March 2023 Founder’s Message: How do we make the Medicaid message stick?

March 2023

Founder’s Message

How do we make the Medicaid message stick?

Repetition is associated with comprehension and memory at all levels. As children, we heard our parents constantly repeat warnings, “Look both ways before…..” and coach us on manners, “Say please and thank you” and give us positive reinforcement, “Well done!” and negative reinforcement, “Don’t touch!”

As we age, we might need to read something twice to fully retain all the information or give ourselves trigger association words to remind us or notations in our schedule or smartphone. If we want to recite a poem or sing along with a song, we will have to commit it to memory and that requires repetition.

There are only three ways that information can move from short-term memory to long term memory: urgency, repetition, or association. So sometimes we may tire of our own voice saying the same thing repeatedly, or our own thoughts going around and around on a brain reel – but when it comes to urgency, we have to believe our repetition is not falling on deaf ears. So we forge on and send the urgent message – in this case, to our Texas state legislators.

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December Founder’s Message

December Founder’s Message

“I have always felt that doubt was the beginning of wisdom”

Clarence Darrow 

“Creativity requires the courage to let go of certainties”

Erich Fromm

These two quotes might seem odd for a holiday message – but in a way – I see them as applying to the Christmas day birth and frankly – also the year we have had.  No – the two are not comparable in impact to the world – but the story of the Christmas birth is certainly accompanied by those who heard the news and doubted the truth of the story.  There were those who did not have faith and wanted a black and white reality – they actually feared that the story was true. There were those from faraway lands who heard and had faith without seeing. And there were those who wanted to believe and abandoned all certainties in their life to embrace the miraculous event.

I think this last year – which came on two previous years of uncertainty and doubt – was the real test for us as providers of long term care for seniors. Would we crumble as a company? We have been short on staff, we have experienced the stress of strained resources, we are an exhausted group of people who had to collectively be creative and let go of certainties we knew from the past in skilled nursing care.  That takes courage. Letting go and not clinging to everything you knew before and adjusting, changing, morphing into what was asked of us from payers, regulators and the public – that’s creativity.

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November Founder’s Message: The Power of Rural Healthcare

November Founder’s Message

The Power of Rural Healthcare

I’ve been pretty vocal as of late raising the challenges facing rural health care, in particular skilled nursing care. National Rural Health Day on November 17^th is a commemorative day set aside for those of us who work in rural health care to celebrate our commitment to American’s rural towns and citizens and hopefully, be recognized for the important work we do.  But I’m hoping, and working toward ensuring, that this awareness lasts longer than 24 hours.

When rural health care receives attention, it is typically about rural hospitals – a critically important service for rural communities.  Federal reimbursement policy is discussed at great length, data and research show rural hospital closures, diminishing access to care in the hospital setting for our small town residents.  This is all true and critically important. But we need to include rural skilled nursing in the conversation as part of the post acute care continuum, and a very important part as with some of the most vulnerable residents, we are their home, their family and their caregivers to the end. That’s an incredible privilege we have and a unique one.

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October 2022 Founder’s Message: Countdown to being Counted

Founder’s October Message

Countdown to being Counted

Hopefully, as team members of Focused Care and health care consumers yourselves, if you were not registered to vote, you did so last week – the deadline being Oct. 11. Early voting begins next week  – Oct. 24 and lasts until Nov. 4. Election Day is Nov. 8. Note that Absentee/mail-in ballot requests must be issued by October 28. So if you will be unable to vote in person, your choices can still be counted.

Every single American old enough to vote must believe their vote counts – that it makes a difference. Consider the consequences if everyone felt their voice didn’t matter. That perception shakes the very foundation of a democracy.  Your voice does matter and voting is your way to make it heard.

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Vote your conscience

Vote your financial security

Vote your profession

I’m going to get political in this message but not partisan. These days it may feel as though the two cannot be separated, but they should be.  Rarely does one political party or politician, for that matter, support everything we individually feel, think or want. We may be pressed into a particular identity in order to exercise our right to vote, but we are not limited to towing any party line – which affords us the luxury of voting on what makes the most sense to us.

That’s easier said than done. One candidate or elected official may espouse a viewpoint we whole heartedly agree with and another we are opposed to. We may completely align with an initiative backed by the party we are not registered as and reject a position by our own party.  That is the beautiful dynamic about elections and voting – outside of a primary for an elected official, we can discern for ourselves what we think is right based on our own values and convictions.

But none of this freedom to represent ourselves matters, unless we engage in the process.

We must vote.

