EP. 22 Choosing a Facility: What to Know & How To Prepare

In this episode, Bob and guest, Amy Leep, BSN & Founder of Comply Services, LLC, dive into the importance of person-centered care. This is intended to learn about the individual being helped and what techniques are going to work best for them.

Amy helps organizations with this by studying a facility and identifying what policies may or may not be in place for people with specific impairments to ensure that each organization has things in place to support residents with various types of behaviors or needs. It is crucial for facilities and personnel at them to realize and be conscious of the various diseases that can affect each elder they serve, and maintain specific skillsets and practices to establish relationships and trust within their center. 

Learn more on this informative and interesting episode of the Advice From Your Advocates Podcast.

Transcript

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Welcome back to advice from your advocates. I'm Bob Mannor. I'm a certified elder law attorney in Michigan, and I'm very excited. Today we have a special guest. It is Amy Leep from Comply Health Services. Amy is a really unique and interesting person that has a perspective and opinions about long term care, and I appreciate the efforts that she does and the role that she's lived and she's had some really unique opportunities. So, Amy, welcome. Thank you for having me. Amy, I understand and we've had a few opportunities to talk previously. I understand that you have been a nursing home administrator and you've also been a Director of Nursing at a nursing home. Is that accurate? That's correct. I have years of experience working as a Director of Nursing, but prior to starting Comply Health Services, I worked as a dual role as a Director of Nursing and nursing home administrator in a CCRC. But in the skilled nursing portion of that organization. I find that fascinating. Those are two roles that seem so divergent to be the Director of Nursing and the administrator. Tell me a little bit more about that because it just seems like such an interesting role to be able to do both of those. And I know you couldn't have done that in a huge skilled care facility that had 150 beds, but tell me about your experience with that because it does seem like those are very divergent roles. Yes, I would agree. There are things that were so beneficial to having the dual role, and then there was also many opportunities for having that dual role. So I would say many of the benefits to that were as the Director of Nursing, I was so involved in the day to day operations of the skilled nursing area that when I am doing quality assurance, I am the person running the reports. I'm the person that would have been rounding in the area every day and recognizing what opportunities we have to work on. But then also some of the barriers to that is as the nursing home administrator, you are really overseeing all of the departments within the organization. So I feel like an organization that has that dual role also would have to have an operations director or COO really helping in supervising and leading those other departments. Yeah, that's a good point. So then after that experience, you started comply health services. Yes. Really working through the pandemic as both the dual role of the Director of Nursing and the nursing home administrator, it was really eye opening to see a lot of the opportunities that we have in senior living just really being exploited to a degree I had not experienced before. Interesting. In directing the skilled nursing area, you can recognize what you can do as a servant leader, but then there are also things that you just couldn't help because of the pandemic. Well, and exactly. And so now you went down this path so I'm going down it with you here. So you're being nice because there was a lot of government mandates on this. It's one thing that we can be sometimes worried about some of the policies and procedures that happen in care settings, but in this case, there was a lot that you were mandated by government policy. And so, I have to guess that this was the most challenging time ever experienced in that industry when we were subject to all these COVID rules. Am I wrong on that? You are absolutely correct. I've been in this industry for over 25 years, and I can only speak personally on my behalf. This was the most difficult time. Throughout my entire professional career, I was having updates and changes to mandates. It feels like on a daily basis. By the time you were able to update a policy and get your training and the changes implemented, the things you were implementing had changed again. And you just felt like you were on a roller coaster you just couldn't get off. One of my favorite people that are senior advocates is Alison Herschel. And her organization actually houses the Ombudsman's program through the state of Michigan. She's taught at U of M Law School, and she's just a really practical, down to earth advocate for seniors and incredibly smart. And so, Ellison, one of the things that she would say about that time period, and I don't disagree with her this is very strong language, but she said it was a humanitarian crisis. Locking folks in and not giving them interaction with family, telling them they had to talk to their family through the window when they had dementia. They didn't understand what was going on. They were confined to their rooms. They couldn't even get out to community lunches or whatever. She called it a humanitarian crisis, and I can't disagree with her on that. It was very difficult. It was difficult for everyone involved. And that's one example of what people living within skilled nursing facilities experienced. I could go on and on and on about some of the things that people