Be a partner with your community.

The responsibilities of long-term care managers do not end at the facility's walls. There is an external environment--the community--that requires as much attention as do internal operations. Indeed, the success with which the seniors housing manager deals with the local community will have a direct bearing on the success of the operation itself.

[ILLUSTRATION OMITTED]

The importance of involvement with the local community is graphically demonstrated by the history of other actors in healthcare delivery. Hospitals (and, to a lesser extent, physicians) have always enjoyed community esteem. They have been seen by the communities in which they operate as valuable resources, whose involvement in community affairs is prized.

Nursing homes, on the other hand, have often suffered from community indifference. While that is due, in part, to the fact that long-term care facilities provide services with which most Americans would rather not be associated, it can also be traced to the limited involvement that many facilities have in their communities. Nursing home and even assisted living operators have generally not networked as effectively as their hospital counterparts, they have not sought to make allies of the media, and they have, more often than not, been the target of (rather than stimulus for) political debate.

And just how important is community perception? Well, let's start by recognizing that the community constitutes the market for your services. As many demographic studies have indicated, most residents of seniors housing and care facilities live less than 15 miles from the facility. Well more than half of them have learned of the facility from friends who either were residents themselves or had friends who were residents.

Because word-of-mouth referrals are the source of most admissions, advertising strategies must be based on that fact. It is never enough simply to place ads in front of the general public. Without a carefully planned strategy, including many elements of one-on-one promotions, your marketing dollars may well be wasted. You need to know who your primary referral sources are and how to attract their attention and generate their enthusiasm for your facility. Don't forget that they, too, are key players in the local community--and the greater your own involvement in the community, the more likely it is that they will know you and direct customers your way.

And conversely, don't forget this key dynamic: Dissatisfaction breeds dissatisfaction. When one of your customer segments (resident, family, or staff) is dissatisfied, all segments become dissatisfied. Unhappy employees commiserate with residents. These residents become concerned and nervous and talk among themselves. They tell their families and friends when they visit. Families and friends tell their coworkers and employers. Disgruntled staff eventually leave and take up employment elsewhere, where the stories take on an even wider distribution. And soon you have a plague in the making.

Remember, the number one source for learning about a community is someone who lives there, works there, or has a parent living there. Never underestimate the impact on your marketing activities of customer satisfaction ("customer" being broadly defined). When a limited number of vacancies can spell the difference between profitability and bankruptcy, maintaining customer satisfaction and community esteem becomes paramount to survival.

A second important point: Whether working your referral network or implementing your advertising strategy, don't run the risk of promising more than you can deliver. Your reputation in the community can be easily jeopardized if your candor is widely questioned. Don't promise families that their loved ones can age in place, no matter what their level of acuity, if you don't have the capacity to sustain this commitment. Review your marketing materials carefully, both for inclusions as well as exclusions. Written materials should include the cost of the basic service package and what it includes, the availability (or nonavailability) and costs of additional services, the circumstances under which prices may change, how the facility monitors resident health status, the qualifications of the personal care staff, and your community's discharge criteria. Also, provide your referral sources with an example of the contract you typically use. In cases in which your contract raises doubt, consult with legal counsel.

Important point number three, and one revealing a vital distinction: Public relations should be a part of your marketing strategy, but should not be confused with marketing itself. Marketing is the promotion of products and services. Public relations is the enhancement of image. Good image might be considered a prerequisite for effective marketing; it is not a substitute.

Marketing is a motivational tool and deals with products and services for sale. Public relations is a communications tool and focuses on the creation of a favorable public perception. Marketing seeks to directly influence a customer's purchasing decision. Public relations seeks to change attitudes and make people feel favorably predisposed toward the vendor.

The objective of marketing is to increase sales and, consequently, enhance revenue. The goal of public relations is to garner community acceptance or a more favorable public opinion, even in the absence of a sale.

Public relations is serious business. Good publicity doesn't just happen--it takes work, but it is a critical prerequisite for an effective marketing strategy. Obtaining a favorable impression of your product through media attention is often referred to as "earned," as opposed to paid advertising.

Bear in mind, though, that the story has to be tailored to meet the needs of the media. It has to be substantial (birthdays and bingo parties won't do). It has to have a local flavor, with an angle that the media will find appealing to their particular audiences. Often, providing a local focus for national stories that have received widespread public attention is a good "hook" to attract your local media's attention.

