Episode 10: How Does a Senior Living Community Operate?
“Episode 10: How Does a Senior Living Community Operate?” Released: 2022. Track 10. Genre: podcast.
Transcription
Sue Lanza:
Hi, everyone. And welcome to another episode of House Guest, the podcast about all things related to The House of The Good Shepherd, a retirement community in Hackettstown, New Jersey. I’m Sue Lanza, the CEO, and I’m joined today by my co-host, the Reverend Shawn Carty, who is our chaplain. Please enjoy. Good afternoon, Shawn.
Rev. Shawn Carty:
Hello, Sue.
Sue Lanza:
How are you today?
Rev. Shawn Carty:
I’m doing well.
Sue Lanza: Top of the afternoon to you.
Rev. Shawn Carty:
And to you. How are you?
Sue Lanza:
I’m delightful as always.
Rev. Shawn Carty:
We’re in construction mode here, so.
Sue Lanza:
We are, sO I was going to kind of downplay that.
Rev. Shawn Carty:
You don’t want to talk about that?
Sue Lanza:
No, I don’t want to talk about that.
Rev. Shawn Carty:
All right, let’s talk about something else then.
Sue Lanza:
But wait a minute. We’re on episode 10, which, how is this possible?
Rev. Shawn Carty:
I know.
Sue Lanza:
I’m not sure, but we’re rolling right along. So we have a different slant this time. What are we talking about?
Rev. Shawn Carty:
We do, well in this case, I’m going to sort of interview you, but you’re-
Sue Lanza:
What?
Rev. Shawn Carty:
Yes, indeed. So you’re the expert today.
Sue Lanza:
Oh boy.
Rev. Shawn Carty:
The real question is, how do you set up a place like The House of the Good Shepherd? And I’m thinking a lot about the history. Back in the 1880s, you remember sister Sylvia? We’ve talked about her before.
Sue Lanza:
Oh yes. Yes, yes.
Rev. Shawn Carty:
And a group of churches kind of came together and they said, “Here’s a need, we need to address this. Let’s create The House of the Good Shepherd.” And here we are a 100, some odd 40 years later. My sense is, I just have a sense of it. I know of that things are very different.
Sue Lanza:
Oh, very.
Rev. Shawn Carty:
And that’s where your background in senior living and all of the work that you’ve done puts it into perspective. So tell us what, I mean, as you look at The House of the Good Shepherd or another retirement, senior living community, what is involved in all of that? How do you create something like that? What’s the structure that gets put into place? It’d be helpful for our listeners to know some of that, because then they’ll have a perspective on how this place functions.
Sue Lanza:
Right, how do we get things done around here? And it’s a very good question because people don’t quite understand how all the parts move. And a lot of it is the same. Even if when they were back in the Oranges, I know they made reference to somebody doing the laundry and somebody getting the meals together. Some of those things don’t change. What changes is because of the size and maybe the type of services you offer, some departments are maybe less important or could be done by a person having more than one function. So when you get larger, even though we’re supposedly one of the smaller CCRCs member, continuing care retirement communities in New Jersey. So some people wear more than one hats for their job. We don’t have 10 of something that a larger place might have.
But I think the whole operational question is one that people just don’t understand like, well, how do things get done around here? How does everything happen? Does when they say it takes a village, it does take a village. It takes all the parts working together. And when things are not working together, boy, oh boy, we sure as heck know it around here.
Rev. Shawn Carty:
Well, I was thinking earlier episode or earlier things that we had read, when they moved here in the 1960s from the Orange location, they brought, I think it was like eight staff.
Sue Lanza:
I know.
Rev. Shawn Carty:
What are we now? We’re not eight, I know that.
