Restore Elder Pride: Shift the Paradigm

By Jerry Rhoads

In 2006, seventy-seven million baby boomerspeople who worked hard all their liveswill begin to turn sixty. They have a right to expect the best of everything, but if the nursing home industry doesnt change dramatically and soon, they can only expect the worst. Today, nearly two million people are institutionalized in nursing homes, and millions more will face the possibility of one day joining the ranks of system victims.

Every American has a personal, vested interest in shifting the paradigm of a struggling industry that is on the verge of collapse and that ends patients lives prematurely. Author and CPA Jerry L. Rhoads is a fellow of the American College of Health Care Administrators fellow, a licensed nursing home administrator, and the CEO of All-American Care, Inc. In Restore Elder Pride, he shares an educated insiders look at a system in crisisand how each person can be a part of the solution. He outlines the three prevailing principles that make this problem solvable:

Embrace the restorative care model as a necessary transition between the current medical and social models.
Use computer technology and case management to customize care plans for each patient in order to manage interventions for positive outcomes.
Pay for performance based on outcomes attained.

He calls his approach restorative care, and that involves changing the approach to elder care to embrace more humane and productive outcomes. By restoring function of the mind, body, emotion, and spirit, Rhoads believes that the industry can be saved.

• Language: English
• Publisher: iUniverse
• Release date: Dec 19, 2012
• ISBN: 9781475963892

Jerry Rhoads

Jerry Rhoads is a liberal arts and business graduate of Simpson College in 1961. Born in Indianola, Iowa, he moved, with his wife and first child, to Chicago, Illinois, after graduating from college. He and his wife currently reside in Hawthorn Woods, Illinois. His writing career began in the business environment where he has published nine books and a large number of published articles on health care, his specialty. He and his wife of fifty-seven years have four grown children, twelve grandchildren, and one great-grandson. The Tenth Wonder of the World is the third in a series of poems written over the last thirty-five years. The Eighth Wonder of the World is the platform for sequels, continuing with this book.

Book preview

Copyright © 2013 by Jerry Rhoads.

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the publisher except in the case of brief quotations embodied in critical articles and reviews.

The information, ideas, and suggestions in this book are not intended as a substitute for professional medical advice. Before following any suggestions contained in this book, you should consult your personal physician. Neither the author nor the publisher shall be liable or responsible for any loss or damage allegedly arising as a consequence of your use or application of any information or suggestions in this book.

iUniverse books may be ordered through booksellers or by contacting:

iUniverse

1663 Liberty Drive

Bloomington, IN 47403

www.iuniverse.com

1-800-Authors (1-800-288-4677)

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

Any people depicted in stock imagery provided by Thinkstock are models, and such images are being used for illustrative purposes only.

Certain stock imagery © Thinkstock.

ISBN: 978-1-4759-6388-5 (sc)

ISBN: 978-1-4759-6390-8 (hc)

ISBN: 978-1-4759-6389-2 (ebk)

Library of Congress Control Number: 2012922930

iUniverse rev. date: 12/06/2012

Contents

Prologue

Foreword

Acknowledgments

Introduction

Part 1. Elder Pride: An Idea Is Born

Chapter 1. Eldercide: A Personal History

Chapter 2. A Divine Intervention

Chapter 3. Eldercide vs. Elder Pride

Part 2. Eldercide: A System in Crisis

Chapter 4. Eldercide by the Numbers

Chapter 5. Barriers to Nursing Home Quality

Chapter 6. The Legacy of Eldercide

Chapter 7. Government Reports

Chapter 8. What’s Wrong with the Nursing Home Industry Today?

Chapter 9. Prospective Payment: A Broken System

Chapter 10. Warehouses versus Care Houses

Chapter 11. Needs of the Elderly—Patient-Centered Care

Part 3. Elder Pride: Defining the New Paradigm

Chapter 12. What Is Elder Pride?