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Mentoring for the Future

August 2022 Founder’s Message

Mentoring for the Future

I was considering what to write about for this last official month of summer as a global heat wave descends across land and water, news of layoffs and hiring freezes in many sectors are triggering economic jitters as confusing government reports are released on rising inflation juxtaposed to job growth and increased consumer spending – both seem to contradict a full blown recession.

Life can feel heavy these days and the future might look a little blurred.

In our business – on top of everything else – the nursing workforce shortage is never far from mind – we live and breathe the impact.  What can we do to fill the gap, strengthen the pipeline and keep good people?  The answers to all of those things are numerous and involve a concerted effort among many stakeholders. But one of the things we can all do on both a personal and professional level is mentor.

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June 2022 Founder’s Message

University of Texas Campus Tower                                   1966

First Baptist Dangerfield Church                                        1980

Luby’s Cafeteria Killeen                                                       1991

Fort Worth’s Wedgwood Baptist Church                          1999

Fort Hood   Killeen                                                              2009

Fort Hood   Killeen                                                               2014

Dallas Police Officers                                                           2016

Sutherland Springs Church                                                  2017

Santa Fe High School                                                           2018

El Paso Walmart                                                                   2019

Midland-Odessa Shopping Center                                     2019

Robb Elementary School   Uvalde                                      2022

How many tears? How many broken hearts? How many prayers? How many lives torn apart forever? How much grief and sorrow is possible to bear?

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May 2022 Founder’s Message

I remember when the planes hit the Twin Towers. In the following days we heard stories of those tragically lost, those unfathomably heroic and those who stepped out of their normal bounds to be part of a unified community.  The country rallied, our patriotism soared and our perceptions of what was truly important in life were transformed – at least for a while. Our collective compassion took hold and amazing people did amazing things to help lift us out of the jarring reality of what happened.

Then a fascinating pattern developed. There was a post 9-11 surge in career changes. I read about a former financier who became a fireman after witnessing the unparalleled bravery of the FDNY. After EMTs found her father beneath the rubble days after the explosions, a small child at the time became a mental health counselor years later. Many children of First Responders on the scene that day became health care workers in adulthood – and are now saving lives today.  Many of those people turned to nursing.

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Having a Little Faith

We are often in the position of believing in things we cannot see.

Gravity

Wind

Taste

Thoughts

Potential

We can see the impact or impression of these things but we cannot really see them.

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Matters of the Heart

February stands out in the months of the year in several ways.  It is the shortest month  even when it’s Leap Year,  we commemorate the birthdays of two historic figures in our country, the entire month is dedicated to the culture, history and accomplishments of African Americans as well as heart health and one day marks an opportunity to remind those you love that…well, you love them.

When I started Focused Post Acute Care Partners we talked through what kind of company I wanted it to be. I wanted a company with character, one that respects everyone who works for it – everyone – and in our communities, those for whom we provide care and their loved ones.  Through those discussions on company character came the phrase that drives our mission: It Takes a Minute to Change a Life.

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Checking In as We Begin Again

“Look closely at the present you are constructing: It should look like the future you are dreaming.”

Alice Walker

Pulitzer Prize Winning Author for The Color Purple, Poet and short story essayist

I like this quote and find it very fitting for our times. It is easy for us right now to feel stuck on a treadmill that never stops.  It’s as if we are in a movie that doesn’t end but repeats the same story over and over. Honestly, there is so much about humankind that this pandemic has tested and while we’ve acknowledged the ongoing heroics shown by so many long term and all health care workers – we might find ourselves drifting toward being numb to the state of things – another wave, another spike, another year – is that possible?

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Let’s Be Honest

The holiday when we focus on expressing our gratitude is near and my family and I look forward to being together on that day. Another special aspect of this holiday is that it provides yet another opportunity for me to thank the Focused Care family for all it does.  Please know NONE of your good and noble works go unnoticed. I know what you are doing – I’ve been on the inside of our profession for the last 30 years starting out as a nurse aide and working my way eventually to an administrator – seeing and experiencing so much along the way. I believe, as the founder of Focused Care, in our mission, in our contribution to the health and well-being of our most vulnerable and I know those who choose this profession have a heart for caring for others.

So bear with me when I move the subject matter of this message to those who claim to know us and what we do, who declare they want seniors protected and provided with meaningful options in life and yet, who often, inexplicably work against us. I have in mind a national organization with a powerful and outspoken lobby and one with state chapters across the country – a well-recognized chapter in Texas.

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Staying the Course

Staying the Course. That’s a phrase that sparks some debate as to its origin. Some think it’s a nautical reference and others relate it to horses on a track. The meaning of the phrase when we hear it though – means keep on keeping on.  Don’t falter. Don’t let the headwinds steer you off course. Stay on track. Reach your goal.