Sue Lanza:
We’re, and they use this barometer when they’re looking at a lot of things, of whether you’re employer of a 100 people or less, or a 100 people or more, we have more than a 100 employees. Right now we have about 130 and that’s taking into account, they’re not all full-time. So full-time part-time and then some what they call per diem workers. So they have certain requirements, they have to work maybe a spring holiday and a summer holiday. And then they have to fulfill some other obligations, but they are not a full-time staff member. So it’s changed a lot from eight people.
Rev. Shawn Carty:
And of course we were only 20 or 30 residents back then too, in terms of the ratio of staff to residents, it’s almost a one to one.
Sue Lanza:
Yeah, that was a lot. And some of those folks were wearing multiple hats, you know? So probably when you said the matron, which still give me the willies to hear that name, the matron probably did I’m guessing the bookkeeping.
Rev. Shawn Carty:
Yes.
Sue Lanza:
And probably did the admissions and discharges and a lot of clerical functions. I still do a lot of things like that too, but not to the level that she or he would have done back then. But there’s just, people ask me, “Well, what do you do? What is your role?” And my role, I have a dual role because not only am I the CEO, so I’m the top person in charge. I’m also functioning as the administrator of some of the medical parts of our facility. And I have to have a license for that and I have certain oversight requirements. And it’s only because of our size that I can manage that.
Rev. Shawn Carty:
Because normally those would be separate people doing those jobs.
Sue Lanza:
Two different people. And as we get bigger or change, that may happen too, which would be a blessing for me. Because being an administrator is a huge responsibility, one that I don’t take lightly. And sometimes I have multiple priorities and I have to always remember what’s the most important.
Rev. Shawn Carty:
Well, I think for example, with COVID, I would imagine some of your administrative responsibilities have been, like the reporting-
Sue Lanza:
Oh, the reporting.
Rev. Shawn Carty:
Things to this state and other agencies that happens.
Sue Lanza:
Yeah, yeah. This has to get done, no matter. It doesn’t matter and I, as the administrator I get certain things come to me and I have to make sure they get done. How many vaccinated people are there. We have to turn this in every week. How many of this, how many of that? Every day we have reporting responsibilities and they’re probably never going to go away.
Rev. Shawn Carty:
If somebody was totally unfamiliar with a place like The House of the Good Shepherd, how would you describe that? Using some terms, images that they might be familiar with already?
Sue Lanza:
I think of it kind of like a hotel that has some aspects of medical care connected with it. Because everybody can relate to what a hotel is like, you check in, you have a room, maybe there’s a dining room downstairs, you get a meal, there’s a phone in your room, there’s a Bible in the drawer usually.
Rev. Shawn Carty:
Somebody will come fix the leaky pipe if it’s-
Sue Lanza:
Exactly. The air conditioner’s not working. And then to me it’s sort of like a mini city because we have a lot of different aspects and operational departments that all need from the same songbook in order to make this all happen. And we happen to have here, and different groups might have different things. Like one, or you mentioned that House of Good Shepherd used to not have healthcare. So they decided, and it happened in the early 2000s that they added on the health center. But before that they might have done it in some manner, but not in the official way where we have skilled nursing. So people can come long term or short term. So, that’s a certain license bed. Then we have assisted living. And then we have a form of assisted living called comprehensive personal care. And then we have independent living. So at one point it was only independent living and maybe assisted living, some combination of that. And then they added on the health center.
Rev. Shawn Carty:
And the really big distinction as I understand it, correct me if I’m wrong, but is it’s all about the medical care. So, it’s-
Sue Lanza:
It’s the level of medical care and amount that you need of assistance.
Rev. Shawn Carty:
Yeah. And that is very, and I think rightly so, highly regulated and-
Sue Lanza:
Very.
Rev. Shawn Carty:
… you don’t just hire somebody to be a nurse. You make sure they have the proper credentials.
Sue Lanza:
Right, right.
Rev. Shawn Carty:
When it was simply independent living or when the regulations were different, you wouldn’t have had to worry about-
Sue Lanza:
No, you don’t.
Rev. Shawn Carty:
… much of that.