Chapter 13. Eliminating Wasted Resources

Chapter 14. Incentives for Quality and Cost-Effectiveness

Part 4. Making It Work: Building the New Paradigm

Chapter 15. Stakeholders: The New Paradigm Team

Chapter 16. Employer/Employee Mandate

Chapter 17. Regulatory Mandate

Chapter 18. Healthcare Policy Mandate

Chapter 19. Congressional Mandate

Chapter 20. Provider Mandate

Chapter 21. Build a Flagship and They Will Come

Chapter 22. Back to the Future

Chapter 23. Front of the Line Quality

Chapter 24. Realigning Workflow and Workload

Chapter 25. Focus on Savings

Chapter 26. PHR and EHR for Long-Term Care Facilities

Chapter 27. National Plan of Action

An Epilogue to Elder Pride

Appendix A The Premature Death of Grandma (Dorotha) White

Appendix B

Appendix C

Appendix D

Appendix E

Endnotes

Bibliography

Books Written by Jerry L. Rhoads

Afterword

Open Letter to President Obama

PROLOGUE

by Jerry Rhoads

My son and daughter tried,

And it’s as if I’d just died,

Hoping my pain would subside.

Nothing was said of my Elder Pride.

The only alternative, they said, Was for me to live where I dread, In a nursing home of their choice,

Giving me no say or voice.

I cried and cried As if I’d died—

What, I asked, of my

Elder Pride?

Give me liberty, or give me death.

No one hears my request. If you treat me as if I died,

Nothing is left of my Elder Pride.

Listen, and you will hear Courage overcoming fear.

We can remedy this Eldercide

By restoring Elder Pride.

Compassion, hope,

Companionship, work or love—

And for all of the above,

So easy yet so far.

It is just a matter of finding

The wagon and a star.

Hitching hope to better health

And health preservation to greater wealth

Will give us motivation

To restore an aging nation . . . beware!

The Baby Boomers are here. So we need . . .

A Paradigm SHIFT (Self-Health Insurance Funding Trust)

Cut Illness Cost, Improve Wellness Outcomes

The book proposes Shifting the Paradigm away from Government to Self-Health practices and Self-Health Funding Trusts for individuals to manage their own expenditures and select their own providers. Obama Care will not solve the pressing problems of over medication of the elderly, funding the pursuit and treatment of illnesses and the rationing out of the funding for the disabled and chronically ill patients.

Self-Health is defined as each individual accepting responsibility for their own decisions that affect their health care costs. By funding the costs through withholding from their salaries and spending the funds on preventive health measures and preservation of their own future health care needs; expenditures for the Greater Good are reduced by 40% and outcomes improved 100%.

Remedy Eldercide and Restore Elder Pride are more than eye-popping, heart-stopping words coined to help draw attention to this book. Eldercide in practice is the systematic institutionalization of the elderly in nursing homes; a system that does little more than warehouse patients who receive substandard and inappropriate care that prematurely decertifies many and abuses many more. In the process, Eldercide wastes productive lives and clearly does not meet America’s needs as an aging society in pursuit of a quality of life. Restoring Elder Pride is the solution to that problem; a solution that provides and pays for restorative care for these same patients and rewards the caregivers for their efforts or they will be facing empty beds.

No one wants to live in a nursing home. Everyone knows if you go in, you rarely come out. It is the place to go die not live. Even the nursing home tag line does not fool anyone. That is why there are no respectable flagships, acknowledged leaders or standard bearer in the industry, However, clearly 313 million Americans will be touched by this paradox at some point in their lives. Most sooner than later with aging and chronic illness boring down on all of us. Exposes’ on the nursing home industry are popular for shedding light on the horrors of this corrupt and soon to be bankrupt system. But no one—not authors or politicians or providers or the medical community—has offered a proven, practical, and workable solution. Until now.

Restore Elder Pride examines this debilitating problem that will continue to plague most Americans until it is fixed. History shows that nursing home abuse is directly linked to the manner in which these facilities are paid for their work. It is a cruel paradox that the federal government is both the beneficent provider of reimbursement dollars and the choke point for their disbursement.

