OH, by the way ...(inperspective)

Yes they do.

Since I'm sure all your employees view you as an infallible deity, what is your key management philosophy?

I think at the end of the day, everyone wants to be in a positive environment where people have a lot of energy and passion for what they're doing, and where good work is appreciated. That's the culture we try to create through all the decisions we make on a daily basis. The good part about long-term care is we get so many opportunities to make decisions that show character and drive culture.

Let's suppose, for just a moment, that I'm one of your administrators and I'm feeling overwhelmed by the following scenarios. What would you say to keep me from packing it in:

Five CNAs called in sick.

Hopefully, it's just a one-time occurrence and not a routine problem. I would tell you about the time I had six of eight CNAs call in sick with the flu when I was just starting out. It was all hands on deck--we all worked the floor that day. And that's the kind of teamwork you should expect from everyone at your building.

A family member yelled at me.

You have to realize that the service we provide is very emotional for people, and you're often dealing with feelings that may have nothing to do with you or the facility. You can't let it affect your dedication to the profession.

Wow! You're good. My favorite resident passed away.

I certainly wouldn't want to undermine the fact that you bonded with a resident. It's great you had a chance to make a difference. I'd try to get you focused on the positive things you did to make that person's end-of-life experience as positive as possible. Because of you, they didn't have to stop living or experiencing value and worth.

My director of nursing and medical director are having a fistfight in the lobby.

First, take them out of the lobby and put them in a private room. Why are you laughing? That's a serious response. Then try to assess the problem. The fact that two of your most highly compensated and educated leaders are having a fistfight would suggest you have bigger problems.

My building is losing money fast.

Well, we're going to talk about why. We're going to look at everything you have control of and try to impact those items. Labor hours. Consumable purchases. Contract therapy. We'll try to develop a plan to create margin without sacrificing mission.

What if it's my fault, and you have to fire me?

Usually if I'm doing things right, it's not going to be a surprise. You will know before I get there that it's time to go because we've clearly communicated in the past the things that need to change. You've either not chosen to take action or don't have the necessary skill or talents.

Now I just feel bad about myself.

Sorry.

I heard you're now operating a facility in Las Vegas. Is there a casino in the lobby?

No, but we do have a skilled building there, and every night the residents go gambling. It's a 180-resident facility, and a seat on our 16-passenger bus going to the casino is the most popular, most sought after of any activity. And I don't know if you've been to a casino lately, but there are also a lot of potential nursing home residents in there.

Do you have Don Rickles opening for Celine Dion in the break room?

No. But we should.

Is operating a facility in Vegas your way of settling once and for all whether gambling is a safer bet than trying to make a living in long-term care?

I think running a casino would be easier. That's my guess.

Now let's say I have serious dementia and a very bad attitude. My family wants to put me away in a skilled nursing facility for a long, long time. Why should we choose yours?

(long pause) You've silenced me.

You don't want me. That's what you're saying.

Well, let me ask you, are you private pay?

No. I don't have any money. I was a writer.

Clearly, a psych facility might be better for you.

True, but for the sake of this discussion ...

Okay. Then I'd say yes because we've got staff with a lot of longevity, and we've created a culture of people who care about making a difference in the lives of residents like you.

Well, you seem to have an answer for everything. I wish I had remembered to ask my funny questions.

That's okay. I'm not very funny.

To send comments to the author and editors, e-mail tetz0208@nursinghomesmagazine.com.

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