Archive for the ‘Blog’ Category

Understanding CHANGE

Wednesday, July 7th, 2010

It was many years ago, I suppose it was the late 1970’s, when I came across a presentation at one of the countless lectures and seminars I’ve attended, in which a relatively simple yet poignant chart was shared describing the four quadrants of ‘Change!’ We were taught that all change goes through the exact 4 ‘transitions’ moving in the same way, quadrant to quadrant! This was called the Diagram of Change.

I don’t remember the name of the presenter or the originator of the ‘Diagram of Change’ but I am eternally grateful for all of their efforts to make the nature of change understandable. Allow me to paraphrase a wonderful and dynamic presentation into this brief blog article.

All change in one’s life – big changes such as getting married, buying a house, developing a new career, to the myriad of all small and minor changes we face everyday, can be described and charted in the very same developmental path. In other words ALL change is the same and very predicatable!

Before we begin please understand that with little exception, it is against human nature to just ‘accept’ change without a struggle. Biologists describe something they call ‘homeostatic control’ inherent in all human make up in which our very cells and DNA seek to remain the same. By our very human core, we tend to deny change!

The first quadrant of change is known as DENIAL! It simply is human nature to anticipate potential change by denying the need for change. This allows us to ignore and dispose of having to deal with the need to change. This coping mechanism conveniently allows us to ‘dispose’ of the issue instead of dealing with change.

• {As an example of DENIAL: I have a friend who was being strongly encouraged by his doctor, family and friends to quit smoking. He was a young man in apparent good health. His immediate reaction to the thought of quitting smoking was a perfect example of denial. He absolutely denied the need to quit! He was healthy, felt good and enjoyed smoking! He seemed to have no reason to quit and thus denied the vary suggestion to change.}

If ‘change’ survives the denial quadrant and it becomes more and more inevitable, it moves to the second quadrant of change known at RESISTANCE! You might say, this is the stage where human nature ‘turns up the heat’ in its opposition to a potential change. Of all four quadrants of change, this is the most important and the most crucial stage. This is were there is the deepest feelings are revealed in opposition to change. There can be real anger, despair, and resentment expressed as our nature fights to resist change. Expressing one’s feelings to non-judgmental and active listeners is a great help in providing sincere understanding and soothing to the one facing change. This is what ‘moves’ us through this quadrant. The importance of this quadrant should not be under-estimated. Feelings NEED to be expressed! The deeper the resistance, then at the later ‘quadrants of change’ the more likely the inevitable change will be met with acceptance and success!

• {Example of RESISTANCE: As my smoking friend continued to experience an almost unrelenting pressure to quit, he responded in typical ‘RESISTANCE’ mode by becoming short tempered, he actually increased his smoking at pubic events and parties, and verbally attacked those who encouraged him to quit. He gradually started some calmer and more open conversations expressing his feelings of being pushed to change, feeling belittled and put upon, and feeling angered at being at the center of a ‘forced’ change that he was not asking for! His doctor, family and friends changed their approach and as all became ‘active’ listeners, everyone had the opportunity to share heartfelt concerns and feelings, which ultimately lowered my friends resistance to the thought of actually becoming a ‘non-smoker.’}

The third quadrant of change is EXPLORATION! This is when, truly for the first time, the actual change is considered! So, it is our human nature to deny change, resist change, but then we eventually we consider change! After feelings have been expressed, and people are in essence ‘validated’ that they have the right to ‘fight’ change, then consideration and attention naturally moves to explore what change might mean to them. During the exploration quadrant, both the positive and negative impact of the implementation of change is revealed. This is when the idea of change becomes less scary and more manageable! 180 degree turns from fighting the change to becoming an actual proponent of change is possible in the exploration quadrant!

• {Example of EXPLORATION: My smoking friend started to consider the advantages of becoming a non-smoker. Even though he had no health problems, he openly admitted the reality that continued smoking would likely change his health in the future. He admitted to the problems of smoking odors, bad breath, and burn holes in his clothing. He also conducted some quick math and realized he has spending over $5,000 annually on his two pack a day habit which was money he really needed for a variety of other more important things! Through this ‘exploration’ he decided, now of his own volition, to make the ‘change’ to actually become a non-smoker.}

