Case VI: Chapter 8: Community Assist Program

Chapter 8: The La Vida Aureo Community Assist Program

The discussion with Paloma about the things she had learned through her sopapilla network caused some specific thoughts to begin forming in Dudley’s mind. Many of the staff continued to meet at the end of the day in the small dining/conference room. In fact, a few more people were stopping in as the nature of their discussion had spread throughout La Vida Aureo.   Paloma continued to provide snacks to the group and sat quietly in the corner listening to the conversation. Dudley would stop to visit with Paloma every few days after reading the Wall Street Journal to learn what new information had emerged. “You know,” he said one day, “our own staff would be an ideal place to test any ideas we come up with. They are certainly experiencing many of these same issues and undoubtedly would very candid input and feedback. They have the somewhat unique perspective of dealing with the diverse issues of aging both at work and at home.”

“That is an excellent idea, Señor Doc. I am certain that they would not hesitate to tell you exactly how they feel.”

“That sounds a bit intimidating. Perhaps you could sit in the room with me.”

“You are too modest, but I would be happy to attend. It might also be a good idea for Isabella to hear their comments first-hand.”

“If you don’t think the staff would be afraid to talk openly in from of her.”

“Trust me. That will not be a problem.”

“Paloma, there is one more area I want to explore before I get back to Isabella and that is franchises. I’ve noticed advertisements in many magazines for franchise opportunities in the general area of home health care. I don’t know if that is an appropriate option for La Vida Aureo, but it certainly seems to be gaining popularity. I may even try to do some investigation on the Internet! One of my buddies was teasing me about my new smart phone and he told me I could surf the Web with my phone. I better check that out or I will not hear the end of it.”

“Well, haven’t you become a modern man?”

After he had done considerably more reading, Matthew Dudley thought he had developed a reasonable approach to addressing Isabella’s challenge. He had even done a preliminary cost analysis of various alternatives. There were still several specific aspects of his proposed approach that he had not resolved in his own mind. One of his basic assumptions was that the primary goal of any new program for La Vida Aureo to undertake was to keep people in their homes as long as possible and out of facilities like La Vida Aureo. He wanted to be certain that this approach had merit and realized that sharing it with Paloma’s so-called sopapilla network would provide his the feedback he knew was necessary.

As Paloma had surmised, Dudley’s meeting with the staff was very successful. The discussion was lively and candid and ended only when most of the group had to meet their ride home. After everyone left, Paloma and Dudley sat in the small room sharing the last of the sopapillas and coffee and reviewing the past hour. “I want to thank you, Paloma, for the opportunity to talk with the group. There were many valuable comments and suggestions. I am once again impressed by the quality of our staff and their commitment to the residents of La Vida Aureo as well as to their own families. They are a most remarkable group.”

A few short weeks later, Dudley felt he was ready to have an initial discussion with Isabella about ways to serve an ever increasing population of elderly citizens with a growing diversity and complexity of issues. He was aware that the other condition Isabella had specified was that any new activity be totally consistent with La Vida Aureo’s philosophy and be complimentary with all existing services. He felt that he had given the matter a great deal of thought and the meeting with the sopapilla network had been invaluable. He felt prepared to share his thinking with Isabella and was confident that they would have a lively and productive discussion.   Nonetheless, he was a bit apprehensive since he had not made a formal presentation since retiring. He decided to try to set Isabella’s expectations at the outset.

Isabella invited Dudley into a small conference room next to her office which she had insisted on including during the initial facility planning phase. There was small round table and four comfortable chairs. There was a white board on one wall and an easel with paper in another corner. It was an ideal arrangement for just this kind of discussion.

“First of all, Isabella, let me thank you for including me in this process. It means a great deal to me to know that you value my input. This is obviously a very complex subject and one of my primary conclusions is that we should move with deliberation. These problems are not going away and will only increase as more people age. And, as you know, aging is not a single issue; it will continue to evolve and change over time. Therefore, we must remain highly flexible. Finally, we must accept that we cannot be everything to everyone. I believe that any success will be based on having the courage to say “No” to many individual opportunities. Hopefully, our visible participation will encourage other reputable organizations to provide any products and/or services that we choose not to.”

Dudley continued. “I’ve come to the conclusion that essentially all aspects of healthcare share one common problem. That problem is staff. Consider everything from home healthcare to nursing homes, even non-medical staff at hospitals. You know, Isabella, dealing with old people is hard work; they can be very, very difficult. I believe that it requires a special person with special skills to remain professional and caring under these difficult circumstances.   For the reading that I’ve done, there has been unprecedented growth in home healthcare and it has lead to serious staffing problems. Too many of the professional caregivers are poorly trained and terribly underpaid; some have questionable backgrounds, etc.   This creates too many opportunities for neglect and potential abuse. Compare that with the staffing policy here at La Vida Aureo. We, particularly you and the Supervisors, work very hard to find, train and retain competent staff. The situation is particularly acute in the Memory Care Unit, where resident behavior is an everyday challenge. This staffing issue appears to me to be compounded when you create a national franchise network for home healthcare. I just don’t see how you can maintain an appropriate level of quality control. Therefore, I’ve rejected that as an alternative for us.”

