The Art of Finesse

By Steven Mattingly

At our daily meeting recently our team was reviewing our staff’s concerns about a particular resident’s behavior.  We discussed various strategies and different approaches that we might use to help this somewhat new resident more easily adjust to the daily rhythm of our community.  Our Culinary Service Director chose an unexpected and interesting word to describe his suggestion. That word was finesse.

I was amazed to observe how quickly our discussion took on a totally different tone.  Prior to this brilliant word use, the focus had been on preventative and outcome driven strategies.  By thinking how we might finesse our interactions with this individual, a much more caring attitude was immediately apparent.  The team began to examine how our approach and actions would affect the resident’s response.  Instead of taking actions that we thought would give the desired result quickly; we began to think in terms of building a multi-step process with individual small results.  The small successes would allow us to build toward the bigger goal that we hoped to achieve.  When we thought about it even more we realized that this approach would offer continual positive reinforcement to the resident.  As we all have heard more than once, success breeds success.

I recently downloaded a dangerous new “app” for my smart phone that may take over my life as it once did when I was in college, Bridge.  Why could that happen?  Both my mother’s and my father’s families whenever they gathered for any family event, inevitably a card game of some type would break out.  Eucher (sp), Hearts, Canasta, Spades, Tripoli, numerous Poker variations, or Buckpitch were just a few of the games I learned to play.  It seemed perfectly normal at both of my parent’s funerals to have extended family members playing various card games in the side rooms of the funeral home.  I think it may be a Southern thing. 

When I arrived at college I was introduced to Bridge and for a good portion of my freshman year I along with other card playing friends from my college days, ate dinner early and retired to Parrish Parlors for an hour or two or three of competitive bridge.  We used rotating dummies so you learned to play various styles of bridge quickly.  I found that my card playing days with my family pre-college served me well.  If you are a regular reader, at this point you are asking yourself “where is he going with this?”.

Back to the art of finesse.  When our Culinary Director used finesse to describe a resident care strategy it just seemed so obvious.  Card games like Bridge use finesse to overcome missing trump or face cards in order to win the required number tricks to meet the bid amount.  It was the classic “aha” moment.  Using a bit of finesse when working with residents allowed us as well as the resident to overcome missing trump cards and make the bid.

This meeting also produced a flood of memories for me that included the places and the faces of my past bridge playing time so many years ago.  It is after that meeting that I searched out the Bridge app that now seems to have taken over my spare time.  Each and every time I celebrate a Bridge finesse I am reminded of how one simple but out of context word produced a significant change in thought for our team.

There are obvious challenges for those of us who care for seniors face on a routine basis.  I can see now how using a little finesse every now and then can produce great results.

Contributing author Steven Mattingly is the Executive Director of Pacifica Senior Living in San Leandro CA.

That's Amore

By Rebecca Weitzel

Pacifica Belleair was entertained and delighted by the Fun Time Singers who came to perform for us a couple of weeks ago.  Singing many songs including Patsy Cline’s “Crazy” and Elvis’ “Love Me Tender”, our residents and care givers alike were  clapping and tapping along with the music.  The highlight for me was when one of our residents opened up and belted out the refrain to “That’s Amore”.   Perhaps this isn’t so exciting, but when you consider that this lady hardly speaks anymore, it was quite a surprise to hear her lovely voice belting out “When the moon hits your eye like a big pizza pie, that’s amore”!  Her face was beaming, her hands were waving in expression to the words and when I asked her if she liked the music, she lit up into a big smile and said, “Yes, I was remembering!”  It made me think of how hearing a certain song can sweep us all back in time. Pat Benatar whisks me back to my freshman year in college, The Eagles, well that’s high school and of course there is that special song that takes me back to my minivan, loaded with my school age kids, all of us singing at the top of our lungs to Billy Ray Cyrus’, “Achy Breaky Heart”!  Even today, when that song comes on, each of us will start singing (yes, at the top of our lungs!), inharmoniously, but loudly and enthusiastically nonetheless.  Now, thanks to the Fun Time Singers and a lovely lady, another memory has been cemented; from now on, when I hear “That’s Amore”, I will be reminded of the sweet woman who lives at Pacifica and wonder what memory she relives as she’s transported back in time and hears “When the moon hits your eye like a big pizza pie….that’s amore”!

