Imagine finding two bags with thousands of dollars in it. Then consider returning them to a nursing home, the rightful owner. That's what Barry Stringer did, and news of his good deed has stretched far and wide.  

Steven Yokley, administrator of NHC Healthcare, said the act reaffirmed his faith in other human beings.

“From my perspective, to know that in a world today when you only hear the negative things that occur, there's lots of positive people who do the right thing,” observed Yokley, who runs the 211-bed nursing home in Dickson, TN. (A total of 191 beds are skilled; the rest are assisted living.) He spoke to me this week from his facility, which is about 45 minutes from downtown Nashville. 

In case you have missed this “feel-good” story, about two weeks ago, Stringer, a dental assistant, found two green deposit bags of cash and checks on the ground outside Yokley's facility. He returned them the next day.

“I knew what I was going to do with them as soon as I found them, even before I opened them,” said Stringer, according to The Dickinson Herald newspaper.

After finding the bags, he took them to the bank. When he found the bank closed, he called the facility the next day and spoke to the bookkeeper.

“I asked her, ‘Did you lose something yesterday?” Stringer told the Herald. “She said, ‘Like what?' I said, ‘I don't know, you tell me.' She said, ‘Yes, I lost something yesterday.” I told her I found it and she was just hysterical about it.”

There's a good Samaritan for you.

So what, you may be asking, was all this money—$200 in cash and $71,800 in checks, according to Yokley—doing on the ground? The employee who was supposed to take it to the bank had left it on the top of her car and drove off, Yokley said. The facility noticed it missing within the first five minutes.

Oops.

Yokley, speaking about the incident, did not seem fazed, despite the publicity it generated.

“It was an honest mistake,” he noted. 

Of course, it must not have been easy for the facility to go 20 hours without knowing where thousands of dollars from operations were. But because most of the money was checks, Yokley said he was not too worried. The facility was following policies to protect the deposit. The only real loss would have been $200, he explained.

But when Stringer returned the money, “we definitely showed our appreciation to him,” Yokley said. “He's a very humble gentleman.”

Stringer did not receive a financial reward, but he knew the facility was grateful, Yokley said.

Of course, the news, which has spread nationwide, also must also be a kind of reward in itself.

Stringer should bask in the media hype. Not everyone would have been so honest.

Watching a resident jump out of an airplane. Seeing a resident die holding her loved ones. Improving the dining experience at a community. These are some of our readers' most memorable moments. Read on to see why.

A few months ago, we ran a Reader Poll question (see the bottom of the McKnight's home page for the latest one) on readers' most memorable moments in long-term care. I was deeply moved by the answers we received.

Here's a sampling (you may want to grab a Kleenex):

Watching a resident fulfill his wish of jumping out of “a perfectly good airplane” was one of Raymond Prudencio's most memorable moments.

“The moment occurred simply because the employees at our facility cared enough to ask a resident the question, ‘If you could do anything in the next month, year, whatever … what would it be?' And the response from him was, ‘Skydive,'” said the administrator of The Terrace at Fleming Island, in Orange Park, FL.

“The joy felt that day by everyone from the resident and skydive instructor to the director of nursing and activities director was incredible and what life in a nursing home should be about—making the most of and enjoying the time we are given on this earth.”

And then there's the story about a beloved 101-year-old resident who died in a most dignified way:

“The family was keeping a watch and didn't want her to be alone when she went to heaven, so two of her granddaughters were staying the night with her,” recalled Tracey Mayén, director of social work at Conesus Lake Nursing Home, in Livonia, NY. “At one point we went in to check in and see how things were going and one (adult) granddaughter was lying in bed with her and the other was lying across her lap.

“Family to them was the most important value in their lives and this resident went to heaven just like that, holding two of her babies, knowing that they will all be OK. This was the most perfect end to her journey on Earth, and my most memorable moment in our home.”

Now do you see what I mean about the tissue? Here's a couple more that are sure to make you sigh:

Dawn Ciokan, director of clinical services at Century Care Management, was overwhelmed by the experience of creating a “fine dining” experience for residents in geri-chairs.

“Tables were placed to allow room for the geri-chairs, linen tablecloths and napkins were used as well as having flowers on the table. The night we initiated this was like opening night at a fine restaurant.

