Jim's CEO Blog

Why is the CEO doing laundry?

2011-10-01T08:17:00.000-07:00

Why, you may ask, is the CEO doing laundry?

A) He needs the overtime and cash?

B) His wife said he needs practice?

C) He has nothing else to do?

D) None of the above?

If you answered "A", sorry you're wrong. The CEO is an exempt position and not eligible for overtime pay, although in these tough economic times, who couldn't use more cash?

If you answered "B", sorry you're wrong also. My wife won't let me even go in the laundry room at home. Okay, it was only a little laundry mishap a long time ago and for the record, I did offer to replace all of her sweaters I shrunk!

If you answered "C", sorry you are really wrong. That same day I also had to respond to a Medicaid Assistance appeal, work with our broker on an insurance renewal proposal, work on a strategic planning process and participate in a late afternoon community health committee forum.

The correct answer is "D", none of the above. I was participating in our periodic "Walk in My Shoes" program. This is a fun and informative program where staff is able to spend most of the day shadowing and assisting a peer staff member. The objective of the program is to help us better understand the work of others so that we can have a greater level of support and teamwork among us.

I chose to work with the laundry staff, although when I made that choice I wasn't aware that the first shift starts at 5 a.m. They cut me some slack knowing I had a late day scheduled and only gave me a little ribbing when I showed up at 7 a.m. If they were intimidated by the CEO in the laundry room, you couldn't tell. Within minutes of my arrival they had me sorting and labeling personal laundry, making deliveries to the resident rooms, picking up and sorting dirty laundry from the households, running washer and dryer loads, folding and storing clean linens.

It was hard work, but I was amazed at the efficiency of their processes and how well they all worked together as a team. Piles and piles of dirty laundry flowed in and just as quickly it was sorted, weighed, washed, dried, folded and put back on the shelf. When noon came, I was exhausted but looked proudly at the shelves of neatly stacked rows of clean linen that we all had worked so hard to process.

And then......................they started loading the carts to bring clean linen back up to the households. "What are you doing?" I asked with a selfish whine. "We just cleaned those!" I have to admit I was a little overwhelmed by the fact that life in the laundry room is a recurring and never ending cycle of clean and dirty laundry.

My time in the laundry room was very informative. In addition to getting to know the staff better and seeing first hand how efficient and knowledgeable they are in their roles, I was able to see a critical cog of our operation and mission from the front lines. We talked about the equipment, the supplies needed and why we do things the way we do. I was even able to make some suggestions for adaptive equipment to help protect them from injury or infectious waste.

As the old adage goes, "you can't begin to understand what another person goes through until you have walked a mile in their shoes". At Seniorsfirst every person and every department is of equal value to our mission and we are reminded of this with the help of our "Walk in My Shoes" program.

Thank you to all who have participated in this program and keep on walking!

Helen Bennett (Therapeutic Recreation) walks in the shoes of Pamela Davis (Housekeeper)

Valley Manor 40th Anniversary

2011-09-11T08:15:00.000-07:00

July 2011 marked the 40th anniversary of Valley Manor's first year of operation back in 1971. Organized in 1967, the Presbyterian Residence Center Corporation opened the doors to Valley Manor 40 years ago as New York State's first full-service retirement community.

On Saturday, September 10, 2011, we held a special 40th anniversary celebration to commemorate this wonderful milestone with our residents, staff, families, board of directors and other friends of Valley Manor.

We were blessed with a beautiful evening that was just perfect for pre-dinner fellowship in the lovely Valley Manor courtyard, where the Mayor of Rochester proclaimed the day as "Valley Manor Day" and reflected on his own fond memories of when his father lived at Valley Manor.

The Valley Manor food service staff then treated everyone to a first-class dinner experience that showed off the culinary and customer service skills that Valley Manor residents enjoy every day.

The evening was capped off with a dessert and coffee bar followed by a formal celebratory program that recapped the history and highlights of Valley Manor's past 40 years and included remarks from board Chairman, Sam Huston, Resident Association President, Reverend David Dubois and past Valley Manor President and current President Emeritus, Michael C. Walker.

I concluded the program remarks with my own congratulations and reflections since taking over the CEO reins shortly after the 1999 affiliation between Valley Manor and Kirkhaven under the newly established parent umbrella organization of Seniorsfirst.

In my remarks, I commented on the 3 primary reasons for this affiliation:

To provide a more seamless continuum of services for our residents.

To better compete with other senior care communities who were offering a similar array of senior services and levels of care within their own organizational structure.

To benefit from cost saving by cost-sharing certain "back office" functions that were being duplicated in both organizations.

I then commented on the 5 keys to success that have guided us for the past 40 years:

Location: located in the heart of Rochester's Arts & Cultural district in a real neighborhood, just a short walk to shops, restaurants and many of the city's finest attractions. For the best in city living on beautiful historic East Avenue, Valley Manor is the only logical choice!

High-Rise Convenience: Every amenity is just a short elevator ride and a few steps away. The views are incredible. The one-foot concrete walls provide unparalleled privacy, soundproofing, security and safety. They just don't build them like that anymore!

Custom Apartment Homes: As individual as our residents, every apartment is customized to meet the unique desires and needs of its occupants. Other communities give you paint and carpet choices, but at Valley Manor we can offer complete floor plan reconfigurations that truly enable you to make it your home!

Arts, Culture & Lifelong Learning: Our residents are active, vibrant and engaged. Our full calendar of special events, social gatherings, wellness programs and day trips in collaboration with leading arts and cultural venues is a tribute to the active lifestyle of our residents. No other community offers as much and as rich a lifestyle as Valley Manor.

Customer Service: Our people make the difference and after 40 years of experience, no one does it better!

Yes, 40 years is a long time and we have certainly come "a long way baby". Over the years we have experienced peaks and valleys, challenges and successes, consistency and changes. Although the past is never a guarantee of what the future will hold, I suspect it will be much the same.

We know we have an aging building that while still has an historical and quaint charm to it, also needs constant restoration and upkeep. We'll continue to keep our fingers on the pulse of senior desires and trends and adapt accordingly. We'll monitor which way the winds of the economy are blowing and shift our sails to enable us to keep moving forward.

But most importantly, we'll continue to stay focused on the 5 keys to our success that have led us over the past 40 years.

Happy 40th anniversary Valley Manor and may I say, "you look marvelous!"

The Person Behind the Face

2011-06-11T06:05:00.000-07:00

I learned an important lesson early in my career when I would read the obituaries of recently deceased residents of our Seniorsfirst communities. I learned just how little I really knew about the person behind the face.

Oh sure, I may have known the resident's name and probably had met their son or daughter a time or two. I may have had the pleasant opportunity to have had some conversation with the resident as I visited in the households or participated in a resident activity. Depending on the resident, it was very likely that I was privy to some other specific data about their medical history, current behavior tendencies or personal care needs. But did I really know them?

Too often we fall into the trap of "knowing" our residents only by the way they live their life today. Time and age may have robbed them of elements of their independence and health, requiring them to adapt in ways that threaten the identity of the person they once were.

Yes, I learned this lesson when I would read an obituary full of life-long accomplishments, active pursuits and a fulfilling life that often defied the person I thought I knew.

Behind that aged and sage face was a teacher, businessman, doctor, nurse, banker. Not that long ago they were world travelers, first-time authors, avid golfers or gardeners. Somewhere in their past are those wonderful childhood years, first loves, marriage, children and grandchildren. Their lives are as full as they are unique and each has an amazing and wonderful story to tell if we take the time to listen.

Thankfully, at Seniorsfirst we not only take the time to listen, but we take the time to ask. The relationships that develop between residents and staff are not only built on the person they are today, but the person they have always been. Resident routines and activities are established following their life-long pursuits and preferences. Of course, there are compromises and limitations brought on by aging, but it doesn't change the person inside or take away the person they have become over a lifetime.

At our Valley Manor retirement community, we take great pride in the cultural and learning pursuits that our residents continue to pursue. If time and age are slowing them down, it sure is hard to tell based on their active schedules and fulfilling lives.

At our Assisted Living Cottage and Adult Day Program, every resident and client is uniquely supported in a manner that recognizes their individual needs, preferences and lifestyle. Ensuring a safe and caring home where every individual can feel loved, respected and able to live in the manner they choose, is our primary objective.

At Kirkhaven, we don't let the nature of one's frailty or age detract us from this same objective.

Our residents are all unique, but they all have the same desire to live meaningful lives in the manner they choose and as independently as possible. Our role is to foster this desire by seeking out their preferences and learning to know the person behind the face.

All Good Things Come to Those Who Wait!

2011-05-23T07:02:00.000-07:00

At the January 2011 annual Seniorsfirst General Meeting, I used the theme "All good things come to those who wait". It was a "tongue-in-cheek" optimistic twist on what certainly was a frustrating year of delays, stagnation and waiting, Waiting and WAITING.................

Nearly 6 months later, it appears that good things do come to those who wait, especially if you push hard enough for what you passionately believe in.

We pushed hard with our state legislature to implement the NYS Medicaid rate revisions, that were suppose to go into effect April 2009. It took a combination of many personal visits with several of our elected officials in Albany and a group lawsuit filed against the state of New York, but the final 2011 state budget passed in April includes the promised Medicaid rate revisions. This revision will rebalance Medicaid dollars across the state at no net cost to the state. There will be losers and winners in the rebalancing. Kirkhaven will be a big winner when the rates are implemented and retroactively settled next month.

We pushed hard with the local NYS department of health in finalizing our assisted living licensing application and, after more than 6 years of administrative red-tape that has delayed the licensing of all active assisted living facilities, we finally received our official licensure notice.

We pushed hard and after months of inconveniences and disruptions to our routines, we have successfully completed a Kirkhaven redecorating project that spruced up our resident households with a much needed "face lift" while we wait for the day when we are able to totally replace our antiquated building with our household cottages.

There is still much that we are waiting for, but we will continue to push hard for these as well. We are working hard with our board and leadership staff on strategies to strengthen our Valley Manor occupancy and fiscal operation. We are working hard with our strategic partners and contacts to pursue available funding for our Kirkhaven Replacement project.

There never seems to be a lack of challenges, a detour to navigate or a frustration to overcome, but we'll keep pushing and continue to believe that "all good things come to those who wait!"

Anne DiCesare, RN (Assisted Living Manager) and I proudly displaying our license

Re-dedicating My Blog!

2011-05-17T12:40:00.000-07:00

I know I haven't been faithfully blogging at the pace I was, but to tell the truth, it seemed like I was beginning to blog on the same tired topics and running out of interesting material. I also think that every new fad has its time and place and then its time for something new.

I thought about closing down my blog and then decided that perhaps it still could serve a useful purpose even if I only used it to share monthly or quarterly updates on our Seniorsfirst Communities.

Heck, there must be something worth writing about that is new and exciting at least periodically. So, I will re-dedicate my blog going forward to simply providing periodic updates on what's happening at Seniorsfirst from the CEO perspective.

You can check me out from time to time on our website at Seniorsfirst.com.

A Good Investment in Valley Manor!

2010-11-22T08:34:00.000-08:00

With the year 2010 quickly coming to an end, it is a good time to reflect on the operations of our Seniorsfirst independent retirement community. While the nursing home business has been a cash challenge, our Valley Manor apartments has been a "cash cow".

Now don't get me wrong. We have had our challenges at Valley Manor over the past few years and the tough economic times have definitely impacted retirement communities. Seniors are much less apt to make major lifestyle changes in these uncertain times. They have seen their investment portfolios diminish, their income remain flat at best and selling their home has become a really big challenge. All of this has had a significant impact on occupancy and limited the number of seniors actively seeking, or moving into, retirement communities.

So how has Valley Manor fared this year?

Well, apparently folks have determined that a property investment in Valley Manor is a real good investment in these challenging times. If they can't take the volatility of the stock market and the fixed investment market is returning a dismal interest rate, many seniors have opted to invest their available capital in a refundable entrance fee apartment at Valley Manor. And why not? Real estate has a history of being a very good long term investment and a good hedge against both inflation and stagnation. In the case of Valley Manor, it is also a lifestyle investment in that it provides housing and a quality of life for the investor.

We have had a record number of new move-ins this year opt for the refundable entrance fee option and as a result expect to take in over 1.5 million dollars in entrance fees alone. This represents a 50% increase over our historical averages and despite a decrease in our current occupancy, we will end the year with ample cash to meet both our current obligations and escrow funds for future obligations.

We continue to benefit from our low, variable interest rate mortgage and we have allocated some of these savings towards a continuing occupancy enhancement program that includes both marketing and capital improvement initiatives. While we anticipate continued pressure and challenges with respect to occupancy, we also anticipate the continuation of high numbers of entrance fees.

We will continue to advertise what many seniors have already come to recognize- that Valley Manor Apartments is a very good investment!

How far can we stretch?

2010-11-22T07:41:00.001-08:00

If you are a faithful reader of my Blog, you are aware that at Kirkhaven we have been "patiently" waiting for the State to retroactively begin paying nursing homes the new, updated Medicaid rate effective all the way back to April 1, 2009.

For Kirkhaven, this promises to increase our rate approximately $25 a day and retroactively reimburse us for nearly 1.5 million dollars. Since the State is merely shifting capped Medicaid dollars between nursing homes across the state, they can actually afford to do this. There will be winners and losers when the new rates are paid, and fortunately Kirkhaven is among the expected winners.

The reason for this is in part because Kirkhaven is one of only a few nursing homes who is still receiving a cost-based Medicaid rate calculated from its initial 6 months of operations back in 1984. A lot has changed since then and our cost structure today is very different from what it was back then. While our rates include an inflation factor adjustment, it hasn't kept pace with our real cost increases or inflation.

A recent survey of our peer nursing homes showed that our $155/day Medicaid rate is well below the $183/day peer average. As a result, we are forced to operate at a lower cost per day than our peers while still providing the same high quality of care. This same peer survey showed that over the past 10 years, Kirkhaven's operating costs have increased 36.3% versus the peer average of 64.5%. Our salary costs per bed increased 33.2% over the same 10 year span versus the peer average of 55.6%. And while the peer average staffing per bed increased at a rate of 10.5% over the past 10 years, Kirkhaven's staffing per bed decreased 2.4%.

These are not statistics we necessarily wanted to aim for, but rather had to hit in order to maintain fiscal integrity. With a federal quality rating from CMS of 4 stars, Kirkhaven has attained the envious status of a low cost-high quality nursing home. But how far can we stretch?

In 2010, we pushed our available line-of-credit to the limit and implemented a 6-month austerity budget to keep our cash flowing while we waited for the "imminent" Medicaid rate upgrade. We have literally used every option available to us to out wait the State, but how far can we stretch?

Our Board of Governors has authorized us to continue to leverage our operation in anticipation of the new Medicaid rates rather than cut our staffing and expenses even further. We have requested some level of relief from the State and will continue to do what we can to bridge the gap while we wait for the State to pay the new rates. But how far can we stretch?

2011 promises to start out in much the same fashion as 2010. Still getting paid $155/day for Medicaid residents, who comprise nearly 70% of our resident population and who cost us on average $216/day. We will continue to operate on an austerity budget and hold off on any wage increases, new positions and discretionary expenses. We will advocate and lobby for the State to fulfill its promise of updating the Medicaid rate. And we will wait and pray that we can continue to make ends meet while the State gets it's house in order.

But how far can we stretch?

Recognizing our Dedicated Employees

2010-10-04T09:32:00.000-07:00

We recently held our annual recognition luncheon at Oak Hill Country Club and had the opportunity to recognize those individuals celebrating major length of service tenure, volunteer service and exceptional service awards.

I'm not really sure how many recognition functions I have attended over the past decades, but I do know that I keep trying to come up with new and innovative ways to say thank you for the dedicated service of staff and volunteers.

This year I thought it would be fun to take many of my past remarks and themes and create a super-sized, all-in-one, one size fits all, mega recognition presentation. I called it my "greatest hits" collection of recognition presentations.

Perhaps my most memorable remarks were the years 1990 and 2000 when I did the "What's Hot and What's Not" routine to illustrate how much things have changed within our workplace, even though so many of our staff have been with us all along. I listed the "hot items" of each decade such as:

voice-mail/e-mail/texting

fax machines/e-mail/scans

pagers/cell phones/smart phones

recycling/energy efficiency/go-green

DOS/Windows/Office

Yes, over the years a lot has changed, but our staff & volunteers represent the one thing that has not-loyal, dedicated and caring individuals.

One year I compared our staff & volunteers to the everyday things in our life that we come to depend on:

The alarm clock that wakes you up

The hot shower that revives you

The coffee that stimulates you

The car or bus that gets you to work

I spoke about how miserable our day is when any of these things we depend on lets us down, like:

Power failure shuts off alarm

Out of hot water, shower runs cold

Forgot to turn on the auto coffee maker

Car won't start or the bus runs late

I marveled at how our staff and volunteers all represent the dependable things in our life. So many depend on them and they have not let us down.

Another year, I shared that there were 4 approaches to deliver my sincere appreciation and thanks for their dedicated service:

Emotional (where I get all mushy and huggy and say a heartfelt thanks)
Paternalistic (handshake, pat on the back and say thanks for all you do)
Rational (tell you how much you mean to those you serve and thank you on their behalf)
Analytical (equate what your years of service means by the numbers)

I wrapped up my remarks by saying that no matter how one chooses to say it, the common denominator is you have given a lot and contributed vastly to our success for which we are greatly appreciative.

Not too long ago, when we held our luncheon at a winery, I noted in my remarks the similarity between fine wine and fine staff. I concluded by saying:

You represent the cream of the crop

Like fine wine, you come from good stock

You have distinguished yourself by not being just one of a bunch

You have flourished in your environment

You have matured into fine staff

You have an aura of excellence compatible with the finest wine and best of class

Then there was the year I said our staff were all 3rd class ticket holders. I shared that in the days of the stagecoach there were 3 classes of tickets:

First Class could remain seated during the entire trip no matter what happened.

Second Class could also remain seated, until there was a problem at which time you had to exit the stagecoach until the problem was resolved. You could stand off to the side and watch as others worked, but could not re-board until the problem was fixed.

Third Class definitely had to get off if there was a problem, because it was your responsibility to help fix the problem.

The moral of my remarks was that what impressed me most is that we have so many 3rd class ticket holders at Seniorsfirst. Some organizations have too many 1st class ticket holders who expect to be catered to, waited on and pampered. Other organizations have a lot of 2nd class ticket holders who will ride along until there is a problem, but then become detached spectators. But the 3rd class ticket holders at Seniorsfirst get out and push when the going gets tough. They accept the call for servant leadership and understand that in our resident's and client's eyes, third class is really first class.

Finally, there was the time in 2003 that after attending a seminar on "The Disney Way", I spoke how the principles that Walt Disney set for his staff were not unlike the values and principles shared by all of our staff:

Treat others as you would want to be treated yourself

Focus on the customer

Create a magical and enjoyable experience for all you touch

Safety first, courteousness second and efficiency third

Yes, over the years I have found many ways to recognize the dedicated and amazing service that our staff and volunteers represent. But perhaps the most meaningful way to recognize their contributions is to simply reflect on how each uniquely touches and makes a difference in the lives of those they serve.

Congratulations to all our staff. You are all caring and loving individuals and although there are many ways to say it, it is my pleasure to simply say a heartfelt "thank you"!

Summer Time Fun at Valley Manor

2010-09-07T11:50:00.000-07:00

This past week the staff at Valley Manor held their summer picnic out on the courtyard at Valley Manor. A staff committee planned the event and with help from the HR and Food Service staff, summer time tropical fun was in full bloom.

It started with cold, refreshing tropical drinks and a food buffet that included chicken, pork, white hots, veggie burgers, potatoes, rice, salad and more. Perhaps the biggest hit was the home-made tropical beef dish provided by Brent in the maintenance department. Who knew that Brett could fix up dinner as well as he can fix up equipment?

After lunch, the competition began and it got very competitive as staff played for extra raffle tickets to increase their chance of winning any of the many prize packages on display. I don't like to brag, but the CEO plays a mean game of "ladder ball" and "can jam"!

It was a hot and sunny day, which made the ice-cream desserts a welcomed treat and nobody seemed to mind the occasional watering from some errant squirt guns. Staff never seem shy about shooting the CEO.......... although it is all in good fun.

Good food, fellowship and fun was the order of the day at the Valley Manor staff picnic. I really enjoy watching the staff have at fun at work and I cherish the opportunity to jump in with them. For a few hours we forgot about our work roles and just enjoyed each others company as we got silly and had some good old-fashioned summer fun.

When the party was over, it's back to work. But our batteries are recharged, our bodies refreshed and our hearts lifted as we resume our work roles and come together again as a team, serving our residents and clients.

Thanks for all you do every day. Individually, you are all unique and wonderful individuals. Together, you are an amazing staff!

Getting Wet & Wild at Kirkhaven!

2010-08-25T13:13:00.000-07:00

Kirkhaven held a fun water day event that both residents and staff had a wet & wild time with. A picture tells a better story, so "read on" and enjoy...................

Double-fisted and dangerous!

Just shoot me already

Death by water can be fun?

Approach at your own risk!

I may be the pastor, but I'll shoot if you make me.

I got you covered.

That has to hurt!

Don't mess with my residents!

Don't mess with the "Terminator"!

Everybody messes with this guy.

I got your back Mable.

That still hurts!

I mean business!

Still Friends!

The Sage Project

2010-08-10T09:07:00.000-07:00

After months of planning and planting, the Seniorsfirst "Sage Project" rolled out with great fanfare and success this past weekend at the annual Park Avenue Festival.

The Sage Project was an idea designed to blend public relations, resident activities and fund-raising into a fun event. Every year the Park Avenue merchants hold a massive festival that attracts thousands of people looking for crafts, food, entertainment and fun. Since Kirkhaven resides on the avenue, we often participate in some small way. But this year we decided to step it up a notch.

With so many of our residents being avid gardeners, we decided to engage them in an herb growing activity and then pot and sell the herbs at the Park Avenue festival to raise funds and awareness towards our wonderful home. The Sage Project involved residents from our nursing home, assisted living home and adult day program. It extended to our staff and several community volunteers.

It literally began with seeds and tending of the gardens. It then proceeded to potting and arranging. Finally it came to the event set-up and sale. With the help of a "Bright Spot" that advertised our event on the local news the day before and a beautiful day that brought out huge crowds, the foot traffic into our courtyard along Park Avenue resulted in plenty of sales. I was amazed at the positive interaction between customers and residents. I was pleased to hear the pleasant comments about our Kirkhaven home and the Sage Project. I was humbled by the show of gratitude and support from the volume of sales. On more than one occasion, people would simply give us a donation or tell us to keep the change.

The project was a great success on every level. The residents enjoyed the meaningful activity and the opportunity to interact with each other, staff and the community. Seniorsfirst enjoyed wonderful public relations in getting the good word out into the community about our innovative communities and services. We sold over a thousand dollars in herbs with the net proceeds to go towards our resident activity funds.

As our VP of Marketing said afterwards, "the smiles on the faces of the residents and staff/volunteers add another million dollars in value to the project!" With the lessons we learned and the success we had, we will definitely bring the Sage Project back next year.

The Man Behind the Room

2010-08-10T07:39:00.000-07:00

For the past 18 years, when there was a need for a group of people to meet and dialog on important work related to the Kirkhaven mission and operation, chances were the meeting was held in the Wilcox Board Room.

In 1992, when the south wing addition was built, the conservative but eloquent board room was named after one of Kirkhaven's premier pioneers-Harris Wilcox. For those who often use the Wilcox room and utter its name regularly, I thought you might appreciate a bit of history about the man behind the room.

Harris Wilcox, a prominent area businessman, internationally renowned Auctioneer and Realtor, Chairman of the Board of Harris Wilcox Inc, a generous benefactor of Charitable, Civic and Youth Organizations and a lifelong devotee to American Agriculture, was born in Bergen, NY on 1919 and recently passed away in July 2010.

Mr. Wilcox was a devoted Christian and member of the Bergen Presbyterian Church who lived his life in direct relationship to his faith. He was Chairman of the Board of Directors of Kirkhaven from 1980-1985, the period of Kirkhaven's initial start-up and development. A time of both challenges and opportunities that might never have been navigated successfully had it not been for the unique style incorporating knowledge, energy, humor, stamina, and the "larger than life" presence that defined Harris Wilcox.

When I first met Mr. Wilcox, I was a 27 year-old, still "wet behind the ears" Director of Finance. I was in awe of the man and his gentle, yet determined, command of every encounter. His kindness and chivalry stood out among all others in the room and when he spoke, people would hang on his every word. His command of the English language, his tact, his decisiveness rarely left an inkling of doubt that if Harris was behind a project, the project would get done.

I remember the trials and tribulations Kirkhaven encountered with respect to the initial funding requirements of our H.U.D. financing program. The head bureaucrat at H.U.D. was a woman named Helen Moore, who dragged us through every regulation, code & rule she could find before we finally received project approval. The tactful, yet humorous, gentleman that Harris Wilcox was, could not resist taking a parting shot at the mortgage closing when he declared with much pride and determination, " We give thanks for this blessed day, for Lord knows we have been through hell-an-more".

As I sat through the funeral of Mr. Wilcox, I could not help but to reminisce about how far Kirkhaven has come since those early start-up days. Slowly we are losing the great pioneers, like Philip B. Price and Harris Wilcox, whose vision and dedication have led us to where we are today. But although these pioneers are gone, their memories and the lessons they taught us remain as a gift for all of us to carry forward.

My wish is that each of us will remember and respect the "presence" of Harris Wilcox whenever we sit in the Wilcox Room. The presence of a gentleman.......the authority of a born leader. Mr. Wilcox had it right when he would say, "Chivalry is not extinct" and "We have a Great God and a Wonderful Savior".

Thank you Harris for all you have given Kirkhaven. "Well done Thou Good and Faithful Servant".

BLOG Respite

2010-07-31T06:45:00.000-07:00

If you are a regular visitor to my weekly Blog, you have probably noticed that I haven't been very timely or active with my Blog of late. Not sure why, but I guess I have just been busy with summer or have hit the "Blog wall".