Contributing author Rebecca Weitzel is the Community Relations Coordinator for Pacifica Senior Living Belleair in Clearwater, Florida. 

Age In Place....Really?

by Rebecca Weitzel

When introducing families to our community, I explain that our residents enjoy "Aging in Place".  This is a popular buzz phrase that’s currently misused, misunderstood and incorrectly offered by many assisted living providers.  Saying that mom can “Age in Place”….sounds nice, but what exactly does it take to make (and keep) this promise? 

Regrettably it is important to understand and anticipate that a person suffering from dementia declines over time.  As conditions worsen, care levels increase, frequently to the point of becoming acute.

Most Tampa Bay AL’s operate with a Standard License and provide routine personal care services to their residents.  Florida guidelines specifically define these services, which are quite limited in scope, as they do not permit delivery of the higher care needs required of more progressed residents.

Pacifica Senior Living Belleair has earned and been awarded a Specialty License called an Extended Congregate Care License (ECC License).  This permits us to legally give and manage higher acuity care needs than can other communities.  Having this designation allows residents to live here without the threat of one day having to move into a skilled nursing home.  Therefore when speaking to families, I legitimately offer “aging in place, here in our cottages, because we are licensed to provide for the increasing healthcare needs of our residents. 

We are one of few dementia care communities in Pinellas County to hold an ECC license.  Having been awarded this specialty license by the State of Florida, Pacifica Senior Living Belleair offers "Aging in Place" ....really!  From the earliest stage of memory care need through the entire journey, our residents remain here, at home, with us. This is one more promise we make (and keep) that makes Pacifica “just the right place” for many Bay Area families.

Contributing author Rebecca Weitzel is the Community Relations Coordinator at Pacifica Senior Living Belleair in Clearwater, Florida.

The Value of Saying Thank you!

By Steven Mattingly 

This past week, September 9-15 was a special one in the world of Assisted Living Communities. It was National Assisted Living Week.  Our community used a large poster to say thank you to our staff and encouraged staff members, residents, and family members to personalize it with notes and encouraging words.  It was great to see as the week went along the growing and glowing tributes that appeared.  We also used this week to honor two members of our staff for their “above the call of duty” care giving skills.  They were honored at a Happy Hour event in which all members of the community participated.   I felt that we had hit a home run in the thank you game for the week.

It was with a concerned ear this past week that I listened to one of our healthcare vendors tell our concierge how glad they were to see our poster since in their visits to most assisted living clients they serve, they saw nothing in observance of National Assisted Living Week.  I made a point of seeking out that vendor during their visit and ask them if that remark was really accurate.  Sadly they said yes.  We commiserated about what the caregivers in locations where there was no observance might feel.  The buzz words of under-appreciated, un-feeling, and we need to do more were tossed about and we both felt better afterwards or was it perhaps our smugness showing.

This incident in so many ways forced me to reflect on how I as a manager perceived my staff.  Were they worthy of some special acknowledgement during National Assisted Living Week; absolutely.  But are they also worth my time and energy to say thank you each and every day; again the answer should be absolutely.  Do I say thank you each and every day?  I have to admit to my shortcomings and say no I don’t.  I mean to, I really do!  But then that report comes due, I get a call from my boss, a family member needs answers, a resident walks into my office with concerns, etc.  I think you get the picture.  Like everyone else I have constant distractions from my good intentions.  To quote my now infamous mother “the road to hell is paved with good intentions”. 