“We came up to a resident who had been at the facility for over 10 years and of that time, the resident had been in a geri-chair for eight of those 10. I leaned over and asked her what she thought about the dining room. She looked up at me with big tears in her eyes and said very softly, ‘This is the first time in a long time I have felt like a real human being. Thank you for making all of us feel special.'”

Finally, Sondra Eppard, a long-term care administrator in the greater Denver area, was overcome with emotion after she learned that a deceased resident had left $10,000 to employees in 2008.

“I was completely overwhelmed with joy and happiness,” she wrote. “When the check was presented to me I cried.”

You know those MasterCard commercials about priceless moments? I don't think you can put a dollar amount on these experiences. And it takes a caregiver to really understand that. 

*Check out these and other answers to the Reader Poll question on memorable moments in the upcoming March issue of McKnight's Long-Term Care News.

My how things change. Just a month ago a healthcare reform bill seemed en route to passage. Now its very existence is in question and, by extension, some key long-term care services are too.

I have been reminded of the precarious state of reform as the therapy caps issue has resurfaced. The Medicare Part B caps, imposing a $1,860 limit on physical and speech therapy, and a $1,860 ceiling on occupational alone, took effect at the beginning of the year. Thousands of nursing home residents are at risk of bumping up against the caps.

This, of course, would not be the case if a bill passed. The healthcare reform bills contained provisions extending an exceptions process that exempted most skilled nursing residents from the limits.

Three senators stressed the need to delay the implementation of the caps in a letter this week to Department of Health and Human Services Secretary Kathleen Sebelius.

Sens. Blanche Lincoln (D-AR), Charles Grassley (R-IA) and John Ensign (R-NV) told the secretary they are concerned that enactment of the caps “is causing undue hardship on Medicare beneficiaries, particularly for those who are recovering from a stroke or a debilitating injury such as a hip or joint fracture.”

A “national provider” reported that more than 1,000 of its patients had hit the cap as of Feb. 1, and several more thousand could reach it by Feb. 28, according to the senators.

Of course, if nursing home residents exceed the caps, they could be forced to go to hospital outpatient settings, which are not subject to the cap. If that is not possible, nursing homes may have to pick up the tab. And the worst-case scenario: Residents would go without therapy.

This is troubling. It's also a reminder of the adage, don't count your chickens before they're hatched (or rehabbed, as the case may be).

That old saying certainly rings true in Washington today.

[Photo: Pinecrest residents and former caregivers Caroline "Dolla Crnich (left) and Hazel Rochon are participating in the walk for healthcare assistants.]

Administrators, don't be alarmed if you notice pedometers around your facilities. Starting today, more than 800 frontline caregivers and their supporters have started to log miles for “Stepping Up for Quality,” a fund-raiser sponsored by the National Association of Health Care Assistants.

This first-time event aims to raise awareness of the hard work of certified nursing aides—those long-term care workers who are often overlooked and underpaid. 

“We try to encourage [CNAs] to be advocates on behalf of their profession, but a lot of them don't have the opportunity,” Lesley Collins, NAHCA's director of strategic initiatives, and event coordinator, told me. “We empower them to speak on their behalf. This walk allows them to do that.”

The event is modeled after the American Cancer Society's Relay For Life, and similar fund-raisers. During the month-long walk-a-thon, participants are accepting pledges—either flat payments or per mile for what they walk while working. Walkers, who wear pedometers to track the number of miles they walk, include everyone from CNAs to their directors of nursing to friends outside of the facility. The money will go to the Academy of Certified Health Professionals, the nonprofit arm of NAHCA, to support educational opportunities for CNAs.

The event has generated excitement at facilities and communities around the country. Longtime CNA Deb Pitts of Pinecrest Medical Care Facility in Powers, MI, has signed up 159 people. Most are employees. About 75 are CNAs.

“There's been a lot of positive feedback,” said Pitts, who is an officer on the NAHCA National Steering Commission.

Facilities are using the walk-a-thon as an opportunity to promote wellness and other causes. The idea has prompted the administrator at Pinecrest to do an employee run for wellness, Pitts said. Employees at a facility in Galena, KS, are going to be hitting the walking track more often during the month of February.

