CALA News & Views | Issue 46 | Relationships

News &Views CALA

EFFECTIVE COMMUNICATION WITH FAMILIES

OMBUDSMAN BLANCA CASTRO

DEVELOPING RELATIONSHIPS WITH LPAS EMERGENCY RESPONSE PARTNERSHIPS RELATIONSHIP BUILDING WITH POLICYMAKERS

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IN

THIS ISSUE A Conversation with Blanca Castro Effective Communication Between Caregivers and Family Members is Vital Cultivating Local Relationships for Emergency Response Developing Good Relationships with LPAs Growing Your Workforce Pipeline – One Partnership at a Time Excellence in Services Awards Building Relationships with Policymakers Carrying Your Message to Washington, DC

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Assisted Living, Memory Care and Continuing Care Retirement Communities are differentiated from other services through the relationships that are woven into daily life. On any given day, you interact with residents, their families, associates, licensing, the ombudsman and others who may intersect with service delivery such as home health or EMS. It’s no wonder you may feel energized or spent within a short period of time. This issue of the News & Views tackles fostering those varied relationships and invites you to think about ways to improve communication with different audiences. As CALA’s News & Views audience, you’ll notice this issue is coming to you in a different way – electronically. The format is the same, tackling a broad topic and examining through a variety of lenses, but without paper! I hope you’ll pass it along to others within your organization and use it to talk about ways to build and strengthen the relationships that make what you do so fulfilling. Regards, Sally Michael CALA President & CEO

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A Creative View

Mark Your Calendar Advertiser Index

CALA News & Views – Submission Policy At this time, CALA does not accept unsolicited articles or queries. Many of the articles we publish are written by our regular contributing writers. We appreciate the time and energy people put into making suggestions for our current and future issues. Our organization’s policy, however, prevents us from accepting for review any unsolicited submissions.

Nancy Ball Director of Meetings and Events

nancy@CAassistedliving.org Selena Coppi Hornback Director of Public Policy selena@CAassistedliving.org Agnes de la Vega Education and Workforce Associate agnes@CAassistedliving.org Heather Harrison Senior Vice President of Public Policy & Public Affairs heather@CAassistedliving.org Jason Hunter

CALA STAFF

Director of Membership jason@CAassistedliving.org Katherine McLoskey Director of Operations katherine@CAassistedliving.org Sally Michael President & CEO sally@CAassistedliving.org Haty Pietrasz

CALA BOARD OF DIRECTORS

Board Chair Danielle Morgan, President, Clearwater Living Vice Chair David Eskenazy, CEO, Cogir Management USA, Inc. Treasurer Ron Mead, Vice President of Operations Senior Resource Group, LLC

Secretary Todd Shetter, Chief Operating Officer,

ActivCare Living Past Board Chair Rick Jensen, President & CEO, Northstar Senior Living

DIRECTORS OFFICERS

Director of Creative Design haty@CAassistedliving.org Maddie Robbie Associate Director of Public Policy maddie@CAassistedliving.org Kevin Swartzendruber Director of Marketing & Communications kevin@CAassistedliving.org Jan Trifiro Vice President of Workforce & Professional Development jan@CAassistedliving.org

Josh Allen, Principal, Allen Flores Consulting Group Michel Augsburger, Chairman & CEO, Chancellor Health Care, Inc Dave Coluzzi, President & CEO, Carlton Senior Living Tara Cope, Chief Legal and Administrative Officer, ,Vi Senior Living Wayne Curtin, Principal, WTC Public Affairs Advisors, LLC Carmel Dolcine-Joseph, Vice President of Wellness, Elder Care Alliance Laura Fischer, Regional Vice President of Operations, Brookdale Senior Living Joel Goldman, Partner, Hanson Bridgett Collette Gray, President & CEO, Integral Senior Living Paula Hertel, Founder, Senior Living Consult Rodger Lederer, Senior Vice President, Marsh Senior Care Practice Douglas Lessard, COO & Executive Vice President, Belmont Village Senior Living Nancy Schier Anzelmo, Principal, Alzheimer’s Care Associates Courtney Siegel, President & CEO, Oakmont Management Group Jay Thomas, Assistant General Counsel, Operations, Atria Senior Living Lisa Thompson, Senior Vice President of Operations, Sunrise Senior Living

CALA 455 Capitol Mall, Suite 222 Sacramento, CA 95814 Phone: (916) 448-1900 www.CAassistedliving.org

Copyright © 2023 California Assisted Living Association. All rights reserved. No part of this publication may be reproduced or transmitted in any form - print, electronic, or otherwise - without written permission from CALA.

