Different Perspectives & Perfect Imperfections

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

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:

1. 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.


2. 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.


3. 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.


4. 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.


5. 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".


6. 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.


7. 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.


8. 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.


9. 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.


10. 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!"

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

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!

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!

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

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