Continuum Magazine (spring 2009)

Spring 2009

A publication for Wisconsin’s Long Term Care Profession by

Let’s Talk About

Sex

PLUS:

www.whca.com www.wical.org

• Get ready for the 47th Annual Spring Conference and Expo! • Sexuality and the Non-Decisional Resident • Workplace Romance: Should It Get the Kiss-Off? • Making News is Good News

welcome THE “SEX ISSUE” of Continuum magazine is intended to raise awareness and stimulate a dialog on the sensitive issue of sexuality in the long term care setting. You will fi nd several articles discussing the subject of intimacy and relationships within the long term care provider community. We wrestled with some provocative cover ideas that certainly would have caught peoples’ attention, but we decided to not make light of this serious subject that is worthy of greater attention and discussion. These issues are important now and will only increase in the coming years with the changing consumer attitudes and expectations. Wisconsin has a proud history of being ahead of the curve in the provision of long term care services. Recognition that sexuality is part of the human condition, with varying levels of importance, is an idea that Continuum hopes will be yet another area in which Wisconsin’s provider community takes leadership. We hope that you fi nd this issue informative and provoking of thought. We encourage comments and input on this and future issues of Continuum. Comments are welcome at [email protected].

Sexuality issues are important now and will only increase in the coming years with the changing consumer attitudes and expectations.

Sincerely, Brian R. Purtell WiCAL Executive Director and WHCA Director of Legal Services

Advocacy, Education, Excellence

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contents 17 Continuum is published for the Wisconsin Health Care Association and the Wisconsin Center for Assisted Living 121 East Wilson Street, Suite L200 Madison, WI 53703 608-257-0125 Fax: 608-257-0025 www.whca.com/www.wical.org

Spring 2009

CROSSROADS: Sexuality and the Non-Decisional Resident This article will explore the ways that facilities should engage in a careful, case-by-case analysis of the situation when confronted with the question of whether a non-decisional resident should be permitted to engage in sexual activity within the facility.

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HR 4 LTC: Workplace Romance – Should It Get the Kiss-Off? Workplace romance is a concern of nearly all employers. Some employers have outright banned dating between employees; others have instituted workplace dating policies; and still other employers require dating employees to sign “love contracts.” What’s the best solution for your facility?

Managing Editor Brian Purtell Editorial Associate Erin Celello

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Published by

12 Naylor, LLC 5950 NW 1st Place Gainesville, FL 32607 800-369-6220 or 352-332-1252 Fax: 352-332-3331 www.naylor.com Publisher Mark Migliore

16 MEDIA MATTERS:

Making News is Good News If the public, customers and elected officials aren’t hearing anything about your facility, you’re missing an opportunity to build name recognition. Follow five easy steps to garner increased news coverage for good things you’re already doing at your facilities.

Editor Saara Raappana Marketing and Research Associate Zach Swick Project Manager Rick Jablonski

LET’S TALK ABOUT SEX Some of the more difficult and sensitive situations in long term care settings involve residents and sexuality. Given the delicate and for some, uncomfortable nature of the topic, facilities and staff are often challenged by it. But it doesn’t – and shouldn’t – have to be that way.

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CAPITOL BEAT: Can One Voice Make a Difference in the Legislative Arena? Because legislative decisions will have a critical impact on your ability to provide the highest level of care to residents, providers must make lawmakers aware of the issues and impacts on the profession. Learn a few general rules for the most effective communications with legislative leaders.

Account Leader Patricia Nolin Account Representatives Denise Creegan, Janet Corbe, Steve Hall, Scott Pauquette, Mark Verceles, Cherie Worley Layout & Design Irene Pohoreçka

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BUYERS’ GUIDE PROFILES

Advertising Art Elaine Connell

20

STAKEHOLDER SPOTLIGHT: Otis Woods

©2009 Naylor, LLC. All rights reserved. The contents of this publication may not be reproduced by any means, in whole or in part, without the prior written consent of the publisher.

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Otis Woods, director of the Division of Quality Assurance (DQA), discusses the role of his Division and shares his thoughts on regulatory matters.

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ADVERTISER.COM/

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INDEX TO ADVERTISERS PUBLISHED MARCH 2009/WHC-B0109/8316 Cover and feature story photography by Adam Senatori

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crossroads Sexuality and the Non-Decisional Resident The Role of the Guardian or Agent By Robyn Shapiro and Colleen O’Connor Patzer

