“Ambient Despair”

I started Sparky’s Policy Pub back in May because I believed it would be a productive and enjoyable means of sharing information, thoughts, opinions and insights on public policy issues likely to impact providers of affordable housing, aging services and post-acute/long-term care. 

Four months and 27 posts later, rather than write about the what, the how and the wherefore of healthcare policy, I want to pause and focus on the why.  The only significance of my chosen timing is the recent availability of an interview on Terry Gross’ Fresh Air: Advocate Fights ‘Ambient Despair’ In Assisted Living.   In this program she interviews Mr. Martin Bayne, a long time consumer advocate of long-term care – and current resident of an assisted living facility.

In the early 90s Martin started a web site called, Mr. Long-Term Care.  Back then while the world wide web was still in its infancy Martin was years ahead of his time in recognizing the tremendous value the Internet would offer in sourcing, aggregating and organizing content.  He embraced this vision by not only providing – but producing, through both written and audio interviews – what was widely recognized as the definitive online knowledgebase on all matters relating to long-term care in the United States.

I met Martin the way many did – through being first attracted to the tremendous resource that was Mr. Long-Term Care.  It became an indispensable means of quickly accessing statistics, research, opinion – anything that existed or was being developed to help better understand the market, operational and financial characteristics of the long-term care delivery system.

Fortunately for me, my relationship with Martin went beyond just accessing his web site.  In 1998 we cofounded the National Long-Term Care Policy Institute as a reflection of our shared passion for believing there was more needed to be done in terms of taking an honest, objective and candid look at what was working – and what was not working – in our delivery system.

To compare my passion to Martin’s beyond that, however, would be a disservice to him and his life’s work.  I wanted to see change – Martin has effected change.  Some years on now, I still look fondly on the time I spent working with him.  And while we each in our own way continue to fight the good fight, as you listen to Terri Gross’ interview, you will understand why my deference is not humility but personal pride in not only having had the opportunity to learn from Martin – but being able to still consider him a friend.


Click on Mic to listen to interview . . .


Pub Chat # 4: Community-based Care Transitions Program

In this edition of Pub Chat I interview Lori Peterson, founder and Principal of Collaborative Consulting.  Lori has been directly involved in helping to facilitate several successful Community-based Care Transition program applications, and she shares with us her insights about what it takes to put together a quality CCTP application.

For more information on the Community-based Care Transitions Program visit the Center for Medicare and Medicaid Innovation web site.  To contact Lori directly, e-mail here at Lori@collaborativeconsulting.net or call 866.332.3923.

Click on Larry’s mike below to hear this interview:


Pub Chat No. 2: Mark Testa ~ The Data-Driven Future of Healthcare

In this second installment of Pub Chat I am posting an interview with Mark Testa, the Vice President of Quality & Analytics at Catholic Health Services in Miami, Florida.  Mark is a Six Sigma Master Black Belt trained at Motorola and now responsible for planning, designing and implementing quality and process improvement strategies at CHS.

With or without last week’s SCOTUS decision to uphold the Affordable Care Act the healthcare industry – including post-acute/long-term care providers – has been steadily seeking to make greater use of Lean and Six Sigma methodologies in quality and performance improvement.  There are a lot of talking heads out there running around promoting the future of, “Data-Driven Healthcare.” Frankly, I don’t think many of them understand what that really means – and this is an area where having a little bit of knowledge may be more detrimental than continued ignorance if bad resource investment choices are made.

So I thought it would be helpful to provide some basic understanding of these concepts, as well as several suggested resources where you can learn more about quality and performance improvement in healthcare.  I hope you enjoy the interview, which you can listen to by clicking on Larry’s microphone, below:

  ~ Sparky

Recommended resources to learn more about Quality, Performance Improvement and the applicability of Six Sigma principles to Healthcare:
ASQ ~ Lean and Lean Six Sigma in Healthcare
Quality Digest
Lean-Six Sigma for Healthcare: A … Guide to Improving Cost and Throughput
Six Sigma in Healthcare: Today and Tomorrow (HIMSS)

Administration for Community Living

Last week I posted an audio interview with colleague and industry thought leader, Rob Hilton, President & CEO of the A M McGregor Group.  It is my intention (or at least strong hope) that will be the first of many such informative Pub Chats in the future.  My goal is to post two-to-three interviews per month.