A CONVERSATION WITH

Ombudsman Blanca Castro

I n December 2021, Gov, Newsom appointed Blanca Castro of Lincoln, CA as State Long-Term Care Ombudsman at the California Department of Aging. The role of the long-term care Ombudsman is unique and different from any other program funded by the Older Americans Act and Older Californians Act. Ombudsman representatives work solely at the request and wishes of the resident in a licensed LTC facility. At the present time, there are 1,206 nursing home facilities and 7,475 residential care facilities for the elderly, which include larger assisted living facilities, and board and care homes. CALA News & Views recently sat down with Ombudsman Castro to talk about her role and what her goals are. Thank you taking the time out of your busy schedule. Please tell us about your background and professional history. I am a first-generation immigrant from Mexico and arrived with my mother and two sisters from Mexico City at the age of one. I was raised in the San Gabriel Valley and attended public schools. I am one of six children and was the first to graduate from college at UC Berkeley in 1981.

It’s important to mention that my professional path was strongly influenced by significant events in my life as many people may be able to relate. At the young age of 39, my mother had a massive stroke that left her paralyzed on the left side of her body. I was 15 and was catapulted into the role of a caregiver, when I didn’t even know what that word meant. In the 1970s, when my mother had her stroke and was placed in a skilled nursing facility/rehabilitation center in Los Angeles County, there were no supportive services for family members to be educated on the impact that a stroke survivor would face, and the various behavioral changes that my mother would go through. I believe it was this major life event, which planted the seed to become an informed advocate serving people who were at a disadvantage of understanding the choices they could make, if they only had the information in a language and culture they could understand. When did your career in public policy begin? My professional career in public policy and administration began after I completed the Coro Fellows Program in Los Angeles. I was just re-entering the workforce after being a stay-at-home mom for eight years with my three sons. The Coro Fellows Program is a post-graduate program that trains people interested in public service to develop skills as effective and ethical leaders using the democratic process.

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Coro was the launching pad I needed to enter the world of public affairs and prepared me to serve in various leadership roles in the private, non-profit, and public sectors. I was appointed by Gov. Gray Davis as Deputy Director of Public Affairs for the California Department of Social Services. This is where I learned about how the myriad programs of social services for youth, families and older adults are designed and implemented. I learned about Community Care Licensing and the way in which the state oversees the licensing and regulatory enforcement of Long-Term Care Facilities. Following the change in Administration, I found a job in the private sector during the early years of outsourcing government services. I worked with the CDSS in the Electronic Benefits Transaction (EBT) program, and Department of Health Care Services, as a manager for Provider Relations in Medi-Cal. I had the opportunity to work as the Director of Advocacy for AARP California, and worked on federal and state initiatives that were the first in the nation. For example, the law that created the CalSavers Program and the law that prohibits pay-to-delay practices in California in the pharmaceutical industry, creation of the California Disability and Aging Alliance (CADA), which helped raise the issue of the lack of a way for middle income Californians to pay for long-term services and supports. This was a coalition of labor, aging and disability rights advocates, and was instrumental in raising the importance of focusing an age friendly platform for the 2018 gubernatorial election. Gov. Newsom has kept his promise to Californians and made older adults a priority in his administration, through his Master Plan on Aging blueprint. Right before I was given the opportunity to serve under Gov. Newsom’s administration, I was working with a diverse coalition during my time at AARP on a nursing home package of bills. In 2021, California was one of the first states to pass legislation that increases financial transparency in the nursing home industry. When the long-term care ombudsman position was opened, I jumped at this opportunity to continue advocating to improve the quality of the long-term care system in our state, and nation. What kind of training do Ombudsmen receive? Residents in long-term care facilities and/or their families, staff or other representatives contact the Ombudsman representatives to resolve a variety of problems. Oftentimes, this is to address basic quality of life concerns and complex matters of eviction or abuse and neglect. Therefore, a baseline competency of both knowledge and skills is necessary to support effective Ombudsman program services.

We have less than 700 volunteer and paid certified long-term care Ombudsmen as the result of the impact of COVID-19. Many volunteers are older adults and did not want the risks associated with the LTC Ombudsman position, so we lost over 40 percent of our volunteers during 2019-2020. A certified LTC Ombudsman representative, paid or volunteer must pass a background clearance, and then complete 36 hours of training that includes the following topics: • Roles, Responsibilities and Authorities (federal and state) • The Resident and Resident Experience • Putting the Resident First • Long Term Settings, Resident Rights, and Enforcement • Access and Communication • Conducting Facility Visits • The Complaint Process, Intake, Investigation, Analysis, Planning and Implementation • Challenging Complaints and Referral Agencies • The Documentation Process • Cultural Competencies • Witnessing Advance Health Care Directives (AHDCs), and Property Transfers In addition to the required completion of the 36 hours of training, internship and/or mentoring with an experienced LTC Ombudsman representative in the field, also included are structured tours, and meeting with resident and family councils. In order to maintain their certification status, the LTC Ombudsman representative is required to attend 18 hours of annual training on various subjects, such as working with people with dementia or dementia-related illnesses, disaster preparedness, working effectively with family and resident councils, elder abuse, etc. The idea for the LTC Ombudsman Program was developed by Dr. Arthur S. Flemming, Counselor on Aging to President Nixon. He envisioned a program as an advocacy program for residents in nursing homes, due to their rapid growth and concern for the quality of care and quality of life experienced by residents of these facilities. In 1972, it began as a demonstration program. Today, the LTC Ombudsman program operates in all states, the District of Columbia, Puerto Rico, and Guam, under the authorization of the OAA. Each state has an Office of the State LTC Ombudsman, headed by a full-time State LTC Ombudsman who directs the program statewide. Ombudsmen designate staff and thousands of volunteers as representatives to directly serve residents (Programs & Harris-Wehling J). Tell us about the history and the mission of the Ombudsman program.