IT IS GENERALLY accepted that an individual should not lose his/her right to make decisions about his/her sexuality upon entry to a nursing home or assisted living facility. However, questions as to whether and how a guardian or health care agent may make decisions related to a non-decisional resident’s sexuality are complicated and difficult. As discussed below, the law does not provide concrete direction on these issues, which leads to the conclusion that facilities must engage in a careful caseby-case analysis of the situation when confronted with the question of whether a non-decisional resident should be permitted to engage in sexual activity within the facility. HEALTH CARE AGENT’S DECISION MAKING Under Wisconsin law, an agent appointed in an activated power of attorney for health care document is authorized to make health care decisions on behalf of the incapacitated principal. “Health care” means “any care, treatment, service or procedure to maintain, diagnose or treat an individual’s physical or mental condition.” Whether decisions about a resident’s sexuality constitute “health care decisions” under the statute, and thus can be made by the agent, is open to debate. As a practical matter, facilities often look to agents to make decisions that are not squarely “health care decisions” within the statutory defi nition, but that impact the psychosocial well-being of the resident. Examples include deci-

sions about a resident’s involvement in social activities or religious worship. If a facility views decisions about sexuality as relating to the psychosocial wellbeing of the resident and, therefore, a decision that the agent is authorized to make, the question becomes: How does the agent go about making that decision? By law, the agent is required to make decisions consistent with the principal’s desires if known to the agent (i.e., substituted judgment) or, if unknown, in the best interests of the principal. To know whether sexual conduct is consistent with the principal’s desires and/or in his/her best interests requires consideration of the person’s lifestyle and values, and the impact of such conduct on his/her current wellbeing. GUARDIAN’S DECISION MAKING The recently rewritten guardianship statute does not specifically empower a guardian to make decisions related to a ward’s sexuality. However, the guardianship statute does provide that the ward retains all rights except those that are not assigned to the guardian or otherwise limited by the court, and that a guardian must advocate for the ward’s best interests. In addition, the statute provides that the guardian, in exercising his/her powers and duties, must “make diligent efforts to identify and honor the individual’s preferences with respect to…choices related to sexual expression.” In making a decision to act contrary to the individual’s expressed wishes, the guardian is di-

To know whether sexual conduct is consistent with the principal’s desires and/or in his/her best interests requires consideration of the person’s lifestyle and values, and the impact of such conduct on his/her current well-being. SPRING 2009

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rected to take into account, among other factors, the individual’s understanding of the nature and consequences of the decision. PRACTICAL APPROACHES While the law currently lacks clear guidance on the subject, it suggests the need to carefully evaluate the following cornerstone question in determining whether a non-decisional resident may engage in sexual intimacy: Does the non-decisional resident who is engaging

in, or desiring to engage in, a sexual relationship have the necessary mental and emotional capacity to understand and benefit psychosocially from the relationship, and is this relationship consistent with the resident’s values? Consultation with the resident’s physician, a psychologist or psychiatrist, and/or the facility’s ethics committee may be indicated in instances where the answer to this question is not readily determinable, or if there is disagreement among caregivers and/or family members.

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It may be advisable for facilities to develop guidelines or policies regarding sexual expression between residents. If the answer to the cornerstone question is yes, and nothing in the legal documents confl icts with this conclusion, the facility should seek the agreement of the resident’s agent or guardian and family members, provided that the answer to the cornerstone question is also “yes” for the other party involved. All consultation, evaluation and consent information should be well documented in the chart. If the answer to the cornerstone question is no, then it is reasonable to conclude that the relationship is not in the resident’s best interests and, therefore, may not be condoned. In these circumstances, residents must be protected from harm or coercion that could result from sexual expression by others or themselves. It may be advisable for facilities to develop guidelines or policies regarding sexual expression between residents to assure that these sensitive matters are addressed carefully and proactively in a manner that protects residents’ rights and well-being.

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HR4LTC Workplace Romance Should It Get the Kiss-Off? By Mindy Rowland

POP QUIZ: You just found out two coworkers are dating each other. What do you do? a. Confront the couple and demand that they stop dating or be terminated; b. Contact your employment attorney and ask her to draft a love contract for the couple to sign immediately; c. Review your handbook to ensure your sexual harassment policy is up to date; or d. Think to yourself, “Great! Another couple to have dinner with!” Most employers assume the answer is “a.” However, such a knee-jerk reaction is probably not the right way to address workplace dating. Workplace romance is a concern of nearly all employers. Many fear the epitomic example of a supervisor/subordinate relationship gone sour, where the subordinate files a sexual harassment claim after the relationship ends and the supervisor begins treating the subordinate differently from other coworkers. Out of concern, some employers have outright banned dating between employees, others have instituted workplace dating policies, and still other employers require dating employees to sign “love contracts,” a contractual agreement between the couple and the employer where the couple attests that the relationship is consensual. Interestingly, a study conducted by the Society for Human Resource Management indicates that less than 4 percent of individuals involved in a failed office romance file a formal complaint. Likewise, recent studies demonstrate