The final quadrant of change is ACCEPTANCE! Acceptance is the completion of what is known as the diagram of change, the fourth of the four quadrants of change. It is marked by the change being done, completed and a transformation has been made to having the change now become the new reality! The biggest mistake made in this stage is failing to ‘celebrate’ the change! However big or minor, it is appropriate to recognize that a change has actually been made! Our minds are more willing to maintain the change when we celebrate the change! Celebrating change makes a kind of ‘exclamation mark’ within us and it allows others to acknowledge the change. When we celebrate a graduation, a retirement, or a birthday with a party, the celebration marks the conclusion of a change in our lives. One is now a ‘graduate’ of college; a ‘retiree’ from a job; or the ‘next year older’! We can’t go back – the change has occurred and we all acknowledged the change! We have accepted the change!
• {Example of ACCPEPTANCE: At some point, my smoking friend decided it would be better to be a non-smoker! After denial, resistance and exploration the decision to quit seemed like a good idea. Moment after moment, day after day and week after week, my friend fought hard to become a ‘changed’ man. About six months after quitting smoking, my friend was comfortable to declare he was now a NON-SMOKER! LET THE PARTY BEGIN! And boy did it ever! Tears, beers and hugs were shared! The ‘acceptance’ celebration was wonderful and years later we occasionally remind the ex-smoker of the wonderful change he experienced!}

The important thing to remember about the nature of change and the four quadrants is simply this: ALL CHANGE IS THE SAME! ALL CHANGE GOES THROUGH EXACTLY THESE FOUR PREDICTABLE STEPS! What is exhausting about being a human is that in our daily lives, we are in some quadrant with literally hundreds of changes we are facing! But once we understand where we are personally with dealing with change and that other people, the ones we love, we work with, we elect, and we admire are going through exactly the same thing, it makes it some much easy to simply understand and to accept literally ‘where they are coming from!”

Taking the first step in a long, long journey – National Health Reform – CLASS Act

Friday, June 11th, 2010

As a nursing home administrator (to paraphrase Abraham Lincoln) for two score and six years, one of my many constant concerns are the reimbursement levels to our healthcare organization from the Medicare and Medicaid program for the services we provide.

Medicare and Medicaid certainly are forms of universal healthcare which this nation has experienced for decades. These programs provide medical and therapy coverage (with limits) for seniors 65+ and for the elderly in need of care and housing who are without personal funds and assets.

The success of Medicare and Medicaid (M/M) is in question on many levels. One area in question is the reasonableness of the reimbursements provided to healthcare organizations. Medicaid, in particular, dramatically under covers the actual direct care costs that are required to be provided for by long-term care (nursing home) organizations. Our not-for-profit organization is under reimbursed over $2 million dollars annually from the Medicaid program. This strains every aspect of our operations and has real ramifications on donor requests, employee wages & benefits, staff retention, and our ability to do additional charity work for others in need.

Most leaders in similar organizations and I, join our state and national associations to constantly call on state and national legislators to bring to their attention the financial calamity of M/M.

Now to be fair, they do listen (most of them)! They do feel our pain (most of them)! They do to take action (read: too little, too late)! Year after year, decade after decade . . . we complain. Year after year, decade after decade . . . they respond to nursing homes with occasional small (M/M) reimbursement increases, but certainly not getting near keeping up with direct care costs or even basic inflation, yet year after year, and decade after decade they keep demanding more care, more training, more staffing, and back that up with more regulations and onerous inspections. Year after year, decade after decade nursing homes do more with less, until they reach a point, when they start closing! (More and more common!)

Let me state the obvious! This strategy of complaining to correct a governmental system, that is likely not correctable, is insane! Everyone agrees – a new approach would be welcomed by all.

Say hello to the CLASS Act! The Community Living Assistance Services and Supports Act is a part of the recently passed National Healthcare Reform legislation. The CLASS Act establishes the nation’s first voluntary (though it will be difficult to ‘opt’ out of the CLASS Act) insurance program to purchase long-term care services and supportive care from the community.

[Note to all: CLASS Act is NOT a replacement for Medicare / Medicaid, BUT has the potential to do some ‘easing’ of these ‘stressed to the max’ programs! Also note that the CLASS Act will benefit not only the elderly, but also those younger who have certain disabilities.]

As the so called ‘Silver Tsunami’ or Baby Boom hits the U.S. the CLASS Act takes a new approach to the age old problem of ‘who’ll pay for my healthcare needs when I am old?’ Well the CLASS Act (overly simply stated) requires all working adults to set aside a monthly amount. Lets say for illustration purposes $125/month. This money is put in a private insurance ‘pool’ with government oversight. After paying ‘in’ for a minimum of 5 years (5 years vestiture), the CLASS Act program reimburses (directly to the individual) an amount of $50 to $100/day to cover health care and related community assistance, thus reducing the ‘strain’ of moving directly to Medicare / Medicaid and each individual participating in the CLASS Act.

The CLASS Act is NOT a government entitlement program. It does not use government dollars! It is a government ‘blest’ national private insurance program! It is bold and innovative! It is this kind of thinking that many of us have been encouraging. It was promulgated and promoted by organizations such as AAHSA (American Association of Homes and Service for the Aging) and a variety of national organizations representing the needs of our disabled citizens.

