are we not an industry that is committed to offering the best quality of care and life to those we serve?

Memory care units and facilities have exploded, with no definition of what a memory care program actually is or should be. However, few would argue that an “authentic” or effective memory care program include well-trained staff, individualized care and programs. Staff in many facilities have not received appropriate education or training on the disease process, or techniques to enhance outcomes and quality of life. Not only is it lacking in nursing homes, but in assisted living as well.

And yet consumers reading brochures and websites often find language that imply that a facility’s memory care program provides “trained staff,” “individualized programs and activities,” etc. Unfortunately, all too often that is not what they experience.

An effective memory care/dementia program is beneficial to the residents, families and staff. Staff want to be trained to deliver the best care possible. Working with individuals with memory loss requires initial training as well as ongoing education and communication. It is an ever-changing disease process and dependent upon the knowledge and abilities of caregivers for a chance at any quality of life.
While you can read about Alzheimer’s disease and dementia forever, the clinical experience and knowledge gained with “hands-on” involvement is far superior. And the sharing of each caregiver’s strategies and experience enhances the success of their colleagues and the outcomes for residents.

Gathering and communicating information about each individual resident, their history, current status and effective strategies to promote a high quality of life simply generates better care, but in dementia care it is essential. Organizational processes and procedures for the admission and transition to long term care for the resident and family should be carefully planned as well as a system for family input, engagement and communication.

Prepare now. Ask yourself if you are prepared to develop handle internally or if you would be better served to seek external experts. A CEO recently told me that he saved years of work and a great deal of money. He wanted to develop a “best practice” memory care program and had decided that they would do so in-house with his own staff. After attending a national conference and listening to dementia care expert presenters discussing their memory programs, he realized that each program was created and evolved over 20 to 25 years of “hands-on experience.” He decided to hire an expert consultant confident that he had saved countless years of work as well as tens of thousands of dollars.

Regardless of new regulations, remember that true person-centered dementia care can make a difference in the life of a person, their family and staff. As an industry we owe it to those we serve.

Save Time and Money – Expertise Found at Annual AHCA/NCAL Convention

A CEO recently told me that he saved years of work and a great deal of money simply by attending a national conference. He wanted to develop a “best practice” memory care program and had decided that they would do so in-house with his own staff. After attending a conference and hearing expert presenters discussing their memory programs, he realized that each program was created and evolved after over 20 to 25 years of “hands-on experience.” He decided to hire an expert consultant and saved countless years of work as well as thousands of dollars.

We often say experience is the best teacher and learning from others expedites programs and processes, enabling organizations to be successful quickly. Can you do it yourself? Sure, if you want to spend the next 20+ years learning and refining. Decide what you are trying to accomplish – new programs or enhanced services – and seek out those experts at conferences. It will likely save you a great deal of time, energy, frustration and money.

Conferences are an opportunity to gain new information, strategies, seek expertise and find colleagues who can serve as a resource and guide when needed. In addition, they are refreshing, rejuvenating and fun.

I am excited to participate in the upcoming AHCA/NCAL conference as a speaker and an attendee.

The AHCA/NCAL meeting will be held in San Antonio, October 4 through October 7, 2015. I will be presenting “Components for a Successful Staff Stability Strategy” for NCAL on Sunday, October 4th, 11:00 AM – 12:00 PM, and again for long-term care staff on Wednesday, October 7th, 11:00 AM – 12:30 PM. I will also present “Enhancing Consumer Satisfaction: A Person-Centered Memory Care Model for Families” on Tuesday, October 6th, 8:00 AM – 9:30 AM.

Come, meet new colleagues from around the country and examine how others are being more successful in their work. New contacts made often become friends and are important resources on whom to call when in need – I hope to be one of them. See you there!

Customer Service Transforms After A CEO’s Personal Experience

A recent article* about a hospital CEO elevates him to hero status, and his willingness to share his experience deserves attention. The point is he was willing to share a very personal experience about the customer service during his mother’s hospital stay, and how it transformed his own hospital.

Upon spending time with his mother in another hospital the CEO noted that it took a long time for someone to answer her call light. He was not pleased with the environment as her room was not very attractive and it was not clean. In addition, he observed that his mother’s pain was not well managed, that it was not assessed or treated in a timely manner.

Why do we not treat every patient like our own mother? Why did it take this experience for him and others to notice that services were subpar? When are we going to realize that we are in the people business and those people consist of many mothers, fathers, wives and husbands, and treat them as we would our own?