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The OAA requires Ombudsman programs to: • Identify, investigate, and resolve complaints made by or on behalf of residents. • Provide information to residents about LTSS. • Ensure that residents have regular and timely access to ombudsman services. • Represent the interests of residents before governmental agencies and seek administrative, legal, and other remedies to protect residents; and • Analyze, comment on, and recommend changes in laws and regulations pertaining to the health, safety, welfare, and rights of residents (Programs & Harris-Wehling J). What goals do you hope to accomplish? As I mentioned in my background, I have been working to improve the long-term care services and supports system in our state and, perhaps, our nation. I have many goals I would like to accomplish during my time at the California Department of Aging’s Long-Term Care Ombudsman Program. The role of the LTC Ombudsman representative took on a role of greater need and visibility during the COVID-19 public health crisis. The LTC Ombudsman has always been the advocate that represents the wishes of the resident. However, during the pandemic, the LTC Ombudsman representatives became the eyes and ears and–at times–the only people who could enter facilities to meet with residents or check on the well-being of residents as the result of a complaint. Therefore, one of my main priorities is to utilize the rich data that the Ombudsman Program has and can share with the public, legislators, advocates, and stakeholders to demonstrate the need to increase the funding for the program. We are required to conduct regular facility visits, in over 1,200 nursing homes and almost 7,500 residential care facilities for the elderly. However, we have experienced an increase in the number of complaints we handle in all these facilities, resulting in over 40,000 complaints we investigated and closed in 2022. The top five complaints we investigate in all types of facilities are: physical abuse, neglect, and exploitation; eviction and involuntary discharges; care, infection control, and medications. Current annual funding for the LTC Ombudsman Program is less than $18 million annually (state and federal funds I am pleased to announce that the Ombudsman Program was awarded $1.9 million from the Administration on Community Living (ACL) that will be used to develop, design, and implement a statewide volunteer recruitment campaign in 2023-24.

Ombudsman Program was awarded $1.9 million from the Administration on Community Living (ACL) that will be used to develop, design, and implement a statewide volunteer recruitment campaign in 2023-24. In addition, the Governor approved $3.5 million for the California Department of Aging, part of which will be used in the LTC Ombudsman Program to design, develop and deploy revised, culturally and linguistically relevant collateral messages and materials to inform the public about the LTC Ombudsman program and how to access their local program for assistance. I would like to strengthen the state LTC Ombudsman Program so we have a robust training team to support the local program volunteers and staff to ensure all Ombudsman are receiving uniform training at all levels. The previous state Ombudsman served 20 years and saw many changes in that time. What new challenges do you anticipate in the years ahead?

Joe Rodrigues was a tireless advocate for Older Adults in LTC facilities and served the people of California well in his 20 years of service. He established a solid foundation of policies and procedures upon which the LTC Ombudsman Program needed to be an effective

By 2030 over 11 million Californian’s will be 60 years and older. With this growing older population, the need for an effective, affordable long-term care system is here now.

program. I am humbled to have been given this opportunity to be the State’s LTC Ombudsman, and the challenges we are facing are the following: By 2030 over 11 million Californian’s will be 60 years and older. The population is diverse; we have over 40 percent of the state’s population that is Hispanic/ Latino, AAPI, and Black. With this growing older population, the need for an effective, affordable long-term care system is here now. We must create a system of care that provides a path for professional advancement beginning with a living wage for the caregiving workforce, benefits and better training. In addition, the Biden Administration issued a directive to reform the quality of care in nursing homes. We, as a state, need to work in collaboration with the long-term care industry, advocates, and policy makers to try new approaches to how we pay for long-term care, not only increasing enforcements for bad actors, but incentivizing performance outcomes. We also need to establish and enforce minimum staffing standards in California that take into account the higher acuity level of care many residents in long-term care require. Another challenge, besides setting minimum standards, and enforcing them, is preventing the eviction/illegal discharges that often result in older adults being unhoused. We need to come to a solution in California that will provide middle-income individuals to be able to afford paying for long-term services and supports wherever they may need them.

