Friday, December 27, 2019

Nursing Home Over-Regulation and Solution

Complaining is a job, problem solving is a vocation. I have always appreciated people who don’t just complain, but come with a plan to fix the problem. That gets harder the bigger the issue, the less control we have. Our current politics and societal changes come to mind.

Recently, I found myself once again railing at the overwhelming issues health care professionals face due in large part to over-regulation. Our national nursing home regulatory process costs millions and doesn’t work. We are regulating nursing homes as we have since the 1970s and just continue to pile on more regulations and more penalties and more paper, but we are not getting the return in quality and cost efficiency our parents, our nation’s senior’s, deserve.

I’d like to offer a solution, not just a complaint. In this age of technology, our federal government is spending millions of dollars a year to drive 4-5 or more inspectors to every nursing home in the United States for 3-5 days every year, or more often. Think of the salaries, the mileage, the hotels and meals. Then add the administrative costs, the teams that inspect the inspectors, and the people who go out and inspect when a complaint is lodged. The government is spending millions of all of our tax dollars, health care professionals aren’t providing care because they are responding to inspectors, and quality is not much affected.

This failed system is not the inspectors’ fault. By and large I have found inspectors to be dedicated public servants, they are just working in a broken system.

There’s a better, simpler, cheaper way than the current broken system. Nursing homes can be monitored through technology, inspections of high performing nursing homes could be curtailed so more time could be spent with true under-performers who need it, all nursing homes can be routinely monitored through current technology, the complaint process could be improved, inspectors can become collaborative consultants, not just inspectors. Quality could go up, and cost go down. How many times do taxpayers get an opportunity like that? Instead, our country continues to live by the quote from Albert Einstein, “The definition of insanity is doing the same thing over and over and expecting different results.”

Tuesday, July 30, 2019

Refugee Defined

Language matters. As we discuss refugee and immigration issues with people on both ends of the political spectrum, it is clear that language divides. We have not done a good enough job educating people on the simple definitions of a refugee, immigrant, and asylees.

A refugee is a person who has had to flee her/his country of origin out of fear of persecution or death. I have started to use the term legal refugee. Legal refugees are people who have been extreme-vetted, generally wait years in a refugee camp in a third country, and then are invited by the United States government to come live in the United States. Non-legal refugees could slip into the US, but that doesn’t happen often as it’s too difficult to get to the United States. A good example of non-legal refugees would be the boat-loads of Syrian refugees making their way uninvited across the Mediterranean Sea into Europe. I would still categorize non-legal refugees as illegal immigrants.

An immigrant is someone who has chosen to leave her/his country of origin for economic and other reasons. Legal immigrants are those who have applied to the United States and been granted permission to enter the country. An illegal immigrant is someone who has entered the U.S. without that permission, or who overstayed their time if here on a time-limited status. A 2017 study estimates that 42% of the illegal immigrants, 4.5 million people, are here because they have overstayed their expired visa!

Asylees are people who have entered the U.S. or arrived at a port of entry and requested asylum to escape persecution or death in their country of origin. Chinese people account for the most asylees in the U.S., followed by El Salvador, Guatemala, and Honduras, Mexico, India, Nepal….

When Lutheran Services Carolinas talks about serving legal refugees, and advocating for legal immigrants to fill jobs when there are no Americans to fill them, I have heard no opposition save the most extreme. Language matters.

Tuesday, June 18, 2019

Seeing Jesus

Dear Friends,

I had the opportunity to visit a border state on June 11, 2019 with a group of health and human services leaders. It's easy to fall into the political debates; it's hard to ignore suffering people.

A bus took us to a very nice neighborhood where a number of the homes have been built by Habitat. In a row of six Habitat houses, three are owned by legal refugees who escaped war and death for a new life in America. The home owners were from Afghanistan and the Congo. They are succeeding! They are working homeowners who keep a spotlessly clean home. All three proudly opened thier homes for us to tour and talk about thier journey. The extreme political rhetoric on both sides doesn't match reality.

Our next stop was an aging auto repair shop where we met the proprietor and another entrepreneur, Iraq and Cuban refugees respectively. Both escaped to come pursue the American dream. The car repairman now employs eight people and has a successful business. The other has started a commercial cleaning service that is growing rapidly. He's keeping his day job till he's got enough business and help to transition to full time. Both took out and quickly repaid a micro loan from a sister Lutheran organization to our Lutheran Services Carolinas. The extreme political rhetoric on both sides doesn't match reality.

Our last stop was to a church where every Monday one or two ICE buses pull up and dump approximately 100 asylum seekers. The Lutheran organization arranges housing, communications, clothing, etc. for these people who are on their way to sponsoring family members across the country. We had the privilege of plating and serving lunch and visiting with 47 of these asylum seekers. They had been in the United States for less than 24 hours. Thanks to the Lutherans, they had had a good night's sleep, a shower, etc. after a horrible ordeal. The extreme political rhetoric on both sides doesn't match reality.

The Bible tells us that when we clothed and fed those in need, we have done the same to Jesus. Wow, I saw Jesus this week.

Monday, May 20, 2019


Criminal podcast 114 was interesting, then went sideways into infuriatingly one-sided. They started bashing nursing homes, ignorant that many organizations have transformed into skilled living communities.

The speakers stated that the big problem with taking care of someone’s body is forgetting about their mind, and giving agency and dignity to people. “No one listens to you when you’re in a nursing home. No one listens to you when you’re over 65.” Then they discussed the rate of suicide, and nursing homes try to make residents easy to manage, just getting their bodies thru the day. Fake news!

Since one person is a thief, do we extrapolate that all people are thieves?

The speakers obviously have not heard of person-centered care, or life in a Lutheran Services Carolinas community: chaplains, activities from singalongs to games to beach trips, one on one visits with bedbound people, snow sledding, painting classes for people with memory issues, drum circles, political discussions,.... People can sleep late, stay up till all hours, it’s their call, not ours.

Go see for yourself! And go visit to make life better for a person living in any assisted or skilled living community!