Meet "Imajean Resident"

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

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?

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

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.