This Month’s Victim:

A widely respected MDS expert and frequent presenter at state and national conferences, Leah has been called “the Erma Bombeck of long-term care.” Never at a loss for words, she brings her own unique insights and humor to any discussion. I tracked her down at her Alliance, Ohio office, where she was just kicking back after an intense week of nurse training.

Hi. Is this Leah?

There’s nobody else here at this time of night, honey.

Let me make sure my recording device is working.

Would you like me to sing a few bars of the “Star-Spangled Banner” while we’re waiting?

That’s always a good way to start.

I have been known to spontaneously vocalize at various times in my career.

Such as?

When I have a seminar group that’s not paying attention, I use all kinds of ulterior and alternative methods to get them to focus.

Such as?

My style has always been on the edge, and I do a lot of things spontaneously. I’ll move people around the room, or sit on the lap of a participant. I have placed lipstick-laden kisses on the foreheads of men with receding hairlines, particularly when they say something profound related to my topic.

As positive reinforcement?

Right. It brings a certain sense of camaraderie and enjoyment to the learning environment. Usually I try to focus on the most unsuspecting members of my audience, especially those who try to hide in the back row.

So who were you working with today?

All week I’ve been training nurses to be excellent teachers of caregivers.

Did they pay attention? Did you have to throw an eraser or send anyone to timeout?

No, but I had to make them relax. Nurses are so serious.

Do you use any special tricks to train nursing home administrators?

Something I suggest is for them to show up to work in sweats and actually stay in a resident’s unit for half a day. Get in the bed, listen to the noises, experience things from the resident’s perspective. Ideally, I have them do that for a 24-hour period, where they have to ask for assistance to get to the bathroom, have their meals brought to them, and are actually a recipient of care. Those who do this tell me how much they’ve learned, but it takes a certain degree of bravery to put themselves in that position.

Do any of them crawl into bed, pull the covers over their heads, and refuse to return to their jobs as nursing home administrators?

I think that on various days that would be an excellent escape.

For people who aren’t familiar with your enterprise, you’re the founder of the Alliance Training Center (ATC). Is that in any way connected to the shadowy international organization that was Sydney Bristow’s nemesis on the TV show Alias?

No, I have no part of that. In fact, the ATC is a fabulous nonprofit foundation that was conceived to focus on caregiving and caregiver education.

You’ve never met anyone named Sloane? You have no knowledge of the Rambaldi device?

I do not have any knowledge of that, nor do I wish to. That’s beyond my skill set.

The show seemed to center around people in tight-fitting costumes performing late-night spy tasks in Baltic countries.

I have traveled in Baltic countries in loose-fitting clothing and found it to be very enjoyable.

So what exactly do you do at the ATC?

Among many other things, I’ve been running a caregiver education program since 1989. We’re also the only company in the country that offers a nationally recognized MDS competency program for interdisciplinary professionals.

As a young girl, when was the first time you remember lying back on the grass, looking at the clouds, and dreaming of the day you could spend every waking moment immersed in nursing home regulation?

At the age of 17, I was told by my mother that I was going to be a nurse. I didn’t have any significant introduction to the profession, other than that I had been a candy-striper in the hospital snack bar. I enjoyed working there because we could have two hot fudge sundaes every day. So basically I got into nursing because I liked ice cream.I was the first child in our family to go to college. My parents packed me in the car one day and dropped me off at the campus with my two little suitcases and bedding. It’s a far sight different from the way kids go to school today, renting the U-Haul truck and making 14 trips.

Did you immediately know you’d found your niche?

Yes, but when I graduated, the dean of my school of nursing warned me that I should never work in institutional care because I was much too unbridled. This was back in the early 1960s, and I was one of the nurses who wouldn’t stand up when the doctors came on the unit.

Why not?

I didn’t see any reason why I should. I was busy.

So you left hospital nursing and gave up all that ice cream?

No, I didn’t give up the ice cream.

And now doctors stand when you walk into the room.

Well, I hope some of them do.

How did you get into long-term care?