Sue Lanza:
So that’s why people could wear multiple hats easily in a very small place. The guy who’s cooking the eggs maybe didn’t have to have the same kind of guidelines that we would if you were working in a skilled facility.
Rev. Shawn Carty:
I will just go on the record and say, I’m very glad for the health department when it comes to inspecting the restaurants-
Sue Lanza:
Food and stuff. No, me too. Me too. Oh man, the health departments have really grown in their importance as healthcare has evolved, because look at us today with COVID. They had to hire people from other states to be surveyors to keep up with the demand. And it’s really changed a lot.
Rev. Shawn Carty:
Well, it makes sense too, as you describe it as a hotel that provides medical care. Because I have a background in hospitality and I get that, but I was never in a place where we offered medical care, except having a first aid kit somewhere in the building in case somebody cut themselves. But that’s very different from what we offer here.
Sue Lanza:
And I think it’s a great way to describe it to somebody who really doesn’t have a clue what we’re doing, because everybody pretty much has been to a hotel. If you add medical care, there’s a lot. There’s all the hospitality aspects as well as all the technical care aspects.
Rev. Shawn Carty:
Well, and you know I love words.
Sue Lanza:
Oh?
Rev. Shawn Carty:
Hospitality and hospital are the same words, of course. So, and I would say particularly from the perspective as a chaplain and a church person, part of our mission in the world, in the church is to be hospitable to other people, to welcome them. And there’s a wonderful line in one of the books in the New Testament in the Bible that says, “You may entertain angels unaware.”
Sue Lanza:
It’s true.
Rev. Shawn Carty:
So when we welcome folks into the community, that’s part of what’s happening is hospitality that kind of springs from our roots really.
Sue Lanza:
No, that’s a good point.
Rev. Shawn Carty:
For someone who’s not familiar with the kind of operational and structure stuff here at the house, how would you describe that? What are some of our departments and?
Sue Lanza:
Yeah, there’s quite a few actually. You’d be surprised how many we have. And again, this is why I’m saying people wore other hats, because some of these things had to get done no matter what. So of course there’s administration, you have to have a head banana of some sort running the place.
Rev. Shawn Carty:
You’d rather be a banana?
Sue Lanza:
Yeah, I feel like a banana half the time, ready to slip on that peel and go right down now. So there’s got to be somebody who’s in charge. So in some places it’s called an executive director, some places a president or a CEO. It’s a person who the buck stops with them, no matter what. You’re hoping as a CEO or administrator, whatever it is, that things are supposed to be handled at a lower level, and with the chain of command. But things do bubble up, and when they do, I have to get involved. And as I do, we have a whole system for that.
Rev. Shawn Carty:
As you know, I’m sympathetic because in my own work in parish ministry over the years, we don’t talk of it like this. But parish priests is essentially the CEO of the-
Sue Lanza:
Exactly.
Rev. Shawn Carty:
It’s-
Sue Lanza:
Yeah, I understand it.
Rev. Shawn Carty:
That’s not really the model we use, but-
Sue Lanza:
No, because it sounds too corporate.
Rev. Shawn Carty:
But at the end of the day, if an official paper needs to be signed or if a decision needs to be made about hiring a plumber to fix something, somebody’s got to make this decision.
Sue Lanza:
You do, you have to step up and be able to lead. Leading has gotten very challenging these last few years. But the good thing is, I do have support. I have an executive assistant, which many people would have, someone who would be kind of the right-hand person that could keep the day-to-day office running. We have receptionists that kind of fall under administration. So the people who greet you, the concierge when you come in, or the people are answering the phones. People are vital. We need this. Especially when we had lockdowns and people need to get information, these people are valuable. And I am going to have an AIT, which is an administrator in training going to be joining soon. These are poor folks who want to become an administrator.
Rev. Shawn Carty:
Oh my goodness.
Sue Lanza:
I know. I’m not sure why. I’ve asked the woman, she seems very delightful and we have to check into this and see what she’s up to.