experienced during that time. It was a very difficult time. You could see and feel the hardships and the people that you're caring for. And then you also felt just as the caring and the commitment from the staff that worked in skilled nursing facilities, and they took on that burden. And that hurt for the people that they care for, because we're a long term care facility. So these are not people that come in and come out. We have relationships with these individuals. And you feel their pain because you love them. Absolutely. And you know so much love for those that withstood that and because, honestly, they were the the only connection to any kind of compassion was the employees and the caregivers that were working there. And they were under tremendous stress, too, because none of us really knew what was going to happen with this pandemic and going to work every day, not being told that, well, if we contract this, there was just so much that we didn't know about it. And they still showed up at work every day, and they still provided that level of compassion and care that sometimes the families could have supplemented, but they weren't allowed to. And they were the only link to just some humanity. And I can't say enough about the caregivers that stood through, showed up every day, did what they need to do to care for our seniors and for our loved ones. Absolutely. They're all heroes. And that's where a lot of my passion comes from, is recognizing that your caregivers and your employees within your organization are the backbone. And recognizing that as hard as it was for them to come to work and put themselves and their families at risk to be able to care for individuals during the pandemic, they were still at the forefront, advocating that in a lot of areas that, hey, this may be wrong. Who is listening to us at how we could do this better and still keep people very safe? It was difficult to go through the pandemic, but I think we've learned a lot from it. One of of the things that I appreciate about you when we've been talking is you now have devoted your life to education and advocacy as it relates to all of these issues. And one of the things that you do as part of your training, I believe you have a whole training program to help train folks within this industry, and we'll get into why that's good for management, why providing better and best training to the staff, to the caregivers, to the first line is going to be best for management, best for business, all of those types of things. But let's start talking about before we get there what some of that training entails. And one of the things that I think is fantastic is you do a whole training on in empathy and teaching empathy, which part of me thinks is it possible to teach empathy? And you assure me that it is. It is. And I think that's where different senior living organizations may struggle with is recognizing from prior to hiring someone that we assume that people come in with certain skills or certain attributes that maybe previous generations I don't know. I think there's a difference between previous generations and people that we have in our workforce now and recognizing what attributes do people come in with, what are great attributes that we can grow upon and strengthen, and what are attributes that we can help people with so that they remain long term successful employees for us. I'm really passionate about helping caregivers learn how to better give care. And sometimes that starts with them learning about themselves. Sometimes it's easy to be critical of any profession, every profession. There's going to be some really bad lawyers out there. There's going to be some really good lawyers, there's going to be some really good health care providers and some really bad health care providers. But one of the things that I've noticed as an employer, as somebody that employs people, is that a lot of times the quality of the services that that employee provides is directly related to the tools I've provided them. And so, well, it's easier to think about from somebody in construction. But the same thing is true for somebody in a law office. But if I were a construction company and I didn't give a hammer or a screwdriver or I didn't give them any tools and expected them to work with their hands, and then I criticized them that they can't get the house built in a month, anybody would see how foolish that is. But I think the same thing applies in a law office and the same things applies in a care setting we need to provide the employees with the tools. And my experience is it is directly related to the quality of the services and the quality of the work provided by the employees is what tools I've provided them. Have I given them enough training? Have I given them enough resources, checklists whatever it is to make sure that they have the ability that they have the tools necessary to do the job properly? Absolutely. And there are programs within our state that help organizations be able to provide these tools. CMS mandates a lot of things, but then depending on payment, things change. So based on the level of services that you provide, is how you get paid and how much is there for education and training. Right, but talk about that. I promised that we were going to talk about that earlier. So I am a big believer in that you invest in your employees to get the results that you want. And whether there's money for it or not, the money will work out. In other words, just because there might not be reimbursement for training, it's still worth it from a management standpoint to do the training to provide those tools because then everything else will run smoother. There'll be less management issues, there'll be less times where management has to intervene, there'll be less people refusing to pay the bill, all of those