It has been 2 years since I began my Blog and while I really enjoy the writing and sharing of stories, my creative energy and time appear to be fading.

Perhaps once summer ends I'll find that inner source of imagination and desire to capture my thoughts and share them with you within my Blog again. Until then, have a great summer.

Dream big, dream often.............................Jim.

Is the CEO really working?

2010-06-26T03:40:00.000-07:00

I remember when I was just a young kid; there were three specific concepts that I had a hard time grasping. Of course my older and “wiser” siblings loved to mess with my mind and to this day still give me a hard time about these.

The first was my sister telling me that long before God created the world, there was nothing. No night and no day. No darkness and no light. Now to my way of thinking, that was impossible. If something isn’t dark it must be light and vice versa. “But no”, she would exclaim, “ there was no day or night, no light or darkness at that time”. That concept still drives me crazy to this day!

The second is a little embarrassing seeing that I eventually grew up to be a business and numbers guy. But as a kid I had a tough time grasping the concept of statistical odds. You see to my way of thinking back then, everything had a 50/50 chance of occurring. Either it would or it wouldn’t. I’m still teased to this day about the time I tried to convince my family, as we were driving up to our camp for the weekend, that there was a 50/50 chance that we would have a head-on collision with another car around the next corner. Either we would or we wouldn’t!

The third was the whole tree falling in the forest thing. If nobody was there to hear it fall, did it make a sound? “What are you talking about?” I would plead. “What difference does that make? Of course it makes a HUGE crashing sound. Haven’t you ever heard a tree fall?” But my sister would insist and try to explain that if the sound waves never hit an eardrum, no noise would be heard. Okay, I get it now, but you have to admit that is a tough concept for a kid!

Which brings me to the purpose of this particular Blog posting and a related question to pose. If the CEO is working alone in his office or out in the community, but staff isn’t there to notice, is he really working?

I only bring this up because this past week I had the luxury and joy of spending more time than usual out on the resident floors and at various staff and resident events. Heck, I even took a lunch break one day last week and showed up in the staff dining room. I received a fair amount of “Hello, where have you been?” or “Hi stranger, haven’t seen you in a long time,” or “Have you been on vacation?” or “Good to see you, you need to get out more.”

Don’t get me wrong. I appreciate the sentiment and folks appear genuinely pleased to see me. My concern is simply, what do they thing I’m doing when I’m not so visible to them? When I was the administrator and even assistant administrator, I took great pride in my visibility and day-to-day involvement in the operation. I knew the staff, residents and families, many by name. That was a key component of my role back then.

Some might argue it still should be as CEO, but the reality is it just can’t; at least not at anywhere near the same level. One reason is that I have to be respectful of those in the position now to fill the hands-on role. Another reason is that I have new responsibilities that require my attention to different priorities. My day is often filled with meetings, both in and out of the building. I spend the vast majority of my day on “big picture” items that involve strategic planning, community outreach, analysis and communications. I spend a great deal of my time doing office work, on the telephone, on the computer, meeting with contacts. I admit I missed the operational side of our business when I first transitioned to CEO, but eventually came to love the role and the work I do.

So, back to my original question posed. Is the CEO really working?

Well, I would hope the answer is as obvious as night and day, but then again maybe that concept isn’t all that clear. Perhaps I should suggest there is a 50/50 chance that I’m really working. Either I am or I’m not. Or is it like the tree falling in the forest and if you aren’t there to see me, then I’m not really working?

I think I’ll just keep it simple and continue to do what I am asked to do as the CEO. I’ll be the guy behind the scenes, out in front, helping to scout and navigate our way forward. I’ll keep on communicating to everyone all the wonderful and challenging things our organization does and faces every day. I’ll work tirelessly to ensure that Seniorsfirst continues to have a bright and successful future and that our residents, staff and families find comfort and joy within our communities.

But I’ll also try to get out more because as much as I love my job at Seniorsfirst, I do understand that it is our people that make the difference! Thanks for all you do and for being the “face” of our organization.

My First Novel Published

2010-06-05T06:00:00.001-07:00

Many of my Blog readers have often shared kind words with me on how much they enjoy my Blog and my style of writing. Heck, a few of you have gone so far as to suggest that I should write a book!

Well my long time Blog faithful might recall that in my December 29, 2008 Blog posting I revealed that I had set a 2009 goal for myself to do just that. And so, for the past year and a half I have spent much of my "free time" writing in my journal, transcribing from my journal to my computer, editing, reviewing, editing, reviewing, editing................well you get my drift.

Finally, earlier this year I set out to publish my final, final work of fiction. I had no idea of the details and work this process would involve. It had to be just right and it had to be my way, so I spent hours every evening and weekend navigating my way through virgin territory. I learned a lot and would probably do it differently if I knew then what I know now, but I am thrilled with the final result. It has been a labor of love with no real expectation or objective other than to write a book to share with my 4 grandsons and any other interested family and friends.

So, without further ado, allow me to introduce you to my first novel:

Coming soon to a bookstore near you, a breakout novel for "Young Adults" and "Tweens" by local author James E. DeVoe.

Daydreamer is an entertaining and enlightening adventure story with comic book like superhero excitement and unexpected twists as it moves from reality to fantasy.

DYLAN LAWSON IS a typical 13 year old boy growing up in a small, rural community in the northern Adirondacks of New York; a community that provides a lifestyle rich in outdoor adventure and homespun values. Together, with his best friends Brennan and Kennedi, Dylan finds adventure and excitement in what always turns out to be anything but a typical day.

But Dylan lives in a different world than everyone else. Dylan is the world's biggest daydreamer and he lives his life in both the real world and his dream world. Worlds that often collide, causing struggles and challenges that also provide valuable lessons learned.

It begins with a harrowing experience when the boys find themselves lost on Titus Mountain in the midst of the season's worst snowstorm and ends with the kids taking on the challenge of solving the great murder mystery when they stumble upon a dead body while out kayaking. In between, they become entrepreneurs of a successful start-up business as a result of a school project, compete for the state championship on the school's hockey team, attempt to win a national contest to bring a superstar singer to perform at the school's spring dance, confront a terrorist attack at school and become entangled in many more adventures.

Dylan's daydreaming often causes him to be absent-minded, disengaged and irresponsible, but with the help of his adult mentors, he ultimately uses his vivid imagination to become a real-life hero.

The action-packed suspense within each story and adventure will keep you riveted and guessing, but is it real or just another Dylan Lawson daydream?

You can take advantage of my "Friends & Family" advance sale discount offer to order your copy today at $14.99 (25% discount). The advance sale offer will be open to all until June 30th and then I will place the bulk order with my publisher to access the discounted pricing. You will receive your copy by July 15th. After that date, my book will be available at the publisher's standard rate and at Bookstore retail rates.

SO ORDER NOW IF INTERESTED by using the link below that will take you to my secure Daydreamer PayPal ordering site.

Friends & Family Advance Sale Offer:

My curious adult friends and family can now purchase an advanced copy of my novel, check it out themselves and then gift it to their children, grand-children, nephew, niece or other child. You'll satisfy your curiosity and enjoy reading my breakout novel, and have one less birthday or Christmas gift to buy this year!

To ORDER YOUR ADVANCED COPY click ORDER DAYDREAMER NOW!

Thanks for your interest……………………….Jim DeVoe.

This Place is for the Birds!

2010-05-28T05:38:00.000-07:00

I thought I would dedicate this Blog posting to shining the spotlight on our unique Assisted Living cottage and Adult Day program at Valley Manor.

I call them unique because they represent a relatively new trend and focus in the delivery of support services to seniors. With more and more interest and demand by consumers for support service alternatives other than nursing home care, assisted living and community-based services are gaining in popularity and attention.

Here on the campus of Valley Manor, located in the lovely East Avenue neighborhood, sits the cottage that houses our 8 apartment assisted living residence and our distinct adult day program community.

I stopped by recently to visit with the residents and clients to see what was new and exciting in their world, and wow, there is a lot going on! Let me share just a sample of what they shared with me and what I saw.

As I arrived at the cottage, I was greeted by a resident and staff having a quiet conversation in the foyer as they basked in the sunlight and warmth from the windows looking out on the neighborhood. They welcomed me in and graciously allowed me to take pictures and explore their cozy home.

I then met resident Beverly Fink sitting outside her dining room working diligently on a jigsaw puzzle. I wasn't much help to her with her puzzle but we did enjoy a nice conversation. Beverly lived in an apartment at Valley Manor for years before deciding to move into the assisted living apartments where she would have access to more aide support. She still has dinner at Valley Manor every Wednesday evening to stay in contact with her "woman's support group" that was an important part of her past routine. She has also rediscovered her love for playing piano and often plays during tea times and sing-alongs with her new friends at the cottage.

Ms. Fink insisted that I check out the gardens off the back patio so I then made my way outside. The residents had been busy in the weeks prior starting up their vegetable and flower gardens in the backyard and participating in the "Sage Project" (I'll blog on that project in the near future).

Other projects that the residents have been enjoying include creating centerpieces for their dining room tables, wreathes for each individual apartment door, baking for each others' birthdays and embarking on their daily exercise and wellness program.

But the newest and biggest news of the week was the addition of Pete and Kiwi to the cottage. Pete and Kiwi are parakeets that the residents have named and adopted as their new cottage pets. In addition to their beautiful colors and singing voices, the parrots provide a sense of companionship, responsibility and enjoyment.

I then wandered next door to to visit with the clients of the adult day program. Here I was greeted by a group of seniors seated in the bright, roomy dining room enjoying an afternoon snack and finishing up a card game. I asked who was wining all the money, but they just laughed and said "not them".

Outside in the courtyard I saw a large congregation of folks enjoying the warmth and sunshine (that does bless Rochester from time to time). I walked out to see what was going on and was immediately introduced to Tiddly and Wink, two other parakeets that the adult day program clients have named and adopted as their pets. The birds are awesome and will even sit on your finger, head or wherever and provide hours of enjoyment.

By the time I left the cottage, it was clear to me that this place is very special. The "smallness" of the community fosters a unique family atmosphere that is so much like home and nothing like an "institutional setting". Relationships, friendships, activities and person-centered support are obvious key components to the joy and laughter that was so evident to me in just my short, one hour visit.

As I left and walked out to my car, I thought to myself what a wonderful place to live or come to. This place may be for the birds, but it is also a delightful place for our elders.

Some Things Improve With Age!

2010-05-14T12:10:00.000-07:00

Kirkhaven held a "Celebration of our Elders" event this past week in recognition of National Nursing Home Week. I was asked to give a special honorary toast to kick-off our resident celebration.

In planning for my toast and words to our elders, it occurred to me that aging in general seems to get a bad rap. You know what I mean. The car we bought 10 years ago doesn't run as well as it once did and what is that strange rattling noise coming from under the hood. Those fresh plump grapes I just bought last week now are turning brown and soft. And oh yeah, don't get me started about my lower back and knee joints.

So what exactly was I going to say to these elders that would be appropriate for a celebration rather than a precursor to a doctor visit? Then I got an idea! There must be some things that improve with age. So I did some on-line research and it turns out this aging thing ain't all bad.

Under the category of Food & Drink I submit the following:

Wine & Cheese- sure we all knew that

Eggs- turns out the older eggs are the better eggs

Beef- remember to cure and age your beef for the best taste

Casseroles- I love lasagna, but it always tastes better later reheated

Cookbooks- the best are always your grandmother's old recipes

Under the category of Nature:

Fruit Trees- my dad would know that the more mature trees bear the best fruit
Soil- it takes years to "warm your soil"
Shade Trees- that century old elm is the most majestic of them all
Compost- isn't worth a dime without mother-nature and time
Bird's Song- didn't know this but the older birds have a sweeter, stronger tweet

Under the category of Tangible Items:

Antiques- well of course these become more valuable over time

Real-Estate- don't you wish you bought that piece of property 20 years ago
Leather- it only gets better with age

Classic Cars- what we wouldn't give to own our father's first automobile now

Photo Albums- the older the picture the better the memory

Under the category of Relationships:

Friends- the best friend is usually an old friend

Grandchildren- if I knew grandchildren would be such fun I wouldn't have had kids
Traditions- the older the tradition, the more meaningful

Memories- they grow fonder over time
Family- we grow closer and more appreciative as we grow older

Which brings me back to my "Celebration of Elders" toast. After sharing these tid-bits that improve with age, I raised my glass, as the elders and others in the room did the same, and saluted the top 10 benefits of aging under the category of Elders:

Vocabulary- we learn more words and how best to use them as we age
Common Sense- it doesn't come naturally, we learn it over time
Humor- it becomes more acute and important as we age
Emotional Stability- it takes time, but eventually we discover who we are
Perspective- the longer we live, the broader our outlook on life becomes
Resilience- we learn to handle whatever life gives us as time moves on
Acceptance- we don't sweat the little things and tolerate diversity as we age
Wisdom- the older we get the wiser we get
Faith- thank God our faith grows stronger as our years and fears grow longer
Soul- while our body might desert us, our soul remains with us forever

So here's to our Elders, may they age well and gracefully. SALUTE!

A" Beer" Story

2010-05-09T09:06:00.000-07:00

Happy Mother's Day to all my Blog readers who are mothers.

Here in Rochester, we use this special day when we honor our mothers, to also remember and support our most senior and often frail mothers and grand-mothers who reside in senior care homes. Mother's Day is designated "Homes Offering Day", where our local Presbyterian church congregations take up a special offering to help support Kirkhaven's mission.

You know, whenever I tell people what I do for a living, I often still get the response, "Jim,I'm sure you run a nice facility, but if I ever get to the point where I need a nursing home, just shoot me!"

Yes, it is pretty obvious that despite our best intentions to provide quality care for seniors, something is still wrong. As I have Blogged about before, with its typical hospital furniture, sterile rooms and endless routines day after day, there is nothing even remotely like home about the traditional nursing home.

But thankfully, things have begun to change and Kirkhaven is leading the way here in Rochester. As I have shared with you before, the keystone of this culture change is person-centered care, where seniors are empowered to direct the decisions that affect their daily life.

By providing them with the opportunities to live their lives in a similar manner to how they always did, pursuing the same type of activities, routines and rhythms of daily life, that is what culture change is all about.

On Mother's Day, I spoke at my own church, Summerville Presbyterian, and shared this true story which I think helps define culture change to a tee.

This past Friday, I volunteered as a celebrity bartender at Kirkhaven's weekly Friday afternoon resident Happy Hour. We were about 15 minutes into the Happy Hour and I had set everyone up with their first round of drinks and bar snacks, when a young man, probably around 35-40 years old, walked into the lounge wearing jeans, a Buffalo Bills jacket and a ball cap. He looked around the room for his mother and then saw her sitting at a table with some friends, a beer and a bag of chips in front of her. He strolled on over to her and pulled up a chair as the waitress came over and asked him if he would like a drink. He looked around with this look on his face that said, "Where am I? Am I in the right place?", and then gladly ordered up a beer. I popped a top and poured him a tall , cold beer and set it down next to him. "What's the matter buddy," I said to him. "Aren't you used to coming in to the nursing home for a frosty beer and some fun." He just looked at me and said, "I love this place! I'm just going to sit here, relax and share a beer and some conversation with my mom."

Now that's the response I'm looking for!

It's not just about Friday afternoon Happy Hours, but it's about nursing homes looking and feeling like home, where residents can pursue their life-long interests and routines. It' s about person-centered care.

Kirkhaven is on the Pathway to this remarkable evolution and you can help. The Mother's Day Homes Offering is an opportunity for anyone to make a donation towards supporting this journey. I invite my Blog readers to click on the Kirkhaven website link to the right of my Blog and then click on the Seniorsfirst Foundation button at the top of the web page. You can make an on-line donation (or mail in a donation) to the Directors' Discretionary Fund in honor or in memory of your own mother to help make a difference in the lives of our seniors.

On behalf of the current and future residents of Kirkhaven, I thank you for your support!

Evaluating Your Supervisor

2010-05-08T09:46:00.000-07:00

Most organizations conduct an annual routine whereby supervisors conduct a performance evaluation of each of their staff, but only a few have the courtesy and courage, like Seniorsfirst, to give staff an opportunity to evaluate their supervisor.

I have always been a big supporter of this program and lead the way by encouraging my own direct report staff to participate and provide confidential feedback on my leadership and supervision performance. I use the feedback to monitor my strengths and potential for improvement. I always report back to them the collective results and any action plans I develop to follow-up on their feedback.

Seniorsfirst has been conducting this program for years, but not without some controversy. Some managers argue that at times you have to be stern disciplinarians or conduct employee counselings that obviously leave their staff resentful or angry. "How can I do my job as a supervisor and still expect my staff to like me?" they might ask.

I'm a stern believer that in most cases you can and that is what all great leaders should strive for.

We use the results from our "Evaluate your Supervisor" program to identify both individual and organizational leadership training and support needs. Our objective is to help ensure the proper development of our leadership so that our staff feel properly supported.

I am delighted with the collective results and scores of our leadership team. At Kirkhaven the average leadership performance rating, based on 10 specific leadership skill questions and a scale of 1 to 5 (5 being highest), was 4.1 and at Valley Manor was 4.4.

These scores represent a slight increase in our previously consistent and high supervision and leadership skills. Supporting our staff and ensuring their satisfaction leads to a direct correlation of their quality service and resident/client satisfaction.

Here are some photos of a recent resident art show at Kirkhaven:

Here is a nice photo of our honorary nurses at a recent Nurses Recognition Luncheon:

Here are some fun photos of my grandson Logan playing basketball with our dog Jessi:

Thanks for visiting my Blog. See you next week.

The CEO takes a Vacation!

2010-04-27T18:28:00.000-07:00

Everyone needs a break from the day to day work routine including the CEO, so my wife and I rented a beautiful lake house for a week on Lake Anna located in central Virginia. "Welcome to the Good Life", boy they weren't kidding.

We left on Saturday at 6:30 in the morning and drove 7 hours where my wife dropped me off at a sport's bar so I could watch my beloved Buffalo Sabres play a hockey game while she continued on to the lake house to check in and unpack. Fortunately, she willingly drove back the 45 minutes to pick me up after the game to bring me back to this fabulous home.

The back of the house had great views of the lake from every room and the wrap-around deck. There was even a Wegmans not too far away where she picked up groceries and we were relaxing and enjoying the good life within a short time after our arrival.

The lake and dock were just a few steps down the waterfront where every evening the sun set slowly in the sky over the Lake Anna State Park located directly across from our home for the week. The weather was clear, sunny and warm every day. I even jumped in the lake for a swim on more than one occasion and enjoyed my early morning kayak trips exploring the vast lake and coves.

In addition to enjoying our time relaxing by the lake, we also drove the short distances to both Richmond and Fredericksburg to take in the historical tourist attractions, shop and dine. We thoroughly enjoyed the Virginia area.

One of the reasons we chose the Lake Anna region for our vacation destination was because we are interested in possibly retiring someday to the area. We figured we needed to visit and check it out if we were really serious about it. We looked at several lakefront homes for sale to begin to evaluate future opportunities. We found our dream home, but the sale price may keep it just a dream. Oh well, even dreams are fun and you never know?

By the end of the week, we were sort of ready to come home. I knew I would have a slew of e-mail, voice-mail and snail-mail waiting for me back in the office as a welcome home. I'll get to it eventually and should be caught up by the end of the week, but you'll have to excuse me if I seem a little more relaxed than usual. You see, I'm still basking in the after-glow of the "good life".

To check out more on Lake Anna click on: http://www.lakeannaonline.com/

We Give You Bob (and more)!

2010-04-12T09:44:00.000-07:00

Many of you have probably seen our most recent Valley Manor television ads that have been running over the past few months. Our most recent ad featured "Bob" as just one of the many helpful staff that go out of their way to make Valley Manor Rochester's premier senior living retirement community.

Our next ad will expand on this feature and include a glimpse at the nearly 100 dedicated employees of Valley Manor, all of whom work tirelessly to ensure our residents experience the positive customer service we are renowned for.

Here are some still shots taken while the marketing production crew were at Valley Manor shooting the video for our next advertising campaign.

There are many senior retirement community options available to people and thus it is important to pay attention to what differentiates us from the competition and defines our unique brand and culture. When we researched this and asked our customers, this is what they told us:

Location- Valley Manor is located in the heart of Rochester's Arts & Cultural District in a real neighborhood, just a short walk to shops, restaurants and many of the city's finest attractions.

High-Rise Convenience- Valley Manor's high-rise convenience with one-foot thick concrete walls provides unparalleled easy access to amenities, privacy, security and safety.

Custom Apartment Homes- Valley Manor apartment homes are as individual as our residents! In addition to 10 primary layouts, Valley Manor allows you to fully customize your home. Not just paint and carpet, but complete floor plan reconfigurations.

Arts, Culture and Lifelong Learning- Valley Manor offers a full calendar with special interest groups, wellness programs, social events and day trips in collaboration with leading arts and cultural venues.

Hey, there is a reason we have been Rochester's premier senior living retirement community for nearly 40 years. Experience has taught us what our residents want and nobody does it any better than Valley Manor.

Take a look for yourself by clicking on the link below to view our most recent marketing materials and Valley Manor website. Experience the Valley Manor lifestyle!

http://www.seniorsfirstonline.com/valleymanor/video_tour.htm

Meet "Imajean Resident"

2010-04-07T07:22:00.001-07:00

Once a year, Kirkhaven is required by regulations to provide staff sensitivity training on resident rights. It is always a challenge to come up with yet another innovative and interesting way to present this important material, but our social work department seems to be up to the task every time.

This year, Paula Henry (Director of Social Work) introduced us all to Imajean Resident (but everyone calls her Ima). Ima Resident spoke directly to the staff and shared her unique perspective on being a resident at Kirkhaven. Her message was a great reminder to us all about how important it is to be respectful of every resident's rights, dignity and individuality.

To follow is some of the message that Ima shared:

Hi Folks..........my name is Imajean Resident, but everyone calls me Ima for short, Ima Resident. I have been living here at Kirkhaven for about 5 years now. I moved here from Pennsylvania to be closer to my family. I didn't want to move, but it turned out okay and I have met some great people and have made some good friends. Maybe you know some of my friends. Do you know Alice, who lives on the 2nd floor? Alice is a wonderful woman and I just love her room. Speaking of rooms, I do wish mine was larger and more private. Don't get me wrong, the staff is very good at knocking before they enter and pulling what they call the privacy curtain, and I do like my roommate. It's just her TV volume that gets to me. Sometimes staff has to remind her to wear her head phones, it's a constant battle and yet we manage. Still a private room would be nice.

Do any of you know Lula who lives on the 5th floor. She moved here from Florida and did you know she was the first woman cab driver in the state of Florida. One of my best friends from the 4th floor is Lillian. Lillian is on Hospice and failing, but you know, she still has a great attitude and whenever I see her she is as friendly as ever. Lillian's friendliness smiles through her eyes. Then of course there is Bill on the 5th floor, the former Mayor of Avon who also spent over 50 years volunteering for the ambulance and fire departments in Avon. It makes a huge difference when people take the time to know how you lived your life before moving to Kirkhaven so we can continue to pursue our life-long interests. One of the staff the other day asked me what my favorite book was because she knew I loved to read. We had a great conversation.

Ok, enough about me and my friends. I want to take a few minutes to talk to you about this Pathway you all are on. There seems to be a lot of good things happening here to move away from an institutional feel to more of a feeling of home. Of course, going "bibless" was fun and we elders gave our input. I was one of the elders who voiced a concern that even though I liked the linen napkins, I missed the good old-fashioned paper napkins. The linen napkins do look nicer than the old "bibs", but thank you for listening to us and also giving us back our paper napkins to wipe our mouths on. Those linen ones were just too slippery. I also know that I can refuse a linen napkin if I want, just as I can refuse other things if I want. Did you know I refused to give up the shoes I am wearing. Some staff thought I would be safer in flat heeled shoes. I said Baloney! This is what I have always worn and will continue to wear and I am willing to risk a fall. They listened and you can see I am still wearing my favorite heels. Occasionally, I will still meet someone who thinks they know better than I do about what is best for me and they want to treat me like a child. They act like they are the boss over me, but I must say this seems to be happening less and less, and that's a good thing. I don't need "bosses" and I am certainly not a child, so I don't need anyone to act like my parent.

The best part of this changing the institutional culture is that I understand it really put us elders in the center of thinking and more importantly, includes us in the thinking. Nursing homes have always historically kind of done things to and for elders, so seeking more and more input from us and asking us what is best for us only makes sense. When I was in my own home, I made decisions every day and no one told me where to go, or when to sit down, or when to go to bed, or when to get up, or what to eat, or what activity to attend.

You know, there are a lot of fun activities here and it is nice to see more people helping us get to things. I am lucky I can still walk and get there myself, but I fear one day this may change, so I especially like that more and more people seem to be getting involved to help. I didn't get to attend any of the Celebrity Chef programs on the 5th floor, but I heard it was a lot of fun and I love the people volunteering to be Celebrity Bartenders for Happy Hour every Friday afternoon.

Lastly, I just want to say that I know that many of you have been working to change the language around here and I like this. I used to hear words like feeder more than I do now. I never want to be known as a "feeder". I just want to be known as Ima, the nice woman who had a wonderful family, was a great teacher and likes to watch Wheel of Fortune and Jeopardy every evening. I also used to hear the phrase, "that's not my resident", but I don't hear that so much anymore. That speaks to great teamwork and resident-centered care. Also, I like the word community. I much prefer living in a community and being part of a neighborhood, instead of living in a "facility".

Change is rarely easy, and I know that things will never be perfect. Perfection does not exist. However, the Kirkhaven way has always been great and it keeps on getting better and better. So, stay on the Pathway, continue to work together to build relationships with us elders and with each other. Celebrate the Kirkhaven Way and please know that we residents so appreciate all that you do to ensure our wellness, dignity, individuality and rights.

God bless you all.....................Ima Resident.

A Real Great Leader Is Gone

2010-03-14T16:07:00.000-07:00

On March 6, 2010, Philip B. Price, President/CEO of Kirkhaven from its inception until his retirement in 1999, passed away following a series of illnesses and a final battle with cancer. He was 76.