combined), to fund 35 local LTC Ombudsman programs and about 700 volunteers and

staff. Therefore, in addition to increasing the funding to build local capacity, I am pleased to announce that the

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The 2022 report by the National Academies of Sciences, Engineering and Medicine entitled The National Imperative to Improve Nursing Homes Quality: Honoring Commitment to Residents, Families and Staff provides national and state policy makers with excellent recommendations that will require more “funding, organizational commitment, education, and changing health policy – it will require moral courage. Improving the quality of care in long-term care facilities for the decades ahead will require research to strengthen our knowledge of the best care, test models to deliver that care, and investment in the education, and training of all those who work in long-term care settings.” Communication, communication, communication. The pandemic showed us how important simple, linguistically and culturally relevant information is to ensure older adults were informed about how to stay safe, get vaccinated, and infection control practices. Communication from the admissions process, not only what services and supports the resident will receive in the facility, but provide information about who residents may contact if they have questions or concerns about their care. How can senior living providers help Ombudsmen face these challenges?

Long-term care Ombudsman representatives focus on the wishes of the resident. However, they also need to communicate effectively with staff, administrators, and health providers as part of their advocacy role. Providers should invite LTC Ombudsmen to provide presentations to their staff, and other groups the Providers believe would benefit from understanding the role of the LTC Ombudsman.

We need to come to a solution in California

that will provide middle-income

individuals to be able to afford paying for long-term services and supports wherever they may need them.

I encourage Providers to provide for the space and time for residents or family councils to meet in their facilities. Resident and family councils are an excellent way to develop two-way communication channels between staff and residents to provide an open, safe, and inclusive living environment. These councils don’t just serve as a way to identify any trends or issues that residents want to raise with the facility staff and administrators, these are also excellent forums for Providers to share information with residents and families on changes to any policies, laws or programs that may impact the residents.

Blanca Castro was named as State Long-Term Care Ombudsman at the California Department of Aging in December of 2021. Her career encompasses service at the California Department of Social Services, in the private sector coordinating with the Department of Health Care Services, and as an advocate for AARP California.

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Effective Communication Between Caregivers and Family Members is Vital By Paula Hertel

It is essential to set clear expectations early on and avoid relying solely on written policies or residency agreements.

H ave you ever caught yourself saying something like “I’ve been very clear and told her 1,000 times. She just doesn’t listen?” Communication is complex and dynamic. Layer on the fact that we often practice communication on the fly through a variety of different modalities such as face-to- face, phone, messages, text, email, and relayed through others. Effective communication is an active two-way process involving both sending and receiving information. It requires dialogue, where both parties have a shared understanding of what has been communicated and agree upon the next steps. Stating “I’ve told you” isn’t communicating, it is broadcasting. Rick Ross, author of the Fifth Discipline Field, suggests three tips for improved communication which require us to slow down and be more intentional: Be more reflective: become more aware of our own thinking and reasoning. • Check for understanding: ensure that others understand our thinking and reasoning. • Be inquisitive: ask questions of others, listen to other’s points of view and test our own assumptions.

These are good reminders for all of us. In addition, when communicating with family members in senior living, it is important to clarify expectations, find common ground and check for understanding. I have found that if we take the time to focus on these three areas when talking with family members, we resolve many of the issues. Conversely, when we ignore them, situations escalate.

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Clarify Expectations It is essential to set clear expectations early on and avoid relying solely on written policies or residency agreements. Regular conversations with family members can help build trusting relationships and avoid communication challenges.

Once you recognize these dialogue barriers, you can stop the conversation and bring it back to a place of common ground. One example includes talking to a family member who is angry because you are encouraging her to support a move to a memory care program.

She is yelling at you that “If you just did your job, we wouldn’t even be having this conversation.” Remember, this isn’t about you, and it isn’t about you being right or wrong. The daughter is in violence mode, which is a dialogue stopper. If you bring it back to the agreed upon common ground which is “we both want the same thing for your mom; and we want your mom to live in a place where she can feel safe and can participate in the daily programs,” then you can move back into dialogue stating the facts.

Every Executive Director knows that when we welcome a resident into our community, we also welcome their family members. Sometimes, the expectations of family members and resident are not aligned, and sometimes they do not have a clear idea of what the benefits and limitations are. The senior living experience is often new to them. One of my favorite questions to ask family members is, “What does quality care look like to you?” If a family member says, “I want my mom to be happy and live here the rest of her

Regular conversations with family members can help build trusting relationships and avoid communication challenges.