things that yes, okay, I get it. There might not be money that is reimbursed for training, but do it anyway because that's what's going to make the business run. smoother. Absolutely. And there are opportunities for organizations to find money for training. And you just said it perfectly. It's all going to come back to benefit that organization. Their star rating is going to improve because their retention is going to improve and their culture. So your marketing and your sales are going to improve because you're going to have longevity in your staff and you're going to have satisfied customers within your organization that are going to talk really well about how they're treated, the care that they receive, and the good things that are happening within that organization. Right, absolutely. A lot of what you're training on is improving communication. I have a philosophy that most problems Honestly, I don’t think I’m overstating this, but I think that in order for this to be true, you have to be really kind of dig deep on it, which most problems could be resolved with communication. And now I'm going to go down the political path. I think most political problems could be resolved with communication. The reason why things get log jammed is because there's an intentional lack of communication, intentional lack of not trying to compromise or come together and agree on, okay, how can we work through this together to get a good result that's going to be better for everybody. Maybe not exactly the way I wanted it or exactly the way that you wanted it, but ultimately better for everybody. And I think that whether it's politics or business or caregiving for caregiving in particular, I think communication is huge. And that's one of your big points of advocacy is if we could just increase the level and quality of communication, we could get better care, better results. Yes, absolutely. And I think that starts at the level of education. I think people that are going to work in the healthcare and the senior living in particularly you need to have extensive communication training that covers everything from listening to understanding your self knowledge of what triggers you and how. Do you self manage your feelings? And to learning how to appropriately respond to someone that you're having conflict with or someone that has just experienced a significant change in condition. How do we provide empathy and be empathetic to individuals when we are working in a stressful environment? And those are things that can be talked and practiced and then performed. Amy, I'm going to put you on the spot here for a second. I didn't warn you about this, but I'm going to give you a couple of scenarios, okay? If I can give you these scenarios and you can tell us more about how would you teach communication, how would you teach to respond to these scenarios? And I just think these will be helpful for our listeners. So the two scenarios I'm going to give you and I'll just give you both, and you can address them in whichever way. Okay. One is a resident of an assisted living memory care type place, and we've been getting reports that in healthcare they often call it behaviors. That's a word you used a minute ago. Behaviors meaning that they might lash out verbally and say mean things or physically. And in this case, it wasn't verbal lashing out, it was physical. And the most recent example was an aide trying to change their sweater, take their sweater off because it had gotten warm out. It had been colder earlier. They said they complained about being hot. So the aide was trying to take off the sweater. They approached from behind, started taking off the sweater, and she lashed out and hit the aid, which is awful. We got to make sure our caregivers are physically protected. But maybe there was some communication issue that we could teach there that could have addressed that differently. Then I'm going to give you another example. And this is one where I have clients all the time. And I can only imagine if you've been married for 50 years and this is your spouse, there's bound to have been in that 50 years times where you were grumpy towards each other or stubborn towards each other. And so sometimes the perspective is, yeah, I know they have dementia, but they're just being grumpy. They can do that thing, but they're just being grumpy. And so I had someone that their spouse was always the one that took care of the finances. And now that spouse that took care of the finances is deep, deep into Alzheimer's. And there was no possible way they could understand the concept of money, let alone balance a checkbook. And the husband keeps going to the wife and asking permission to do things with regard to the finances, like, I really want to sell the car. I really want to consolidate our accounts to make them easier to manage. And the spouse's response, of course, is, absolutely not, don't do. That You better not sell my car. And this is the spouse that has deep dementia. So I want you to maybe address both of those issues and how things might be handled a little bit differently. Sure. So I think the situation where the caregiver approached someone from behind is one, recognizing that no one would feel comfortable with someone approaching them and touching them from behind. You would automatically get defensive and you could feel anyone could feel like they were going to be attacked just before. I don't mean to interrupt you, but isn't it true that one of the things with Alzheimer's or a lot of dementias is it also affects vision, that sometimes we don't have the peripheral vision. And so even though maybe they think that they see you because most people have that peripheral vision, but with Alzheimer's or other dementias, sometimes our vision narrows. Sometimes we just don't have very good vision. That's