KIRKHAVEN- the right place at the right time!

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!

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!

A Tour of Valley Manor Custom Apartment Homes

Not all my Blog readers are that familiar with all aspects of the Seniorsfirst Communities & Services, so I thought I would dedicate a few blogs to exploring more about who we are and what we offer at Seniorsfirst. So this week I decided to take my camera and me on a self-guided tour of Valley Manor Apartments. If you're interested, come on along but please don't lag behind as we have a lot of ground to cover and much to learn and see............................


Our tour starts here just outside the beautiful Valley Manor grounds on historical and eloquent East Avenue.

East Avenue is the home of many historic mansions and places of significance. The home of Kodak founder, George Eastman, as well as the Susan B. Anthony House are neighbors of Valley Manor. Within a leisurely, short stroll along the avenue one can shop at Wegmans, dine at several eateries, workout at a health club, browse the many shops, do their banking or attend one of several magnificent churches.

Our prime location is also in the heart of the Rochester culture district which makes attending a play at Geva, a concert at the Auditorium, a performance of the RPO, a visit to the Science Center, Art Museum or wherever your interests take you, a snap for our residents. Most other senior retirement homes go to great lengths to try and create activities and conveniences for their residents, but at Valley Manor they are already here in our neighborhood.


Our next stop is just inside the quaint and tastefully decor of the main lobby where staff are ready to serve and help you 24/7.

Scheduling transportation, sign-ups for events, directing visitors, monitoring facility activity and assisting residents with their needs, this is the hub of Valley Manor and our staff have customer service down to an art-form.

Let me show you a few of our custom apartment homes. Keep in mind, pictures can never duplicate the amazement of seeing with your own eyes. I am always in awe when I have the opportunity to visit residents in their unique apartment homes. Valley Manor is the only retirement community in the area that actually allows residents to customize their apartment, and boy do they ever. I'm talking moving walls, built-in bookcases, personalized amenities and more. Every apartment takes on the owners personality and is customized to their preferences and them it becomes home!

Mr. and Mrs. Sherman posing in their newly customized apartment home which they plan to move into soon.



Just one unique customization aspect of Mrs. LaBudde's new apartment home which
she began to move into last week.

A model apartment living room

The living room area and East Avenue view of Mrs. Packard's custom apartment home.

Of course, no tour would be complete without a visit to the dining room. Valley Manor residents have several meal plan choices to meet their needs and lifestyle. Whichever they choose, they always know that they will enjoy fine dining in a casual yet eloquent setting. Ivia and her dining staff are always fixing up specials and events that make each dining experience unique and Chef John is never shy about cooking up something new or an old-time favorite recipe to satisfy your appetite.

I know you'd like to stay and enjoy a nice meal, but we need to move on and keep up with the tour. Did I mention the beef tenderloin and Atlantic salmon that is on the menu this evening?

One of the key attributes of Valley Manor is it's convenient in-house amenities. In addition to all that is available just outside our doors along the avenue and in the City, we offer many convenient amenities inside Valley Manor. Our high-rise building not only offers some of the greatest views, but everything our residents need is just a short elevator ride and a few steps away. This can be very important to folks as they age and mobility becomes more of a challenge.

So you will always find the dining room, fitness center, pool, deli, mail room, post office, bank, art gallery, bistro, chapel, music room, auditorium, library, game room, therapy center, education center, computer lab, hair salon, underground parking, storage lockers, green house and more, all within easy access within Valley Manor.

Education Center and Bistro

Therapy and Wellness Center

Deli and Gift Shop

Fitness Center

Pool and Spa

Okay, please keep up with the tour guide. I know the pool looks inviting and yes it is kept at 88 degrees, but we have one last stop along our tour. Right next door on the grounds of Valley Manor is our quaint little 10 apartment Assisted Living Cottage.

Modeled after the same exquisite style of the independent apartments, these apartments are for those who need a little assistance with their care needs and activities of daily living. Here residents receive 3 meals a day, housekeeping and laundry service, supervision and assistance as needed. With an RN and aides on staff, residents and families have peace of mind that independence, safety and care needs are being maintained.

