assisted living

Delivering the best customer experience

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Regardless of the industry you represent your goal must always be to deliver the best customer experience.

Bar Harbor Cruise ShipI have read and viewed many advertisements in which a company assures a future customer that their goal is to deliver the best customer service to each and every customer they serve.  This is a very commendable goal in my eyes – a goal that must be reached by every provider of products and/or services.  Whether I am a passenger on a multi-level cruise ship or a seaport’s rickety party boat;

Photo credit: www.definefishstudio.com
Photo credit: Rob Owen-Wahl

whether I dine at a casual eatery or a popular Michelin 3-star restaurant; whether I am a guest at a Residence Inn or a resident at a senior citizen housing community, you must provide me with the best customer experience you can muster.

A couple months ago, I commented on a LinkedIn article that discussed one particular goal that should be considered by long-term care (LTC) providers, e.g., senior housing, assisted living, and memory care owners and operators.  The particular goal stated in that article was to fill the buildings, attain high census, or as some industry leaders describe as putting “heads in the beds.”

My comment to this article centered on my work as a long-term care ombudsman (advocate for residents living in long-term care facilities).  I explained that when a new General Manager was hired for any of the facilities to which I was assigned, I made a point of meeting her or him to explain my role as a resident advocate and to get to know a bit about this new person who was now in charge of 50 to 100 or more residents.

I asked one particular newbie what he felt was the greatest challenge as the new General Manager for this particular independent/assisted living community.  “Fill up the apartments.”  I suggested that a more appropriate goal might be to retain the residents he already has.  I explained that retaining residents most likely means that he and his staff are doing the right thing in delivering the best care and customer service experience to each of his residents.

  • Retaining the residents he already has equates to fewer additional apartments to fill;
  • Retaining the residents he already has means satisfied residents who say great things about the building thereby attracting additional friends/acquaintances as future residents;
  • Family members of happy residents in LTC means happy adult children who will also spread the good news to others;
  • It stands to reason, therefore, that satisfied current residents are the best tool a manager can maintain in his marketing tool chest.
Dining room at my dad's memory care facility.
Dining room at my dad’s memory care facility.

I have retired from working in long-term care housing and from my advocacy work as a certified LTC ombudsman.  I know first hand the pressure that employees experience each and every month to report the right numbers to the corporate office.  The suits want the bottom line, baby, and if you can’t deliver the numbers they want and need, you’re outta there!  (Just like all the losing pitchers the Seattle Mariners have gone through in the past ten years or so.)

I’m not saying that the Suits are only concerned about profit, but I will say that perhaps their focus needs to center more on the delivery of exceptional care for those who are entrusting the Suits with the lives of mom, dad, spouse/significant other, or sibling.  Those family members want to be able to sleep at night knowing that their loved one is receiving the best care possible, the most nutritious meals known to man, and that their loved one is living in a safe environment staffed by employees who care.

All you have to to is deliver the best customer experience. Do that and the bottom line will take care of itself.

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Evil undercover: Alzheimer’s, Abuse, and the Elderly

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Alzheimer’s and the Elderly.

I’m attaching the above article from a fellow blogger.  He, like so many of us, find it difficult to fathom how anyone would take advantage of a vulnerable human being.  The very unsettling fact, however, is that incidents of abuse of the elderly occur and are far too common.

Whether the abuse is instigated by family members upon the elderly in the privacy of their home, or by “professionals” in long-term care settings such as assisted living facilities, nursing homes, or group homes – it happens.  Oftentimes such incidents go unchecked for months, or years, and are discovered only when a death occurs, or when someone with a conscience steps forward and complains to the authorities.  Those being abused either don’t have the ability to complain or they fear that doing so will make matters even worse for them.

Worse?  Residents fear that if they complain, they’ll be thrown out of the place in which they live – the place in which they receive the abuse.  I know that you and I are quick to say, “Fantastic!  What a great relief that would be if the person no longer lived with his or her abusers!”  We say that because we have not experienced what they have experienced; we have not heard the threats and vicious statements directed towards these vulnerable human beings.  These violated human beings don’t understand that abhorrent behavior is not normal because it’s all they’ve known.

