Letters.

Editor:

Regarding "Listen With the Ears of Your Heart" by Dorothy Seman (September 2003, pages 34-40): Wow! What an amazing article. I was very impressed and inspired. Being a social worker in a skilled nursing facility exclusively for Alzheimer's disease, I could relate so much to your scenarios and interactions with residents afflicted with the disease. This article was a good reminder for our staff and provided me with some pointers in comforting and nurturing my residents and their families. Thank you!

[ILLUSTRATION OMITTED]

Huong L. Butel, BS

Director of Patient and Family Services

John Douglas French Center for Alzheimer's Disease

Los Alamitos, California 

Editor:

Paul Willging's recent column, "Long-Term Care Needs to Change Its Focus" (February 2004, pp. 14-17), emphasized the relationship between consumer choice, quality of care, and the perceived value of long-term care services in this country. I share his view that this connection holds the key to the future of longterm care nationwide.

Toward the end of his piece, Dr. Willging cites comments I have often made about the future of the long-term care industry. I believe, as do many others, that the current system is unsustainable and cannot possibly bear the burdens that the age boom would place upon it. Many disagree with me. They hold that the current system can be saved only if the regulatory restraints that bind it are loosened and greater funding is made available to support its activities. These are dreams that cannot come true.

In fact, the most important question we face today is, "What comes next?" To forecast the demise of the current system means that one must begin to imagine a long-term care system that does answer to consumers' wants, needs, and preferences. Hidden within the crises that are currently roiling long-term care organizations is the possibility of a new long-term care, one that stands in high regard with taxpayers, elders, families, politicians, and even regulators.

The organizations that will succeed in the future will be those most willing to question their own assumptions, explore new ideas, and discard the habits of the past. What the future will look like, I cannot say, but I look forward to being part of an explosion of creativity and innovation in our field.

Dr. William H. Thomas 

Founder of The Eden Alternative[TM] and the Green House Project Sherburne, New York 

Editor:

It was interesting to read the comments of Dr. Paul Willging in his column, "Long-Term Care Needs to Change Its Focus" (February 2004, pp. 14-17). As he suggests, there are as many opinions on the virtues--or lack of them--of nursing homes and assisted living as there are stars in the sky. Yet, an indisputable point is that the outlook of Americans, particularly the baby boom generation, has changed with respect to long-term care.

For economic and sociologic reasons, looking to the future and how boomers will receive care is alarming, even for the most optimistic person. And the fact remains that those who are failing to plan for a future--one that surely will see many boomers in need--will create a mammoth challenge for all providers within the chronic care delivery system.

As one who has practiced in a CCRC environment for more than a quarter of a century, I agree with what Dr. Willging says about the emphasis being on housing and not on health. Yet, even when thinking about this direction, I am convinced that ingenuity will be required to build a service model that replicates the virtues of home which, in my opinion, is the major competitor with our field of practice. It could be that when we find the right strategy for meeting this challenge, we will be getting close to bringing into focus what will need to be done to meet the needs of tomorrow's seniors.

Daniel W. Farley, PhD, CNHA, ACSW 

President/CEO

GlenWood Park Retirement Village

Princeton, West Virginia 

Dr. Willging:

I read your column ("'Aging in Place' Can Be a Marketing Trap," October 2003, pp. 12-15) with interest and share your concern about marketing implications. I have been in marketing for CCRCs for 23 years and am concerned about the shift away from the independent lifestyle.

I have worked for two CCRCs that allowed independent living residents to age in place to a dangerous point in the ways mentioned in your column. It took them many years and many dollars to turn it back around.

I have always maintained that if we lose the look of an independent living neighborhood, we simply will not attract active seniors, and the entire community will eventually take on an assisted living/nursing home atmosphere. CCRCs that are diligent in making people move through the system usually do well in attracting younger, healthier clients.

Have you done any research on how "aging in place" affects CCRCs? While many of us in the industry share my thoughts, are there any hard data out there? Thanks for the article and your insight.

Breta Marie O'Masters

Marketing Director

Southminster CCRC

Charlotte, North Carolina 

Response:

Thanks so much for your note. You've clearly put your finger on one of the two major downsides of "aging in place." There is little question that marketing a community that has taken on the appearance of a high-acuity nursing or assisted living facility is problematic, at best.

The other disadvantage might be more of a dilemma for freestanding assisted living, however, particularly as regards the residents' interests. At least in a CCRC, the capacity to care for the higheracuity case is usually in place and available. In too many assisted living facilities, "911" becomes the provider of choice (or care is simply not provided at all). It is probably for that reason that we see average ages in the independent living units of CCRCs reach into the eighties.

While there are few hard data available (one of our recurring problems in seniors housing and care), the trends seem obvious to most observers.

Paul R. Willging, PhD

Dr. Willging:

Thanks for your thoughtful (as in "thought-filled") and effective column, "Quality Management Isn't as Tough as It Looks" (December 2003, pp. 13-15). As a marketing professional, I have worked in several industries and am now working for a vendor to long-term care. By reading the industry publications, I have become sensitized to the shortsightedness and culture of doom and dependency that seem to be rampant in long-term care. I have seen this culture before: in the airlines, in education, in government-contract manufacturing, and in accounting, among others. Whatever government regulation or money touches, it ruins.

The second-last sentence of your third paragraph encapsulates a jewel that far too few have studied: "By allowing the government to assume the role of customer, nursing homes guaranteed only that their product would meet government, not customer, expectations."

I could go into a treatise and sound like a pamphlet from the Libertarian Party, but I'll refrain. It is enough for me to know that there are folks involved in the system who are humble enough to see the roots of the problem without simply villainizing one party or another.

Later in the article, you say that the MDS is a treasure trove, despite its government origin. Doesn't leaf follow stem? For the sake of my parents, aunts, and uncles, I hope you are right. I hope providers can innovate and separate themselves from focusing on making the MDS meet those detached standards to the point that they can merely use it as a tool. Government's intent is usually leagues separated from its effect.

Name withheld by request

Dr. Willging:

Thank you so much for stating the understated in your column, "Quality Management Isn't as Tough as It Looks" (December 2003, pp. 13-15). Quality management does not have to be costly, it does not take a lot of time to provide and, most of all, it makes the resident the winner.

I am going to do a research study for my dissertation on how competency testing of CNAs increases the quality of care for residents. This increase in quality is made evident by reductions in staff-induced skin tears, staff-induced falls, unintended weight loss, and avoidable pressure sores.

I hope to show that CNA competency testing, administered upon hire and followed with demonstrations, repeat demonstrations, monitoring, and retraining as needed, will provide better care for all residents. There is no cost to the facility, but the benefits are tremendous, not only in terms of increased quality of care for the resident, but also in reduced costs to the facility (for litigation, treatment modalities, liability insurance, etc).

Elaine Townsley, MSN, RN,C 

Convacare Management & Nurse Consultants of Arkansas, LLC 

Batesville, Arkansas