This Month’s Victim:

Phil Fogg, Jr. is founder and president of Marquis Companies, offering skilled nursing, assisted living, Alzheimer’s, and home care services since 1989. As though running 26 facilities throughout Oregon, Idaho, Montana, Nevada, and California isn’t challenging enough, he also provides pharmacy, rehab, staffing, and consulting services through Consonus Healthcare Services. Phil has served as president of the Oregon Health Care Association, and as an American Health Care Association board member.

You are what they call a provider.

Yes? (with some low-grade fear in his voice)

I’m envious of that designation because it’s a very important-sounding word. It seems essential, like you’re the lifeline of civilization. You Provide—with a capital P. How does it feel to be a Provider?

I have a lot of pride in the term because I think what we do is so important in the lives of seniors, and to our staff. Being a provider offers a mechanism to make a difference. And it’s better than being a non-provider.

You’re talking about me, aren’t you? You’re suggesting I’m a leech, a barnacle on the hull of society.

No, you’re not.

Thanks.

I truly mean this. Everybody has a role and a chance to make an impact. Aligning your values with your professional career is the important thing, and that’s the great part about long-term care.

What is it like to do what you do in this 21st century?

Well, it can be very challenging, especially if you lose sight of why you are a provider. The workforce shortages create a lot of stress for people, from the caregiver to the executive level of long-term care, and I don’t see that easing off any time soon. It creates constant pressure on the quality of job you can do and the amount of service you can provide.

How did you get into this profession?

I’m actually a fourth-generation nursing home administrator. I had a great-grandmother who started acquiring facilities in Oregon in the late 1950s and ’60s. She was pretty entrepreneurial for her time, and eventually transferred the facilities to her kids. I then started my own company in 1989.

Four generations. That’s an impressive heritage. Did you know that in the early 1900s, members of the same British family served as chief executioner of Britain for 50 years? So you’re in good company.

I did not know that.

Was there ever a question that this is what you were going to do?

Not for me. From the time I was about 12, I worked in the facilities and immediately gained a passion for long-term care. I loved the residents, the staff, everything about it. And when I went to college, I was one of the one percent of kids who knew exactly what they wanted to do when they got out of school. To this day I think long-term care administration is the most challenging thing you can do, and I was drawn to that challenge at an early age.

What’s your earliest memory, your first connection with the profession?

I was probably six or seven. I remember walking the halls in my dad’s first facility, and pushing my brother down a very steep hill into a sticker bush. That one always brings back a smile from time to time.

There was a hill inside the facility?

No. Outside.

Your grandmother recently passed away. What was the most important thing you learned from her about success in long-term care?

What grandma did better than anything when working with staff was to clearly define her very high expectations and always follow through. She was very consistent about that. She was also incredibly organized. She had the ability to effectively balance multiple roles in her life, and I find 75% of the people who are not successful as administrators in our company generally fail because they are not organized. All the demands and the paperwork just overwhelm them.

What’s your family secret for sticking with it all these years?

I know this sounds like a platitude, but I think what’s kept us in it more than anything is a strong work ethic, a passion for what we do, and being able to keep a positive attitude. If you’re doing something that’s tough or that you don’t like, and you can’t maintain a good attitude about it, you’ll burn out quickly. But we have fun with it.

We have a little saying: “We take what we do very seriously, but we don’t take ourselves seriously.” I think that is one of the things that has helped us keep positive attitudes. Because everywhere you go, you run into people who take themselves pretty doggone seriously.

Those people are called regulators.

(Laugh)

What have been the greatest threats to your positive attitude over the years?

When your Medicaid reimbursement rates are much less than your actual operating expenses, that makes it very challenging to maintain a positive attitude. And the whole regulatory process is not very enjoyable, especially when you’re evaluated unfairly.

What’s the key to overcoming those threats?

I’ll tell you exactly what it is. It’s to stay focused on why you do what you do, which again is making a difference for people. You have to keep those other things in perspective. They’re just a part of the challenge. And the great thing about long-term care is when you go through tough times, you see people’s real character.

How should your profession be reimbursed? What makes better sense to you, and wouldn’t undermine your positive attitude?

First of all, let me say that to be in business, it is not unreasonable to think that at a basic level you will have your costs covered. Having said that, I also think that since Medicaid is a majority of our revenue streams, or is for most providers, and since it is taxpayer dollars, utilizing funds responsibly is also key. I’m for a flat rate system at the 75th percentile of costs for the state. It does create some losers, but those are a small percentage and, in general I see the total dollar disparity between cost and what you’re reimbursed much closer in flat rate systems than I do in cost-based systems.

How about if I go to Harvard Business School for several years, and then we can finish this discussion?

Okay. But let me just add this about Medicaid. I think we have to reexamine our income eligibility. If I were president right now, I would undo the asset protection that people have. If they didn’t realize there was a limit on how much they would have to contribute before Medicaid would kick in, and if there weren’t these trust vehicles to protect people’s assets, you would see more motivation for individuals to invest in long-term care insurance, which I think is a big part of the funding solution.

If you were president, most people would be saying, “Wow, he looks like John Edwards.”

(Laugh)

None of what you’ve described will ever happen in your lifetime, right?

