Posts Tagged ‘Cedar Community’

Health Care Reform: Impact on Citizens and Employers

Friday, September 17th, 2010

We are just months away from actually experiencing the onset of the nation’s new Health Care Reform legislation. With the passing of the Health Care Reform bill last April it has taken some time to ‘digest’ the bill’s impact. The legislative bill passed was thousands of pages long and unfortunately most members of the House and Senate admitted not reading the bill in its entirety.

When providing a ‘summary’ of the impact of this bill, one must always be a little tentative striving ultimately to be both succinct and yet accurate. Using a variety of resources, but mainly articles written by Jill Jackson and John Nolen of CBS News and “The Heart in Health Care Reform” published in April by the ‘Faithful Reform in Health Care’ organization of Cleveland, OH here is a brief synopsis of the Health Care Reform bill divided into two categories: Impact on citizens and Impact on employers:

Health Care Reform – Citizens:

o The over-all cost of the bill is estimated to be over $940 billion over the next 10 years.
o Health Care coverage would be added for over 32 million citizens now not covered.
o Uninsured and those self-employed would be able to purchase insurance through state-based ‘exchanges’ with subsidies available to individuals and families with income between 113% and 400% of poverty level. To qualify, these people can not be eligible for Medicare, Medicaid or have insurance covered by an employer.
o Separate exchanges would be available for small businesses to purchase coverage in effect in 2014.
o Closes the Medicare prescription drug ‘donut hole’ by 2020.
o Six months after the bill begins, insurance companies can no longer deny children coverage based on pre-existing conditions.
o Starting in 2014 insurance companies can no longer deny coverage to anyone with pre-existing conditions.
o Insurance companies must allow children to stay on the parent’s insurance plans until the age of 26.
o In 2014 everyone must purchase health care insurance for face a $695 annual fine (some low income exceptions).
o Illegal immigrants will not be allowed to buy health care insurance in exchanges (even if they completely for it on their own).
o Some persons can choose to remain uninsured by choice and choose to pay a penalty (up to $695/year or 2.5% of their annual income in 2016)

Health Care Reform – Employers:

o Beginning in 2011 employers will be required to include the value of health insurance on employee W-2 forms, but the value remains tax free.
o In 2011 the new ‘Class Act’ will commence requiring a employees to make a monthly deduction of approximately $75 to be placed in a private (though government ‘observed’) fund. After a 5 year period, cash premiums will be paid to individuals who require medical and assisted care services in order to offset some Medicaid / Medicare coverages.
o In 2014 employers with more than 50 employees will pay a penalty if their contributions toward health insurance do not result in affordable premiums for full-time workers who then seek and qualify for coverage and subsides in the exchange.
o In 2014 employers with 200 employees will be required to automatically enroll all employees in health insurance, allowing employees only to ‘opt – out’ of the plans (rather than ‘opt – in’).
o In 2018, employers will be subject to an excise tax on the ‘Cadillac’ health plans. (tax will be about 40%).

Is this new Health Care Reform the final solution to the plethora of health care problems in the United States? Likely not! Is this a ‘foot in the door’ to start addressing major health insurance coverage inequalities? Likely so!

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!”

The Not-for-Profit Difference

Monday, January 18th, 2010

I am finding that more and more people are unaware of any real difference between For-Profit and Not-For-Profit Senior Retirement Continuing Care Communities. From the outside they pretty much look alike, they seem to offer similar services, and their residents seem generally satisfied with life in these communities.

So what is the difference between them? I would say the difference is great and I’ll be specific. Let me first say that many For-Profit organizations can and do offer fine services. But intrinsically, they are judged by their owners/shareholders on the earnings they produce. Their mission is to provide a return on investment and their product is services, programs and housing for seniors. Success is easily measured by the bottom-line of their financial reports. Cutting expenses is an important tool to meeting their mission. There is typically a stong focus on reducing expenses such as overhead, supplies, services, and staffing. Their residents can struggle to find comparable quality when in comparison with most not-for-profits, whose mission and purpose is something other than the ‘bottom-line!”

Not-For-Profits are judged by different standards. Most Not-For-Profits are charitable, church-related organizations. They were created not to return earnings to investors, but to meet their organizational missions. In our case, that mission is to “. . . serve the Lord by creating relationships, services and environments that enhance the well-being of seniors and their families.” Financial stewardship does have an important place in Not-For-Profit operations and wasting resources can not be tolerated. Any earnings at the end of the year though, are not given out to owners/shareholders, but rather those earnings stay within the organization to benefit the residents, allow for expanded services and outreach, and are utilized for charitable services.

When considering the differences in quality in nursing homes, here are some interesting facts for you to consider. [Based on “Quality of Care in Nursing Homes” – Medical Care; 2003; Volume 41, Number 12, pp 1318-1330] Residents of Not-For-Profit nursing homes receive 6% more hours of LPN nurse care; 10% more C.N.A. care; 37% more RN nurse care and 22% more care from additional licensed staff. Also, Not-For-Profit nursing homes have 42% LESS serious total deficiencies than For-Profit nursing homes.

The difference between Not-For-Profit and For-Profit Senior Communities is greater than you think! Bottom-line: It’s the mission!