Valley Manor Assisted Living "The Cottage"

The lobby as you enter

The quaint dining room

Playing cards in the Living Room

While we're here, lets stop in at the Social Adult Day Program located inside the Assisted Living building. Here we have around 20-24 seniors who come for the day to enjoy activities, fellowship, meals in a safe and supervised environment. This is an ideal option for those who are either living alone with risk of isolation or who live with a caregiver who works during the day. We also offer overnight respite for these folks in our Assisted Living cottage.

Dining and Activity Room

Living Room and Activity Area

Well that concludes our tour today. I hope you enjoyed your visit and that you learned a few things you didn't know at the start of our tour. Our primary and best source of referrals are word-of-mouth so I'm glad you were able to join me for today's tour.

I recently met with two of our most recent new move-ins and had a conversation with them about why they chose Valley Manor. In both cases they stated the following:

1) City location near all the places they want to be

2) Ability to customize their apartment to make it home

3) The convenience and reputation for excellence of all our in-house amenities and services

4) They have friends living at Valley Manor

Thanks again for visiting my Blog. For more information about Valley Manor check us out on the web (link located to the right of my Blog) or give us a call to schedule a visit. Be sure to visit my Blog again soon when I will be hosting a tour of our Kirkhaven Community!

Riding the Wake of Economic Turmoil

As an avid water skier, I love the thrill of being pulled across the water at break-neck speed as you leisurely cut in and out and over the boat's wake. My favorite ski times are the calms of the early morning and late evening runs, when the lake water is smooth as glass and it's just you and the water, in perfect harmony, as the boat cuts an easy path for you to frolic in its wake.

I suppose there is a correlation here to how we go about the business of our work. The economy is much like the boat, in that it is the energy and engine that is needed to pull us along our way. I have skied behind smaller less powerful boats and it is not as easy. Without the necessary horsepower, it is difficult for the boat to pull you out of the water. The longer you are dragged before you reach a level plane, the more resistance you encounter and the more effort you must extend. The vast majority of falls and failures occur at this point.

It's no different in business. Without a strong and powerful economy, we don't have the economic engine necessary to pull us through the "resistance" of all the routine challenges and obligations of our business.

I have also skied on lakes and at times when the conditions are rough and the waters are whipped into massive waves by outside conditions. Sometimes the boat traffic is so outrageous that your own boat must constantly veer to the right or left to avoid congestion, confusion or collision. The water skier is left holding on for dear life and the ride becomes more about survival as you helplessly hang on and follow the boat's wake.

When the economy is whipped into a frenzy, the ride becomes a similar condition of survival. Like the water skier that needs to become more cautious and defensive to navigate the swirling massive waves, so does the business person to navigate the changing economic tides. Suddenly the fun and thrill is gone and one must be prepared to ride out the waves or suffer the consequences of a fall.

At Kirkhaven, the current economy of the State threatens once again to challenge our revenue stream with massive cuts to our Medicaid rate. About two thirds of our residents are Medicaid recipients and currently Medicaid pays us only 75 cents for every dollar we spend caring for Medicaid recipients. The shortfall must be made up by "profits" made on the private paying or Medicare covered residents. Since the private pay market is dwindling and Medicare rates are also declining, nursing homes are facing a potential revenue crisis.

The common response to this revenue crisis is to simply cut costs. The dilemma is where. Nursing homes are already operating on slim (if any) operating margins and costs are already at lean levels having been forced to reduce in response to previous revenue reductions. Two thirds of our costs are labor related and reductions in staff have a direct negative impact on the quality of care we can provide.

And what impact does the current economic turmoil have on the Kirkhaven Replacement project and our vision for culture change? Will we be able to continue funding our planning and development costs? Will we be able to find the necessary funding for our project? Will the economy support our project? The waters are getting very choppy and the ride suddenly is less fun!

At Valley Manor, we are entirely dependent on the private pay market and seniors who desire and are able to move into our retirement community. As current residents "age out" and move out to nursing homes or pass away, we are dependent on new move-ins to generate the revenue necessary to meet our routine costs. Often new move-ins are dependent on the ability to sell their existing home in order to generate the necessary capital to reinvest in their new home at Valley Manor. How will the current real estate market impact their ability to sell their home? How will the current erosion of savings and investment accounts impact the ability for seniors to make a move? How will Valley Manor be able to meet expense obligations if occupancy continues to fall? The economic wake is creating waves that are not going to be easy to handle.