that workplace romances are proliferating. What is an employer to do? 1. BAN WORKPLACE ROMANCES ALTOGETHER? Probably not. Not only is such a prohibition difficult to enforce uniformly, but employees may see such a ban as an affront to their privacy and out of touch with the realities of the workplace. In addition, if you already have employees dating, it will be difficult to retroactively require those couples to end their relationship. Moreover, your employees will likely ignore any such prohibition, setting you up to make a difficult decision as to whether to enforce the policy by terminating an otherwise quality employee. In addition, such a policy is still inherently difficult to craft. How do you describe the behavior you are seeking to forbid? Do you intend to prohibit dating, socializing, a romantic involvement or something else? An employment attorney can certainly draft an “anti-fraternization” policy for you, but often, the employer realizes the futility in doing so and opts not to outright ban employee relationships. 2. ENACT A NOTIFICATION POLICY? Probably. A notification policy requires employees to notify a company representative, often the EEO officer, when a workplace relationship commences and when it ends. A notifi cation policy allows the company a certain level of protection from later

Some employers require dating employees to sign “love contracts,” a contractual agreement where the couple attests that the relationship is consensual. SPRING 2009

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claims of sexual harassment, and also provides the company information to respond to any complaints by co-workers of discrimination or favoritism. Practically speaking, it also allows the company to “keep an eye on” the status of the relationship. While employees may consider this policy intrusive as well, it is less so than a complete ban on workplace dating. Employees can be informed that the existence of the relationship will not be disclosed to anyone unless necessary.

Love contracts, or consensual relationship agreements, are gaining popularity among employers.

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3. REQUIRE COUPLES TO SIGN A “LOVE CONTRACT”? Possibly. Love contracts, or consensual relationship agreements, are a tool gaining popularity among companies. Such contracts require dating couples to sign an agreement that confi rms the relationship is voluntary, informs the couple of the company’s sexual harassment policy and provides information on how to report any complaints. It also outlines expected behavior of

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the couple, such as refraining from public displays of affection and notifying the employees that neither may retaliate against the other if the relationship ends. An employer requiring that dating employees sign a love contract can expect resistance. The couple may view the contract as intrusive. Therefore, a company considering instituting a policy requiring love contracts may want to determine whether it is, in fact, necessary. The company’s sexual harassment and anti-retaliation policies can and should cover the information provided to the employees in the love contract, including how to report a complaint. Likewise, the employee handbook can prohibit unprofessional behavior, such as public displays of affection in the workplace. The love contract, then, really is simply requiring that the employees attest to the voluntary nature of the relationship and requiring that the employees notify the company if the relationship ends. As to the former, the couple is very unlikely to dispute the fact that the relationship is consensual during the pendency of the relationship itself. As to the latter, the company can institute a notification policy without having to require dating couples to sign a contract.

4. DO NOTHING? Probably not. At a minimum, a company should review its sexual harassment and anti-retaliation policies to make sure they cover the consequences of consensual relationships, and whether your handbook prohibits inappropriate conduct, such as public displays of affection in the workplace. To be sure, a solid sexual harassment policy, coupled with sound antiretaliation and reporting policies, are the foundation for an employer to defend itself against a claim based on love turned sour in the workplace. Better practice includes a notification policy, if the company opts not to require its dating employees to sign love contracts. So, what is the answer to the pop quiz? The answer is “c.” With up-todate policies addressing sexual harassment, retaliation and a comprehensive notification policy, a company can feel comforted that it will be ready when and if its employees begin an interoffice relationship. Mindy Rowland is partner at DeWitt Ross & Stevens S.C. She can be contacted at 608252-9320 or mjr@ dewittross.com.

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Let’s Talk About Sex Coming to terms with the sexuality of assisted living residents. By Brian Purtell Photos by Adam Senatori 12 CONTI NUUM | www.whca.com • www.wical.org

A nurse aide enters a room which she expects to be unoccupied. To her surprise, she happens upon Robert and Mary, two unmarried, fully decisional residents engaged in an intimate act. She expresses surprise and mild disgust towards the couple for their behavior. The aide quickly leaves; the couple is mortified and embarrassed. Word quickly spreads among staff and residents, leading to snickers and whispers. The residents become withdrawn from each other and staff. Jane and Gwen, residents of an assisted living memory care facility, develop an extremely close friendship after several months at the facility. They are often seen holding hands and holding each other close. Some staff What if the facilities in the above scenarios had established policies to deal with these sorts of situations? What if staff members better understood that older adults still need some form of intimacy? How different could these situations be if the facility had created an environment where their residents’ sexuality was respected and treated for what it is: an important element of human nature? It may be hard to imagine, but for many elderly, sexuality and intimacy are still vital parts of their lives. Some of the more difficult and sensitive situations in long term care settings involve residents and sexuality. Given the delicate, and for some, uncomfortable nature of the topic, facilities and staff are often challenged by residents’ sexual needs. But it doesn’t have to be that way. Some would argue that intimacy in the long term care setting should be addressed right along with other needs such as nutrition and hydration. It should be understood that sexuality is not limited to sexual contact, but rather the entire range of intimacy; from emotional connections and companionship to non-sexual touching or closeness. It is important to recognize and acknowledge that adults, including the elderly, maintain a level of sexual interest and desire far into their golden years. While this may not be high on the list of needs for all long term care residents, something does not have to impact a majority of residents before it deserves attention from providers. To be clear, while