Is CLASS ACT the ultimate solution? NO! It is froth with issues and yet to be tested assumptions! Many might say that $50-$100/day won’t buy a lot of healthcare, but this does substantially address the current problem and it does eliminate some growing strain on the system.

In essence, the CLASS Act is a new national approach allowing for everyone to get Long-Term Healthcare Insurance! Is additional long term care a good idea? Yes! Will insurance companies refine their products to enhance the CLASS Act? Yes!

No matter how, politically, you might feel about the need for ‘change,’ . . . as a health care provider organization, caring for our frail and elderly citizens with chronic health care needs, I believe that years after the CLASS Act is fully enacted – it will represents exciting new options for its participants! The CLASS Act recipients will have the dollars in hand to make their own decisions on who they select to provide for their healthcare needs and hopefully allowing them to get those services while remaining in their own homes. The future is all about allowing our disabled and senior citizens to have choices. The CLASS Act will help them to have the wherewithal to make such choices. This approach . . . a REAL improvement!

The Value of Unlearning . . . Re: Nursing Homes

Wednesday, May 26th, 2010

In the tenth chapter of his book titled, Jump the Curve (understanding the exponential growth of technology), author Jack Uldrich discusses the need for ‘Learning to Unlearn.’ He would suggest that, not only is it important for us to learn new concepts, but we must also ‘learn to unlearn’ the outdated concepts. We must refresh (re-program?) our brains to accept new versions of reality and to be open to project future realities in a hyper-changing world, without clouding ourselves with outdated education, notions and trivia that can get in the way with new learning!

In my 26 years of administrative experience in long-term health care (nursing home), I am astonished to see the amount of change in virtually every aspect of resident care.

In 1984, the average resident lived in our nursing home for 6.5 years. Today our statistics show our average length of stay is about 9 months! In the ‘old days,’ nursing home residents would line up (typically in wheelchairs) an hour or more before meal times in a long hallway, waiting for the ‘magical’ moment when the food was ready and a mad wheelchair dash was created, as dozens and dozens of seniors eventually made it to ‘their’ assigned table. Basic nursing care was provided, but it pretty much was to maintain one’s condition, all with very basic medical equipment. Any real medical ‘episodes’ meant a trip to the local hospital. A part-time physical or occupational therapist occasionally appeared, thus any aggressive ‘therapy’ was not likely. Resident rooms typically held 2, 3, or 4 people. Bathrooms were located at the end of the hall. Activities were few and far between with the usual bingo, card playing, or singing providing the full array of activity options. Highly waxed and polished linoleum floors, offset by cream colored painted block walls, was the interior design which permeated the entire building, including resident rooms! Nursing homes were basically considered the ‘final destination.’

It’s now 2010! It’s time to UNLEARN your old nursing home lessons! It’s time to LEARN the new nursing home reality! ‘Cause WOW have things changed! Meet the new nursing home!

The new nursing homes are generally referred to a Health and Rehabilitation Centers, indicative of a huge change in the health care ‘focus.’ In the past, the goal was generally to provide care and comfort. Today, the focus is on rehabilitation and a possible discharge sending residents back to their ‘real’ homes! This is why statistically the average length of stay is just 9 months (though appropriately, many live some long wonderful years as residents or as we prefer ‘Community Members!’), instead of 6.5 years in the past! Last year we had over 80% of our residents return to their homes, who entered seeking sub-acute care and rehabilitation!

At the Cedar Lake Health and Rehabilitation Center, a huge effort has been made to make mealtime a time of fine dining, choice and dignity! Each household (about 30 residents) has its own beautiful kitchen and dining area. Most food is prepared right at the individual household kitchens by training cooks who become part of the care team. Meals are available at the decision of the resident and a time that feels right! Choice of menus and custom meals are the goal. Mealtime is a wonderful time of conversation and relaxation!

Highly skilled nurses and certified nursing assistants, with advanced medical equipment, computerized records, immediate access to physicians, and advanced training has brought medical effectiveness to new levels.

Today, resident rooms are all private or semi-private. Carpet, wood grains, colors, accents, paintings, soft lighting, and music in the air create a stark contrast to the old nursing home environment.

With a plethora of new and exciting activities, our nursing home residents participate in computerized ‘brain exercise,’ pontoon boat rides, casino days, ‘senior’ proms, dog shows, county fairs, golf cart rides through the woods, fishing,
and oh yea, bingo!

With a very strong focus on rehabilitation, large teams of physical, occupational and speech therapists work with a single therapy goal of pursuing discharge for each resident! Bottom-line: In the old nursing home, administratively our goal was to ‘fill’ all the resident beds [Get people IN to the nursing home]. Today the goal, is to empty of resident beds [Get people OUT of the nursing home]. Time to unlearn and relearn your thinking about the status of nursing homes!