The Anatomy of Change The Anatomy of Change - LeadingAge

magazine
March/April 2011
VoluMe 1, NuMber 2
The
Anatomy
of Change
• Serving More People
With Organizational
Overhauls
• Reaching Out To
the Underserved
• The Anatomy
of Partnerships
• Understanding
Accountable Care
Organizations

Mission
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Services for LeadingAge Members
Our Capabilities*
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magazine
March/April 2011
VoluMe 1, No. 2
EDITORIAL
Editor
Gene Mitchell
(202) 508-9424
gmitchell@LeadingAge.org
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Deborah Cloud
Sarah Mashburn
ART DIRECTION
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LeadingAge magazine (ISSN 1554-3390) is published bimonthly
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November/December 2010 issue January/February 2010 issue
Cover Photo: Eileen Biermann, Goodwin House, Alexandria, Va., by Jaime Windon,
The Blonde Photographer, copyright 2010-2011, all rights reserved.
features
6 The Anatomy of Change
Forward-thinking not-for-profit providers are
considering ways to serve more people and offer greater
variety—smart long-term thinking for the people
they serve and the organizations themselves.
bY DIANNe MolVIG
12 Reaching the Underserved
As relentless change affects aging services, providers
will be expected to make changes of their own by
serving new populations and doing more to serve
traditional ones.
bY ColleeN KINDer
16 The Anatomy of Partnerships
For these providers, giving more seniors what they
want and need means building partnerships with other
organizations.
bY KIM FerNANDeZ
6
MJHS

Well Spring
Christian Care Communities
20 The ACOs Are Coming …
Though the rules applying to accountable care
organizations (ACOs) are not yet codified, agingservices
providers can begin thinking about how they
will interact with and potentially fit into these caredelivery
arrangements.
bY MICHele HAYuNGA
24 A Switch (Just) in Time
How and why two top CCRC executives switched jobs to
improve their organization’s performance.
bY DAVID TobeNKIN
16
36
28 Celebrating Our 50th
A look back–and ahead–from the perspective of
LeadingAge luminaries.
bY GeNe MITCHell
36 Self-Scheduling for Nursing Assistants:
A Pilot
Keiro Senior HealthCare
How one provider implemented a retention
strategy for long-term care workers.
bY DoNNA HoWArD, r.N., AND DoNNA blACKburN, r.N.S
departments
40
4 Vision
Innovative Communities: Who’s The Trusted Guide?
6 From the Editor
Responding to Change, Making Change
32 Advocacy
LeadingAge Public Policy Objectives: A Brief Guide
40 Ideas & Innovations
43 Synergy
43 Index of Advertisers
LeadingAge magazine | March/April 2011 3

Innovative Communities: Who’s The Trusted Guide?
LeadingAge is a founder of the Long
Term Quality Alliance. Sparked by
leadership from Dr. Mark McClellan
of Brookings and chaired by Dr. Mary
Naylor of Penn, the LTQA is an umbrella
body whose mission is to improve the
effectiveness and efficiency of care and the
quality of life of people receiving long-term
services and supports by fostering personand
family-centered quality measurement
Larry Minnix, Jr. and advancing best practices.
LTQA is focused on “transitions” of service delivery and
specifically on prevention of unnecessary hospitalizations. Not
coincidentally, “transitions” is one of the LeadingAge 5 Big
Ideas to transform our field from fragmented silos to a seamless
network at local levels.
One big strategic question for our members is this: Who will
be the “trusted guide” to help seniors, other vulnerable people,
and those who love them to navigate a difficult non-system?
I submit that many of you—yes, our members—should be
those trusted guides. Why? Because you have been a staple of
services in your communities for generations. You know what
seniors need when they must navigate that ER visit that turns
into a hospital stay and often ends abruptly with a discharge
planner telling your resident she must move on with short
notice while giving the family a “Yellow Pages” list of options
and a “good luck finding a bed” kind of support. Yes, you
know the problem, and how to help other agencies (that mean
well) to fix them. You must lead that process.
The LTQA sponsored an Innovative Communities Summit
in December—140 people from coast to coast, with 20
communities of all types represented. Three case studies were
presented, including two LeadingAge member leaders: Carol
Woods in North Carolina and Cathedral Square in Vermont.
The third was a Detroit-based hospital program called CARR.
Carol Woods is a CCRC; Cathedral Square is low-income
housing; and CARR is a health system. All are showing
promise in identifying and managing services to prevent
unnecessary hospitalization, on a large scale.
More quality of life is lost, and more Medicare dollars
wasted, on unnecessary hospitalization than any other single
circumstance for seniors! The proceedings from that Innovative
Communities Summit are a must-read for your strategic
plans, regardless of the services you offer or the size of your
organization. Leadership comes in many packages.
Based on the LTQA’s work, I have reached three fundamen-
4 LeadingAge magazine | March/April 2011
tal conclusions:
vision
1. Fragmented, silo services are killing seniors.
2. Fragmented, silo services are killing existing service
models.
3. Our members are the key community partners to
address conclusions 1 and 2.
There is plenty of scientific knowledge around major causes
of unnecessary hospitalization: unsafe homes that produce
falls, inadequate medication management, poor discharge
preparation from hospitals, lack of follow-through on care
plans at home, and poor care coordination to connect the dots
for seniors who have an average of at least five chronic health
problems. In addition, our case studies show there are plenty
of resources to solve these problems—it’s not a resource issue.
The solution? Not clinical science. Not more money. No, the
solution is in the management science of learning to partner.
The key barriers? There are regulatory barriers; Cathedral
Square, CARR and Carol Woods are addressing those. But the
biggest barrier to solving the devastating effects of unnecessary
hospitalization is CONTROL! Every party involved wants to
maintain control. The need to control too often trumps the
potential for community.
In the early 1990s, Wesley Woods, where I was CEO, began
discussions with the AAA, the VNA, Senior Connections (a
broad-based HCBS program), Emory Clinic and others—11
groups in all—to create a network called Atlanta Senior Care.
Envisioned to develop a coordinated services plan for Atlanta,
we were professional friends. But the group nearly fell apart
because we could not agree on who “owned” case management.
The sobering reality was that we were about to walk
away from two years of study, legal bills, foundation support
and good will—all because of control. We backed off the ledge.
We re-thought roles, responsibilities and protocols of case/care
management and realized all had a role to play depending on
the needs of the clients and their family situations—and that we
must work virtually to give clients one contact to help them—
regardless of the employer of the case manager. And we had
to have one database of information to ensure conformity. A
crisis avoided. A partnership established.
A friend on the faculty of Emory Business School was Dr.
Brown Whittington, a guru in creative corporate relationship
partnering. I bootlegged consultation and perspective from
continued on facing page

Responding To Change, Making Change
The world has always been about
change, but it seems to be upon us
with greater ferocity these days. Old certainties,
social and political relationships
and long-standing balances of power are
shifting both at home and abroad. Anyone
running a provider organization must be
thinking about what will be expected in
years to come, and perhaps ready to cope
with austerity the likes of which we have
Gene Mitchell
not seen for decades.
“The Anatomy of Change,” this issue’s theme, is one we will
need to cover continually. I’m optimistic enough to see change
as opportunity, and lots of LeadingAge members are as well.
That’s why they are rethinking business models, building partnerships
and finding new people to serve.
In “The Anatomy of Change” (p. 6), you’ll see how a few
provider organizations have changed their business models,
partly out of necessity and partly because their visions compel
them to advance their missions.
The seniors we traditionally serve are changing and providers
adapt. Some take it a step further and take on responsibility
to serve new and/or underserved populations. Learn how in
“Reaching the Underserved” (p. 12). While some providers
reach the underserved by changing their service mix, others do
it by partnering and integrating their own well-earned expertise
with other entities. See “The Anatomy of Partnerships” (p. 16)
vision continued from page 4
him frequently. I reviewed this situation with Whittington. He
asked me one day how I was doing. I replied, “My work has
never been more complicated. I have never felt more responsibility
for the people we serve even when they are served by
organizations we don’t manage. I have never felt more out of
control of what happens. And I have never been more excited
about the potential we have to help people better.”
Whittington responded, “The business relationship principle
you are experiencing is this: You and your colleagues have all
chosen to give up a measure of control to gain more power for
the people you serve in the marketplace.”
The power of community may be the only thing that will
improve service delivery to seniors while curbing costs. The
“trusted guide” is the key role. Who better than you? Guiding
seniors, guiding the development of innovative communities:
your leadership challenge.
from the editor
to see how these partnerships arise and are maintained.
An important part of health care reform, from the eyes of
health providers of all stripes, is the anticipated growth of
accountable care organizations (ACOs). While many of the
details of how ACOs will be structured and operate are still
being worked out, it’s not too early for aging-services providers
to think about how they may fit into that system in years to
come. See “The ACOs Are Coming” (p. 20), to learn more.
Our feature on p. 24, “A Switch (Just) in Time,” was a story
we initially planned to integrate into one of the features above.
But this tale, of two top CCRC executives who switched jobs
as a result of careful organizational introspection, was just too
unique.
As we prepare to celebrate our 50th anniversary at this year’s
LeadingAge Annual Meeting and IAHSA Global Ageing Conference,
we’re kicking off a series of articles on the past and
future of the association. See “Celebrating Our 50th” on p. 28.
Providers hoping to improve operations are encouraged to
launch pilot studies when trying out new systems. In “Self-
Scheduling for Nursing Assistants: A Pilot” (p. 36), read about
how one Kentucky organization introduced self-scheduling for
CNAs as a way to reduce turnover and absenteeism.
LeadingAge magazine | March/April 2011 5

The Anatomy of Change
Forward-thinking not-for-profit providers
are considering ways to serve
more people and offer greater variety—smart
long-term thinking for
the people they serve and the organizations
themselves. Here are three
stories of providers that changed their
business models, moves with significant
organizational consequences.
One provider, judged to be on the
decline, altered its service mix, modernized
its board structure and pushed
some leadership responsibilities
down to individual communities. A
second provider made similar moves
and is reaching out to another state
to expand services. The third, once
a traditional bricks-and-mortar organization,
is committed to leveraging
home and community-based services
to reach more seniors and expanding
the definition of who it serves.
6 LeadingAge magazine | March/April 2011
by Dianne Molvig
The late business philosopher and consultant Peter Drucker once said
that predicting the future is like driving a car down a country road in
the dark, with no headlights, while looking out the rear window.
Perhaps you know the feeling. As you maneuver your organization into the
future, you face shifting consumer needs and wants, an uncertain pay environment
and an unknown economic climate. You wonder what it will take to
remain financially viable, relevant to consumers and true to your mission in
the years ahead. How must your business model change to accomplish that?
Answering the latter question first demands clarity on exactly what’s being
asked. Confusion abounds on this point, says Mark Andrews, president and
chief operating officer of Greystone Communities, a senior living consulting
firm based in Irving, Texas.
“Organizations often tend to think in terms of changing their physical
plant because it’s old and tired and the units are too small,” Andrews says.
“That may be one aspect. But you also have to consider how you’ll change
what takes place within your walls. How will you change your mix of programs,
services and revenue sources?”
Still, that merely scratches the surface of the deep changes that accompany
a change in business model, Andrews emphasizes. “The toughest part,” he
says, “is getting people to recognize that every dimension of your [work] will
change. You have to be prepared for the fact that the organization itself goes
through a shift in its culture.”
This affects everyone: staff, management, board members and current
residents and clients. Thus, managing a change in the business model
requires managing change across a broad base of constituents. It’s no small
feat. “Deciding to change your mix is almost the easy part, to tell the truth,”
Andrews says. “It’s the delivery of all the promises that’s very difficult.”
A Balancing Act
Ron Jennette knew what he was up against three years ago when he took the
job as president and CEO of Methodist Retirement Communities, based in
The Woodlands, Texas. Some of the organization’s communities were losing
money every month, and foundation funds were being drained to try to keep
up with operational costs.
“It was clear to me that Methodist Retirement Communities was in the
process of dying,” Jennette recalls. The board hired him to revive the organization.
One step he’s taking toward that end is to modify the service mix.
When Jennette arrived in 2008, the mix was 66 percent skilled nursing,

ehab and affordable housing; 24 percent residential; 6 percent
memory-support assisted living and 4 percent regular assisted
living.
By late 2012 or early 2013, the breakdown will be 43 percent
nursing, rehab and affordable housing; 33 percent residential;
13 percent regular assisted living and 11 percent memorysupport
assisted living.
“Our goal is to create a more balanced organization,” Jennette
says. “We’re moving towards all of our communities
offering the full continuum” of living arrangements. Plans are
MJHS resident Angelina Alaimo (101), enjoys a moment with Carol Robinson, one of her
favorite caregivers.
underway to build home health and community-based services,
as well.
Methodist Retirement Communities has decreased the number
of Medicaid licenses from 434 to 86. “We weren’t happy
about doing that,” Jennette says, “but we had to reduce the
Medicaid component dramatically.” That’s because Texas ranks
as the next to the worst among states for Medicaid reimbursement.
The situation will get even bleaker if the state legislature
approves proposed funding cuts of 34 percent. “But I think we
can continue to have some Medicaid within our CCRCs,” Jennette
says.
Service mix changes required other
major shifts in the organization. An
early step was to realign the board structure.
Over the years, the parent board
had come to defer most responsibilities
to the affiliate boards representing each
community. “Each had become more
protective of its particular location to
make sure it didn’t go down with the
ship,” Jennette says.
Now the affiliate boards have input,
but the parent board makes final
decisions on significant matters, and
everyone follows one strategic plan.
“We’re all on the same team,” Jennette
says. “It’s not one community versus the
others, or one versus the system.”
Jennette also revamped the corporate
office staffing. “When I came here,” he
says, “I kept hearing that everything
was about the corporate office.” He
eliminated positions that didn’t directly
benefit the communities, thus reducing
corporate staff from 30 to 13. To
drive home the office’s true purpose, he
renamed it the central support office.
Jennette hired a chief financial officer
and created a new vice president of philanthropy
position. Plus, he eliminated
the chief operating officer position and
made each community’s executive director
the COO for that location. “I told
them they needed to step up and be the
MJHS
leaders there,” he says, “and they’ve done
that.”
LeadingAge magazine | March/April 2011 7