think it’s “cute,” while others, including the family of one resident, do not approve of this new relationship. At the insistence of the family member, the women are redirected from further physical contact. Jane becomes withdrawn while Gwen returns to her previous level of heightened agitation. Jim is a frequent user of the common area computer made available to residents for internet access. A staff member notices Jim viewing adult content sites. He is confronted by a caregiver who tells him he shouldn’t be doing this and mutters, “You dirty old man”. Jim is restricted from computer use and so embarrassed that he has made indications that he wants to leave the facility.

we may speak of “addressing” resident needs, this is not to be construed in any way as providers having any obligation to “fulfill” client needs. Though a resident may express a need for sexual contact, it is not the provider’s obligation to play match-maker or affirmatively seek out a partner. What was once a “forbidden” subject is becoming a topic that requires an informed dialogue. As resident expectations and attitudes change, the time is ripe – and it’s becoming increasingly important – to address the complex issues of resident sexuality. A FRANK DISCUSSION. The long term care community is overdue for a sit-down about sex. Sexuality is a basic human characteristic and while a decline in physical abilities may impact performance, the need for intimacy does not go away simply because of age. Opening a dialogue can bring about greater understanding, create an environment where desires and interests are discussed openly and provide ideas about addressing sexual situations in a respectful manner. While there has been significant attention given to inappropriate resident behavior, there has been less focus on

the positive aspects of companionship, intimacy, self-gratification, and yes, sexual contact between residents. The emphasis on response to inappropriate sexual behavior may have exacerbated the taboo. When focus is placed on stopping certain behaviors, healthy aspects of sexuality and intimacy become lumped together with forbidden expressions. Here we do a disservice to both our residents and staff: the residents who may benefit from intimacy, and staff who are ill-prepared to address situations that should otherwise be permitted. This is not to minimize the obligations providers have to protect elders within their facilities. Continued vigilance must be paid to the role of protection. However, through the development of anticipatory policies, staff education and working with family members and surrogates, we can ensure that elderly residents have the very best quality of life that we can give them. THE MAIN MYTH: SEXUALITY DISAPPEARS WITH AGE Based on multiple factors, the significance of sex will vary throughout one’s lifetime. But sexuality does not always go the way of taught skin and supple joints.

“... having an established policy on resident sexuality and intimacy in place can be a more comfortable method to broach an often cringe-inducing subject.” SPRING 2009

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“What if staff members better understood that older adults still need some form of intimacy?” We are only recently seeing reports demonstrating the levels of sexual interest and activity in the elderly population. Some studies indicate that while fewer long term care residents remain sexually active (8 percent of nursing home residents reported sexual activity in the past month), 17 percent expressed a desire for sexual activity and as many as 70 to 90 percent of nursing home residents indicated that they have sexual thoughts. While less data is available for the assisted living population, it can be assumed that figures would fall between the data of the community-dwelling and nursing home populations. This ever-changing demographic will bring evolving beliefs. With recent pharmacological developments and changing attitudes towards their use, long term care providers face a new set of circumstances to which they must adapt. Sexuality and intimacy is an important part of the lives of many residents – with demonstrated physical and psychological benefits – and just as providers seek to meet clinical, social and psychological needs, they should not allow embarrassment, ignorance or their own beliefs to interfere with the often unmet needs of residents. ESTABLISHMENT OF POLICY GUIDANCE While most providers have policies in place to address inappropriate sexual behavior, few provide proactive guidance in 14 CONTI NUUM www.whca.com • www.wical.org

promoting respect for the sexual needs of residents. The development of policy guidance must be at the basis of a proactive framework. Policies should initiate the gathering of evidence-based information, regulatory requirements and practical implementation input from appropriate staff leaders. Suggested elements for such policies include: (1) staff education on the unique expressions of sexuality in the elderly, (2) affirming support for addressing resident intimacy needs, including the establishment of communication channels (3) the provision of appropriate risk-related information to residents and their surrogates, (4) and reasonable limits and conditions on activity that may be supported by the facility. Policies should make it clear that, while sexuality should be addressed in an open manner, residents should in no way be pushed toward sexual activity. Having guidance in place establishes that residents’ sexuality as an important need. It provides an anticipatory framework for staff to follow and improves the staff’s understanding. Guidance will also provide information that can be shared with surveyors to demonstrate the facility’s efforts to meet resident needs within regulatory dictates. EDUCATING STAFF ON SEXUALITY AND THE ELDERLY The issue of intimacy and the elderly is rarely included in staff training. So it’s no surprise that studies have shown that staff members often have only a minimal understanding of elder sexuality. This lack of understanding can lead to negative or inconsistent attitudes by staff. As a result, residents’ needs are often neglected or even condemned. Research also shows that staff education and training on resident sexuality can go a long way in demonstrating the benefits to both staff and residents. Training programs should include: (1) the meaning and functions of sexuality for older adults, (2) identification of barriers for residents’ meeting sexual needs; (3) strategies to help residents appropriately express their

