When I was asked to write this commentary, I assumed I too would take the familiar position dictated by my “corporate instinct” and rush to the defense of our industry, because one of our own was being attacked. “Let him without sin cast the first stone,” right?

I asked John, who has become one of my favorite writers if he would be willing to write an insiders perspective.  This is what he sent me and it is terrific. – Steve Moran

When I was asked to write this commentary, I assumed I too would take the familiar position dictated by my “corporate instinct” and rush to the defense of our industry, because one of our own was being attacked.  “Let him without sin cast the first stone,” right?  Those of us who can claim the moniker of senior housing “veteran” know all too well the challenges we face with a transient employee base, 24/7 operations and the risks and potential for human error inherent in an industry that seeks the promotion of decision making and independence in a frail population.

After all, who among us can claim to be deficiency free in 100% of our surveys?  Anyone receive a call or letter from a current or former employee complaining about being short staffed?  Anyone else make decisions driven in large part by the requirement to make the bottom line? 

I think we can agree that perfection may be something we strive for, but the reality of achieving and maintaining it is rare in any business.  When I read and saw the expose on Emeritus, I felt that many of the criticisms arguably fell into the category of “reasonable imperfection.”  Human error will be here as long as there are humans.  I touched on this in my piece, “The Dirty Secret about Assisted Living.”    

Come with me on a little metaphorical trip.  You’re driving with your family when you come upon a sign that states, “Warning – Structurally Deficient Bridge Ahead!  – US Dept. of Transportation” Would you drive yourself and loved ones over the oncoming bridge span?   Maybe, if you were being chased by an angry international drug cartel firing bullets at your vehicle and this was the only escape.  How about a bridge with the same warning sign that happens to be part of your daily commute?  Fact:  one in nine bridges in our nation are currently classified as “structurally deficient.”  That’s roughly 66,000 bridges, on which more than 260 million trips are made each day.  But, according to the Federal Highway Administration, the fact that a bridge is classified as “structurally deficient” does not imply that it is unsafe.  I imagine that the people who lost friends and family in 1997 when the Interstate 35 Bridge collapsed in downtown Minneapolis might disagree.

Using the above scenario, replace the “bridges” with Assisted Living communities; cars and their passengers with residents; and the number of trips across the bridge with resident days.  In our industry, we have to “do it right” 100% of the time – each day a resident lives in our community (each trip across the bridge) has to be safe.  Does a survey deficiency, a complaint, a fall or medication error make a community unsafe?  Does it make all communities unsafe?  No.  But I imagine that many of the family members of residents who’ve experienced negative outcomes – like those featured in the PBS documentary – might disagree. 

Now, here’s where I take leave of my comfort zone.  Maybe it’s my Jerry Maguire moment, although I hope not…I don’t like Tom Cruise movies in general.  There are several very troubling issues highlighted in the PBS expose that from all appearances seem to be driven – either intentionally or not – from Emeritus’ corporate office.  The either tacit or overt direction to disregard state regulations to expedite move ins, the low priority given to staff training, and the culture of revenue over residents are egregious and shameful.   

 Having worked in nearly every community-level position before moving into regional and corporate roles in the industry, I can tell you that there are many executives in our industry that have lost sight of our residents – if they ever had it.  If you have a passion for seniors and work in this industry, hearing the term, “heads in the beds” should make you nauseous.  A corporation can create brochures and beautifully crafted mission statements, but – as I point out in, “Pop Rocks for Dinner,” this is meaningless unless backed up with actions and resources.  One truth I’ve learned in my 27 years in senior housing is that there are far too many people sitting around corporate conference room tables that shouldn’t be there.   I can give you a few names if you’d like.       

 Steve_Moran_PBS_ShameBefore you think me naïve, I am all too well aware that this is a business; and no one benefits from a poorly run or failing business; not the residents, not the staff, not the stake holders – not us.  I’m continually reminding colleagues that this business requires a constant balancing of the head and the heart; of compassion and business sense.  If, as a community, regional or corporate level manager, you are not in a constant state of conflict, then you’re doing something wrong – something is out of balance.  Ladies and gentlemen of the jury, something appears to be dramatically out of balance at Emeritus, and it’s to our collective shame.    

I hope and pray that this public exposure of what can and will happen when a company gets out of balance, placing the desires of shareholders over the needs and rights of the residents, will be a wake-up call for our industry – especially for those of us fortunate enough to work in the decision-making positions of senior housing.  A former company executive with whom I worked, would often respond to my residents-should-come-first objections to bottom-line driven decisions, with the trite phrase, “We follow the golden rule.  Whoever has the gold makes the rules.”  Hmm, maybe that should have been on our brochure.  Besides, aren’t the residents really the ones with the gold?  Someone forgot to tell me that our mission statement to “do the right thing” stopped at the door to the conference room. 

What’s your mission statement?  Is it being lived out? Prioritized? Funded? 

No doubt this publicity will prompt renewed calls for federal oversight of our business, or for increased state regulations.  If you’ve been in senior housing for any length of time, you know that the states are struggling to keep up with adequate oversight of assisted living.  This lax oversight creates an opportunity for some providers to skirt safeguards and regulations in favor of greater expense control, occupancy growth and increased revenues.  But, we can do better.  Our staff deserve it.  Our residents deserve it.  Our shareholders deserve it.

 I remember when our industry reached out and began serving the dementia population by developing secured care units and alarmed wings within our assisted living communities.  We ratcheted up the stakes by expanding the scope of our services, and increased our rates as well as our risk.  Caring for the most vulnerable of the senior population – those with high physical and mental needs – requires even more heart, compassion and care – but even more – it requires additional training, resources and a clear understanding and acceptance by providers of this great responsibility. 

Many of us saw this evolution as a huge opportunity to provide innovative services and programs to a population that had been underserved, in an environment that still promoted independence and dignity.  I know many communities are striving to do just this.  Unfortunately, some in our industry are all too eager to accept the increased revenue without ensuring their ability (or willingness) to provide the necessary resources under mounting pressure to perform financially.   

Perhaps because of ignorance, perhaps driven by greed, and perhaps because of a disconnect that occurs once a company becomes too large to ensure that its vision, mission and priorities to the field aren’t distorted as it filters through the many layers of management; but for some providers, accepting higher acuity residents and those afflicted with dementia and related diseases – and all that goes with this – may have been going a bridge too far.