I had the good fortune to be hired by Phil Price 27 years ago as a member of his initial leadership team called to help open and operate Kirkhaven. I was 27 at the time and it was my first real leadership position. Phil would later share with me that when the Chairman of the Board first met me, he said to Phil, "Are you sure about this guy, he’s awfully young?" Phil’s response was simply, "Don’t worry, I’m sure."

You see, Phil appreciated the value of a PhD, Masters or experienced-filled resume, but he also valued the potential he saw in one’s character. And he was masterful in mentoring and fostering one’s character development.

Lately, it seems, we are bombarded by accounts of leaders in government, business, sports and entertainment who fell from grace because of immoral, unethical or dishonest behavior. It leaves us wondering sometimes if there IS such a thing as a "real good leader".

Well, anyone who had the pleasure of working with Phil, knows that he was a great leader. Phil was the most kind-hearted, genuine, caring, servant of God’s good works, that I have ever known. He was my mentor and taught me through his own behavior and actions, lessons in character that you simply can’t learn from any text book or manual. There was no room for power politics, hidden agendas or lack of teamwork on Phil’s team, and he always, always led by example. Phil created a rich culture at Kirkhaven. A culture that will forever be a reflection and tribute to his amazing character and servant leadership.

I remember the evening he and I appeared before the Session of the Downtown United Presbyterian Church to formally request and address questions concerning a substantial bank loan guarantee to help bridge our current expense needs in the early months of our start-up. Our initial Medicare and Medicaid billings were being delayed, as they processed our start-up paperwork, and we were quickly running out of money to cover our payroll obligations. The Session peppered us with questions, but since we were only months into our operation, our only answers were often: "I'm not sure" or "We'll have to get back to you on that".

When we finally finished, I said to Phil in the parking lot: "There's no way they're going to approve that loan guarantee." Phil's response was, "It's in the hands of the lord now and we just have to have faith". It was close to midnight that same day when Phil called me knowing that I wouldn't be sleeping and would want to hear the final outcome. "They approved our request," Phil said and I believe my response was something like, "Holy sh....t, what the h...ll happened?" That was my first lesson from Phil on faith leadership and many more would follow.

I remember the annual budget meetings Phil and I would have in his office. He would sit patiently for over an hour as I shared with him my analytical calculations and strategies. I’m pretty sure he hated those meetings, but he never let on. In the early days, I would conclude my presentations by asking him, "So what do you think we should do?" But Phil would always answer my questions with questions of his own.

"What do you think we should do? Why do you feel that way? Are you comfortable with that decision?" By the time we were done, I had answered all my own questions, felt confident in my decisions and was ready to conquer the world. Now that’s leadership! The man was a gentle giant of a leader who always took great satisfaction in orchestrating the diverse talents of others to create harmonious results.

With his passing, sadly one of the real great leaders is gone, but he has left in all of us a piece of himself that lives on. If it is true that the measure of one’s worth over a lifetime is measured not by what you take with you, but by what you leave behind, then Phil enters heaven’s gate a very rich man.

Thank you for your gifts Phil and God bless you.

Are We There Yet?

2010-03-06T04:18:00.000-08:00

For any parent embarking on a journey, the most familiar 4 word question often raised from the backseat is- "Are we there yet?"

We get the same question at Seniorsfirst in response to the "Pathways Journey" that we are on at Kirkhaven. So today I'm dedicating my Blog posting to revisiting this journey and providing an update on where we are along our pathway. To follow is a recent magazine article (authored by Amanda Brown, Executive Director and Administrator of Kirkhaven), which revisits the reason and passion for our journey.....................

When I hear someone say, “I hope I never get to the point where I need a nursing home”, it’s pretty obvious that despite our best intentions to provide quality care for seniors, something has gone terribly wrong. In fact, the nursing home industry’s attempts to care for our elders, to provide safety, security and good medical care, have actually eroded their quality of life in many ways. Even with the most caring staff, nursing homes have not been nurturing environments. With its hospital furniture, sterile rooms and endless routines day after day, there is nothing even remotely like “home” about the traditional nursing home.

How did this happen? In the 1960s, Congress passed Medicare/Medicaid legislation to fund the growing need for senior care. Overnight, tens of thousands of seniors became eligible for nursing home assistance. To meet this influx, health care providers turned to what they knew best and built very efficient, cost-effective little hospitals. And we were excellent at providing food and housing and skilled nursing to large numbers of seniors. But five decades later, we can now see the unintended consequences of institutionalizing our seniors. Nursing home life has become associated with boredom, isolation, loneliness, depression and deteriorating health.

Quality of life depends on physical and emotional well being. Replacing the daily rhythms and spontaneity of life with routines and isolating seniors from the mainstream of the community limits the opportunity for meaningful interactions and relationships that are so critical to their well being. And when the caregivers rather than the seniors themselves make life’s daily decisions, we rob our elders of their individuality, their independence and their basic humanity. The traditional nursing home may have succeeded as a business model, but it has failed miserably as a human model.

Thankfully things have begun to change. A grassroots revolution (which began here in Rochester in 1991 as the Pioneer Movement) is quickly gaining ground. Known variously as the Eden Alternative, Green Houses or simply “culture change”, nursing homes across the nation and around the world are embracing the challenge of transferring their medical model facilities into social model homes. At Kirkhaven, we have coined this journey as “Pathways to Meaningful Living”.

The keystone of this culture change in nursing homes is person-centered care. In its effort to maximize efficiency and consistency of care delivery, traditional nursing homes sacrificed individual choice for routines and regimens. Culture change is about breaking down those barriers and empowering the seniors themselves to direct the decisions that affect their daily life.

Our next step in the process at Kirkhaven is to replace our current building with one based on multiple “households” of 12 resident rooms surrounding a common living room, kitchen and dining area. With the assistance of specially trained homemakers, each household will plan their day, eat when and what they choose, share chores and interact throughout the day as housemates. Like any home, these households will reflect the individuality of its residents with distinctive furnishings, pets and their favorite hobbies and activities.

At Kirkhaven, we are daily challenging the mindset of what a nursing home should be. We have taken great strides in shifting from management-centered to person-centered care. Going forward, we will measure our success as care providers by the quality of the life of our residents.

Over the past seven years, we have been on this “Pathways” journey. We are probably further along than many think. In terms of progress, I would bullet our journey as follows:

· Assessment and planning (market analysis, facility appraisal and strategic planning)
· Education and awareness (Eden training, seminars, data research and field trips)
· Evaluation and goal setting (committee/board meetings and project team work)
· Soil warming and training (staff training and education, book club and steering committee)
· Implementation of initial initiatives (tray-less dining, remodeling, household teams and learning circles)
· Preliminary household design
· Site search
· Preliminary project cost analysis

Where do we go from here, I would bullet as follows:

· Locate our site
· Finalize our project design
· Analyze the project costs and sustainability
· Develop the project funding plan
· Implement the construction phase
· Continue the organizational change implementation

This is an exciting and crucial time for long-term care providers. Through one lens, we see a challenging economy and failing health care system that is quickly becoming unsustainable and has a questionable future. Through another lens, we see a next generation of elders who will demand and need something much different and better than the nursing homes of today. Our challenge is to design the next generation of nursing home that is sustainable under both lenses.

The Pathways model is our blend of many innovative and current thinking models pioneering this culture change movement. The beauty is that there is no one perfect scenario or solution, but this is the decade for change. If we wait any longer, we not only let our parents and the next generation of elders down, but we sentence ourselves to the institutional nursing home as well.

They deserve better than they are getting, and it’s time to step forward and get moving before time runs out. At Kirkhaven, we are well along our journey but still have a long way to go. Funding support is a key element in this journey and we are currently working towards securing major grant support. We are also continuing our dialog and planning with potential new sites on which to build upon.

Like Israel's deliverance from Egypt in the book of Exodus from the Bible, we too are on a long journey which we believe is our calling. It won't be a short trip and it won't always be easy. But we will follow our conscience and passion along the pathway that God always provides.

Are we there yet? No, but sit back and enjoy the amazing and enjoyable ride!

Different Perspectives & Perfect Imperfections

2010-02-20T04:53:00.001-08:00

As CEO of Seniorsfirst, one of my responsibilities is to foster and ensure a culture of respect, kindness, caring, honesty and forgiveness in how we interact and treat each other. A culture that values friendship, spontaneity, laughter and fun in addition to the important work we do every day. A culture that values diversity; acknowledging and accepting both the differences and similarities among us.

I was reminded of this challenge recently when hearing of a couple of unfortunate interactions between staff. I say unfortunate because I know the hurt and suffering incurred by all parties and I also know the dedicated and well-meant intentions of all parties. Trust me, there were no villains in any of these incidents, but they were all victims.

In my earlier days, I might have tried to resolve these issues via a comprehensive investigation into the facts in a determined effort to find who was at fault. But experience has taught me, more often than not, it is simply a case of misunderstanding..........misunderstanding of each other.

What we all tend to understand best, is our own perspective. We know what we need to do to do our job right. We know why we do it the way we do. We know how it makes us feel when others don't seem to cooperate or follow in our ways.

What we often misunderstand, is the perspective of others. We evaluate others and cast our opinions based on the perspective we understand the most..............our own! And since we all often have different perspectives, even when we have a common goal or objective, we can end up at odds with each other.

So what is the answer? How can we create a more understanding culture and avoid conflict interactions? I believe it first begins with simply acknowledging that every issue can be viewed from different perspectives. Second, we must try to understand the issue from this different perspective. Third, we must understand that we are all different and we act based on our personal characteristics and perspective. Embedded in our personal characteristics is what I like to call our "perfect imperfections".

Hypothetical Example: Mary is a very dedicated and conscientious nurse who believes in the Seniorsfirst philosophy of resident-centered care. When Mary saw that her resident needed a specialty medical supply, she took prompt action and ordered what was needed. Bob is a very dedicated and conscientious office-worker who always follows the Seniorsfirst policies and procedures. When Bob learned that Mary didn't follow the approved protocol of ordering supplies from the vendor-of-choice with the proper documentation, he became upset.

Mary and Bob are both awesome employees with a common goal consistent with that of the organization. But they each have different perspectives and perfect imperfections.

Mary's perspective is that her resident needed something and her first priority and role was to see that the need got filled promptly. Her perfect imperfection is that Mary was never very detail oriented and thus tended to be absent-minded when it came to process details. Bob's perspective is that resources are scarce and the organization needs to be prudent in order to provide the very best for its residents. Bob's perfect imperfection is that he tends to be very detail-oriented and expects everything to be by the book.

The combination of different perspectives and perfect imperfections is often the cause of hurtful interactions and relationship issues. The ultimate answer is to recognize and try to understand each other's perspective and perfect imperfections. Walk in the other person's shoes and embrace their perfect imperfections as you do your own. And when all else fails, treat others as you would want to be treated yourself.

For we were all created equal in Christ Jesus for the good works which God prepared beforehand....................but we view the world from different perspectives and are each perfectly imperfect.

10 Random Opinions on Health Care Reform

2010-02-13T11:33:00.000-08:00

I was asked to participate last week on a Health Care Reform panel for Leadership Rochester. While I said yes, I couldn't help but wonder what qualified me to speak on behalf of health care reform. Like everyone else, I haven't read the volume of text on the subject and don't know anything more about it than the next guy. But there I was sitting up front at the panelist table between two VPs from Excellus Blue Cross and MVP.

We hadn't rehearsed our individual talking points, but as we were called upon by our moderator, Fran Weisberg Executive Director of the Finger Lakes Health Systems Agency, we each shared some insights and opinions. Surprisingly, we covered a lot of ground and presented a very comprehensive and informative perspective on the complicated and controversial subject matter.

I guess 30 years in the health care business qualifies me to serve on a panel of "experts" and to even have an opinion or two on the subject. So if you're interested, here are 10 random opinions on health care reform:

The U.S.A. spends too much on health care and isn't getting its moneys worth. We spend 16% of gross national product on health care (more than any other country) while the rest of the developed countries range between 7-10%. Our health care cost per capita is nearly double the average of all other developed countries. While we are a leader in cancer treatment, we have a high rate of deaths from preventable/treatable conditions and a far higher prevalence of heart disease, stroke and cancer in individuals over 50 years of age.

The cost of health care is growing faster than it should. Our annual rate of growth from 1980-2007 is higher than any other nation at 7%, compared to the average of 2.3%. 27% of this increase is general inflation, 30% is health care cost in excess of inflation and 43% is increased utilization. The average cost for a single and family health insurance policy has increased 131% in the past 10 years and now averages $4824 and $13,375 respectively.

There's too much waste, inefficiency and fraud in our health care expenditures. In 2007, we spent 2.3 trillion on health care and it is estimated that more than 800 billion is waste and inefficiency. For the record, only 11 cents of every insurance premium dollar goes to administrative costs.

Health care reform needs to prioritize managed care. Efficient utilization and health care management are key to controlling costs and maximizing benefits. Understanding and navigating the complexities of proper health care management is not easy for most individuals. Professional case management and uniform clinical pathways will lead to better utilization and outcomes.

Health care reform needs to be "person-centered and person-directed". We won't stand for any reform that feels like it is being dictated to us or is simply financially or politically motivated. Today's consumers are more demanding, more informed and more involved. We want options, choices and "one size doesn't fit all".

Individual consumers need to have "skin in the game" to ensure proper choices. If health care is free to all and of equal quality across the board, there is no incentive to make wise consumer choices with respect to utilization and cost. Reform needs to include consumer co-pays, deductibles and incentives to drive good choices.

Health Care reform should include basic coverage only. We can't ignore anyone in need who shows up outside our health facility doors, but our focus should be on basic health care coverage. Like food, shelter and clothing, we need to protect every one's basic health care needs. Beyond that, every individual can choose to work towards whatever level of enhanced or luxury health care they desire and can afford.

Reform should include the option for dignified and individual-directed death. We are living longer and healthier. Health care technology and advancements provide us with many life-extending options. But when should we accept the inevitable end of life? We spend an exorbitant amount of health care dollars within the last year of one's life and more specifically in the last 100 days. Advanced directives and dignity in dying should be embraced. Reform should include an individual choice to receive more preventative/maintenance health care coverage in lieu of acute and chronic care coverage later in one's life.

Reform should include "bundled rates". We currently have a silo-system of health care providers. Hospitals, nursing homes, physicians, home-care, out-patient clinics all providing services independently and being paid on an individual fee-for-service basis. This creates fragmented care, duplication, inefficiencies, confusion and higher costs. In a bundled rate system, one controlling entity would be paid a lump sum for any individual spell-of-illness and be responsible for the care-management of that individual throughout the spell-of-illness. This would require joint-venture cooperation and collaboration among all providers and promote incentives for cost containment, balanced with quality standards.

Keep it Simple Stupid! Yes, this is complicated stuff and the devil is always in the details, but twice we have failed to pass any meaningful health care reform because we have simply made it so complex with volumes of regulations that nobody can understand it or trust it. Like the old joke says, "How do you eat an elephant?.............One bite at a time." If we follow some basic premises and move slowly, one step at a time, perhaps we can enact some real health care reform in the future.

My opinions only. Thanks for visiting my Blog and here are some fun pictures you may enjoy!

Here I am tending bar again, this time as a guest bartender at the Kirkhaven Friday afternoon Happy-Hour.

Now that my wife is retired and between jobs, she is busy cooking me meals and baking sweet desserts (how many calories are in that thing anyway?)

Eating grandpa's pasta for lunch (out of camera's view is my dog Jessi sitting nearby and eating every ziti that Logan managed to drop).

"A Day at the Beach!"

2010-02-06T12:51:00.000-08:00

In my line of work, I spend a great deal of time and energy advancing causes to benefit the quality of care and life for seniors. Because I like balance in my life, I also volunteered 4 years ago to serve on the board of directors of the Mary Cariola Children's Center. MCCC is a great organization that is dedicated to helping kids realize their potential, despite whatever disability or challenges they must deal with. The agency supports the children and their families by providing specialized school programs, therapy programs, residential group homes, support groups, advocacy and much more.

This past weekend, the Agency and Families sponsored a "Day at the Beach" fun day in the middle of a frigid February. Over 150 people participated and I was amazed at how much fun and joy filled the room. The kids and their families swam, played games, danced to live music, ate pizza and loved the refreshing smoothies served up at "Brad & Jim's Tiki Bar".

Similar to my role at Seniorsfirst, the office and board room work is a critical component to ensuring the day to day success of the organization, but nothing compares to the benefits one gains from the face to face interaction with those you are serving. Whether it's a simple conversation with a lonely elderly lady or sharing a funny joke with a young child with multiple disabilities, the smile on their face is the ultimate reward for nothing more than your time.

Here are some pictures of just a small sample of the joy and love that was abound at our "Day at the Beach".........................

Eating, playing and socializing

Wheelchair Dancing

Making Smoothies at Brad & Jim's Tiki Bar

Swimming in the 92 degree pool

Swinging to the Music

For more information on this wonderful agency and how you can help support the kids, check us out on the web at Marycariola.org.

Seniorsfirst General Business Meeting

2010-02-01T19:08:00.000-08:00

As is our standard routine, we recently held our Seniorsfirst General Business Meeting where I present an annual review of our recently completed operating year and an initial look at our priorities and objectives for the upcoming year.

In addition to our board of governors, we invite many of our business associates, advisory board committee consultants, supporters and senior leadership staff. It is always a great way to bring all our stake-holders and participants together to review and celebrate our accomplishments and focus on the challenges ahead of us.

This year's meeting was very upbeat as we celebrated what eventually turned out to be one of our most successful fiscal and operational years at both Valley Manor and Kirkhaven. Our objective now is to build off these accomplishments and maintain our positive momentum into what still promises to be yet another challenging year.

The State's fiscal crisis is far from resolved and that threatens the stability and sustainability of our Medicaid rates; the same rates that were just re-issued and were the primary reason that Kirkhaven's 2009 fiscal results were so positive. While at Valley Manor we will need to continue to work hard and smart to maintain and gain market share, within the very competitive senior housing industry, in what is still a challenging economy.

Additionally, I presented the same PowerPoint summary to the joint leadership staff at both Valley Manor and Kirkhaven. It is critical that everyone shares in our accomplishments and rallies around our priorities and objectives. Our successes were not the result of any one individual or any one factor. As I was careful to point out at both meeting, "our successful results were not by accident, but were because we were good!" The occupancy enhancement program at Valley Manor and the Medicare/Medicaid reimbursement maximization programs at Kirkhaven were perfect examples of how we worked smart and created our own successes.

On a lighter note, many of you have heard me talk about my obsession with building a skating rink in my front yard. I did this last year and vowed to make this year's rink even better. After an early season setback, when I discovered the tarp I reused had a leak in it, I started over during the recent January thaw. With a new tarp and additional lumber, I was able to create the rink I had envisioned. Here is a picture of a recent ice-skating party we had to help celebrate my wife's birthday.

I call this my "winter garden" and it does take a lot of time to keep it up, but I love it. I now look forward to frigid temperatures and most evenings you can find me out skating and shooting hockey pucks into the net followed by a routine of scraping the ice, shoveling the rink and resurfacing it with a thin layer of water. Similar to our Seniorsfirst operation, it's a lot of hard work but the results are worth it. Besides it's a labor of love!

Thanks for visiting my blog. Be sure to visit again soon.

Yes Virginia, There is a Santa Claus!

2010-01-16T05:35:00.000-08:00

If you have been following my Blog, you know that we have been waiting (not so patiently) for the State to issue our new 2009 and 2010 Medicaid rates. This past week nursing homes finally received written notice of their 4/1/09-12/31/09 and their initial 1/1/10-3/31/10 Medicaid rate.

As a quick refresher, the new rates were to incorporate several new rate-setting methodologies that would ultimately result in both winners and losers among nursing homes across the state.We were hopeful that the preparation and work we have put in over the past 2 years, to help maximize our Medicaid rate reimbursement, would make us a winner and result in a higher rate for us.

Although we had some guidelines to make some reasonable estimates, not enough was known to compute an accurate rate for 2009 or 2010. Until the actual rates would be published, we opted to use the existing rate of $ 155 for the 2009 interim financial statements and established 3 budget scenarios for 2010 using a worse case ($155 rate), moderate case ($163 rate) and best case ($171 rate). Based on these scenarios, we estimated we would need to enact a deficit reduction plan of $300,000 under the moderate case and a $600,000 reduction plan under the worse case.

Well it looks like Christmas may have come late for Kirkhaven this year. Both our 2009 and 2010 rates calculate to $183.00/day (better than even our best case scenario). This should result in a retro settlement payment for 2009 of around $ 750,000 . That will pay off our $500,000 line-of-credit and other short-term borrowings and bring us to a decent surplus with our 2009 financial performance .

For 2010, the $183 rate will eliminate our need to enact any immediate deficit reduction plan, and result in enough of a surplus to resume fully funding our depreciation expense (reserving for future capital replacements) and perhaps enact a wage increase for staff. How and when we would spend any projected surplus will still need to be evaluated and approved by the board.

The issue still for 2010, is that the $183 rate is only "solid" until 4/1/10, at which time a whole new rate methodology (regional pricing) is expected to be put in place. Similar to what we just went through in 2009, nobody really knows the impact of this methodology and thus our rates could go down, up or stay consistent. Since the 4/1/10 rate will have a significant impact on our 2010 budget assumptions, we may have to still be cautious with granting wage increases or other spending until we have a clearer picture.

Regardless, we are at a much better place now than we were before. 2009 has been salvaged and 2010 is off to a good start. We still don't know when these new rates will actually be paid. They must be approved by CMS and run through the Medicaid administrative process. It could be weeks or months but as far as we know, it is just a matter of standard process and protocol. I'll be "dancing on the tables" when we actually receive the cash, but in the interim, I'm still smiling on the inside and will sleep a little sounder.

Kudos to all the staff at Kirkhaven who have worked tirelessly and professionally as new strategies, policies and procedures have been implemented in preparation for maximizing our reimbursement rates. Our higher rates are not an accident or a whim, we earned them!

Yes Virginia, there is a Santa Claus!

At Seniorsfirst, Our People make the Difference!

2010-01-11T12:46:00.000-08:00

There is a proven relationship between the level of job satisfaction by the staff and the level of quality outcomes by the organization. In the senior services field, quality care and service cannot be provided without satisfied employees.

Therefore, as CEO, it is important to me that I ensure and foster an organization that has a high level of staff satisfaction. My philosophy is that if I can keep our family of staff happy and joyful in their work, than Seniorsfirst will always be a happy and joyful place for our residents and clients. Sounds simple enough, but it is a challenge and something we must work at every day!

To monitor our success in this endeavor, we routinely hire an outside, independent consultant to confidentially coordinate, compile and report on an employee satisfaction survey process and its results. We want to know how are employees are doing and how they rate their employment experience at Seniorsfirst.

We recently completed the 2009 Employee Opinion Survey and I'm pleased to say that the results continue to be outstanding. We will be sharing the results with staff at special employee meetings, but all my blog readers can get an advanced peek at the summary results.

At Valley Manor, with 66% of the staff responding:

80% are satisfied overall with the organization's leadership
88% are satisfied overall with the direct supervision they receive
68% are satisfied that they receive a fair wage for the work they do
81% are satisfied overall with their benefits package
95% are satisfied overall with the work environment & safety conditions
82% are satisfied with the communication within the organization
95% would recommend Valley Manor as a good place to work
91% would recommend Valley Manor to family and friends for service
90% are satisfied overall with the job environment
86% believe the survey results will be used to make Valley Manor better

These scores far exceed industry standards (our consultant tells us) and have been attained and sustained for the past several years.

At Kirkhaven, with just under 50% of the staff responding:

68% are satisfied overall with the organization's leadership (65%)
79% are satisfied overall with the direct supervision they receive (69%)
57% are satisfied that they receive a fair wage for the work they do (54%)
80% are satisfied overall with their benefits package (67%)
88% are satisfied overall with the environment & safety conditions (70%)
66% are satisfied with communication within the organization (60%)
85% would recommend Kirkhaven as a good place to work (73%)
82% would recommend Kirkhaven to family and friends for services (71%)
86% are satisfied overall with the job environment (69%)
80% believe the survey results will be used to make Kirkhaven better

These results represent even greater improvement from the previous year and in all cases are higher than what the national averages are within the nursing home field (shown in parenthesis).

As senior service facilities continually work to develop a comprehensive approach to quality outcomes, assessing employee satisfaction is essential. Providers that monitor and foster staff satisfaction and commitment to their work, position themselves for better success in retaining the best employees and the best quality of service.

I am both thankful and proud of our employee satisfaction results and pledge to continue to support staff in as many ways as we possibly can to ensure continued and improved results. For we all know that, at Seniorsfirst, Our People make the Difference!

Merry Christmas

2009-12-26T05:15:00.000-08:00

While it may seem like we have had a poor performance year within our Seniorsfirst Communities and there has been a lot of talk about a weak economy or declining resources, 2009 hasn’t been all doom and gloom. Sure, there are plenty of needs and wants still on my “Christmas list” for Seniorsfirst:

1) A rebased Medicaid rate for Kirkhaven retroactive to April 1, 2009

2) A couple of more Entrance Fee move-ins for Valley Manor

3) An 8 million dollar grant to help fund our Kirkhaven Replacement Project plan

4) 92% occupancy at Valley Manor

5) Additional revenue to enable us to give staff pay increases

But, there have also been some very nice gifts received this year that we don’t want to lose sight of and are very grateful for:

1) Occupancy at Valley Manor has improved from 83% to 89.5%
2) Occupancy at Kirkhaven has remained high at 95%
3) Staff turnover has been consistently low
4) Customer satisfaction has been consistently high
5) Employee satisfaction has remained consistently high

With a New Year only days away, our hope is for a brighter future despite the challenges that the economy presents. We know that the State’s budget woes create a concern for our Medicaid reimbursement at Kirkhaven and that a tough economy means we have to work even harder for new move-ins at Valley Manor. But we also know that our service and staff are among the best and thus customers will always beat a path to our doors looking for only the best.