These are older human beings who at one time were innocent children showing up on their first day of school; worried teenagers fretting over what to wear to the prom; young adults heading off to college and/or a career; husbands and wives, moms and dads … people just like you and me.  Now they’re nothing but broken, barely alive bodies who have been treated worse than a junk yard dog.

That makes me mad.

Dad’s last Father’s Day – June 17, 2007

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My distingushed Dad in the 1980's.
My distinguished Dad in the 1980’s.

The last Father’s Day that I spent with my dad, Don Patrick Desonier, occurred on June 17th, 2007.  That year had been a definitive year in my father’s decline from Alzheimer’s so I didn’t need to be prescient to know that his time to escape the disease was drawing nigh.  (Additionally, it didn’t help that his inoperable prostate cancer had decided to grace his body – like it needed something else to assault it.)   I would normally not leave my husband to his own devices on Father’s Day – he’s a terrific dad and deserves to be spoiled – but I knew his adult daughters would give him his due so I left our Redmond, Washington home and flew down to Medford, Oregon for this mid-June celebration with my dad.

We enjoyed a subdued Father’s Day breakfast in the memory care unit’s dining room.  My father didn’t eat all that much but he seemed to enjoy the ritual of sitting with his fellow memory-impaired friends as smiles and congratulations circled the table.

Walking with Dad in 2007.
Walking with Dad in 2007.

Those of you who are familiar with a memory care unit of an assisted living facility are also acquainted with the dearth of engaging activities therein, especially when your loved one can no longer participate in a meaningful way.  Because of that dilemma, I always took my father “off campus” to take a walk at a nearby park.  Mind you – his ability to ambulate was hindered, but we usually managed to walk the full perimeter, as we did that day.  June in Medford, Oregon is H-O-T, but like many older people whose inner thermometer doesn’t seem to be working at full power – my father was dressed in a long-sleeved heavy cotton shirt buttoned right up to the neck, and an old standby wool cardigan – one of his faves.

Part way through our walk, I somehow convinced dad to at least take off his sweater, and to enjoy some hydration from the bottled water I always carried with me.  Shortly thereafter, two 20-something year old men on bicycles approached on the path in our direction; they slowed down and before they passed us one of them uttered, “Happy Father’s Day, Sir!”  Dad wasn’t quite aware of what they said but I reiterated their greeting, “Dad, they said Happy Father’s Day to you – isn’t that nice?”  “Yes, Irene, it really was.”

Fast forward to June 16th, 2013; this adult daughter still remembers, and cherishes, the random act of kindness by those young men.  It made my day in June 2007, and it’s made my day ever since.  I’ve never forgotten your greeting, given to an old man who had certainly experienced many Father’s Day events in his 89 years.  Thank you – bike riders at Hawthorne Park, on Main Street, Medford, Oregon.  I hope you will always be on the receiving end of timely acts of kindness.

You are my heroes because you are ordinary people who did the ordinary right thing on June 17, 2007, making my dad’s last Father’s Day an extraordinary time.

My dad and I in February 2000.
My dad and I in February 2000.

Don Patrick Desonier:

March 12, 1918 – October 13, 2007

Pooped in your pants lately? How’d that feel?

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Were you eating breakfast in bed at the time? 

Or perhaps while sitting in the easy chair next to your bed, you tried your very best to ignore the urge to purge … but you couldn’t wait any longer for someone to assist you so you let it all out, leaving you in a shameful way, sitting in a mushy pile of excrement while a stream of urine puddled at the base of your chair.

Welcome to the life of a vulnerable adult living in a nursing home.  From coast to coast across the United States skilled nursing facilities (SNF) are filled with adults needing the greatest amount of assistance with their activities of daily living (ADLs) – toileting is one of those ADLs.

The following true scenarios occurred recently at a nursing home in a Seattle suburb, and at a similar facility in a suburb of San Francisco.