Meanwhile, the Missouri Veterans Home in Warrensburg, MO, is walking for fallen heroes.

“Everyone's kind of put their own spin on it and have embraced it and made it theirs,” Collins said.

In some cases, even residents are “stepping up” for quality. Three examples are Caroline “Dolla” Crnich, Hazel Rochon and Daisy Smith. All are residents of Pinecrest—and former nurses and CNAs. Crnich and Rochon actually worked at Pinecrest.  

“I worked with them. Now I'm taking care of them, said Pitts, who has worked at the facility nearly 38 years.

That sounds like reason enough to put on those walking shoes.

It's not too late to walk or give money. Those wishing to participate or donate should visit http://www.nahcacares.org/sufq.htm.

[Photo by Talia Frenkel/American Red Cross]

They are not all touting their good works, but many long-term care communities and their vendors are providing valuable relief to disaster-stricken Haiti.

The organizations are great and small. Here are a few examples among many:

The Beth Abraham Family of Health Services in Bronx, NY, has donated $7,000 worth of supplies, such as gauze, bandages, canes, wound supplies, aspirin and non-perishable goods, according to Peter Fragale, senior vice president, chief human resources officer. Its linen service producer, Unitex, has donated about six palettes of linen supplies. Employees also have contributed box loads of non-perishable items, Fragale said.

The initiative began when the president sent an e-mail to employees at Beth Abraham, informing them the provider will provide as much help to the country and those affected in the organization as it can.

Besides the monetary and supply donations, the organization has acted on a personal level, Fragale said. He and Chief Operating Officer Clari Gilbert, who is from Haiti's neighbor the island of St. Vincent, toured each of the four nursing homes that make up the Beth Abraham Family and consoled their Haitian workers. The organization continued to pay the salaries of two workers who went to the battered nation to help. (See blog entry from Tuesday.)

Such an outpouring of support has overwhelmed the workers, Fragale said. Many posted the president's e-mail on doors and walls.

The effort reflects the spirit of the organization, Fragale said.

“We're a healthcare organization and that's what we do. We care about people,” he said.

Other good works

Here are other stories of charity in the long-term care field:

— Immediately after the earthquake, Jewish Home Lifecare/Sarah Neuman Center in Mamaroneck, NY, donated 300 mattresses to the AFYA Foundation, which obtains and ships vital supplies to support medical and surgical needs worldwide, said Harriet Rosenberg, director of Public Affairs and Media Relations for the organization. Trustees also have donated $5,000 to the American Jewish Joint Distribution Committee from the Fund for the Aged, she added. Jewish Home Lifecare has 3,561 employees. A sizeable number are Haitian, Rosenberg said.

Staff and tenants also are collecting donations. Social work staff members also are providing counseling to members.

— On a larger scale, the International Association of Homes and Services for the Ageing (IAHSA) is reaching out to Haiti through its partner HelpAge International (HAI).

“HAI is the only relief and development organization focused on the needs of older persons in developing countries and has had a presence in Haiti for eight years,” according to a member letter from IAHSA, an affiliate of the American Association of Homes and Services for the Aging.

— The Assisted Living Federation of America also has established a relief fund to provide financial support to Haitian employees of senior living companies.

The executive committee established the fund with a seed grant of $10,000 from the ALFA treasury.

“Senior living companies rely upon the professionalism and commitment of Haitian employees day in and day out,” said Richard Grimes, president and CEO of ALFA, in a statement. “This is the least we can do to relieve some of their anguish over the loss and suffering of their homeland.”

It's worth noting that Haitian staff across the country are continuing to come to work, despite not knowing the fate of their family members in Haiti. That is dedication.

A few charities offering relief to Haiti are mentioned above. See a list of other organizations accepting donations at AAHSA's “The Future of Aging” blog. 

Feel free to let McKnight's know about what you are doing to help your Haitian employees and the country of Haiti.

[Photo by Matthew Marek/American Red Cross]

Seeing the devastation in Haiti “was emotionally destroying for me,” said Ginette Sangosse, assistant director of nursing for the Beth Abraham Family of Health Services in Bronx, NY. Sangosse, who grew up in Haiti, returned last week to provide medical care.

