Look to your leaders, not healthcare reform, to change long-term care

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Anthony Cirillo
Anthony Cirillo

There has been a lot of policy debate on healthcare reform. I have purposely tuned a lot of it out because frankly no one is saying how on a day-to-day basis it will affect the average American. In terms of healthcare delivery, the need will not change. The U.S. is ranked 37th in the World Health Organization and we are plagued with chronic conditions. We will need services across the aging continuum. And we will need nursing homes.

Consider a report released recently from the Department of Health and Human Services and the U.S. Department of Commerce entitled An Aging World: 2008. Key findings:

· People aged 65 and over will soon outnumber children under age 5 for the first time in history.

· Most countries show a steady increase in longevity over time, which raises questions about the potential for the human lifespan.

· The world's population aged 80 and over is projected to increase 233% between 2008 and 2040, compared with 160% for the population aged 65 and over and 33% for the total population of all ages.

· As people live longer and have fewer children, family structures are transformed and care options in older age may change.

As much as people want to embrace aging in place (hey, I want to live at home too) the fact is we will need long-term care facilities. And boomers will not accept them as they are today when they need them later. And even as boomers make decisions for their parents they are starting to demand more.

This brings us to person-centered, care, culture change, experience management—whatever you want to call it. 

I have some theories as to why it has not caught on and will not until we think differently about leadership. Here are some of the obvious ones:

· The bottom line is unless there is a clear correlation between pay for performance and the experience of employees, residents, and families, few will act. Carrot and stick. Will new F-tags around dignity change anything? Some are skeptical. 

· People are daunted by programs that seem to address experience management less from hearts and minds and more from hammers and nails. Renovations of facilities might be a by-product of culture change and experienced management, but it does not have to be. The thought or misperception of huge investment stops people in their tracks.

· Change. People are terrified to step out of their comfort zone. They have done it the same way for decades; why change now?

· Command and Control. The hierarchy of nursing facilities lends itself to this and people have a hard time understanding that letting go of control within context and empowering staff actually benefits everyone.

But consider this even more systemic issue: Healthcare workers are like firefighters. They do dirty jobs, look death in the eye every day and celebrate the joys of life, too—rescuing a kitten or celebrating a centenarian's birthday. So why does the firefighter culture thrive with low attrition and people clamoring to get in? Firefighters face their mortality every day and they have created a culture where they can talk about it, release it, joke about it and move on. The firehouse is their community, their home.

Healthcare workers do their job and take it home with them. When they are burned out, they leave. Firefighters are treated like heroes; healthcare workers, not so much. So part of it, in my opinion, is building cultures that recognize this and help people release the fear and anxiety. That is not part of any rewards and recognition system. It goes fundamentally deeper. 

It contributes to the notion that for many, long-term care is a job, not a career, calling or passion. That points to more fundamental issues about how our culture looks at aging.

Is healthcare reform going to aid this? No. With an eye toward squeezing dollars from the system, bottom line-motivated people will hunker down and continue business as usual.

Enlightened and visionary leadership will change the industry, however. They recognize that educating the public about aging issues is not just the right thing to do but also builds relationships and what we marketers call tipping points for choice. When they need a service like the one you offer who will they think of first?

Enlightened and visionary leadership knows that changing the employee experience will change the resident experience and people will talk about it. That's marketing. That generates future revenue. That reduces attrition. That retains the best and allows you to hire the best.

Enlightened and visionary leadership recognizes that culture change is not the program of the day, driven by more rules and regulations.

So don't look to healthcare reform to solve systemic cultural issues in long-term care. The Harvard Business Review has an excellent article on leadership, "Leadership in a (Permanent) Crisis." (See it here: http://www.4wardfast.com/wp-content/uploads/2009/08/leadership-in-a-permanent-crisis.pdf.) It contends that even when we recover from the economic downturn, new leadership must emerge or organizations will perish.

Enlightened and visionary leadership, they contend, use times like these not to hunker down but to press the "reset" button, changing the rules of the game, redefining the work, changing the organization.

Enlightened and visionary leadership will understand that empathy will assist in cultivating loyalty and an understanding that employees are not following the organization down a blind path but are helping to uncover the path with you.

Enlightened and visionary leadership realize that empowering staff with tools allows them to collaboratively solve problems. It helps creates context. That sets off light bulbs in people's heads so that they figure out how to make the long-term care experience better for everyone.

The bottom line is that trusted leadership recognizes the fragile life-and-death nature of long-term care and allows staff to celebrate and grieve and become empowered to change it, to make it better.

Don't look for healthcare reform to make this happen. Look inside yourself.

Anthony Cirillo, FACHE, ABC, is a healthcare expert, elder advocate and expert blogger for Wellsphere in the area of aging and senior health. He works with long-term care facilities and is available for management retreats and association keynotes. He is the author of "Who Moved My Dentures?" His company, Fast Forward Consulting empowers organizations to change the healthcare experience and leverage it in their marketing. In his spare time he entertains residents in assisted living and nursing facilities. To read more, go to www.4wardfast.com and www.anthonyssong.com

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