As a follow on to the topic Rob discussed with us – Affordable Housing Plus Services – I wanted to make sure patrons of the Policy Pub are aware of the new Administration for Community Living (ACL), as well as provide some general information and background on this new division within the Department of Health and Human Services.

In her April 16, 2012 news release, HHS Secretary Kathleen Sebelius shared the following statement:
The Administration for Community Living will bring together the Administration on Aging, the Office on Disability and the Administration on Developmental Disabilities into a single agency that supports both cross-cutting initiatives and efforts focused on the unique needs of individual groups, such as children with developmental disabilities or seniors with dementia. This new agency will work on increasing access to community supports and achieving full community participation for people with disabilities and seniors.

Key objectives of the ACL include:
1. Reduce the fragmentation that currently exists in
    Federal programs addressing the community living
    service and support needs of both the aging and
    disability populations.
2.  Enhance access to quality health care and long-term
     services and supports for all individuals.
3.  Promote consistency in community living policy across
     other areas of the Federal government.
4.  Complement the community infrastructure, as
      supported by both Medicaid and other Federal
      programs, in order to better respond to the full
      spectrum of needs of seniors and persons with

At a conceptual level, these objectives should be supportive of new public policy efforts designed to integrate affordable housing, community-based services and healthcare: acute, post-acute and long-term.  Taken together, they represent a paradigm shift from a policy perspective that focuses on the “who” to the “what.”  Rather than a top down approach to providing for the variety of needs for distinct populations (e.g., elderly with chronic conditions, adults with behavioral health needs, children with disabilities), the ACL’s purpose is to transcend programmatic assistance across demographic characteristics.

If – and it is quite admittedly a very big if – the ACL can be successful in facilitating greater cooperation and improved communication by, between and among various federal, state and local agencies responsible for providing home and community based services (HCBS), the opportunities for the social integration of the populations served by those organizations is tremendous.  More importantly, the potential to develop local, community-based solutions that reflect a holistic view of individual health and wellness should – at least initially – merit our strong support, rather than a inclination to dismiss, “just another federal agency,” as I believe most of us have been prone to do.

But I will wager this: the ultimate success of the ACL will depend critically upon its ability to build productive knowledge exchanges with private sector organizations.  If successful in its mission, the ACL can help to knock down walls of bureaucratic obstruction that have historically impeded the efficient creation of community-based solutions that provide integrated services and care.  It will be the role of organizations having real world experience in planning, developing and providing HCBS, however, to work with the ACL in crafting public policy that aligns with and supports those solutions.

I think the Administration for Community Living has the potential to be a very positive step forward in addressing the tremendous challenges we face in providing affordable housing, community-based services and healthcare to our seniors.  I think it has the potential to create the type of excitement Rob Hilton shared with us in last week’s Pub Chat.  What do you think?

  ~ Sparky

Pub Chat No. 1: Rob Hilton ~ Affordable Housing Key to Long-Term Care

In this premier edition of Pub Chat, Rob Hilton, the President & CEO of the A M McGregor Group in East Cleveland, Ohio, shares with us his knowledge, experience and insights on the importance of affordable housing when addressing public policy efforts regarding aging services and long-term care for the elderly.  Rob has been actively and passionately involved in the national dialogue on Affordable Housing Plus Services (AHPS) for over a decade.

Rob was gracious enough to stop by the Pub last week to discuss how during his tenure at McGregor he became interested in the potential for AHPS and the challenges we face as a society in combining affordable housing with aging services and long-term care policy solutions.  He also provided some great insights on where he sees opportunities – and risks – for other provider organizations interested in exploring AHPS.  Finally, he offered his thoughts on where the future of AHPS is headed from a provider and public policy perspective.

You can listen to my interview with Rob by clicking on the mic below:


As always, comments welcome and encouraged.

  ~ Sparky