September 28th, 2009 by cswenson
Some background…
Boomer Time!
Yes that is me - one of the 78 million born from 1946-1964. Along with our other traits, we are classified as the Sandwich Generation. Stuck in the middle to care for our children, parents and, if we are lucky enough, grandparents. I was blessed to assist in care decisions for a great grandmother, as well as grandparents.
A Nurse – so I know it all, right? Wrong!!
My grandmother thought I knew it all! It is so different to be on the patient and family side of the bed. We as health care professionals think we remember what it is like on the patient and family side of life in our practice. From my perspective, this is not so. Health care functions in silos. One area, the clinical side, is rarely concerned with the financial or payment side. I understand hospital settings very well. I have very little knowledge of the long- term care world.
Long-term Care - the unknown odyssey.
So much to know. So far behind.
The Daddy - He was and is just the best! To be honest, he is not even my biological dad. No one would ever know. He raised me from a baby barely walking and is still teaching me today. You see, he is 73-years old and has Alzheimer’s. Looking back, personality changes had already occurred 16 years ago when my son was born. He was emotionally disconnected. He has always looked healthy. And other than his degenerating brain, is healthy. He is not on one medication, and has perfect blood pressure!
In the beginning it was so frustrating for him. He noticed the changes… slow changes. He started to become overwhelmed in activities with multiple steps. Packing - pack, unpack, and pack. Money concerned him, but he was not sure why. He eventually forgot how to work the remote control for the television, how to dial the phone, how to cook. The man was a great cook. He tried to motivate his brain – crossword puzzles and a dictionary stayed on the kitchen table. Eventually, slowly, cognition declined. Even with my frequent visits, it become apparent he could not live independently. My family became more concerned and frequently fretted about next steps. We could not be sure he was eating. We knew he was not bathing regularly. More serious, he lived in an attached condo. He could forget and leave the stove on or a burner with a pan, causing a fire. We had great concerns he could harm himself or others, or someone would take advantage of his condition.
He and my mother were married for 26 years and then divorced. Still bonded, my mother chose to move him to Tennessee where she lives, to care for him. Big commitment, right? My sister was also there to support as a caretaker.
He became part of my mother’s neighborhood. Walking was his thing. He would walk and walk and walk. He would stop and attempt conversations with the neighbors. The community came to know him, love him and look out for him.
Moving him to my mom’s was the easy step. Next came time for long- term care. This decision alone is stressful. When is the right time? The family members feel guilty and helpless. Ok, so that is one side - the family connection, feeling like you are abandoning a loved one. The other side is the unknown minutia of red tape, regulations, and facilities – in other words the real world of health care and the reason health care reform is so critical.
We hired an elder care attorney. While I know many cannot afford this, we could not either, but did. We chose to hire the attorney simply to guide us on the best decisions for my dad. It is amazing, however, the attention and response we received from health care representatives once they learned an attorney was representing my dad’s interests.
I consider our family responsible. We had records and documents and yet, still never seemed to have the right documents. What about those who do not? Maybe records and belongings have been lost in catastrophic events like Hurricane Katrina.
There were so many issues and decisions. What kind of facility is best? How do we pay and what is the financial impact to his long-term care that will be needed? He could live another 15 years. My dad is a vet. He was not in active duty, but was a paratrooper. Hence, he ended up with some chronic back issues. Of course there are no records to document this injury due to a fire at the VA records facility in St. Louis. My dad could not speak to this – no memory. One recommendation – keep every document!
This is not an unusual story. It is happening to thousands of families as you read this. During this experience with my dad, one thought repeatedly entered my mind. How do people that do not have family or significant others with their best interests at heart survive in our health care world? Everyone needs a personal advocate. Every patient is a person with a history, a story, and is a human being who deserves the very best treatment at the end of life. But not every patient is lucky enough to have that advocate. Certainly the guiding principle of assuring that advocacy should be an integral part of health care reform
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September 21st, 2009 by cbarber
There’s a lot of current discussion about how important transparent leadership is in developing engaged, motivated workforces. So true! In fact, I’ve read research that shows that frequent, honest communication from the top of organizations can override the damage done by inept supervisors. Pretty amazing when you think about it, huh?