The facts being that she isn’t participating in activities even when she is escorted to them; refuses to come to the dining room; and yesterday was in the parking lot looking for her car. Tell the family member that we are worried about her and want to partner to find a solution. Show empathy and encourage the family member to share her perspective while you listen. One note about facts is that they must be true and consistent. There are times when the leadership team discusses situations with family members and then family members check in with the care team who share differing information. It is important that all team members have access to the factual information and that messages to family members are consistent. Check for Understanding The next steps should be measurable, time bound and reasonable to accomplish. Confusing technical terms, threats, and words such as “never” or “always” are usually not helpful. It can be beneficial to break big challenges into smaller parts and recognize that it may take several conversations and time to work through them all. Of course, this assumes there are no immediate safety or security risks. After the next steps are stated, check for understanding, show empathy and gratitude, and schedule a follow-up to continue the dialogue. In summary, be patient and empathic while clarifying expectations, finding common ground, and checking for understanding. Following these tips can improve communication with family members and lead to positive outcomes for all involved. Paula Hertel has spent 30 years focusing on improving service delivery systems for the elderly while in executive management positions with consulting projects throughout the U.S. She has a proven track record in senior housing and assisted living operations, staff training, regulatory compliance, and new program development. She can be reached at Paula.Hertel@ unwiredltd.com .

life” or “I don’t want her to fall and end up in the hospital” this is an opening to talk about how we want to welcome her and her mom into the community. However, we do not promise daily happiness or that someone is never going to fall. Nor can we promise that every resident can live here forever. Having these types of open conversations and describing how the team partners with residents and families to build community, while not over promising, can begin to build a model for healthy dialogue. Find Common Ground Finding common ground and using open-ended questions can help keep the conversation moving toward a shared outcome. Family members feel valued when they know others are really listening to them. Could we be missing something? Are there other strategies we could try? Listening with an open mind can keep the dialogue open. Questions that start with “Why” or “Tell me more” can prompt answers that lead to a deeper understanding of differing perspectives. In difficult situations we can find ourselves being defensive or wanting to prove we are right. It is hard to find common ground in these situations. We need to own our triggers. Stepping back and remembering that this isn’t a personal attack may help to keep the dialogue moving forward. In the book, Crucial Conversations by Patterson et al, the authors talk about communication styles under stress. They define two common ineffective communication styles as silence or violence modes. People who enter silence mode can withdraw or withhold information, avoid the conversation altogether, or mask their opinions by using sarcasm, mocking others or rationalizing the situation. People who enter the violence communication mode can try to over control the conversation by persuading people to take their side or talking over people, labeling people or ideas in a derogatory way or attacking, which usually leads to making it personal versus factual.

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LOCAL RELATIONSHIPS CULTIVATING

For more ideas and resources, check out CALA’s Emergency Preparedness webpages that provide information and tips from CALA members that can help you prepare for various emergencies. Emergency Preparedness Web Resources includes state and federal web resources that can help providers with staff training, community preparedness, emergency alerts, and disaster relief services. Types of Emergencies can help prepare licensees for a variety of emergencies and learn which types of emergencies to prepare for based on geographic location. Some of these resources require the CALA-member password. Don't know it? Just ask!

FOR EMERGENCY RESPONSE

By Selena Coppi Hornback

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Local relationships, whether with emergency responders, city and county agencies, transportation companies, or other senior living providers are often key to a successful response in times of crisis. In fact, the emergency preparedness statute encourages Residential Care Facilities for the Elderly (RCFEs) to have local emergency responders review their plans. Connecting with your local emergency responders for this purpose can provide licensees with expert input and provide an opportunity to make them aware of your community and your residents and any special needs. CALA recently asked Stan Szpytek, president of Fire and Life Safety, Inc., to provide insight and information that members can use in emergency preparedness planning and when looking for ways to cultivate relationships with local emergency responders. Q: What are some practical ways senior living providers can cultivate relationships with local emergency responders? A: Considering the increasing demand for service placed on every state’s first responders, I challenge Assisted Living providers and senior living communities to reach out to their local fire department, law enforcement agency, EMS provider and emergency management agencies to initiate discussions on how they can partner with these agencies to better serve their residents. In a true disaster, collaboration will be the only way to navigate towards successful outcomes. Invite first responders into your communities and give them an opportunity to tour and get to know the resident population that you serve. It is not uncommon for first responders to make assumptions about the resident population of a senior living community based on their “impression” of the residents. Providers should take it upon themselves to educate the community's emergency services about the unique nature of residents in an RCFE or Continuing Care Retirement Community so they will be prepared to provide critical services in an appropriate manner during a crisis. For example, first responders need to know that a memory care community can’t simply evacuate their residents to a large school gymnasium without a significant elopement risk. Q: What has been your experience as a former emergency responder and now as a consultant to senior living providers as to the success of these relationships and any notable outcomes? A: Providers should be part of the solution—not part of the problem when it comes to emergency management. They should be involved with healthcare coalitions and sitting at the table with nursing homes, hospitals, first responders and other stakeholders responsible for the management of local emergencies and disasters. As a retired Deputy Fire