A handicapped toilet in South San Francisco, C...
(Photo credit: Wikipedia)

A man who is fully reliant on mobility assistance pushed the call button near his bed to register a need for assistance.  In this case, he needed to go “Number 1” and “Number 2” and had the audacity to require assistance while the staff was busy attending to other residents’ needs – but not his needs.  When a staff person finally entered his room an hour later, she did so to simply indicate that she didn’t have time to take him to the bathroom so he should just go in his pants.

A woman equally as vulnerable needed the assistance of a staff person upon waking in the morning and – knowing that breakfasts were brought around to the rooms at 7 a.m. – the 91 year old started to press her call button at 6 a.m. hoping to have her morning pee prior to the arrival of her breakfast tray an hour later.  That “luxury” was one that would not be afforded her; instead, a caregiver brought a breakfast tray to this patient in the seven o’clock hour and when the patient asked if she could receive help to the toilet prior to eating her breakfast, the employee told her to just go in her pants because no one had time to help her at that moment.

I can’t help myself – here’s another incident:  A staff person helps a woman to the toilet first thing in the morning.  The woman who is clothed in a lightweight nightgown finishes using the toilet and is ready to receive assistance back to her bed – but lo’ and behold, the staff person forgot to place the call button within close reach of the patient so she is not able to alert someone of her desire to go back to bed.  Enough time has passed that by this time the patient is shivering and screams for help – screams that went unnoticed for a quarter hour.  In desperation this elderly woman somehow managed to lean far enough forward to push over a metal trash pail which she then kicked repeatedly until someone finally arrived to see what all the commotion was about.

These stories don’t paint a very pretty picture do they?  They depict a low quality of life that no one deserves.

What does Quality of Life mean to you?

  • Eating at fine dining establishments?
  • Having a clothing wardrobe that rivals the catwalks of Paris?
  • Driving in a luxury vehicle that provides amenities previously only found in limousines?

For most of us, quality of life boils down to leading a dignified existence in which we are allowed to take advantage of the basic necessities of life.  For me, those necessities should include a safe living environment, sustenance, the inclusion of loving family and friends in my life, the freedom to make choices about matters that are important to me, and being on the receiving end of respectful behavior from those with whom I come in contact.

The most vulnerable among us should expect no less than those basic necessities, but “the system” isn’t working to guarantee those basics.  Try to imagine, if you will, your own grandparent, parent, spouse, partner, or other family member in any one of the above scenarios.  How comfortable are you with that type of day-to-day existence for them?  You’re not comfortable at all – as a matter of fact you’re feeling a bit uneasy about this whole subject matter.  I’m sorry to place doubt in your mind about the care your loved one is receiving but I’ll just bet that you need to get out of the comfort of denial you’ve been enjoying and into the eye-opening role of resident advocate.

Lack of caring = lack of care.  Nursing home management is a tough job to do correctly, but I know it’s possible because there are some reputable and well-run facilities out there – not perfect by any means, but fairly acceptable.  So yes, some nursing facilities employ stellar care staff but there are also those employees who just don’t give a damn.  “I go to work.  I go home after work.  I get paid.  What more do you want from me?”  Caring – that’s what we want.  You’ve chosen to work in this particular type of environment so don’t act like you didn’t know what you were getting into.  Withholding proper care for those who have no recourse but to depend upon you is not only unfair, but it’s illegal.  And how about answering these questions about your own aging prospects: Do you think you’ll somehow skip the journey into old age?  Do you not realize that you too will be as old as the patients whose care is entrusted to you?  What type of care will you hope to receive?  Does it resemble any of the scenarios I’ve illustrated above – or are you under the impression that you’ll be at a “Champagne and Chandelier” type of place where you’ll be waited on hand and foot?

Not gonna happen.

This article just scratches the surface of the sub-standard care that can be found in nursing facilities.  I only mention the toileting issue because it’s been front and center in my experiences with some of my acquaintances lately.  One place to start getting some positive traction where these matters are concerned is the National Long-Term Care Ombudsman Resource Center where you’ll find links to advocacy programs in your state.  Call those local representatives and report any concerns you may have about how your loved one is being cared for, or not cared for, in their nursing facility, assisted living facility, or group home.