sexual needs; and (4) inappropriate sexual expressions and strategies for response. Incorporating education in these areas has been shown to dispel misconceptions while reducing biases and anxieties often based on a hazy understanding. By providing staff with educational opportunities, providers create an environment where appropriate sexual expressions are recognized and respected and staff members can comfortably engage residents in non-judgmental discussions concerning these issues. FAMILY AND SURROGATE INVOLVEMENT IN RESIDENT SEXUALITY Thinking about your elderly parents having sexual needs is not easy or comfortable. But it’s not an issue that a resident’s family can – or should – sweep under the rug. Rather, having an established policy on resident sexuality and intimacy in place can be a more comfortable method to broach an often cringe-inducing subject. Here again, an educated staff may be in a far better position to explain to family members the diverse ways that elders express sexuality. When dealing with fully decisional residents, issues primarily involve privacy, barriers, and certain risks, such as resident health and sexually-transmitted diseases. The issue gets more coplex when dealing with individuals of reduced decisional capacities. While the legal analysis of when an individual loses decisional capacity for sexual consent is outside the scope of this article, the development of a policy should incorporate this issue and the expectation that the legal decision-maker (guardian or health care agent) be involved early by identifying sexuality issues as well as responding to intimacy concerns of the ward/principal. Clearly, sexual contact involving an individual with diminished decision-making capacity must be treated with the utmost of attention to assure that a vulnerable resident is not exposed to contact without consent. Equally important is that incapacity/

“While most providers have policies in place to address inappropriate sexual behavior, very few provide proactive guidance in promoting respect for the sexual needs of residents” incompetence is not an all or nothing proposition. While an individual may have lost capacity to make some decisions, this does not forever preclude their ability to make all decisions, including decisions concerning intimacy. SCENARIOS REVISITED Let’s return to the opening examples and see how these situations may have differed in a setting where the facility has a clearly articulated policy that anticipates intimacy issues, where the staff is trained in understanding elder sexuality and where residents are encouraged to express their needs and preferences relative to sexuality. Robert and Mary (whose tryst was interrupted) may feel comfortable discussing with staff their desires for some privacy together if such issues are brought up early in their admission and assessment process. Asked in a professional manner about the importance of their respective sexuality by an educated and responsive staff, Bob and Mary could have addressed their interest in some alone time. Staff members could discuss options and barriers, make sure that both parties understand risks and a convenient and private space could be arranged for them. The staff may further appreciate the importance of respecting these adults’ privacy and refrain from gossiping. For Jane and Gwen, proactive education would provide staff with an understanding that it is not uncommon for

same-sex relationships to develop late in life. Jane and Gwen’s contact may be a response to loneliness or the grieving process, regardless of their sexual orientation. Staff may have been better able to explain to family members this newfound relationship and its possible meanings. Staff members may also understand that they are not to project their personal beliefs and opinions towards a situation that clearly provides comfort and benefit to Jane and Gwen. Jim may have been able to articulate his frustration towards his lack of a sexual partner. It could have been better understood that his viewing of pornography provides a private outlet. A policy of acceptance and exploration of this subject might have identified a more private opportunity for such an outlet and could have trained staff to reserve their judgment towards individual needs. With a policy that serves as the basis for an initial discussion tool, staff could more comfortably discuss this situation with Jim’s son, who assists the facility by providing adult magazines containing pictures and articles of interest to Jim. These scenarios only scratch the surface of current and future situations that providers face in responding to sexuality in the long term care population. Development of policies that anticipate these types of situations, along with staff education, will allow providers to better address common issues and prepare for the unique and diverse manners in which individuals express their sexuality.