This very timely book offers practical, proven solutions for fixing the problem: a field-tested system that is already in use and has a proven track record for delivering successful outcomes to patients and caregivers. Each political election avoids the comprehensive solution to the problems of healthcare delivery because the current payment methods are supported by providers who fund the political process but don’t want to be held accountable for results. So healthcare and eldercare are bound to be major issues, and this book is sure to be a catalyst for discussion and change. Just look at the voting pool. Seventy-seven million baby boomers, that grew up expecting the best of everything, are turning 60 this decade. If the nursing home industry does not change they can only expect the worst. About 36 million people have joined AARP because they want bargaining power, 1.7 million people are already institutionalized in nursing homes and are facing extinction, and millions more will have to face the possibility of one day joining the list of system victims.

Every American has a personal, vested interest in changing this struggling industry. Without a comprehensive overhaul the current healthcare system will be bankrupt in 2010 with the cost exceeding $4 trillion annually or 36 percent of the GNP. Six percent of those costs are funding the nursing home industry. That means that unless we make a change we will spend $960 billion, in four years, to fund a system that kills its patients and bankrupts itself and its operators. Statistics clearly demonstrate that nursing home abuse is on the rise. Nursing home complaints increased from 145,000 in 1996 to 186,000 in 2000. Resident care complaints were the most prevalent and grew 37 percent from 1996 to 49 percent in 2000. There are no outcome-based quality standards for nursing homes in America, and we are paying a deadly price for their absence. Approximately 556,000 lives are lost per year in nursing homes, by natural and unnatural causes. If only 10 percent are from neglect and abuse that is 55,000 wasted lives for which we spend 80 percent of the healthcare budget. Outcome is not counting the provider mistakes but well thought out measures of successful care planning and implementation of preventive and preservative interventions that demonstrate wellness, not just treatment of illness.

The pursuit of wellness is dramatically more cost-effective than the pursuit of treatment without regard to cause and cost. For the most part, under the current system people receive the worst possible care at an unjustifiable cost from a system they and/or their employers have funded their entire working lives. This comes at a time in their lives when they need restorative care, and hope, the most. The current nursing home service model warehouses the sick until they die instead of restoring and discharging them back to the community. Today’s victims are our parents, brothers, and sisters. One day we will all join that list. Even though the nursing home system in America is very broken, as the book demonstrates, it does not have to remain that way.

Restore Elder Pride first provides a history of the nursing home industry in America, to help readers fully understand how the industry evolved into such a deplorable state. The truth is, the models for the current system are the hospitals, TB sanatoriums, and mental institutions of the late nineteenth and early twentieth centuries. Patients living in a mental ward in the early 1900s lived under rigid hospital conditions. They were told when to wake up and when to sleep. Mealtimes were planned and prepared by others. They had no responsibilities, were not allowed to make decisions for themselves, and were often neglected. Similar to the situation with today’s nursing homes, families would often commit their elderly relatives to asylums because they lacked the resources and/or time to deal with them appropriately.

By the 1880s, asylum conditions had deteriorated significantly, and the word asylum was replaced by hospital to reduce the stigma of mental illness. While the deinstitutionalization movement in the 1950s radically changed and improved the treatment of mentally ill persons across the nation, many patients at these facilities still faced life-threatening conditions including neglect, physical, sexual and verbal abuse, and inhuman and degrading treatment. In many mental institutions this abusive treatment continues even today just as it does in nursing home, which borrowed their structure from these other antiquated systems.

Exposes’ of the current nursing home industry typically detail abuses in gruesome detail to make the reader angry enough to want to change the system. As important as it is to expose the atrocities of the current system, no change can occur without the right tools. But most writers cannot offer workable, real-world solutions because, frankly, they just do not have the breadth of industry experience the author has. His industry-related duties have included:

• Consultant to the U.S. government on costing patient care and using assessment to develop case mix formulas

• Manager, administrator, and operator of nursing homes

• Recognized industry expert on industry regulatory and reimbursement issues

• CEO of successful industry accounting, software and consulting business

With this broad base of experience, he moves beyond the expose’ in this book to deliver practical and proven solutions to the acknowledged problems of escalating costs and incalculable breakdown of care. These real-world solutions are based on his personal business experience using computer modeling and case management to restore the elderly to their highest level, not prior level of functioning in over 150 Elder Pride nursing homes across

America. Under this scenario nursing homes become transitional care houses rather than warehouses. They make money. Patients get better and more go home. Staff morale is greatly improved, which minimizes turnover. The communities served by those nursing homes notice the positive changes and that in turn helps generate more business. This will set those facilities apart as the Flagships not sinking ships.

