Let’s be honest: people do not like nursing homes. No matter what we call them–skilled nursing facilities, long term care providers, post- or sub-acute care centers–it doesn’t really matter. All people “know” is that they are places of death and despair, and that to spend any significant period of time in one is a fate arguably worse than death itself.
I say this not to shock or demoralize my beloved colleagues who work every day in and around nursing homes to try to make them better. As you know, I believe that the work being done inside nursing homes is the most sacred work being done anywhere on the planet today. But we as an industry have to be brutally honest with ourselves about how we are perceived by “the outside world” if we are to have any chance of surviving the coming wave of Medicare cuts and market-driven financial pressures.
We congratulate ourselves on “culture change,” and “person-centered care” while the rest of society still looks on us with a mixture of horror and disgust. To the extent that nursing homes make the news at all, it is almost always in a negative light: grotesque stories of abuse and neglect in which the nursing home industry plays the role of the villain and trial lawyers play the role of the vanquishing hero. Most people read these stories uncritically, and the cumulative effect is that society sees us as incompetent at best, and downright monstrous at worst. What a sad state of affairs!
I want to be clear: as unfair and inaccurate as this public image may be, we have primarily ourselves to blame for it. For most of the industry’s existence, we have been content with incremental change and a purely defensive posture with regard to our critics. Our reimbursement model is such that have been unnaturally insulated from both market forces and our customers. We have, perhaps unconsciously, adopted what Karl Albrecht calls the “car wash model” of service: we tend to think in terms of processing customers through the facility rather than focusing on their total service experience.
That’s not good enough anymore, not by a long shot. There are 70 million Baby Boomers coming our way, and they are retiring at a rate of over 10,000 per day. They have come to expect an extraordinary level of service and innovation because that is precisely what they have gotten in other areas of experience. Most Baby Boomers today would rather gnaw off their own fingers than spend any significant period of time in a nursing home. But we have to build a positive emotional connection with them, or we are doomed.
If we had already built a positive emotional connection with the Boomers, does anyone honestly think that the 11% across-the-board Medicare cuts would have happened? Of course not! The Baby Boomers are still by far the largest and most powerful political bloc in this country. Quite simply, they have the power to make or break entire industries, to dictate budget priorities, and to determine the political direction of the country. And yet the pitiful nursing home industry, which will be the only safety net for millions upon millions of aging Boomers whether they like it or not, is utterly powerless to stop cuts that threaten our very survival.
And let’s be clear about the nature of those cuts: they are far more than an emergency fiscal measure or a case of long-overdue fiscal belt tightening. They are a message: “You are expendable.” There is no other way to interpret them. The bureaucrats and politicians have tipped their hand. In periods of socio-economic decline, such as the one that we appear to be entering, resources become scarce and fear is ascendant. The weakest members of society are the most at risk. In our ancient, pre-agrarian past, the sick and the elderly would be left behind to die when the tribe was under pressure. Much has changed since our hunter-gatherer ancestors discovered agriculture and cobbled together the rudiments of “society,” but human nature has not changed one iota. It never does. If the worst socio-economic scenarios come to pass, resources will be allocated with brutal efficiency. The young and able-bodied represent the future survival of society, while the sick and the old are expendable. If you think that a society under severe economic stress will continue to allocate resources to a nursing home industry that already suffers from major image problems, you are delusional. The 11% cuts are merely the opening salvo in what could be a true existential war for survival.
Joe Steier understands this. I believe that is why he talks about Signature in terms of it being a social movement, rather than a business. I believe that is why he sees our work as Revolutionary rather than custodial. It is not merely jobs, profits, and shareholder equity that is at stake here. It is the very essence of civil society: the idea that we can and should provide for our elders when they can no longer do so for themselves.
That is why it is essential that we focus on LOVE. It is not enough for some small subset of society to need us. In this transient modern culture, where generations no longer live together and families are spread out across the continent, our customers have to love us. Their families have to love us. The broader community of Baby Boomers has to love us. Do you understand the revolution in thought and action that requires? We have to find a way to transform the aura of skepticism, horror, and disgust that has grown up around the nursing home industry into one of true love and appreciation and respect for what we do. And we don’t have much time to do it.
Robert Greenleaf, the author of Servant Leadership, put it this way:
The core problem, as I see it, is…in the attitudes, concepts, and expectations regarding business held by the rest of society. People…do not love business institutions. As a consequences, many inside business do not love them either. [But] businesses, despite their crassness, occasional corruption, and unloveliness, must be loved if they are to serve us better. How, one may ask, can one love this abstraction called the corporation? One doesn’t! One loves only the people who are gathered to render the service for which the corporation is enfranchised. The people are the institution!”
We have to work fast, work smart, and work hard to radically transform this industry. The stakes couldn’t be higher. If we fail, then one of the great achievements of western civilization may fail along with us: the idea that our elders can and should be protected. But it starts and ends with love. Love for each other. Love for our customers. Love for their families. Love for the work we do. Love for the society we serve.
If we can’t demonstrate and win love, then we will not survive, and frankly, I’m not sure we would deserve to.