With respect to our personal lives and the pandemic, I wouldn’t be surprised if most of us feel like we’re done with the whole thing.  Here we are in the midst of yet another surge of COVID cases and we haven’t recovered from the previous onslaught. We all want our lives to be lifted from the pressure and constant awareness of this virus.  Perhaps when we’re at home reading a book, watching sports or cooking dinner – we momentarily forget about this insidious virus and the regularity of life brings us some peace.

Then we turn on the news or we walk outside.  Or in our case, we go to work.

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Rising Gas Prices, Billionaires in Space, the Olympics and Fall Sports

I would like to write about any one of those topics and draw clever analogies to what we do every day in long term care.  But I can’t while a fire rages around us. I have to at least encourage all of you that I care so much about – to get the hose and help to put it out.

I just finished reading a story in the Texas Tribune with this headline:

“COVID-19 is spreading fast among Texas’ unvaccinated” 

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Two Steps Forward and One Step….

The Quandary Around the Choice to be Vaccinated

The toll of the pandemic on health care workers is real – being under siege operating in crisis mode for a full year will impact anyone.  So if there are options to protect oneself from COVID-19 and the now very virulent Delta strain circulating, why are vaccination rates so low particularly among health care workers in skilled nursing care?

Fully understanding and respecting that we all have a right to choose to be vaccinated, it’s worth exploring the reasons that motivate those who do and those who don’t.  The latter might offer a more varied response such as religious or cultural reasons.  However, education can be the antidote to fear if reluctance to receive the COVID-19 vaccine is seeded in skepticism or distrust.  Science-based, highly credible sources are the best place to gather information and to best assess how to protect yourself from a virus still on the war path.

The benefits of the vaccination roll out are evident in a recent analysis by the National Investment Center for Seniors Housing & Care (NIC) of data produced by the Centers for Medicare and Medicaid (CMS), indicating COVID case counts within skilled nursing facilities (SNFs) are down 98% since December 20 of last year and by mid-May 2021 account for about 0.3% of our country’s cases. In fact, NIC says nursing homes are the safest places for seniors required skilled nursing care. Good news indeed.

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A Season of Graduation

June is the season for graduations. While some take place at the end of May, many are held into June after diplomas have been processed, caps and gowns ordered and logistics are settled.  This year obviously came with greater anticipation as decisions were individually made by schools as to whether ceremonies would be in-person, hybrid versions or limited in attendance. Whatever the graduation looks like, it represents a rite of passage.

That got me thinking. Where did “the graduation” tradition come from? Some say it started back in the 12^th century with scholastic monks donning their robes and partaking in a ceremony – and that perhaps the original event has evolved to fit modern society. But all passage of rituals have common functions – a societal movement facilitated by an achievement – and a return to society with a new status.

Does this sound familiar?

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Motherly Love

May is a special month for many reasons. The tradition of leaving a basket full of flowers on a neighbor’s doorstep on May Day (May 1^st) is holding on though recognition of the commemoration is sadly waning.  Cinco de Mayo is alive and well and the lifting of pandemic restrictions added even more elation to this year’s celebration. There is Memorial Day, a solemn remembrance of the fallen heroes of past wars and the opportunity to express our gratitude to veterans fortunate enough to come home and resume their lives.

And of course, there is Mother’s Day.

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The Life-Affirming Spirit that comes with the Transition of Seasons

Spring is an uplifting season in that we see dormant growth from winter’s wrath shooting up to catch the light of the sun and remind us that after a cold and sometimes bleak period, life can still burst through.

It has been challenging for many of us to recall a time when we actually celebrate the new season and reflect on the next stage before us.

After 2020 and into 2021, optimism is a hard sought commodity but one we need to value and continue to pursue.

Recently, we have seen optimism and hope as clearly as the daffodils in full bloom.

While necessary precautions remain to protect our residents, their family members and our team members, Focused Care has had the privilege in the last few weeks to witness the coming together of family members and those residents who are vaccinated – as the separation of the two has effectively dissolved.  The hugs, hand-holding and tears are illustrative of the very human need to be with those we love.

It is a renewal of an extraordinary kind.  We hope it is a transition from a dark and sometimes desolate season into one with the warmth of compassion, mended hearts and a routine in life blessed with the personal touch.

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A Mixed Bag

By definition a mixed bag is an assortment of things or people. Anyway you use the expression it’s in reference to things grouped together that are not all alike.

Texas is a bit of a mixed bag right now with the announcement of Governor Abbott lifting all pandemic-related restrictions and fully opening up the state with the goal of churning our state’s economy and returning us to a time we all yearn for.