Methodist Retirement
Communities now has
had two good years backto-back,
Jennette reports.
“With hindsight,” he says,
“we’ve been doing exactly
what’s necessary to survive,
going forward.”
Branching Out
Diversification has become
the theme at Minneapolisbased
Augustana Care.
That has entailed adding
new services, such as adult
day and home health services,
as well as expanding
geographically. Augustana
Care, which operates 23 communities across Minnesota,
closed the deal for its first community in Colorado in March
2011.
The shift in focus began about seven years ago. “We realized
how dependent we were on nursing home beds,” recalls Tim
Tucker, president and CEO. “It was clear we needed to look
at other kinds of services, revenue sources and locations to
increase our financial stability.”
The nursing home portion of the organization’s total revenues
has since dropped from 85 percent to 62 percent.
Meeting changing consumer preferences is one driver behind
that shift. Another is the funding climate in Minnesota, where
Medicaid rates froze or increased little at various times over
the last decade.
“That can be okay if you get enough revenues from private
payers,” notes Craig Kittelson, Augustana Care’s chief financial
officer and vice president of finance. “But in Minnesota, private-pay
rates can’t exceed Medicaid rates, so we were locked
in on the revenue side. That forced us to think about how we
could gain more control of our revenues, rather than being at
the whims of Medicare and Medicaid funding.”
Coinciding with shifts in services and revenue sources were
changes in management structure. Early on in the change process,
Augustana hired a vice president of business development
to add entrepreneurial talent to the team. A new chief operations
officer position relieved Tucker and Kittelson from being
mired in the day-to-day. “We’ve been able to move away from
our inward focus and look outward,” Tucker says. “We have
time now to work with the board to think more strategically
for the long term.”
Augustana’s governance structure had to change, as well. The
15-member parent board had drifted into becoming mostly
8 LeadingAge magazine | March/April 2011
Augustana Care has made changes to become less reliant on nursing
home revenue and to offer a wider array of services.
an operational board. The
real need, however, is for
the board to spot trends
and opportunities that lie
around the corner.
The 23 communities
now each have a mission
advancement council.
“They’re the eyes and ears
of each community,” says
Kathy Kopp, vice president
of business development.
“They keep us connected
to the fabric of the com-
Augustana Care
munity’s culture.”
The move into Colorado
was a logical progression
in the diversification process,
Kittelson notes, because many Midwest retirees move to
Colorado. “We looked for where we could be of service,” he
says, “and where we’d have natural constituencies.”
As Kittelson and Tucker, who have worked together at
Augustana Care for 20 years, look back at the business model
changes of the last seven years, they acknowledge one thing
they would do differently. “We should have started sooner,”
Kittelson says, “because I think there were plenty of missed
opportunities.”
“We probably could have done this more like 10 or 11 years
ago,” Tucker adds. “We missed opportunities, both to be of
service and to help our financial stability.”
A Major Shift
In 1978, MJHS (formerly Metropolitan Jewish Health System)
consisted of two sites providing sub-acute and long-term
health care in Brooklyn, N. Y., with an annual budget of $60
million. Today, it’s an $800 million operation with a revenue
breakdown that’s 52 percent Medicare and Medicaid managed
care; 30 percent post-acute home care, hospice and continuing
care; and 18 percent facility-based services, including housing
and adult day services. MJHS now has the largest hospice
and palliative care program in New York state, and it provides
home-based health care in eight counties.
“The evolution of MJHS continues,” says Eli Feldman, who’s
been with MJHS for 44 years and has been instrumental in
steering it in new directions since he became president and
CEO 33 years ago.
“When I took over as CEO, we were just bricks and mortar,”
Feldman says. “I was never enamored with bricks and mortar
because it isn’t the place where most people want to be. I
think community-based services are where it’s at. If we build a

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LAge_DigitalMag_March'.indd 1 11-02-16 11:41 AM
1,000-bed facility, we can take care of 1,000 people. But we can
take care of 40,000 to 50,000 people a year in the community.
It’s a better leveraging of service delivery.”
Along with the shift in service types has come a change in
who receives services. The target group is no longer solely the
elderly. MJHS provides home health care and hospice care to
people of all ages.
“When you define yourself as an organization that delivers
services to chronically impaired, frail and at-risk individuals,”
Feldman explains, “you can serve anyone from birth to death.
That also opens up a lot of different income streams.”
He admits it was initially a challenge to convince the MJHS
board of his vision. “I had to drag them kicking and screaming,”
he says. “But I had champions on the board. You have
to have champions who are willing to stand with you and say,
‘Listen, we have to look at this as investing in our future.’”
The future also looks bright for forming partnerships with
other service agencies, as Feldman sees it. For instance, MJHS
has a joint venture with St. Mary’s Healthcare System for Children
that provides post-acute home care for children.
“We’ve diversified our services for a reason,” Feldman says.
“We did not want to be dependent on one type of market and
the changes that might occur in that market. This is not about
starting outreach programs, which is the way many organizations
view this. It’s a major shift in thinking about the way you
deliver care.”
By making such a shift, aging-services organizations could
ensure their future viability in a changing society, Feldman
believes—if they act soon enough. It’s a bit, he says, like the
ending of the movie, “On the Beach,” in which humankind
faces nuclear annihilation. As the movie closes, “Waltzing
Matilda” plays while the camera focuses on a banner that
reads, “There’s still time, brother.”
“That applies here, as well,” Feldman says. “The window of
opportunity for long-term care organizations to make the shift
is narrow. But there’s still time.”
Dianne Molvig is a writer who lives in Madison, Wis.
Resources
Methodist Retirement Communities, The Woodlands, Texas
Contact: Ron Jennette, president and CEO, rjennette@mrcaff.org
or 281-210-0135.
Augustana Care, Minneapolis, Minn.
Contact: Tim Tucker, president and CEO, thtucker@augustanacare.org
or 612-238-5101.
MJHS, Brooklyn, N.Y.
Contact: Eli Feldman, president and CEO, efeldman@mjhs.org or 718-921-8066.

Reaching the Underserved
As relentless change affects aging services,
providers will be expected to
make changes of their own by serving
new populations and doing more to
serve traditional ones.
Here is a look at three providers with
experience serving the underserved:
One is reaching out to the homeless,
including homeless veterans; another
is finding new ways to serve lowincome
elders, many still affected by
the trauma of Hurricane Katrina; and a
third offers community and residential
care programs for both older adults
and persons living with HIV/AIDS.
12 LeadingAge magazine | March/April 2011
by Colleen Kinder
When National Church Residences (NCR) made the choice to
open a 100-unit housing complex for the formerly homeless
in downtown Columbus, Ohio, it knew it would require great
resources, not to mention partnerships with other providers. What NCR
didn’t anticipate, however, was the intense public relations battle that ensued
when residents of a nearby neighborhood tried to block the construction of
the new housing, which they mistook for a homeless shelter. Patrick Higgins,
vice president of communications at NCR, suddenly found himself doing
newspaper interviews, making town hall appearances, and assuring local
business owners—one by one, in private meetings—that permanent supportive
housing would not bring down the neighborhood.
This is just the kind of battle that providers who serve disadvantaged
populations face: the unforeseen kind. Before even opening the doors of The
Commons at Grant, the staff at NCR had to solve a quandary with which
they had no prior experience. The solution, Higgins quickly discovered, was
to treat the controversy as an opportunity to educate the public. “We met
with the opposition whenever and wherever they wanted,” he explains. “We
went to one public meeting at the library and we very calmly explained,
‘Here’s who we are going to serve.’” Many months and media appearances
later, Higgins reports that the Commons at Grant has been “very quietly
successful,” though as NCR gears up to open another housing complex, specifically
for homeless veterans, they’re braced for new surprises and trials.
Consider the conundrum that staff at Christopher Homes, New Orleans,
La., faced, years after Hurricane Katrina, when residents began hoarding
large quantities of food and possessions. “Even one person [with] this issue
in their apartment can be a problem or concern for the entire community,”
says Dennis Adams, executive director of Christopher Homes, highlighting
the related health and fire hazards. Though Adams and his colleagues
can’t be sure this behavior is a direct result of Katrina—that is, “triggered
by having lost everything”—they nonetheless tackled it as they do all problems
at Christopher Homes: holistically and head-on. Service coordinators
paid regular visits to residents, worked one-to-one to explain the hazards of
hoarding, and cleared out cluttered apartments. It’s an ongoing challenge,
says Adams, but so far they’ve managed to avoid any evictions.
Understanding and Helping the Whole Person
As wide-ranging as their obstacles may be, providers to the underserved
echo one another on the essentials. Whether they champion the destitute

elderly or people living with AIDS, what providers underscore
is the importance of holistic health. “We look at the complete
needs of the population,” Adams says, emphasizing that the
key is to “pay attention to the whole person.” At Christopher
Homes, this means bearing in mind the psychological health
of residents, as well as their social and nutritional well-being.
NCR’s philosophy echoes this. “The reason NCR has been
successful,” says Higgins, “is because it’s multifaceted.” NCR’s
board made “a strategic decision” to “extend our outreach
beyond the usual boundaries.” As a result of this shift, NCR
offers not only housing, “but the services that would allow our
seniors to age in place successfully.” These services range from
alcoholism counseling to employment training, financial lessons
to addiction counseling. “The premise [of NCR] is to not
Christopher Homes
Christopher Homes, badly damaged by Hurricane Katrina, has
bounced back and insists on going the extra mile for residents with
creative service coordination.
only give people a roof over their heads,” Higgins elaborates,
“but to give them the services they need to reclaim their lives
and end the cycle of homelessness.” He calls this a “housing
solution to a national health care problem.”
Taking such a comprehensive approach requires budgeting
outside the box. Christopher Homes, in spite of cuts in
HUD funding for food programs, has successfully incorporated
a dining program into half of its housing complexes “so
[residents] have at least one good meal daily at an affordable
price.” The function of this program is to create a social fabric,
Adams explains, so residents don’t fall through the cracks.
And because there’s no government funding earmarked for
social connectivity, Adams and colleagues appoint themselves
responsible for finding funding. “Just because it’s not in the
HUD budget,” as Adams sums up his attitude, “doesn’t mean
it’s not our issue.” He admits that sometimes “it’s a matter of
robbing Peter to pay Paul so that we can budget the services
that are needed,” offering the example of heightened security
(i.e., night guards and security cameras) as something that
Christopher Homes struggles to afford, but maintains as a top
priority. “Because of [our residents’] vulnerability, they feel
more concerned about security than others may.”
Providers of the underserved also see eye-to-eye on the
importance of attending to the individual. As challenges arise,
rather than consult a rulebook, care managers and service
providers pay close attention to the person in front of them.
“We first work to understand what our clients are trying to
achieve,” explains Emma DeVito, president and CEO at Village
Care, a health and supportive services organization in
New York serving people with chronic and disabling conditions,
“and then fold in health care goals that support those
aspirations.”
DeVito offers the example of a client with HIV who was
extremely concerned with his appearance. The case manager—after
listening carefully to this concern, then explaining
the tie between health and appearance—was able to motivate
him to take medication with more regularity. “Our staff find
meaning and challenge in helping clients meet their own
goals, rather than in counting the tasks they’ve done on any
given day,” DeVito comments. Even the substance abuse
counseling at Village Care is heavily tailored to the individual,
taking into consideration how much a patient is ready to
moderate substance abuse. “We integrate ‘low-threshold’ interventions,”
says DeVito, “So at least the impact of substance use
on their health and treatment adherence is lessened.”
At both NCR and Christopher Homes, service coordinators
are the lynchpin in extending this degree of individual
LeadingAge magazine | March/April 2011 13

