LONGEVITY: ONE LTC PIONEER'S SECRETS.

Based on an interview with Rita and Richard Welch, Welch Healthcare and Retirement Group

When Thomas and Rita Welch opened the doors of John Scott House in Braintree, Mass., in 1949, they were reviving a family tradition begun by Mrs. Welch's mother, Florence St. John, almost 15 years earlier. Assisted by Rita and her other daughters, Mrs. St. John, a community nurse, cared for frail elderly individuals in her Quincy, Mass., home from 1935 until World War II came along and made it impossible to hire adequate help.

Along with her husband and seven children, Mrs. Welch, a licensed nurse and administrator, helped their endeavor grow from a "Mom and Pop" rest home, serving a handful of residents, to the first licensed nursing home in New England to an organization employing more than 1,500 caregivers and staff today and offering the full continuum of care.

Soon after John Scott House opened in 1949, it became licensed by the Massachussetts Department of Health for 11 beds. At that time, Thomas and Rita and their three oldest children lived upstairs in the large, Victorian home, and the residents lived downstairs. Later, Thomas converted a barn on their property into a house and moved their family there, and they expanded the original house to accommodate 22 residents. Today the name of the original facility has been changed to John Scott House Rehabilitation and Nursing Center, and it's part of Welch Healthcare and Retirement Group. With its headquarters in Norwell, Mass., the Welch organization has six skilled nursing facilities and four assisted living residences, as well as providing post-acute care and short-term rehabilitation, adult day care, home care services, which it provides directly, and senior apartments for more than 1,500 clients throughout the South Shore area near Boston. The organization also serves as a consultant to and provides temporary s taffing solutions for other longterm care organizations.

It's been quite a ride, according to Rita Welch and her son, Richard. She recalls parking herself on a politician's desk to get his attention on behalf of the elderly and spending many hours sitting around her kitchen table with other rest home operators who, together, formed what became the Massachussetts Federation of Nursing Homes (today, the Massachussetts Extended Care Federation).

Mrs. Welch looks back fondly on those earliest days, when she helped her mother care for people in their home: "If we went to the beach, we took the people to the beach. They sat at the dinner table. They were part of the family." She recalls, "We had one man who loved to plant a garden, so my mother let him dig up the front yard. I'd come home from school and he would have rearranged all the plants. I guess he was 'rotating the crops,"' she says with a laugh.

"We weren't terribly sophisticated back then; we basically provided a home and meals and lots of tender loving care. And people weren't nearly as sick as they are in nursing homes today," Mrs. Welch explains. "The most common diagnoses were 'senility,' hip fracture and arthritis." That's not all that's changed, according to Mrs. Welch. She says, "For 24-hour care of total needs, we received $18 to 20/week in 1949; by about 1960, the per diem rose to $5.75."

When asked what has contributed to their company's longevity, Mrs. Welch and her son agreed that being family-owned and -operated has been a major factor. They have at least one family member on staff at every one of their facilities, and family involvement spans four generations.

Mrs. Welch also credits an "excellent, dedicated staff' with their company's success. "We can't do it without them," she emphasizes, adding that some staff members have been with the company as long as 36 years. The organization provides opportunities for staff to grow, such as scholarships, in-house educational programs and career ladders they can follow.

Another key to success is that the Welch facilities have been accredited ever since accreditation was available, approximately 35 years ago. "We've always endeavored to attain higher standards than those that are required and have kept seeking alternative methods of care," says Mrs. Welch. "And we believe the total continuum of care is necessary to success-I just don't see how you can stand alone today.

There have been challenges, too- plenty of challenges.

"Recently we've had to adjust to going from a reimbursement system based on actual costs to a prospective system," says Richard. "The only way to survive such changes is to be 10 steps ahead in preparing for them," he points out. "You have to be aware of what's coming, and you have to educate your staff in how to deal with it, to develop systems that work."

Another challenge Richard points to is staffing. "We deal with this one by reaching out to the community. We make sure the schools know who we are and that we're a good employer. We take every opportunity to speak to people about long-term care and to attract them to the field. Also, we offer attractive benefits, such as child care, to our staff, and we have an incentive program that rewards nurses who recruit additional nurses for us. We also supplement our permanent staff through our temporary staffing agency."

Despite what many consider to be the over-regulation of the long-term care industry, Mrs. Welch would not like to return to the unregulated 1940s, when care providers had no guidance or proper payment system. She much prefers the professionalism increasingly associated with the long-term care field today.

She says, "The adjustment to higher educational standards for administrators over the years was difficult for some people. Back when anyone could open a facility, you had these dedicated people who were committed to providing the care residents needed. But as the rules and regulations came along, these people were being left behind. One of my deans at Northeastern University and I put together a course to help these administrators learn how to run their homes in a businesslike manner. That eventually evolved into a four-year degree program for administrators."

"The best change I've seen over the years," says Richard, "is the broadening of long-term care. Today we can offer a full continuum of care, which gives people more choices as to where and how they want to receive services. We didn't have that 20 years ago." He says that despite the increased professionalism associated with regulation, the worst change he's observed has been the proliferation of paperwork and documentation that comes along with it: "Nursing staff are so tied to paperwork that they can't do as much hands-on care as they once could. It is assigned to certified nursing assistants and other staff."

"In our role as consultants to other organizations, we see facilities struggling to meet the standards today," says Mrs. Welch. "We see administrators, intelligent people, just going along in skilled nursing or whatever level of services they provide, and then all of a sudden 40-some regulatory requirements are dumped on them and they don't have the resources to comply."

"That's why it's a good idea to be involved with the various long-term care associations," Richard adds, "both at the state and national level, so that you can anticipate the regulatory changes that are likely to affect your operation. Another benefit of association membership is that it gives you the opportunity to fight for what's right, which is quality residential care, as well as higher reimbursement." He adds that taking advantage of purchasing groups for things such as insurance, food and supplies will help the bottom line.

Mrs. Welch sums up their company's keys to success as anticipating change, seeking ways to innovate, staying solvent and, above all, never compromising on high standards of care. She urges, "Don't be afraid to speak up for what you feel is right. Otherwise, you will be left behind."