The earthquake that rocked Haiti has also affected the U.S. nursing home community, which employs large numbers of Haitians. Two medical professionals from Beth Abraham, Sangosse and Dr. Yvonne Jean-Francois, recently traveled with Haitian organizations to help.

Sangosse, who has lived in the U.S. for more than 40 years, spent a week—from Saturday, Jan. 16, to Friday, Jan. 22—at the hospital in Port-au-Prince.

There in the capital city she witnessed “the complete destruction of the town I knew so well,” she told me.

Buildings had crumbled. She saw several dead bodies in the street.

“A lot of us could not stop crying and it was very hard,” said Sangosse, who traveled with the organization Association of Haitian Physicians Abroad.

The hospital where she worked the night shift was missing equipment, personnel and supplies. There were times when the staff worked in the dark, she said.

Working 16-to-18 hour days, she delivered babies, performed wound care services and delivered food and drinks. Nearly all of the patients were amputees “with big wounds and a lot of pain also,” she said.

“I had never seen things like that before because people were crying because they were in pain,” she explained. “They didn't know where their loved ones were.”

She came with 54 other nurses and doctors. They helped establish a post-op ward. When they arrived, there were not enough nurses to take care of the post-op patients and the wounded had just spent a night by themselves. 

More people were working outside the building, she said. Many of the patients, who had been evacuated, did not want to return to the hospital for fear of another earthquake.

Despite her sadness, she also felt proud how well patients behaved at the hospital. No one was looting, she said.

Now that she is back, “I am more depressed … because at least while I was there I was able to help,” said Sangosse, whose great-great aunt, 98, died during the disaster.

She plans to return soon to the area where she received her First Communion and where her mother's childhood house stood.

“Words cannot describe how I felt,” she said.

Stay tuned for more stories of outreach from the nursing home community to Haiti.

Larry Minnix sounded weary but determined. The CLASS Act may become a casualty of healthcare reform, but it is not going away, the head of the American Association of Homes and Services for the Aging assured me Wednesday.

Minnix, whose organization has become a leading backer of the legislation, suggested that the plan, which would provide a cash benefit to workers who become disabled, will live even if the current healthcare bill doesn't.

“We're not going away; we're just going to regroup,”  Minnix said by phone from Washington.

Democrats were dealt a major wallop Tuesday when Republican Scott Brown defeated Democrat Martha Coakley in a special election for the open Senate seat in Massachusetts. The outcome resulted in more than a loss of a seat. It has taken away the party's 60th vote to pass healthcare reform. It is not clear what, if any path, the party will take to pass its package.

If necessary, AAHSA will form a new CLASS Act-type plan with the 200-something organizations supporting it and lawmakers, Minnix said.

“We're not without advocate friends or friends in Congress,” he said. “We may go back and see what could be done on a more bipartisan basis.”

The problems that led to the proposal still need to be solved, he insisted.

“Long-term care has got to be funded differently and Medicaid has got to have some relief, and the CLASS Act does both,” Minnix said. 

It can't be easy for Minnix and the rest of his conscientious team to see their work of the last several years begin to smolder along with the rest of the hard-fought provisions for long-term care and healthcare.

But Minnix, with a hint of defeat in his voice, said the organization and partner organizations should be proud of what they accomplished. The provision made it into both bills and won the support of the president. 

“I don't know what else we would have done,” he said. “A year ago, no one would have given us a chance at getting it done. The thing I can't control is voters in Massachusetts.”

How right you are, Larry.

Silver lining?

Meanwhile, one long-term care expert is seeing the current crisis facing healthcare reform as a positive development for long-term care.

Steve Moses, president of the Center for Long-Term Care Reform, feels like the new setback for the legislation offers Congress a chance to establish a better long-range Medicaid plan for the field.

He recently published a document called  “Doing LTC Right” in conjunction with Rhode Island's Ocean State Policy Research Institute.

The report points out the major problems right now with Medicaid, such as the program's somewhat lax rules regarding financial eligibility. In a nutshell, according to the report, the program is losing money because people who have the means to pay for long-term care are using built-in exemptions to join the Medicaid rolls.   