The tough economy will continue to challenge us, but together we will take the necessary steps to ensure an operation where revenues are in balance with our expenses and our hallmark quality is always maintained. We will continue to wish for a Merry Christmas and a Happy New Year, but will be grateful for whatever gifts are bestowed upon our organization. In the end it is the relationships we have and how we work together that counts the most. Every great organization faces adversity, setbacks and change- it’s how an organization reacts and uses the gifts it has, that is the key.

Over the years, I’ve seen this played out over and over again. I have every confidence that our great Seniorsfirst organization will navigate through these rough times and even flourish in the days ahead. So let’s keep our heads held high, our nose to the grindstone and give thanks to God for the gifts in our lives.

Happy Holidays to all! Here are a few pictures with me playing Santa with Kirkhaven residents:

Jim DeVoe, President/CEO

Albany Acts- But Call Me Scrooge!

2009-12-03T07:55:00.000-08:00

The State Legislature and Governor finally reached an agreement on a deficit reduction plan for fiscal year 2009/10. The news is good (at this point in time), but call me Scrooge as I will hold off any personal celebration until a few more unknowns come to pass. First the good news:

Yes, most of the proposed deficit reduction plan items (10% and 3.7% rate cuts, delay in implementing the 2009 rebasing rate and 2010 regional pricing rate, .5% cash receipt assessment increase) were rejected. These items were included in our Kirkhaven "worse case" scenario Medicaid rate projection for 2010 (Medicaid estimated rate of $155.30). Therefore, our moderate or even best case scenario Medicaid rate for 2010 ($163-171) are "back in play".

Yes, with the 2009 Medicaid rebasing rate still in law, we should expect to receive a revised 2009 rate retroactive to April 1, 2009.

Now the reality check where I play the part of Scrooge:

We still have no further guidance on when the April 2009 rate will be paid and what the rate will actually be. This is a continuation of the issue that has plagued us all year long. We have rate methodology estimates that suggest the rate will be good for us ($171/day versus the $155.30 currently paid), but it is an estimate at best and we can't keep paying out expenses at our current level while we only receive the deflated $155 rate. Cash flow is an issue and we still may need to take immediate action to level our cash flows despite the expectation of a retroactive Medicaid payment of approximately $300,000 for 2009.

We still have no further guidance on the April 2010 Regional Pricing Medicaid rate or methodology. This is also a continuation of the issue that plagued us with the development of a meaningful 2010 budget. We have estimates that suggest that Regional Pricing could be good for us, but it is very subjective and based on limited actual data or facts. While our moderate and best case scenario budget projections appear more viable based on the recent action by the legislature, we are still in the same waiting game as before and until actual rates are issued and paid, we have an operating challenge to meet cash flow needs in the interim.

By the Governor's own admission, the action by the Legislature still falls short of meeting the State's needs. Therefore, we can expect more of the same with respect to delays and threats to our future Medicaid rates. We just seem to be always treading water and never seem to find dry land where we can finally move on.

With respect to what the Legislature did pass:

The elimination of the 1.7% Medicaid trend factor for the first quarter of 2010 obviously removes cash from our future operation, but does not impact our 2010 Medicaid rate projections as we had the foresight not to include a trend factor in our rate projections.
The HEAL-NY payment delays has no operational impact for us, but does send us a message that the likelihood of future HEAL-NY grant opportunities is probably non-existent until 2011 at best. This certainly impacts the timing of our KH Replacement Project, which is contingent upon HEAL funding.
Increase in Fraud & Abuse recoveries has no immediate impact on our operational budget but does send a scary message that we can expect more scrutiny and audit recoveries from not just blatant acts of fraud (of which we support), but money grabbing schemes aimed at innocent and outrageous documentation and procedural omissions.

In short, the news is good compared to what was on the table, but many of the critical question marks related to our 2009 and 2010 rates and HEAL-NY funding access for the KH Replacement Project continue to remain unknowns. The continued delay by the State to address these will have the impact of our needing to implement a deficit reduction plan of our own at Kirkhaven in order to meet cash flow requirements. I'll keep you apprised of any further developments. Happy Holidays!

Dear Albany: Just do it!

2009-11-14T06:20:00.000-08:00

Hockey legend and the NHL's all-time scoring record holder Wayne Gretsky once said, "you miss 100% of the shots you don't take". Likewise, it is the wise baseball coach who tells his younger players, "if you're going to strike out, at least go down swinging".

So please, Albany, enough already with the stagnation, inaction and waffling. While you sit on your hands trying to figure out what to do to make things work, the rest of us are left trying to figure out how to do our work with what you're not doing. And what you're not doing is:

establishing a definitive strategic vision
creating an effective & efficient plan to arrive at that vision
implementing a plan
staying the course

Instead all we have gotten out of Albany is:

an unfulfilled "promise" to finally re-base our 1983 base-year Medicaid rates to a more fair and current 2005 base-year in 2009
a stall tactic that as of yet has not produced or paid us this promised revised Medicaid rate
a "temporary" reduction in our Medicaid rate while Albany is "working out" the implementation plan details of a new Medicaid rate
a "sudden" change of plans when Albany unilaterally came up with a new Medicaid Regional Pricing idea
a lack of clarity on what our final 2009 & 2010 Medicaid rates will look like or when they will be paid

In the interim, we are left in the dark while continuing to care for the elders of your State for whom you pledged to represent and serve. Your failure to pay us what you promised has left us with deficits and debts that we must now recover from. Your lack of clarity makes it impossible for us to make informed decisions or long-term strategies. Your inaction leaves us helpless in our attempt to rationalize what action we need to take.

So please, Albany, get your act together and just do it! Better that we at least know where we stand, so we can plan for where we need to move. But don't take back what you already promised and don't look backwards at what already has passed. It's unfair and unconscionable to expect us to absorb or plan for reductions retroactively enacted. Look forward, establish a vision, create and implement a manageable plan, and stick to it.

If you can at least give us a clear and reachable target to aim for, we might stand a chance to hit it. If you can at least tell us where our final destination is, we can hopefully set a course to get there. If you can at least provide us with a rule book, we can try to play the game. But please, Albany, give us something and just do it!

A Busy Week of Activities

2009-10-31T09:53:00.000-07:00

My week began with a scheduled visit by U.S. Senator Chuck Schumer to Valley Manor where he held a press conference to announce his sponsorship of the National Silver Alert Act. Anytime the Senator comes to town, it is a big deal for Rochester. To have him come to Valley Manor, is a big deal for Seniorsfirst. A big "thank you" to board member Sharon Boyd (president/CEO of the Rochester Alzheimer's Association) for referring this opportunity to Valley Manor.

The Silver Alert Act is modeled after the AMBER Alert and will provide federal coordination and assistance to local and state enforcement to assist efforts to locate missing senior citizens across the country. The Senator's visit brought out all the media and a room full of Valley Manor Residents and community supporters. Not surprisingly, once the Senator finished his prepared statements, the conversation turned to the issue of national health insurance.

On Tuesday, I had the excitement of attending the state auction of the Armory site (see earlier Blog entry). That turned out to be more drama than I had anticipated and was certainly an interesting experience.

On Wednesday and Thursday we held our Kirkhaven and Valley Manor board meetings. At both communities we had a strong focus on financial performance and fiscal strategies as we reviewed our 3rd quarter statements and prepared for our 2010 budget development. I wish I could say all is well, but in these challenging economical times, I'm not sure that is even a reasonable expectation. We'll be putting together a contingency plan to ensure we are prepared to handle whatever comes our way. I'll Blog on that subject in the weeks to come.

On Friday, I attended the Greater Rochester Awards luncheon, which celebrates the exceptional work accomplished through our community's human services sector. Congratulations to Seniorsfirst board member, Pat Grover from the National Multiple Sclerosis Society, who was honored with a Community Champion award.

On Friday afternoon, I volunteered to perform for the Kirkhaven residents at their weekly Happy Hour. I had a blast playing and singing Halloween songs to mark the occasion. When I ran out of Halloween music, I played some of my country music and other favorites. I wasn't really surprised that they enjoyed singing along with "Amazing Grace" and "America the Beautiful", but who knew they would have so much fun with Neil Diamond's "Sweet Caroline".

Lastly, here are two cute pictures from a little pre-Halloween activity my wife and I had with our grandsons Logan and Brennan.

Thanks for visiting my Blog. See you next time!

A Day at the Auction- Going Once, Going Twice..........?

2009-10-28T18:45:00.000-07:00

As many of you know, Kirkhaven has been actively working with local Real Estate Developer, Larry Glazer and Buckingham Properties on a potential Kirkhaven Replacement project on the site of the former Armory on Culver Road across from Cobbs Hill Park. The site is owned by the State of New York and earlier this week the State put the site up for public auction. I have never attended such an event, but since Kirkhaven had a keen interest in the outcome of the auction, I went to observe the action. I had no idea I was in for such high drama worthy of a Blog posting.

At exactly 1 p.m. Tuesday afternoon, I walked into the Ebenezer Watts Conference Center where the auction was scheduled to take place. The room was packed, standing room only in the back and every news station and media lined up along the side wall with cameras and microphones at the ready. I sat down in the seat saved for me along with the Buckingham Properties team. The State auctioneer began his prepared statements and "rules of engagement" as I measured up the competition. A full house didn't set well with me and for the first time I began to think this might not go down the way we hoped.

It was about a year ago when Larry and I first spoke about the Kirkhaven Replacement project. Larry is one of the biggest local real estate developers and he took an immediate interest in our project. Over the next several months we would periodically touch base about properties he owned, but then he called me to say he had the "perfect site for us". He was talking with the City of Rochester about the old Armory site and attempting to pull together a 3-way deal to gain site control. In the final analysis, the decision was made to forgo a deal through the City and instead let the property go to public auction where we might pick it up at a better deal. The site has an ideal location, but some environmental issues that although our project could work around, other projects could not without substantial cost.

Larry and I spoke a few days prior to the auction to discuss a maximum bid price strategy that we thought the project could support. Since Buckingham Properties would be the bidder and potential property owner, Kirkhaven was only an interested party in a potential lease deal on the eventual developed property. All the risk and decision making were in the hands of Buckingham Properties, but this was nothing new to Larry.

I arrived at the auction site at 12:30, spoke to a State representative and learned there were several registered bidders. I also learned that 2 other auctions for armories in other parts of the State had been woefully attended and sold for nearly nothing. That was encouraging news. The room was pretty empty, but I also discovered the auction wouldn't start until 1:00, so I opted to take a walk. I picked up a burger and coke from the street vendor at Court and Main and sat outside the conference center eating and sizing up the folks who began to enter the building.

When the auctioneer finished his introductory remarks he then informed everyone that the bidding would begin at $500,000 and move up in $20,000 increments at first and then $10,000 or $5,000. Bidder #1 boldly opened the bidding at $500,000. A few others threw out competitive bids, but bidder # 1 quickly countered every bid with a brash and arguably erratic higher bid each time. In no time at all, the bidding passed the $750,000 mark and the bidding slowed down. I was intrigued by bidder #1, although I could only see the back of his head. He sounded like a kid and wore a Buffalo Sabres cap and cut off sweat-shirt. I whispered to the "suits" on either side of me, "who is this guy," but neither knew. As the auctioneer shouted going once, going twice............suddenly a suit from the other side of the room threw out his first bid and the game was on. Bidder # 1 and Bidder # 8 went back and forth and back and forth. The kid rarely paused as he threw out his cocky bid retorts, the suits took their time as everyone waited in anticipation. Was this it, was it over? But each time the suits raised the bid.

Then Larry jumped in with a bid at $900,000. My blood began to run faster. "Okay", I thought, "Larry's in the game and this might get really interesting now". The suits and bidder #1 kept raising it higher and Larry jumped in again at just over a million dollars, but the bid went higher yet and Larry put his card away. The bidding had gone beyond our intended limit and now the only drama that remained was would the kid in the Sabres cap out last the suits.

The whole process took about 20 minutes and every minute was intense. With each bid, the cameras would shift their attention to the other bidder and the room would wait. You could cut the tension with a knife and when a counter bid was finally shouted out, the room would take a breath and shift its collective attention to the other bidder. And so it went until the suits put out a bid of just under 1.5 million and the kid laid down his card. Going once, going twice...........SOLD!

The winning bidder was another local real estate developer who would later explain that he has no known plans for the site, but couldn't pass up the opportunity for such a great piece of real estate. We'll talk to him about our plans, but that is a long shot given the high price he paid for the site. The "kid" wasn't as young as I had thought and turned out to be a partner in a local group that wanted to turn the Armory into some type of sporting venue for the neighborhood.

I am disappointed that yet another option for our Kirkhaven Replacement project has appeared to have hit a dead end, but for every door that closes, another door opens up. We'll keep on searching and talking and something will eventually come along. Maybe something with less drama and a happier ending. Larry Glazer has already indicated to me that he has another possible venue for us to explore, so let the games continue and keep the faith!

Judging the Judge

2009-10-17T06:34:00.001-07:00

Most voters don't know a lot about the candidates that run for Judge and thus either don't bother to cast a vote or cast a vote simply on party lines or name recognition alone. Since my wife Jennifer works as the Law Clerk for a sitting judge up for election this November, I have become more attuned to the judge race and thought my Blog readers might be interested in an "inside" perspective that represents my opinion only.

Depending on what Town you live in, there are probably many candidates vying for a local town or City judge seat. The advertising and array of lawn signs can be very confusing at best. But if you live in Monroe County, everyone will see on the ballot an opportunity to elect to keep Judge Brain McCarthy on the Monroe County Court bench. Here are a few basic reasons why Judge McCarthy should receive your vote and then I'll share with you the inside reasons:

3 decades of experience as a Prosecutor in the Monroe County DA's Office and the U.S. Attorney's Office.

B.A. from St. John's Fisher College and Law Degree from Syracuse University.

Respected and supported by his peer judges on the bench and most every law enforcement agency within Monroe County.

A stellar track-record in the court room based on fairness, integrity, justice and results.

A judge doesn't impact your taxes, develop budgets for spending of public funds or create legislation that affects your life, so why should you care about voting for a judge? Simply stated, a judge ensures that justice is attained in the court of law. A judge helps to keep our communities safe and law abiding. A judge ensures a fair and just trial for the accused and the victims of crime. In choosing a judge, one should focus on experience, integrity and knowledge of the law.

I have had the privilege of getting to know Judge McCarthy and I can share with you that what impresses me the most is his integrity. Experience and knowledge can be attained by almost anyone and Judge McCarthy's career exceeds expectation and need, but integrity is what separates him from others. He is a kind and gentle person who truly cares about people and justice. He is not political, arrogant or self-serving. He is tough on crime, but fair and honest in seeking justice. His personality traits are exactly what we want in a judge serving this County.

His opponent (John DeMarco), claims in his advertising to be: experienced, respected and trusted. Here is my perspective. His experience is limited to town court only. Only one law enforcement agency has publicly endorsed DeMarco-the Jail Deputies Union. Every other law enforcement agency which has endorsed a candidate for Monroe County Court Judge, including Rochester Police Locust Club and Monroe County Police Benevolence Association, endorse McCarthy. Insiders know who to respect and trust. A recent D & C news article (October 17th) reported on several former town court rulings by DeMarco that were controversial and soft on DWI and arguably legally off-base. The Rochester Against Intoxicated Driving organization has claimed DeMarco is "soft on accountability".

So, on election day, despite what frustration, anger or objective you might have as you go to the polls to cast your vote for our elected officials, please consider that the role of a Monroe County Judge is entirely different from most public officials and we need to keep good judges serving our community. From an inside perspective, the candidate who is truly experienced, respected and trusted is Monroe County Court Judge Brian McCarthy.

Keep Judge McCarthy for Monroe County Court

Lobsters Supporting Seniorsfirst Alzheimers' Programs

2009-10-17T05:50:00.000-07:00

We recently held our annual lobster bisque fundraiser to help raise funds to support the Alzheimer's programs at Seniorsfirst. It was a long (and sometimes cold and rainy) day, but our goal was to sell off our inventory and we came fairly close.

For those who are less familiar with this annual event, several years ago we purchased the former Dickens' restaurant (located next door to Valley Manor) and eventually renovated it into what is now our Seniorsfirst Adult Day Program. As part of the purchase, we also received the "secret" recipe to the Dickens' famous lobster bisque soup, which we now have canned and sell as a fundraiser. It never ceases to amaze me the number of people who yearn for another taste of this infamous soup and eagerly await our annual community event.

This year we set up 4 convenient drive-thru sites across the greater Rochester area and introduced new "soup stimulus" pricing on our popular 6-pack and case purchases. In total we sold just over 1600 cans of soup (slightly more than last year) and grossed approximately $12,000 in sales.

The challenging economy continues to impact fundraisers like ours as we have seen a dip in sales the past 2 years compared to the record volume of previous years, but the demand appears to still be there. Our soup makes a unique Christmas present and is always a special treat for holiday dinner guests. We only have a limited number of cases left, but will continue to sell the bisque on-line at http://www.seniorsfirstonline.com/.

In addition to supporting the Alzheimer's programs at Seniorsfirst, your purchase qualifies as a tax-deductible donation. Good soup for a Great cause!

Pictures along the Pathways Journey

2009-10-10T06:47:00.000-07:00

At both Kirkhaven and Valley Manor we are pioneers in a culture change movement that has us on a journey towards revolutionizing how we serve our elders. Our mission is to eliminate the 3 plagues that account for the bulk of suffering among our elders in skilled nursing and assisted living homes.

The antidote to the 3 plagues of loneliness, helplessness and boredom are:

Loving & meaningful companionship and a life that revolves around relationships in a truly human community that includes children, plants and animals.

A community that balances both the ability to give care to others and to receive care gracefully.

A life with variety, spontaneity and choice.

A picture tells a thousand words, so here are a few that illustrate how we are living the pathway journey:

The first 2 pictures are from a special breakfast buffet, prepared by all the 5th floor household staff, for the residents who live in our dementia care household at Kirkhaven. Residents (and staff) love the variety and fun of something different and unexpected.

These next photos were taken at a fall clean-up and gardening event to prepare the Assisted Living cottage patio for the coming of winter. Residents loved the opportunity and responsibility of caring for their home.

Thanks for visiting my Blog and joining us on our Pathways journey!

A Journey to "Oz""

2009-10-08T08:27:00.000-07:00

Last month I traveled to Kansas to visit a very special place that has a national reputation as one of the most advanced culture change organizations in providing care to our elders. This trip enabled me to witness first-hand the amazing opportunities and potential that exist within our imagination and capabilities.

The fact that we were in Kansas, the home of the infamous story of "The Wonderful Wizard of Oz", got me to thinking of the similarities between the story of Dorothy's journey and that of our own journey. And thus, I have penned this short story entitled........A Journey to "Oz".

Amanda Gale is a young, professional nursing home administrator who helps care for several chronically ill elders. One day her office, with Amanda sitting at her desk, is caught up in a whirlwind of regulatory redtape, reimbursement cuts and staffing shortages that whisk her off to a far away land named Oz. When she lands, her desk falls on and kills the wicked health department director of the East.

Glinda, the good doctor of the North, comes with the elders of Oz to greet Amanda (and her little dog Yoshi) and gives Amanda the silver pen that the wicked health department director had in his pocket when he was killed. In order to return to Rochester, Glinda tells Amanda that she will have to travel to the "Golden City" and ask the Healthcare Czar of Oz to help her.

On her way along the "pathway to meaningful living", Amanda meets a lonely old lady who she talks to and befriends, a helpless old man who she seeks assistance from, and a bored old woman who she invites to join their party. All are convinced by Amanda that the great Czar can help them too. Together, they overcome obstacles along the pathway to the Golden City including regulatory requirements, a lack of funding and the deadly naysayers to change.

When the travelers finally arrive at the Golden City, the great Healthcare Czar agrees to help them, but first they must kill the 3 plagues of elders- lonliness, helplessness and boredom, which account for the bulk of suffering among the elders of Oz.

As the friends travel across the land of Oz, the 3 plagues attack them and all the others elders of Oz. Everywhere they go, the elders appear to be lacking meaningful living in the places where they live and are cared for. Amanda is not detered and uses her silver pen to craft new ideas and a vision for a better world in a land free of the 3 plagues.

When the wicked health department director of the West snatches the silver pen from Amanda by trickery, Amanda in anger grabs a bucket of water and throws it on the wicked director, who begins to melt. The elders rejoice in their freedom and ask the lonely old lady to come live with them, and the helpless old man to become their new leader, and the bored old woman to become head of all activities. All agree to do so after helping Amanda return to the Golden City and home.

When Amanda and her friends meet the great Czar again, he tries to put them off. Yoshi accidently tips over a screen in the corner of the Czar's throne room, revealing an old man who had journeyed to Oz a long time ago in a hot air balloon. Amanda and her friends are heart-broken to learn that the Czar has no awesome powers to help them.

But then Amanda correctly points out that they all have the power within to change and that the antidote to the 3 plagues of lonliness, helplessness and boredom are simply:

Loving & meaningful companionship and a life that revolves around relationships in a truly human community with children, plants and animals.
A community that balances both the ability to give care and receive care gracefully.
A life filled with variety, spontaneity and choice.

At Glinda's palace where they head to next, the travelers are greeted warmly, and it is revealed by Glinda that Amanda had the power to return home all along. The silver pen she held in her hand can take her anywhere she envisions. She tearfully embraces her friends, all of whom will stay in Oz and flourish in their new roles with all the other elders and people of Oz.

Amanda and Yoshi return to Rochester where she continues her "pathways journey" with all her peers, determined to destroy the wicked 3 plagues of lonliness, helplessness and boredom that continue to account for much suffering among the elders back home. She dreams of the day when all of the country becomes like Oz and all our elders rejoice in the joy of meaningful living forever.

THE END!

Dedication of the new Valley Manor Courtyard Garden

2009-09-14T13:55:00.000-07:00

We recently had the formal dedication of our new Valley Manor courtyard garden. After several months of planning and renovation work, the final product was completed and we are thrilled with the results. The new area is much more accessible and safe for residents and the beauty of the design provides a wonderful place for outside group activities or peaceful individual enjoyment.

The "before renovation" pictures to follow illustrate the vast improvement. In addition to replacing all the brick work, we added a gazebo and water fall pond. We reused many of the plants, but reworked the layout and added many other plants and amenities to the courtyard.

This project was only possible through the generous contributions of the Valley Manor residents over the past 2 years and a special gift from the Schmitt Foundation in honor and recognition of former Valley Manor CEO, Mike Walker.

We look forward to many splendid hours and activities enjoying the beauty of our new Valley Manor courtyard garden.

Congratulations to Sam Scorsone in Purchasing who won the $25 Wegmans gift certificate random drawing from last week's Blog.

"Win a Wegmans Gift Card" Blog Contest & Tutorial

2009-08-29T04:41:00.000-07:00

My wife Jennifer is teaching an on-line law course for RIT students this Fall. Both my son and daughter-in-law received their Master's degree from an on-line graduate program at Marist College. What a great concept! On-line, on-demand, when you can.

I worked part-time tending bar while attending college and can still remember how difficult it was to work until 2 a.m. and then drag myself out of bed for my Friday morning economics class. Where was this on-line course study back then?

Anyway, I was recently asked to present a short tutorial on nursing home reimbursement for a group of community leaders serving on a commission to help formulate a vision for how the greater Rochester area should provide healthcare for seniors in the future. So I dusted off an old summary, honed and updated it and voila! Then I thought, "why not share it with my blog readers as an informative on-line tutotorial."

Now you won't earn any college credits for taking the time to read this, so instead I have decided to offer all who take the time to read it a chance to win a $25 Wegmans gift card. If interested, read the tutorial to follow and then follow the simple instructions and contest rules to enter your name for a chance to win.

Nursing Home Reimbursement 101

Although the reimbursement methodology for nursing homes is riddled with complexities, nuances, adjustments, ceiling caps and other various amenities, in its simplest form can be summarized as follows:

Medicaid (on average represents 65-70% of patient day utilization, 50% of service revenue)

Medicaid Assistance helps pay for the cost of nursing home care for those who meet specific resource and income limitations and are qualified by the Department of Human Services. Medicaid pays the NH a facility-specific per-diem less any portion of that per-diem which is determined to be the responsibility of the resident based on their net available monthly income (NAMI).

The facility-specific Medicaid per-diem rate is determined by compiling the facility’s base-year (1983) costs into 4 distinct categories:

1) Direct Costs (i.e. nursing, therapies, pharmacy, social work)
2) Indirect Costs (i.e. administration, maintenance, laundry, housekeeping, dietary)
3) Non-Comparable (i.e. physicians, dental, speech & hearing, utilities)
4) Property Costs (i.e. depreciation/principal, interest, insurance, rent, RE taxes)

The facility base-year direct costs are then adjusted by a facility-specific case-mix factor and a regional price index factor and divided by the facility’s total patient days to arrive at an adjusted cost-per-day. A clinical assessment tool (MDS), designed to measure resident acuity and resource utilization, determines the case-mix factor. This rate is then compared to a similar state-wide average cost-per-day and if your cost falls within a corridor established at a 95% floor and 105% ceiling, you receive your actual case-mix adjusted cost-per-day. If you fall below the floor, you receive a case-mix adjusted floor and if you fall above the ceiling, you are held to the case-mix adjusted ceiling.

The same process and formula is applied to your facility-specific indirect costs, except there is no case-mix factor applied since resident acuity is not a significant cost driver of indirect costs.

The facility-specific non-comparable costs are divided by total patient days to arrive at an actual cost-per-day and are reimbursed at cost.

Property costs are not reimbursed on base year costs, but instead are reimbursed at actual cost on a two-year lag based on reported costs. Major capital additions are subject to prior approval via the Certificate of Need (CON) approval process and all reported property costs are subject to subsequent audit & review by the Department of Health.

The sum of the calculated per-diem for direct, indirect and non-comparables is then trended forward from the base-year to the current rate year using an aggregate inflation factor established by the Department of Health. The facility-specific property cost per-diem is added to this sum along with other minor per-diem adjustments to establish your facility-specific Medicaid rate.

Medicaid Reimbursement Issues

* 1983 base-year costs are no longer very representative of the cost structure of the current nursing home operation.

* The annual trend factors designed to adjust the base-year costs to current costs have not kept pace with actual cost movement.

* On average the Medicaid rate computes to 75-80% of actual cost-per-day.