Well, who knows? I’d like to think so. But it’s going to be really hard. You can choose to print this or not, I don’t care—but there are so many special interest groups, including our provider community, out there funding the political machine that it’s very difficult to get anything done that’s in the best interest of the taxpayer and the country as a whole. And most of the initiatives to significantly change long-term care policy seem to get driven by state or federal government. That means you can’t get any consistent policy because every four years there’s a leadership change.

What are the key traits of a great administrator? You’ve seen a lot of them over the years.

One is, again, organization. That’s a key. But the other is leadership. They’ve got to be able to motivate and manage people in a positive way. It’s a very labor-intensive service we provide and you have to be able to work with people. And not just with their staff. You have to be able to build and maintain relationships with the regulatory agencies, the counties, the state, the families. You have a multitude of people who are involved in the process of caring.

What about the worst administrators you’ve ever known? Feel free to use their real names.

(Laughs) The number one thing that causes trouble is if someone doesn’t treat residents and staff with respect and dignity. If they don’t do that, they’re gone. Along with that, if they don’t have a passion for seniors or the people we care for and don’t enjoy being in that environment, they fail immediately. Third, this is a tough job, and if they don’t have a work ethic they won’t succeed.

Those are the three things that usually trip administrators up at the beginning of the job. After that, if they’re not strong leaders with a strong constitution, they’ll fail in our organization.

How soon can you tell if somebody is going to make it?

My staff might disagree, but I think I can tell at a first interview within about an 85% success rate whether somebody’s going to be successful or fail.

How? Through their handshake or maybe the lack of direct eye contact if they’re Canadian?

Exactly. But the thing I love most are the people I’m wrong about. They’re the ones who are more compelling to me later than the ones I was right about.

They keep you humble, too.

Yes they do.

Since I’m sure all your employees view you as an infallible deity, what is your key management philosophy?

I think at the end of the day, everyone wants to be in a positive environment where people have a lot of energy and passion for what they’re doing, and where good work is appreciated. That’s the culture we try to create through all the decisions we make on a daily basis. The good part about long-term care is we get so many opportunities to make decisions that show character and drive culture.

Let’s suppose, for just a moment, that I’m one of your administrators and I’m feeling overwhelmed by the following scenarios. What would you say to keep me from packing it in:

Five CNAs called in sick.

Hopefully, it’s just a one-time occurrence and not a routine problem. I would tell you about the time I had six of eight CNAs call in sick with the flu when I was just starting out. It was all hands on deck—we all worked the floor that day. And that’s the kind of teamwork you should expect from everyone at your building.

A family member yelled at me.

You have to realize that the service we provide is very emotional for people, and you’re often dealing with feelings that may have nothing to do with you or the facility. You can’t let it affect your dedication to the profession.

Wow! You’re good. My favorite resident passed away.

I certainly wouldn’t want to undermine the fact that you bonded with a resident. It’s great you had a chance to make a difference. I’d try to get you focused on the positive things you did to make that person’s end-of-life experience as positive as possible. Because of you, they didn’t have to stop living or experiencing value and worth.

My director of nursing and medical director are having a fistfight in the lobby.

First, take them out of the lobby and put them in a private room. Why are you laughing? That’s a serious response. Then try to assess the problem. The fact that two of your most highly compensated and educated leaders are having a fistfight would suggest you have bigger problems.

My building is losing money fast.

Well, we’re going to talk about why. We’re going to look at everything you have control of and try to impact those items. Labor hours. Consumable purchases. Contract therapy. We’ll try to develop a plan to create margin without sacrificing mission.

What if it’s my fault, and you have to fire me?

Usually if I’m doing things right, it’s not going to be a surprise. You will know before I get there that it’s time to go because we’ve clearly communicated in the past the things that need to change. You’ve either not chosen to take action or don’t have the necessary skill or talents.

Now I just feel bad about myself.

Sorry.

I heard you’re now operating a facility in Las Vegas. Is there a casino in the lobby?

No, but we do have a skilled building there, and every night the residents go gambling. It’s a 180-resident facility, and a seat on our 16-passenger bus going to the casino is the most popular, most sought after of any activity. And I don’t know if you’ve been to a casino lately, but there are also a lot of potential nursing home residents in there.

Do you have Don Rickles opening for Celine Dion in the break room?

No. But we should.

Is operating a facility in Vegas your way of settling once and for all whether gambling is a safer bet than trying to make a living in long-term care?

I think running a casino would be easier. That’s my guess.

Now let’s say I have serious dementia and a very bad attitude. My family wants to put me away in a skilled nursing facility for a long, long time. Why should we choose yours?

(long pause) You’ve silenced me.

You don’t want me. That’s what you’re saying.

Well, let me ask you, are you private pay?

No. I don’t have any money. I was a writer.

Clearly, a psych facility might be better for you.

True, but for the sake of this discussion…

Okay. Then I’d say yes because we’ve got staff with a lot of longevity, and we’ve created a culture of people who care about making a difference in the lives of residents like you.

Well, you seem to have an answer for everything. I wish I had remembered to ask my funny questions.

That’s okay. I’m not very funny.

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.