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One on OneResident Life: Please give us a brief historic profile of your company, how it was started and what the company's initial goals were. Patricia Spence: Encore Senior Living is one of the nation's largest, privately owned providers of senior-living services, with primary emphasis on the expanding assisted-living industry. Incorporated in Delaware in November 1996, as a limited liability company whose members include the company's officers or affiliates and Rockwood Living Inc., an affiliate of Hyatt Corp. Prior to November 1996, the senior-living facilities were owned, leased or managed by Brim Senior Living of Portland, Ore. Brim Senior Living operated as a wholly owned subsidiary of Brim Inc. Brim was established in 1971 and shortly thereafter entered the senior-living industry, growing into one of the nation's most active developers and operators of senior-living facilities for the more than 20 years preceding the establishment of Encore. All five members of Encore's senior management team were previously part of the senior management team at Brim. Encore plans to develop 14 new facilities by the end of 1998. These new developments will be focused on a "niche" market within the assisted-living industry, directed at serving residents with Alzheimer's disease and related dementia. Encore has operation, fiscal and employee goals, yet, our number one objective is to own and operate buildings that are full of happy people. Resident Life: What was the impetus behind the most recent merger? Spence: Encore and Elderhaus merged because of our common approach toward the philosophy and care of Alzheimer's residents. Elderhaus focused on Alzheimer's and related dementia care, an area Encore also targeted. Through the merger, Encore is able to gain corporate growth, enter new markets with the Rediscovery program, continue to focus on Alzheimer's care and share knowledge and experience. Resident Life: How will this affect members of your staffs, as well as residents? Spence: Our existing staff and residents will go unaffected. New residents and staff members will benefit from the combined training and quality-assurance programs developed by Delores Moyer, senior vice president of Rediscovery, and me, which were an integration of the training methods and quality-assurance programming from Encore and Elderhaus that will bring a strong end product and place our combined company far ahead of the competition. Again, the merger benefits everyone. Resident Life: How has the company's mission statement evolved over the years? Spence: To discuss an evolving mission statement would be challenging at this point. Our young company feels our mission statement directly speaks about the role of Encore: Encore provides senior-living solutions that nurture the spirit, enable free choice, encourage independence, respect privacy, foster individuality and preserve dignity. Resident Life: How did you find your way into this industry? Spence: When I was young, my grandmother lived with me. Every day when I would get home from school she'd be waiting for me with a snack and a story from her youth. I relish those times spent with her and, eventually, I came to understand there was something very special about seniors. When I decided on a career in nursing, it made perfect sense to choose geriatrics as the field of nursing I'd work in. In 1988, after taking a sabbatical to raise my daughters, I reentered the workplace in Florida as a staff nurse in an Alzheimer's special-care unit. It was love at first sight. Since that time, I've been very fortunate to have found a company that is willing to nurture my passions with opportunities to grow in assisted living and Alzheimer's care. Resident Life: You were instrumental in developing an Alzheimer's curriculum for Encore. How did that program evolve? Spence: It was a combination of many things. First, the company had groomed me well by placing me in multiple positions over the course of six years or so. I had been a director of nursing, marketing director, administrator, regional marketing director and regional operations manager. This gave me the background I'd eventually need to understand all the encompassing aspects of the company's goals and objectives, and how I'd need to apply them to this position. Secondly, I had a lot of hands-on training with staff. I had to deal with staff, residents and families, many of whom I had cared for in past positions. I became a sponge for Alzheimer's knowledge. Anything I could read, any seminar I could attend and anyone I could talk to--for whatever reason was well-versed in this disease--I gravitated to. So, when it came time to write the actual program curriculum, I concentrated on practical application from my learned experience, as well as knowledge from the experts that have written programs of their own. Once I had the basics down, I tested it on a few small groups, and focused on feedback so I could make improvements. That aspect has now become a very important part of my presentation to staff. I teach, and they teach back. It's a lot of fun. Resident Life: Tell us how the program works. Spence: The program is written in eight modules that make the staff knowledgeable and proficient. The program is a "train the trainer" concept. After my initial presentation, the entire program can be delivered to ongoing staff by the nursing program director. There is a training manual, trainer's workbook, caregiver's workbook and overhead series that make up the actual teaching tools. Four steps are used to deliver the series: dialogue, study guide, module review questions and visual aides. I also include many games that relate to what I teach, such as memory, communication and problem-solving games. It's a way to let the