Chief/Fire Marshal, I remember all the training, drills and exercises my fire department facilitated for senior services providers in my jurisdiction. Positive relationships with first responders, other “like” communities, and the entire healthcare continuum is essential for positive outcomes when emergencies or disasters strike. Q: Emergency transportation is key to successfully evacuating residents. What are your suggestions to senior living providers for securing transportation that shows up when needed? A: Senior living providers should know their transportation capabilities by typing and inventorying the assets they have available to them. Emergency planning involves a great deal of “getting your ducks-in-a-row.” The time to think about your transportation assets is not when you need them as a fast-moving wildfire approaches. Instead, a provider should know what internal resources they have available like buses, vans and passenger vehicles, as well as know where they can get assistance when they need ambulances or wheelchair vans. Contracts or letters of agreement with transportation providers or other communities that have vehicles available to share should be part of every senior living community's Emergency Operations Plan (EOP). Q: It isn’t a new idea for senior living providers to connect with other providers to help house and care for residents during an evacuation. What other options would you recommend and is there an untapped or unconventional resource that senior living providers are overlooking? A: The best outcome when evacuation and relocation is required is to get the residents to a similar or “like” community. When this is not possible, it is not uncommon for providers to use hotels/motels to house residents that need to be evacuated from a disaster zone or localized emergency that makes a community uninhabitable. Again, it’s about getting ducks-in-a-row. Predetermine the locations where you may need to transport your residents and—first and foremost—make sure that those locations are suitable for your residents. You wouldn't want to use a multi-story property that is not equipped with an elevator, for example. The relocation site(s) need to be able to accommodate the needs of your residents. Don't be satisfied with just one or two contingencies. Keep in mind that during a major disaster like an earthquake or wildfire, multiple providers will be competing for the same types of resources. Challenge your team to think out of the box and develop a comprehensive list of contingencies and places to relocate your resident population during an emergency or disaster. Stan Szpytek is the President of Fire and Life Safety, Inc. Szpytek is a former deputy fire chief and fire marshal with more than 35 years of experience in life safety compliance and emergency preparedness. Stan works with several state health care associations around the country and can be reached at Stan@FLSafety.org .

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GOOD RELATIONSHIPS Fostering positive relationships and clear communication is the key to good relationships with LPAs. with LPAs Developing By Lisa Kopochinski

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Fostering and Maintaining Positive Relationships

Cheryl Martin has been an executive director of assisted living communities for 18 years, with the last three years at Prairie City Landing in Folsom . In her role, she is responsible for the day-to-day operations of the community. “This is a multi-faceted job that encompasses regulatory compliance, staff training, resident, family and team member satisfaction, financial stewardship and so much more,” she explains. “I have eight department leaders and we have approximately 82 team members.” And, while many individuals could not succeed in this role, Martin loves the relationships she is able to build with the residents, families, and team members. “My entire career has been in different areas of senior care. I attribute my work ethic, values, and professionalism to the multitude of seniors with whom I have been blessed to know over the decades. And I try to pass those values onto our team members. We have an opportunity to positively impact the lives of our residents and if we are open-hearted they will positively impact our lives as well.” Tracy McLinn certainly understands this too. As the marketing director at Golden Pond Senior Living in Sacramento from 2014 to 2019, she returned as executive director in March 2022 after receiving a call from the previous executive director who had to leave to care for a family member. “My scope of responsibilities includes overseeing the well being, care, engagement, and safety of 100 to 135 residents, hiring and training qualified, caring staff, ensuring the physical plant is in great condition, and reporting to our owners and LPA,” she explains. McLinn says what she likes most about her job is working with seniors every day to ensure that they feel a sense of purpose, that they are well cared for, and that they are as active as they would like to be. “Working alongside my team—to not only teach them all of the things that I have learned in my 33 years of working in this field—but to learn from them as well. Every day (even on the tough ones) there is something rewarding that happens and just fills my heart with gratitude!” It is no surprise to those who choose a career in Assisted Living that they will face challenges. However, their love for what they do — helping and caring for older adults — often surpasses the challenges.