One of the best reasons to embrace this system is that it gives the industry’s main client—federal and state government—exactly what it asks for, what is mandated by law, and what it is currently not getting. Actually the federal guidelines are very specific about what kind of restorative steps to take, how to take them, and how to report them correctly for reimbursement. Nursing home operators have either been unwilling to take the necessary steps or are unclear how to take them. The author’s recommended system automates the entire process so that the government gets the reporting it requires, patients get the restorative care they need, and the operators are rewarded for their efforts and they will not be facing empty beds. It is evidence based, performance measured, and outcome driven. The system is based on three prevailing principles that make this future # 1 political and social problem resolvable:

1. Embrace the restorative model rather than the medical or social models that are currently in place. The restorative model is based on the pursuit of improvement outcomes, evidenced-based diagnosis, and eventual discharge to community-based programs. This approach replaces the pursuit of expensive medications, unsupported testing, warehousing of the sick for money, and re-hospitalization at the whim of doctors that, more often than not, never even see the patient.

2. Utilize computer technology and case management processes to map out restorative and psychosocial programming from a software library of statistically proven models of care with outcome goals customized for each patient’s functional problems. This Six Sigma approach to more efficient and cost effective care mimics Deming’s model for eliminating waste in the business world. Specially trained case managers set up the plans of care and direct the clinicians toward an outcome destination versus chasing treatment without a plan. Outcomes are based on the specific Medicare models prescribed by the government.

3. Pay for performance based on the outcomes attained. The criteria for performance are the quality standards promulgated by the models of care from a standardized software library. The models then can be customized to each patient. This will eliminate wasted resources that pay for counterproductive medications, continual testing of the same acute problems, and hospitalization for chronic diseases, then care providers would be rewarded for lowering the dependence on medications, screening for problems before they occur and avoiding hospitalization through fitness, nutrition, and natural self-health preservation technologies.

IN MEMORY OF DOROTHA C. WHITE WHO LOST HER

LIFE TO ELDERCIDE AND IS NOW THE HEART OF

ELDER PRIDE.

9780595602612_txt2%20-%20FOR%20REFERENCE_img_1.jpg

Grandma White at the age of ninety-two was from a family of centenarians . . . her aunt Edith lived to one hundred nine, her uncle Ernie one hundred two and other relatives lived to be one hundred. She would have to if the nursing home would have meet her needs . . . but instead they increased her medications from eight per day to eighteen per day . . . put her in diapers . . . in a wheelchair with a monitor . . . failed to hydrate her and missed giving her diabetic medicine one hundred eighteen times in three months.

Foreword

by Maya Hennessey, author of If Only I’d Had This Caregiving Book

Jerry Rhoads’ book on restoring Elder Pride is one of the most important books to be published regarding the nursing home industry in decades. A model for nursing home reform, the book illuminates totally preventable atrocities and offers viable solutions. The Elder Pride model is a perfectly choreographed dance of patients, loved ones, employees, political, economic, and cultural forces. It incorporates all the elements of highly successful evidence-based collaborative projects, with easily attainable solutions to the shameful abuse, neglect, and wasted resources in the nursing home industry.

Throughout my career in human services, I’ve advocated for the oppressed and fought to change systems, learning lessons from master communicators and change agents. As a counselor, supervisor, executive director, state employee, and women’s substance abuse and treatment specialist, I’ve always been fascinated with group dynamics and the synergetic power of collaboration to launch sweeping changes. I’ve been in environments that were empowering and others that were oppressive. I’ve had the privilege of being on high-level committees and witnessing policymakers courageously and radically changing lifesaving policies. From the vantage point of my personal and professional experiences, I’m honored to give you a glimpse into the Elder Pride model.

In 1995, my husband was dying from brain cancer. After numerous medical emergencies, falls, and the endless frustration of trying unsuccessfully to get the home services we desperately needed, my own health began to fail more rapidly than his. I had to face the fact that, for his own safety, he had to go into a nursing home. But I had to find the right one.