The program also examines the benefits of Rhode Island's long-term care “global Medicaid waiver.” The waiver allows the state to provide more home- and community-based services in exchange for a five-year cap on federal funding.

Taking several steps could improve the waiver program and make Rhode Island a model for the rest of the country, the report says. These include targeting those who truly need Medicaid, expanding estate recovery, imposing more stringent rules on Medicaid eligibility, encouraging people to use long-term care insurance and other private means to pay for long-term care, and educating people about long-term care planning.

It is an interesting analysis. Those who are serious about finding answers to the long-term care and Medicaid problems would be wise to read it.

The buzz among long-term care providers today, as expected, is the upset in the Massachusetts Senate race. How healthcare reform will play out now is anyone's guess.

To say Tuesday's defeat of Republican Scott Brown over Democrat Martha Coakley has thrown a monkey wrench in the works of reformers is an understatement. A cannonball may be more like it. The Democrats have lost their crucial 60th vote, and therefore, their filibuster-proof majority.

Of course, the dramatic irony is that the new senator, who campaigned on blocking healthcare reform, is taking the seat formerly occupied by the liberal healthcare reform champion Sen. Edward Kennedy.

That the election may is a referendum on the president is arguable, but there is no question that it has jolted Congress about its plans for reform.

“Obviously, the election of Scott Brown brings more questions to the table as to how the administration and Democratic leadership will pursue healthcare reform,” said Susan Feeney, spokeswoman for the American Healthcare Association.

Commented Larry Minnix, president and CEO of the American Association of Homes and Services for the Aging: “I think it puts healthcare reform in a very tight place. There are major things in the bills that could help a lot and, in that respect, it certainly makes things difficult because we thought we were close to a bill. It's disappointing, but the needs and objectives are still the same. There's hope that something will get done.”

Minnix, whose organization has been leading the charge for the Community Living Assistance Services and Supports (CLASS) Act, is hoping that the House will adopt the Senate's version, for the sake of expediency.

Otherwise, it could be back to the drawing board for healthcare reform—and many major provisions, including the CLASS Act, a stronger Medicare commission, nursing education grants, an expansion of Medicaid, transparency requirements and millions of dollars in Medicare cuts. 

Meanwhile, among the thousands of pages of reform legislation is language extending the therapy caps exception process, which expired at the end of the year. Providers have been depending on passage of the bill to resolve this problem.

It appears they will have to wait some more.

A new phrase appears to be emerging in the lexicon of long-term care. That phrase is "long-term services and supports." (Notice the omission of the word “care.”)

The language has received widespread attention as a result of the healthcare reform provision known as the CLASS (Community Living Assistance Services and Supports) Act, which addresses some of the overlapping needs of the long-term care and disability communities. Advocates for the disabled are directly responsible for two key terms in the word CLASS: "services" and "supports."

“In the disability community, long-term care is synonymous with nursing homes,” explained Lauren Shaham, director of media relations with the American Association of Homes and Services for the Aging. “What they have been arguing is disabled people need supports to facilitate independence.”

The phrase now seems to be resonating with AAHSA and other advocacy groups. It certainly fits with the mission of AAHSA, which serves home- and community based care organizations, as well as nursing homes.

Aging people “still want the same kind of independence and choice that has been the mantra in the disability community for years,” Shaham noted.

The National Council on Aging also has taken to the term because it connotes a broader range of services for older adults.

“We don't just mean care,” said Jim Firman, president and chief executive of the council. “We mean services and supports.”

NCO is so serious about using the phrase that “long-term care” is now taboo there. Offenders have to pay a quarter when they use it as an incentive to break themselves of the habit, Firman said. 

The new terminology is important to unite the long-term care and disability communities, he believes. Firman remembers a few years ago when there would be three different bills from three different groups: seniors, long-term care and the disability communities.

“None of the groups realized they were talking about the same thing,” Firman said. “Language does matter in terms of uniting the consumer constituency around these issues.”

The terminology arguably reflects a new way to think about getting older and the living options that are available. To the extent it makes people think more positively about the spectrum of aging services, I, for one, hope the phrase sticks.