SOURCES AND RESOURCES In developing policies and educational training, providers are not without authoritative resources to assist them. Examples include, but are not limited to, the following sources that were utilized in this article: Arena, J. M., & Wallace, M. (n.d.). Geriatric Nursing Resources for Care of Older Adult: Sexuality Issues in Aging. Retrieved January 3, 2009, from http://www.consultgerirn. org /topics/sexuality_issues_in_aging / want_to_know_more Considerations Regarding the Needs of Long-Term Care Residents for Intimate Relationships and Sexual Activity. (n.d.). Retrieved January 3, 2009, from www.practicalbioethics.org/FileUploads/Intimacy percent20Guidelines percent20Updated. Aug percent2007 Everett, B. (2008). Supporting Sexual Activity in Long-Term Care. Nursing Ethics, 15(87). Hajjar, R. R., & Kamel, H. K. (2004). Sexuality in the nursing home, part 1: Attitudes and barriers to sexual expression. Journal of the American Medical Directors Association, 5(2 Supplemental), S42-S47. Lindau, S., Schumm, P., Laumann, E., Levinson, W., O’Muircheartaigh, C., & Waite, L. (2007). A Study of Sexuality and Health among Older Adults in the United States. N Engl J Med, 357(8), 762-774. (2003). Sex and Sexuality in Long Term Care: A training program for staff. Washington DC: American Health Care Association. (2008). Sexuality in Nursing Homes, Educational module to Promote Excellent Alternatives in Kansas Nursing Homes (PEAK). Kansas State University Center on Aging. .

Brian Purtell, WiCAL Executive Director and WHCA Director of Legal Services, is also a partner at DeWitt Ross & Stevens S.C. He can be reached at [email protected], [email protected], or [email protected]

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media matters Making News is Good News By Erin Celello

Take a longterm approach to generating coverage; the best PR plan is a series of small steps with occasional bursts of exciting news. 16 CONTI NUUM www.whca.com • www.wical.org

NO NEWS IS good news. We’ve all heard that saying, but public relations professionals everywhere resoundingly disagree. In public relations, no news means that the public isn’t hearing anything about you, and you’re not doing much – if anything – to build up name recognition with consumers or elected officials. That’s where “earning media,” or publicizing good news, comes in. But what is news? According to former executive editor of The New York Times, Turner Catledge, “News is anything you didn’t know yesterday.” More particularly, news is anything of interest – an event, new idea, or new information – to your community. Easy enough, right? Now for the hard part: How do you even begin to go about letting people know what your news is? Luckily, the hard part isn’t so hard. Below are some easy-to-follow steps to garner increased news coverage for good things you’re already doing at your facilities. KEEP A MASTER CALENDAR. There are good things – good newsworthy things – already going on at your facilities. You just need to spend a very little bit of time thinking ahead to what is going to happen when. Hold quarterly or monthly brainstorming sessions with your activities, marketing, and administrative staff to get events on the calendar and ready to be publicized.

CONVEY WHY YOU’VE “GOT IT GOING ON.” You need a hook, or a reason, for media coverage. Are you celebrating an anniversary? Are you expanding or remodeling and offering new, improved services as a result? Are you implementing a culture change? Recognizing residents or staff for accomplishments? Are you celebrating or recognizing a holiday or special day in a unique way? If so, make sure to give your local media – either via e-mail or a quick phone call – the 5-Ws: who, what, when, where, and why. Especially in smaller media markets where reporters and editors are often desperate for news, few announcements or events are too small to publicize. START CULTIVATING RELATIONSHIPS WITH LOCAL REPORTERS NOW. Take a long-term approach to generating coverage; the best PR plan is a series of small steps with occasional bursts of exciting news. Plan ahead, keep your facility information and announcements in front of reporters, and the stories will happen over time. Likewise, acknowledge that not every event or announcement you call a reporter about is equally newsworthy. Saying something to the effect, “I know this isn’t front page-worthy, but if it’s a slow news day, you might want to cover this because…” will go a long way toward building your credibility with a reporter. When you do have front-page news, they’ll be that much more incline to believe you.

Finally, follow the work of your local reporters. If they do a particularly interesting piece especially well – even if it’s not related to long term care – drop them a note to tell them so. Reporters get plenty of mail telling them about all the things they didn’t get right, but it’s those rare notes that say, “Thank you for doing this story; it was a great service to our community,” that really stick with them. The next time you call, they’ll remember you.

way to do that is to ensure they know what great things are happening inside your facilities. In addition, look for the WHCA Media Toolkit in the “Media Room” section of our Web sites: www.whca.com or www. wical.org for tips on drafting media advisories, news releases, and more.