attention. Describing their service coordinators, Higgins and
Adams use the same word: resourceful. Whether residents
lack resources for healthy dinners or a ride to the doctor’s
office, their staff work rigorously and creatively to fill the
gaps, finding free services in the community and arranging
for affordable food and transport. At Christopher Homes, for
instance, service coordinators work with low-income residents
to make sure they can afford the in-house nutrition program.
At NCR, one simple measure taken to ensure that residents recognize
their service coordinators is instituting a uniform shirt
that’s bright red. According to Higgins, residents are now more
likely to approach service coordinators and express their needs.
When Listening Is the Best Medicine
Of course, not every need can be met. Try as they may, stretch
funding as they do, providers can’t possibly meet the expectations
of every resident. While Adams acknowledges this, he
maintains that hearing out individual residents is more crucial.
“We need to make it clear that we hear them,” he says. “Often-
14 LeadingAge magazine | March/April 2011
National Church Residences
NCR's The Commons at Grant is a 100-unit housing complex for
formerly homeless people in Columbus, Ohio. The opening of
the complex created controversy and required sustained public
education by NCR staff.
times the great need of the underserved is just to be heard.”
This was a lesson he and colleagues learned in the wake
of Hurricane Katrina. “Oftentimes, [residents] just wanted
someone to sit down and listen to them and hear their story,”
recounts Adams. He tries to reiterate the importance of listening
during staff meetings, so staff members know they have
the permission to slow down and hear out individual people.
“Yes, we all have our responsibilities, our duties,” Adams elaborates,
“but we’ve got to give time to listen to our residents.”
Additionally, he tries to lead by example: “I always leave my
office door open, so the staff knows I’m here to listen to them.”
Listening is the central theme of the advice these providers
lend to colleagues in the field, specifically to those reaching
out to the underserved. “Keep your ear to the ground,” advises
Higgins. “It really comes down to grassroots knowledge as to
how seniors will stay at home as long as possible. Know what’s
going on in your individual residents’ lives.”
According to DeVito, openness is another key component
in working with the disadvantaged. “[It’s] a matter of ensuring
a nonjudgmental and welcoming environment so that [underserved
people] can engage in their care and partner with us as
providers,” says DeVito. “Poor experiences will only drive such
populations further away.” Treatment of staff, she contends,
should rise to the same high standard. “Village Care provides
family benefits to spouses or domestic partners of its employees,”
she explains, “in part to put its money where its mouth is.”
The greatest job benefit of all, say Higgins and Clark, is the
gratification that comes from attending to people with a history
of neglect. They both note how grateful many of their
residents are for the most humble living arrangements and
basic services. Adams, who used to work at a private golf
course, found the gratitude especially startling. Years ago,
when he took a job at Christopher Homes, a press release
titled “From Riches to Rags” reported his career shift. If you
ask Adams, though, providing for the poor elderly of New
Orleans during its most traumatic hour has meant the greatest
rewards of his career.
Colleen Kinder is a writer who lives in Brooklyn, N.Y.
Resources
National Church Residences, Columbus, Ohio
Contact: Patrick Higgins, vice president of communications, phiggins@ncr.org
or 614-451-2151.
Christopher Homes, New Orleans, La.
Contact: Dennis Adams, executive director, dfadams@christopherhomesinc.org
or 504-596-3460.
Village Care, New York, N.Y.
Contact: Emma DeVito, president and CEO, Emmad@vcny.org or 212-337-5763.

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The Anatomy of Partnerships
For these providers, giving more seniors what they want and need
means building partnerships with other organizations.
by Kim Fernandez
As providers expand their menus of
services and the populations they
serve, smart partnerships with other
human-service organizations are
a good way to leverage assets and
strengths.
Here is a look at three providers that
have built partnerships: One turned
a problem—too much space for a
planned PACE—into an opportunity to
build a one-stop senior-services shop
with three other organizations. A second
provider partnered with a nursing
school and a public housing authority
to bring health and wellness services
to low-income senior housing residents.
A third partnered with an order
of nuns to build a CCRC for their own
retirement, at the same time providing
a new living option for community
residents.
16 LeadingAge magazine | March/April 2011
They say it takes a village to raise a child. As time goes on and people
live longer, it’s become clear that it may very well take a village not
only to raise a child, but to see him or her through adulthood and
into old age.
Partnerships between not-for-profit organizations flourish, in no small
part because by working together, they can do much more than any one individually.
They see the real benefits offered to seniors and their communities
as a whole, and say that carefully constructed and contracted partnerships
can answer a number of wishes, from health care for Mom and Dad to the
proper housing for different stages of life, to making Medicare and Medicaid
access easier for everyone involved.
Here are three stories of successful partnerships that work. In each case,
those involved say the sum is so much greater than its parts that they’d do it
again in a heartbeat—and many already have.
LifeCircles PACE clients take an exercise class.
Porter Hills Retirement Communities & Services

A Partnership Centralizes and
Streamlines Senior Services
Several years ago, the leaders of Porter Hills Retirement Communities
and Services, Grand Rapids, Mich., decided to launch
a Program of All-Inclusive Care for the Elderly (PACE). It
sounds simple enough, but for one large roadblock: The only
building Porter Hills could find to house the program was an
empty grocery store measuring 37,000 square feet. And that
was 20,000 square feet more than Porter Hills could use.
They realized that with the right partnerships, that roadblock
could be a huge boost to the older residents of Muskegon
County.
“This ended up being two levels of collaboration,” says Life-
Circles PACE Executive Director Bob Mills. “The building
partnership started with the idea that we found a space that
was ideal for the PACE but was too large for us. And the other
happened when we found partners and created this continuum
of care for very healthy seniors to those who are frail.”
Porter Hills put out the call to area organizations with
similar missions—to serve seniors—to share the building,
and wound up with three partners. Since 2008, the PACE has
shared the building with the Area Agency on Aging (AAA),
Agewell Services, which provides everything from Meals on
Wheels to art and fitness classes, and “Call 211,” which helps
seniors find resources in the community.
“There were a couple of agencies we had to turn away
because we ran out of space,” says Porter Hills CFO Reed
Vander Slik. “That’s a good problem to have.”
In the beginning, says Vander Slik, there were two main
goals for the partnership: to save costs by combining space and
sharing some staff between the agencies and to pool resources
to better serve seniors. Both have worked well, say the partners,
providing a host of benefits and services to seniors who
walk through the door.
“There’s a very programmatic collaboration that occurs,”
says Mills. “We purchase our dietician time through Agewell,
and they do our meals for us in the PACE program. Senior
resources are critical, and we share an intake counselor. So any
call that comes in where somebody’s looking for counseling,
the counselor can talk with them and get them where they
need to be for services. It’s been an absolutely incredible benefit
for our referral numbers.”
The center has a state Department of Human Services
employee who works on-site who can authorize seniors for
Medicaid benefits. “That normally takes two to three weeks,”
says Mills. “It can occur here within three days, and that can
be critical with cutoff points and intake points.” The DHS bills
the AAA agency for the cost of that employee and then Life-
Circles picks up half of the cost.
Mills says the benefits of the partnership play out every day.
“Last fall, we had a family visit us from out of state whose
frail mother lives here,” he says. “They knew she needed more
help to stay at home independently, so they came into the
building. Within the week—before they left to go home—she
was enrolled to come into [the] PACE and get some other services.
They were able to take care of everything within days of
coming here, and they had no idea when they came in what
they were looking for.”
“Whenever a senior walks through that door, we somehow
meet their needs,” says Vander Slik. “Together, the partners do
a tremendous job of making sure we don’t turn anyone away
without an answer. We always try to put them in touch with
someone who can help. That’s good from a business standpoint,
but also from a community standpoint.”
The four agency directors meet twice a month to go over
details of the partnership and ensure that everyone stays on
the same page moving forward. And it hasn’t all been sunshine
and roses from the start. Vander Slik says designing the space
to meet everyone’s needs was quite challenging, and a consultant
was finally brought in to work out the collaboration’s
details. But the benefits have far outweighed any issues along
the way.
“The benefits of this have been above and beyond what we
thought might happen,” says Vander Slik. “As the senior population
grows, it really makes sense to centralize and be able to get
people to one place where they can find the help they need.”
A Partnership Brings Health
and Wellness to Public Housing
Stephen Fleming, president and CEO of Well Spring Retirement
Community, Greensboro, N.C., says his group always
tried to provide health care services to the seniors it served.
But it wasn’t until the organization partnered with the University
of North Carolina-Greensboro Nursing School and the
Greenville Housing Authority that things really took off and
Fleming felt confident that his residents were getting all the
routine health care they needed.
“The nursing school had a small program at each of our
individual housing authority locations,” he says. “In 2008, we
approached them about the possibility of forming some partnerships,
and that came out of a lunchtime conversation I had
about ways to expand the programs that were already offered.”
He met with the directors of the two programs, a partnership
was forged, and the health care clinics went from
twice-yearly offerings to year-round opportunities to receive
health care services.
“In 2005, we came up with a strategic plan that was updated
in 2008,” he says, noting that he’s getting ready to update it
again this year. “We saw a need to evaluate our services and
expand our opportunities outside of our core continuing care
LeadingAge magazine | March/April 2011 17

University of North Carolina-Greensboro Nursing School students serve residents at Hampton Homes, a Greensboro Housing Authority
housing community. Well Spring Retirement Community invested in a partnership with the nursing school and the housing authority to bring
health screenings and wellness checks to low-income housing residents, facilitating aging in place. Efforts are underway to bring primary
care health care to the clinics as well.
retirement communities business.”
Well Spring refurbished space in a housing authority
property for a clinic and invested in medical equipment for
screening and other wellness checks. The doors opened, and
they started seeing patients, and counting.
“In 2007, they had 500 resident contacts,” Fleming says of
the clinics. “We came into the program in the second half of
2008. In 2008 and 2009, we had 1,426 contacts. In 2009 and
2010, we had 1,547. That’s a 300 percent increase in the contacts
we’ve been able to make.”
Initially, he says, the agreement called for funding for five
years. That will likely be extended, as the money is going to
last longer than they anticipated, thanks to participants’ efficiency
with resources.
The partnership serves both seniors, who are now receiving
routine well-health care as well as care when they are ill or concerned,
and students at the university, who work in the clinics.
“At the end of the five years, we decided we wanted to
involve other agencies and departments at the university,” he
says. Students from audiology, exercise science, and other
departments were added to the clinic.
“We’re also starting to get some true data to allow us to go
back to potential funding sources and show them that we’ve
had real results. We keep people out of acute care and out of
18 LeadingAge magazine | March/April 2011
Well Spring
the emergency room setting. We’ve also developed a PACE
program.” He says that model of chronic care fits in well with
his goal of providing preventative care to seniors. “If you invest
in preventative care, you’re better off on the chronic care side,”
he says.
When we spoke to Fleming, the partnership was in the
process of contracting with a physician’s practice to provide
primary care through the clinic. “That will allow folks, more
than likely, to stay in their housing authority living units longer
than they would have previously,” he says. “Ultimately, that
will help reduce some of the burden on the Medicaid system.”
A Partnership Builds a CCRC
Seven years ago, the Sisters of St. Joseph, Roseville, Minn.,
started thinking about their housing options as they aged.
Their convent, which was next to St. Catherine University, was
very modern when it was built in the 1950s, but didn’t meet
the needs of an aging population very well. The sisters started
looking at retirement communities in the area to get an idea of
who might provide them with the best options as they aged.
They decided to partner with Presbyterian Homes and Services,
St. Paul, Minn., for a number of reasons, but one of the
biggest was that the proposed community would serve both the
sisters and the surrounding community, which had a large need

for the same sort of housing the nuns had been looking for.
The result is Carondelet Village, a 259-unit CCRC built in
three phases on the sisters’ property, that will house as many
of the 150 nuns as choose to live there plus other seniors from
the community.
“To date, more than 1,400 individuals have expressed interest
in the property,” says Campus Administrator Beth Carlson.
“We have reserved all of the senior apartments and assisted
living units, and we’ve not yet opened our care center or memory
care center. Another 400 people have asked to be on the
wait list for available apartments.”
Sharon Klefsaas, director of operations for Presbyterian
Homes and Services, says the partnership has been a true winwin
for the sisters and area seniors, who needed the same kind
of property.
“The project will apply for licensing and certification, which
will support both the sisters who may need a level of Medicare
or Medicaid that they’ve not been able to access to date, and
the city. There is a need in that portion of the city for skilled
nursing beds. This partnership serves both.”
It’s exactly the kind of partnership Presbyterian Homes and
Services likes, says CEO Dan Lindh. “We’ve done about 15 or
so of these partnerships,” he says. “We like partnering as a way
to extend our mission in ways we couldn’t do if we just stayed
on a balance sheet within our own organization. And it helps
other organizations who share common goals get stuff done
that they couldn’t do on their own. They don’t have the access
to capital markets or equity or land or people or other attributes
that are necessary.”
And it’s not all one-sided. “It works for us because it allows
us to finance things off our own balance sheet,” Lindh says. “It
doesn’t have the kind of financial implications and isn’t a limiting
factor as it would be if we were trying to do it all ourselves.
We look for partnerships that have a synergistic outcome.”
He says the partnership with the Sisters of St. Joseph has
absolutely lived up to its goals, and then some. “I don’t think
we anticipated it at the level it turned out to be,” he says.
“Because of its geographic location, it’s in an area of strong
unmet demand.”
Kim Fernandez is a writer who lives in Bethesda, Md.
Resources
Porter Hills Retirement Communities & Services,
Grand Rapids, Mich.
Contact: Reed Vander Slik, CFO, rvanderslik@porterhills.org or 616-949-4975.
Well Spring Retirement Community, Greensboro, N.C.
Contact: Stephen Fleming, president and CEO, sfleming@well-spring.org
or 336-545-5410.
Presbyterian Homes and Services, St. Paul, Minn.
Contact: Sharon Klefsaas, director of operations, sklefsaas@preshomes.org
or 651-631-6145.
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LeadingAge magazine | March/April 2011 19