For example? Well, increasing data show that seniors can reap large rewards from weight training. It improves balance and ambulation and even builds muscle. That, in turn, can help prevent falls, reduce hospitalizations, and increase the perception of facility safety. What if you have installed a modest exercise room in your building? Does that make for a story likely to be picked up by your local enterprising journalist? Probably. The image of a senior on a treadmill or one pumping iron (admittedly less weighty iron) is, in the minds of much of the lay public, not that common. And the uncommon makes for good stories.

That's just one example of how normal operations in your community, if packaged appropriately, can attract public interest and work to the ultimate benefit of your marketing strategy. And journalists are happy to give play to such stories (which, incidentally, make their jobs easier). But it has to be their story, so get to know your local editors and broadcasters. Find out what they're looking for and customize your stories accordingly. Don't insult them by creating the impression you're simply looking for some journalist to act as a company "shill." Keep your presentations and your deportment polished, professional, and to the point--but also be tenacious. Follow-up is important.

Public relations is more than planting good news, though. It is equally important that managers know how to contain "bad news." The best marketing strategy in the world can be rendered worthless with just one story casting doubt on the quality of the services provided to a community's customers. There is little question that occupancies will suffer if such stories are not dealt with quickly and effectively. The impact will be reflected not only in move-in rates, but also in the willingness of your current residents to remain in the facility. Your better-performing staff will find your community less desirable to work in, precipitating higher turnover that, in turn, will diminish the quality of your service. And the end result might be even more stories about the quality, or lack thereof, in your community.

When a story like this breaks, establish your priorities. Do not make the mistake of simply lashing out at "guilty" parties (the media, the person who "leaked" the story, et al). Your first goal is to minimize damage, not to find out who caused it. Depending on the facts at hand, one approach might be to deny the significance of the allegations; another is to shift the focus of blame elsewhere. And there is a third alternative: Candidly admit to the problem and offer details of a conscientious effort at improvement.

The effectiveness of this last approach cannot be overemphasized. We all make mistakes. Sometimes admitting to them is the best defense. I'm reminded of an example from the university with which I'm currently affiliated. A few years back, Johns Hopkins was the recipient of some damaging media attention based on its biomedical research programs. Much of it had to do with full disclosure (or the lack thereof) to the subjects of some of its research protocols. And much of the criticism was accurate.

While the university's first inclination might have been to minimize or deny, it took the opposite tack. It admitted to the problems and informed the public as to the extensive changes it was proposing to deal with the issue. Media attention dissipated rapidly, and the story soon disappeared. There was no scandal left to write about--end of story.

All of which explains why honesty is indeed the best policy. Our many publics are more willing to forgive transgressions admitted to than transgressions denied. There's an old adage in Washington (and elsewhere) that "the cover-up is worse than the crime." While Johns Hopkins University was certainly guilty of no crime, it did understand the principle underlying that adage and acted accordingly. Would that more institutions would follow its example.

Another creative response worth mentioning is to use media attention to "bridge" to stories that might put allegations in context. Long-term care staffing difficulties, financing shortfalls, the characteristics of facilities that perform well despite all this--these all might be valid topics for this bridging maneuver.

Let's say, for example, that your nursing facility has been cited for understaffing, and the press has picked up on the story. You need to submit a plan of correction, right? Why not focus media attention on the plan, as opposed to the transgression? Moreover, use your attempts to rectify the staffing situation as a means of focusing public attention on the underlying societal problems faced by all long-term care facilities. What better way to elicit public understanding than to put the reader or viewer in your shoes?

How many in the community understand that your level of staffing (and turnover) are a direct reflection of Medicaid rates? How many grasp that, for all intents and purposes, the state tells you how many staff members you can hire and how much you can pay them? Broaden the discussion into a critical public dialogue on the relationship between inputs and outcomes, between resources and expectations--not as a means of excusing the problem, but as a means of putting it into a societal context giving the reading and viewing publics something to think about.

Of course, if the issue is as much societal as it is managerial, then the true "plan of correction" lies not just in your hands, but in the hands of governors, state and federal legislators and, yes, presidents. Here another form of community involvement comes into play: lobbying. More about that next month.

To send your comments to Dr. Willging and the editors, e-mail [e-mail]. To order reprints in quantities of 100 or more, call [phone].

Paul R. Willging, PhD, was involved in long-term care policy development at the highest levels for more than 20 years. For 16 years as president/CEO of the American Health Care Association, Dr. Willging went on to cofound the successful Johns Hopkins Seniors Housing and Care postgraduate program (cosponsored by the National Investment Center for the Seniors Housing & Care Industries), and later served as president/CEO of the Assisted Living Federation of America. He has enjoyed an equally long-lived reputation for offering outspoken, often provocative views on long-term care.