Monday, December 29, 2014

Prayer and Bifocals

The end of the year is always a time to try to throw away, clean up, and prepare for the new year. Part of that preparation is deciding what my focus will be for the next year.

I've decided on PB. Not peanut butter, but Prayer and Bifocals. Prayer is pretty self explanatory. I want to do more of it, and I want people to pray for our ministry unceasingly! Every time I pray, I include our ministry and the LSC family, which includes each person touched in any way by our ministry (clients, residents, families, staff, visitors, etc!) Won't you add your prayers? Please add LSC to your personal, church, prayer chain, and any other opportunity.

Now let's talk bifocals. Not the glasses, but the vision. I plan to practice bifocal leadership for the coming year, which we'll define as the ability to focus on the near things and the far off things.

Near vision includes communication, customer service, and waste. No organization works harder than LSC at communicating with everyone, but it's never enough. My goal is for everyone to know everything about everything. While impossible, we can strive for it!

The LSC team can put our customer first every time, and every one reading this is a customer. We can smile at each other and treat each other as we want to be treated. That smile is also part of our security plan, believe it or not. If a teammate smiles and makes eye contact with a stranger in the hall or a person standing in front of a group home or in front of our offices, they are aware they have been identified. We can easily welcome the friend and warn off anyone bent on doing harm.

Waste should be the enemy of each of us. Ben Franklin is still right, "a penny saved is a penny earned." We should: not print documents unless necessary, recycle old file folders, never throw away files till we've saved the paper clips, commute together to meetings, turn out the lights, recycled plastic, only buy absolutely necessary office supplies, and on and on! We are over a $100 Million organization! Ink pens add up! The day my time is too valuable to haul the trash to the dumpster is the day I don't need to work here any longer. More importantly, I'd rather spend money on caring for people!

Bifocal also refers to the long vision. We have to keep an eye on the little things and we have to keep our eye on the horizon. Our country and our profession are in the midst of great turmoil. In that turmoil and crisis there exists danger and opportunity. Prayer will allow us to skirt the danger and take advantage of the opportunity. LSC has to keep one eye on the long view to survive and thrive.

So when you hear me talking about PB as we move into the new year, join me in prayer and vision.

Wednesday, July 30, 2014


PACE, Program for All-Inclusive Care of the Elderly, is a vital component of care and services in our society. PACE is a program that serves seniors who can live safely at home who qualify for both Medicaid and Medicare, providing all of their health care needs for a set amount of money paid for by the government. The model is popular with state/federal governments because it shifts all financial risk to the nonprofit PACE provider.

As a relatively new service, PACE has had to battle for its place in the long term care continuum. Some PACE advocates have tried to market PACE as the total replacement for assisted living and nursing homes. Assisted living and nursing homes have not wanted to share already inadequate Medicaid funding. Competing philosophies are a classic example of the silos in long term care, when partners need to be collaborating.

Lutheran Services Carolinas is in a unique position, being involved in home and community based services from PACE to nursing homes. LSC has been able to see the synergies and need for the entire continuum of long term care services.

PACE is a new and vital component that is serving the very under-served indigent elder population. PACE participants must meet the minimum requirements for Medicaid nursing home placement. Those criteria are very gray and broad, which has led to some misconceptions.

Some PACE proponents have latched on to "qualified for nursing home placement" to call PACE a replacement for nursing homes. In reality, every PACE has a contract with at least one nursing home so PACE participants can be admitted when nursing home care is needed.

What PACE can do is keep medically fragile seniors healthier and more stable, allowing them to live where we all prefer to live, in our own home. Coming to a PACE site one to five days a week for medical care, observation, socialization, good food, therapy, etc. improves health and quality of life. Thus, PACE participation can delay and in some cases prevent nursing home placement and unnecessary hospitalizations.

