Like the great TV detective Columbo, Long-Term Living columnist Gary Tetz (Funny You Should Ask) always has one more question. In this bimonthly feature, he talks with long-term care leaders about anything that pops into his mind. He’s as surprised as you are that they’ll speak to him, and apologizes in advance for whatever inanity he might blurt out in the pressure of the moment.

Susan Gilster is smarter than me. Let’s start with that. She’s a nationally recognized leader in innovative healthcare project development, and an expert in leadership, organizational development, staff retention and dementia care. While I spent most of the ’80s listening to Mr. Mister and twisting my Rubik’s Cube, Dr. Gilster developed the first freestanding dementia facility in the United States. She’s also published two books: Changing Culture, Changing Care: SERVICE First and A Way of Life: Developing an Exemplary Alzheimer’s Disease and Dementia Program.

Hi, Susan. You’re based in Ohio, right?

Yes. Cincinnati. Home of the Bengals and Reds. I wish I could say that more proudly. Actually, I’m not a fair-weather fan. I’m an unbelievable sports fanatic and I’m very proud of them.

You’re an expert in organizational change. Why can’t you turn those teams around?

Give me five minutes with them.

Where would you even start with the Reds?

I think it’s all about leadership. Organizations and teams are about having expectations and accountability. It’s not okay to go out there and play half a game. It’s not okay to go out there and not hustle. I think when you have a job, you should do the very best all the time. And as a leader, you need to expect that. If you expect anything less, you get a whole lot less.

In the context of long-term care, you’ve said that it’s not how much people are paid that turns them into winners. The Reds are living proof.

(Laugh) Absolutely.

You’re nationally known for your work in Alzheimer’s care and leadership development, among other things. How can I become an expert in something? It looks like fun.

You know, it is a lot of fun. I think you become an expert when it’s something you feel strongly about, and when it makes a difference in your life and in the lives of other people. When you find something you have that kind of passion for, it’s easy. It’s not work. It’s just constant learning, getting better with every passing day.

You developed the Alois Alzheimer Center, the first freestanding dementia care facility in the United States. What was different about your approach?

Part of the dilemma in relationship to Alzheimer’s disease is we have a tendency to talk as though everybody is one and the same. From the beginning, we were very individualized in our approach to care. The founders were varied in their backgrounds in health and business, which I think helped us. We came in with a whole different perspective, and said it was all about individual service. When we look at somebody with Alzheimer’s and the trendy things that come and go, they’ll work for some people but not for others. Our job is not done until we figure out what works for each person.

I think the other thing was that they said it had never been done before, and those are just challenging words to me. I like to do things people haven’t done. We like to challenge the status quo, and we’ve been doing that now all these years.

How do you feel about the state of Alzheimer’s care generally?

When people talk about things like person-centered care, we scratch our heads and say, “What other kind of care is there?” You know? The fact that we should be of service to people was the foundation of the development of the center. And I mean service to everyone, not just the residents and their families. Service to the staff, service to whoever calls us on the phone, service to the man who delivers the boxes. I think people are finally starting to think more about what we’re really here to do and how can we do that better.

You also do leadership development. What makes a great long-term care leader?

I think they have to come with a real desire to serve others, and respect for the people they care for and work with. It’s fascinating that we’ve been doing research in long-term care for 30 years asking staff what they want, and the answers haven’t changed. What people are seeking is respect, the ability to make a difference in another person’s life, appreciation—all things that don’t cost anything, and yet we don’t seem to be able to get it down. Respect is certainly paramount.

But a person can come into a long-term care leadership position with great passion and respect, and still be overwhelmed and fall to pieces by what can come at them in a typical day.

Well, yes, they will go to pieces if they’re not well prepared, and we can’t just throw them into these situations with no support. We’re pretty good at getting them to understand the regulations, but that’s not the important part of being an administrator in a long-term care facility. If you’re a good leader, other people will take care of those things. I think the reality is the leader is in the people business, in the preparation business, and in the support and nurturing business. It’s not about how wide a door needs to be. It’s about how to nurture staff.

Why aren’t more resources committed to leadership development?

I think that’s changing. The truth is, money talks, and satisfied staff make for satisfied residents and families, which makes for good census and profits. So if people start to take a look at the impact of leadership in relationship to the costs of staff and the bottom line, they’ll find that more developed, better-prepared leaders have much better outcomes in their facilities. The research is out there.