absolutely correct. In standard nonverbal communication skills we would be teaching, you always approach from the front and just what you pointed out, you don't even approach from the side because of possible visual deficits. And you get at someone's level if they're sitting, you sit. You don't stand over or tower above someone when you're speaking to them. That's a dignity issue. Someone could feel like you are overpowering them or they may feel unsafe. And I think that's what we need to recognize is people with particularly any type of memory impairment or they're in an environment that is different to them. They could be feeling scared or unsafe. So everything you do should be to reinforce that they are safe with you, that you are there to comfort them, to help them. So if that individual, instead of approaching them from behind, would have brought the sweater in front of them, maybe gave them an option of, would you like to wear this? Or Would you like to wear this? Gave them a little bit of control of what was going to be placed on them, then asked them, can you put your arm in here? And try to assist them in keeping their control and their independence and doing for themselves what they can that builds that trust in that bond of this person is here to help me versus how the situation occurred. One of the things I know that it just requires so much patience, and frankly, probably more patience than I have to deal with this kind of stuff So what you mentioned was that takes some time. If you're trying to rush through it, that's not going to be ideal. One of my social workers here, we have a couple of social workers on staff, and they mentioned to me that possibility exists that it could take up to 30 seconds for somebody with Alzheimer's to process what you said. Now, if you ever sat still for 30 seconds in silence, it seems like an eternity. And so if you say, hey, I'm going to put the sweater on you, I'm going to take the sweater off of you, or do you want me to do those things? It could take a good time of them just sitting there, not saying any more words, waiting for their reply before they've even processed what it is that you're saying. And so sometimes we just assume they can't process it, but in reality, it just might be a slow processing of it. But that takes a whole lot of patience. And I understand why it would be easier just to kind of rush through it. But if there is somebody that we're worried about experiencing behaviors or lashing out, it might require that. But when you teach an individual how to do it properly, and they're doing it properly every time, it becomes second nature. And then the individual then trusts you more as you're approaching them. The next time you approach them with a sweater and they trust you in that feeling. Even if they can't tell you what your name is or they don't know their name, that bond or that feeling of being safe around you, they may extend their arm for you to put the sweater on the next time. You can’t, just as though you can't anticipate when something is going to go wrong, you can't anticipate that something is going to go right. But when you build that trusting relationship with someone, whether they have memory impairment or not, it's always going to help you. It's a really good point. So for the second scenario is yes. One, recognizing that I particularly think with that situation, it is that husband, I think I took the scenario correctly, the person that has impairment is the person that took care of the finances. Right. The person that's having this discussion with them. When you're used to doing something, there's a sense of companionship, of still going over some things, whether they can give you the right answer or not. I feel like people that are partners have a sense of intimacy with sharing things that they've always shared, and I think it may be me in that particular situation. I would probably have a conversation outside of them being together and recognizing maybe what the needs of the individual, bringing the information about the finances to the person that can no longer understand it. That's such an important point. I think so much of the time we're so focused on the person with dementia and really adapting to them. And the reality is that they're not the only one that needs attention and care and understanding, and especially if they're married, but for children that are taking care of parents too, but especially if they're married the spouse, this is a huge adjustment for them. And getting them the support and attention that they need is as important as making sure that we're getting the care that we need for the person, the spouse with dementia. Absolutely. So I think that scenario is twofold. I think the person that has dementia, maybe there are ways that we can help the person that's speaking to them, give them a sense of they still are part of the family, they're still involved, they're still loved, all while not asking them specific questions that they don't have the ability to give answers to. Yeah, it's one of the things I often face with clients. And this is so difficult to experience in your own family in real life. And it's easy for me as the outsider that can just tell you what to do. It's easy for me to tell you what to do. When it's your family, it's much harder. But sometimes when I have met the spouse, the parent, whatever, and I've been able to interact with them, and I can tell they don't have the executive decision making ability anymore, that's one of the things that's a term of art that we use with regard to dementia, is the brain function of executive decision making. That means being able to decide between options, being able to make wise, good, daily living choices. And frequently we'll have family members, sometimes it's a spouse, often it's kids, where they'll