Lots of business schools graduates and experts have spent lots of time coming to the conclusion that the one thing managers can do that motivates employees the most is show real and genuine appreciation.  Public appreciation like the poster we used, the recognition in front of the community for some, and happy hour for all certainly were signals and signs of appreciation.  But those same experts have told us that quiet moments and simple words of appreciation have an even greater effect.  In my upbringing we were reminded regularly to say our please and thanks yous.  I can remember all too well my parents at the dinner table not serving us food until we used the “magic” word please and we often heard the phrase did you forget something when we didn’t say thank you.  Now I understand and appreciate those gentle and even not so gentle urgings of my parents all the more when I think about saying thank you and asking staff members in an appropriate way to work harder and do more.  The phrase “how much more our parents know as we get older” keeps coming to mind.

There has been a general (do I dare used the in-the-news-word) bounce in good feelings around and about the community following last week.  I hope our tracking polls show it as more than a bounce and something that we can continue to build.  I hope that my good intentions don’t send me to hell but I do have a plan to say thank you more to our care giving team in some way every day I am in the community.  Little did I know that my parents were as smart as or perhaps even smarter than the business school crowd when they taught us good manners?

Contributing author Steven Mattingly is the Executive Director of Pacifica Senior Living in San Leandro, CA.

Our Aging Parents Continue to Change

By Steven Mattingly

One of the most difficult tasks you face as an Executive Director of an Assisted Living Community is talking with family members about changes you and your staff see in their loved ones.   It’s never easy for family members to see the changes or as is more often the case, to process how the changes are affecting their loved ones daily life.

I’ll give you an example from personal experience.  All other members of my family are located near our ancestral home in Kentucky.  I moved to California more than 15 years ago and as a result I didn’t see my mother regularly the last 12 years she was alive.  Unlike my siblings I didn’t get to enjoy her Sunday fried chicken, watch her consistently lose at cards, or for the umpteenth time ask “which hand are we on” in Shanghai (a rummy type card game).  The image I instead saw during my semi-annual visits was how much my mother was changing as she aged.  When I tried to talk to my siblings about the things that I saw they were always either surprised or defensive.  I was the person who informed my younger sister that our 80 year old mother could no longer safely provide free childcare for her two children after school.  You can imagine how well that was received.  I added a different and at times not welcomed perspective to the family dynamics, not unlike what I often do with family members of residents of our community.

Perhaps the most important role of an Executive Director and his/her team is to be the objective viewpoint in the family dynamics that envelope every single resident in a community.  I often tell family members that we are the people who now live with their loved one 24/7/365.  We are better suited to know a resident needs because we see and experience the difficulties their loved one encounters each day.  Family members sometimes tell me that their loved one saves all their complaints and sad stories to share when they visit; I think that is not the case in most instances.  What our team most often observes is the “gearing up” for the visit phenomenon.  Residents, even those with advanced dementia, go into a different functionality when loved ones visit.  They are more engaged, more alert, participate in the conversation more, and exhibit their “best” behavior when families visit.   What happens when the visit is over I describe as the “crash”.  Even residents who normally have great coping skills when dealing with their daily challenges experience, albeit small in some instances, some diminishing of their coping skills.  That’s when my staff sometimes tells me “I wish their son/daughter/friend could be here now”.  The implication is the family needs to see and hear what they are experiencing after a visit.

A few years ago I worked with a family who adamantly maintained that their mother was not incontinent and how could we charge them for that level of care and the accompanying undergarments.  After many rounds of discussion I finally in a moment of great exasperation told the family fine, take Mother to live with you for a week and if you don’t come back with an understanding that she is incontinent, I’ll not charge you rent for a month.  It took less than 24 hours and mother was back in the community.  As much as I wanted to feel a sense of triumph I couldn’t.  What I had done was remove one more element of the dignity that Mother had in the eyes of her children.  It was needed to make sure their mother got the care she needed and we were correctly paid for providing that care, but it was hardly something that I saw as a victory in any sense.

Many of you by now have realized that I often use my own family to illustrate situations or problems.  I find it is often easier to talk with a family about a problem or concern if you use a third party to illustrate the point.  But I also think I use my own family stories so that our resident’s families can know my empathy is real.  I too have had to face a world with aging parents.

Contributing author Steven Mattingly is the Executive Director of Pacifica Senior Living Assisted Living in San Leandro, CA.