North Carolina nursing home residents have among the highest level of acuity in the southeast United States. While PACE participants and nursing home residents very loosely meet the nursing home placement criteria, again, they are not the same. PACE participants are more well and able to live at home in safety, a key PACE requirement. Nursing home residents have multiple, chronic health issues who require 24 hour care and services. Examples would include a person with Alzheimer's disease who could never be left alone or an unresponsive, bedridden person who is totally dependent on 24/7 staff for every activity of daily living (movement, eating, toileting, bathing, etc.).

A good example of the great difference between PACE and nursing homes is 24/7 direct care. Drive by a PACE program after 6 pm or on a Saturday and Sunday. It will be deserted, closed up. PACE participants have family or a friend to watch over them at night and on weekends, or they can get along alone. PACE does supply an emergency telephone number, but that is for emergencies, not for basic care. Drive past a nursing home at 8 pm or on Sunday afternoon and you will see the same beehive activity you see at any other time. That doesn't make one or the other less important, it only makes them different.

The long term care continuum is a continuum, an ever changing mix of physical, mental, and social needs from senior centers to promote wellness and continuing education to nursing homes to hospitals for acute care needs. People will be better cared for when the person is the center, and the providers work collaboratively to meet their needs with the right balance of quality and cost efficiency.

Friday, June 20, 2014


I begrudge most trips I have to take unless Cheryl is with me. I'd rather be at home and in my office. However, my job has me on the road more and more. Just when I am at the height of begrudging, nuggets arise that make it all worthwhile.

This trip is a great example. I am sitting in the Baltimore airport waiting on yet another delayed US Air flight. But it has given me time to reflect on the last 36 hours. I flew into Baltimore at midnight Thursday morning. After 4 hours of sleep I was up and ready for a bus ride to DC with about 150 mostly refugees participating in Lutheran Immigration and Refugee Services' World Refugee Day Academy. We were to visit our Congressional delegations to advocate for more welcoming laws and regulations regarding refugees and immigration.

I was teamed up with 21 year old Mo San, a Burmese refugee and Guilford College student who was resettled by LIRS and Lutheran Services Carolinas. Mo and I made a great team. In just a few hours we met with aides to Senators Richard Burr and Lindsay Graham and Representative Ellmers. We got to meet in person with Representatives David Price and Howard Coble. I introduced or reintroduced them to LIRS and to Lutheran Services Carolinas, then Mo shared her touching story. Growing up with her family in a refugee camp for 11 years!, then coming to the Raleigh area in 2009!
All of the legislators and aides were attentive and supportive. We don't often get the chance to share our story with so many people who are stakeholders in our ministry.

Last night iced the cake. At the LIRS Gala, Maryland Senator Ben Cardin revved up the crowd with a great keynote. Charlotte Hornets General Manager Richard Cho was honored with a Walk of Courage Award: came to US as young refugee, degree in engineering, Boeing, back to Pepperdine Law School, now GM at Charlotte. What a journey! My table mates were two very interesting fellow Academy participants who are refugees, Rev. Dr. and Mrs. John Denninger, President of the SE District of the Lutheran Church MS, his predecessor Rev. and Mrs. Jon Diefenthaler (always very supportive of LSC), Judy Benke (another great supporter of LIRS and Lutheran social ministry), and Baltimore Catholic Bishop Denis Madden. As much as I love home, there was probably no better place for me to be!

I hope to be back in Salisbury and in my office by 1:30 pm today. Then I can start begrudging my next trip, which God will use to humble and teach me--again!

Wednesday, March 19, 2014

Letter to Gov. McCrory Re People Who Live and Work in Nursing Homes

I wrote our Governor Pat McCrory a letter on March 18, 2014. North Carolinians can't just sit around and let our already weak safety net disintegrate. People who are indigent and live in nursing homes can rarely speak for themselves. Nursing assistants and other workers need to be paid a wage they can live on. They have little voice also. The two issues are one. It will take a leader like Gov. McCrory to speak for all these people and remedy this situation. The letter:

March 18, 2014

The Honorable Pat McCrory
Office of the Governor
20301 Mail Service Center
Raleigh, NC 27699-0301

Dear Governor McCrory:

Thank you for your service to the citizens of North Carolina. You have a tremendous responsibility and work in a challenging political and economic environment, to say the least. I have met you in person only twice, most recently at the grand opening of Searstone in Cary. Lutheran Services Carolinas has a small but important connection with Searstone, coordinating their sizeable community stewardship fund to serve indigent seniors in Wake County.

