OH, by the way ...(inperspective)

Like the great TV detective Columbo, Nursing Homes/Long Term Care Management columnist Gary Tetz (Funny You Should Ask) always has one more question. In this bimonthly feature, he talks with long-term care leaders about anything that pops into his mind. He's as surprised as you are that they'll speak to him, and apologizes in advance for whatever inanity he might blurt out in the pressure of the moment.

This Month's Victim:

Phil Fogg, Jr.

Founder/President

Marquis Companies

Phil Fogg, Jr. is founder and president of Marquis Companies, offering skilled nursing, assisted living, Alzheimer's, and home care services since 1989. As though running 26 facilities throughout Oregon, Idaho, Montana, Nevada, and California isn't challenging enough, he also provides pharmacy, rehab, staffing, and consulting services through Consonus Healthcare Services. Phil has served as president of the Oregon Health Care Association, and as an American Health Care Association board member.

You are what they call a provider.

Yes? (with some low-grade fear in his voice)

[ILLUSTRATION OMITTED]

I'm envious of that designation because it's a very important-sounding word. It seems essential, like you're the lifeline of civilization. You Provide--with a capital P. How does it feel to be a Provider?

I have a lot of pride in the term because I think what we do is so important in the lives of seniors, and to our staff. Being a provider offers a mechanism to make a difference. And it's better than being a non-provider.

You're talking about me, aren't you? You're suggesting I'm a leech, a barnacle on the hull of society.

No, you're not.

Thanks.

I truly mean this. Everybody has a role and a chance to make an impact. Aligning your values with your professional career is the important thing, and that's the great part about long-term care.

What is it like to do what you do in this 21st century?

Well, it can be very challenging, especially if you lose sight of why you are a provider. The workforce shortages create a lot of stress for people, from the caregiver to the executive level of long-term care, and I don't see that easing off any time soon. It creates constant pressure on the quality of job you can do and the amount of service you can provide.

How did you get into this profession?

I'm actually a fourth-generation nursing home administrator. I had a great-grandmother who started acquiring facilities in Oregon in the late 1950s and '60s. She was pretty entrepreneurial for her time, and eventually transferred the facilities to her kids. I then started my own company in 1989.

Four generations. That's an impressive heritage. Did you know that in the early 1900s, members of the same British family served as chief executioner of Britain for 50 years? So you're in good company.

I did not know that.

Was there ever a question that this is what you were going to do?

Not for me. From the time I was about 12, I worked in the facilities and immediately gained a passion for long-term care. I loved the residents, the staff, everything about it. And when I went to college, I was one of the one percent of kids who knew exactly what they wanted to do when they got out of school. To this day I think long-term care administration is the most challenging thing you can do, and I was drawn to that challenge at an early age.

What's your earliest memory, your first connection with the profession?

I was probably six or seven. I remember walking the halls in my dad's first facility, and pushing my brother down a very steep hill into a sticker bush. That one always brings back a smile from time to time.

There was a hill inside the facility?

No. Outside.

Your grandmother recently passed away. What was the most important thing you learned from her about success in long-term care?

What grandma did better than anything when working with staff was to clearly define her very high expectations and always follow through. She was very consistent about that. She was also incredibly organized. She had the ability to effectively balance multiple roles in her life, and I find 75% of the people who are not successful as administrators in our company generally fail because they are not organized. All the demands and the paperwork just overwhelm them.

What's your family secret for sticking with it all these years?

I know this sounds like a platitude, but I think what's kept us in it more than anything is a strong work ethic, a passion for what we do, and being able to keep a positive attitude. If you're doing something that's tough or that you don't like, and you can't maintain a good attitude about it, you'll burn out quickly. But we have fun with it.

We have a little saying: "We take what we do very seriously, but we don't take ourselves seriously." I think that is one of the things that has helped us keep positive attitudes. Because everywhere you go, you run into people who take themselves pretty doggone seriously.

Those people are called regulators.

(Laugh)

What have been the greatest threats to your positive attitude over the years?

When your Medicaid reimbursement rates are much less than your actual operating expenses, that makes it very challenging to maintain a positive attitude. And the whole regulatory process is not very enjoyable, especially when you're evaluated unfairly.

What's the key to overcoming those threats?

I'll tell you exactly what it is. It's to stay focused on why you do what you do, which again is making a difference for people. You have to keep those other things in perspective. They're just a part of the challenge. And the great thing about long-term care is when you go through tough times, you see people's real character.

How should your profession be reimbursed? What makes better sense to you, and wouldn't undermine your positive attitude?

First of all, let me say that to be in business, it is not unreasonable to think that at a basic level you will have your costs covered. Having said that, I also think that since Medicaid is a majority of our revenue streams, or is for most providers, and since it is taxpayer dollars, utilizing funds responsibly is also key. I'm for a flat rate system at the 75th percentile of costs for the state. It does create some losers, but those are a small percentage and, in general I see the total dollar disparity between cost and what you're reimbursed much closer in flat rate systems than I do in cost-based systems.

How about if I go to Harvard Business School for several years, and then we can finish this discussion?

Okay. But let me just add this about Medicaid. I think we have to reexamine our income eligibility. If I were president right now, I would undo the asset protection that people have. If they didn't realize there was a limit on how much they would have to contribute before Medicaid would kick in, and if there weren't these trust vehicles to protect people's assets, you would see more motivation for individuals to invest in long-term care insurance, which I think is a big part of the funding solution.

If you were president, most people would be saying, "Wow, he looks like John Edwards."

(Laugh)

None of what you've described will ever happen in your lifetime, right?

Well, who knows? I'd like to think so. But it's going to be really hard. You can choose to print this or not, I don't care--but there are so many special interest groups, including our provider community, out there funding the political machine that it's very difficult to get anything done that's in the best interest of the taxpayer and the country as a whole. And most of the initiatives to significantly change long-term care policy seem to get driven by state or federal government. That means you can't get any consistent policy because every four years there's a leadership change.

What are the key traits of a great administrator? You've seen a lot of them over the years.

One is, again, organization. That's a key. But the other is leadership. They've got to be able to motivate and manage people in a positive way. It's a very labor-intensive service we provide and you have to be able to work with people. And not just with their staff. You have to be able to build and maintain relationships with the regulatory agencies, the counties, the state, the families. You have a multitude of people who are involved in the process of caring.

What about the worst administrators you've ever known? Feel free to use their real names.

(Laughs) The number one thing that causes trouble is if someone doesn't treat residents and staff with respect and dignity. If they don't do that, they're gone. Along with that, if they don't have a passion for seniors or the people we care for and don't enjoy being in that environment, they fail immediately. Third, this is a tough job, and if they don't have a work ethic they won't succeed.

Those are the three things that usually trip administrators up at the beginning of the job. After that, if they're not strong leaders with a strong constitution, they'll fail in our organization.

How soon can you tell if somebody is going to make it?

My staff might disagree, but I think I can tell at a first interview within about an 85% success rate whether somebody's going to be successful or fail.

How? Through their handshake or maybe the lack of direct eye contact if they're Canadian?

Exactly. But the thing I love most are the people I'm wrong about. They're the ones who are more compelling to me later than the ones I was right about.

They keep you humble, too.