Like the pebble tossed into the lake that causes a ripple effect across the water or the waves of passing boats that eventually crash upon the shore line, the economic turmoil is and will have a drastic negative impact on Seniorsfirst. Short of "getting out of the water", our only choice is to get into survival mode and "ride it out". We will not be alone, as every business will be challenged and suffer to some extent. Our strategy will be to proceed cautiously and diligently. We will move to a conservative position with regard to new expenses and hold costs down where we can, while continuing to provide our service. We will look for opportunities to save where we can and must.

We don't really know yet what the real impact of the economy and State budget crisis will be on Seniorsfirst, only that the economic engine is sputtering and in its wake the waves are growing treacherous. We can't assume it will impact others and not us. Our ride will get bumpy and may not be enjoyable, but we can hang on and navigate through it. We will certainly communicate our intentions as they are known and work together to develop any required action plans, so please be patient, supportive and stay tuned for developments.

Somewhere in the future there is another beautiful sunrise over a serene mountain lake where the water lies still, waiting for the dawn of another joyous day and the continuation of our mission and journey.

Seniorsfirst Gala and other Fun Activity

Sorry I haven't posted in a while. It has been a very busy last few weeks and my weekends have been equally busy. But welcome back and thanks for visiting my blog for an update on what's happening.

On October 15, several of our board members organized a very nice staff appreciation event at both Kirkhaven and Valley Manor. Board representatives came in on all three shifts to pass out treats and express their thanks and appreciation to the staff for all they do. What a nice expression of gratitude, which the staff absolutely loved. At Kirkhaven, the board also included with every treat bag this thoughtful poem about our culture change "Pathways & Conversity" program:

It once was just a start, but you have taken these two words and placed them in your heart. You've gone from there and learned to care in a whole new way, it's true, and you've become the REAL person that's you, as only you can do. With thanks and appreciation for all you do............from the Board of Directors.

My wife and I took some time off from work and drove down to Raleigh, North Carolina to visit our grandson (and his parents) on his 1st birthday. Dylan DeVoe is a real cutie and it is amazing how much they change in just the 3 months since we last saw him. We had a great time and loved every minute we got to hold or play with him. By the time we left, I think our little grandson loved his "ma and pa DeVoe" and we can't wait for our next visit.

Here is a nice picture of the 4 generation DeVoe boys...............................

and here is grandpa and grandma with the birthday boy.............

The following week was hectic as we made final preparations for our annual Seniorsfirst Gala. We were well prepared, but it is amazing how many little details and last minute items have to be dealt with to ensure a well run and enjoyable event. When Saturday evening, October 25th finally came and went, the Gala was a big success and all our hard work was worth it.

We had about 175 guests that started out with a lovely reception that provided a nice opportunity for fellowship and featured a display of our preliminary design drawings of the new Kirkhaven. We then had a marvelous dinner prepared by the Rochester Riverside Convention Center chefs followed by a short program. The program featured the premier showing of our new Seniorsfirst marketing video and the presentation of our 2 feature awards: Community Visionary and Ancora Imparo. The evening ended with 2 hours of casino games where guests won as much "money" as they could for chances to win great raffle prizes at the end of the night.

The Gala was very successful in that it helped spread the great news about Seniorsfirst's mission and vision for senior services and it raised $30,000 toward that end. Thank you to all our participants, sponsors and supporters. Thank you also to the staff and board who worked so hard to make the Gala another big success.

In between all this, it was business as usual as we held our October board meeting and discussed such issues as: occupancy strategies at Valley Manor, progress and planning with the Kirkhaven replacement project, 3rd quarter financial reports and investment funds performance.

We are also very busy with the 2009 budget process. All of our leadership staff have submitted their department budget requests and the finance office is compiling them along with revenue assumptions. Balancing revenue with expenses is always challenging. Balancing mission with margin is always frustrating. Balancing competing needs is always an art. Balancing the known with the unknown is often insane. In short, the budget process is a blend of art, science, data, instinct and statistical estimates, but it provides us with a reasonable road map to gauge our progress and recognize when we need to change direction.

In closing, here are some Gala pictures. Thanks for visiting my Blog. Be sure to visit again soon as I report more on our budget & finances, Valley Manor initiatives, Kirkhaven project and more!

Here I am presenting our design boards to guests

and (below) guests try their luck at the gaming tables and Larry and Jane Glazer accept their Visionary award.