Erin Celello is the WHCA Director of Communications. She can be reached at erin@ whca.com

ANTICIPATE WHAT THE REPORTER WILL NEED TO KNOW AND HAVE THAT INFORMATION READY. Reporters are overworked, underpaid, and have short deadlines. The more work you can do for them, the more likely they are to cover your news. Do you have pictures (with captions) that you can supply? Say so! Do you have a FAQ sheet that you can hand out? Type one up! Will it be valuable for the reporter to know certain numbers? Have all of those figures available in advance! The reporter will thank you by covering your story or covering your story better. BE AVAILABLE. Once you’ve pitched a reporter on an event, make available a contact person to fi ll in any information before, during, and after. There is nothing that frustrates a reporter more – and nothing that will ensure the story ends up in the trash folder faster – than not being able to get information to complete a piece. Let the reporter know when and where they can reach the contact person to answer any and all questions. And always ask a reporter’s deadline so you can work within that timeframe. With these few simple steps, your facility could be well on its way to making a name for itself in your local community. With tight state and municipal budgets, you need all of the support you can get from your elected officials and local community. And the most sure-fi re SPRING 2009

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capitol beat Can One Voice Make a Difference in the Legislative Arena? By Jim McGinn

LEGISLATIVE LEADERS OFTEN remind audiences that, from a legislative standpoint, if representatives receive as few as four letters from constituents on a particular issue, they will recognize this to be an issue of significance. With the state legislature in the midst of negotiating a biennial budget and attempting to address the $5 billion-plus budget deficit, it is all the more impor-

tant that providers take steps to communicate to their legislators to make sure that they are aware of the issues and impacts on the profession. They need to be made aware of the affect that legislative decisions will have on your ability to provide the highest level of care and services to the residents you are proud to serve. Moreover, it is imperative that the

Joint Finance Committee Members 2009-10

It is imperative that the provider community develop on-going relationships and dialogue with its legislative leaders.

18 CONTI NUUM www.whca.com • www.wical.org

SENATE ASSEMBLY Mark Miller, Co-Chair (D-Monona) Mark Pocan, Co-Chair (D-Madison) Dave Hansen (D-Green Bay) Pedro Colon (D-Milwaukee) Lena Taylor (D-Milwaukee) Cory Mason (D-Racine) Judy Robson (D-Beloit) Jennifer Schilling (D-LaCrosse) John Lehman (D-Racine) Gary Sherman (D-Port Wing) Julie Lassa (D-Stevens Point) Tamara Grigsby (D-Milwaukee) Alberta Darling (R-River Hills) Robin Vos (R-Racine) Luther Olsen (R-Ripon) Phil Montgomery (R-Ashwaubenon) Some of the 2009-10 COMMITTEE CHAIRS who are responsible for issues impacting the long term care profession include: Aging and Long Term Care: Representative Peggy Krusick (D-Milwaukee) Health and Health Care Reform: Representative Jon Richards (D-Milwaukee) Insurance: Representative Dave Cullen (D-Milwaukee) Jobs and the Economy: Representative Louis Molepske (D-Stevens Point) Labor: Representative Christine Sinicki (D-Milwaukee)

provider community develop on-going relationships and dialogue with its legislative leaders to make them aware of the issues that face the provider community. In doing so, you may become a resource for these individuals who are expected to be versed in such a wide variety of issues ranging from the mundane to the incredibly complex. There are certain general rules that make for the most effective communications with legislative leaders: Direct communication with your elected representative is the most effective method to get your message across. Invite your representatives to visit your facility, staff, and residents. This allows you to be able to discuss many issues and demonstrate the impact and worthiness of consideration of your issues. Written communication in the form of a letter directly from a constituent to the legislative offices does make an impact. Avoid lengthy treatises in favor of succinct individualized letters stating the issues and your position, with an offer to meet with the official or staff should they need additional information. Letters should be mailed, faxed or attached as e-mails to the legislative offices. Avoid simply putting your name on a petition or fi ll-in-the-blank postcard communication that evidences little or no effort on your behalf. Such communications have far less impact and persuasiveness and can be seen as not being important if you did not even take the time to write an individual letter. While it is important that you become known and visible to your individual elected officials, attention also should be paid to those legislative leaders who have increased ability to impact your issues. Typically, legislators in the majority party have far greater ability to impact the issues that you seek to advance. Committee chairmen have the greatest impact on your issues. Do not be offended or think that your issues are being minimized if you are unable to meet with your legislator directly. Given time schedules and the

magnitude of issues facing these individuals, it is not uncommon that you would be asked to speak with their staff. This is not a slight to you or a failure on your part; rather legislative leaders rely heavily on their staff to gather information. If you have a meeting scheduled with the legislator and are asked at the last minute to discuss your issues with their staff person, this is not a failed communication, as they are the ears and eyes of the official. Recognize that legislators are working people just like you. While they may hold a position of influence, ultimately they are interested in many of the same issues as you. Speak to them on a professional and personal level, as many of them have had experience with family or friends within the long term care provider community. Humanize issues for both your residents and staff. Even when you are talking about fi scal or regulatory dictates on providers, discuss with the legislators the impact that these have on your ability to provide the care and services that you both want for the residents you serve. Many issues impacting the long term care provider community will be discussed and debated in the 2009-10 session and now it is more important than ever that we make our voices heard. Mobilize your staff, residents and family members and make them aware of the issues. Communications from you and all other interested parties with legislators will impact their view and votes on issues. Mobilizing your staff, residents and family members can have a powerful impact on the question or action of the profession. Make your staff aware of these issues and encourage them to join you in communications with your legislators.