* Medicaid eligibility process can result in lengthy cash flow delays (> 6 mos.) or subsequent denial of coverage that often results in sizable bad debts.

* Medicaid case-mix adjustment methodology has recently been changed to only utilize Medicaid residents in the calculation, thus further reducing the reimbursement due to higher acuity Medicare skilled residents not being factored into the case-mix adjustment.

* Effective 4/1/2010, the methodology will be changed dramatically when Medicaid intends to move from facility-specific costs for direct, indirect and non-comparable to a regional average price for all within that region. This is expected to dramatically re-allocate Medicaid per-diems creating both “winners and losers”, while driving future costs towards decreasing averages.

* Medicaid loopholes and sheltering of assets has significantly added to the growing number of Medicaid recipients as the private pay sector diminishes and the public sector grows, further straining the State Medicaid budget.

* Medicaid reimbursement shortfalls result in nursing homes having to limit the number of Medicaid admissions they can take, which subsequently leaves many Medicaid residents without access to the proper level of care or backed up in hospitals.

Medicare (On average represents 7-10% of patient day utilization, 10-15% of service revenue)

Medicare Part A covers skilled nursing inpatient care for those over 65 year of age (or disabled) for a period up to 100 days in any one spell-of-illness. Skilled nursing care is a Medicare defined term that requires the patient to be receiving and needing certain high-level skilled services related to an acute care episode and minimum 3-day hospitalization. A new spell-of-illness is defined when a patient has an onset of a new acute care episode after a minimum of 30 days has passed from the last episode. Medicare beneficiaries can choose a Health Maintenance Organization (HMO) plan in lieu of traditional Medicare benefits. HMO plans generally follow traditional Medicare benefits, but can offer some enhanced variations. Medicare Part B covers physician services and certain skilled therapy services when provided outside of a Medicare Part A covered stay.

Medicare does not pay a facility-specific rate, but instead pays an established price for an array of over 50 Diagnostic Related Groups (DRGs). A patient is classified into the proper DRG based on the completion of a clinical assessment tool (MDS). A series of MDS are completed throughout a patient’s Medicare Part A stay, resulting in the potential for different DRG Medicare per-diem rates paid within a stay. Medicare DRG rates vary significantly and are driven by the assumed DRG medical acuity and resource utilization need. On average, Medicare rates fall between $300-400/day. The average Medicare Part A covered stay falls between 20-30 days and is generally a function of the duration of the need for skilled care, the potential for documented progress and the approval of the HMO case managers. Medicare Part B pays an established fee for billed physician visits and therapy treatments provided to Medicare beneficiaries in a nursing facility during a non Medicare Part A stay.

Medicare Reimbursement Issues

* Although the rates are significantly higher than Medicaid, the cost to care for these clinically complex patients is also significantly higher.

* Medicare has been continually decreasing the DRG price structure to address Medicare budget restraints.

* While on a Medicare Part A stay in a nursing home, the nursing home assumes payment responsibility for most all medical needs regardless of who or where these needs are met (excludes hospitalization, radiation treatments, prosthesis).

* Maximization of DRG payment requires significant documentation and process to ensure you capture all clinical interventions and thus receive the most favorable rate.

* Most Medicare Part A stays are short-term rehabilitation patients cared for in distinct rehab or transitional care units of nursing homes and are highly sought after by nursing homes.

* Federal government is actively pursuing a new Medicare payment methodology where Medicare payments for all providers of service (hospital, nursing home rehab, physician, home-care) to a covered beneficiary during any one spell-of-illness will be paid to a single “controlling entity” at an all-inclusive established capped price for that DRG. The “controlling entity” will be responsible for providing, contracting out and allocating the Medicare DRG payment among the various providers of service. Medicare’s payment is capped, while the “controlling entity” and its care partners own risk management and cost control.

Private Pay (on average represents 20% of patient day utilization, 25% of service revenue)

Private pay residents are those who do not qualify clinically for a Medicare Part A stay (although they may have Medicare coverage), and they do not qualify financially for Medicaid. Assuming they do not have other means of insurance (and most do not), they are responsible for paying the facility-specific private pay rate as agreed to in the admission agreement. The average private pay rate in this region is approximately $330-350/day for long-term care and $400 or more for short-term rehab.

Private Pay Issues

* Medicaid reimbursement shortfalls force providers to subsidize losses through higher private-pay rates thus shifting the Medicaid cost burden onto the private sector.

* More individuals are sheltering assets to qualify early for Medicaid Assistance, thus reducing the private pay sector.

* The Medicaid Assistance application process for private pay residents transitioning to Medicaid Assistance can be so demanding and difficult that many fail to follow-thru or qualify leaving the nursing home with extensive bad debts.

* The State currently assesses nursing homes a 6% cash receipt “tax”, which is generally passed on to private pay residents as a 6% (approximately $20/day) add-on to the private pay rate, further shifting public costs to the private sector.

Summary

A typical simplified 120-bed nursing home operating structure (based on industry averages) might look as follows:

Medicaid Revenue 29127 days (70%) X $185/day = $5,388,500
Medicare Revenue 4161 days (10%) X $400/day = $1,664,000
Private Pay Revenue 8322 days (20%) X $330/day = $2,746,000

Total Service Revenue 41610 days (95% occupancy) $9,798,500

Total Operating Expense $235/day = $9,778,350

Operating Margin .2% $ 20,150

Congratulations, you have successfully completed the Nursing Home 101 tutorial. To enter for your chance to win a $25 Wegmans gift card, simply click on the comment button and leave your full name (and a brief comment if you desire). You can use the URL option and just type in your name or use the anonymous option and just type in your name in your comment box. Only one entry per person and all my blog readers are eligible (staff, board members, volunteers, family and friends). One gift card per every 20 entries (up to 5 winners in total) will be randomly chosen from the list of names on Saturday, September 12th.

Good luck and thanks for reading and learning from my blog!

The Workers Compensation Story

2009-08-26T07:53:00.000-07:00

If you only like light-hearted, fun blog postings then you might want to skip this week's entry as I plan to dedicate this posting to a recap of our 15 year history with a unique self-insured workers compensation Trust joint-venture. While it may be informative, I can't promise you it will entertaining. So proceed at your own risk...........

In 1992, a group of 8 nursing homes created a self-insured group Trust for the purpose of providing statutory workers compensation benefits for its members. Workers Compensation pays for lost time and medical expenses associated with a work-related injury. While nursing homes and related senior communities don't have the same injury risks as manufacturing companies, they actually have high claim experience due to claims and risk associated with lifting and positioning residents.

In the 90's, conventional insurance policies and the default option State Insurance Fund had become high cost and low service options. Many organizations were looking to take more control by self-insuring this mandatory program. Unfortunately, unless you were a very large organization, self-funding was generally considered to be too risky and cost prohibitive. Thus the advent of joint-venture Trusts where several organizations joined forces to pool their premiums, risks and costs.

In 1994, Kirkhaven joined the Long Term Care Risk Management Group (LTCRMG), which had increased from the original 8 members to now 15 members. Members included both not-for-profit and for-profit nursing homes, assisted living and retirement communities in the Rochester and Buffalo area. Potential members were screened and had to meet certain minimum financial, loss control and claims experience requirements.

In short, the Trust was structured to allow all the member organizations to share in the routine overhead costs associated with a program like this while self-insuring their workers compensation risk. These include:

Program Management
Claims Administration
Loss Control Services
Auditing & Actuarial Services
Reinsurance Premiums

Each organization pays into the Trust based on a standard formula applied to their total payroll exposure modified by a organization-specific historical claims experience factor. However, your ultimate program cost is your actual claims experience for your organization plus your pro-rata share of the non-loss administrative costs. To help mitigate the exposure for large losses, the Trust includes a large loss sharing formula among all members and also purchases reinsurance to cover very large claims. Every year an accounting of each members premiums paid minus the total cost of claims paid, reserves established and pro-rata overhead costs results in either a refund or additional assessment to continually balance your ledger until all claims in that year are ultimately closed.

The benefit of these self-insured Trusts is that you could control the service providers and ensure you are getting the service you desire or fire them and hire someone else. There are no insurance company profits built into the costs and the investment income earned by the claim reserves inures back to the Trust and the members to help offset costs. You still need to manage your risk and control claim costs as best as possible, but the structure of a self-insured Trust simply sets up better to control and manage both claims and cost.

While it is not possible to accurately know what the alternate insurance market rates might have been in future years to enable us to compare historical costs and savings, there is no doubt that the Trust saved us significant dollars over the early years. In 2000, we added Valley Manor to the Trust, which had now grown to over 30 members.

Within the past several years, the federal workers compensation program has undergone significant changes, scrutiny and regulatory reform. Additionally, many self-insured Trusts have gone bankrupt or terminated leaving unfunded liabilities in the hands of the State. In turn, the Workers Comp Board of the State has levied higher assessments and more stringent regulatory requirements on remaining self-insured Trusts to recapture losses and minimize risk for future losses. This action has made it more difficult for Trusts like the LTCRMG to operate and compete with other workers compensation insurance programs.

Within the past few years, the challenging economy and tougher Trust restrictions has resulted in nearly half of the LTCRMG members terminating their participation in the Trust. Additionally, both current and former members have fallen behind on their payment obligations resulting in higher accounts receivables and risk of bad debts. Six former members have either gone bankrupt or left the group with bad debts totaling 2.2 million dollars, resulting in legal costs to attempt to collect and/or reallocation of the bad debt cost to the other members.

As the once solid core of our innovative Trust begins to unravel, the handwriting is on the wall. The Trust must be dissolved. What was once a viable solution to a problem has now been faced with a changing scenario that questions the on-going value of this Trust as structured. Our goal now is to manage a responsible and organized exodus that also includes a new direction for how we will provide workers compensation benefits.

The tough reality is that no matter where we choose to go from here, none of the LTCRMG members can "run" from the cost or claims still in the works from all previous years. We can close and lock the "barn door", but the "cows" that have already left are still all of our responsibility. The board of directors of the LTCRMG, which is comprised of the CEO or CFO of each member, is taking on the responsibility of working with our legal advisers and program administrators to enable us a "soft landing" with the least amount of cost and risk.

From my perspective, the LTCRMG was an excellent program in its time, but has now become too costly and risky to continue as a viable option. Sadly, it is time to move on to something else and our challenge is to mitigate the transition cost and find the next new solution for today's workers compensation environment.

Dear Diary

2009-08-15T04:55:00.000-07:00

Tuesday, August 11..........Dear Diary:

7:30 a.m. I'm back at work following a wonderful week vacation. I didn't leave town, but had a blast spending time on the boat, taking kayak trips, going to a concert, taking in a baseball game, knocking off household projects and working on the writing of my novel. Weather was great and I had a relaxing week. Having a hard time getting used to wearing shoes and a tie again.

8:30 a.m. A lot of people stopped by to welcome me back. My desk and work load isn't to bad. The nice thing about not going away on vacation is that I was able to check my e-mail and voice mail daily. I found by spending a little time each day managing my office data it kept things from piling up upon my return. Kirkhaven Administrator, Amanda Brown, stopped in to say hi and get me caught up on things. Quiet week while I was gone. Poor Amanda, she has been trying to schedule a vacation of her own, but is afraid the Health Department will show up for their annual surprise inspection while she is gone. Now that I'm back, she has finally decided she is starting her vacation tomorrow.

9:00 a.m. What's all the commotion outside my office? Uh oh, I think we have visitors. Like wild fire, the word spreads throughout the nursing home. "The Department of Health surveyors are here!" A team of nurses, sanitarian, dietitian, social worker have arrived armed with lap tops, manuals and paperwork. Amanda has postponed her vacation plans. Let me see, at this time yesterday I was kayaking out on the Genessee River. Welcome back to work Jim.

Noon It's hard to explain the atmosphere during a survey. We go about our business as usual, but it is like someone just pushed the "fast-forward" button on your life but you're running in knee deep sand. Everything we do is under the microscope and magnified. The surveyors observe, ask questions, talk to residents & families, review charts, dig deeper, ask more questions, watch your every move as you try to go about your "normal" day. I guess you could say it's a little intimidating and nerve wracking for our staff.

5:00 p.m. End of the first day. According to Amanda, all is good so far. Staff is okay and nothing major appears to have surfaced. Time to go home, this working for a living is tiring.

Wednesday, August 12........Dear Diary:

9:00 a.m. I can't believe I'm stuck in this meeting across town. Didn't the rest of the world get the memo about the surveyors being at Kirkhaven? Doesn't our regular work go away when the annual State survey is underway? This is a pretty important meeting in its own right, so I need to focus. I know Amanda and her team have things under control at Kirkhaven.

11:00 a.m. Finally, this meeting is over. We accomplished a lot. I'm helping to lead a potential shut-down of our self-insured Workers Comp Trust, which we participate in along with several other health care organizations. A significant initiative with critical implications. I wonder how the survey is going today.

1:00 p.m. "Houston we have a problem!" Seems the coffee temperature is too hot according to the surveyors. Could cause serious injury to our residents. But our residents like hot coffee and often complain it's too cold? According to the surveyors, this could put us at an "immediate jeopardy" deficiency level. That's not good! Immediate Jeopardy (IJ) means no new admissions and potential fines until the problem is adequately resolved.

4:30 p.m. Still a lot of commotion going on about coffee temperatures. Surveyors taking coffee temperatures throughout the house. We pulled the plug on the coffee dispensers on each floor and started serving coffee from urns. The coffee vendor has been called. Amanda copies me in on an e-mail from our Medical Director entitled, "Coffee, Tea or IJ". You have to have a sense of humor to get through this stuff. I wonder what tomorrow will bring.

Thursday, August 13.......... Dear Diary:

8:00 a.m. Amanda and I met with our Medical team Director. Our new physician team is awesome and all is well, but we need to work on some coordination issues to ensure the staff and physicians are working as efficiently and effectively as possible. We identified some good ideas and a process to begin working on this. I wonder how the survey is going today?

10:00 a.m. I had to attend an important meeting with the County Department of Human Services. I'm working with other industry representatives on a unique initiative to help expedite the vast backlog of Medicaid Assistance applications that cause critical cash flow issues for nursing homes. The meeting is very productive and we agree in principle on a process to move forward with.

noon I met with Amanda to get an update on the survey. The coffee debacle seems to be resolved for now. A few other issues are cropping up. Nothing devastating, but the normal little things that eventually happen when under the microscope. There are so many resident interactions within a day, so many clinical treatments, so many opportunities to both do well and slip up, that eventually the surveyors will find something to write you up about. That's just how the system works. The surveyors are just doing their job, no different than us.

2:00 p.m. I went to participate in the Valley Manor Newcomers Welcoming party. What a nice respite from the rest of my week. We have had a lot of new residents move in over the past several months. All have such interesting backgrounds. All the residents come to meet and greet everyone. It is a lovely event and enjoyed by all. The renovated Valley Manor courtyard is finishing up and looks great! I wonder how the survey is going?

Friday, August 14.............Dear Diary:

7:00 a.m. Early start today. I'm finishing up two big projects. The first is the completion of our annual IRS filings for our 4 corporations. These are usually done by our auditors, but there are significant changes in the forms this year and there's no way a third party can complete them without us providing them the information anyway. The filing has gone from approximately a 10 page form to a 25 page form. I can't ask the finance office to take on yet another project. Sometimes I find that the best way for a CEO to stay in touch with the organization is to immerse yourself in the operation. It's a fine line between micro-managing and staying informed, but I like to walk it. The second project is the compilation of the Assisted Living licensure application data to submit to the State. Staff have been working hard on this and we appear to be getting to the end of the long process.

10:00 a.m. Spoke with Amanda for an update. She seems a little ragged. It's been a long week. She shared some incidents that the surveyors and staff have shared with her. Seems like some potential for deficiencies are adding up, but still nothing real major. Then again , maybe we're just paranoid at this stage of the game.

Noon Had lunch with board member, John Billone, a local developer. We had good conversation about the Kirkhaven Replacement Project and the current property opportunity we are evaluating with Buckingham Properties for the old Armory site on Culver Road. Some good ideas, input and support from John who is very knowledgeable about the property and development projects in general. The survey exit conference is scheduled for 2 p.m. today.

2:00 p.m. The survey team leader sits down with our entire leadership team in the conference room. We open up the Exit Conference to the entire team. We work as a team and we take the good and the bad as a team. The survey team leader begins with her scripted disclaimers and instructions. She then begins to identify the survey team findings which represent the "potential" for any deficiencies. She indicates there are no deficiencies that represent substandard care. Nice, we're off to a good start!

She then proceeds to identify 3 circumstances whereby they witnessed a failure of staff to properly wash their hands, which is an infection control issue. I struggle to keep up with my notes as she rattles off the details. Then she begins to thank us for our cooperation during the survey and do we have any questions. "Uh.........is that it?" I wonder to myself. Could I have dozed off for 20 minutes and just woke up in time for the concluding remarks? The room is stunningly quiet as Amanda escorts the survey team out and sees them to the front door.

I never noticed before how long it takes for the conference door to close itself. When it finally clicked closed, everyone looked at everyone else and burst into a collective sigh and then laughter. "What just happened?" everyone asked. "Well," I said, "It appears we just aced our survey with the potential for only one little deficiency of minimal scope and severity."

When Amanda returned she had the biggest smile on her face that any of us have ever seen. "Amazing job everyone," she said. "we did it!" The key word being "we". It has been a long and tiring week for all, but because of the work of all, we aced our survey. Now I still believe that the State survey is only one measure of our quality, and arguably not even a great measure. But it is a measure and a critical component of our regulatory compliance requirement and public relations. We take it seriously and thus are overjoyed with our awesome results!

3:00 p.m. "Great job everyone. Take the rest of the week off," I said to an exhausted yet elated leadership team.

p.s. Thank you Amanda for your incredible leadership and enjoy your well-deserved vacation. Thanks for visiting my Blog. Talk to you all again next week.

Seniorsfirst Musicfest

2009-07-25T17:02:00.000-07:00

"Add another event to the list of Rochester's successful summertime music festivals", said the Democrat & Chronicle in its front page local newspaper article highlighting the Seniorsfirst Musicfest.

The Seniorsfirst Musicfest at Valley Manor is a three-day public event featuring Opera and a harpist on day 1, the Gateswingers Big Band on day 2 and the Rochester Philharmonic Orchestra on day 3.

Over 1500 attendees enjoyed the diversity of music, food and fun over the three days. Despite the threat of or intermittent rain, all 3 shows dodged the storms and the crowds came out to enjoy the event.

My vision for the musicfest is to become the premier venue for music for seniors. Rochester is known for its music festivals, but only the Seniorsfirst Musicfest is truly senior-friendly and aimed to meet the musical tastes of seniors.

In addition to showcasing our Valley Manor Apartments Community, the Musicfest also provided priceless public relations for all our Seniorsfirst Communities & Services. We also held a special VIP Donor luncheon in conjunction with the RPO Musicfest day to thank and recognize key supporters of our Kirkhaven Replacement "Pathways" project.

All in all it was a very busy, yet very successful 8th annual Musicfest. An event of this magnitude is only successful because of the dedicated and hard working team of staff who collectively do all the many tasks that go into producing an event of this magnitude.

Bravo to all and thanks to our many sponsors and attendees for supporting Seniorsfirst.

A Tale of Two Families

2009-07-14T04:42:00.001-07:00

"It was the best of times, it was the worst of times,..............". These are the opening words of Charles Dickens' "A Tale of Two Cities" as he wrote about the triumphs and struggles of the human emotions and reactions related to the period of time just prior to the French Revolution.

These same words could also be used to tell of the triumphs and struggles of the human emotions and reactions related to the period of time when a loved one requires nursing home care.

I was reminded of this recently when I received two polar opposite letters from the family of two different residents of Kirkhaven. The first was hard to take and it clearly illustrated a family struggling with the challenges and emotions associated with watching their father age and dealing with the medical acuity and failing health related to the aging process.

"Your facility appears to function without a shred of loyalty, compassion and communication."
"Kirkhaven could care less about the residents and it's sense of professionalism."
"Kirkhaven certainly does not operate as a family institution."
"It's all about the MONEY."

These are just some of the quotes the writer used to share their concerns and issues related to the care their Dad received while he was a resident at Kirkhaven for 7 years. Seven years translates into 2,555 days of care or 61,320 hours of care. A long period of time, however you choose to define it, and a period of time undoubtedly filled with both triumphs and struggles for all parties.

What a shame that the last few struggles weigh the heaviest on every one's mind. Could we have been more attentive and sensitive to the resident's and family's needs? Could the family have been more understanding and sensitive to the issues? I'm thinking yes to both, but it isn't always easy to be a family advocate or a caregiver when dealing with the challenges of aging.

And then I received the second letter from another resident's family, which clearly illustrated an entirely different perspective and opinion related to the care Kirkhaven provides.

"When I visited Mom, I was so pleased.......she was clean,calm,appeared contented. She was clearly enjoying her life."
"I believe Kirkhaven gives Mom the best quality of life she's capable of having at this stage of her life."
"Mom's caregivers at Kirkhaven are taking the time, interest and patience to really know and care for her."
"Thank you for helping us through this transition. Words alone cannot express how grateful we are."

Those are just some of the quotes this writer used to share their joy and gratitude for the support and care Kirkhaven has provided during a very difficult and challenging time with their aging mother. The need for her to move to a nursing home was initially accepted with fear and anxiety, but now has brought them peace of mind.

Two completely opposite letters. Which accurately reflects the true Kirkhaven? Perhaps it isn't really about Kirkhaven at all, but more about the the normal emotions and reactions to life and the aging process.

Yes indeed, Charles Dickens had it right. It was the best of times, it was the worst of times!

Senior Living Meets Global Aging

2009-06-29T10:45:00.000-07:00

I recently attended an educational session that took an interesting approach to the future challenge of senior living and global aging. I shared an overview of the session with the Seniorsfirst board of governors as a mini-education item within our regular agenda.

I thought my Blog readers might enjoy the innovative and informative perspective as well. I'll break it down into 3 parts for you:

Global Aging
"Nana" Technology
The "Next Generation" of Senior Housing

Part 1: Every 8 seconds a U.S. baby boomer turns 60. There are 78 million of us born between 1946-1964. The U.S. population of age 85+ is expected to double from 4.3 million (2000) to 8.5 million (2030), then double again to 18.2 million (2050).

1900 U.S. census recorded 3,536 people age 100+
2050 U.S. census estimates 834,000 people age 100+

Global aging will affect us long before global warming!

So here are two questions we should be asking:

Who will take care of them?
Where will they live?

You should also know that 80% of current senior care is provided by 34 million unpaid "caregivers" (family or friends). But this informal structure of care giving is collapsing as you read this.

Time: dual-working spouses means less care giving time
Proximity: 20% of family caregivers live an average of 480 miles away
Energy: If your Mom is 100..............how old are you?

You should also know that there is a growing professional caregiver labor shortage to meet the growing demand.

35 million more jobs of any kind than people to fill them by 2030
2 million long-term care nurses and nurses aides today, 6 million needed by 2050

So what is the answer you might be asking? Well fortunately, there may be some answers to mitigate the issue:

Congregate staffing: we need to group available workers in facility-based environments to produce efficient use of available labor force. Should home-care be a right or a privilege? There is a good cost reason why the government doesn't fund "home-schooling".
"Nana" technology: utilize technology that allows seniors to remain independent longer and/or make congregated labor more productive.
Congregate housing: create housing models where seniors want to live!

Part 2: "Nana" technology is unofficially defined as microchip-based technology designed, intended, or that can be used to improve quality of life for older adults. There are real examples of such technology that are currently in development or study and that will have a significant impact on care giving in the future.

Magic Medicine Cabinet- face recognition and voice communication that will take blood pressures, monitor vital signs, maintain medical history, remind and dispense medications.
Smart Shoes: monitors balance deficits and signals the brain to adjust accordingly. A recent pilot study resulted in 73-year olds having same balance as 23-year olds.
GPS Xplorer Shoe: tracks within 30 feet anywhere on planet. So a caregiver can be miles away and receive a notification if a loved one wanders outside of their established routine.
Virtual Dinner Window: a large picture frame hangs on the wall next to your dining room table where a family is enjoying dinner and conversation along with grandma, who appears to right beside them but is actually miles away.
Smart Shirt: a lightweight t-shirt that monitors vital signs and conducts safety monitoring. A version is being tested that can actually perform CPR when vital signs indicate. Now when you are told to make sure you're wearing your good underwear, you'll want to do it!
Ri-Man Robot: can "see, hear and smell" and currently lifts up to 90 pounds. Next phase to be designed for assistance to Japanese elderly.

Part 3: By 2050, there will be more than 2 billion people in the world over the age of 60...............and every one of them will be a unique individual. Baby Boomers will change the face of senior housing and long-term care just like they have done at every other juncture of their life.

Before Boomers, there were 3 flavors of ice cream.........now there are a thousand!

Before Boomers, there was Coke and Pepsi...........now just within the cola's there's regular cola, diet cola, cola one, vanilla cola, cola with a twist of lime and on and on!

Boomers want individual choice and variety. They will demand the same when it comes to senior housing and long-term care. And by the way, Boomers are not attached to their homes forever, nor do they want to live alone. They have never been alone!

Boomers created large suburbs
Boomers attended large high schools
Boomers graduated from large universities
Boomers worked for large companies
Boomers will move & live together if offered the housing choices they desire

So what are the new "flavors" of senior housing and long-term care?