When asked for any practical tips on the best way to foster and maintain positive relationships with LPAs, neither Martin nor McLinn miss a beat. “The best way to foster positive relationships is to be honest with each other and communicate,” says Martin. “Many of us do not interact often with our LPA, unless we have a question, or are sending reports. We do not see each other unless there is a complaint or at our annual inspection so it is difficult to get to know each other. Honest and respectful communication is key.” Adds McLinn, “The best ways to foster and maintain positive relationships with our LPA is to be communicative, transparent, honest, knowledgeable about the situation at hand, and proactive.” She says if a situation arises in her community, her team approaches the situation with a “how can we ensure this does not happen again” attitude right away. “Our LPA appreciates the fact that we already have a plan of correction in place prior to their visit. Self-reporting and constant communication with our LPA have been very instrumental in having a trusting relationship with them.” Challenges and Finding Solutions McLinn’s advice to LPAs who encounter challenges is to remain supportive and focus on the good things that community staff are doing as well. She adds that her current LPA makes it a point to have conversations with her that are conducive to building a trusting relationship. “This makes it easier to reach out when I have a question or situation that requires his attention. He always leaves us feeling supported and that support is what gets us through the tougher times!” Martin says when challenges arise for LPAs, this is the time to ask clarifying questions. That is, give the community enough information for them to help you if you are investigating something. But knowing some complaints are confidential, it can be tough. She cites an example of this when she worked in the Bay Area and an LPA came in to investigate a complaint from a hospital. The LPA would not tell her what the complaint was or who it was about so it was difficult to help gather information. “If I could have received a clear answer, I could have given them information directly related to what they were looking

for and saved us both so much time.” Something no one has enough of.

Lisa Kopochinski is a freelance writer and editor working with associations and companies in the United States and Canada. She can be reached at Lisakop@sbcglobal.net .

CALA NEWS & VIEWS I ISSUE 46 | APRIL 2023

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Assisting Executive Directors in Meeting Challenges with LPAs CALA asked former LPA Edna Musoke, residential care program educator and compliance consultant with CareerSmart , to provide her insight. When asked what advice she can provide to Assisted Living professionals who encounter challenges with LPAs, she says it is extremely important to connect, communicate, and collaborate with their assigned LPA. “If there is a potential issue that may arise, the Licensee/Administrator/Executive Director should research the matter. When sufficient information has been gathered, they should communicate with the LPA and seek direction. If the LPA is not available, contact the Licensing Program Manager (LPM), or the duty officer of the day who are available Monday through Friday, 8:00am to 5:00pm.” “For example, if there is a disgruntled employee, the facility representatives should discuss that with the LPA so if a complaint is filed by the employee, the LPA will be aware of it which may help during the investigation. Facility representatives should always be professional, even when there is a disagreement between them and the analyst.” Expected Challenges There are a number of challenges that licensees, administrators and executive directors can expect to encounter in their positions. Musoke offers this advice for these specific challenges: • Licensees/Administrators/Executive Directors or their designated substitutes, need to know what they are cited for during any inspection. They should review the regulation sections from Title 22 Division 6 Chapter 8 or the Health and Safety Code sections (i.e., 1569 and their subsections), to determine whether the LPA is citing under correct regulations. Or, whether the LPA is citing for something that is not citable. If there is a discrepancy, the facility representatives should reach out to the LPM to discuss the issue and resolve it during the visit. Otherwise, the facility representative will have to pursue the appeal process with the Regional Manager, which may take a while to be resolved. In addition, the facility representative should avoid appealing citations when they know that the facility was at fault. • Licensees/Administrators/Executive Directors may have residents’ representatives direct them not to call 911 in certain cases. However, the facility representatives need to know when the emergency personnel must be called, despite the representatives’ wishes. This is because the facility must abide by Community Care Licensing Division’s (CCLD) requirements. • Facility representatives should clearly show the topics for staff training, the number of hours completed, and the individual who is qualified to perform the training. “This will save a lot of time for the LPA, because the LPA will not have to calculate the hours,” explains Musoke. “In addition, if the LPA asks for staff and resident records, all records for staff and residents that the LPA identifies should be provided for review. If some of the documents are in different locations, retrieve them so that a complete set of records will be provided to the LPA to avoid citations for incomplete records.” She adds that if any resident receives care from either a home health agency or hospice agency, the facility representatives must ensure that those agencies leave documentation after each visit to indicate what was performed for that resident. In addition, the staff should know what health services those agencies are performing for the residents. “Medications are another area where facilities tend to get cited. All Licensees/Administrators/Executive Directors should be familiar with the Technical Support Program (TSP) and they can access it at https://www.cdss.ca.gov/ inforesources/community-care/resource-guide-for-providers . The TSP has valuable information regarding Hospice Care for RCFEs, Pressure Injuries, Medications Guide for RCFEs and RCFE Self Assessment Guides. “These tools can be used to train staff and to help them prepare for LPA inspections.” She also stresses the importance of being proactive.

Edna Musoke is a Residential Care Program Educator and Compliance Consultant at CareerSmart in Brea, California. CareerSmart provides Continuing Education Units and Caregiver Training.

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GROWING YOUR WORKFORCE PIPELINE – ONE PARTNERSHIP AT A TIME Looking for creative, collaborative ways to grow your workforce pipeline? Consider partnering with these organizations and programs with broad reach and access to an expansive talent pipeline, and connect with programs and prospective employees near you. Check these out and let us know!