One of my closest girlfriends accompanied me as we traipsed through dirty, depressing, cold, unfriendly nursing homes that reeked of urine, homes filled with broken hearts and the broken bodies of drugged-up, terrified-looking patients. We pressed on in our search for facilities that were cheerful and clean, that offered fun and stimulating activities, good food, flexible visiting hours, and lots of warm and friendly interactions between staff and patients. We found two that matched all my criteria.

I knew there was nothing I could do to prevent my husband’s death, but I was determined to fight to the finish to assure his safety and comfort. So I borrowed a friend’s lab coat and sneaked in during the night, watching and listening to the interactions between staff and patients to see if the cheerful atmosphere during the day was the same after visiting hours. I never regretted the nursing home I picked, but I wondered, how do nursing homes where the elderly are buried alive stay open?

Aren’t reviewers supposed to uncover violations and oversee corrective action? There’s certainly no shortage of reviewers—the Joint Commission on Accreditation of Hospitals (JCAHO), Commission on Accreditation of Rehabilitation (CARF), state departments of public health, federal, state, county, city government regulators, ombudsmen, licensing and funding bodies. Why can’t they put a stop to the abuse, the neglect, the confining of drugged patients to wheelchairs, the mistakes in diagnoses, the overmedicating, and the dangerous drug interactions?

When a survey is scheduled, the staff starts dashing around, frantically auditing files, checking and double-checking, inserting missing dates, details, and documentation. Hysteria abounds while patient care takes a backseat. Aren’t surveyors supposed to assess the quality of care? Facilities justify their actions, saying they must stop at nothing to get high scores to avoid greater scrutiny. After all, they say, publication of low scores might mean fewer admissions, therefore less revenue, and then patients will get even less care. So they signal the alert, All hands on deck! Surveyors are coming! Reviewers are coming!

Everyone is scared. Surveyors are scared that some blatant violation they didn’t find will hit the news a week later. The administrator’s job hangs on survey scores, so he does a bunch of saber rattling at the director of nursing, who in turn strikes fear in the hearts of everyone who reports to her, and so on and so on. Patient care suffers while everyone runs around trying to doctor up the paperwork—hide, fix, cover up, replace—creative writing at its best. No one in that food chain sleeps for weeks before a site visit, while a hurricane of finger-pointing whips through the facility.

Nursing homes are regulated and surveyed up one side and down the other, with little or no coordination or collaboration across the various systems. These redundant reviews overburden facilities—the high-and low-quality ones alike—without making one iota of difference. The toothless watchdogs called surveyors bark and growl, write endless reports, cite violations galore, and demand corrective action plans backed with threats for noncompliance. And nothing changes. Nursing home violations continue, surveyors keep critiquing, and, worst of all, patients keep suffering.

I know from experience with training site reviewers that, after minimal training, nursing home surveyors will embrace the benefits of the Elder Pride audit trail that makes surveys, interviews, and investigations far easier. Corrective action and follow-up steps are built right into the recordkeeping process. Reviews will be more accurate and conducted in a fraction of the time. Additional enforcement is not the answer. Counting mistakes rather than coaching performance never works.

Currently, multiple systems, in ridiculous power struggles, each demand their own unique reports, refusing to collaborate, forcing facilities to write and rewrite. You’d have to be a CPA, a psychologist, an FBI decoder, an attorney, an investigative reporter, and a fly on the wall all built into one to reconcile the endless, fragmented paperwork. So, surveyors stay for a week, and they leave the broken hearts behind. And the patients, desperately hoping that this surveyor will answer their prayers, sink deeper into despair, watching yet another surveyor walk away, taking with him all hope.

One of the many highly successful collaborative projects I participated in was the Real Choice Systems Change Project. This collaborative, client-centered, federally funded pilot project assists nursing home patients with multisystem complex cases (mental illness, homelessness, aging, developmental and physical disabilities, etc.). The team helps coordinate services necessary to live in the community. Rockford, Illinois, one of the pilot sites, successfully diverted hundreds of individuals from nursing homes by providing the appropriate community services. Those who had to be placed in nursing homes temporarily were provided restorative services and followed by a case manager who coordinated the community services. My participation in this project gave me deeper insight into the challenges to those within the industry and its stakeholders: patients, families, community services, politicians, licensing and funding bodies, to name a few. Real Choice and Elder Pride share client-centered and collaborative approaches. Elder Pride is more comprehensive, assuring the best possible services for all—those who will go home, those who will stay with limited improvements, and those, like my husband, who will die.

