LETTERS TO THE EDITOR.

Dear Mr. Peck:

I read your January editorial ("From Over the Wall," p. 4) and agreed with it, until I read the statement that today's problems are "nothing that a conscientious, hardworking, good-hearted administrator can't handle, given the appropriate information." There are many reasons that qualified people are leaving the field of long-term care and others are not entering it, and you named many examples. Noticeably absent, however, was mention of the intense focus large corporations place on financial performance. This focus on monetary success as a primary goal above all else has caused, and continues to cause, a serious decline in patient care and employee satisfaction.

Yes, all these companies have mission statements that mention "quality care" and "highest possible standards," for the public's consumption. The administrator, however, is told, "Stay on budget! Keep your census up!" But "staying on budget" means keeping staff to a bare minimum and wages to nearly state minimum, which causes employee turnover to soar and the quality of care to plummet.

Many of these corporations tout their state-of-the-art information systems, but the "information" is largely available to corporate staff. The administrator's job is only to oversee the entry of accurate, timely information for use by the corporation. Only the most basic reports are usually available for use at the facility level. By basic information I mean the budgeted and actual amounts for expenses and census--very little else. Corporations don't really care about putting faces and stories to the numbers. They want the administrator to act as a buffer between themselves and the residents, families and employees. The administrator is the one left to deal face-to-face with anyone in the facility who is angry.

Add this scenario to the factors mentioned in your editorial, and the result is a high-stress occupation that many are choosing to either leave or not enter at all! Who shoulders the responsibility for everything that happens in the facility, good or bad? The administrator. The corporation's "plan of correction" for poor financial performance? Fire the administrator. The corporation's "plan of correction" for poor care and high turnover? Fire the administrator and the DON. The corporation's "corrective action" for poor regulatory compliance? Fire the administrator and/or the DON. Never mind that you told corporate headquarters months before that something needed to be corrected or it was going to be a regulatory issue. The money to pay for the correction was drawing interest until it absolutely had to be spent.

So, I, too, have become disgusted and bitter, and have left the field. I have taken my considerable skills and applied them to another field where I can be just as successful, more appreciated, and proud of my work. I do not lie awake wondering if the company will meet payroll, if the telephones will be turned off, or if the regulatory agencies will be revoking my license when they visit next.

(name withheld by request)

(The following is a letter to Jaime Todd, author of the January "Voices From the Field" article, "Beware the Misguided Mentor," p. 44):

Dear Jaime:

Please excuse the use of your first name, but I feel that I know you. Your article was one of the more meaningful articles I have ever read. I want to thank you for writing it and for sharing it with so many others.

One of the opportunities of my professional life has been that of training and preparing others for leadership as NHAs. I have learned over the years who I want to have as my role models. Even bad models teach us what to avoid. One of my favorite stories:

I served as the VP for the Homes and Care Services of a fairly large, church-related not-for-profit here on the East Coast. My boss was the president and came from the education field. The management team had participated in interviews for the new director of Human Resources. Our president told us that he had narrowed the field to this one person, and we all felt quite comfortable in recommending him as part of our team. The president said he had one more thing to do, and that was to take him out to a family restaurant for dinner that evening. He planned to meet with us the next day to let us know if the individual had accepted our offer.

What a surprise to learn on the following day that he had not been offered the position. We knew the president well enough to know that there had to be a valid reason. His keen eyes looked around the room, and he said, "Well, I took him out to eat and he was very rude to the waitress. He made derogatory comments about her education, her speech, etc. That did it for me. How could we ever expect him to relate to some of our housekeepers, laundry workers, nurse's aides, when he couldn't see past his own prejudices?"

I remember that as a gift.

Catherine "Kay" Price

United Church of Christ Homes

Hummelstown, Pennsylvania