THE ARC CALIFORNIA The Arc California and its numerous chapters throughout the state creates successful relationships with large and small businesses by connecting candidates with developmental disabilities to job opportunities to excel in their professional roles. CALIFORNIA COMMUNITY COLLEGES California Community Colleges provide workforce development in healthcare, human services, and the culinary arts making their graduates perfect employees to fill the workforce gaps in Senior Living communities. THE CA COUNCIL ON GERONTOLOGY & GERIATRICS (CCGG) The CA Council on Gerontology & Geriatrics (CCGG) links academic institutions — including students, educators, researchers, and administrators — to older adults and their families and to legislators, service providers, businesses, and other stakeholders. CSU CAMPUS CAREER CENTERS CSU Campus Career Centers can help you expand your talent pool, simplify your recruitment efforts, and save costs by connecting you with CSU students and alumni who are well prepared to contribute to your organization’s success. CSU HOSPITALITY & TOURISM ALLIANCE The CSU Hospitality & Tourism Alliance offers a passport to the world of hospitality and tourism management. Our graduates prove to be an immediate asset to any employer. They come from a rigorous academic background, with a strong work ethic and real-world experience. EARN & LEARN Earn & Learn is an Education Technology organization that works to effectively scale work-based learning experiences for all learners. We are a funneled point of contact for employers to work with a region’s schools, colleges, and community organizations to develop a local diverse talent pipeline. NURSING SCHOOLS Nursing Schools throughout the state prepare the next generation of professionals with the knowledge, skills and attitudes necessary to continuously improve the quality, safety, and effectiveness of health and human services. Consider partnering with a school to host early-term nursing students for clinical rotations. PROSTART® ProStart® is a career and technical education program that unites the foodservice industry and the classroom to teach high school students culinary skills and restaurant management principles, as well as employability skills such as communication, teamwork, professionalism, and time management. WOUNDED WARRIOR PROJECT – WARRIORS TO WORK Through collaboration and partnerships, Wounded Warriors Project Warriors to Work collaborates with employers to facilitate productive onboarding, identify optimal roles for veterans and provide qualified candidates, and develop practices to help increase retention among veteran employees. CALA’S WORKFORCE DEVELOPMENT WEB PAGES CALA’s Workforce Development website pages include numerous tools and resources developed by and for CALA members to help you build connections, as well as recruit and retain a talented workforce.

Interested in obtaining key contacts or learning more about a particular organization? Contact CALA’s Vice President of Workforce & Professional Development Jan Trifiro at jan@CAassistedliving.org .

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RECIPIENTS SHARE THEIR TIPS

The Excellence in Services Awards recognizes the heroes among us in CALA member communities who step up and reach beyond the boundaries of their job description to support the care and well-being of residents, help fellow team members, and lead with strength. These unsung heroes inspire and challenge those around them to be and do their best, and their influence is far reaching. CALA is pleased to recognize and shine a light on these outstanding individuals through the Excellence in Service Awards.

The 2022 Award winners included these three impressive individuals: JENNIFER MAURER Outstanding Executive Director in Service Award

Jennifer is Executive Director at WellQuest of Elk Grove , a senior living community that offers independent living, Assisted Living and memory care. She has worked in senior living for more than 15 years, starting as a caregiver and then working in culinary, activities, and business departments before becoming Executive Director. When the pandemic brought staff shortages, Jennifer often worked 12-hour days assisting the maintenance department in cleaning floors, moving furniture or helping housekeeping clean apartments and cottages. She is a leader who goes out of her way to create memorable experiences for both employees and residents, whether that means dressing up in goofy costumes or celebrating the hard work of staff through all kinds of fun days and treats. She is also well known for her positive attitude and contagious laughter heard throughout the community. She greets everyone from residents, staff and guests with a smile and kind word every day. MARIA DUMPIT Outstanding Department Director Award (for non-clinician) Maria is the Executive Chef at Cogir on Napa Road in Sonoma . She began in 2008 as a housekeeping supervisor and, within two years, she supervised dining as well. In addition to being Executive Chef, she also oversees the housekeeping department. Maria is known for doing whatever it takes to support the community. When the community was without a maintenance director for an extended period, she cross-trained her teams and oversaw maintenance and repairs. She is perhaps best known for creating a 12-foot gingerbread house complete with a table for two inside so residents could host a loved one. GERALDINE MOGUEL Outstanding Community Nurse Award Geraldine is a LVN at Carlton Senior Living San Leandro and has been recognized by Carlton Senior Living with their Best of the Best Award multiple times. She is a tireless advocate for the resident’s needs, proactively working with the primary care physicians to ensure that communications lead to correctly updating the resident’s care plan. Under her guidance, care partners, medication technicians, and other nurses have grown in their knowledge and understanding of healthcare and clinical needs.

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