Collaboration has many challenges, as I learned after years of working on collaborative projects in state government. Even when the majority agrees in concept, the more powerful bureaucrats often dictate services, even those who know nothing about clinical services. That’s why the successes of the Real Choice Systems Change project were such victories. Those successes underscore the absolute necessity for Jerry Rhoads’ Elder Pride model.

With his forty years of industry experience, Jerry has a proven solution for America’s nursing home problems. Elder Pride is a progressive, evidence-based nursing home performance model, a call to action, with powerful yet practical steps to improve quality of life for patients, reduce waste, and dramatically change a system adrift in a sea of losses: loss of lives, loss of compassion, and loss of money.

Nursing homes that have adopted the Elder Pride model love the easier paperwork, increased revenues, reduced turnover rates, and high satisfaction surveys from patients, families, and staff alike. The model is synergetic, empowering patients and staff, while enhancing quality. Whether you’re the researcher analyzing the data, a caring employee in the nursing home suffering from compassion fatigue, a patient or a loved one, an administrator frustrated with time-consuming compliance reviews, nursing staff wrestling with excessive, redundant paperwork, a state surveyor trying to uncover problems of abuse and neglect, or a politician ready to demand more affordable loving care for our aging population, Elder Pride is the solution you have been searching for.

The philosophical underpinnings of Elder Pride are respect and dignity, restorative care, a richly rewarding team environment, and recordkeeping that follows patient improvements. Elder Pride is a model of congruency between patient-centered care, staff and team activities, and documentation that highlights progress while providing an audit trail that just as easily prevents violations.

Jerry Rhoads and his family have dedicated their lives and all their resources to creating and shaping this vital nursing home performance model. His experience, education, passion, and lifelong commitment to revolutionizing—or, as he puts it, pre-forming—the nursing home industry have all contributed to his reputation as one of the best reimbursement experts in the country. But he does not fight this battle alone.

Jerry’s wife, Shari Rhoads, is the chief executive officer of the Dorotha C. White Foundation, dedicated to Shari’s mother, who died of abuse and neglect in a nursing home. One day, Jerry commented that we are a nation that adopts highways, kids, and pets. Why not our elderly? The words were no sooner out of his mouth than Shari adopted a nursing home patient. While visiting her adopted patient, other patients reached out for a touch of her loving spirit, all eager for her gentle love. Soon other family members, friends, employees, and volunteers adopted elders too. The Adopt a Nursing Home Patient program was born, quickly gathered steam, and garnered local and national press coverage.¹

Jerry’s vision for a computerized approach to improved care and increased revenues was driven by his son, Kip Rhoads. With his programming skills, Kip developed a workable, practical system that continues to evolve under his care, and as it does so, it improves thousands of lives. Among Kip’s many creative contributions is a guidebook for simple, enjoyable exercises that have profound effect, improving and preserving the overall health of elders in facilities.

Time and time again, I have had the joy of seeing the Rhoads family in action. Respect, dignity, and restorative care are the heart of the Winchester House mission in Vernon Hills, Illinois, where the Elder Pride principles are working daily for all to see. Interactions between patients and staff are warm, friendly, playful, and family-like. I recall one visit, in August 2007, just after the Dorotha C. White foundation donated Bow flex equipment to Winchester House. Patients were using the equipment and were delightfully engaged in conversation with visitors and the Rhoads family. A resident proudly showed us something she’d won at bingo. She said that when they run out of presents, they win money, but they like the presents better. Shari said, Maybe we could ask on the Web site that re-gifting items be sent here?

The patient’s eyes lit up. Oh, yes, she said, gifts are much more fun. Shari got back to the office and requested re-gifting items for Winchester

House. Since then, thirteen more Bow flex machines have been placed in deserving homes that are committed to restoring the dignity and functioning of their patients.