Many people approach you with their hand out, and I am no exception today. But my hand is out only on behalf of the people we serve, primarily one thousand mostly indigent seniors across our state. On January 1, 2014, the N.C. Medicaid rate for our citizens living in nursing homes was cut by 3%. Although nursing homes had not had a Medicaid rate increase since 2008, I felt we were being good citizens by understanding the state’s and nation’s great recession and its aftermath and making do with our meager reimbursement. Those rates are now the lowest in the entire southeast United States!

Now to get a 3% cut is disastrous to our care and services. This can only negatively affect quality and Medicaid accessibility for indigent seniors across North Carolina. I am at the point of pleading, so I plead that you at least restore the 3% that has been cut. As I write this, I lament a system so broken that I am forced to beg for substandard reimbursement. We need adequate reimbursement to care for our most vulnerable citizens, but the return of this latest 3% would at least allow us to limp forward.

Any increase we receive goes almost entirely to pay the wages of the people who actually care for those we serve. Nursing assistants and all staff deserve adequate pay to afford to live and for us to stay reasonably competitive.

Thank you for listening. I am available at your convenience to discuss this further.


Ted W. Goins, Jr.
President, Lutheran Services Carolinas

Monday, March 17, 2014

We Are Family

I was asked to give a combination faith-life talk and Lutheran Services Carolinas' temple talk Sunday at my own church, St. John's Lutheran, Salisbury, NC. While half of it is more personal, it does speak to the importance of families of all kinds.

Cheryl and I heard the song "We Are Family" by Sister Sledge last night. You won't find that in the hymnal, but family is my subject for today. In March 1958, Asst. to the Bishop Pastor Ernest Misenheimer came to Statesville and baptized the son of Sharon Lutheran Church Pr. Ted and Frances Goins. That would be me. My parents took their vows seriously, not because dad was the preacher, but because they were committed Christians with a lifetime contract. You will hear those baptismal promises throughout my remarks.

My earliest memories are looking out my window at the church cemetery, my play ground. I remember family trips, fishing, camping, covered dish dinners, Luther League, Scouting, helping church members haul hay and corn at harvest time, 30 boys playing football in the church yard.
Life was family based. My family was close and if the church was unlocked, we were there. My family extended to every member of the church and beyond. Not that I ever did, but if I had ever thought about stepping out of line, there seemed to always be a church member there to smile, reminding me that my family was always there. Sometimes that was confining, but it kept me safe and out of trouble, mostly.

I went to Camp Lutheridge every summer and went to Lenoir-Rhyne to college. Dad said I could go anywhere in the country to college but he was paying at LR.

I lived among God’s faithful people, my family and church families. We worshipped together and shared the Lord’s supper. We proclaimed the good news of Christ in word and deed by being family, supporting each other, raising $ for March of Dimes, painting the first Lutheran Family Services group home, growing up in the church. And church wasn’t just inside the walls.

I found my vocation, not a job, in serving the most vulnerable in our society. I founded another family with Cheryl, Sara and Meggie, and now a son-in-law and God’s best earthly gift to date: grandchildren!

My vocation led me the best job I could hope to have working with Lutheran Services Carolinas. Not only did my parents take their baptismal vows seriously, but so did millions of Lutherans around the United States. Proclaiming word and deed left us no choice but to do what Christ told us to do, to love one another, to care for the widow and orphan.

So together us 8 million Lutherans are only 2.5% of the US population, but we have the largest social ministry network in the US, serving 1:50 Americans! Just our little Lutheran Services Carolinas is still a $109 million ministry that resettles refugees fleeing death, finding homes for abused foster children, rents an apartment and provides services for a person with mental illness so he can not live in a mental hospital, and provide all the services you see right here in Rowan County: independent living, nursing home, assisted living, Alzheimer’s care, adult day care, and in home services. We don’t provide 3 hots and a cot. Our vision statement is from John, “I came that they may have life and have it abundantly.” We strive to provide more than the basics, the extras, the cherry on top!