The ACOs Are Coming …
Accountable care organizations
(ACOs) will become part of Medicare
next year as a tool for promoting value
over volume. Though the rules applying
to ACOs are not yet codified, agingservices
providers can begin thinking
about how they will interact with and
potentially fit into ACOs. Here is a
look at the issues involved and how
providers can position themselves to
thrive in an ACO environment.
20 LeadingAge magazine | March/April 2011
by Michele Hayunga
They’ve been debated in health care circles, hyped in the media and
even parodied on YouTube. Yet, despite the buzz, there are still more
questions than answers about how accountable care organizations
(ACOs) will play out. Here’s what we know so far—and what you can do to
prepare.
The ABCs of ACOs
Broadly speaking, ACOs are an approach to care designed to promote value
instead of volume. The idea is to create formal arrangements among physicians,
hospitals and other providers to coordinate and deliver care needed by
a specific set of patients. If an ACO succeeds in cutting costs without sacrificing
quality, the providers comprising it will be rewarded financially.
ACOs differ from HMOs in that care coordination is driven by providers,
as opposed to insurers. They also offer consumers more choice, because
patients don’t have to stay in network.
While the ACO approach is relevant to public payers, private insurers and
employers, many ACOs will get their feet wet with Medicare. The health
reform law created a Medicare Shared Savings Program for ACOs, scheduled
to begin Jan. 1, 2012.
Under this program, ACOs must be willing to participate for three years
and have the capacity to serve at least 5,000 Medicare beneficiaries. Beyond
that, the details will be spelled out in a proposed CMS rule that was expected
in February or March of this year. After a comment period, CMS is expected
to issue the final rule over the summer.
Shaping Medicare’s ACO Program
One of the biggest decisions for CMS is what the incentive (or incentives)
will look like. On one end of the spectrum is a low-risk shared savings
approach in which providers receive fee-for-service payments with a modest
bonus for achieving quality and cost benchmarks. At the other end is capitation,
which offers greater reward but requires providers to assume more risk.
Whether CMS offers both choices, or only shared savings, will influence
what kinds of providers participate.
Another key question is how CMS will determine the quality
benchmarks—and if there will be risk adjustment. “Statistics show that notfor-profits,
because of their mission, tend to take care of everyone, as long
as there is the need,” explained LeadingAge’s Peter Notarstefano, director of
home and community-based services. “There is not the cherry picking of

Experts believe ACOs will create new expectations and opportunities
for aging-services providers. Many long-term services and supports (LTSS)
providers may find themselves marketing their organizations
to ACOs in order to receive referrals.
cases that has occurred with some for-profit providers.” Not-forprofits
will also be looking closely at the incentive, as they tend
to spend more on quality initiatives and staff training, he added.
CMS is also grappling with how to assign beneficiaries to
ACOs—and ensure that they’re informed about the change.
Additionally, the agency must balance providers’ legitimate
need for data with consumer concerns about privacy.
In a December panel discussion at the Center for American
Progress, CMS Deputy Administrator Jonathan Blum
described the program as one of his agency’s highest priorities.
“If the ACO program is done well and done right, it’s going to
change the incentives,” he says.
Yet Blum also acknowledged the challenges of regulating
uncharted territory. “Our notion here is that we’re starting
from scratch,” he says. He emphasized that CMS is counting
on consumers, providers and insurers to offer feedback on the
proposed rule.
What ACOs Mean for Aging-Services Providers
While much remains unknown, experts believe ACOs will
create new expectations and opportunities for aging-services
providers. Many long-term services and supports (LTSS)
providers may find themselves marketing their organizations
to ACOs in order to receive referrals. Eventually, some may
become formal parts of ACOs with the potential to share in
rewards. Even providers in residential settings will likely find
themselves interacting with ACOs.
For example, residential providers could see ACO-contracted
care managers visiting patients who live in their
communities, predicts Nancy Rehkamp, a principal with the
health care division of LarsonAllen. ACOs may also want to
bring in technology to monitor patients with certain conditions.
This could create revenue opportunities for LTSS
providers with expertise in wellness, care management and
telehealth.
ACOs will be even more engaged with LTSS providers
on the skilled care end of the continuum. “Skilled nursing
facilities and home-health providers will be included in care
planning, best practices implementation and ongoing care
monitoring in greater ways than historically,” Rehkamp says.
“Providers will be expected to work closely with the patient’s
physician to reduce hospitalizations, emergency room use and
readmissions—and to offer wellness and prevention services.”
This type of interaction represents a paradigm shift from
today’s system, where LTSS is often not on the radar of hospitals
and physicians. Under the ACO model, these groups will
have a much greater stake in the quality of post-acute care.
The emphasis on post-acute care is expected to play out
even in regions where ACOs are slow to form. This is because
other elements of the health reform law—such as bundled
payments and penalties for certain readmissions—also tie
reimbursement to outcomes.
The Hospital Perspective
As ACOs and hospital executives turn their attention to postacute
care, what will they be looking for in their partners?
Rehkamp’s colleague Greg Hart, a principal with LarsonAllen’s
hospital practice, anticipates the following questions:
• Which will deliver the best clinical outcomes? For which
groups of patients?
• Which will help our hospital avoid unnecessary
readmissions? Facilitate effective use of home care
services? Avoid infections and falls?
• Which will work best with our hospital care team and
case managers to integrate and coordinate care, with
planned and measurable protocols and shared data
systems?
• Which is willing and able to share risk?
• Which might consider economic integration with our
system?
“Simply put, systems will be looking for value, measured by
quality and cost,” Hart says.
Strategies for Success
To thrive in an ACO environment, first and foremost, providers
will need to demonstrate their value in a tangible way. In the
article, Examining Acute/Post-Acute Care Partnerships Under
Healthcare Reform, Scot Park, a partner with Dixon Hughes
Healthcare Consulting, offers suggestions for how to do that.
His insights are based on interviews with hospital CEOs.
“The key takeaway here is to realize and accept that successful
post-acute care organizations will need to intensify and
LeadingAge magazine | March/April 2011 21

“Successful post-acute care organizations will need to intensify and improve
their ability to record, track, quantify, analyze and report on patient care
outcomes. And they will need to do this in ways that reflect an effective
integration of acute and post-acute care clinical pathways.”
improve their ability to record, track, quantify, analyze and
report on patient care outcomes,” Park explains. “And they will
need to do this in ways that reflect an effective integration of
acute and post-acute care clinical pathways.”
From a practical standpoint, hospitals are also looking for
partners that have the capacity to serve their geographic market.
Park suggests post-acute providers think about how to
handle increased volume while maintaining cost efficiencies
and quality outcomes. In some cases, this may mean partnering
with other LTSS providers.
Financial strength and information technology (IT) capabilities
are two other critical elements. Integrating clinical and
technology systems can be costly and time-intensive, so hospitals
are looking for stable partners who can share some of the
investment.
Not surprisingly, hospitals want partners whose mission,
vision, values and organizational culture are closely aligned
with their own. They’re also looking for providers with strong
brand awareness in the market, particularly if that brand is
associated with quality. Interestingly, many hospital CEOs
viewed faith-based sponsorship as a “double-edged sword”
when it comes to branding.
On the Front Lines
Jeffery Lemon is paying close attention to these considerations.
As president of Spectrum Health Continuing Care in Western
Michigan, he leads the LTSS arm of an integrated delivery network.
Lemon is charged with preparing his own portfolio for
an ACO environment—and identifying other post-acute partners
for Spectrum Health.
“The primary focus for us will be on reducing unnecessary
emergency room visits and avoiding re-hospitalizations,” he
says. Lemon is working with Aging Services of Michigan to
develop a standardized tool to evaluate how well post-acute
providers achieve those aims. Criteria such as staffing ratios
and physician involvement will also be looked at carefully.
Another major consideration will be an organization’s size.
“We want to deal with providers that have geographic reach,
because it’s easier to write one check than a hundred,” he says.
“I’m encouraging my post-acute colleagues to come together
and form consortiums.” Lemon also echoes Park’s comments
about financial stability and IT capabilities.
22 LeadingAge magazine | March/April 2011
Within his own post-acute portfolio, Lemon is exploring
how to improve integration with Spectrum’s HMO. “We’re
finding more and more opportunities to collaborate around atrisk
patients on the home and community-based side,” he says.
Now, when at-risk patients are identified, Spectrum provides
a nursing assessment in the home and—when necessary—
remote monitoring.
Lemon is also working on increasing providers’ ability to
respond to clinical complexity. For example, many of Spectrum’s
skilled nursing centers are installing telemetry units.
“We’re trying to raise our game clinically, so we can be another
stop along the continuum for these patients.”
The First Step
LeadingAge members are at different stages of preparing for
the changes under health reform. But one thing every organization
can benefit from is becoming more informed. LeadingAge
recently released a report on transitions and integrated services,
which includes additional perspective on ACOs.
A number of groups are holding conferences and webinars
on these topics as well. ACOs will be featured in a session at
the upcoming Future of Aging Services Conference & Leadership
Summit. Another resource is The Brookings-Dartmouth
Accountable Care Organization Learning Network, which
offers webinars and conferences for members.
LTSS providers should also focus on strengthening relationships
with local hospital systems and physician groups, and
be a part of discussions about emerging ACOs. “It’s absolutely
worthwhile for LTSS providers to be at the table,” says Lisa
Lehman, president of the consulting firm Holleran. “You can
start with a simple phone call, but that has to happen at the
right level, which is your CEO and board.”
More broadly, providers should be thinking about what
kinds of integrated models they want to be a part of and who
else in the community will be involved. “The person who
writes the first draft has more say in how they’re positioned
than the person who is just reacting,” says LeadingAge Senior
Vice President Zachary Sikes. “It’s up to our members to create
a compelling vision of what success looks like for them, and
then work among stakeholders to achieve it.”
Michele Hayunga is a writer who lives in Eldersburg, Md.

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A Switch (Just) in Time
How and why two top CCRC executives switched
jobs to improve their organization’s performance.
Management expert Jim Collins, as
part of his Good to Great approach
to organizational excellence, believes
success requires not only having the
right people running an organization,
but having them all “on the right seats
on the bus.”
Here is the remarkable story of an
organization that took self-assessment
seriously, and of two top managers
(a CEO and a COO) who, after years
of working together, recognized that
they were better suited for each other’s
jobs, and switched.
24 LeadingAge magazine | March/April 2011
by David Tobenkin
Some of the best leadership teams are composed of top executives with
years of experience guiding an organization together. One strength of
such arrangements is that each executive’s different skills, personality
traits and experiences are reflected in a well-defined leadership role. But
as a recent, remarkable executive shuffle at Western Home Communities, a
Cedar Falls, Iowa-based CCRC, shows, sometimes leadership roles must be
changed to preserve what is best in a management team.
From 1995 to 2009, Jerry Harris served as Western Home’s president and
chief executive officer and Kris Hansen as its vice president and chief operating
officer. Harris directed overall operations while Hansen tended to the
financial planning and operational details necessary to ensure that goals were
realized. In September 2009, after much reflection, they decided that for
the best interests of the organization, they should switch roles, and Hansen
assumed the top position.
For many years, the earlier arrangement, with Harris in the top role,
worked well. Both men brought strengths to their leadership roles. Harris
had more formal training in aging services, having worked in senior care
since college and obtaining an administrator’s license. He brought a lifetime
of commitment to Western Home, having joined the organization after graduating
from college.
Hansen brought financial acumen from his training as a certified public
accountant and an ability to plan future growth. He brought a more varied
world-view, having had previous careers as a farmer, a deputy sheriff and a
custom engineer at IBM. He also brought a greater willingness to take risks,
having, among other things, decided to forgo going to college immediately
out of high school to instead farm 300 acres, some of which he bought while
still in high school.
But the two men saw eye-to-eye in their commitment to senior care. Both
grew up in farm communities surrounded by “lots of grandparents” and had
experience with senior care: Hansen’s grandparents were administrators of a
Presbyterian home, while Harris as a high school student spent many hours
helping at a Lutheran home. They were also good friends: a pair of six-footfour
jocks who biked, worked out and socialized outside the office.
For many years, the organization moved along smoothly under their
watch. They trusted each other, operating under a loose management style
with overlapping roles that led both of them to address different problems as
they came up.