“Despite reading a great deal, I don’t fully understand the concept of reimbursement for medical services. We are fortunate here at La Vida Aureo that many of our residents are either private pay or have adequate insurance from a large and reputable company. Other organizations are less fortunate. I have a growing fear of old people being essentially warehoused in the near future. If the Government doesn’t get a grip on total healthcare spending, their only course of action is to reduce the amount they can, or are willing to, pay. That means that healthcare companies will have to manage their costs to remain profitable and that means reduced staffing levels. We have made significant advances in medical technology, but I don’t see how a computer can insert an IV, or change a dirty diaper, or even just hold someone’s hand.”

“I apologize, Isabella, for that brief rant, but when I consider what continues to make La Vida Aureo successful and why we have a significant waiting list, it all comes down to the quality of our people. Sure, we have fancy facilities and Paloma’s meals are consistently above restaurant quality, but we have really competent and caring people to support all of our residents.”

“My other major area of emphasis relates to needs; that is, what are the most significant needs of our aging population. Rather than give you a list of things like diapers, canes, etc., I want to suggest that what most seniors want more than anything is to retain their dignity, to remain in their own home for as long as possible and to have as much control over their lives as possible. I realize that this is simply not a realistic expectation for many seniors, like those with serious physical or mental limitations. But, these folks really need a more highly specialized form of healthcare.”

“My primary recommendation to you is that our goal for this new business should be to keep people out of places like this, out of the less desirable places and certainly out of state-run institutions. We can accomplish this by helping people lead healthier lives, by preventing serious accidents that occur in the home and by educating family members and other caregivers. What do you think?”

“Wow, Doc! Thank you, not only for the information, but the level of passion you brought to the subject. Sometimes, I get so deep into the routine of daily operations that I forget to sit back and look at the bigger picture. OK, so tell me how to keep people out of here. I can’t believe I actually asking that, but I know you’ll enlighten me”

“The key is education and the delivery vehicle is through the highly trained Specialists of the La Vida Aureo Community Assist Program. There are a great many elderly citizens who are part of a family, often an extended family. That is especially true here in Albuquerque, something we learned through Father Michael as well as Martina Trujillo. The younger members of the family are willing to be caregivers and typically feel a sense of responsibility for their parents. What they lack is basic information; things such as what should I expect; are these behaviors typical, etc.?

“I envision our Specialists to function like Project Managers more than social workers. They would serve as a focal point for the collection and dissemination of information. They could tell people where to go for specific information about a particular issue or refer them to another organization. Our Project Managers would work with other organizations to provide access to a broad range of products and services. Think about what we able to do to locate and distribute those diapers for Our Lady of the Valley parish. Is there an opportunity to develop similar partnership arrangements with Walgreen’s or CVS? Or, how many people are aware of programs like Meals on Wheels to deliver tasty and nourishing meals directly to the home. Another area would be to facilitate the creation of support groups among families dealing with similar issues.”

“I do not believe it would be prudent for us to start a new business to address the unique problems of aging; there are already a large amount of resources currently available and more starting each day. But we certainly could create is a unique service that helps caregivers in need to locate them.”

“Like a clearing house,” asked Isabella?

“Yes, but our people would take an active role in not only identifying potential resources, but also rating or qualifying them before they become part of our approved list, so to speak. I suspect the Internet could be a powerful tool for the dissemination of information. I could also see us developing actual printed check lists and information cards. For example, one such card could show specific steps to prevent common accidents in the home.”

“The critical factor for success for this endeavor goes back to the point I made initially. The key is staff. Our Project Managers would have to be highly capable individuals with the necessary skills to operate competently in many areas.”

“I follow you, Doc. Instead of trying to compete with other businesses in the field or, heaven forbid, building another large-scale facility like this one, La Vida Aureo hires and trains a small group of Information Specialists to function as coordinators, project managers, quarterbacks, etc. We could achieve a very high level of positive impact in the community with a relatively small staff. I love it.”

“I would ask you to do one thing before you reach a final decision,” suggested Dudley. “I want you to meet with what Paloma calls her sopapilla network and get their input to this potential approach.”

“Sopapilla network? I’ve never heard of that. Is it some kind of social group Paloma belongs to?” asked Isabella.

“Actually, it is our own staff. They typically gather in the afternoon while waiting for their ride home. Recently, the topic of discussion has been the various problems they are facing in their own families with aging parents and grandparents. I’ve met with them and, as you would expect, they have some very valuable insights and comments.”

“I guess I shouldn’t be surprised that Paloma had her finger on the pulse of this entire complex. That sounds like a marvelous idea, Doc. Would you please arrange for me to sit in with our folks as soon as possible?”

Over the next week, Isabella and Dudley met with the staff on several afternoons and refined the basic concept of the La Vida Aureo Community Assist Program based on what they heard. After everyone had left to go home, Isabella, Dudley and Paloma remained in the small room. “Paloma, I can’t thank you enough,” said Isabella. “I really don’t know where to begin; I truly appreciate all the things you do, large and small.”

“La Vida Aureo is my life too, Señora Isabella.”

Isabella and Dudley met each morning for the next several days to refine the proposal they would make to La Doña Jaramillo. “I want you to join me when I talk to Señora Jaramillo; you are really the person who put this all together. Besides, I know she wants to meet you, after all I’ve said about you.”

“I would be honored but somewhat intimidated, based on what you’ve said about her.”

The meeting with Señora Jaramillo and Father Michael went very well and both agreed that the Community Assist Program was a reasonable and practical approach to a complex set of problems. Isabella was encouraged to move forward and develop a detailed work plan to launch the Program as soon as possible.


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