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Time to Update the Nursing Home Survey Process

April 28th, 2014

Prior to the federal government’s 1987 Omnibus Reconciliation Act (a.k.a. OBRA 87) the state and federal government’s approach to surveying nursing homes was dramatically different. With OBRA 87 rules, codes, regulations, and standards by which nursing homes were annually surveyed became very, very strict. Surveyors were schooled to establish and strongly enforce any and all regulations. Room for rule interpretation became an entrée into a new picayune approach, going far beyond basic regulation into instances of harassment at worst, and browbeating at best.
Some would suggest justification in this approach to offset and ‘re-set’ an industry in which a reputation permeated where elder neglect and even abuse was occurring with more and more regularity.
Mission accomplished! The government’s CMS (Center for Medicare and Medicaid Services) oversight has implemented OBRA 87 to the nth degree! In a newer twist, CMS has devised a flawed, yet interesting, system for the general public to ‘rate’ nursing homes. It’s called the 5-Star rating. Nursing homes are rated a 1-star (lowest) to a 5-star (highest). Accuracy in this case, not so important!

All seems good doesn’t it! Very tenacious surveyors visit nursing home’s using criteria devised in the 1900’s (1987 to be exact). Tough surveyors willing to bust the morale of every nursing home employee, assuming their participation in fraud, abuse, neglect, and general ineptitude, all in the sake of bettering the nursing home! Uhm…really?

It is now 2014, well beyond the 1900’s, yet the very same OBRA 87 Nursing Home Survey criteria continues to be at the top of every surveyor’s clipboard! It’s the rule!

We in the nursing home industry, were kind of hoping the surveyors (and for that matter, our national and state legislators) had noticed a few changes going on in the past 27 years. Nursing homes of today can only exist by meeting the needs, wants, and demands of a new breed of residents, their families, physicians, and career healthcare professionals who expect sophisticated quality care delivery using the latest technologies; creating homelike environments; serving delicious meals; providing a robust array of activities; and encouraging positive social interaction!

The typical 1987 nursing home resident, once admitted, would likely live out their lives in the nursing home. Today, that is really becoming an exceptional story. Most nursing home residents are not nursing home residents! It is common for patients to stay less than 30 days in the nursing home setting. REHABILITATION is the focus with the goal of getting residents to leave the nursing home are relocate back to their private homes, condo’s or apartments. Therapy services as post-acute care programs means people today are quickly admitted to hospitals, quickly discharged to nursing homes (Rehab. Care / Transitional Care); then quickly discharged to go back home!

It’s obvious that it is time for CMS to update their criteria for surveying the nursing home! Resident/Family satisfaction; effectiveness of therapy; innovation in problem-solving; staff satisfaction; utilization of available technology; communication between acute, post-acute; therapy; and home health providers; and readmission rates need to be the new survey criteria. Along with those changes, we ask for a new surveyor attitude of cooperation, collegiality; education, and guidance which would actually assist in making improvements would go much further than penalties and finger-pointing!

“*Why Fund-Raising Is Fun” by Arthur C. Brooks

March 31st, 2014

ONCE, I asked a class full of aspiring social entrepreneurs — all with business plans and ambitions to start nonprofits — how many of them were looking forward to fund-raising. Exactly zero hands went up. The consensus was that raising money might be a necessary evil, but it was a distraction from a social enterprise’s “real” work.

To their disappointment, I told them that today, soliciting donations is often the single biggest part of a nonprofit leader’s job. For example, I lead a research institution in Washington. Private philanthropy makes up our entire budget, so I travel every week, and the majority of my time is spent fund-raising.
Sound like fun? Actually, it is. Here’s why.

In 2003, while working on a book about charitable giving, I stumbled across a strange pattern in my data. Paradoxically, I was finding that donors ended up with more income after making their gifts. This was more than correlation; I found solid evidence that giving stimulated prosperity. I viewed my results as implausible, though, and filed them away. After all, data patterns never “prove” anything, they simply provide evidence for or against a hypothesis. But when I mentioned my weird findings to a colleague, he told me that they were fairly unsurprising. Psychologists, I learned, have long found that donating and volunteering bring a host of benefits to those who give. In one typical study, researchers from Harvard and the University of British Columbia confirmed that, in terms of quantifying “happiness,” spending money on oneself barely moves the needle, but spending on others causes a significant increase.

Why? Charitable giving improves what psychologists call “self-efficacy,” one’s belief that one is capable of handling a situation and bringing about a desired outcome. When people give their time or money to a cause they believe in, they become problem solvers. Problem solvers are happier than bystanders and victims of circumstance.

If charity raises well-being, there is no obvious reason it would not also indirectly stimulate material prosperity as people improve their lives. By the time I published my results in an academic journal and book about philanthropy, the only real question was why I hadn’t intuitively understood this all along.
But studying the link between service to others and happiness changed more than just my research; the evidence led me and my wife to reconsider our personal behavior. We raised our financial support for the causes we cared about, increased our volunteering, and — proving that the path to the human heart can run through 100 megabytes of social science data — adopted our youngest child. These things have enriched our family beyond imagination, just as the research promised.

I have found that the real magic of fund-raising goes even deeper than temporary happiness or extra income. It creates meaning. Donors possess two disconnected commodities: material wealth and sincere convictions. Alone, these commodities are difficult to combine. But fund-raisers facilitate an alchemy of virtue: They empower those with financial resources to convert the dross of their money into the gold of a better society.

[*The author is Arthur C. Brooks is a contributing opinion writer and the president of the American Enterprise Institute. “Why Fund-Raising is Fun” appeared in the New York Times Sunday Review]

Nursing Homes – Changing Lives – Ellen’s Story

February 25th, 2014

Living life to its fullest means living ‘purposefully’ each day of our lives. A major fear of residing in a ‘nursing home’ is that of isolation, loneliness, and lack of significant and meaningful activity. Unfairly nursing homes can be thought of as warehouses for the elderly. This is very sad and a very inaccurate description of our church-related nursing homes and senior care centers.

Take for instance, the story of Ellen. Ellen is an 86 year old retired farm woman, whose husband died a few years ago. Ellen lived in a large rambling farmhouse, where she raised her family of eight children and was actively involved in running the family farm. After Ellen’s husband died, the eight children took turns ‘checking in on Mom.’ Clearly, Ellen was experiencing memory loss. She did not dress well. She went to the mailbox many times each day seeking letters. This became a major activity for Ellen as she became more and more debilitated both in mind and body. Safety and security, also became a concern of her children. With busy days and lots of responsibilities, the family was stretched to care for Ellen and their own family’s needs.

With angst and fears, Ellen came to live at Cedar Community’s Friendship House, an assisted living memory facility driven by a commitment to ‘resident-directed’ care and specialized programming. Ellen was obviously distraught in giving up her home and farm. The family was feeling guilt and trust issues with moving their beloved mother to an ‘institution!’

Within a few weeks, Ellen became engrossed in life at Friendship House. She dressed nicer; she became
interested in all that surrounded her; she enjoyed food again; she participated in group singing and found the
exact words to songs that others assumed were lost to her; and, participated in every activity offered.

While Ellen’s life was changed, the lives of her family changed! The weight of responsibility, guilt, and mistrust were lifted. Quality visits between Ellen and family became very pleasant and more prolific. As the family said,
“We have seemed to get our mother back.”