That does not mean the veil has lifted and everything is as it was before COVID. Some businesses will continue to enforce a mask rule and worry, to quote a Fort Worth small business owner who said the Governor’s dictum in effect on March 10 is “putting us in the firing line where you have to make the best decision for you and your business and you’re going to be fighting people who are literally celebrating in the streets,” a new spike in positive cases or an angry and jubilant fracas might result. Texas courts are cleared for in-person trials and local officials will decide if mask mandates remain in place.

So in terms of what we are likely to encounter wherever we go and whatever we do in our great state, we will come upon a mixed bag that includes restrictions still in place, a combined response or a no holds barred approach without a hint of the cloud and impediments we’ve been living with under for the last year.

I plan to view Governor Abbott’s bold move with CAUTIOUS OPTIMISM.

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Choosing to Speak to the Future

“No space of regret can make amends for one life’s opportunity misused” ― Charles Dickens, A Christmas Carol

Most of us know the tale of Ebenezer Scrooge and how on Christmas Eve he is visited by three ghosts – one from the past, one from the present and one from the future. None of these momentary glimpses are particularly pleasant as the ghosts are trying to show him how his stinginess, greed and insensitivity set him on a path to potential doom.

Long ago he had much to be happy about but chose to turn away from his joy and forgo a life of friends and family.

In present day, he was shown how his disregard for others impacted real people and their lives to such an extent, if it continued, a family and many others would be heartbroken.

The future is just plain scary as Scrooge, shaking from the fear of facing his own headstone in a dark and forbidding cemetery, realizes he can change the trajectory of his life and therefore his death.

A Christmas Carol stands the test of time as its ultimate message is about how the effects of poverty, sickness, neglect and contempt can have on the lives of those who experience them and the difference we can make by just caring about our fellow human beings.

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You are Essential

Focused Care team members have a deep and abiding sense of what they have been able to do under unimaginably challenging conditions. Years from now, we will all ask ourselves “How did we do that?”

I will answer that now and I hope our entire team remembers this: You saved lives, you brought happiness and relief during a time of fear and grief, you poured forth compassion for your residents and each other and you somehow found the energy and drive to show up every day for your families, your community and those dependent on your attention to their health and well-being. You share a mission with Focused Care and you are determined to see it through.

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Healing

Coming together is a beginning. Keeping together is progress. Working together is success.
—Henry Ford

It’s what we help our residents do at Focused Care. The ironic thing about that is that helping to heal others, heals us at the same time. We could be sad, angry or disappointed when we start our day, but when we help someone feel better, more comfortable, more hopeful, we also feel better. That’s a reliable reaction from the human spirit.

Life is complicated and our personal experiences impact the way we perceive and process what goes on around us. Can we all see eye to eye about everything? I think we know given human nature – that is not likely.

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What it Takes to Win

In golf, there is a game called Captain’s Choice. Captain’s Choice changes the spirit of the competition from individual accomplishment to “team performance.” We don’t generally think of golf as a team sport – it traditionally calls for acute concentration, silence by the crowd of onlookers and announcers, and a solo achievement shared only with the caddie if the player is gracious enough.

In Captain’s Choice – you take the best from your team and that is what drives the score. Let’s say you have a team of four. Each person takes a swing, and the next swing by all is taken where the best shot out of four is positioned. Each person on the team benefits from the best stroke taken on a given shot – be it the drive, the approach, the putt or in between. Consequently, the end result is a much better golf game than any one individual could have played. Captain’s Choice highlights the best of everyone.

This is a light hearted analogy to providing long term care to our seniors. But it is still illustrative of how we can achieve excellence and successfully fulfill our mission.

Hurricane Laura and COVID-19 have taught us more about working together under harried and fast-moving conditions as well as how much we truly rely on each other to carry out our individual and collective responsibilities.

We are better together.

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The Real Test

How will history record our response to COVID-19? No one in the health care field has time to think about that right now but it’s hard not to notice through news reports and even our own chance observations, that we are not yet collectively coming together as a country to manage this pandemic, stanch the infection rate and save lives.

While we are relying on diagnostic outcomes that identify positives or negatives, isn’t our conduct, our decision-making, our commitment to our families and to those we care for – the real test?

Our health care workers can be likened to soldiers at war, too often seeing illness and death, exposing themselves to the enemy in order to save others, and showing us all what it means to have real courage and real character.

For those who shun science-based precautions, can it be enough to see that protecting yourself in turn, protects others? If it seems you are sacrificing your freedom by wearing a mask, what if you are protecting the safety and care of another person by keeping your distance and shielding your nose and mouth? To protect others takes character. Shifting your priorities and your perspective to reflect the safety of others – takes courage.