participants relax a bit and, at the same time, place themselves in a situation they might face when working. It usually has a powerful impact. At the end of each module, I use real case studies for the trainee to work through as well. Resident Life: Are there any success stories that you'd like to share regarding the program. And how, exactly, do you measure the success of an Alzheimer's program? Spence: There are many success stories I could relate to you, but the one that always stands out, and the one I most often share with staff in training, is about a sweet lady I cared for several years back. She was an Alzheimer's patient in the middle stages of the disease. She presented very few care problems for staff, and was pleasant most of the time. The only problem we had with her care was her refusal to shower. She would scream and become abusive if we tried to get her into the shower. Her family and my staff became so frustrated in our attempts to bribe and congeal her to bathe. The family helped brainstorm in hopes of finding a solution to their mom's incredulous fear of showers. After little success, her son gave me the name of her only living sibling, a brother who lived in New York. I contacted him, hoping he would be able to tell us why she feared water the way she did. With much reluctance, he explained their dark family secret: They had been victims of the Holocaust, and had been witness to the death of their entire family. She was scheduled to die in the showers at Auschwitz, but the showers failed that day. They had vowed never to speak or share their past again. Together, they had kept that promise. We stopped trying to shower her and devised a plan of personal care that would meet her needs without fear. Instead of showering, we assisted her with full sponge baths daily, and once a week took her to a beauty parlor to have her hair done. Success happens with Alzheimer's one small victory at a time. Overcoming obstacles and breaking down barriers always leads us to another story of success. As far as measuring the success of an Alzheimer's program, we utilize tools such as family surveys and outcome-based measurement programs to evaluate such things as orientation to the environment, drug programs and remaining skills. How we really and truly measure success is by seeing the residents we care for experience a quality of life higher than what we could have hoped to achieve when they first came to us. Resident Life: What type of training is provided for caregivers in the Rediscovery program? Spence: Along with the classroom curriculum every caregiver attends, which we've already discussed, a clinical program is done as well. After classroom training, the caregiver is placed in a cottage where they shadow an experienced caregiver and are observed by the RN program director. An evaluation of strengths and weaknesses is developed as a learning tool for the individual. Depending on the results of the evaluation, they are given repeat training on an individual basis until they have successfully achieved the program's goals for caring for the residents. Each month ongoing training is given to all direct-care staff to sharpen their skills as well as introduce new techniques for care. In essence, training never stops. It remains constant and well-monitored on a facility, regional and corporate level. Resident Life: What are some tips listed on the "Caregiver Tip Cards"? Spence: These are some of my favorite tools created for staff members. The first run of cards lists tips on behavioral issues one might see when caring for someone with Alzheimer's. The set includes seven areas of common behavioral difficulties: agitation, sun-downing, paranoia, inappropriate sexual behavior, wandering, incontinence, personal-care problems and sleep disturbances. One side of the card lists the problem and possible causes, and the flip side lists the approach to problem-solve it. For example, if a resident is showing signs of difficulty with personal-care tasks, the staff can pull the cards to look at the possible cause. The resident's behavior may indicate the cause to be Apraxia (difficulty in initiating and completing tasks). Staff could then choose the approach for meeting that individual resident's needs. I have now begun a second series of tip cards entitled "Activities at a Glance" for the caregivers that assist with quick and easy activities set up for failure-free results. Resident Life: Does the program offer guidance for family members, as well? Spence: Families are an integral part of the Rediscovery program. Right from the initial contact, families are informed of the special way this program works. Administration spends a great deal of time relaying concept goals and objectives to the family so they can understand the program's expectations. Once families are tuned into the "remaining abilities concept," they are much more at ease and better equipped to actively participate in the on-going care of their loved one. Resident Life: In what ways do you market your services? What methods have proven most successful? Spence: There are several ways we market services. Prior to opening a new project we study the area to develop the best strategy. Typically, we'd utilize print media, radio and, in some areas, television advertising. We then create a "marketing plan," a guide for the staff that markets the project. The plan includes a full program of community networking and outreach. The method I have found most successful is word-of-mouth advertising. Nothing speaks stronger than that of satisfied families spreading the word that our facilities are the best placement decision they could have made for their loved one. You can't do any better than that. Resident Life: Do you feel the role of assisted-living professionals is changing? And, if