Driven by the spirit of compassion and collaboration, the Rhoads family evinces love and dedication to Elder Pride. It permeates their words and deeds. They give their time, their money, their hearts, and their heartaches to make a difference.

As a result of their efforts, the Elder Pride model is not just theory. It is a living, breathing, successful solution already at work in over 150 Elder Pride American nursing homes. And it is a healthy solution for all the rest. As Jerry details throughout this book, every person in this nation is a stakeholder who will benefit from jumping on board this lifeboat: patients of all ages, family caregivers, baby boomers, ombudsmen, state and federal site reviewers, operators and nursing home employees, politicians, and healthcare providers.

I wish I’d had the choice of Elder Pride homes when I was looking for a place to take my husband. My search would have been easier. I encourage you to read this book, to discover how this model will benefit you professionally, personally, financially, and emotionally, and to take that all-important first step to restoring Elder Pride.

Acknowledgments

First and foremost, I am indebted to my parents, George and Velma, for giving me the chance to live, love, work, and write. And I am indebted to my wife and her parents, whose lives inspired me to write this book. The untimely and unwarranted deaths of my parents and Shari’s mother, Dorotha White, convinced me that there is a better way to live and a better way to die than what they experienced.

I would like to thank my wife, Shari, and our son, Kip, for their support and their belief that we will remedy Eldercide and restore Elder Pride. Shari is the heart behind this project. Kip is the left brain behind the way we will do it. And I am the right brain, proving it will work. In the process, we are garnering backers, believers, and those that will make it work. So these acknowledgments are only the beginning of the mission that I call the 20/20 dream: shall be in twenty major cities, establishing a franchise model of care for the world to follow. The seventy-seven million baby boomers will be the judge, and the healthcare profession and health preservation industry will be the jury. And we hope they will decide that aging is a journey, not a dead end.

I would also like to thank my mentors: Rabbi Hillel Yampol, who taught me persistence in the pursuit of my dreams and let me practice on his playground; Ray Tutwiler, who took a chance on me and then regretted it and then rehired me to help him pursue his dreams; Betty Cornelius of HHS/ CMS, who believed in me and promoted my writings and theories in her pursuit of prospective pay for nursing homes; Faye Abdellaha, RN, director of the Division of Long Term Care and assistant to the surgeon general of the United States under Richard Nixon, who engaged me to write the white paper for prospective payment for long-term care; Jean Duffy and Elaine Wheaton, chiefs of Medicare claims review at Aetna, who helped me begin the process of developing a deductive library of care-planning models and put me onto Transmittal 262; Keith Hutson, president and CEO of Americana Nursing Centers, who triggered the team concept and quality based on focus in my brain; Steve Warneke and Terry Penniman, who provided testing grounds for our computerized deductive systems; and over 150 nursing home facilities that have successfully used a limited version of our deductive case management systems in their operations; Harry Karabel, who took a bunch of fragmented manuscripts and put them together into a masterpiece of readable and understandable facts and stories; Pat Keegan, who came late to the party but contributed her experiences and writing skills; Noreen Kelly, who also contributed to the written materials by doing valuable research so the credibility stands behind the speculation; Spencer Maus, who is the supreme connector to the political scene; Mark Nakiyama, who helped put together the public relations and writer crew that supports this effort; Maya Hennesey, who stepped into a role advocating more help for the homebound caregivers and lends her regulatory experience to the practical application of personalized caring; Gary Glenn, who provided proofreading; Robert Paul, who is the legal backbone of whatever I do when it comes to the regulators; Duane White, Shari’s brother and my brother-in-law, who has been in and out of the business for twenty-six years, always believing in me and my efforts; Kim Lawrence, my daughter, who lent her artistic ability to my marketing materials and seminar offerings; Richard Peck, editor of Nursing Home Management, which has published numerous articles that I have written over the years; Ross Reardon, past director of Illinois Health Care Association, who got me into this mess in the first place; Phyllis Vandervelde, Shari’s sister, who typed many of the original manuscripts that ended up in the book; Tom Elwood, who is the backbone of the sales force that implements the concepts in the book; Chris Casey, who is the driving force behind setting up the model flagships that we plan to build around America; Bob Florio and Marty Dickson, my former bankers who are believers in Elder Pride and is helping to fund the future efforts that this book represent; and finally, all the bureaucrats, politicians, consumers, and providers that will make the proposed deductive systems and methods work over the next three decades.