If you could hypnotize new administrators and plant one thought in their brains as they embark on this career, what would it be?

Service. If you are determined to be of service to all the people you touch, it’s hard to not be successful. And you have to evaluate that service. I had someone tell me the other day that they don’t like to do surveys because only the complainers fill them out. Well, if you aren’t a big enough person to look at what you’re doing wrong, you’re destined to never get any better.

You talk a lot about change. Are you with the Obama campaign?

He stole my thunder.

The audacity of that man.

I know. Can you believe it?

How would you evaluate the leadership skills of the three remaining candidates?

My parents advised me two things: Never talk politics or religion, and I’ve lived by that.

Don’t worry. We’re not looking for an endorsement here.

To be a good leader you have to have walked in the shoes. You have to get down and understand the people who are working for you and who you’re working for. For instance, a good leader in long-term care does whatever it takes to get the job done. It’s not unusual for me or any of my managers over the years to have run the sweeper, to have cleared tables, to have taken someone to the bathroom. People need to know you’re going to be there and that you understand what they’re going through. That’s why it’s important for all of these candidates to have had jobs and paid taxes and understand what it’s like to run an organization in order to be able to speak to the needs of the people.

It seems like Sen. Clinton would be the one most likely to know the regulations, and Sen. Obama would be all about inspiring and motivating the staff. But he might not have the same depth of knowledge and experience. So who would you choose to run your facility?

I want the person with the passion. I can teach people tasks and how wide a door needs to be, but I can’t teach them to care.

See. I got you to talk about politics.

Yes, even though I’m not supposed to.

We’ve heard a lot about the word “change” in this Presidential campaign. In long-term care, isn’t just saying culture change over and over again enough?

No. For one thing, what is culture change, Gary? Can you tell me what it is?

I cannot. I was advised by my grandfather to never talk religion, politics, or culture change.

Well, culture change is the in-vogue buzzword, but I challenge people to define what it means. I think it really is more about culture creation, and there are some specific programs and pieces that make for a positive culture in long-term care. We’re talking about people, not about things. Culture change is not about residents having refrigerators in their rooms. Changing or creating a culture is about the people who work there. There’s been a lot of environmental emphasis in culture change, and I think that’s because it’s easier. I can go out and get a refrigerator or a dog and put it in a facility this afternoon, but I’m hard pressed to find a fabulous director of nursing who’s going to stay. We believe we need to consider the needs and desires of all the people who live and work in long-term care, as well as the environment, to bring about positive changes in the culture.

So what steps would you take to create a positive culture?

For one thing, we need to prepare and educate new staff. We can’t just throw people in a facility and then be mad when they don’t do what we want them to do. We have to set clear performance expectations, and include staff in planning and problem solving. Also, as I said before, respect is paramount in long-term care, and I can’t for the life of me understand why we can’t demand it of all parties involved—demanding that staff respect other staff, that staff respect families, that families respect staff. Finally, both administrators and staff need to take care of themselves and grow. Leadership development runs parallel to personal development, and that’s a lifelong process that should be never-ending.

Can I apply any of this advice to my own home? My wife seems to be demoralized. What can I do to change the culture and improve my spousal retention rate?

(Laugh) I would suggest that perhaps you talk to your wife and listen to what she has to say. If administrators would be open and listen to their staff, families, and residents, then perhaps they could fix some of the culture issues in their organizations, just like you could fix your marriage.

And I suppose you’re going to say it’s cheaper in the long run to keep the spouse I have, rather than to be always finding and training new ones?

Oh, honey, you’ve got it. That’s for sure. It’s going to cost you on both sides of that equation. (Laugh)

Well, thanks Susan. I’ve appreciated talking to you. But I’ve read some of your work, and haven’t we forgotten something?

What’s that?

Now that the interview is over, shouldn’t we recognize and celebrate my accomplishment?

Absolutely. (Laugh) I think we should. You’ve done a delightful job.

That’s it? I thought I’d get a cake in the break room.

Gary Tetz

Gary Tetz is multimedia consultant at Consonus Healthcare Services. He was a columnist for I Advance Senior Care / Long-Term Living from 2005-2012.