Jim McGinn is the WHCA Director of Government Relations. He can be reached at [email protected].

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stakeholder spotlight

A focus on individuals who are influential in the Wisconsin long term care community This edition: Otis Woods, Administrator, Division of Quality Assurance (DQA)

Regulating to Improve Quality OTIS WOODS HAS served as the director of the Division of Quality Assurance (DQA) for about three and a half years. Given the DQA’s oversight responsibilities for Continuum readers, we recently sat down with Woods for some insight into the role of his Division and his thoughts on regulatory matters.

We have an obligation and a responsibility to ensure we are acting responsibly in ensuring safe practice in our health care facilities and to see that consumers of health care services are safe. 20 CONTI NUUM www.whca.com • www.wical.org

CAN YOU DESCRIBE YOUR REGULATORY PHILOSOPHY AND GOALS FOR THE DQA? First and foremost, it is necessary that we ensure a consistent application of state and federal rules no matter the provider type, as a lack of consistency leads to an ineffective system. I am proud of the work DQA has done in the quality improvement arena. That is my overall goal…to improve quality but to do so with effective enforcement of state and federal regulations. We have an obligation and a responsibility to ensure we are acting responsibly in ensuring safe practice in our health care facilities and to see that consumers of health care services are safe. I expect to be held accountable for DQA responsibilities. My regulatory philosophy may be summed up through effective, effi cient enforcement of the regulations and continued involvement in publicprivate and public-public quality improvement partnerships/collaborations. Please note, however, that we cannot be a partner with the regulated community. We have a distinct role as regulators, and this must never be confused. We will collaborate on quality improvement initiatives because it should be everyone’s goal to ensure

that quality is good and that people are safe. HOW WILL THE ROLE OF DQA CHANGE IN A FAMILY CARE ENVIRONMENT? DO YOU SHARE PROVIDER CONCERNS THAT THEY WILL HAVE ANOTHER SET OF RULES AND OVERSIGHT BODY TO SATISFY? The DQA’s role in implementing Family Care is minimal, with the exception of the continued expansion of the assisted living provider community and the oversight that will be required. Our most significant role, however, will be sharing the results of our reviews with the Managed Care Organizations (MCO) as they are an extension of the Medicaid payment arm. Regarding my concerns for another set of rules, the only comment I have is comparing the MCO standards to that of being accredited. We have, in other regulated entity settings, accreditation standards that licensed and certified providers meet, although these are voluntary. The focus of the MCO is very different from our focus, and we try to explain that as much as possible. Since this will be new to many providers, and to ourselves, we will continue to look at any similarities there may be.

It should be everyone’s goal to ensure that quality is good and that people are safe.

LEADERSHIP T ur n To Your Long-Ter m Car e Leaders For Your Anti-Harassment T raining

Brian R. Purtell Health Law, Compliance and Appeals [email protected]

WHAT IS YOUR FAVORITE PART OF YOUR JOB? Knowing that what we do as an agency makes a difference in the lives of vulnerable people; seeing the successes achieved through the many quality improvement efforts (collaborations and partnerships), and talking with DQA staff at all levels about their jobs. It’s important to know what’s going on and to whenever possible, participate in positive change. LEAST FAVORITE? Having to read about and followed up, from a regulatory perspective, on the unfortunate and preventable events that cause pain, harm or, even worse, death, to a vulnerable person that has occurred in one of our heath care settings. The state should always be looking for ways to improve and learn from preventable adverse medical events that happen to vulnerable individuals.

Mindy J. Rowland Labor, Employment and Litigation [email protected]

hen Wisconsin’s long term care providers face unique legal and compliance issues, you can count on the attorneys at DeWitt Ross & Stevens. Our knowledgeable and resourceful attorneys can help you navigate through complex issues, including personnel training, regulatory compliance and enforcement, handbook audits, policy reviews and other compliance concerns. Capitol Square Office Two East Mifflin Street, Suite 600, Madison, Wisconsin 608-255-8891

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ANY PEARLS OF WISDOM OR SUGGESTIONS YOU WOULD WANT TO IMPART TO THE NURSING HOME AND ASSISTED LIVING PROVIDER COMMUNITY? Focus on systems improvement as a means of being innovative and improving the quality of care provided in each setting. Continue to share information across settings, especially because the vulnerable person that was previously served in the nursing home setting is now an assisted living resident. The key is ensuring that there are professional nursing, social services and other therapies available to the assisted living consumer. However, this by no means diminishes the significant importance of the nursing home; quite the opposite. Nursing homes remain an important component in the long term care continuum and will always be needed. The types of customers they will serve will differ greatly than in previous years.

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