All of us, this Lutheran family, proclaim the good news of Jesus Christ 24-7 through all that social ministry and in many other ways! We serve the larger family, our community. Christ said “just as you have done it unto one of the least of these, you have done it to me.”

I am privileged to see Christ every day, especially in the eyes of the most vulnerable: the unresponsive nursing home resident, the frightened foster child, the abandoned child refugee, the friend with a developmental disability, a person with mental illness. And I get to strive for and with them for justice and peace. I thank the Big Family, Father, Son, and Holy Spirit, for the other families that love and support a sinner like me that makes it possible for me to share this today: my immediate family, my church family, the Lutheran family, our Lutheran Services Carolinas family, and many others.

Sunday, February 23, 2014

Don't Tread On Me

Sadly, the NC General Assembly agreed last year to withhold 3% of the Medicaid funds from hospitals, nursing homes, physicians, assisted living, etc. Nursing homes have not had a Medicaid rate increase since 2008. The "withhold" was sold to health care providers as a quality and efficiency incentive. If we could prove quality and efficiency, then we could get that money back. Since then, the NC Department of Health and Human Services has determined that this is a cut, not a withhold. If we can save money beyond the 3% cut, then it might be shared with us providers. I serve on the NC Medical Care Advisory Committee, which is to advise the state Medicaid program. They asked us to discuss and advise on the savings beyond 3%. Finding savings beyond the 3% when we haven't seen an increase since 2008 is a farce. We were to discuss this in a meeting on Feb. 10, 20114. Instead I offered a resolution that was greatly improved by the Committee members and unanimously adopted. It's a shame we are only advisory and have no authority! But at least we took a stand to "Don't tread on me!" The resolution encourages the state to reconsider the 3% cut as it harms the most vulnerable people in our state. The resolution is printed below. I am non-partisan. But I can talk about issues, and about harm to the people we serve. We have got to stand up for the people we serve, since they cannot stand up for themselves! North Carolina Medical Care Advisory Committee Resolution Adopted 2-10-14 Whereas, states are required by Federal rule to establish a Medical Care Advisory Committee (“MCAC”); and Whereas, the purpose of the MCAC is to advise the Medicaid agency on health and medical services that may be covered by Medicaid; and Whereas, 42 CFR 430 and 42 CFR 447 require states to adequately reimburse providers for quality services and to not limit access; and Whereas, the MCAC has reviewed the Division of Medical Assistance (“DMA”) Shared Savings Plan and have found the following to be true: 1. The MCAC, along with various groups, including those representing providers and beneficiaries, and a variety of other health care policy makers believe a well-designed, jointly-developed shared savings program can be an effective way to reduce costs and improve quality and access, and 2. North Carolina lawmakers mandated in Section 12H.18 of Session Law 2013-360 requiring a 3% withhold of Medicaid payments for certain Medicaid providers and instructed DMA to implement a plan whereby providers subjected to the withhold could earn back all or a portion of the withheld funds (“the earn back plan”), and 3. DMA has begun to implement the withhold effective January 1, 2014, and 4. DMA does not currently have an approved state plan amendment for the withhold; such an amendment may take in excess of a year or more, possibly causing uncertainty about when providers could be eligible to receive incentive payments under the earn back plan, and 5. DMA has not established the earn back plan as required by S.L. 2013-360, and 6. Since DMA is currently withholding 3% of provider payments without having adopted ways to measure savings for subsequent incentive payments to providers, it is risking violation of Federal rules by potentially restricting access to care, and could cause cost increases if less community care is available for routine problems that could become more emergent or urgent. Therefore be it resolved, that the North Carolina Medical Care Advisory Committee asks DMA to implement its earn back plan by developing incentives for effective and efficient care that result in positive outcomes for Medicaid and NC Health Choice recipients, and that payments under the earn back plan be paid to providers from funds currently being withheld (3%) during the 2013-15 fiscal year, and not by any other means or additional requirements to achieve savings above three percent being withheld as of January 1, 2014, and prohibiting withheld funds from being transferred to the General Fund; and Further be it resolved, that the MCAC requests that the 3% withhold be suspended immediately until such time as an agreed-upon shared savings program can be developed and any subsequent state plan amendments are approved by CMS; and Further be it resolved, that the MCAC asks the Division of Medical Assistance to keep it fully informed of all activities associated with implementing the requirements of Section 12H.18 of Session Law 2013-2-360 and any other shared savings plans that may be considered.