A friend of mine was the director of nursing at a local nursing home, and needed another nurse. I had a bachelor’s degree, and she named me the assistant DON. I had no idea what that meant. It was a rather large facility and I became absolutely dedicated to improving the lot of the residents. I also discovered I had an innate skill to communicate to groups, so I started teaching and have never stopped.

I see on your Web site that you teach a MEPAP course. Isn’t that a mask-like device people slip over their faces at night so they don’t die in their sleep?

(laughs) No, that’s a CPAP.

Oh. I think you’re right. I shouldn’t make fun. I actually have a CPAP machine.

Then you know how it can change a person’s life.

Absolutely. It has totally cured my apnea—mostly because when I wear it, I can no longer sleep at all. But what does MEPAP stand for? It sounds really selfish.

(Courtesy laugh) The MEPAP is the Modular Education Program for Activity Professionals, and it’s way overdue in our industry. If I ever go to a home, the activity coordinator is going to be my best friend because that’s where the quality of life comes from.

If you ever become a nursing home resident?

Right. I tell my audiences that there are only three things I’m going to need when that time comes—my cell phone with all the programmed CMS phone numbers, a simple dietary regimen of merlot and lobster, and handsome caregivers to take care of me. Of the male gender, if possible. Handsome, sensitive, young caregivers.

On a scale where 10 is playing with a puppy and 0 is cleaning up after a puppy, how much fun is conducting MDS reviews at facilities?

I realize this is a very perverted part of my thought process, but I get great satisfaction and joy from it. I’ll go around the corner and down the street on a Saturday for a chance to do an audit. It’s like mining for gold.

That is perverse. You should have that checked.

There’s nobody out there to check it, or to help me with my problem.

You have clients and do presentations all across the country. Any favorite stories?

Many. One day a frustrated administrator called me in to do an audit. His MDS coordinator was a very tall lady, and I quickly noticed that to get her computer monitor high enough so she could sit comfortably, she had it on top of six unopened MDS manuals. The first thing we did on that audit was replace the manuals with a block of wood, and get them to the people who needed them. Their system worked better after that.Another time I was in Oklahoma giving a presentation to about 200 people. I was facing large windows in the back of the room, and could see what looked like a tornado taking shape, but the audience could only see me. I guess they were so fascinated by my stories that they didn’t realize something very bad was coming. Finally, someone came rushing in and told us to evacuate.

Then you found out later that it wasn’t a tornado. It was an arriving survey team.

(Laughs) The tornado did touch down less than a mile from where we were. We wound up in a basement corridor surrounded by lots of very congenial healthcare workers.

What’s your view of the survey process these days?

It’s much more focused and organized than it’s ever been, and that is not to be taken as a compliment. The regulations are still very difficult and much too broad. We are over-regulated in areas that could be handled with very fundamental programs.

But then again, you’re a rebel who wouldn’t stand up when doctors came into the room, so you could be just defying authority.

Perhaps. (laughs) But I’m actually very close to the age when I could be a recipient of care, and I look at the regulatory process selfishly, asking “Is this something that would improve my care?” One of the things I have continually fought against is that surveys have to be done over and over again in buildings where good care has been substantiated. I just think it’s a waste of time.

And now they’re going to charge facilities for revisits.

Well, maybe if they get paid for the visit they’ll have a better attitude when they get there.

Do you think back at the CMS home office they’ll put up a big tote board with the revisit fee leaders in big black letters?

Yes, and they’ll probably give away trips to the Bahamas, or have a pizza party for the survey team that does the most.

What about MDS 3.0?

The 3.0. Oh, my gosh.

I hate sequels. Is this turning out to be more like The Godfather, Part III or Daddy Day Camp III?

I have a very basic issue with the 3.0. I want to know where the money’s going to come from to adjust all these facilities’ computer programs to the new form.

That’s easy. It will come from all that extra Medicaid money nursing homes get.

Yeah, (sniffs) and what about all the training we’re going to have to do? We’ve been working with MDS 2.0 since before 1999, and we don’t have it right yet. I think we should do a good job with the form we have.

But on the bright side, the 3.0 will guarantee endless work for you and your cohorts.

As I told you before, I find MDS work exciting. Some people might consider that kind of sick enjoyment, but it’s not. It really is all about getting better care for the resident.

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.