Changing Times, Increasing Stresses
As the new millennium began, however, the environment
changed. It became clear that the demand for aging services
was expanding. Other providers were considering moving into
Western Home’s service area, and the organization would need
to increase the number, size and complexity of individual residential
projects, along with the range of services it offered, if
it wished to remain an aging-services leader. In particular, the
company was facing difficulties keeping up with the demand
for independent and assisted living. The duo spurred Western
Home into rapid growth; within a few years, the company had
added 400 more residents and 200 more employees.
Under those pressures, the informal management style that
had worked so well in the past began to show cracks. By 2005,
when another growth spurt took place, the cracks widened
to fissures. There were miscues as one of the pair would take
actions of which the other was unaware or reverse the other’s
decisions. Employees sometimes began to play a version of
“mommy-said, daddy-said” by telling one that the other had
approved the action they sought. Too, the pair simply could
Apply by April 30 for LeadingAge Annual Awards
Does your aging-services workplace shine as an example of
excellence? Have you or a colleague created an innovative program
or exhibited leadership that deserves special recognition? Give that
person or organization the chance to be recognized by entering the
2011 LeadingAge Annual Awards. See our Call for Nominations for
details.
From your entries, our judges will select the outstanding nominees.
Winners will receive a free registration for the 2011 LeadingAge
Annual Meeting & IAHSA Global Ageing Conference in Washington,
D.C., Oct. 16-19, where they will be honored. The winning individuals
and organizations also will be featured in the September/October
issue of LeadingAge.
Even though not every entry will receive an award, all entries are
carefully considered and often lead to further opportunities to “tell
the story” of the nominees’ accomplishments through such avenues
as education programs, media outreach, this magazine, our daily
blog and other means.
not maintain the degree of informal contact with employees
and residents that had been possible when the organization
was smaller and the demands on their time were fewer. And
Harris, always the more cautious of the two, was placed in
the uncomfortable role of having to guide the organization
through rapid and aggressive expansion.
“It worked well in the beginning because we were smaller,”
Hansen says. “Jerry and I were together and neither of us realized
how much informal information went back and forth
between us outside of work. But as we got larger it began to be
dysfunctional, we got stressed with day-to-day responsibilities,
and family life also changed for both of us.”
While on paper Western Home’s financials and growth trajectory
looked strong, it became clear to the two men, to the
company’s auditor and consultant, and then to the board that
something was amiss.
“Something had to be done,” says Ron Leibold, then and
now a member of the Western Home board. “They were a
two-headed dragon and the employees didn’t know who to go
to on a given issue because they were both about equal. They
It’s easy to submit an award entry. Simply fill out the online
nomination form and answer a few questions telling us for what
achievements the person or organization is being nominated and
why they deserve the award. Award categories include:
• Award of Honor
• Excellence in Leadership Award
• Excellence in the Workplace Award
• Innovation in Care and Services Award
• Hobart Jackson Cultural Diversity Award
• Dr. Herbert Shore Outstanding Mentor Award
• Excellence in Research and Education Award
• Public Trust Award
• Outstanding Advocacy Award
Nominate a person or organization that is making a difference.
Entries must be submitted online—again, the deadline is April 30. If
you have questions, contact Deborah Cloud at dcloud@aahsa.org.
LeadingAge magazine | March/April 2011 25

were being played off one another by employees like children
do with parents.”
Assessment and Change
At the recommendation of the board, a management consultant,
Russell Jensen of Jensen Consulting, was brought in to
conduct an organizational assessment. Over two intense days
in July 2009, Harris and Hansen’s aptitudes and attributes were
tested through online questionnaires, intelligence tests and
interviews with Jensen and his organizational psychologist
about their management approaches. They also were placed
in role-playing scenarios in which they had to explain, under
extreme time pressure, how they would solve the management
challenges of a dysfunctional family company whose chief
executive dies of a heart attack. One area Jensen specifically
probed was how they would react if they switched management
roles. Jensen also obtained the input of the board and
employees regarding how the organization was being run, and
their interactions with the men.
The final day included a review of the previous day’s exercises.
“They were still measuring us,” Harris says. “They would
say, ‘If we say to you “you should be COO and Kris should be
CEO,” how would you feel about it?’ My response was ‘I don’t
care about titles. I want to do what I am good at. I’d move Kris
into it.’ They were testing us to see if we were going to blackball
each other.”
Then the report was released to both men and the board.
It said that while both men offered strengths to the organization,
a more formal management style with clearer task and
employee supervisory responsibilities was needed and, more
dramatically, that management performance would improve
with Hansen at the helm and Harris as his second-in-command
charged with executing the operational details. The
report said that Hansen was the better long-term strategist
who could better chart the company’s future, while Harris was
the detail-oriented operations taskmaster who could ensure
that all the necessary steps to execute that strategy were taken.
The board asked Harris and Hansen to give their own
assessment of what should be done. They took a month to do
so, working out the changes they planned to propose. That
kept the board in a state of high suspense as to whether one or
both of the men would leave, or if the board would be faced
with having to choose the appropriate roles for the two, Leibold
says. Then the pair delivered the hoped-for outcome: they
would accept the consultant’s recommendations and switch
roles.
26 LeadingAge magazine | March/April 2011
Leibold recalls that he responded with elation: “I’m so happy
you’ve come back! You’ve made my day, you’ve made my week,
you’ve made my month, you’ve made my year! You’ve come up
with this without forcing us to make a tough call between you.”
The choice to accept his new role as chief operating officer
was not that difficult, Harris says, noting that he had agreed
with that result during the testing: “A couple of times during
testing I felt—not like I was being demoted—but rather, ‘Am I
a failure in a couple areas?’ I won’t say I didn’t do some soulsearching.
But we read each other’s letters from Russell. Both
had positive and glowing statements and other areas that were
not so glowing. And if not for the utmost trust I had in Kris, I
would have felt differently.”
Still, both men realized that the optics of the change would
be difficult. To many, the switch might look like something
was wrong at Western Home, or that it was a demotion for
Harris, Hansen says. Hansen says that they responded through
a press release that emphasized the positives and sought to
anticipate and dispel negative rumors. They also intentionally
made few changes at Western Home for the first six months to
reemphasize a sense of continuity and avoid the appearance of
a cleaning of house.
The effects of the realignment have been positive, the pair
say. “There is not as much stress as there was because we are
not tripping over one another,” Hansen says. “Being in the role
you are designed for helps limit that.” Harris says he is pleased
he can now spend more time cultivating relationships with
residents and employees.
And Western Home, which will celebrate its 100th year of
operations in 2012, continues its growth. Formed originally
by the Evangelical United Brethren Church to develop a small,
12-unit retirement home, it now has 500 employees and serves
approximately 750 residents in several levels of care. Western
Home also manages and consults with other long-term care
and senior living providers around the state.
More than anything, Harris and Hansen say, it is the realization
that they are only one part of that community that has
helped ease the transition: “This organization is not just about
Jerry and me,” Hansen says. “We are smart enough to know
that employees are our customers and if we take care of them,
the ultimate customers will be well taken care of. We try to
come as close as we can to being a bicycle wheel where we all
support one another. If you break a couple spokes, you end up
in a pretzel.”
David Tobenkin is a freelance writer who lives in in Chevy Chase, Md.

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Celebrating Our 50 th
A look back—and ahead—from the
perspective of LeadingAge luminaries.
2011 is the 50 th anniversary of the founding of LeadingAge,
which began as the American Association of Homes for the
Aging (AAHA). In anticipation of our celebration of the
anniversary at this year’s LeadingAge Annual Meeting &
IAHSA Global Ageing Conference in Washington, D.C. (Oct.
16-19), LeadingAge is talking with a long list of prominent
members who helped build the organization. Highlights of
those conversations will be published throughout the year.
Two classic and quite rare
publications from the history of
LeadingAge are now available for
download. The Social Components
of Care, published in 1966, was
an early example of association
members’ long-standing interest
in helping seniors maintain dignity
and independence in all care
settings. The idea for the book grew
from our early leaders’ desire to
advance the concept of “psychosocial”
care—what we would
call “person-centered care” today.
A second book, The American
Association of Homes for the Aging:
The First 25 Years, is a history of the
association from 1961-1986. Filled
with detail about our growth, the
issues the association addressed
and the people who built it, the
book gives today’s readers a
valuable sense of the origins and
evolution of today’s aging-services
continuum.
28 LeadingAge magazine | March/April 2011
by Gene Mitchell
Though the beautiful Arden House Conference Center,
at the crest of a mountain in upstate New York, is no
longer in use, its name still resonates with LeadingAge
members, especially those who worked in aging services in
1961 or in the years afterwards. What would those 99 pioneers
who gathered there to found the American Association of
Homes for the Aging (AAHA) have thought if they could look
ahead half a century to see the varied and sophisticated continuum
of services that has grown up since then?
In this first in a series of articles to be published in 2011, we
talked to some prominent LeadingAge members about the history
of the association, how aging services have evolved, and
their hopes for the future.
Msgr. Charles Fahey
Msgr. Charles Fahey is as good a historian of LeadingAge as you’re likely to find.
Involved almost from the association’s beginning and a recipient of its Award of
Honor, Fahey has been at the intersection of aging services and public policy for
decades. He was a charter member of the Federal Council on Aging and was later
appointed its chairman by President Jimmy Carter. Fahey has also been president
of AAHA and of Catholic Charities, and has served on the boards of a number of
other aging-related advocacy organizations. He is professor emeritus of Fordham
University’s Third Age Center for Gerontological Studies and is a program officer for
the Milbank Memorial Fund.
LeadingAge: You were involved with AAHA from very early
on, and were also active in public policy around aging as well.
Could you discuss the environment at the time AAHA was
created and how it and the field developed?
Fahey: If you go back to the beginning, I wasn’t at Arden
House but one of our institutions was, and I became involved
early on while at Catholic University as a student. Clearly at
that time these were homes for the aging, they were social in
character. There was only a little of the beginning of health
care in them, primarily within the Jewish community. I’ve
often said the founders of AAHA were liberal Jewish social
workers, retired ministers and dancing nuns. Before inter-reli-

gious cooperation was de rigueur these folks immediately hit it
off with common values and constituencies.
At that time the facilities were dependent on private philanthropy
and old-age or public assistance. It was basically local
and state welfare, private philanthropy, a lot of informality and
not highly regulated.
In 1961 there were almost no advocacy organizations in
aging. NCOA [National Council on Aging] became an organization
of organizations, largely of those with an interest, but
not primary, in aging. Early on, not-for-profit homes became
a part of NCOA but … there was concern they would overwhelm
NCOA. So Ollie Randall [vice president of NCOA]
went out and got funding to start AAHA.
One characteristic of AAHA in the early years was the
volunteer leadership (who we’d now call board members)
performing administrative functions … very intensely. Lester
Davis [AAHA’s first executive vice president, the title then
used for what is now the president and CEO of the organization]
was a fellow who was beloved, was a one-man band.
Another coterie wrote manuals, ran meetings, did everything.
For almost the first 15-20 years of [AAHA] it was in very
stressful economic conditions.
You can’t disengage AAHA from the social milieu of which
it was a part. The civil rights movement brought the country
together to face an issue nationwide. All these things were
coalescing, and as this was happening there was quite a movement
for a national health insurance program, largely led by
the labor unions. During discussions about what should be
done, in the run-up to [the passage of] Medicare and Medicaid,
AAHA participated in the hearings, being an advocate for
the frail elderly in institutional care.
The passage of Medicare and Medicaid was a sea change, as
was the Older Americans Act, all of this in 1965.
LeadingAge: The mission of LeadingAge is “Expanding the
World of Possibilities for Aging.” What does that mean to you?
How do you hope to see LeadingAge—the organization and its
members—develop and change in the decades to come?
Fahey: The identity of the association may be [affected]
going forward, because of three elements:
1. The structural element—the demographics of the aging
and on what basis there should be public support.
2. The condition of the economy. We’ve lost our economic
advantages in the world, I don’t know how we’ll be able
to develop new jobs, thereby putting a heavy burden on
deficit spending and debt and the role of government,
which will leave older persons and the institutions that
support them in difficult straits.
3. The bifurcation of the American public with regard to
assets—with rich getting richer and stagnation of wages
and the poverty level, that will spill over into caring for
the aging. Baby boomers’ fiscal condition is likely to be
in jeopardy.
The health care reform, which is likely to survive, will
change health care and [the way] we serve older people. Every
community is trying to deinstitutionalize the care of older
people. HCBS will become more important.
Editor’s note: For another look at how the thinking of early association leaders,
including Msgr. Fahey, Dr. Herbert Shore and others relates to today’s issues and
the future, see the article, “Needed Now: A Public Policy for Long-Term Care,” in
our September-October 2009 issue. Click here, then scroll down to “Needed Now:
A Public Policy for Long-Term Care.”
Mary Alice Ryan
Mary Alice Ryan is president/CEO of St. Andrew’s Resources for Seniors, St.
Louis, Mo. A former AAHSA chair and board member, Ryan has served on many
association committees and task forces. She also chaired the AAHSA Development
Corporation and has served on the board of the International Association of Homes
and Services for the Ageing (IAHSA).
LeadingAge: Reviewing your years in aging services and
with LeadingAge, what are the milestone events or trends in
our field that stand out the most in your mind?
Ryan: I have been in the field since 1979 and have seen
widespread changes over these years. We, as a group of nonprofit
organizations, have closely looked at how we delivered
care and found ourselves wanting in many areas. This introspection
lead to [untying] the elderly, person-centered care,
Green Houses, moving people to the lowest level of care
needed instead of only using skilled care, continuing care
accreditation, diverse groups joining together to purchase
[goods and services] more effectively, and the sharing of information
and best practices so that all of us can learn from each
other, just to name a few.
LeadingAge: What were the milestone events, programs,
people or changes in this association that you believe were
most important, and why?
Ryan: The world has changed so much over my years in
[the association]. We have become a more highly educated
group of senior leaders as the complexities of rules and regulations
changed. [LeadingAge’s] own leadership assistance has
changed from one of helping us to do the business side better
to also helping us to do the caring side of our service better,
inspiring us to change our preconceived notions of doing services
in a manner that is easiest on our staff to viewing each
LeadingAge magazine | March/April 2011 29