If you act on behalf of your loved one, you’re also acting on behalf of everyone else in the facility because trust me – your mom isn’t the only one being neglected on her nursing home floor.

The Sunday Family Visit at an Assisted Living Facility.

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Another Sunday Family Visit at the Assisted Living Facility.

This article, written by a fellow blogger, is beautifully descriptive and paints a clear picture – not just of the visual scene – but also of the emotions that exist in those who step into the world of their loved one with Alzheimer’s and other dementia.

The two poignant themes that resonate with me are: the development of resident boyfriend/girlfriend relationships within a memory care community; and the wonderful interaction between a great-grandson and his great-grandpa with cognitive difficulties.

I honor this blog author and her family for choosing to integrate a youngster into what could be a scary or challenging environment for a child.  One of my articles, “Alzheimer’s Heartache: young family members adjusting to a grandparent or parent with dementia,” addresses the difficulties that families oftentimes experience in long-term care (LTC) settings.  I can see that this family already figured out how to soften the hard edges to make the visiting experience beneficial to all.

Seattle Times: Seniors for Sale, Part 6

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In yesterday’s post, a Seattle Police Detective defined elder abuse as:

  • sexual abuse
  • physical abuse
  • financial exploitation
  • neglect

In Part 6 of Seniors for Sale: Placement perils and successes, Michael Berens, Seattle Times reporter, delves into the senior housing placement industry, focusing on one placement company that placed a client in a Tacoma-area Adult Family Home (AFH) with a history of safety and health violations – elder abuse –  even a fatal event, but because the placement company had not done its research, it was not aware of the home’s previous infractions and kept placing unknowing vulnerable adults in the home’s care.

Many of these placement service companies operate state-wide and/or nation-wide, and believe that there is no way that they can help as many people as they do if they are required to visit each and every home/assisted living option available to the public that they are trying to assist.  These companies are oftentimes characterized as Bed Brokers – an industry that is growing exponentially without much scrutiny or State controls.

CAVEAT: Just as in every assisted living situation – there are good senior housing options and there are bad senior housing options – so too there exist reputable senior placement companies, and not-so-reputable placement companies.

I personally think that these companies can be helpful to those looking for a senior housing option that suits their, or their loved one’s, needs.  I caution those using these agencies, however, to understand that not every option out there is listed with placement companies.  If a senior housing company does not choose to be listed with a placement service company, that option will not be offered, even if that particular housing option might be the very best choice for some families: cost-wise, location-wise, and even service-wise.

In a news update, Michael Berens’ article, State gets tough on referrals for elder care, we see that attention is now being directed at these placement referral companies in the hopes that those they serve – vulnerable adults in need of some sort of daily care – are protected from those companies who are simply aiming to make a profit at the most vulnerable time in an elder’s life.

As I mentioned in previous articles found in my blog category, Senior Housing, there are numerous resources available for those looking for senior housing for themselves or a family member.  Please go to that category and type in a search term in the space located on the right-hand side of the page to find the topic that interests you most.

Seattle Times: Seniors for Sale, Part 5

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Part 5, of Seniors for Sale: Hiding Harm: the human toll, is one example of the lack of reporting that goes on in some assisted living residential settings – in this case – an Adult Family Home (AFH).

When you watch the video link above, you’ll be shocked at how a particular accident happened – and its after effects on the victim –  and you’ll be horrified at how long it took before it was reported to the police.

Perhaps this statistic will provide a partial explanation:

only 16% of all incidents of elder abuse are reported.

The Seal of Washington, Washington's state seal.
The Seal of Washington, Washington’s state seal. (Photo credit: Wikipedia)

Not only are many caregivers not reporting incidents of abuse that occur; surprisingly, family members fail to get beyond the denial stage when they discover that their loved one just might be in danger in the very location entrusted to his/her care.  They can’t believe that the caregiving solution they found for their loved one has turned out to be disastrous in every way.

The police investigator for this case states the following:

We don’t tolerate domestic violence, but that’s not always the case with elder abuse.

The final episode of Seniors for Sale will be submitted tomorrow, Saturday.