Rev. Shawn Carty:
So this is kind of a mentorship or apprentice?
Sue Lanza:
Yes. In order to become an administrator, this is the same pretty much in every state, but varies on how many hours and things. But you have to do a certain number of hours, which is almost equivalent to a full-time job’s worth of hours over a period of time. And you have to do it outside of your regular job. And you have to do it usually in the evenings, on Saturdays or take days off. Every administrator has been through it and it’s quite grueling. You have to hook up with somebody and you have to kind of beg somebody to be willing to do this. Because there’s a commitment of time that’s involved to really spend time with the person and not just sign the papers and move them along. Because the COVID thing’s got frozen down a little bit, but somebody has been, a friend of mine referred this woman to me that she’s been an assisted living administrator, but she wants to get her administrator’s license for long-term care.
Now, if you have your long-term care administrator’s license, you can be an administrator of assisted living, but not the other way around. She can’t. So she’s going to come next week. And so she has a certain number of hours she has to do in every department. We had to go over it, what’s it going to cover? The Department of Health had to approve it. We’ll write reports and we’ll try to get her through here. So she’ll be a big help. See, this is where I get the benefit because I’ll be able to assign her projects and I’ll have another set of hands to help me with things. Especially bigger projects that take a lot of time over a period of time, I know she’ll be here, that’s good. But so that’s another piece of administration. And sometimes we have interns that work in other departments and we have to kind of oversee. They’re doing their college credits or things like that.
Rev. Shawn Carty:
And one thing, I don’t know if you’re going to say this later, but part of your work is an administrator is also working with our board of trustees.
Sue Lanza:
Yes.
Rev. Shawn Carty:
That’s-
Sue Lanza:
I’m glad you reminded me of that.
Rev. Shawn Carty:
… different in our situation because we are a nonprofit.
Sue Lanza:
Sure.
Rev. Shawn Carty:
We don’t have a single person who owns us.
Sue Lanza:
No. And I used to work with owners, so it’s the same way, but it works a little differently. Because it’s by committee versus I would, sometimes have one owner or brothers or something that own the facility and, “Talk to this one, he’s the finance guy. Talk to that one if you have an operational question.” But this is done a little differently, so you’re right. The board management piece and governance is a whole thing into itself. Even this example of having the renovations take place, that doesn’t just happen overnight, it’s a process and it literally started two and a half years ago. You have to get the funding. You have to have the idea and what has to change. There’s so many pieces to it, but I’m grateful because I’m glad you mentioned that is another part of administration.
Rev. Shawn Carty: Again, that’s part of my background in churches and I just know sometimes nonprofits are not always known for being nimble when it comes to making decisions.
Sue Lanza:
They don’t spin on a dime.
Rev. Shawn Carty:
No. And by definition, because you’re tending to work on community consensus on things with the governing board or with the community. So there are some things that are challenging about that, but also some in that as well. But I just know that’s part of your work as well with the administration.
Sue Lanza:
Yes, good point.
Rev. Shawn Carty:
Tell us about another department?
Sue Lanza:
Well, the next biggest one and sometimes some of us administrators have often said, there’s what we call the big nurse theory, because the nurses are, you cannot have a nursing home without nurses and they will remind you of that because that is true. If you have a true nursing home, like we have a skilled nursing unit, that means you have 24-hour nursing care rendered by nurses and nursing assistants. All the rest of us are also there, all the housekeepers, but it is a nursing home. That was the old-fashioned way of calling it. We don’t call it that, we call it skilled nursing, campus, facility, unit, whatever it may be. But that’s the way it is. So the nursing department traditionally has someone who’s in charge, either a director of nursing or a clinical services manager, somebody who is managing the clinical complement of the unit, which is totally different.