senior as a individual who should have choices and options.
LeadingAge: The mission of LeadingAge is “Expanding the
World of Possibilities for Aging.” What does that mean to you?
How do you hope to see LeadingAge—the organization and its
members—develop and change in the decades to come?
Ryan: In the future my dream is that LeadingAge is seen as
the advocate for choices and options for the aging population
and that LeadingAge has brought together all nonprofit organizations
with a mission for aging services to work together to
change the world for the better. We need to work to inspire the
seniors of the future to help shape the world into which they
will be entering. We need to elevate the role which we all play
to one that is honored and respected, not feared.
M. Joe Helms
M. Joe Helms, a former AAHA president and Award of Honor winner, was very
active in the association’s volunteer structure for many years. He retired as CEO of
Methodist Retirement Communities, The Woodlands, Texas, in 1997.
LeadingAge: Why did you get into the aging-services field
and become active in the association?
M. Joe Helms: I joined the staff at Wesley Woods in Atlanta
in 1966. I immediately connected to older people. They were
themselves and comfortable with themselves. You didn’t have
to spend energy figuring out where they stood on issues nor
how they felt about things. It was the feisty ones that most
attracted me. They were still full of life and stood up for their
rights and opinions. [In 1972] I told my board that I wasn’t
the smartest person but I had access to a lot of people with a
lot of brains and experience in AAHA. I told them it would be
beneficial to our organization as well as myself to be involved.
That prophecy proved to be true.
LeadingAge: The mission of LeadingAge is “Expanding the
World of Possibilities for Aging.” What does that mean to you?
How do you hope to see LeadingAge—the organization and its
members—develop and change in the decades to come?
M. Joe Helms: There’s one thing I’ve learned since I retired
and have become a member of the older population: You have
to walk in an older person’s shoes and live in an older person’s
skin to fully understand how an older person feels and thinks.
While working, I thought I understood the older person, that
I could think the way they think, to feel what they feel all
without being old. But, it wasn’t until I became an older person
that I saw and felt a new dimension to their life. If I was
managing a retirement home today, I would have a member of
the older population on my staff as an advisor and councilor. I
would let that staff member have a voice in policy formulation,
care programs, sensitivity training and all phases of operations
30 LeadingAge magazine | March/April 2011
that directly affect the residents. When you are young and
“smart,” you tend to have all the answers when really you don’t
know the questions. Once you have a few answers, no one asks
you the questions anymore.
William Thayer
William Thayer, who retired as president and CEO of the Madrid Home for the
Aging, Madrid, Iowa, in 2001, is a former president of the association (who served
during the 25th Anniversary Celebration in New York) and board member.
LeadingAge: Reviewing your years in aging services and your
work with LeadingAge, what are the milestone events or trends
that stand out the most in your mind?
Thayer: When attending my first meeting at Kansas City
approximately 35 years ago, [it] was a very hands-on organization
but was struggling for its financial survival. … I was a
skeptic [but] caught the spirit of AAHA at that meeting and
saw firsthand the need for not-for-profit representation and
educational programs. I found this meeting to be a real moral
lifter, a celebration of what we do and have hungered for this
experience for the next 35 years and have not missed an annual
meeting even though I have been retired for the past 10 years …
We always kept, foremost in our plans and programs, that
we were obligated to the public though our not-for-profit mission
to provide services that were in the best interests of those
we served. This public trust was and is to be transparent, promote
excellence, provide services and programs for the most
vulnerable members of society, and to keep getting better as
we go along. Major items include things such as championing
restraint-free nursing homes, pet-friendly housing, accreditation
and certification programs and peer review for state
associations.
LeadingAge: The mission of LeadingAge is “Expanding the
World of Possibilities for Aging.” What does that mean to you?
How do you hope to see LeadingAge—the organization and its
members—develop and change in the decades to come?
Thayer: This goes way beyond institutional living and
services and gets to the individual level throughout society.
It promotes the use of the retired through mentoring, volunteering
and part time employment. It promotes standards for
architectural design as well as programmatic design for serving
the aging. It promotes and advocates self-help products
and services as well as other services that can meet the unique
needs of the aging with emphasis on those products and services
that enable people to live independently.
In the May/June LeadingAge magazine: interviews with more
LeadingAge members, a look at some of the watershed legislative
events that shaped our field and the association’s role, and more.

LeadingAge recognizes its
2011 Partners
2011 Premier Sponsors
For more information, visit LeadingAge.org.

LeadingAge Public Policy Objectives: A Brief Guide
Editor’s note: Here is an abbreviated rundown of the LeadingAge Public Policy
Objectives for the 112th Congress. For a more detailed look, visit the Advocacy
page at the LeadingAge website.
The opportunity—and the growing need—to serve an
unprecedented number of seniors in the not-too-distant
future, and the challenges involved in providing those services,
call for broad visioning and concrete implementation.
The vision must acknowledge the time and resources that
consumers and their families already contribute to pay for
services and supports. The vision must also embrace the
reality that outside support or more formal care settings frequently
are needed. Services must be of high quality across the
constellation of settings. Those steps, well-implemented, will
not only create a sound future for aging services but will also
help grow the country’s economy and develop its talent.
Here is a look at our public policy priorities, categorized by
LeadingAge’s Five Big Ideas.
Quality
Quality the public can trust is the core of the LeadingAge mission.
Trust results from excellence in service, transparency in
governance and operations, and a long-term commitment to
people and community. As new consumer choices emerge,
attention to quality will be paramount.
LeadingAge and its members have a long history of initiatives
that have achieved measurable improvements in the
quality of aging services across the continuum.
From need to solutions—LeadingAge supports:
■ The advancement of not-for-profit ideals,
values and unique responsibilities.
■ Member-developed quality improvement models
such as accreditation, EQUIP, and Collage.
■ A reexamination of the nursing home oversight
process by an objective and credible organization
such as the Institutes of Medicine, as recommended
in our report, Broken and Beyond Repair.
■ Short-term reforms to the existing survey and
certification process for nursing homes, such as
joint training of surveyors and nursing home
staff, expedited dispute resolution and correction
of the nurse aide training two-year lock-out.
32 LeadingAge magazine | March/April 2011
■ Suspension and revision of the fivestar
nursing home rating system.
advocacy
■ Effective resolution of issues with the Drug Enforcement
Administration to ensure that nursing home residents
can receive adequate and timely pain relief.
■ Modification of Department of Labor rulings
to enable teenaged nursing home employees
to use mechanical patient lifts.
■ Medicare/Medicaid payment systems that support
and promote quality of care, including systems
that target scarce resources toward direct care.
■ Research and development of additional approaches
to value-based purchasing; broader implementation of
strategies that demonstrate high potential for success
in improving quality, appropriately measured.
■ Tiered oversight for high-performing subsidized
senior housing and other federally subsidized
housing and services providers.
■ Continued improvement in the HUD Real Estate
Assessment Center protocols for the physical
inspection of senior housing to address quality
of housing and resident safety issues.
■ Help for LeadingAge members to maximize outcomes
in the Consumer Assessment of Healthcare Providers
and Systems (CAHPS®) Home Health Care Survey.
■ Improvement in Aging and Disability Resource
Centers’ dissemination of person-centered information
on all long-term services and support options
to consumers, especially adult day services and
Programs of All-Inclusive Care for the Elderly.
■ Continuation of the current model of state-based
regulation of assisted living, allowing for flexibility
of assisted living models and standards that
demonstrate transparency related to admissions,
discharges, services, quality and costs.
■ Research on new models to ensure
quality care in all settings.
■ Development of evidence-based quality
initiatives for hospice providers.
Transitions
Consumers deserve a clear path to affordable, accessible
services and supports as their needs change. Providers are
essential community leaders in partnering with consumers

Those steps, well-implemented, will not only create a sound future
for aging services but will also help grow the country’s economy
and develop its talent.
to address their individual needs and in planning and implementing
a community network of services.
From need to solutions—LeadingAge supports:
■ Implementation and funding of demonstration projects
authorized under the Affordable Care Act to improve
transitions among different levels of care, to enhance
collaboration among different types of health care
providers, and to avoid preventable hospitalizations.
■ Opportunities for providers of long-term services
and supports to partner in programs demonstrating
the integration of acute and post-acute services.
■ Inclusion of a “housing with services” program in
the re-authorization of the Older Americans Act
to improve care coordination and long-term care
service delivery in affordable senior housing.
■ Effective implementation and funding of the Community
First Medicaid option, Medicaid rebalancing option and
the Money Follows the Person program in all the states
that are eligible for the enhanced federal funding.
■ Research on models of successful integration of services.
■ The goals of the Interagency Coordinating Committee
on Seniors. Congress must ensure cross-agency
collaboration to help federal agencies identify and
better meet the multifaceted needs of seniors.
■ Implementation of Section 202 reforms and housing
preservation legislation enacted in 2010 to streamline
financing, eliminate wasteful red tape, and preserve
the existing portfolio of affordable housing.
■ Funding for service coordinators who help residents of
senior housing locate the services they need to remain in
their communities. As the long-term services and supports
field moves toward a national insurance program, with
the emphasis on keeping seniors independent, the role of
service coordinators will become increasingly important.
■ Promoting the service-enriched housing
model for which the Section 202 Supportive
Housing for the Elderly Act provides.
■ Funding for Older Americans Act programs,
including nutrition, transportation, adult day,
personal attendant care and other services
essential for elders to remain at home.
■ Availability of end-of-life care, including
hospice, for all who need it.
■ Advancement of technology applications
in long-term services and supports.
■ Inclusion of this sector in federal programs to encourage
broad use of health information technology.
■ Authority for certified adult day programs
to provide post-acute services.
■ Co-location of housing and service providers such as
adult day, PACE, senior centers and meals programs.
Talent
Developing talented people from the bedside to the boardroom
is highly correlated with quality. A healthy management
culture supports teamwork, trust and competence. Member
success depends on talented people.
From need to solutions—LeadingAge supports:
■ Implementation and funding of Affordable Care
Act provisions for geriatric health professions
programs, direct care workforce training, and geriatric
nursing workforce development programs.
■ Culture change policies within the longterm
services and supports field, including
concepts developed by the Pioneer Network,
Sanctuary, Green Houses and Small Houses.
■ Resources to support environmental
changes for person-centered care.
■ Changes in the regulatory system to
accommodate these advances.
■ Training and resources for family caregivers.
■ Implementation of Affordable Care Act requirements
for separate reporting of direct care staffing
expenditures on nursing homes’ Medicare cost
reports. This provision will help to create a nursing
data base to support evidence-based decisions about
Medicare services and workforce financing.
■ Developing core competencies across all settings
for all varieties of long-term care professionals,
including administrators, nurses, medical directors,
social workers, and direct service workers.
■ Joint efforts of federal, state and local employment
services and non-profit agencies to promote long-term
services and supports as an attractive “encore” career.
LeadingAge magazine | March/April 2011 33

■ A federal pilot training program to give public
housing residents the opportunity to be become
trained and certified as home care aides.
Financing
Current methods of financing aging services are not working
for individuals, families or government and are unsustainable.
LeadingAge supported innovative funding ideas such as the
Community Living Assistance Services and Supports (CLASS)
provisions of the Affordable Care Act. LeadingAge also recognizes
the centrality of Medicare and Medicaid funding to its
members, and does not favor any further restrictions on Medicare
reimbursement to providers of long-term services and
supports. Other issues of note include advocating for better
access to capital across all settings and preserving not-forprofit
status at both federal and state levels.
From need to solutions—LeadingAge supports:
■ Effective and timely implementation of the
national insurance approach to long-term
services and supports financing contained in the
CLASS provisions of health care reform.
■ Annual Medicare payment updates for skilled nursing
facilities, home health, therapies and hospice as provided
in the Affordable Care Act with no further reductions.
Workshop Schedule
April 26 - 28
Richmond, VA
May 10 - 12
Mobile, AL
May 24 - 26
Knoxville, TN
August 9 - 11
Raleigh, NC
September 27 - 29
Louisville, KY
November 8 - 10
Columbia, SC
December 13 - 15
Washington, DC
34 LeadingAge magazine | March/April 2011
AANAC MDS 3.0 RAC-CT ®
Certification Workshop
■ Research to develop needed further refinements
to the Medicare SNF payment system,
including better accounting for outliers and
non-therapy ancillaries such as drugs.
■ Appropriate limits on the length of time hospitals
may hold Medicare beneficiaries for observation
without admitting them as inpatients.
■ Increased funding for affordable senior housing as
a platform for long-term services and supports.
■ Implementation of the Section 202 Supportive
Housing for the Elderly Act to encourage the
use of refinancing proceeds to foster service
enriched housing and aging in place.
■ New preservation and mortgage maturation policies
for senior housing to foster aging in place and
rehabilitation to provide the necessary amenities.
■ Helping seniors remain independent through continued
funding of programs such as transportation and nutrition.
■ Maintenance of current Medicaid eligibility standards
and benefit packages for people with modest incomes.
■ Research and development of additional approaches to
value-based purchasing for home health and hospice.
■ Diversification of payment sources for adult
day services including Medicare coverage for
skilled services delivered in a licensed, certified
or accredited adult day services program.
Reap the rewards
of improved resident, staff and facility functionality.
This intensive program is designed to help long-term care professionals
increase their command of clinical assessment, care planning and the
connected regulatory process through a series of proctored courses and
exams.
Earning your RAC-CT ® designation gives you the credentials to prove
your expertise in MDS 3.0, benefitting your facility, residents and career.
Register today. Visit www.aanac.org/wilhide or call 1.800.768.1880.
Judy Wilhide MDS Consulting is an Official Training Partner of:

■ Improved funding of Older Americans Act programs that
fund home and community-based services, especially
supportive services, the national family caregiver
program and congregate and home-delivered meals.
■ Making capital accessible to not-forprofit
aging services providers.
■ Making Section 202 pre-development funding available
as seed money that comes in prior to securing permanent
financing for affordable senior housing projects.
■ Development of funding from local sources,
foundations or grants so that not-for-profits
can secure permanent financing for building,
rehabilitation and supportive services.
■ Appropriations for the National Housing Trust Fund.
■ Further reform of the Section 202 senior housing
program to better leverage private funding
including tax credits and bond financing.
■ Reinvigorating tax credits and tax-exempt bond
financing for not-for-profit aging service providers.
■ Inclusion of senior service-enriched housing
among states’ priorities for tax credits.
■ Preservation of state, local and national tax exemption.
Technology
Technology holds great promise as a catalyst for improving
quality of life as people age. Investments in technology solu-
Leading Age ad - March 2011 2/10/11 11:54 AM Page 1
tions must be built on evidence of efficacy. Such solutions will
support more effective transitions, enhance quality, support
the workforce and lead to better use of resources.
From need to solutions—LeadingAge supports:
■ Standards for electronic health records (EHR) that
include long-term services and supports. Pilot projects
for EHR technology should be ongoing in aging services.
■ Federal financial incentives to advance
technology applications in aging services.
■ A pilot program to provide incentives for home
health agencies across the country to use home
monitoring and communications technologies,
giving seniors greater access to the care they need.
■ Information and assistance to LeadingAge
members on positioning themselves to compete
and thrive in an environment driven by
technology-enabled care delivery models.
■ Dissemination of information on innovative technological
applications adopted by LeadingAge members.
Written by Barbara Gay, LeadingAge director of advocacy
information. For a more detailed breakdown of these priorities, visit
the LeadingAge Advocacy page.
Salary & Benefits Reports
Hospital & Healthcare Compensation Service (HCS), the leader in healthcare
salary and benefits research, publishes four national compensation studies
specific to long-term care:
CCRC Salary & Benefits Report – study underway
Nursing Home Salary & Benefits Report – study underway
Assisted Living Salary & Benefits Report – published January 2011
Multi-Facility Corporate Compensation Report – published January 2011
These Reports provide comprehensive data and analysis at an affordable price.
LeadingAge members receive special discounts. To order or to receive a questionnaire
for participation, call (201) 405-0075 or go to www.hhcsinc.com.
Hospital & Healthcare
Compensation Service
PO Box 376, Oakland, New Jersey 07436
(201) 405-0075 Fax (201) 405-2110
www.hhcsinc.com
LeadingAge magazine | March/April 2011 35

Self-Scheduling for
Nursing Assistants: A Pilot
How one provider implemented a
retention strategy for long-term care workers
Inundated by the types of workforce
challenges that affect aging-services
providers nationwide, this organization
piloted a self-scheduling project
for certified nursing assistants in one
of its health centers. Frontline workers,
initially skeptical, have embraced
the concept and now feel a greater
sense of control and self-confidence
and enjoy the opportunity to better
manage their personal and family
schedules. The organization is enjoying
reduced turnover and absenteeism
as well.
36 LeadingAge magazine | March/April 2011
by Donna Howard, r.N., and Donna blackburn, r.N.
Long-term care providers nationwide are feeling the effects of the
nursing shortage. According to the 2005 report of the National Commission
on Nursing Workforce for Long-Term Care, nearly 96,000
nursing staff positions were reported vacant in long-term care. Magnifying
this problem are the high turnover rates of certified nursing assistants
(CNAs). Turnover of CNAs also represents a significant financial cost.
According to Castle and Engberg (2006), replacing a CNA will cost approximately
$2,200.
Self-scheduling has been successful in the recruitment and retention of
both nurses and CNAs. This approach, which allows staff to make their
own work schedules using specific guidelines, has been widely used in
hospital settings to increase staff flexibility and satisfaction. According
to Allensworth-Davies and colleagues (2007), self-scheduling has also
contributed to increased autonomy, trustworthiness, empowerment,
delegation, consistency and mentorship. These qualities are key ingredients
in forming a culture that attracts and retains employees.
According to Cohen-Mansfield and Bester (2006), flexibility is often
a deciding factor for workers considering long-term care employment,
and increases job satisfaction by giving employees a sense of control. The
employee is able to schedule work around family and life events while maintaining
the responsibility of having each shift covered.
Supported by the benefits documented in this literature, we implemented a
self-scheduling pilot project to help improve employee attendance and retention
on our long-term care campus, Village Manor, Christian Health Center
in Bowling Green, Ky.
Staffing Challenges on Our Campus
CNAs are the backbone of our nursing home and without them the system
would likely fail. Our CNAs are diverse in age and background. Many are
single mothers trying to make ends meet, wives/husbands supporting the
household, students attempting to advance their education, and others facing
hardships and challenges. Along with these difficulties are the mandates
associated with a CNA position, that is, continually being told when to come
to work and what to do.
Within our community, it was the nursing department that had the worst

percentage of call-ins. To address this situation, incentives for
perfect attendance and other rewards were implemented; however,
call-ins and absenteeism continued.
Christian Care Communities, which houses four continuing
care retirement communities, uses a no-fault point system to
track staff absences and late arrivals. The system was developed
collaboratively by our human resources manager and
the executive directors/administrators of each CCRC. If an
employee calls in, is late or leaves early, a specific number of
points are added to his or her attendance record. Twelve points
indicates automatic termination. Before we tried self-scheduling,
at least weekly an employee was receiving a disciplinary
action for attendance. Many employees were terminated
because they exceeded the points allotted.
Self-Scheduling Strategy
Our self- scheduling system was developed by the director
of nursing and the administrator, based on systems they had
used in their previous places of employment. Implementation
of self-scheduling in our 32-bed community involved
various steps. During the planning phase, specific guidelines
were established related to the number of employees required
to cover each shift. In-services were held with the staff, and
ongoing evaluation was conducted to address staffing problems
as they arose.
The next step was to seek buy-in from the staff. Following
an interview process, two CNAs were selected to fill the position
of “lead CNA”—the “go-to” people. If another CNA has
a question or concern, the lead CNA assists with answering
questions or problem-solving.
A blank schedule was made available for staff to complete,
using established self-scheduling guidelines [see the table on
page 38]. Policies were included regarding covering a shift that
a CNA could not work. For example, if a CNA failed to get
coverage for an anticipated missed shift, the individual would
receive three points. If a CNA contacted another CNA to cover
the shift, the individual would not receive any points and
would continue to be eligible for perfect attendance.
Initially there was resistance from the CNAs to this change
in scheduling. With the implementation of the new self-scheduling
system, the value of accrued points for absences and late
arrivals increased. Therefore, administration was fearful of losing
staff who accumulated more points for call-ins. To address
staff resistance, the lead CNAs positively supported the change
and assisted their peers with the transition. Several in-service
programs were conducted, focusing on the self-scheduling
guidelines as well as benefits. Using an open-door policy, the
director of nursing readily answered questions and encouraged
her staff to discuss any related issues with her.
Each subsequent week, new situations arose that were not
encountered within the first couple
weeks of implementation, and new
policies were made to address these
issues. After 30 days the self-scheduling
approach seemed to be working well.
Incentives were given out for no uncovered
shifts after 30 days, 60 days and
90 days, resulting in an improvement
in morale. Incentives included such
items as gift cards and free dinners at
local restaurants. Each CNA who had
no uncovered shifts for six months was
given a $100 gift card and a day off with
pay.
Christian Care Communities
Della Bruch, a resident of Christian Care Communities’ Village Manor, discusses news and
events with Staff Development Associate Denise Mitchell.
Benefits of Self-Scheduling
Following implementation of self-scheduling
in our community, several benefits
were realized:
• Giving employees the opportunity
to make their own schedules instilled
a sense of control and a feeling of selfconfidence
in the CNAs.
LeadingAge magazine | March/April 2011 37

Self-Scheduling Guidelines Used at Village Manor,
Christian Health Center
Scheduling will include 4 weeks at a time.
Generally:
• Minimum 4 CNAs for 6a - 2p (excluding restorative aide)
• Minimum 3 CNAs for 2p - 10p
• Minimum 2 CNAs for 10p - 6a
Must schedule yourself during your normal shift:
• 6 a.m. – 2 p.m.
• 2 p.m. – 10 a.m.
• 10 p.m. – 6 a.m.
You can schedule yourself to work other shifts as “fill-in” to help coverage.
• If you schedule yourself at an odd time, like 8a – 2p, you must have someone on previous or following shift
that will stay until you arrive, etc.
Must schedule yourself based on your normal status as an employee: full-time, part-time, etc.:
• Full-time is 30–40 hours per week or minimum 8 days every two weeks
• Part-time is 29 hours or less per week, maximum 8 days every two weeks
Must schedule self at least two weekends in each 4-week schedule:
• One weekend requires working Friday, Saturday, Sunday
• One weekend requires working Saturday, Sunday, Monday
Must cover your own shift for any call-ins:
• Shifts that are not covered will be considered “No Call, No Show” and 12 points
• “Covered” means someone reports to work at the time your shift started
• Covered shifts are not considered call-ins and no points will be given
° Ex: You are sick, but get another CNA to work your shift for you; therefore, you do not accrue points
from call-in and you are still eligible for the perfect attendance awards
If you are the CNA working for someone else’s call-in:
• Upon arrival at work, circle the shift under the CNA you are covering
• Write your initials beside the circled shift
• Write in the hours you are working on that day under your name
For any day that you want to request off, place an “R” on that day:
• Any “R” on the schedule that you want vacation, sick, holiday, bereavement pay must have a form filled
out by you and placed in schedule book; forms will be reviewed and submitted once final schedule has
been approved.
No requests or self-schedules are guaranteed. Changes will be made by the director of nursing as necessary to
assure staffing is adequate for resident needs.
38 LeadingAge magazine | March/April 2011

• Employees who had never received perfect attendance
awards were now receiving them.
• Very few employees have been “written up” or terminated
for absenteeism or not covering their shifts.
• CNAs worked for each other, creating a buddy system to
insure that shifts would be covered.
• The director of nursing no longer had to get coverage
when someone called in.
• We have seen a steady decrease in turnover rates—from
54 percent to 46 percent since implementing selfscheduling.
CNAs make positive comments about self-scheduling. Sherria
Hawkins says, “I am a single parent and it works around
the daily schedules of raising children. I can make appointments
and attend school functions while continuing to work
full-time hours. I also attend college and it allows me to make
my own schedule and still pursue an education without worrying
about completing school and working full time.” Alicia
Cowles says, “The self scheduling works for me in that it
allows me to attend to my kids’ school schedules and appointments.
I am aware of the days I need to work because I have
scheduled them myself. It cuts down on call-ins and boosts
morale when I know there will be enough employees here to
take care of our residents.”
There was concern that employees would not work as hard
to find others to cover their shifts once the incentive program
ended. However, after a year of self-scheduling, there
were no uncovered shifts by the CNAs. We also implemented
self-scheduling for our nurses, and after nearly a year, there
have been no uncovered shifts by our RN/LPN nursing staff.
These successes have led us to incorporate self-scheduling as
a permanent policy for our campus, though Christian Care
Communities has not required its other communities to start
self-scheduling.
Based on the benefits experienced to date, we anticipate a
continued improvement in recruitment and retention of staff
as well as benefits to our residents. Our experience indicates
that nursing personnel who take pride in their work are less
stressed, knowing that they will not be short-staffed. Ideally,
adequate staffing will not only promote retention of staff but
enhance positive outcomes for those for whom we care.
Donna Howard is director of nursing at Village Manor, Christian
Health Center in Bowling Green, Ky. Donna Blackburn is a professor
of nursing at Western Kentucky University and a board member
of Christian Care Communities. For a copy of this organization’s
attendance policy or for a list of background sources for information
in this article, please contact the authors at donna.howard@
ccc1884.org or donna.blackburn@wku.edu.
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LeadingAge magazine | March/April 2011 39