But just because a leader comes off like an open book and can serve up some tasty Kool-Aid doesn’t guarantee he can be trusted. I suggest that transparency is rather easy to accomplish, especially for gifted communicators. Trust, on the other hand, can only be earned through behavior that demonstrates honesty, fairness, unyielding commitment to doing the right thing, and irreproachable accountability.
Indeed, we’ve seen leaders whose eloquence changed the course of history. Adolph Hitler was one of them. So were Ken Lay and Jeffrey Skilling of Enron. Their public personas were powerful, engaging and seemingly transparent; only their greedy inner circles knew the juxtaposition between what they said and what they did. When their evilness was exposed, it left millions in shock and misery, and questioning how they could have trusted such despicable losers.
Let’s face it. We’ve heard elected officials blatantly lie to us. We’ve seen corporations run from their responsibility for human and environmental safety. And we’ve all been in personal or professional situations that made us think twice about who we can trust. Despite all that, for every miscarriage, we can probably cite a counterpoint.
Take the Tylenol tampering case in the 80s. Instead of dodging the issue, Tylenol’s maker, Johnson & Johnson, immediately stepped up to the plate with transparency and action. They backed their public service announcements with responsible solutions, starting with pulling every bottle of product from shelves across the nation. Then, they used the lessons from the tragedy to create tamper-proof packaging that’s become the industry’s standard. Now, nearly 30 years later, Tylenol is still one of the world’s most popular and trusted brands. I wonder if that would be true if J&J had treated the incident as just the isolated work of a lunatic?
Another very recent example involved a horrible error made by a surgeon on infant. The physician not only admitted his culpability, he is now working with the family to ensure ongoing care for the child, which he is funding out of his own pocket. Versus the normal outcome, a mega-lawsuit, the doctor’s remorse, personal accountability and actions were so appreciated by the baby’s parents that they felt they could not further punish him for his mistake.
At a wedding I attended, the minister started the service with a statement about his own life. He said, “My wife and I have been married for 30 years. We’ve lasted this long because she expects certain behavior from me and I oblige.” I believe that’s the essence of trust…responsible, considerate actions that speak much louder than words.
Long and short, I’m all for transparency. I want honest communications - good, bad or indifferent. But throw in consistent behavior that I can respect and trust me, I’m yours.
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September 14th, 2009 by khart
The August unemployment and jobs report has been released and the numbers were not good for the acute health care setting (or the workforce in general). Hospitals shed 700 jobs in August. Overall the health care industry added 27,900 positions in August and 180,400 new jobs over the course of 2009. These overall numbers include all job gains including physicians’ offices, dialysis centers, blood and organ banks, ambulatory care, etc.
Cumulative data for hospitals shows that from January 1 to September 1 of this year, hospitals added 17,100 positions as compared to 94,100 over the same period in 2008 and 66,800 for that same period in 2007.
We know anecdotally that hospitals are being cautious about adding positions due to the overall economy this year and we also know there have been significant hospital layoffs in some geographic areas. The ranks of uninsured have proliferated, leading to more uncompensated care. The overall financial situation for much of the hospital industry has worsened due to a number of factors. New building has decreased. Donations and endowments are down.
Additionally, many members of the health care workforce have had to rethink retirement due to the economy and are working longer than they anticipated. Those who were part time or per diem may have had to extend their hours to compensate for spouses who have either been laid off or are under employed. These factors have resulted in precious few job openings in general.
Adding to all the above is the huge unknown of health care reform and the uncertainty of how that will look and how the coming reform will impact hospitals, technology, usage, staffing, etc. Add to this the threat of an H1N1 epidemic this fall and you are looking into the great unknown.
Given all of these factors, what is a cogent argument for the health care recruiter or HR executive doing the work to develop a workforce plan during these tough economic times?