Friday, February 7, 2014


It was my job to provide devotions this morning for the Lutheran Services in America Disabilities Network. We talked about vision, Proverbs 29:18, and gifts, Corinthians and Timothy. I used a picture of Cheryl on her pottery wheel to demonstrate vision, and a picture of our grandchildren to demonstrate gifts. Lutheran social ministry has a vision to serve God and serve those in need. We do that with and through gifts. Dorothy is a gift to me. She works at our Trinity Living Center, in the same building I work it. She comes by the office once in a while to check on me, or we meet in the parking lot. She expresses genuine concern for me, worries about me, and thanks me for all I do. Dorothy inspires me to work harder to provide for those we serve, for her, and for all of our teammates. What a gift! Lutheran Services Carolinas is full of gifts like Dorothy. Who and what are your gifts?

Wednesday, February 5, 2014

Overhead is good!

Nonprofits often get beat up over their administrative overhead cost. Overhead is not a dirty word; it's certainly not waste. Waste is wrong in any setting. Lutheran Services Carolinas' overhead is low, which looks attractive, but may be too lean to get the job done. Nonprofits would not exist without overhead. Let me introduce you to some of LSC's overhead. None of us teammates would get a paycheck if it weren't for the Tammys at the LSC Administrative Office. Joyce Hathcock in accounts receivables brings home the bacon at Albemarle, collecting from Medicare, Medicaid, and private pay. What she brings in as revenue, we use for salaries, supplies, and food for the people we serve, the power bill, etc. If Matt Hembree wasn't the Quality Management Director out of the Charlotte Office, LSC wouldn't be COA accredited. If not accredited, which is required, child and family services would be out of business. IT is overhead, but we would all be out of a job today without our computers and technology! Marketing at Trinity Oaks is considered overhead, but if prospective residents don't hear about us and ultimately move in, then we won't be able to provide the desired services for residents or jobs and benefits for employees. The list of essential overhead is long. Some people think overhead is bad. It is not. It's really just a way to distinguish between those people and services who directly touch a person we serve, and those who don't. Neither can live without the other. As in everything in LSC, it takes all of us to get the job done.