This is the real test.

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Facts Amidst the Unknown

This virus that insists that mankind not become complacent or overly confident continues to vex some of the smartest scientists on our planet.  We still don’t know if contracting and weathering COVID-19 makes us immune to a repeat infection. Do masks protect us from getting the virus or if we have it, from spreading it to others? Is six feet of physical distance really enough? Laboratory diagnostics have at once become extremely vital and in some cases, grossly inaccurate, the latter causing great concern with false positives and false negatives. A cloud of confusion surrounds antibody tests, their accuracy and what we can use them for.

Never has the time for separating fact from fiction become more important.

Since this is our first foray into the world of a global pandemic, we can perhaps be somewhat forgiving when considering mistakes made be they in public policy, health care provision, and even journalism – that’s if we accept the premise that all of us are trying to get this “right” – in the course of our respective responsibilities.

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We Are at a Juncture

“For … those in positions of public trust, I have this message: Yours is the duty to bring about a peaceful change in America. If your response to these tragic events is only ‘business as usual’ — you invite not only disaster, but dishonor.” — President Lyndon Johnson, address to the nation, July 27, 1967

We are at a juncture.

Make no mistake. And this is not about a global pandemic.

This IS about something that is sickening and deadly and if not treated properly has the potential to kill our nation like no virus can.

This is not about politics – it is far bigger than that. We have to ask ourselves. Are we a nation built on freedom or fear? Do we truly share the same American experience – and I mean as an American who is proud to be a citizen of a durable democracy that affords us the opportunity to build an enriching life? Many of us know but perhaps not all of us would say the answer to that is no.

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Taking Care of Yourself While Taking Care of Others

People often cite the airlines instruction when applying oxygen masks – put your own on first and then assist others – as a pretty good rule to abide by throughout life. I agree. Our value to others is dependent upon our self-respect, integrity, compassion, and yes, our own health.

Health care providers, parents of young children and school teachers tend to build up immunities to illnesses because they are often exposed to various ailments and develop a resistance. But none of us should take for granted any unseen defense system within our bodies. Particularly, when we care for vulnerable individuals.

The current virus wreaking havoc globally is certainly disturbing and every one of us must take sensible precautions moving forward. But those precautions are no different than those we have in place every day – as a rule. Keeping our Focused Care team members healthy – whether it’s the seasonal flu or the common cold making the rounds – is of utmost importance so we can continue to protect the health and well-being of our residents.

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April 2020 Founder’s Message

April usually brings to mind the renewal that spring ushers in – fresh colorful blooms as nature comes out of hibernation to remind us of the rich beauty that is always with us – just hidden for a while when the cold sets in.

I think it’s important for all of us, in the midst of what can feel like a very frightening time, to stop and notice and take in the sounds, the fragrance and the feel of spring. This virus can’t take away the breeze, the warmth of the sun or the fresh air we breathe. We may be challenged in ways like never before and fear and sorrow and desperation can drag down our spirits if we let them. Physical and emotional exhaustion can wreak havoc on our perspective and the weight of responsibilities many of us bear can crush us if-we-let-it.

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A Month of Commemoration

Life as we knew it a month ago has dramatically changed. We are all rising in the morning with an acute awareness that things are different. We take our mask when we leave the house. We have hand sanitizer with us or maybe have Clorox wipes in the car. We only see the eyes and ears of faces we pass. Taking a daily walk for many has become a necessity.

The loss of life due to COVID saddens us all, but we have also collectively albeit temporarily lost many of the meaningful traditions in our society. We cannot experience together as families unless limited in number, the births of babies, weddings, funerals, graduations, birthdays – celebrations acknowledging some milestone or a life well lived. We may feel robbed of the common commemorations that unite us in joy or grief and allow us to share a moment together.

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Happy 3rd Birthday Focused Post Acute Partners

Happy 3rd Birthday Focused Post Acute Care Partners!

Walking the walk and talking the talk. Haven’t we heard those phrases so often? We celebrate the hero in movies who lives by his convictions that eventually overcome the bad guy.

We happily cheer for the hero who beats the odds and rises triumphantly while his foil who chose to compromise his ethics sees his plan fall apart.

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Looking Back on the Last Year

Bringing in a new year can give us reason to look forward – for some – a clean slate, for others finishing work to be done, and perhaps for many of us, meeting new goals, taking on new challenges and raising our own standards to reach new heights in our quest to be a better human being.

This time of a new year can also be constructive in looking back on what brought us to today.

Who was Focused Care in 2019 and who will we be in 2020?

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