Evidence-Based Programs Are Core
of Institute’s Community Education
Keiro Senior HealthCare, Los Angeles, Calif.
Contact: Dianne Kujubu Belli, chief administrative officer,
(323) 980-2350.
Keiro Senior HealthCare in Los Angeles has served the
Japanese American community for 50 years, but its reach far
exceeds the four Keiro communities that serve 2,500 residents
annually. Since launching the Institute for Healthy Aging
(IHA) in 2006, it has provided evidence-based education for
good health to some 10,000 people in 40 locations.
To do this, Keiro has collaborated with universities and
agencies including the University of California at Los Angeles,
University of Southern California, Partners in Care Foundation,
AARP, Alzheimer’s Association Southland Chapter
and the Nikkei Senior Network, a consortium IHA created
to serve the education and networking needs of community
organizations, churches, and temples that serve Japanese and
Japanese-Americans in Southern California.
To supplement its small staff, IHA maintains a robust corps
of hundreds of skilled volunteer coaches for its evidence-based
memory enhancement, fall prevention, savvy caregiving and
other programs. Community needs assessment and expressed
consumer preferences determine the wide-ranging subject
matter of classes and conferences.
IHA’s costs are underwritten by grants, sponsorships, an
40 LeadingAge magazine | March/April 2011
Saint Simeon’s Episcopal Home
Raygon Risdon (seated) asked for a last fishing expedition as part
of Saint Simeon’s “Tree of Dreams” program. Risdon, who passed
away about six weeks afterwards, was joined by Auxiliary volunteer
Landon McJilton.
ideas & innovations
Keiro Senior HealthCare
The Institute for Healthy Aging at Keiro offers evidence-based
courses such as A Matter of Balance (developed by Boston
University).
annual fundraising event and the Keiro Senior HealthCare
endowment fund. Local organizations that partner with
IHA to present conferences and seminars provide in-kind
donations of venue, promotion, volunteer support and refreshments.
In Japanese, “Keiro” means “respect for the elderly.” For promoting
a healthy, fulfilling, culturally-sensitive experience for
older adults, whether home is Keiro or another place in the
community, this is an organization that clearly lives up to its
name.
Cultivating the ‘Tree of Dreams’
Saint Simeon’s Episcopal Home, Tulsa, Okla.
Contact: Chris Gruszeczki, director of life enrichment,
(918) 794-1904.
Long before the 2007 Jack Nicholson-Morgan Freeman film
prompted movie goers to reflect on their own “bucket lists,”
LeadingAge members were helping residents fulfill late-life
wishes. Saint Simeon’s Episcopal Home in Tulsa is one such
member. Its volunteer auxiliary sponsors the “Tree of Dreams.”
Any resident, staff member, family or friend can put in a
dream request for a resident. The staff helps the auxiliary with
logistics for the dreams, including transportation and, when
needed, medical management.
Chris Gruszeczki, director of life enrichment, says the
auxiliary tries to grant all wishes, even if it can’t be in the
exact form the resident requests. That’s where Saint Simeon’s
excels: finding inventive ways to fulfill seemingly impossible

dreams. For the resident who wished to be 10 years younger:
an “unbirthday party” for her and her friends, and a certificate
granting permission to subtract a decade from her age. For the
memory center resident who longed to bathe in chocolate: a
gift basket of chocolate treats and a “spa” gift certificate for a
cocoa-scented bubble bath in the center’s bathing room.
A gentleman nearing the end of his life wanted to go fishing;
a nurse and aides took him out on a pontoon boat to fish and
have a picnic. “It was a happy memory for him and the family
who went along,” Gruszeczki recalls. “His story about the size
of the fish he caught grew every day until he left us.”
Senior Memoirists Delight in
Creating a Legacy Gift of Life Stories
Baptist Health Nursing and Rehabilitation Center,
Scotia, N.Y.
Contact: Timothy Bartos, president and CEO,
(518) 370-4700.
Baptist Health Nursing and Rehabilitation Center has been
enriching lives for some time with its Senior Life Series of free
seminars. Not long ago, one of these events focused on writing
one’s memoirs. Such a crowd turned out that Baptist Health
realized it needed to devote more than two hours of seminar
time to the topic.
How to fund a more ambitious effort? Baptist Health
obtained an eight-week grant from the New York State Council
on the Arts and Poets and Writers. The resulting program
teaches seniors how to put their memoirs in writing as a priceless,
legacy gift to be passed on to generations to come. Led
by writer Susan Risley, participating seniors have been able to
write and share stories about their childhood, spouses, children
and diverse traditions.
As recounted in the center’s Hearts and Hands newsletter,
“Each participant has a workbook and is given a topic at the
end of each session. They return the next week with their writings.
They have all expressed how glad they are to be a part
of this group. Such diverse backgrounds, yet so much in common.
It’s amazing to see what they are accomplishing.”
Amazing, too, what can be accomplished by thinking creatively
and looking beyond the usual funding sources to find a
way to meet a need.
Grant Funds Music Enrichment for Healing Benefits
Duncaster, Bloomfield, Conn.
Contact: Heather Clinger, director of wellness,
(860) 726-2000.
Duncaster Retirement Community has launched a music
enrichment program with a $10,000 grant from the Richard P.
Garmany Fund at the Hartford Foundation for Public Giving.
Garmany, who loved music, received care at Duncaster’s health
center.
The beneficial effects of music therapy for older adults are
well-documented, and Duncaster has a long history of music
programming. The new, grant-funded program will allow
for more diverse, hands-on and listening music experiences.
These will include a hand-chime choir, drum circle and harp
therapy. The grant also will help Duncaster host appearances
by an ensemble from the Hartford Symphony Orchestra.
Music enrichment is part of the retirement community’s
ongoing wellness program. Director of Wellness Heather
Clinger anticipates 20 to 24 residents will take part in the
hand-chime choir, eventually performing for residents, family
and staff.
Duncaster
Duncaster residents Will Robin (left, on spoons) and George Murray
(on drum), enjoy a song with music therapist Jon Romond.
“No previous musical training is necessary, just a willingness
to learn and have fun,” Clinger says. The same is true
for the drum circle. Many of the drums are hand-held or can
be placed on the floor for ease of use. “Participatory drumming
has been shown to have positive benefits,” Clinger notes,
“including increased socialization, an increase in circulation,
and stress relief.”
St. Andrew’s Helps Seniors Keep Their Pets
St. Andrew’s Senior Solutions, St. Louis, Mo.
Contact: Ann Bannes, vice president, (314) 726-5766.
Pets mean the world to their owners, yet seniors sometimes
find themselves unable to care for their pets the way they once
did. To ensure that seniors continue to enjoy the companionship
of their furry friends, St. Andrew’s Senior Solutions has
added pet care to its comprehensive list of services.
“We realized that we could step in to help, in order to ensure
that our clients weren’t forced to give up their beloved fourlegged
friends,” says Vice President Ann Bannes. St. Andrew’s
offers daily walks, help with feedings and medication provision
for clients’ pets. “These services are proving to be invaluable
for home-bound clients and those in assisted living communities
whose health prohibits them from walking their dogs,
LeadingAge magazine | March/April 2011 41

making regular trips to the vet or keeping up with other routine
pet care activities.”
After Barbara Grabe, 88, had a heart attack and became
unable to take Snoopy, her miniature schnauzer, on his twicedaily
walks, her family sought St. Andrew’s’ help. The service
“is making it possible for Snoopy to stay with me,” says Grabe.
“When I get home, Snoopy is waiting, and I can’t imagine life
without him.”
After St. Andrew’s evaluates the client’s needs and those of
his or her pet, a care plan is created; the nominal pet service
fee is determined by the level of care that is needed. “Our
focus has always been on caring for families,” says Bannes,
“and since animal companions are such an integral part of the
family structure, it only makes sense for us to extend our services
to pets.”
Nighttime Snacks Lessen
Difficult Behavior, Safety Risks
Parker Jewish Institute for Health Care and
Rehabilitation, New Hyde Park, N.Y.
Contact: Ron Shafran, associate vice president,
(718) 289-2251.
Like many nursing homes, Parker Jewish Institute for Health
Care and Rehabilitation had some residents with dementia
who were prone to wandering at night, heightening staff’s
concerns about the residents’ sleeplessness, behavior and safety
risks. One night in late 2007, a certified nursing assistant
observed a man as he got out of bed at 2 a.m., picked up his
newspaper and headed down the hall.
Sometimes a midnight snack is the best response to nursing home
residents who are prone to wander.
42 LeadingAge magazine | March/April 2011
Parker Jewish Institute for Health Care and Rehabilitation
As Ron Shafran, Parker associate vice president, tells it, “He
was preparing to go to the market, which had been his pattern
when he was working. The [nursing assistant] saw him and
thought, ‘If he was going to work, he should eat a little something.’
After having a slice of cake and a beverage, he went
back to bed.”
Thus began Parker’s midnight snack program for nighttime
wanderers. Since 2008, Parker has provided snacks for wanderers:
cake, sandwiches, cookies, pudding, Jell-O, juices, coffee
and sugar-free items. Wanderers’ difficult behaviors have all
but disappeared, Shafran reports, and the risk of accidents
associated with wandering has decreased markedly (falls fell
by 50 percent). Residents’ desired weight is easier to maintain,
as well. Careful research has confirmed the snack program’s
numerous benefits, and Parker staff members have shared the
study results with colleagues at professional conferences.
More Not-for-Profits Turn to Mobile Giving
High-tech fundraising campaigns are sweeping the not-forprofit
world, as more charitable organizations turn to online
and even mobile giving.
During the holiday season, for instance, the Salvation Army
tested a text-message fundraiser in two markets—Norfolk-
Virginia Beach and Dallas-Fort Worth—to supplement its
traditional red kettle campaign. As an official with the Denver-based
mGive Foundation explained to the Denver Post,
instead of ringing a bell and collecting spare change, fundraisers
played a special ringtone on their mobile devices and asked
potential donors for their cell phone numbers. Volunteers
sent those who complied a text with the message, “Thanks for
pledging to give $10 to the Salvation Army; to confirm your
gift, respond with Yes.”
The mGive Foundation, which certifies not-for-profits for
text-to-give campaigns, considers the response after the massive
earthquake in Haiti to be the watershed moment for
mobile giving. Text-message donations raised more than $41
million for the relief effort. The American Red Cross used
mGive’s technology to raise $32 million of that total in $10
donations. Mobile giving could soon permit higher limits for
single donations or attach mobile campaigns to specific charity
events.
The foundation says 40 percent of those who give through
mobile means are nontraditional donors, making cell phones
and laptops fertile ground for cultivating new donors whose
small gifts now may grow into larger gifts later on.
Social-media message sharing can also help not-for-profits
boost support. Facebook has a “causes” tool that permits users
to raise awareness and money directly on the site.

LeadingAge Blog Offers You a
Daily Dose of Aging-Services News
It can be difficult to find the information you need about our
field all in one place. That’s why we update our blog daily with
the latest news and information about the work you do for
older adults. Our “Today’s Aging-Services News” posts feature
links to news stories about our members as well as hot topics
in the field. Each day’s coverage may also feature updates on
legislation and regulations, research findings and resources
like our Workplace Ethics Assessment Tool and marketing tips
from our sponsors. Do you have resources or a story to share?
Please contact Sarah Mashburn at smashburn@LeadingAge.
org or 202-508-9492.
State Associations Join LeadingAge in Name Change
Jan. 25 marked our first day as LeadingAge. That day, 10 state
associations also joined us in changing their names:
LeadingAge Alabama
LeadingAge Colorado
Leading Age Maine & New Hampshire
LeadingAge Massachusetts
LeadingAge Missouri
LeadingAge NE
LeadingAge New Jersey
LeadingAge Ohio
LeadingAge Oklahoma
LeadingAge RI
LeadingAge Vermont
Celebrations across the country included a legislative
breakfast in Vermont’s statehouse and a party in New Jersey
featuring a proclamation from Gov. Chris Christie.
We expect 10 more state associations to become LeadingAge
affiliates by the end of the year.
Look Out Capitol Hill: LeadingAge is Coming
Mark your calendars: Tues., April 12 is the day to join us in
Washington, D.C., as hundreds of LeadingAge members travel
to Capitol Hill to tell Congress about the work we do and the
index of advertisers
American Data ................................................................1
Aon ...............................................................................27
GlynnDevins ..................................................................39
Hospital Healthcare Compensation Service ...................35
Judy Wilhide MDS Consulting, Inc. ...............................34
LarsonAllen .....................................................................9
New Life Styles .............................................................23
PointClickCare ..............................................................10
RehabCare ....................................................................15
Sodexo Senior Living ....................................................11
synergy
people we serve as part of our 2011 Future of Aging Services
Conference and Leadership Summit.
This year, it’s particularly important that Congress hears
what we have to say, because the issues on the 2011 policy
agenda impact LeadingAge members across the continuum.
2011 is also important because of the dozens of newly
elected members of Congress as well as legislators in new leadership
positions.
As you know, we are not just going to Capitol Hill to advocate
for ourselves, but for the people we serve. That’s why we
are asking attendees to bring a photo of a resident or client and
a story about how the policies our legislators are debating now
affect their elderly constituents and those who care for them.
We need stories about the importance of housing with services,
integrating care and services, and why therapy caps are a
form of rationing.
Tuesday will begin with a Capitol Hill Forum where
renowned journalist and Washington insider Eleanor Clift will
be the featured speaker.
Find more information here.
LeadingAge New Jersey
Harrogate Executive Director Donald Johansen (center) and
Associate Executive Director Clyde Sutton (right), visited with
Rep. Chris Smith (R-N.J.) during the 2010 Future of Aging Services
Conference.
The Green House Project ................................................5
Wirthwein Corporation ..................................................19
Ziegler ..................................................................Cover 2
LeadingAge Partners and Premier Sponsors .................31
LeadingAge magazine | March/April 2011 43

Don’t miss four days of
exceptional education and
celebration, as we mark 50
years of excellence in
aging services.
World renowned speakers such
as poet laureate Maya Angelou,
Nobel Prize winner Elie Weisel
and the first female president
of Ireland Mary Robinson will
join us for our 50 th Anniversary
as we Celebrate Age.
REGISTRATION
OPENS IN MID-JULY
october 16 – 19, 2011
washington, dc • washington convention center
C • E • L • E • B • R • A • T • E
A •G •E
2011 LeadingAge
annual meeting
AND
& IAHSA global ageing
conference