And this is why sometimes administration might get not into a clash, I wouldn’t call it that, but maybe a disagreement on things because something may make sense financially, operationally, but clinically it’s what the person needs, so we have to discuss those things. So then we also have somebody who’s either an assistant to that person often, or in our case, like we have a director of wellness here who just oversees the assisted living folks, which is another whole animal in itself, different regulations. And so it’s good to have someone who is very personable and able to handle what are less clinical needs, more social needs over there. And sometimes you have a supervisor, somebody who’s a nursing supervisor who takes charge on the weekends or other things.
Also, you have, of course the nurses, you have RNs and LPNs and in nursing homes or skilled nursing areas, and I’m only using nursing homes because people can relate to that description sometimes better than skilled nursing, we often have licensed practical nurses instead of skilled registered nurses. And there’s a little difference in the training, of course. Sometimes the care needs are not so acute, so a licensed practical nurse can certainly render medications and do so many things, but we still do need a certain number of registered nurse hours in order to remain a skilled nursing facility. We have our certified nursing assistants who do all the care needs, the bedside needs of changing and helping with what they call the activities of daily living, the ADLs, and getting people up and down and fed and to bed, out of bed, showered, all those things. So they do a tremendous job.
Rev. Shawn Carty:
Well, and you know I come from a family with lots of nurses.
Sue Lanza:
I know you do.
Rev. Shawn Carty:
And my mother and my wife, my daughter. In most cases, not all, but in most cases they’ve worked in acute care settings-
Sue Lanza:
Sure.
Rev. Shawn Carty:
… meaning hospitals-
Sue Lanza:
Absolutely.
Rev. Shawn Carty:
… or places. But you’re right, this is different. We’re providing care around the clock, but it’s not the sort of care you would have in a cardiac unit, in a hospital, it’s-
Sue Lanza:
Things beeping and monitors going off. We don’t have that. We’re trying to take care of you. You need things throughout an entire 24-hour period, but it’s not at that acute level.
Rev. Shawn Carty:
As you know from an earlier episode, we discovered that there was great excitement when the local hospital was built.
Sue Lanza:
I know.
Rev. Shawn Carty:
The residents were quite excited about that, that was finally happening. They’d been waiting for four years.
Sue Lanza:
I know. Yeah, well, it does make a difference.
Rev. Shawn Carty:
That’s down the road. What would be another one of the larger units for us?
Sue Lanza:
Oh, yes. Probably dietary, because first of all, we get three squares a day every day. Well, some of our residents maybe don’t opt for meal plan and things like on the more independent side. For skilled and assisted living and our CPC unit, our comprehensive personal care, they get three squares a day. There are medical components to all of that, which our dietician would help with. The director would be the person who oversees the whole kitchen operation, and there’s very strict sanitary requirements. People have to have background in this. You have a dietician who would help with a lot of the menus and specific items that we need. And as you get higher up into the more required care levels, like up on the skilled unit, we have different dietary textures, people who have swallowing difficulties. So we have to provide consistencies that are different, that are by a doctor’s order. Then we also have all the different menus. We have low salt, low sugar, renal diet, there’s all kinds of things that we have to do. And we have to be very specific.
Then on top of it, we have everybody’s likes and dislikes, which as far as I’m concerned, you could put that on the top of the list. We didn’t get this, we didn’t get that. And I put this on my menu and we have that all the time. And this is what goes on at home, in restaurants.
Rev. Shawn Carty:
When families get together for holidays. You know that part of my background, I managed a retreat house for a little while. And the big thing then was gluten free. And I know that’s still part of the [crosstalk]-
Sue Lanza:
It is still one of them, yep.
Rev. Shawn Carty:
Yep. But there was always the question, “Is this because you’ve got celiac disease or is, what’s your level of tolerance?” And trying to be very respectful to folks who have different. And as you also know, I’ve been a vegetarian for 25 years, and so.
Sue Lanza:
Right, we’d have to accommodate you.