so, how are you working to meet these new demands? Spence: Yes. Assisted living has started to evolve into a much larger field than it was even five years ago. We are finally recognizing that the care of older adults can be managed just as effectively in a non-medical model as a skilled environment. De-institutionalization has finally been accepted as an alternative route for the person who doesn't need constant or complex skilled-nursing care. Personally, I believe the kindest thing we can do is allow people with special needs, such as Alzheimer's, to live out the remainder of their days in an environment that is as close to a home setting as possible. As long as we continue to manage their needs in this setting, I feel we have provided them with a higher quality of life than what might otherwise have been possible. Meeting new demands of assisted-living professionals' changing roles goes far beyond the everyday demands of an individual center. Working to educate placement sources as to the advantages of an assisted-living placement decision for the clients they represent is an on-going challenge. Teaming up with regulatory bodies that govern change is vital in the future, and research continues to be critical to the ever-changing needs of this group. Resident Life: Do you feel the industry is serving its patrons in the most efficient and purposeful manner? Spence: I feel the industry is making tremendous strides in the approaches of how we better serve our customers than we did a decade ago. Recognizing there are options to long-term, skilled-care placement that can serve the needs of seniors today in a more appropriate setting is a milestone for this industry. People need to opt for the lowest, most independent level of care suitable for them. As their frailty level increases and their placement needs change, the continuum of care choice available kick in to best meet the individual's care level. Resident Life: If you could change one thing in the industry, what would that be? Spence: I'd change the reimbursement program for care in assisted living. As it stands, there is no federally funded reimbursement program for assisted living. It remains primarily all private pay or reimbursable by only a few chosen health-insurance policies. Some states give supplements that cover small portions, but they are meager with very high criteria for eligibility. I would like to see the focus for supplemental-program needs redirected to better address patient care and the cost of care to the provider, resulting in more cost-effective funding industry-wide. Resident Life: How do you define your role in the assisted-living industry? Spence: As leaders and teachers. I think we are the pioneers of the '90s. We are willing to take risks for what we believe can change this industry for the better, and at the same time, we are not afraid to share what we've learned along the way. We are what I would describe as "keepers of hope" for our dedication in finding new and innovative ways to serve a community of people in a desperate search for a more humanistic approach to meeting needs and achieving a higher quality of life. Resident Life: What have been the most memorable moments in your career? Spence: Tough question. There have been several moments of great personal meaning to me. There are those residents that I've been fortunate enough to have cared for and who have given back to me so much more than I could have ever given them. There have been hellos and good-byes from staff that became like family and there are people who believed I could achieve more than I aspired to and worked so hard to make that happen for me. There are so many moments, it's difficult to try to choose just one. This year, I was selected, along with two other Encore employees, to be the recipient of the Award for Excellence at our national leadership conference. David McCallister, senior vice president of finance, finished an introduction to the ceremony by stating, "Ordinary people doing extraordinary things are what makes companies like Encore truly successful." The truth is, I'm an ordinary person who works for an extraordinary company that makes their employees feel special by nurturing their individual talents and grading them with opportunities to grow. It is not often that one works at a job they love for a company they love. People need to have something to believe in, something that makes them feel valued for their contributions.
Before joining Encore, Ms. Spence held several positions at Brim Enterprises Inc. in Tampa, Fla., until 1996 when Brim merged with the Pritzker family of Chicago to create Encore. Her recent accomplishments include developing the Encore Senior Living Alzheimer's Rediscovery program curriculum and training materials for company-wide utilization. In addition to writing the policy and procedures for all Rediscovery projects, she devised a pocket reference "Caregiver Tip Cards" for staff use. She is also responsible for all staff training of the Rediscovery's standardized program. Ms. Spence received her LPN degree from Taunton School of Nursing in Taunton, Mass. She has also worked as an Alzheimer's specialty nurse for St. Mark Village, a not-for-profit life-care community in Palm Harbor, Fla. There, she assisted with the opening of the first Alzheimer's unit, dedicated by President George Bush.
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A
veteran of senior living and Alzheimer's care, Patricia A. Spence
brings her experience and knowledge to Encore Senior Living of
New Port Richey, Fla., as director of program development and
training. Her previous positions have involved operations,
marketing, communication and sales related to senior living and
Alzheimer's care.|
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