One reason is the possibility that the lull in recruitment may have afforded you the opportunity to think a bit more strategically and to plan for future needs more proactively than in the more hectic past.
Just a cursory look at the health care workforce demographic projections is enough to make the most sanguine person nervous. To say nothing of the U.S. population projections. No one is unaware of the aging RN population or of this same phenomenon in other health care professional groups. And we are all bracing for the impact of the aging Boomer population on health care usage.
Workforce planning can seem like a daunting task if you look at the overall big picture, but taking baby steps can both get you started and also demonstrate that it really is not as difficult as you may have thought.
Why not take some time right now to look at where you currently stand in terms of your workforce-even if you only gather information on ages by department and type of position (including managers), and average age at retirement? Capturing just these current numbers and plotting five and ten years down the road will usually be a real eye opener, particularly when you look at some of those small departments with just a handful of employees. If your current HRIS system cannot provide this information, now would be an excellent time to see if you can change that so that you can easily retrieve this information and get a birds eye view of those demographics.
Looking at your own organization, what are projected changes that might impact hiring needs? Are you adding or contracting services, changing or augmenting technology, changing staffing patterns? Are you regularly having dialogue with practice managers about these changes and forecasting future needs for your high volume areas and hard to fill positions?
Look externally a bit and investigate migration in and out of your area, focusing on age and ethnic groups. What does your current population look like? Do your caregivers reflect the community they serve? What is the business climate in your area? What are your local colleges and universities doing in terms of enrollments and graduations in health care professions programs? Are there new programs or are the current programs contracting or being dropped? What will the impact of all of these factors be on the supply of health care professionals for your facility or system?
These baby steps will give you a real competitive advantage in the months and years ahead. And will lead to your being able to develop a true workforce plan.
Beginning work on this vital initiative now will stand you in good stead when the crunch comes. And it is coming…
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September 7th, 2009 by khart
I am writing this entry on the Friday before Labor Day, immediately after the Department of Labor announced the August unemployment rate was 9.7%, the highest in 26 years. The latest numbers account for 216,000 jobs eliminated in August and represent an uptick from an unemployment rate of 9.4% in July.
However, economists had predicted an even higher job loss, leading some to suggest that the slower pace of job losses signals that the recession is beginning to ease. Still, most experts feel it will be many months before we return to pre-recession unemployment numbers.
How ironic to be celebrating the American worker at such a difficult time for most of those very workers.
According to the Department of Labor, The first Labor Day was celebrated on Tuesday, September 5, 1882 in New York City as a result of plans developed by the Central Labor Union. In 1894 Congress created the national holiday of Labor Day. It was suggested that there should be parades to highlight ‘the strength and esprit de corps of the trade and labor organizations’, and a ‘festival for the recreation and amusement of the workers and their families’.
Of course, over the years the holiday has evolved into a long weekend marked by picnics, family gatherings, and golfing. Labor Day signals the end of summer and the beginning of the school year. We rarely consider the true meaning of the holiday.
It is fitting that on this Labor Day of 2009 and the week that follows, we pause to reflect on the great American workforce, which though perhaps bloody and wounded, still represents the best ideals of our forefathers and those who envisioned this holiday.
This workforce has endured a year of downsizing, layoffs, furloughs and other decreases in hours worked or salary earned. Workers have seen co-workers laid off, have been forced to work harder and smarter because their numbers have been thinned, and have worried about the security of their own jobs.
Companies they had thought safe have gone out of business, leaving more workers unemployed. The nightly news is replete with stories about food banks running out of food, unemployment insurance running out and those seeking jobs giving up the quest. Job fairs attract thousands and workers settle for either part time positions or positions they are wildly overqualified for. There is not a single American who has been unaffected by this recession and its attendant job losses, either directly or indirectly.
We can only hope, going forward, that the long decline is nearly over, that in the next few months jobs will be created, furloughs will cease to exist and that by Labor Day 2010, we can truly celebrate the American workforce, confident the worst of times is over.
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