Now, I am not asking for much and neither was he – he simply raised the awareness of his managers and staff of the personal, people-side of the business. He implemented “standards of behavior” which I call expectations for performance. Communicating these standards and expectations is critical to the training and education process. Employees generally want to please an organization, but if not told what the expectations are they will simply do their own thing – or follow the lead of colleagues.

Changing a culture requires changing a collective group of individual beliefs and mindsets, which will lead to changes in their actions and behaviors. It takes time and a commitment by the leader, the CEO and leadership team. Maintaining it will require an ongoing, never-ending mechanism for communicating expectations, reminding employees, keeping the awareness of the expectations alive and monitoring for assurance.

Once the foundation is laid and the employees believe it is real and lasting, the time commitment declines, as everyone understands the expectations for performance and rationale. This new way of operating, defining success, should become a requirement for hiring new people – and when the culture is service-oriented employees tend to stay. And as this CEO noted, employees, even physicians, will travel a great distance to work with an organization like this. In addition, his effort led to enhanced satisfaction and staff retention – becoming one of the “top places to work” and recipients of multiple awards.

My experience in organizations is that some people don’t want things to change; they have been there a long time and are comfortable with the status quo. Some employees regardless of tenure will not change, and simply must leave. His experience was the same – employees who could not comply with the new culture chose to leave or were let go.

Also important to note, the CEO talks about mission over margins. Understandably, margins are the focus for most organizations. However, can we not have both? Would people not go to a hospital where, as he defined it, success was defined as “positive outcomes, feelings of being loved and cared for by a great group of people?”

With consumers seeking user-friendly health care systems and 30% of Medicare payments into alternative value based models by end of 2016 – 50% by end of 2018 – it seems this direction is the right one and the time is now for such a transformation. Competition is fierce and every hospital is focused on good care and outcomes – how about some humanity to set you apart from the others?

* Wagner, K. “Putting Patients at the Center of Care,” Healthcare Executive, ACHE.  July/August, 2015.

Respect, Staff Satisfaction/Turnover Back in the News

Despite decades of research and examination, millions of dollars are spent every year when staff members leave a healthcare facility. Turnover is rampant, found in all staff positions and at all levels in all departments. Why?

Another new article and report indicates respect outweighs wages when examining staff satisfaction, this time in the home health care arena as well.

Respect and appreciation are what staffs have consistently stated as the number one item they lack – but desire – in their work. They are top on the list of what drives satisfaction in their work. And I believe a major reason for staff turnover. Sadly, for decades, registered nurses, licensed practical nurses, nursing assistants, and other healthcare workers in have reported that respect is absent in their workplace.

These healthcare employees simply ask for respect; respect for what they know, what they give, and what they do. Yet, employees indicate they do not receive respect from administration, managers, physicians, one another and sometimes even those they serve—the residents and families. How can such a foundational element of what individual’s should receive in their working lives be so difficult to obtain/achieve? Respecting another human being is not hard—it does not require a special skill and costs nothing.

Respectful behavior towards another person means that you value and care about them, acknowledge their experience and skills and are open to their ideas and perspectives. It demonstrates that you appreciate them as a colleague, value their gifts, talents, and their unique contributions to the organization regardless of their position.

Creating a respectful environment begins with establishing respect as an expectation for all who live, work, and visit in the facility. It requires talking about respect as a company with all staff in all departments. Discuss it routinely and any time the staff seem to have lost their commitment to respect. Using examples of respectful and disrespectful situations helps the staff understand the expectations, what behavior and approach is desired, and what will not be tolerated. Use stories as an opportunity to facilitate a discussion of the situation as it occurred, outcomes, the feelings – their feelings – and how it might be handled in a more respectful way.

Employees, regardless of their department, position, shift or role, are to be held to the same standards. They must be respectful of their colleagues on all shifts and those who work in other departments. All too often staff in different departments or those on different shifts are unkind, not helpful, and complain about others. This behavior can be stopped if the organizational expectation is equal respect for all. Don’t allow it – demand respect. And if staff is unwilling to work with others in a respectful fashion, then they have a choice to change their behavior or leave.