"Culture Change" nursing homes: the new wave is smaller residential household communities that do away with the current medical model and instead focus on resident centered & directed care in a more home-like setting.
Housing for different cultures: an example is Aegis Gardens in Freemont, California where all 50 staff speak Mandarin, Cantonese or Japanese and features Asian cuisine, architecture, activities and customs.
Housing of "different orientations": Rainbow Vision in Santa Fe, New Mexico is dedicated to gay, lesbian, bisexual and transgender older adults. It features the Billie Jean Fitness center, Truman Capote Dining Room and Drag Queen Bingo.
Housing "at Home": Beacon Hill Village in Boston, Massachusetts resides in the heart of one of America's oldest neighborhoods with convenient access to shopping, transportation, banking, eateries within the area and home health services provided if needed.
"On the road" housing: Rainbow's End RV Park offers 42 sites with wheelchair ramps and assisted living services and health care services via a home health agency.
Housing for "Alums": More than 100 communities open or in development that are university based retirement communities. Residents gain access to classes, athletics, arts & library while universities retain alumni relations and donors.
"S.S. Assisted Living": An 89 year-old widow living on the QE2 since 2000 and will visit 41 cities, 25 countries, 5 continents in one year! Provides all housekeeping, meals and activities at a cost similar to the average assisted living facility. Three cruise ship companies establishing "Residential Ships" for retirees by 2010.
A real "niche" community: In Pasco County, Florida (the nudist mecca of North America) nudists are planning an assisted living facility. There are an estimated 50,000 nudists in the U.S with a median age of 55. If they haven't been wearing clothes all their life, why should they start when they grow old? (that's a rhetorical question, you really don't need to answer!).

In the nest two decades, individuals age 65 and older will come to represent 1 out of every 5 U.S. citizens. They will be ready to embrace new technology, new forms of retirement and new forms of senior housing and long-term care communities.........................Will we be ready for them!

Thanks for visiting my Blog. I'm taking a short summer vacation up at the cottage in the Adirondacks on Indian Lake in conjunction with the July 4th holiday week. I'll share some pictures and more thoughts upon my return.

Seniorsfirst Recognition Luncheon

2009-06-24T13:41:00.000-07:00

On Wednesday June 24, Seniorsfirst recognized and honored 68 employees and volunteers at our annual Employee/Volunteer Recognition Luncheon. This year we held the event at the prestigious Oak Hill Country Club (home of past PGA US Opens, PGA Championships and Ryder Cup).

The venue was superb as we dined on a delicious buffet cuisine prepared by the professional chefs and culinary staff in the grand club house atrium. We enjoyed the company and fellowship of one and other as we dined and left behind (for at least a while) whatever work and challenges waited for us back at Kirkhaven and Valley Manor.

After lunch, we enjoyed the viewing of a video production featuring all of our honorees prior to individually recognizing each with a special gift of gratitude to mark their service milestone. Collectively, we honored over 830 years of service broken down as follows:

19 five-year honorees
10 ten-year honorees
5 fifteen-year honorees
7 twenty-year honorees
14 twenty-five honorees
1 thirty-five honoree

Additionally, we honored our 6 "Compassionate Heart" award recipients over the past year, 3 individual volunteers who have been with us over 15 years and 3 volunteer board members who collectively have given over 100 hours of their time, talent and resources in the past year.

As I reflect on what this day means to Seniorsfirst, I am first in awe of the dedication and loyalty of our staff. In an age where time seems to be measured more in minutes than years, I find it remarkable that we have so many employees and volunteers who choose to serve with us for most of their individual career.

Second, I am reminded that there is no single leader or group at Seniorsfirst that is responsible for our success. We are one team and everyone is a full team member. Each of us has a specific role and brings a unique talent to the table. It is this wonderful diversity of members that creates balance to our team and enables us to provide such exceptional performance. Individually, each of you is special and each of you represent an important part of our organization. Collectively, you are simply the best and represent an awesome Seniorsfirst team.

Third, as I reflect on my own milestone of 25 years of service, I recognize that whenever I get stressed or worried about the challenges we face, I only need to look as far as the people around me. You all are the reason that Seniorsfirst exists today and you all are the reason we will continue to flourish in the future.

On behalf of Seniorsfirst, congratulations to our 2009 service milestone honorees and thank you to all our Seniorsfirst employees and volunteers. At Seniorsfirst, our people make the difference!

Here are some photos of today's event (some are little dark due to poor lighting)...........................

The Good, The Bad & The Unknown

2009-05-30T02:47:00.000-07:00

I thought I would share some updates with my Blog readers to keep you posted on how things are going. To make it easier and more organized, I'll separate my comments into three categories:

The good, the bad and the unknown!

Let's start with the good stuff because everyone prefers good news..........................

We hit 90% occupancy for the first time in quite a while at Valley Manor. You may recall that we initiated an "occupancy enhancement program" this year and it seems to be working, as occupancy has increased from 85% to 90%. We have now set our sights on phase 2 of our program which we hope will take us to 92% occupancy.

We are running at 97% occupancy at Kirkhaven. Additionally, the "Medicare Maximization" program we initiated has increased our average Medicare rate 6.4% and our Medicare utilization 4%. The combination of these 2 items plus an increase in our Medicare Part B (therapy services provided to our long-term residents) is estimated to bring an additional $275,000 in revenue for 2009.

We have raised $35,000 towards the Valley Manor courtyard renovation project and have selected the proposal of choice from the 3 bids received. Total cost is expected to be around $50,000 so we will continue our fund-raising campaign while hopefully implementing at least phase 1 of the project early this summer.
We have had no further reported cases of Legionella at Kirkhaven other than the one resident who is now back at Kirkhaven and doing fine. We are awaiting the test results of the water samples taken from various sources in hopes that it will help us identify where the problem was. After taking the test samples, we conducted a complete "heat & flush" of the water system, which eliminates any bacteria that may have developed within the system.

We recently compiled the results of our "Evaluate your Supervisor" surveys and once again our leadership at both Kirkhaven and Valley Manor were scored outstanding by their staff. On a scale of 1 to 5 (with 5 representing the best score), Valley Manor leadership averaged a 4.5 and Kirkhaven leadership averaged a 4.0. Staff evaluate and rate their supervisor on 12 distinct leadership qualities. We use this program to ascertain leadership training needs and to ensure that we are providing quality support and leadership to our staff. I am very pleased with these results and the fact that our leadership has the courtesy and courage to offer their staff this opportunity to provide direct feedback.

The NHL Stanley Cup final round begins and the match up is a great rematch between last years finalists. My money is on the new kids and the Pittsburgh Penguins over the defending Cup champion Detroit Redwings in 6 games. It's time for a new champion!

The bad news fortunately is light.....................

We still haven't received our 2009 Medicaid rates, so we continue to get paid at the old 2008 rate. This is starting to create a cash flow issue. The passed State budget established the broad methodology of the 2009 Medicaid rates, but apparently calculating and issuing them is going to take a while. In the interim, the State is more than happy to be paying us the lower 2008 rate.

We found it necessary to make a change in our assigned primary care physician at Kirkhaven. You may recall that after 25 years with the same physician group, due to retirement we needed to make a change last October. We are now with the Rochester General Hospital Physician's Group and very pleased with the medical administration and medical director services they are providing. However, the primary care physician they assigned to Kirkhaven did not work out and thus they have worked collaboratively with us to assign a new primary care physician effective June 1.

First my beloved Buffalo Sabres didn't make it to the Stanley Cup playoffs, then my newly adopted playoff favorite Washington Capitals get bounced out by the Penguins. So I decide to root for the Chicago Blackhawks and they lose out to the Redwings. Maybe I should start watching the NBA playoffs!

Now for the unknown...................

Can we maintain our momentum and occupancy at Valley Manor? We know we have some planned move-outs coming up soon, but we are also entering the prime season for move-ins. 90 % occupancy is good, but 92% and higher is better!

The initial evaluation and projections suggest that the 2009 Medicaid rate methodology will be good for us once we finally get it. How good or if so is still an unknown risk until the actual rates are issued.

Will the economy make a dramatic comeback in the second half of 2009? We have begun to see signs of improvement in the first half, but the fall was so great that we need more than signs of improvement to right our investment portfolios and strengthen the economic engine of our country.

Will our Kirkhaven Replacement Project, which has been put on hold until the economic outlook is more certain, resume momentum. We haven't completely stopped planning for this project, but where we go from here and when is still a big unknown.

Who will win the 2009 Stanley Cup and will the Buffalo Sabres do anything to ensure they make the playoffs next year? What will I do with all my time once hockey season is over?

I'm off to Saratoga, New York to attend our State Association's annual Spring Training Institute and Exhibition. Great opportunity to stay abreast of current issues and trends in the field, as well as to network with peers across the State.

Thanks for visiting my Blog and see you next time!

What's in the water?

2009-05-16T06:51:00.000-07:00

What is in the water?

That's a question all health care facilities need to ask on a regular basis. You might be surprised to learn that very often the presence of Legionella bacteria exists in many water distribution systems of large buildings including hotels, factories, apartment complexes, hospitals and nursing homes.

Cooling towers, associated with the central cooling systems in these buildings, have long been thought to be the major source for Legionella, but that is not always the case. Other sources include mist machines, humidifiers, whirlpool spas, drinking fountains and any place where standing water and organic sediment can stimulate the growth of Legionella bacteria.

Most of us come into contact with Legionella more often than we likely recognize. Fortunately for most healthy individuals our normal defense systems fend off the bacteria with little of no ill effects. Legionella is not contagious, or in other words you can't "catch it" from someone else. The Legionella organism is aerosolized in water and people inhale the droplets which carry the bacteria into their body. Another passage way is through aspiration or choking such that secretions in the mouth get past the normal choking reflexes and instead of going into the esophagus and stomach, they enter the lungs. Smokers and patients with aspiration precautions are most at risk for this common mode of transmission.

Contact with Legionella is not normally serious except with high-risk individuals such as heavy smokers, those with lung disease and the frail elderly with low immune systems and risk of aspirations. Symptoms are flu like with fatigue, weakness, high fever, nausea, ache, diarrhea and stomach discomfort.

Treatment for Legionella is the use of appropriate antibiotics and is generally defensible with excellent outcomes. For people whose immune systems are compromised, prolonged hospitalization, complications and death can occur. Often, Legionella is not tested for or diagnosed and the symptoms are simply treated similarly and appropriately as for pneumonia or flu with the same excellent outcomes.

At Kirkhaven, we had a resident hospitalized and diagnosed with Legionella last week. It appears to be a very isolated case and the resident is back at Kirkhaven and doing very well. We have undertaken a comprehensive heightened awareness for any other suspected cases and have initiated appropriate precautions and testing to mitigate risk and identify the possible source. We have several standard preventative maintenance programs that have been in effect for years to minimize the risk of Legionella growth, but recognize that no plan is 100% effective.

We are working collaboratively with the Health Department, who is well versed and experienced in working through the many incidents of Legionella that occur in similar situations. Our team of clinicians, medical staff, facility maintenance and administration is doing a great job addressing the issue and communicating effectively. It makes me very proud and comfortable knowing that all the proper steps are being taken in response to this incident.

If it turns out to be an isolated incident of no major consequences, we will be thankful and appreciative of the response team's immediate and appropriate actions. If it turns out to be a systemic problem that requires remediation, we will be equally thankful and appreciative of the response team's immediate and appropriate action.

Legionella is a problem that can exist in any environment and requires constant attention to control and abate. The risks to individuals is much greater in hospitals, nursing homes and places where individuals with compromised immune systems reside. Understanding the risks and knowing the precautions are important.

Thank you to the Kirkhaven response team for ensuring the continued safety and comfort of our residents. You are an awesome and dedicated team!

We Are Family!

2009-05-09T05:07:00.000-07:00

We adopted the slogan "We are Family" a few years back at Seniorsfirst when we held our annual summer picnic. It seemed like a logical choice as our picnic included an old-fashion family barbecue, lawn games, ice-cream social, fun and fellowship. Who can forget the water pistol wars and the soaking most of received.

Next week is Spring Fling at Seniorsfirst, another family tradition that we truly enjoy. We celebrate the arrival of Spring with a week of special fun events and games. Each day will be a theme dress-down day: pajama day, crazy hat day, go-green day, Italy day, t-shirt day. There will be free food, treats and plenty of family competition as we compete for various prizes in games of skill, chance and silliness.

Coming up in June will be our annual recognition luncheon where we honor members of our Seniorsfirst family who have reached a milestone level of years of service with our organization. We will hold this event at the prestigious Oak Hill Country Club and will celebrate together our appreciation for service and dedication of both our staff and volunteers.

Family fun and celebration is an important part of life at Seniorsfirst. Our communities are really just large families made up of the residents who live there, the staff who work there, and the volunteers who serve there. We spend a great deal of time together and the relationships we build connect us as one extended family.

We work hard and our family life is not always easy. The challenges can be over-whelming at times. We deal with illness and death on a regular basis within our family. We struggle with economic challenges like most other families. We have internal spats when we don't always agree, but then forget and forgive. But most of all, we celebrate and enjoy family life.

I am reminded of the importance of family in our lives as this past weekend I had the joy of spending much time with my immediate family. My son, daughter-in-law and grandson from Raleigh, North Carolina came for a visit as we also celebrated the 1 year birthday of another of my grandsons who lives here in Rochester. It was only the second time that all 3 of my grandsons were together and as they grow older it was special to see them begin to form a relationship together.

Pictures tell the story better than words, so here are some shots of how I spent my extended weekend enjoying family. Like so many of you, I am so blessed to have such a wonderful family, both at home and at work.................

Jen and Me with our youngest grandson Logan James on his 1st birthday

Cousins Dylan John and Logan James checking out the balls

Dylan shops at "Wegmans" at the Strong Museum of Play

Jen spending time with grandson Dylan visiting us from Raleigh

Our family here in Rochester- daughter Kristin, Son-in-Law Dan with Brennan & Logan

Cousins Dylan and Logan playing with the sand box

Daughter-in-law Melissa watching the cousins play together

Dylan reads our dog Jessi a bedtime story

Thanks for visiting my Blog. See you next week!

Understanding the "Mechanics" of our Kirkhaven Operation.

2009-04-25T08:00:00.000-07:00

Last week we took an in depth look at the mechanics of our Valley Manor operation, so this week let's do the same with Kirkhaven.

We currently have 144 skilled nursing beds in operation at Kirkhaven that include a special care unit for residents with Alzheimer's or other related dementia and a short-term rehabilitation and transitional care unit.

The annual expense budget is 11.5 million dollars broken down as follows:

Nursing services- 4.3 million
Other professional services- 1.3 million (therapies, medical, pharmacy, etc)
General services-2.2 million (dietary, environmental services, utilities, etc)
Administrative services-1.0 million (administration, fiscal, HR, PR, etc)
Employee Benefits- 1.7 million
Property costs- 1.0 million

The revenue we earn to pay for these costs come from many sources as listed below:

Private pay resident fees
NYS Medicaid Assistance program
Medicare & HMO insurance programs
Donations
Investment Income

Let's take a look at each to better understand our revenue sources.

Private pay residents are those who don't qualify for other insurance coverage and thus pay for their own care at our regular established per-diem rate. Our current rate is $320/day plus $15/day for a private room. This rate is revised annually in conjunction with our annual cost increases. We also monitor our rates against the market to ensure that they are reasonable and competitive. Approximately 20% of our residents are private pay.

Medicaid residents are those who meet specific resource and income limitations established by the state and thus can't afford to pay privately for their nursing home care needs. Upon application and approval for Medicaid Assistance, the resident's care is paid by the state at a facility specific Medicaid rate. Our current Medicaid rate averages about $164/day. Approximately 68% of our residents are on Medicaid Assistance.

Medicare/HMO residents are those who meet specific clinical guidelines with respect to their care and thus qualify for some limited coverage under Medicare or private HMO insurance policies. Coverage under these insurance programs is limited to high acuity skilled care needs only and often for a maximum of 100 days only within any one spell-of-illness. Short-term rehab and transitional care are generally what is covered by Medicare and HMO insurance. Medicare pays different rates for different residents depending on what rate category their acuity needs and care fall into. On average, our Medicare/HMO rates are about $420/day. Approximately 12% of our residents are on Medicare or HMO insurance.

So you can see that occupancy and payer class are key components to our nursing home revenue. We average about 95% occupancy and thus our average cost per day computes to about $225/day. With a Medicaid rate that averages $61/day below our costs, a private pay rate that averages $100 over cost and a Medicare/HMO rate that averages $195 over cost, payer class mix is a critical challenge that must be managed well.

Donations and investment income help to subsidize our program costs over time, but due to the volatility of the cash flow of this non-operating revenue, can't be counted on for on-going regular operating costs. Often, this income provides for capital improvements or venture capital for special programs.

As a not-for-profit organization, our goal is to create a modest operating margin of 1-2% to meet our cash flow needs. 100% of all revenue goes toward the cost of our services. We continually monitor customer satisfaction and we are subject to on-going regulatory compliance surveys by both the Medicare and Medicaid programs.

Our challenges are many, but primarily include the following:

Occupancy and payer mix utilization
Maximization of third-party insurance rates
Decreasing Medicare and Medicaid program reimbursements
Increasing care acuity of our residents
Decreasing private pay resident market
Aging and antiquated building
Culture Change movement from the medical model of long term care
Shortage of nurses and therapists

Despite these challenges, our work is a labor of love and we have very caring and dedicated staff that really make the difference. The mission of what we do is uncompromising, despite the many challenges.

And now you know a little more about the mechanics of our nursing home operation and how we make it work. Thanks for visiting my Blog this week!

Understanding the "mechanics" of our Valley Manor Operation

2009-04-15T05:50:00.000-07:00

I thought I would dedicate the next couple of Blogs to communicating more about how our communites operate from a business strategy perspective. As you read on, I hope to answer the following questions:

What type of expenses do we incur?

How are our rates set?

What are the opportunities and risks?

How do we monitor results?

What do we do next?

Let's look at our Valley Manor community first.

Valley Manor Apartments is a retirement community for active seniors. It is an independent living facility by New York State definition, which means we can not and do not provide any resident care and thus are not regulated by the State. Independent living facilities provide residents a life-style which includes living accomodations, meal options,housekeeping, security, scheduled transportation and recreation programs. Residents who require personal care services, to help maintain their independence, are permitted to contract with an outside home care agency to provide this service in their apartment home. The home care agency is regulated by the State and is solely responsible for the care plan they establish with the resident.

Valley Manor incurs several costs associated with providing residents a unique style of living within the classification of independent living. The majority of these costs are fixed or fixed/variable, meaning we incur them regardless of any moderate variance in occupancy. These costs include the following:

Staff Wages and Benefits

Food

Supplies

Repairs & Maintenance

Utilities & Services

Mortgage

Real Estate Taxes

Insurance

Marketing & Advertising

Administration & General Support

To ensure that we have adequate resources to pay for these annual expenses, we establish prices for our apartments and services based on our costs. Since we are a not-for-profit organization, we do not need to produce profit distributions for owners or stock-holders. Our objective is to create only a modest surplus that allows for us to pay our costs, meet our cash flow needs and establish a reasonable reserve for capital reinvestment in the building.

We establish our prices using both a cost-based and market-based methodology. First, we compile our actual costs into the following categories:

Property (Mortgage,Taxes,Insurance,Capital Improvement Reserves)

Food Service (Kitchen, Dining Room, Deli, Food)

Environmental (Maintenance,Utilities,Housekeeping,Laundry,Security)

Resident Services (Activities,Health & Fitness,Transportation)

A & G (Administration,Marketing,Sales,Corporate Support)

Then, we allocate the total costs in the Property category to each of our various apartment styles based on square footage. Valley Manor currently has 11 different apartment styles ranging from 1 to 2 bedrooms and square footage from 450 sqft to 1,430 sqft. The larger the apartment, the larger the pro-rata property related costs allocated to it.

At Valley Manor we currently have 137 apartments (11 different styles) that collectively represent 103,330 rentable square feet. Our annual property costs are approximatly 1 million dollars, which thus computes to a cost per rentable square foot of $10.

We recover our property related costs by collecting an upfront Entrance Fee from residents upon initial move in. The Entrance Fee for each apartment style is calculated on the $10/sqft annual cost multiplied by the average length of stay of 7 years and grossed up to account for less than 100% occupancy. An apartment preparation fee is added to the Entrance Fee to recover the average cost associated with preparing an apartment for reoccupancy (painting, carpeting, upgrading, etc.). Entrance Fees range from $45,000 to $133,000.

We recover our other costs by charging residents a monthly maintenance fee. To calculate the appropriate monthly fee for each apartment style, we first deduct from our costs any incremental income received from other services (garage & parking fees, guest room fees, building usage fees, health & fitness fees, laundry fees, outside food functions, guest meals, cafeteria & deli income, transportation fees, etc.).

Then, we allocate the net cost to each apartment style by category. The net Environmental cost is allocated based on square feet, thus the larger the apartment the larger the pro-rata share of environmental costs. Our net annual Environmental costs are approximately 1.3 million dollars or $12.50 sqft. The net Resident Services and A & G costs are allocated evenly to all apartments based on the number of total apartments, as these costs are not driven by square feet. Our net annual cost for both is approximatley 1 million dollars or $7300/apartment.

The monthly maintenance fee (excluding meal plan) is calculated on the sum of the allocated annual costs for each apartment style grossed up to account for less than 100% occupancy and divided by 12 months. An incremental fee is added to the monthly maintenance fee if more than one person resides in the apartment. Monthly Maintenance Fees (excluding meal plan) can run from $1200 to $2150.

The last component of the maintenance fee is the meal plan (if chosen). Our net annual food service costs are calculated to a cost per meal and then meal plan option prices are established depending on the number of meals each resident selects with their meal plan (1 meal/day, 2 meals/day, 3 meals/day, 20 meals/month, 15 meals/month).

Cost-based rates are designed to generate necessary income to recover your costs, but if our costs are not competitive, neither will our cost-based rates. We therefore also conduct a competitive market rate analysis to ensure that our rates are in line with comparable products and competition in our market. We have also recently implemented a "premium pricing" policy, which adjusts apartment pricing to take into account demand for certain apartment locations.

There are boths risks and opportunities associated with this rate methodology.

First, there is the occupancy factor we use in setting our rates. We are currently using 88% in our rate formula. If we experience less occupancy we run the risk of falling short of recovering our costs. Alternatively, if we experience an increase in occupancy we have the opportunity to create additional capital to invest in the facility or to reduce future rates.

Second, there is the cost factor we use in our rates. To the extent that our costs run over or under projections, we experience risk or opportunity to our bottom-line.

Third, there is the length of stay factor used in the Entrance Fee calculation. We base our 7 year factor on a rolling 3-year actual history. While stability in occupancy has an obvious upside, we need a certain turnover rate to re-generate new Entrance Fees of 1 to 1.2 million per year. We offer residents a maintenance-only option on our smaller apartments (no Entrance Fee), but gross up the monthly fee to capture what we would have collected on an Entrance Fee amortized over 7 years on a present value basis. We also offer a much higher 90% refundable Entrance Fee option which is calculated on a 7 year present value basis. Each plan returns the same income over a 7 year period, but there is risk and opportunity associated with the actual length in stay and the interest rate assumptions.

Fourth, there is the utilization factor assumed in the calculation of the meal plan prices, revenue and other ancillary service income projections.

At Valley Manor we also provide Assisted Living and a Social Model Adult Day Program. We compile the direct incremental costs associated with each of these programs and compute the rates for these services such that the Program revenue adequately recovers the Program cost.

We monitor our results using monthly budget variance reports, occupancy statistical reports and financial statements. We also benchmark our results against industry trends where feasible. We conduct resident satisfaction surveys annually to measure customer satisfaction and to learn where risks and opportunities exist from a service perspective.

Based on these monitoring results, we initiate goals and strategies to improve our performance as necessary. We develop a new operating budget annually, that includes expense and revenue projections related to our service goals and strategies. We adjust our rates accordingly, based on both cost and market trends. Our Board of Directors oversees these processes by reviewing, approving or modifying our goals and strategies.

I hope this tutorial Blog helped to shed some light on the "inside mechanics" of the Valley Manor financial operation. Be sure to visit my Blog next week, when I'll talk about the nursing home side of our business. See you then...............

3 Shots for a Quarter!

2009-04-11T04:15:00.000-07:00

As I look back at the end of the first quarter of 2009, there are 3 primary initiatives that pretty much define the first 3 months of our 2009 operation at Seniorsfirst. Lets take a look at each and see how we fared.

First shot........ our state leaders finalized and approved a state budget that goes into effect April 1, 2009-March 31, 2010. As anticipated, it wasn't very kind to nursing homes as the Medicaid portion of the expense budget was slashed considerably to help offset a growing state deficit. The final budget did fulfill a previous promise to update the antiquated Medicaid rate-setting formula for nursing homes, and in doing so resulted in a significant increase in Kirkhaven's (and most other homes) Medicaid revenue.

However, at the same time they were putting money into our "right pocket", they were taking even more money out of our "left pocket". In short, they tweaked other elements of the Medicaid rate-setting formula that conveniently resulted in exactly the desired net savings the State established as their target objective for state-wide Medicaid cost reductions.

For Kirkhaven, we project that the net impact of the state budget will result in an estimated loss revenue of $134,000 from what we had originally budgeted for in 2009. To put that in perspective, Kirkhaven's total annual revenue is about 10 million dollars and we historically aim for an average margin of 1-2% ($100-200,00 net surplus a year). The state's action in affect, eliminated what little margin we attempt to operate on.

On a more positive note, Kirkhaven appears to have fared better than most. We were conservative in our Medicaid rate projections for 2009 and we also were positioned better than most to mitigate the negative implications of many of the Medicaid rate-setting revisions. Still, the reduction in Medicaid revenue represents a deficit for Kirkhaven that needs to be addressed.

Second shot........Kirkhaven has been actively pursuing a third-party reimbursement maximization initiative for over a year now. Our objective is to improve on our ability to legitimately maximize Medicare and Medicaid revenue through enhanced understanding and strategies within the reimbursement regulations. In short, the regulations are specific but there is a vast "area of opportunity" that can be taken advantage of if understood and used both wisely and appropriately.

For example, Medicare pays nursing homes different rates for different residents depending on the specific care acuity of and services provided for the resident. How this care acuity and service provided are documented and reported can result in significant differences in the Medicare rate you receive. This is no easy task though. It takes a lot of effort and coordination between the nursing and clinical staff who are the primary care givers of the services and requires extensive planning and documentation. Medicaid rates also have a component of the rate that is based on resident acuity and thus these maximization initiatives have a similar revenue enhancement potential with our Medicaid covered residents.

