Those People Have Nothing But a House

Success is about So Much more than a Well Decorated Structure

The quote referenced above, "Bruce, those people have nothing but a house" was among the embarrassing comments a family made to me after I sent them to meet operators of an assisted living program in SE Michigan. My office supplied the family with a list of items we recommend shoppers of assisted living services pay attention to along with questions to ask the program operators. This family followed our outline.

Unfortunately this family did not receive the answers they were looking for. Instead they labeled the owners as care oblivious, overly money focused and ill-equipped to manage the care of an elderly person. One home administrator asked the family: "how much can you afford?" instead of providing a fee chart. Thankfully we gave them three, (3) programs to visit and one, (1) was selected to serve our client.

The entire experience reminded me of the sad state of affairs in which the adult foster care community finds itself in the State of Michigan and why a total overhaul is necessary to create lasting, comprehensive initiatives which can serve the aged and catastrophically injured in credible, clinically adept, community based settings on into the next generation. To do so we must get beyond the confidence associated with the "we have a nice house" mentality.

How did we arrive in such a shameful and ineffective place? Adult foster care goes back a long ways. My late Uncle Larry Hughes lived in a state financed facility as far back as the 1950's when he was unable to readjust to society after his return from the Korean conflict. I recall my mom stating how much she hated the place and eventually my late Aunt Ruth took him in with her for the next several decades. Uncle Larry died in 2002; my Aunt Ruth in 2007.

During this same period a boon occurred with tons of people licensing homes to serve the mentally ill with state and federal dollars. Licensing standards with no real emphasis on clinical preparedness continue to be a contributor to a lackluster system.

Eventually in an effort to promote choice and a better system of monitoring services, the Managed Care Provider Network came along with a fee for service model whose clinical aptitude remains questionable in the minds of many today. The eventuality was over capacity, budget stretches, provider disgust, adult foster care homes being developed in a conglomerate mode by profit-seekers without realistic and comprehensive programmatic goals and worse.

Today, several years later there appears to be no clear sign of significant change on the horizon although some close to Michigan Governor Rick Snyder cite his desire to see change in how services are delivered to the mentally ill and developmentally delayed. If the buzz holds true, changes will include more oversight over county management of mental health dollars.

I feel the need to be clear. It takes money to manage a residential program which serves delicate, often aggressive and seriously behavioral populations. Operators deserve to be paid.

However, I also believe there are too many in the business who are not 'quality of life' focused. This includes those who formerly housed a young catastrophically injured man whose care I have influenced. He phoned me not long ago to tell me he is not being fed enough. Can you imagine receiving $400.00 per day to care for someone and a request for an extra sandwich is treated like a burden?

Add to the list those who in my opinion would prefer to be well meaning people but whose sole focus appears to be on the quality of their furniture, how many televisions their home has or maybe how clean they manage to keep it. When I inquire about the sophistication of their recreational therapy program, activities program, physical rehabilitation initiatives, nutritional approaches and more I get a blank stare. To some these are secondary concerns, after all, they have a nice house; right? What a tragic approach to care delivery!

To really succeed in assisted living, especially with so much attention being placed on poor quality (and I have every intention of increasing the pressure) we must give attention to much more than how nice the home is. We need to be focused on the clinical, spiritual, psychological and emotional concerns of every person placed there.

A new class of assisted living pragmatists takes a highly person-centered approach centering around four, (4) key principles I developed called the G.A.I.N. Initiative:

1. Gather as much information as possible on family background
(This only works for the unselfish operator since you have to take a personal interest)

2. Assist in adjusting to less independent lifestyle
(This only works for the 'people focused' since we care about the resident's ability to adjust and their daily comfort level in the new assisted living environment; not just how soon we can generate an invoice)

3. Invest into re-creation of previous environment with a focus on comfort and peace of mind
(This requires a spiritual approach on the part of owners. In order to re-create portions of a person's previous living environment you have to care enough to learn about it)

4. Never stop the effort to heighten customized approach to care
(This is a customization issue; looking, listening, learning daily about the new resident's idiosyncrasies and teaching your staff the value of doing the same. You cannot serve me until you know me!)

I teach these principles in our sister company's Critical Skill Class and no trade association, no industry group is doing the same; a key ingredient in taking assisted living to the next level.

Sadly, as long as I hear of homes which tell residents, "no you can never live independently", - regardless of the legitimacy of the resident's preparedness to move on to different circumstances - solely so the home can minimize loss revenue, we have not arrived. All that is being promoted is "resident discouragement". Is this what you are in business to accomplish? You deserve to be paid, but not at the expense of real person-centeredness.

Now add the other home which opens a resident's mail and keeps income for itself even if it does not belong to them. For them it's live now and "worry about the consequences later." Yes the adult foster care community is loaded with thieves, the angry and unprepared.

I am not alone. The no-fault insurance community has also grown tired of the chicanery and is demonstrating it through a surge of new lawsuits. Yes some re-creation must involve litigation!

Real soul searching and an open mind can lead you to determining if you belong in any aspect of care delivery. These attributes can also help you to determine if your arrival in care is solely based upon the simplicity associated with getting into the business, even though you have no real commitment to the individuality of those you may be called upon to serve. Laundromats, party stores and car washes also make money.

Think about it. For some there may be only one solution: Get out now! Let those of us who are committed to quality of life persevere on into the next generation.

Thanks for allowing us to share.