The Quiet Alarm — When Care Becomes Concern

The Quiet Alarm

When Care Becomes Concern

Each adversity I've walked through to this point has been sequential. Truth be told, that's how life works: a series of highs and lows that we navigate as part of our individual journey. If we're intentional about identifying and nurturing any possible seed from every adversity, we have a strong shot at making sure each high is a little higher and each low is less of a dip - even when the actual issue we're dealing with is more significant than any previous one. Detailing how global disruptions forced us to adapt to unforeseeable situations was very specific to some of the business challenges we encountered through 2020 and 2021. That said, there were plenty to work through in our personal lives as well, a few of which spilled directly into business relationships. Like everything else I've shared through this process, though, I know I'm not alone; I have no doubt the issues you worked through during that period were at least as significant. My goal with this isn't to commiserate with you on who was dealt a worse hand, but to do everything I possibly can to help you pull any seed from that period that may still be hidden.

I shared earlier that just as Cindy and I were embracing some of the biggest leaps we had ever made in our careers, and working through the process of an institutional battle that seemed simply overwhelming at the time, several of our family members were going through health challenges. Cindy's mom's cancer diagnosis and my grandmother's fall that fractured several vertebrae. As I mentioned, Cindy's mom passed away just six months after. Granny progressed, but was never able to return to her "home" apartment in independent living where she had been for close to twenty years. When she left the rehab facility, we moved her into a newly opened complete care facility. It was on the same campus, but at the opposite end from where she had been and she had far less autonomy.

The first two years were reasonable, but carried a hefty price tag. Despite the fall and broken vertebrae, she was eventually able to get around with a walker - but still needed assistance more than she ever had before. By late 2019, though, her mobility had declined significantly. Through all of that, Cindy and I were able to visit several times each week, and my mom was there almost daily. In late 2019, we showed up one afternoon to find her with two black eyes from a fall. We questioned it and learned that the staff had notified my mom, who was listed as the primary point of contact, but didn't necessarily provide her with all the details they should have given the significance. We gave them the benefit of the doubt, while paying very close attention from that point forward.

In the final months of 2019 and the first couple of months of 2020 - until we were barred from going into the facility due to Covid regulations - Granny's falls became more frequent; more than 20 in a three-month period (and I'll circle back to that soon). By then, we were communicating with the facility staff daily. We discussed care plans and every other detail you can imagine. Cindy's time in business development in the senior living industry provided a critical understanding for what we could expect and a detailed knowledge of the state regulations that staff was mandated to abide by.

In one of the last times we were able to visit but the Covid shutdowns began, Granny's care plan notebook was left open on her bed. In reviewing it, Cindy found several documented falls that had not been reported to us or my mom; a blatant regulation violation. More on that next. Even after going through some incredibly challenging experiences, and surviving them, bad situations can surface as quiet deterioration in systems that claim to protect the vulnerable. That's where what we saw as neglect met strong advocacy. Before we dig into that, think about a time you first sensed something was wrong in a care or protective system. What emotions did that trigger and what was one early warning sign you may have minimized?

The Discovery

Neglect Meets Advocacy

I can't say I ever enjoyed doing incident investigations through all the years I spent in safety. That said, the investigations were much easier for me to stomach that providing direct care. I'm fine with seeing my own blood, give me a piece of duct tape and we're good to go, but I might just pass out if I see much of anyone else's blood. The problem with an incident investigation is that someone was almost always injured. One of the seeds I pulled from that experience was a keen ability to analyze data for behavioral trends and root causes. That was incredibly useful through many of the care plan conversations we had with the staff and nursing director we were paying a fortune to see to Granny's safety and wellbeing.

After a quick study of those twenty-plus falls in right at ninety days, I realized that more than seventy-five percent of them had occurred between 10p and 6a. Coincidentally, there were only three staff members covering twenty-two residents during that time. Technically, that fell within the state regulation. The bait-and-switch came with eleven residents being in one building and eleven being in another - and more than 100 feet separating the completely unattached buildings - leaving just one to meet the needs of eleven elderly complete-care patients at any given moment. In theory, a second person was available but that assumed they weren't tied up with something else and that they were even paying attention.

We politely raised this concern in one of the care plan meetings and were told our only option was to hire someone on our own to provide any additional service Granny may need. Knowing the coverage guidelines and learning about the unreported falls led us to insist on a face-to-face conversation with the organization's CEO, someone Cindy had worked with for years earlier in their careers. After a brief check-the-box listening session, the CEO said they wouldn't be able to add more staffing "even if they wanted to," citing a shortage of workers with that skill set.