For the first quarter of 2009, our Medicare Maximization program has resulted in both an increase in Medicare covered days and an increase in our average Medicare rate. Additionally, our occupancy has soared to 98% of late. Further, our Medicaid resident acuity has increased significantly and appears to position us well for maximizing our share of the limited remaining "Medicaid pie". We project that the estimated positive impact of these results is approaching $100,000 on an annualized basis and we're not done yet.

In short, because of the efforts of our staff with the third-party reimbursement maximization program results, Kirkhaven is not in immediate jeopardy of requiring any layoffs or budget cuts as a result of the 2009 state budget and Medicaid program revisions. I don't believe this will be the case with all nursing homes across the State, so kudos to Kirkhaven for a job well done!

Third shot........at Valley Manor we have been pursuing an Occupancy Enhancement program aimed at increasing our occupancy to at least 90% (our 2009 budget is set to work at 88%). The Winter season is not historically a very active time for seniors to be moving into retirement communities and the recent challenging economy has slowed this process down even further. All the more reason for us to invest even more resources towards this initiative, which is the "life blood" of our Valley Manor operation.

The first quarter 2009 results are very promising. We had a net gain of 5 new apartment leases, moving our current occupancy to 86.8%. Additionally, we have 6 more committed apartment sales that are scheduled to move in by May and only 2 projected known move-outs, which will result in a 89.9% occupancy in the near future. We're only getting started, and with the onset of Spring and the continuation of our Occupancy Enhancement program, there is still a lot more upside to pursue. Great job Valley Manor!

A Parting shot........one quarter does not a success make. This is a volatile industry and we can't rest on our laurels or ever think that we have arrived at our destination. This is a continuing journey we're on and the risk of failure and the next big challenge is always just around the corner. The economy is healing, but still hurting. The 2010 State budget is already threatening to be devastating. Cash flow and expense budget controls will continue to be difficult.

But lets just take a moment to take a big collective sigh, catch our breath and maybe even celebrate all we have already accomplished amidst the vast challenges of our work.

Congratulations Seniorsfirst on an awesome first quarter and keep up the great work! Our efforts will eventually show up on the financial statements in the long run, but in the short run give yourself and the person working next to you a congratulatory pat on the back.

Thanks for all you do and for visiting my Blog. See you next week.........................

Business and Politics?

2009-04-04T05:51:00.000-07:00

With so much attention lately centered around the business of politics and what is happening on both the local scene with the Governor and the State budget process and the national scene with new President Obama and his challenges, I got to thinking................

How would things be different at Seniorsfirst if I was elected to the office of President/CEO by all the people of Rochester? The staff, the residents, families of residents, vendors, consultants, future prospective customers, competitors, peers, friends, enemies, etc. What if every 4 years an election was held and all these people decided by their vote if I was the best person for the job?

Would it change the way I perform my job? Would I alter my objectives, my priorities, my style of leadership.? I would think I would have to, or accept the fact that I wouldn't have my job very long. But would the change be beneficial for the overall organization over the long term? Or would it be aimed at meeting the needs of the most vocal, most powerful, most influential?

I like to think that my role as CEO is to balance the conflicting needs of different parties and to serve in a leadership capacity that attempts to unite the organization in a common vision and mission, despite the often conflicting and competing goods. While I always utilize the collective wisdom and perspective of those around me and my ultimate authority is controlled and accountable by a Board of Governors, I make the final decisions that set the course for Seniorsfirst.

How convenient (not to mention effective and efficient) it is that I also am able to choose my support team and create a cohesive group with a common vision and set of goals. From the board on down, everyone pulls in the same direction, and as a result, things get done!

I can't imagine how our political system can ever be efficient or effective the way it is structured. First, the CEO must run for office. Excessive amount of time and money must be spent to "spin" idealistic messages to influence support and gain votes. People who might not really understand your skills or capabilities will determine your fate based on how they think you will measure up to their individual needs and desires.

If you are elected by the masses, you then have to run your office working through groups of other elected people formed to create various eclectic teams, all of whom have different visions and objectives they desire to accomplish. We call these groups the Senate, House of Representatives and the Assembly.

Additionally, everybody has only 1 term (or 4 years) to make a positive difference and thus hopefully get re-elected. Therefore, decisions are made for short-term advantages and immediate gratification rather than the long-term benefit. If by chance you are actually able to succeed in this crazy system, you are eventually thrown out anyway by term limits.

This system has rarely worked and the proof here in New York has either been a history of late budgets or hastily created on-time budgets that are developed behind closed doors by a chosen few and then passed off on by others in the interest of political party support or sheer peer pressure. Every budget passed has been short-sighted and lacks any sense of sustainable long-term vision or goals.

So, with my apologies to our forefathers who may have developed a good system for their times, here is how I would propose we change it for the better today.

First, the people would only elect representatives to serve on a Board of Governors. These Representatives would have to adhere to strict campaign limitations and the majority of the campaign materials and process would be conducted by a Board of Elections that would provide necessary information on candidates to enable people to make informed decisions. The Board of Governors would serve in a capacity much like boards of not-for-profit organizations. They would only help establish broad-based policy, vision and goals but would not play a role in making or approving operational decisions, laws or how policies are carried out. The Board would be charged with hiring the CEO (Governor of the State or President of the Country).

In hiring this CEO, the Board and the CEO would be aligned and work collaboratively. Board Representatives would serve on various cabinet committees and work with the CEO's chosen team of staff to help support and oversee the work of the administration. Monthly Board meeting would be held to ensure that the work and performance led by the CEO was in sync with the vision, mission and goals established by the Board. The Board of Governors would serve staggered terms and would have term limits subject to re-election by the voters. The CEO would serve without limits subject to the will of the majority of the Board.

Maybe I'm just being a skeptic, but the current system doesn't appear to work very well and needs to be changed. And I don't mean we need someone new in charge. It's like trying to cut down a redwood tree with a toothbrush. It doesn't really matter who you have holding on to the handle or what strategies they employ, until you get a new tool you're not going to fall that tree.

Anyway, that's my opinion from a CEO perspective. Probably never will happen, but it makes for fun blogging. In the meantime, I'm just happy that I get to work in an environment where we all sing from the same hymnal, pull in the same direction and aim at the same targets, despite our unique perspectives, ideas and styles.

Thanks for visiting my Blog. Check back next week when we may have a final State budget passed and I will share my insights.

Seniorsfirst by the Numbers (a summary of our 2008 audited financials)

2009-03-21T07:00:00.000-07:00

As a former Chief Financial Officer, I still love the numbers and the messages they convey. Just ask my wife who has to put up with my quarterly financial statements of our personal home budget. She might even tell you her favorite story about the time I gave her a written test to see how well she really understood our personal finances. I don't know if I was more amazed at how well she actually did, or that she actually agreed to take it.

Anyway, the Seniorsfirst auditors have completed our audit for 2008 and issued audited financial statements, so I thought I would share my CEO perspective on them and give you an insiders view.

I'll start with Valley Manor.

First, the bad news.............operating revenue decreased 6% from the previous year based on a drop in overall occupancy. Our independent living apartments fell from 86% to 85% (we were at 91% in 2006 & 2005) and our assisted living apartments fell from 90% to 80% (we were 97% and 92% in 2006 & 2005 respectively).

Now, some good news.............excluding a write off of development costs in 2007, our 2008 operating expenses decreased 3%, primarily as a result of reduced variable costs associated with less occupancy. This certainly mitigated the effect of lost revenue, but still resulted in a loss from operations of $600,000. We knew this was the case and had reported the drop in occupancy and anticipated loss from operations all year round.

More bad news..........our non-operating revenue (contributions and investment earnings) took a big hit in 2008 like everyone else. The failing economy not only impacts our occupancy, but it impacts the level of contributions received from donors and took a huge bite out of our investments. While it is normal for a not-for-profit organization to subsidize operating losses with non-operating revenue, in 2008 we experienced a $600,000 non-operating loss in addition to our $600,000 operating loss. That computes to a total hit to our cumulative net assets of 1.2 million dollars for the year 2008!

Some positive perspective...........accounting standards require certain recognition of activity that doesn't always require an actual outlay of cash. In fact, our Valley Manor operations actually spun positive cash from operations in the amount of $225,000. We spent $500,000 on capital improvement related purchases and mortgage principal payments, for a net negative cash flow of $250,000. The $600,000 non-operating loss is primarily unrealized loss on market rate investments, which in theory can be recovered if and when the economy recovers.

A final perspective...........the Valley Manor fiscal operation and structure works at 90% occupancy. There is a huge upside potential if we can attain increased occupancy. We have recently initiated an "Occupancy Enhancement" program and, although it is still early, we have seen remarkable improvement in the first quarter of 2008. Our objective is to reach 90-92% occupancy which should result in an operating surplus sufficient to cover our cash outlays plus a reserve for future capital improvement needs.

Okay, lets talk about Kirkhaven and see how the failing economy impacted the nursing home business.

First, the good news................operating income actually increased a whooping 8% over the previous year. How did that happen you're probably wondering? First, we initiated a Medicare Maximization program that increased both our Medicare utilization and Medicare rate that resulted in over $650,000 additional Medicare related revenue. Second, our State Medicaid rate actually increased significantly due to a proposed new rate methodology that resulted in just over $560,000 additional Medicaid revenue (which still doesn't cover our costs).

Now, the bad news.............operating expenses increased a whooping 10% over the previous year. How could that be when inflation is running near 3% you're probably wondering? Don't we have expense budget controls? Good questions, so lets break it down and evaluate more closely. We can categorize our cost increases in 4 distinct buckets:

Benefit Costs- unfortunately, we don't have as much control over certain mandated or third-party benefit costs like pension, workers compensation, health insurance and unemployment insurance. These and other employee benefit costs increased over $400,000 or 31% from 2007.

Medicare Costs- our Medicare Maximization revenue didn't just "fall in our lap", we had to earn it. That meant investing in training, consultant fees, increased therapy, pharmacy, lab costs and staff. We earned an additional $650,000 in revenue, but our program cost investment increased our costs $140,000.

Corporate Overhead Allocations- when Valley Manor and Kirkhaven joined together under the Seniorsfirst corporate umbrella in 1999, we consolidated several back office corporate functions (executive administration, finance office, human resources, marketing, purchasing, etc.). The shared corporate overhead costs are allocated between both organizations based on specific utilization statistics. The consolidation of these now shared services has saved both organizations hundreds of thousands of dollars. In 2008, we revised the allocation percentages to recognize the reduction in utilization by Valley Manor when we discontinued or restructured several lines of business. Although we also reduced our total corporate costs, the revised allocations shifted more costs to Kirkhaven resulting in a net increase in corporate overhead costs of $60,000.

Bad Debt Allowance- it is normal for a nursing home to experience bad debts of approximately 1% of operating revenue. Historically, Kirkhaven has conservatively booked allowances for far less than this amount in some years. However, as time passes, evidence has shown that our actual experience is right around the 1% level. Based on this evidence, we booked a significant expense in 2008 to bring our bad debt allowance to a level consistent with the 1% historical experience. This resulted in a bad debt expense increase of $100,000 in 2008.

When you factor out these 4 primary cost increase drivers, the rest of our operating costs (wages, supplies, purchased services, facility costs, etc.) increased at a more reasonable rate of 3.3%. The net of all of this resulted in a loss from operations of just under $500,000.

More bad news.............similar to Valley Manor and the rest of the country, Kirkhaven's non-operating revenue did not fare well either. We experienced a net loss of $70,000 from contributions and related investment losses and a 1.6 million dollar loss related to our pension plan assets. That totals a 1.67 million dollar non-operating loss plus a $500,000 operating loss that took a 2.17 million dollar bite out of our cumulative net assets.

A final perspective...........again, accounting standards require certain recognition of some activities that don't require an actual cash outlay. In fact, Kirkhaven spun positive cash of $560,000 from operations, of which $500,000 was used for capital improvement purchases and mortgage principal payments, resulting in a modest $60,000 cash surplus. Similar to Valley Manor and other organizations, the non-operating loss on investments and the Kirkhaven pension are primarily unrealized market-rate investments, which should recover over time.

Still, Kirkhaven and other nursing homes are in a precarious position. The State budget crisis looms heavy and the likelihood is that the Medicaid rate increases of 2008 will evaporate in 2009. That will seriously challenge our revenue stream and put even more pressure on our Medicare maximization and expense containment efforts.

If all of this seems over-whelming, welcome to my world. There are days when I wonder why I bother. The challenges are huge and sometimes the regulatory and political nonsense can get to you. But I love the mission of Seniorsfirst and I even love the numbers, even if they don't always love you back. Thanks for visiting my Blog. Be sure to visit again as I keep you posted on how we survive in the "jungle".

God Bless Certified Nursing Assistants

2009-03-15T05:55:00.000-07:00

In yet another scathing "watchdog report", Friday's local newspaper carried a lead article with the headline: Nursing home Aides can put residents at risk.

The article went to great lengths to share examples of aides who have been charged with kicking, neglecting, tying up, stealing or sexually abusing residents. If that wasn't enough to strike the fear of God in people, the article went on to say that safeguards for hiring certified nursing assistants, to fully protect nursing home residents, are insufficient.

The remainder of the article went into great detail to outline a few of the worst examples to support this claim and to cast a very negative image on nursing homes and nursing assistants in general.

I don't deny that there are some "bad apples" out there, nor do I deny that the system for purging these bad apples is flawed. But please, can we stop the generalization that suggests all nursing homes are unsafe or that all nursing assistants are evil!

Here are 5 good reasons why we should:

First.... is there any field or industry that doesn't have its share of issues or problems. We live in an imperfect world where crime and criminals exist everywhere. Eventually, it will show up wherever you are: in your neighborhood, at work, in our political system, in business, at school and even at church.

Second..... can we spare some time and newsprint to talk about the many, many wonderful examples of loving care that nursing assistants provide every day. I am always so impressed and proud of the caring relationships that I witness between residents and their primary caregivers. Time and time again, we receive letters of appreciation that give accolades to the nursing assistant and how thankful family is for the love and care they give.

Third..... the work of a certified nursing assistant is one of the most difficult professions one can choose. It is strenuous work with lifting, bending and the need to be on your feet all day. Many of the residents they care for have extensive needs with activities of daily living like: dressing, toileting, bathing, grooming, ambulation, eating. Additionally, many residents have acute or chronic medical or behavior issues that complicate the care giving process.

Fourth.....society has a peculiar system for how it values individual worth and compensates ones contributions. In a world where professional athletes, entertainers, corporate VIPs can earn millions of dollars a year in salaries, bonuses and perks, the average nursing assistant earns between $20-25,000 per year where the only "perk" is earning extra income by working weekends, holidays and overtime.

Fifth.....what would we do if we didn't have the dedicated, caring individuals who have chosen to take on the challenge of being a certified nursing assistant. For these angels are the real faces of the nursing assistant. The ones who go above and beyond the call of duty. The skillful professionals who take on the challenges and work endless hours. The generous souls who give of their emotions and hard work, not for the pay but for the simple perk of knowing they are making a real difference in the lives of the residents they serve.

Thank you and God bless you Nursing Assistants!

I hope we can all remember these 5 points the next time we hear about the bad apple and that we don't allow our nursing assistants to be defined by the few, but instead by the Great!

"Recharging my Battery"

2009-03-09T16:55:00.000-07:00

I'm a firm believer in the benefit of taking time off from work periodically for rest and relaxation as well as to "recharge your battery". This past week, I had the good fortune to do just that and so my CEO Blog for this week is all about my R and R.

I started my vacation a tad early with a day ski trip to Holimont (just south of Buffalo). The weather was ideal and I managed to avoid any broken bones that would have ruined the rest of my vacation plans. After a full day of skiing, I stopped by the HSBC Arena in Buffalo to watch my beloved Sabres lose to the Anaheim Ducks.

The following day was my wife Jennifer's retirement party to celebrate her 20 years of dedicated service to the District Attorney's Office. It was a great event and the presentations and words by her peers made the evening very special for Jen and left me even more proud of her amazing accomplishments. Here she is with Mike Green (DA) and Ken Hyland (former First Assistant).

The following day, Jen and I hopped a plane to spend a week in Cancun, Mexico. We stayed at the Grand Oasis Caribbean, which is a lovely all-inclusive resort located along the hotel zone on the Caribbean Sea. We had fabulous weather and spent most of our time laying out in the sun by the pool or the sea. We both read 3 novels, worked out daily and took many long walks. The food was very good and the service was excellent. It was fairly crowded with a lot of Spring Breakers, but we usually were able to find our own little "quiet spot" somewhere among the crowd.

I was even able to watch the Sabres beat the Montreal Canadians at a sports bar in Cancun. I was the only Sabres fan among a sea of Canadians, but I had the last laugh as Buffalo won 5 to 1. We arrived home on Friday at 5 p.m. and immediately drove off to Buffalo to watch the Sabres win yet again It was a great game and a nice way to end our vacation.

I still had the weekend to rewind and get caught up before heading back to work on Monday. I admit it wasn't easy to get back into the work mode, but with a great week behind me and enough sun to hopefully carry me though March, my battery is recharged and I'm ready to conquer whatever challenges come my way.

The work we do is not easy and the challenges are never ending. I hope you all have the opportunity to take some time and do what you enjoy most. Take a trip, visit family, sleep in, read a book or two, finish a project, whatever floats your boat. But take the time for rest and relaxation and recharge your battery.

Thanks for visiting my Blog and stay tuned for updates on what's new at Seniorsfirst from the CEO perspective.

Happy 25th Anniversary Kirkhaven!

2009-02-21T11:06:00.000-08:00

It's hard to believe, but this past Friday, February 20th, Kirkhaven celebrated 25 years of caring. Was it really 25 years ago on February 20, 1984 when we began admitting our very first residents.

I remember we had a very efficient system of admitting 5 residents a day, Monday thru Thursday and then caught our collective breaths on Friday and the weekend before starting it all over again the following week. We filled up one floor at a time and within 2 months had reached 90% occupancy.

We also brought our staff on one unit at a time over the first few months, although a good percentage of our staff needed to be on the job from day one. I remember well the "assembly line" interviewing and recruitment process we put in place to efficiently hire our initial staff of nurses, nursing assistants, therapists, food service workers, housekeepers, maintenance, office and other support personnel.

And who could forget the hours of preparation writing policies and procedures, ordering supplies, training staff and readying the facility. I'm not sure how, but somehow we managed it all ................and the rest as they say, is history.

And so, last Friday we celebrated our past 25 years with a day of reflection, celebration and homage to our past. The day began with a wonderful President's Breakfast for the 17 staff members who were hired in our first year of operation and are still with us today. In addition we were joined by our first President of Kirkhaven, Phil Price and his wife Vi. What a great thrill and honor to have Mr. Price join us for this special day and breakfast.

10 of the 17 original staff pose for a group photo with President Emeritus Mr. Price

After our President's Breakfast, Paula Henry (Director of Social Work) and I presented a special rose to the resident who has been with Kirkhaven the longest. Amazingly enough, we have one resident who was admitted in our very first year and is still with us today. I'm not sure what her secret to a long life is, but she starts every morning the same............with two cups of coffee with breakfast.

Here I am with Miss Demarco and her special recognition rose

We continued our celebration with a special anniversary luncheon on all resident units followed by an anniversary cake for residents and staff. From 2 p.m. to 5 p.m. we held an anniversary Open House that featured tours, entertainment, refreshments and photo displays of both our past and future plans for the next generation Kirkhaven. Our special day ended with a dessert bar for residents, staff and visitors from 6 p.m. to 8 p.m. and all night long for our night shift staff.

Another very special occurrence that just happened to occur on our 25th anniversary, was the fact that for the first time in several years, we were at 100% occupancy. A great day and a busy week of planning.

There have been thousands of individuals (past and present staff, volunteers, board leadership and business partners) who have helped create and sustain the wonderful mission of Kirkhaven. On behalf of the organization and in my capacity as president/CEO, I thank you all and say, "HAPPY 25TH ANNIVERSARY KIRKHAVEN!

A photo display of pictures from our past 25 years

A display of our architectural plans for the next generation Kirkhaven

25th Anniversary cake

Posing with the ladies at the anniversary luncheon

Thanks for visiting my Blog this week. Visit again next week for more of what's happening at Seniorsfirst, from the perspective of the CEO.

You Gotta Have Faith!

2009-02-07T09:25:00.000-08:00

A couple of significant decisions were made this past week that certainly alter at least our near term future.

After meeting with the Town of Brighton and having good discussion on both our and their vision for the South Clinton Avenue property for which we have a contingent purchase offer on, the Executive Committee of the Seniorsfirst Board of Governors elected to execute our option to withdraw our purchase agreement within the 120 day Inspection Period. In short the Town of Brighton has recently rezoned the parcel away from allowing a nursing home operation to reside on the property and desires low density businesses to be built instead. We could initiate a rezoning application, but the process would be both time consuming and costly with a minimal chance for success.

Therefore, we will continue our site search and hope a more suitable opportunity will be found. While this development is discouraging, you gotta have faith!

The Executive Committee also discussed the Kirkhaven Replacement Project with respect to the timing of our funding and approval applications with the State, financial feasibility analysis and approaching the credit market. With such a challenging economic environment riddled with uncertainty and negativity, the Committee elected to put on hold several elements of our Project until the economic climate improved. We'll still continue with Project design and cost development, but will put the Project "on the shelf" where it will be ready to go as soon as the timing appears right.

Therefore, we won't abandon our Kirkhaven Replacement Project, but will proceed minimally and prudently until the economy strengthens. While this decision makes good business sense, it is also disheartening, but you gotta have faith!

The Development Committee met this past week and discussed its plans to engage a professional capital campaign consultant to help us initiate a major capital campaign to help raise funds for the Kirkhaven Replacement Project. In light of the poor economy, the Committee decided to postpone any immediate feasibility study and campaign on the basis that this is not a good time to be asking for additional charitable support.

Therefore, we will not immediately move forward with the planning and implementation of a major capital campaign, but will revisit the state of the economy and our campaign timing in another 6 months. While this action is an unfortunate by-product of a weakening economy, it is still an unwelcoming reality, but you gotta have faith!

The State legislature passed a 2008/2009 Budget Deficit Reduction legislation this week that initiates Medicaid rate reductions for nursing homes. Depending on which "spin" version you want to believe we either got "nicked" or "lambasted". I think it will take some more time to calculate the true damages, but my guess is that this was just the "first attack" and we survived with "superficial injuries". The real war will be waged with respect to the upcoming 2009/2010 budget reductions in the months ahead.

Therefore, the latest State budget Medicaid reductions will get absorbed into our operations on a retroactive perspective, but the prospective implications of these reductions and the budget reductions to follow will be the real challenge. The battle never ceases and the challenges never get easier, but you gotta have faith!

So while it wasn't the most encouraging week, it certainly helped to set the tenor of our immediate future and where our priorities need to be. Riding the wake of economic turmoil was not going to be easy and we knew there would be many hurdles along our journey. When faced with adversity, disappointment and challenges of this magnitude, there is only one piece of advice that I can offer. You gotta have faith!

On the lighter side of life, many of you have asked me about my skating rink challenge and goal. Back in December I decided I wanted to try and build a rink in my front yard. It took me a couple of attempts and many long, cold hours of preparation and effort. Some days Mother Nature was on my side and other days she wasn't. But you gotta have faith!

Thanks for visiting my Blog.

"The Rest of the Story"

2009-01-31T05:54:00.000-08:00

One of my all-time favorite news reporters is Paul Harvey. I loved to listen to him as he slowly built his stories from the ground up until he revealed his surprise ending with his patented closing statement, "and now you know, the rest of the story". His stories told the side of the news that the other's did not.

I was reminded of Paul Harvey this past week, when on Friday morning (January 30) the local Rochester newspaper and TV news stations ran a headline story on "2 nursing home aides charged with resident abuse"

The news story would lead you to believe that the State Attorney Generals Office, “in a series of investigation in home health care fraud and mistreatment at nursing homes”, saved the day by swooping in and arresting yet another criminal health care worker in the nick of time and thus protecting thousands of our elderly.

Don’t get me wrong, I appreciate the fact that the State Attorney General’s Office is willing to investigate and prosecute resident abuse and fraud to the fullest. Nursing homes don’t want these people working in their facilities either and always cooperate fully with the reporting and investigations of any issue they become aware of.

In the most recent case cited in this article, one of the charged nursing assistants was a result of an incident that occurred at Kirkhaven on May 5, 2007 (more than 1 ½ years ago).

Monique Jones applied for a Certified Nursing Assistant position at Kirkhaven on November 8, 2006. Kirkhaven adheres to a standard pre-employment procedure that includes: an applicant interview, work and personal reference checks, county and state criminal background checks, drug testing and status verification on the New York State Nurse Aide Registry.

She was hired on November 27, 2006 and worked as a per-diem nursing assistant. Consistent with all new hires, she attended the standard 2-day Kirkhaven orientation and a 2-week department training, which begins a 3-month “trial period”. Over the next four months, Monique received numerous in-service training offered to all staff, including “Managing Health Care Stress” and “Resident Altercation Policy & Procedures”. The latter course includes Kirkhaven’s zero-tolerance resident abuse policy.

On May 2, 2007, Monique and another nursing assistant were helping a male resident transfer from his wheelchair to his bed at 2 p.m. The file statement from the other nursing assistant reads, “the resident started kicking as we moved him into his bed and Monique said don’t you kick me and she kicked him in the left side”. This was reported to nursing administration immediately. After interviewing the individuals involved and conducting an internal investigation, Monique’s employment was terminated that day and the incident was reported to the NYS Health Department.

In short, it appears that Kirkhaven followed its standard and prudent policies and procedures designed to minimize the potential for this type of incident and to help ensure the safety and care of our residents. We take these matters very seriously and while we can never guarantee that an incident won’t happen, we do take every possible step to avoid them.

I find it frustrating that it took the Attorney General’s Office over 1½ years to make an arrest of this individual after Kirkhaven took immediate action. We did a NYS Nurse Aide Registry check on Monique today and noted that the State has her listed as “certified” and “active”. The Registry also shows that she was employed by another area nursing home just 5 weeks after her termination at Kirkhaven. The State’s system is failing!

So please excuse my frustration as I read the Democrat and Chronicle article:

http://www.democratandchronicle.com/apps/pbcs.dll/article?AID=/200901300300/NEWS01/90129026.

