Jeremiah 29:11: For I know the plans I have for you,” declares the LORD, "plans to prosper you and not to harm you, plans to give you a hope and a future."

Saturday, December 30, 2017


I hear teachers and people in the Christian community talk about God's favor.

I've read the story of Joseph and seen what God's favor looks like on someone.  No matter what bad thing happened to that man, he still rose to the top. 

Not too long ago when I was studying in Ephesians I felt impressed to research Bible verses on three specific topics: God's direction, God's ability, and God's favor.  I spent several hours pouring through the Scriptures and came up with a list of verses and passages on these topics. I made a page for each topic and put down my favorite verses for each topic on that topic's page.  At the bottom of the page I wrote down a few brief truth statements based on those scriptures.  I began to read these pages aloud daily.  More recently I've read each page aloud once a week. I'll just add reading a page aloud into my time with God in the morning; so that I'm reading a page on 3 weekday mornings.

As a nursing home administrator I've noticed in the past few years that the department of public health (DPH) has come down harder on my industry than ever before.  Although the relationship between DPH and the facility has always been one of policing, in the past I've been able to develop good relationships with local surveyors.  This has become more difficult to achieve in recent times. DPH has been much more adversarial.  I hear about them citing and fining facilities right and left; even though the industry has made some strides toward overall quality improvement.

On my 4th day on this job DPH came in for their annual survey.  We did not pass.  The reason was tied to an event that occurred the prior July. Although the leadership at that time had not handled that specific event in the best way possible, the fact that DPH caused it to make the facility not pass the annual survey was over the top unreasonable.  I wrote the plan of corrections as well as filled out all the numerous forms and wrote letters to go to a hearing about the actual ruling.  None the less the facility must be re-surveyed and must pass the re-survey. 

DPH took two months to come back to resurvey.  That meant two months of not being able to bill for any new admissions.  If the facility passes the re-survey, then they can back bill for those service days.  If they do not pass the re-survey, they basically provided it for free.  I've got a Director of Nursing (DON) who makes a lot of money and thinks it is a 9-5 with an hour lunch break kind of job.  Even when the DON is there, her head is not really in the game.  She doesn't exude any passion for her job  or take ownership. 

Sometimes my job is stressful.

I got sick this past week. Typically I ignore it when I'm sick and just go in to work.  But this time it was weird.  Every inch of my body ached and I was oh so tired. I most likely had a fever since I couldn't seem to get warm; the air just seemed too cold. All I wanted was to lay very very still.  I was nauseous and had a little bit of vomiting (I'd not eaten in a day so there wasn't much to retch up). At 7AM I texted the facility owner, DON and our business office manager (BOM) that I was just too sick and wouldn't be able to come in that day.  DPH showed up at 9AM.  The maintenance director texted me. I texted back the maintenance supervisor as well as the BOM and DON asking if it was for the annual survey. The BOM replied that it was. So I drug my sorry self into the shower, got dressed, and hustled in to work.

It was one of those days when I prayed for God's strength a lot.  At the end of the day I wanted nothing more than to go home and crawl into bed.  I had not eaten by now in two days, I ached everywhere, and could hardly keep my eyes open.  But I prayed for wisdom and presence and met with all the facility leadership to discuss the day's events.  I did my best at facilitating a strategy planning session. I was definitely not on my A game. Nursing homes are set up so that it is the administrator and DON who provides the leadership - without that presence, everyone would just go their separate ways.

I felt better by the second day. Not 100 percent, but at least I could think better and even managed to eat a little something and drink some tea (caffeine at last!).

One of the things that kept hitting me throughout the day was that it was as if these surveyors were going out of their way to do us good. It was as if they wanted us to pass.  When I talked with them they were reasonable.  A few of our high functioning, lucid, articulate patients went out their way to say good things about me (I know this because they each told me the things they'd said about me to the surveyors when I visited with them that day.  And no, I did not ask!)  The surveyors only noted 4 problem findings; which in recent years in California is very good. For this facility it was unheard of. There were things they could have mentioned that would have been very problematic that they chose not to. 

I think experienced the favor of God.

I won't know the outcome for a few weeks.  A month at most.  The supervisor of the surveyors sets the scope and severity for the deficiencies. In re-surveys it has to be a low scope and severity level in order to pass. Typically the supervisor listens and relies heavily on the surveyors.

I'm praying for God's continued favor.

Watching a little miracle

Photo from The endless disconnect
There's a woman at work. I'll call her Hester.
Hester came to our facility about 5 weeks ago.  Our DON didn't want to admit her because her record stated that she originally went to the acute hospital due to suicidal attempts.  It said that she had become withdrawn since her husband died. She had taken knives and attempted to stab herself and tried to jump off a second story balcony.  I felt like we needed to admit her (and it wasn't just because she had good insurance either).  Initially we had a C.N.A. with her constantly one to one.  We removed the call light and gave her a bell. She had plastic serving utensils The DON and I had intense discussions about removing the one to one, but we finally did it (sooner than the DON wanted and later than I desired).  Initially I went in every morning to see Hester but she wouldn't even look at me.  She looked angry.  At first she wouldn't eat. 

Hester only speaks Cantonese. I have staff who can speak Tagalog, Chinese, Vietnamese, Spanish.  I have only one staff person who can speak some Cantonese-Tao. She went in and tried to talk with Hester daily.  At first Hester wouldn't even look at Tao.  She never talked to Tao. I talked to the kitchen on Hester's second day and got them to make her a rice soup porridge type dish that I notice  many of our Asian patients enjoying. After Tao ate one spoonful first, Hester gobbled that right up.  The kitchen kept making that for her since at least she would eat it.  They would make her the regular meals plus the rice porridge soup.  She initially would only eat the soup.  We had to continue to eat one bite first.  Hester wouldn't take any of her medications when she first came.

Her nephew visited on her 5th day.  Hester gathered up all her belongings to follow him out when he left.  She seemed angry that she did not get to go with him. For the first few weeks it continued like this.

Then we stopped having to take a bite of the food first. She started taking her medication. We gave her regular utensils.  She began eating bites of the other food.  She started eating anything we gave her. She began to come to the door of her room if she wanted something such as a snack or roll of toilet paper for her bathroom.

One day she gathered up all her belongings and went to the front hallway.  Eventually we had to take her back to her room.  She started routinely seeking out snacks and occasionally coming out of her room to take short walks in the hallway. She would look at Tao when Tao spoke to her.

The other day Tao mentioned that Hester is now speaking to her a little bit on her daily visits.  Tao said that Hester still won't come into the group activity or dining room for a meal but that she's at least talking with her. Yesterday I saw Hester out of bed and standing beside the bed of her room mate.  She was curiously examining her sleeping room mate.  Hester was taking an interest in someone else!

Hester is going to be all right.


Sometimes I am
acutely aware of my brokenness.
It is not of the beautiful broken variety,
more like trash
sitting by the curb.
Ugly and undesirable.
I hate that I'm this way.
I want to be different.
I grow and change in life
but still at the core
is this broken part.
aren't we all broken?

broken people by lucri
Broken People by Lucri
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