Here's a bit of perspective: from late 2017 to early 2020, we were paying nearly $12,000 per month for Granny to live there and be cared for. And there were ten other residents in that same building. Do the math and help me understand how tough it could be to add another $12-14/hour employee (that was the average wage for that role at the time). The fact that we chose to bring this to the CEO civilly rather than file a formal complaint (based on staffing and unreported falls) wasn't appreciated at all. On so many occasions leading up to that, that same CEO told us how easy Granny was to care for. I guess that $12k/month was nice when there wasn't much work tied to it. I pointed that out when I realized we were being brushed off, saying that apparently the easy quarter million they had already been paid hadn't earned much collateral when any real attention was necessary.

I can't think of a time in my entire career where I wasn't willing to work my guts out to help an organization I had any kind of relationship with. In fact, we had hosted a fundraising event for THIS organization just a few years prior to when all this unfolded. But like the scenario earlier in our careers where the jackass was sexually harassing ladies who were uncomfortable standing up to him on their own, there was no option where I was willing to stand for that crap happening to Granny. In the original Roadhouse movie, Patrick Swayze said "Be nice, until it's time not to be nice." That time came as our conversation with the CEO wrapped up.

Caregiving conflicts test sympathy and courage; discovering harm to a vulnerable person forces a choice between comfort and moral action. I was absolutely not looking for that fight, but I wasn't willing to back down from it either. And that brought family strain, institutional pushback, and professional risk, all of which we'll start working through next. Before that, think of a time you witnessed (or even suspected) neglect or mistreatment of someone vulnerable. What blind spot in loyalty or institutional trust did it expose? For us, having such a strong and test foundation built on our core values made all the difference.

Ripple Effects

Family Strain, Institutional Pushback, and Professional Risk

Our conversation with the CEO and nursing director, neither of which had a direct hand in any of Granny's day to day care but did hold final responsibility for the staff who did, was on February 14, 2020. We were cordial, but we were also very direct in detailing the twenty-plus falls in just three months leading up to that, how 75% of those had occurred in an eight-hour window with only three people available for 22 residents across two separate buildings, the falls that had not been reported, and several other care plan items they committed to that had not been fulfilled. We hoped that talking with them directly rather than filing an anonymous formal complaint to the state regulators would have been a show of good will; it was not received that way.

I already shared how that conversation ended so I won't go there again. To be completely honest, I'm still a little pissed about that all these years later. They claimed to be better and they were very capable of providing better - for Granny and every other resident they were pillaging - but they chose not to do better. What I will share is that each interaction we had with anyone who had even the slightest bit of supervisory or management responsibility in that organization over the weeks that followed was strained, at best. Word had clearly traveled. Make no mistake, that didn't bother me at all. The challenge came around March 12 when the buildings were locked down due to Covid and we could no longer check in routinely to maintain a reasonable level of accountability. Communication had already dropped off dramatically and that "social" distancing meant we could no longer keep an eye on the situation.

Watching a loved one go down hill as they age is hard enough. Having little impact on improving care, especially when you're paying a premium for that care, adds strain in every aspect of a family dynamic. Adding the apprehensiveness we experienced from everyone with the slightest bit of responsibility after bringing our concerns to their attention compounded it. And for good measure, toss in the idea of only being able to talk with that loved one through an iPad screen. Each of those individually is tough to deal with; combined, I don't think "frustrated" begins to describe where we were.

Systems that fail the vulnerable amplify every previous pressure; controlling what we can control and choosing advocacy over silence should prevent deeper resentment and unlock cooperative strength, assuming everyone involved has good intentions. Unfortunately, that's not always the case. As great as that organization's messaging was from the outside, we learned quickly that not everything that glitters is gold. We had heard some rumblings from former and the occasional current employees. After years in human resources and safety, I learned to trust but verify. Not only did those rumblings prove true, we had a front row seat for watching how toxic a situation can become when folks are more focused on putting on a good show than doing the good work to back it. We address that in Stage 4 of each Advantage series pillar: saying one thing publicly and doing something far different internally. The institutional pushback that followed added even more family strain but it spilled over into several business relationships as well.

Throughout Leveraging Leadership Growth, I shared the many things I've been blessed to learn from so many great mentors over the years. As much as anything else I learned from Terry Ward and Rod Little, I learned that standing my ground on principle doesn't have a price tag. We'll look at how a deep understanding of that grows when you're in the thick of it next. Now, though, I'll challenge you to think about a situation where you've had to advocate for someone you cared about. What pushback came your way as a result? What did you learn from that and which one of the leadership attributes we've been looking at through this process did it help you strengthen?