say, well, okay, yes, I know we need to make these changes, but I have to get dad to agree to it, I have to get my spouse to agree to it and that's fine. I appreciate them including their spouse, but depending on the level of the disease, depending on how far along it's come, what folks sometimes have to wrap their head around and not be in denial about is that there is sometimes and frequently the inability to make a rational decision. That executive decision functioning is gone. And so that's so hard if it was your dad or your mom or your spouse that you've depended on for 50 years. But it is one of those things that it's important for families to wrap their head around so that we make sure that we're not making decisions Like leaving somebody home alone when they might wander away, leaving them home. Alone when they might leave the oven on or turn the microwave on for 2 hours or any of the other things that can happen when you leave somebody alone. And they don't have that executive decision making power anymore. Yes, I experience that quite a bit as the administrator, because some people come into senior living organizations and we're doing testing and we recognize that people that are unable to make their needs known or understand their executive function has stopped functioning properly. And some family members or some families have not had those difficult conversations about power of attorneys and finances for health care and then not having those conversations prior to testing being done and recognizing this person has lost that executive functioning and what all the steps are required because of those conversations that were not had while people still had good executive functioning. Well, Amy Leep, tell me more about Comply Health Services. Now, I understand you have a training program built in there, but tell me more about the work that you do and what you have to offer for the folks that might be listening. Sure, so we do staffing, but it's leadership staffing in Long Term Care, home for the Aged and Adult foster care licensing organizations. So when I say that, I mean directors of nursing for Long Term care, it's MDS coordinators, unit managers, and in AFC homes, it's really going in and doing their onboarding education and annual required education for licensing. And then I work when surveyors are going into all of these licensed organizations, if they leave with any opportunities for improvements, I go in and we help organizations get into compliance. But then if the organization has further opportunities that they want to make improvements to, maybe they have a high turnover rate, maybe their quality of care, they have a high infection rate or high fall rate. I help organizations work through those barriers to identify what they could be doing differently to make those improvements so that they are showing by either their CMS Star rating or in their marketing how good of an organization. They are. Excellent. And then I think we were talking about you have a multi hour training program that you put people through, and does it provide continuing Ed credits or is it just a training program? It does not provide continuing education credits, but we recently started a nurse aid training program that it's a two week program The first week of the program is either virtual or in person at our school in Cutlerville. And then we have a lab. The second week is two days of lab and two days in a long term care facility. And then these individuals are able to take their certified exam through the state of Michigan and become nurse aides. Yeah, that's great. So it's basically a prep course as much as everything else then. Yes, it's a prep course, and it's the required curriculum through the state of Michigan. But what we do differently is I add all that extensive communication conflict resolution training, and we also provide American Heart Association BLS with the course. Excellent. And you're right here in Michigan. You're on the west side of the state, I believe. Yes, just south of Grand Rapids. Well, we're in Grand Rapids. Cutlerville is the area. Yeah. But you can work with any organization within the state of Michigan, right? Absolutely. Well, Amy, anything else that you would like to leave with our listeners before we wrap things up for today? No, I just really loved that I had this opportunity to be on this podcast and talk about some of the opportunities that we have in Senior Living because I feel like talking about them is then bringing it to the forefront so that we can find solutions and all be part of the solutions to some of the opportunities that we have. Well, thanks again, Amy. Leep from Comply Health Services. Do you have a phone number if people want to get a hold of you? Absolutely, 616 805 90 95 Or online it’s complyhealthservices.com Great, thank you so much Amy, appreciate all the listeners here to advice from your advocates I would want to remind everybody that we have our annual training for social workers and case managers, administrators.b And we do it every year This year its going to be 5 continuing credits, and it’s a fun day too. Because we’ll invite you at breakfast and lunch and lots of entertainment, and really up to date information that is both legal oriented and care giving oriented. And its a real great opportunity to interact with everybody else within the industry Within the long term care industry and get some continuing education credits. We have that every year And if you enjoyed this podcast and found the information interesting, Then don’t forget to subscribe, and you can look back at some of our past episodes Because we had some really great guests. And that’s one of my favorite things to do, is to interview really interesting people. On this very interesting topics, so don’t forget to subscribe. And thanks for listening.