Wednesday, January 15, 2014

NC Medicaid Work Group presentation

I had the opportunity to represent the NC Health Care Facilities Association before the Medicaid Reform Work Group today. My job was to advocate for the high quality, underpaid nursing homes of NC whose rates have been cut, whose rates have risen only 2 tenths of 1% since 2008, and are facing even more cuts. Who gets hurt? Our indigent parents and grandparents! See my remarks below. Thank you Mr. Chairman and Members of the Medicaid Reform Work Group. My name is Ted Goins. I’m President and CEO of Lutheran Services Carolinas based in Salisbury. I am here today representing the North Carolina Health Care Facilities Association. I’m joined by our President and CEO, Craig Souza. Since 1955, our organization has represented North Carolina’s skilled nursing home providers, both for profit and not for profit. Today there are 406 licensed skilled nursing facilities in North Carolina. States are mandated to provide skilled nursing care as a part of its Medicaid program. SNFs are a vital component of North Carolina’s comprehensive long term care system. It’s a system that focuses on person centered care, promotes choice, and offers a wide array of home and community based services. The North Carolina Health Care Facilities Association understands the need for Medicaid reform. Reform to me means “change for the better” and to achieve meaningful change for the better we must concentrate on program and systems reform, NOT just payment reform. Hundreds of thousands of North Carolinians are depending on us to get it right. We applaud the Department for recognizing that collaboration between all stakeholders will be required for reform efforts to succeed. Providers must play an active role in the debate. A debate that must be open, honest, and encourage new ideas and innovation. Much can be learned from the experiences of other states, but at the same time we should encourage and promote home grown solutions. To that end we want to thank Bob Atlas and Mardy Peal for their leadership in creating an environment that promotes openness and the full engagement of providers. No one would disagree with the three reform objectives established by the General Assembly: ​*Create a predictable and sustainable Medicaid program for taxpayers. *Provide care for the whole person by uniting physical and behavioral health. ​*Increase administrative ease and efficiency for NC Medicaid Providers. To have any chance of success DHHS and the General Assembly need to invest the necessary resources to enable Medicaid to function like the multi-billion dollar human services agency that it is. Reform needs to be done correctly, not quickly. Although budget predictability and certainty are the mainstays of reform, the program also needs stability, immediate stability. As we plan for reform, Medicaid “life” will go on. Best case, "reform" moves forward by maybe 2016 or 2017. In the meantime, we still have to do our jobs. We cannot compromise care while deciding what reform means. Hundreds of thousands of North Carolinians depend on Medicaid for vital health care services. Hundreds of thousands are also employed by hospitals, nursing homes, physician offices, and others. All providers want a predictable and sustainable Medicaid program. We need a system that is free of unnecessary regulatory burdens. We need state agencies that are responsive and data driven. We need reliable budgeting and accurate forecasting. We need sound reimbursement policies that reward quality and efficiency. And we need predictable and adequately funded reimbursement rates. And finally, we need a reliable claims processing system. Nursing homes ARE predictable. Utilization of skilled nursing services has steadily declined since 2009. Budget-wise, it’s pretty easy to project Medicaid payments to nursing homes. Daily rate times days of service. There you have it. I guess one could argue nursing home expenditures are already capitated. Medicaid rates for nursing homes are paid on a per diem basis. A facility receives a daily rate for all services provided. There are no additional fees. We are not fee-for-service providers. Nursing homes are also subjected to a federally sanctioned provider assessment program. The assessment draws down federal funding that reduces North Carolina’s matching rate (FMAP) for skilled nursing care. For every dollar spent on Medicaid services, the State pays roughly 35 cents and the federal government pays a matching rate of 65 cents per dollar. Because of the provider assessment, the effective state matching rate is about 20.8% or 21 cents per dollar. Since 2008, nursing home rates have increased by two tenths of one percent (0.2). Data shows costs for the same period have increased more than 10.5%. Ladies and gentlemen, I refer you back to the stated goals of reform. Objective #1: To create a predictable and sustainable Medicaid program for NC taxpayers. Not recognizing the impact of cost increases is not sustainable now and unless rectified, it will be a major barrier to meaningful reform. Interestingly, when private managed care is discussed as one of the possible options for reform, roughly 10 percent of the anticipated payments to MCOs is allowed for administrative costs and profits. I believe most Medicaid providers would gladly accept similar or even more reasonable terms. And the resources would remain in North Carolina. In spite of the challenging times confronting skilled nursing care, recent data from CMS and the OIG report that North Carolina nursing homes had the lowest hospitalization rates among the eight states in CMS Region IV, the southeastern U.S. We also had the largest percentage reduction in the use of anti-psychotic drugs in the nation. I mention these two issues because they were national benchmarks established by CMS and they can be areas we can build on as we make person-centered care a pivotal part of improvements to our Medicaid program. We have much to do. We have the talent within our State’s borders to build the nation’s best Medicaid system. We welcome the opportunity to engage in reform efforts. Mr. Chairman and members of the Medicaid Reform Advisory Group, I appreciate the opportunity to appear before you today. We are grateful for your leadership and we look forward to working with you. Thank you.