I don’t see the State’s system working as well as they would like you to believe. I don’t see this solely as a nursing home problem. We will continue to follow our procedures and take immediate action to protect our residents and provide quality care. But all our efforts won’t eliminate the risk that bad people do exist and unethical behavior will still occur in our political system, the business world and even in mission-based care facilities for the elderly.

All I ask is that we don’t let the actions of a few speak for the majority. I witness every day the dedication and love that goes into caring for our residents by the many hard working caregivers. The many wonderful stories and words of thanks from residents and family is the real news of the day. I invite anyone to come visit us at Kirkhaven (or any nursing home) and see for yourself the wonderful care and relationships that exist.

………….And now you know, the rest of the story!

25 years of Caring at Kirkhaven (1984-2009)

2009-01-17T06:35:00.000-08:00

I'm feeling a little nostalgic (or old) this week as I convened an ad-hoc committee of staff to develop and coordinate a 25th anniversary celebration for Kirkhaven. Has it really been 25 years already?

So all week, I've been "revisiting" in my head all of the wonderful memories, people and events that have been a special part of Kirkhaven's first 25 years. There are so many memories to recall and stories to tell that I can't do justice in just one short Blog.

In the beginning, I was the young student taking it all in and learning all I could. Today, I am the elder statesman, the story teller to pass on the Kirkhaven heritage so that future generations can understand where it all began.

I remember the day back in 1983 when I was first hired and visited the renovation in process at what was once the Pavillion Nursing Home, but soon to be Kirkhaven. My boss, Phil Price, took me through what looked like a holocaust event. He explained that the former owners had literally ceased operations in a matter of days in a dispute with the State over reimbursement rates. Residents were transferred to other facilities and the staff just left everything and closed up for good. The building sat idle for many years until the Presbyterian group led organization came along with the vision to start a new nursing home named Kirkhaven. There were books left open on counters, reading glasses on desks and rumor has it food left in the oven.

We cleaned it up, completed a comprehensive interior renovation and on February 20,1984 began admitting our first residents. We thought we had planned for everything, which was no easy task starting from scratch. We spent months working out of temporary off-site office locations writing policies and procedures, recruiting staff, ordering supplies, setting up systems. It was a blessed day when the first resident arrived via chair-mobile and was taken to her new room upstairs. Our very first admission, we were very proud and excited. Then our new admission asked for some water at her bedside. Whoops..........seems like we forgot to order water pitchers or cups!

Needless to say, we survived that first day and first week and the rest as they say is history. But it has been a memorable history.

Like just a few short months later when we were running out of money waiting for the "red-tape" to release our first Medicaid reimbursement payment. My boss and I had to present our hard-luck case and need to the Session of the Downtown United Presbyterian Church in a request for them to co-sign a bank loan to enable us to meet our payroll that same week. They peppered us with questions that we couldn't really answer very well based on our short operational history. When we left the meeting, my boss said to me, "it's in the hands of the lord now". I remember thinking to myself, " Oh great, they never taught me faith accounting in college to prepare me for nights like this". It was late that evening when I got the call that the Session had approved our request and we were still in business for another day.

Eventually our Medicaid checks starting coming and the cash flows improved to enable us to become self sustaining. We had an awesome staff who just loved being a part of something so new and special. We created a unique "Kirkhaven Way" that quickly brought us an elite reputation for quality care. There are still 17 employees working at Kirkhaven today from that initial pioneer group back in 1984. I have been blessed to have worked with so many dedicated and caring individuals over the past 25 years. Each have left their own special mark on Kirkhaven, but none so remarkable as the first president/administrator- Phil Price.

In addition to the staff, Kirkhaven's history has been shaped by the many unique and wonderful residents who have lived here over the 25 years. And amazingly enough, we still have one resident with us today who was admitted in our very first year back in 1984. We have had our share of characters and each one has touched our lives in a special way.

One of my personal favorites was a lady named Helen, who drove the staff "crazy". She was very demanding and increasingly anxious and paranoid about everything, but she loved me like a son. Whenever she had an incident, I would visit with her and calm her down. She called me "Jimmy" and is one of only a few people that I accepted that from. I remember the day staff called me to report she had her coat and hat on and was headed out into the cold to leave for good. We sat forever in the lobby just talking, until finally she said she was tired and wanted to go back to her room for a nap. I don't recall her ever threatening to walk out again.

Another of my favorites was a lady named Elsie who I "adopted" as my grandmother. We had a weekly routine where I would visit with her and help her select her menu for the upcoming week. She had an opinion about everything and always would tell me about what was right and wrong with Kirkhaven. Funny thing was, she was usually right on and became my eyes and ears of the organization from an "inside" perspective. I was so grateful that staff contacted me the evening she was dying and we enjoyed a comforting hug just hours before she passed away peacefully in her sleep.

Death is something you get used to working in a nursing home, but you soon learn to not dwell on the loss of friendships, but on the joy of having had the opportunity for the friendships. You quickly learn the value of wisdom in elders and come to appreciate what great gifts they have to share. 25 years of access to this wisdom has made me, and others at Kirkhaven, a very fortunate person.

There have been many relationships developed over the past 25 years. Board members, business partners, volunteers, donors, families, in addition to staff and residents. I guess it is obvious to say that it is these relationships that define what Kirkhaven has become and means to all of us.

As I travel back in my memory, I am reminded of the annual summer resident picnics, the resident Olympics, our first pet therapy dog Mandy, the trials and tribulations of securing our first HUD financing guarantee, the South Wing addition, the Alzheimer Unit addition, our first transport van purchase, our 10 year anniversary, Phil Price's retirement party, the creation of Seniorsfirst Communities & Services and the list could go on and on and on............

I look forward to sharing more history and plans for our 25th anniversary celebration in the weeks to come. We are planning an Open House on Friday, February 20th and several fun events to mark our 25 years of Caring!

Thanks for visiting my Blog. Be sure to visit again next week for more updates on what's happening at Seniorsfirst.

New Year Wishes for 2009

2008-12-29T16:18:00.001-08:00

As 2008 comes to an end and the start of a new year is upon us, I thought it appropriate to make a "top 10" list of New Year wishes as CEO of Seniorsfirst. To add a little fun, I included both my professional and personal top 10 wishes.........................

1) Funding Approval for the Kirkhaven Replacement Project- we need the State health department's approval and funding assistance to keep our project moving forward.

1a) Buffalo Sabres start a Winning Streak- I'm getting tired of them winning one and losing one.

2) Improved Occupancy at Valley Manor- If we can get them to give us a look, they'll see that we have the best value and life style of any independent living facility.

2a) My ice skating rink works- I've spent countless hours rigging this rink on my front yard so it better get cold and stay cold so we can enjoy it.

3) Reasonable and Manageable Medicaid Rate- the Governor is threatening more Medicaid cuts in his proposed State budget, but lets hope it doesn't turn out to be devastating.

3a) My Wife finds Happiness and Success in her New Career- after 20 years serving as an Assistant District Attorney, Jennifer is leaving to pursue other opportunities & challenges.

4) Successful Growth of our At-home Services and Adult Day Programs- these are great community based support programs that just may be the best kept secret in Rochester.

4a) Buffalo Sabres make the Playoffs- I can't go another year without them in the playoffs!

5) New York State Licensure of our Assisted Living Facility- it has been over 2 years since new regulations required us to apply for licensure, and the State still hasn't finalized.

5a) A Granddaughter- I love all 3 of my grandsons, but now I need a little girl to spoil.

6) Continued Progress with our Culture Change Movement at Kirkhaven- we have made great strides and it only gets more exciting as we continue along our Pathway.

6a) Success with my First Novel- I enjoy writing and have decided to try my hand at writing a novel. Even if it never gets published, I will still enjoy the thrill of writing it.

7) Successful Management and Maximization of the MDS Resident Assessment & Reimbursement Tool- this skill will likely become the life-blood of our nursing home operation, so it is critical that we get it right.

7a) Stock Market Bull Run- like everyone else, my net worth took a nose dive in 2008 and could really use a comeback in 2009.

8) Successful Start to our Kirkhaven Capital Campaign- our Kirkhaven Replacement project will need support from our generous donors to help with the financing needs.

8a) An Exotic and Fabulous Vacation- our vacations to Hawaii and Italy seem like a decade ago, so I think it is time to plan the next get-away.

9) Stable and Content Workforce- our staff is key to the quality of our service. Low turnover and high job satisfaction translates to high quality care.

9a) Buffalo Sabres Win the Stanley Cup- hey it's my list and I can wish for anything.

10) Happiness, Peace and Good Health for All!

10a) Happiness, Peace and Good Health for All!

Thanks for visiting my Blog in 2008 and be sure to visit me often in 2009 to keep apprised of what's happening at Seniorsfirst from a CEO perspective. In closing, here are a few pictures of the week:

Santa (me) and his helper (Jen)

Santa giving gifts to residents at Kirkhaven

Sharing some Christmas Cheer with Family

Santa has a gift for everyone

HAPPY NEW YEAR EVERYBODY!

What do "Choosing a Nursing Home" and "Buying a Toaster" Have in Common?

2008-12-18T18:15:00.000-08:00

To most people, choosing a nursing home and buying a toaster would appear to have very little in common. But apparently to the "brilliant minds" at the Center for Medicare and Medicaid (CMS), not so.

Now I must admit, whenever I am in the market for a new appliance, I always check out the Consumer Reports online prior to buying. I figure I don't buy a toaster or washer and dryer very often, so what do I know about which brand is best. Should I go with Brand X, Brand Y or Brand Z?

Appliances can be tricky you know. Fortunately, it can all be "dummied" down to a few basic elements: Features, Performance Ratings, Energy Efficiency & Cost. And then, to make it even easier for us, the Consumer Guides will assign a nifty little "star system" so all we need to do is choose the appliance with the most stars and voila, our work is done!

I'm guessing a lot of people choose appliances this way and why not. It's not very personal and rather subjective based on a series of statistical reviews and results that are formulated by some unknown technicians using data, formulas and processes totally foreign to you and me. But come on, it's only a toaster for crying out loud! If you like the color and the price is within your range, go with the 5 star toaster and don't sweat the decision.

So if this process works so well with appliances, why not use it for other purchasing decisions?Well, many of us do. But not every decision in life can or should be "dummied" down to a simple 5 Star process.

I would put choosing a nursing home in this category, but CMS doesn't agree.

CMS has come out with its own version of a 5 Star system that takes this very personal and emotional decision and makes it all very "simple". Finally, choosing a nursing home for your loved one is as easy as buying a toaster! Simply look for the home with the 5 Star rating and voila, don't sweat the decision. It's only your mother's quality of care and life for crying out loud!

Thanks a lot CMS, but wait....................could there be a flaw or two in this simple process?

For starters, the data used is not current. It is also just a snapshot of the homes data at a given time and not necessarily representative of the on-going operation. Its formula penalizes homes that have Special Care units or who care for sicker residents. The survey and clinical data is totally subjective and inconsistent. At Kirkhaven, we have greatly improved on the documentation that drives the acuity rating of our residents and ensures we are receiving the appropriate reimbursement rate for the level of care we provide. According to the CMS 5 Star rating system, this increased acuity erroneously translates to "poor performance outcomes".

The bottom line is that you can't take an important decision like choosing a nursing home and make it fit into a simple 5 Star scoring system. Consumers need to study the data that is available and use it to ask good questions. Visit the homes you are considering and talk to the staff, residents and family members. Use your senses to observe and take adequate time to review and make your decision. References from friends and professionals in the field are much more reliable and accurate than anything CMS can conjure up from their limited data and real knowledge of the home.

So, what do choosing a nursing home and buying a toaster have in common? Absolutely nothing.................unless of course you're CMS.

Happy Holidays everybody!

Our People Make the Difference

2008-12-13T06:05:00.000-08:00

I recognize that we have many customers at Seniorsfirst. Of course there are our residents and clients for whom we provide services for. In many cases, there are also family and friends that come to visit. I would even argue that the third-party payers, like Medicare, Medicaid and others are also our customers.

Everyone that we come in contact with as we go about our work and life at Seniorsfirst, represent our customers. As CEO, it is important to me that I recognize and foster excellent customer service and relations in every aspect of our organization.

In my role, I don't really provide direct care to residents and clients. Oh sure, I have periodic contact with them and practice good public relations in all my interactions, but when it comes to actually providing quality care and service, that responsibility lies with our direct care and service staff.

I'm talking about the "front-line" staff like the Certified Nursing Assistants, Home Health care Aides, Nurses, Technicians, Therapists, Chaplain, Food Service Workers, Housekeepers, Maintenance Workers, Social Workers.

I'm also talking about the "support staff" that provide the necessary infrastructure and assistance to enable the direct care staff and organization to function, like the Finance Office, Human Resources Office, Receptionists & Front Desk Staff, Security Staff, Secretaries & Clerical Office Staff, Marketing Staff, Resident Services Staff, Development Staff and Administration Staff.

My philosophy is that if I can keep our family of staff happy and joyful in their work, than Seniorsfirst will always be a happy and joyful place for our residents and clients. Sounds simple enough, but it is a challenge and something we must work at every day.

To monitor our success in this endeavor, Seniorsfirst routinely hires an outside, independent consultant to confidentially coordinate, compile and report on an employee satisfaction survey process and its results. We want to know how our employees are doing and how they rate their employment experience at Seniorsfirst.

We just recently completed the 2008 Employee Opinion Survey and the results are very impressive. We will be sharing summaries of the results with staff, residents, families and the board of directors in the weeks to come, but I'll give my Blog visitors an early peek.

At Valley Manor, with slightly more than half of the staff responding..............

89% are satisfied overall with the organization's leadership
96% are satisfied overall with the direct supervision they receive
64% are satisfied that they receive a fair wage for the work they do
88% are satisfied overall with their benefits package
94% are satisfied overall with the work environment and safety conditions
77% are satisfied overall with communication within the organization
85% would recommend Valley Manor as a good place to work
96% believe we provide true quality of care and services to our residents
81% would recommend Valley Manor to family and friends for service.

These scores far exceed industry standards (our consultant tells us) and have been attained and sustained for the past several years.

At Kirkhaven, with just under 50% of the staff responding......................

69% are satisfied overall with the organization's leadership
76% are satisfied overall with the direct supervision they receive
49% are satisfied that they receive a fair wage for the work they do
78% are satisfied overall with their benefits package
81% are satisfied overall with the work environment and safety conditions
61% are satisfied overall with communication within the organization
83% would recommend Kirkhaven as a good place to work
83% believe we provide true concern and quality of care to our residents
75% would recommend Kirkhaven to family and friends for service

These results represent great improvement from the previous year and in most cases are higher than what the national averages are within the nursing home industry. A similar survey conducted with over 200,000 nursing home employees of more than 400 facilities across the country revealed the following:

Job fulfillment satisfaction scored 72% versus 80% at Kirkhaven
Job security satisfaction scored 71% versus 77% at Kirkhaven
Supervision satisfaction scored 70% versus 76% at Kirkhaven
Work environment satisfaction scored 64% versus 81% at Kirkhaven
Pay satisfaction scored 50% versus 49% at kirkhaven
Benefits satisfaction scored 63% versus 78% at Kirkhaven
Leadership satisfaction scored 60% versus 69% at kirkhaven
Staffing satisfaction scored 57% versus 88% at Kirkhaven
Satisfaction in participatory management opportunities scored 52% versus 67% at kirkhaven
Overall satisfaction scored 65% versus 76% at Kirkhaven

The health care field is very demanding and challenging. The senior services and retirement community field is very competitive and challenging as well. But they can also be very rewarding and enjoyable for those who are called to serve their elders.

I am both humbled and proud of these results. I have great respect for the staff at our Seniorsfirst Communities & Services and pledge to continue to support them in as many ways as we possibly can to ensure their continued and improved customer satisfaction.

For we all know that......at Seniorsfirst- Our Staff make the Difference!

Thanks for visiting my Blog..................................Jim.

There but for the grace of God.........

2008-12-06T08:09:00.000-08:00

I'm feeling a little introspective today as I read the morning paper's report about the death of a friend and peer. Kevin Nacy, president and CEO of Lakeside Health System died unexpectedly in his sleep early Friday morning.

As I read his short bio, I am struck by the eerie similarities in our lives. Kevin and I were both born in 1955 and at the age of 53 neither have had any significant illness or health problems. We both resided in Irondequoit and had 2 grown adult children, a son and a daughter. I can't help but wonder if, like me, he had encountered the wonderful experience of becoming a grandfather.

Kevin and I started our careers together, when we both worked as health care auditors for Blue Cross of Rochester. We both used our audit experience to land a finance position in a local hospital. Kevin went to Rochester General and I went to Nicholas Noyes Hospital. Shortly thereafter, we both took CFO jobs when Kevin went to work at Lakeside Hospital and I at Kirkhaven.

Similarily, we both became interested in health care administration and moved up within our respective organizations to become president and CEO. Kevin and I served together on various professional boards and our career paths would often cross within the health care community.

So why am I sitting here writing this Blog, while his life has come to a sudden end?

There is no answer to that question, but one can look to the scriptures to understand that both life and death are ours. Christ has conquered all fears in life, so that in death, we can live an eternal life with God.

All we can do is live our life on earth to the fullest, in the image of God who gave us faith, hope and love. I guess I'm feeling rather privileged today and expect I will have a greater appreciation for the things in my life. Death can be an inconvenient reminder of the true meaning of life.

So the world will keep spinning and the sun will set and rise as it does every day. Life goes on and so will we. Farewell Kevin and may you live in peace in heaven. There but for the grace of God, goes I.

KIRKHAVEN- the right place at the right time!

2008-11-29T03:17:00.000-08:00

As promised, today I want to take you on a short tour of our Kirkhaven community. Kirkhaven was originally built in the 1960s as a for-profit nursing home under the name of the Pavilion. When the owners struggled to make ends meet under Medicare and Medicaid regulations, they shut down in the mid 1970s. In 1980, the building was purchased from the bank left holding the mortgage and after an extensive interior renovation, the facility was re-opened as a non-profit, faith based organization called Kirkhaven.

Kirk is the Scottish (and Presbyterian) name for church and haven meaning a safe place. Over the next 10 years, Kirkhaven added a south-wing addition to create needed space for ancillary and support services. Today, the building continues to serve as a safe haven for those who need long-term care or short-term rehabilitation, but has become antiquated in the wake of new nursing home models of care.

While we take our tour today, I'll point out some of the antiquated design and how our vision for a new Kirkhaven will transition us from a "medical model" to a "residential model" nursing home that incorporates a person-centered philosophy rooted in deep culture change.

As you enter Kirkhaven, you arrive at our reception desk and lobby atrium.

Visitors are always greeted with a smile and helpful directions by Mary Ellen or our other friendly receptionists. We have a reputation at kirkhaven for "admitting" families, not just residents. Our resident families and guests are made to feel very welcomed and become an important part of the care team and Kirkhaven family. When people come to visit or tour us for the first time, they often remark that it "just feels right".

Kirkhaven has 4 resident units, each with between 35-38 residents. The second floor unit includes our short-term rehabilitation center and the fifth floor unit is our Alzheimer and other related dementia center. In our new Kirkhaven vision we plan to build smaller "household" units of only 12 residents each to facilitate a less institutional environment.

Lets head up to the second floor and take a look.

Here residents are enjoying their mid-day meal in the dining room. It's a nice atmosphere and staff have come a long way from serving meals on hospital-like trays. Residents or family select meal choices in advance and staff develop a food preference history file that ensure residents receive what they like and are accustomed to. In our new Kirkhaven vision, residents will be able to eat whenever they desire and much of the meal will be prepared (with resident participation if desired) within their own household kitchen. There is nothing like the smell of eggs and bacon or a fresh baked pie to whet one's appetite.

Lets take a walk down the hall and peek into a typical resident room. I'll warn you in advance, however, that here's where our new Kirkhaven vision holds some desperately needed change.

Notice the typical long, double loaded corridor with no room for necessary equipment except in the hall. Everything is kept on one side per our safety policy, but like so many other nursing homes, this is a medical model design and not appropriate for home. You will find no long, crowded corridors in our new Kirkhaven households.

The resident rooms are also designed after the hospital model with side by side beds and a "privacy" curtain separating resident "A's" space from resident "B". I often say that the only time you should be assigned a roommate is when you join the army or attend college. Our elders who need nursing home care deserve their own private room. That is another vision of our new Kirkhaven community.

The rooms are tastefully decorated, clean and bright and I give staff much credit for making our residents feel comfortable in their surroundings. We have made the most of our design limitations and our residents and families often tell us that while our rooms aren't the greatest, our staff is, and that makes all the difference in the world. I agree, but can't wait until we can have it all!

As we head down the hall we cross thru the atrium that leads to the South wing where residents go for therapy, medical services, recreation events, barber & beauty shop and other services. The decor is very lovely throughout and the vast windows bring sunlight and outdoor views to all who pass by or just choose to sit and relax.

Lets go on up to the Alzheimer's unit and visit the folks there. Kirkhaven was among the first to recognize that this population could be best served in a distinct setting where the environment is uniquely designed to meet their special needs. We're very proud that upon our most recent federal inspection, the surveyors confided to us that our Alzheimer's unit was probably the best they have ever seen. In our new Kirkhaven vision, we will continue our Alzheimer's focus and dedicate 3 households to serve this need.

The large recreation area within the unit.

The central lobby within the unit.

The Atrium within the unit which includes activity space, a wandering loop & beauty shop.

Staff and residents posing in the dining room.

On all our units, the resident rooms and corridors are very similar. In the rehab wing, all our rooms are private and our patients absolutely love the feeling they get of residing in a fine hotel. Here, all their needs are met, in addition to receiving therapy services to help them return home again following an accident or elective surgery.

As we conclude our tour, I should mention some of the areas that we didn't have time to visit or see. There is the administrative and office support areas, training & education center, chapel, laundry and maintenance areas, outdoor courtyard along beautiful Park Avenue and of course our food service areas. Speaking of which, here is the food service crew on a well-deserved break in the staff dining room and a peek outside onto our courtyard area.

Well that concludes today's tour. I hope you enjoyed your visit and learned something new. I didn't mention that Kirkhaven is a 143 bed facility and employs approximately 260 employees. We do about 130 admissions a year within our long-term care units and 100 admissions a year within the rehab unit. Average age upon admission is 80-85 years old and the average length of stay is about a year in the long-term care units and 24 days in the rehab unit.

I am always cognizant of the fact that few people look forward to moving into a nursing home. Except for the short-term stays in our rehab unit, it usually means that you are losing independence and struggling with chronic medical problems.
However, I am always uplifted by the volume of testimonials and thankful comments we receive from residents and families after an admission to Kirkhaven.
The comfort, support, care and love they receive brings a sense of relief and joy to those in need. Which is exactly why we say "Kirkhaven is the right place at the right time!"

Thanks for visiting my Blog and be sure to visit again for more insight and updates on what's happening at Seniorsfirst............

It's only half a million dollars!

2008-11-22T04:09:00.000-08:00

Everything in life is relative. It simply depends on your perspective. One man's "junk" is another man's "treasure". You say "potayto", I say "potahto". Some people are willing to pay $837 for a first-class airline ticket, I'd prefer to fly coach for $288.

Maybe that explains why the CEOs of our Country's 3 largest auto-makers thought nothing of spending $20,000 to fly their 36 million dollar luxury jets to Washington D.C. to ask Congress for financial aid to help bail out their financial "hardships".

Since this is budget time at Seniorsfirst and we have been spending a great deal of time preparing and evaluating our 2009 budgets, I thought I would focus my comments this week on what a half million dollars means to our nursing home operation at Kirkhaven.

Half a million dollars is six times the cost of our planned merit and cost-of-living increase to staff. That would compute to an 18% raise for all our staff.

Half a million dollars would just about pay our monthly mortgage costs......................... for the entire year.

Half a million dollars is equal to the average annual salary of 20 certified nursing assistants. That would allow us to practically double our unit staffing on days.

Half a million dollars would pay our prescription drug costs.......................... for the next 3 years.

Half a million dollars would pay for our grocery, meat and dairy costs for the year and still have enough left over to cover our entire recreation budget for the year.

Half a million dollars would pay for our utility costs............................. for this year and next.

While it may be relative, half a million dollars is a lot of money and it is also the estimated amount of the impact of the Governor's proposed Medicaid cuts to Kirkhaven over the next two years.

An immediate 8% across-the-board reduction in our Medicaid rate followed by another 2% reduction as of April 1, 2009. Additionally, he proposes to eliminate both the 2008 and 2009 trend factor adjustment that is routinely added onto the previous year's rate to reimburse us for inflationary cost increases. To top it all off, he would also delay, reduce or eliminate several other components of our rate to generate State savings while cutting the reimbursement for caring for the needs of our most frail elders.

Maybe it's just my perspective on things, but I don't think we should give for-profit corporations "bailouts" to continue their greed-based profits, while imposing "dump-outs" on non-profit nursing homes that threaten their mission-based services.

Yes, the State has a critical financial crisis and all sectors must participate in the solution. But, if we want a Medicaid budget similar in costs to other states, lets compare what we are providing and how we can balance service levels, risk tolerance and cost. We need to first reduce regulations, mandated services, paperwork, fiscal and other reporting requirements before we can simply expect to cut funding.

If you agree, call your State Senator and Assembly Representative and let them know you oppose cuts to nursing homes without first considering concessions. Remind them that:

* Medicaid long-term care has already withstood reductions (twice in 2008) in excess of 1.7 billion in the past three years.
* Medicaid already only pays on average 70-75% percent of the average nursing home cost per day.
* A rapidly increasing elderly population requires a stable and growing long-term care infrastructure.
* Non-profit nursing homes already operate on modest 1-2 % operating margins at best.
* The State's savings on every Medicaid dollar cut is only 50 cents, due to the loss of federal matching funds and thus represents a rather inefficient "efficiency".
* We need to preserve and support our non-profit, mission-based nursing homes.

Kirkhaven's State representatives are Senator Joseph Robach (585-225-3650) and Assembly Woman Susan John (585-244-5255)....................and remember, it's "only" half a million dollars!