While we spend a great deal of effort ensuring that employees respect residents and families, we spend very little time on the need for residents and families to respect staff. This is equally important. You cannot allow a cognitively intact resident to consistently be cruel and disrespectful to a member of the staff. Similarly, it is not appropriate to allow family members and visitors to be consistently disrespectful towards staff either. Should residents and families show disrespect toward an employee, it is critical that it be investigated thoroughly and not ignored.

First, get the facts. Then if indeed a situation has occurred, a meeting with the resident and/or family should be scheduled to discuss the expectation for a respectful approach towards all who work in the facility. Regardless of a resident or family concern or complaint, it is unacceptable to be consistently disrespectful towards staff. Even if staff members have made a poor decision or an error, a family need not be rude and cruel. Those family members who will not cooperate must be addressed if repeated, action taken. The willingness to deal with a disrespectful family member sends a very powerful message to the staff—showing that they are valued by an organization who believes that they deserve respect from residents and families, as well.

Respect toward all who live, work, and visit assisted living and long-term care is an expectation. It is the foundation of relationships, and it is simply just the “right” way to treat people. Those who dedicate themselves to assisted living and long-term care are some of the most giving, nurturing, loving, and humble people one might ever meet and we need to demonstrate that we care—by our words and our actions.

Communication, Inclusion Benefit Staff Satisfaction and Turnover

Much has been written about common themes that are important to staff, as found in numerous staff satisfaction surveys. Most themes relate to being respected and heard, included in daily operations and decisions, and appreciated. All are such simple and basic requirements, and all can be addressed if administrators and managers create a culture by genuinely welcoming and valuing staff input.

All managers and administrators need to stay open and truly listen to staff members. The challenge is to facilitate the interchange of issues, problems, ideas, and solutions. When staff are not permitted to voice their perspective or are not heard when they do, the organization will suffer. Although it is not always pleasant or easy to hear suggestions or criticism, the ability of employees to express themselves without repercussion or judgment is essential. The administrator and managers must allow the staff to state how they honestly feel, or the facility will never change.

This practice by necessity requires listening to all views and perspectives. The most successful leaders surround themselves with individuals who challenge their thinking and who make significant contributions to the direction and progress of the organization.

In order to hear staff constructively on a consistent basis, you need to establish a means for creating dialogue. Formal and informal mechanisms serve to enhance communication. Create avenues for communication individually and globally. Formal, planned communication could include a communication board or book, e-mails, letters attached to paychecks and those sent to staff homes. Routinely scheduled forums conducted by administration/leadership should include all staff on all shifts, serving to promote communication and the opportunity to keep staff informed of current issues, actions, initiatives. When meetings are consistently scheduled, this practice gives staff the expectation that regular forums will occur, allowing them to prepare in advance and save issues for those designated times.

Employee forums can be substituted for one of the weekly in-service programs. Initially, in the establishment of a new facility or transformation of an existing one, forums should be held at least quarterly by leadership. Later, less frequent encounters will be necessary, as long as one is held with every important change or project. This may involve issues such as changes in employee benefits, major renovations, or a new initiative.

Informal communications happen on a day-to-day basis as management and administration make themselves available to staff. Being with the staff provides opportunities to educate and communicate and enhances the ability to grasp how staff is performing and coping. There is no substitute for time spent with staff and nothing more effective than staying connected with the ongoing operation of the facility.

When communication flows readily in all directions, issues and concerns are handled quickly with sufficient amounts of information. This promotes better procedures and projects. Everyone is content when they feel free to communicate and know that they are heard to the benefit of all involved: residents, families, and staff.

On The Road Again…Talking About The Culture Change Journey At The 2015 Pioneer Network Conference

Just one week after returning from presenting at the Alzheimer’s Association International Conference (AAIC) in Washington, I and other experts will head to Chicago for the 2015 Pioneer Network Conference August 2nd through August 5th.

The 15th annual conference is billed as the nation’s largest conference focused solely on culture change and person-centered living.

I’m eager to present a session entitled, “Leadership Model Assists in the Culture Change Journey,” on Tuesday, August 4th. In this session we share the way to change or create a culture in an organization step by step. This model, developed over 25 years of experience and research, has generated a culture in which each person is special, enhancing the lives of those who live and work in long-term care.

Replication research will be shared, demonstrating significant decrease in staff turnover and improved staff, resident and family satisfaction, as well as significant financial savings.

Let me know if you plan to attend!

The conference will take place at the Hyatt Regency O’Hare in Rosemont /Chicago. For program and registration information, click HERE.