Introduction

What Is Eldercide?

Eldercide. It sounds mysterious and dangerous. It sounds frightening, disturbing, and intriguing. It sounds like something we would not want to be a part of. And yet it is a deeply engrained part of us all. It sounds like something we would want to change if we could. And it is something we can and must change, because, for most Americans, Eldercide will one day be a sad and menacing presence in our lives.

It’s easy to find Eldercide. Step into just about any American nursing home and take a deep breath. If your senses are assailed by soiled clothes and bedding, waste and wasted lives, and the pervading uneasiness of decay, you are in the presence of Eldercide.

If you see hopelessness and scattered wheelchairs and walkers and empty parking places and empty beds and faraway eyes and tears and bruises, you are in the presence of Eldercide.

If you hear crying and shouting and frustration and anger and incessant call bells and deafening silence, you are in the presence of Eldercide.

Eldercide is the systematic institutionalization of the elderly and the infirmed in nursing homes, taking away their dignity, privacy, companionship, and feelings of self-worth. Elder abuse and the mistreatment of senior citizens in nursing homes are now shockingly common and increasingly so. Today’s victims are our parents, brothers, and sisters. One day, we may join that list. That is why I wrote this book.

Once you find its source, even Niagara Falls can be turned off. The premise of this book is that we can change the route of healthcare by turning off the faucet of current funding, rerouting it to pay for performance based on medical evidence, and then turning it back on. But the shift must be made by all of the stakeholders, not just the providers or the government. We all have a stake in preserving health and avoiding the chronic illnesses that now beset society at a fearful pace. However, the focus must be on moving to a deductive method of delivery, not the current inductive methods practiced by all of the healthcare professionals and paying agents.

I want to change, or rather pre-form, the nursing home industry in America and do away with Eldercide forever. I have learned how to do just that in converting over 150 skilled nursing facilities to the Restorative Model of Care funded by Medicare not Medicaid. This book is my why and how-to guide for eliminating institutionalized Eldercide in the rest of the more than sixteen thousand American nursing homes.

It won’t be a simple fix. That’s why I need the help of the 77 million baby boomers, many of whom turned sixty in 2006, the 36 million members of AARP, the 1.7 million people currently living in nursing homes, and everybody else. But as you will soon see, once we embrace and begin to make this change, it will become a rolling juggernaut that will gather everyone in its wake. The truth is, we have to change hearts and minds more than laws. We have to change attitudes and perceptions and procedures. We have to change business models and practices. But in the end, we will be creating a much healthier business and healthier people. In the end, we will provide dramatically improved care and staff morale, while the operators and the government make and save more money.

My purpose here is not to cast blame but to create synergy. If the operators, the government, the care providers, and the nursing home customers—you and me—would band together, we could set new standards for elderly care that all Americans would be proud of. Using this model, we can remedy Eldercide and restore Elder Pride.

Throughout this book I use the term pre-form, rather than reform or transform, to refer to the type of performance we need. This may sound like a play on words, but it is not. We need a system that pre-forms the care of the elderly in the pursuit of outcomes—in other words, help them to get healthier—so we can measure performance against a quality standard. If the patients’ health conditions are improving, then we are clearly doing the right things. This approach would replace the current, reactionary system, which only pursues treatment, counts mistakes, and pays more for illness than wellness. It is managing the process before the fact not after and eliminates doubt in advance of the action to alter and shape the outcome.

MY BACKGROUND IN ELDERCARE

I didn’t enter the workforce with the idea of pre-forming the nursing home industry. I was simply trying to build a career and raise a family, just like everybody else. I was a quick study, had good analytical skills, a head for accounting, and a knack for managing people. My career opportunities gave me a sickening, firsthand view of the sad circumstances under which most American nursing homes operate. Sure, there were abuses and mismanagement. But in many cases, there were also misunderstandings about how to interpret the convoluted regulations governing the industry and how to get