Rev. Shawn Carty:
Slightly aware of how that goes in certain places, but you’re right, foods can be such personal tastes, and-
Sue Lanza:
Well, yeah. Yeah, some of the residents will say, “You can make whatever spaghetti you want forever, but it’s never going to be like grandma’s.”
Rev. Shawn Carty:
They’re right, of course.
Sue Lanza:
And we’re saying, “You’re right, because we don’t put the exact amount of sugar or salt or whatever you put in your.”
Rev. Shawn Carty:
Exactly.
Sue Lanza:
So the cooks are the ones and the chefs are the ones who put this all together. And then we have a dietary staff, as well as a chef that we have sort of a decentralized system here, which many places do. We don’t have every tray come them out of the kitchen and go upstairs. We have some little satellite kitchens that they serve the plating and stuff right out of there, and then deliver them to either the dining rooms now that they’re open, or resident rooms. And then the back end of it is the cleaning of everything, the dishwashers and the pot washers who have to clean this all up. So we can, guess what, start all over again in the morning.
Rev. Shawn Carty:
Well, and I have some experience in that too.
Sue Lanza:
Oh boy.
Rev. Shawn Carty:
The commercial dishwashing is a sight to behold.
Sue Lanza:
Oh, it really is. It’s something, if you’ve never done it, you should go in and ask, see what that’s like. They do amazing job, but that environment is wet, damp, hot-
Rev. Shawn Carty:
Hot, yep. Slippery on the floor-
Sue Lanza:
Slippery-
Rev. Shawn Carty:
… The whole thing.
Sue Lanza:
Yeah, even with mats and stuff. We’re grateful for our dietary department as well as nursing and administration, for sure.
Rev. Shawn Carty:
Absolutely. And as you know, in the chapel right across the hallway from our kitchen, so I’m very fond of them. The other group I’m fond of, which I think is your next group, is housekeeping.
Sue Lanza:
Yes.
Rev. Shawn Carty:
Tell us about that?
Sue Lanza:
They are a great group, and I’ll tell you, I’ve loved housekeeping people over the years, housekeeping laundry, environmental service, whatever you want to call them. They’re the cleaners and the ones who take out the trash every day with a smile on their face. They have really come into their own as being such a vital member of our team. They always were. But with COVID they are wiping surfaces, high touch areas. They have a vital role in this whole thing. And when we had our COVID unit open at different times, just like many other facilities, they had to go in and be in the line of fire. Hats off to them.
Rev. Shawn Carty:
Absolutely.
Sue Lanza:
So there’s a director, of course, somebody who’s in charge. And then there are housekeepers and porters. And a porter is simply someone who usually does the floors. We have some carpeted areas, so they would do carpet cleaning, but they would do floor mopping and maintenance does a little bit of this sometimes. Like after every meal you have to sweep, we have to mop the floors. Just like at home, if you dropped your hamburger piece on the floor and you don’t have a dog that’s going to immediately eat it, you better get a broom out or your vacuum and you got to sweep because you got breakfast coming the next morning.
Rev. Shawn Carty:
Well, and one thing I would say too is that the housekeeping staff is all over the building, much like the maintenance staff, I think.
Sue Lanza:
Yes, everybody knows them, who they are.
Rev. Shawn Carty:
Exactly. And the other thing, and I’ve noticed this too, is that they pay attention to the very small but important details.
Sue Lanza:
They do.
Rev. Shawn Carty:
The things that are out of place. And I think of the number of times something needs attention. It’s our housekeeping staff that [crosstalk] first.
Sue Lanza:
You’re right about that. Yeah, and even with resident changes in behavior, they’ll sometimes be the first one to tell the nurse, “You know what? I was talking to Mrs. Smith and she’s just not herself today. She seemed.” And it could be the beginning of some illness or something coming on. They give that great information. Good point on that. And Lisa’s kind of right into maintenance. Those two departments are kind of connected. They do a lot of work together. The maintenance department and keeping a building, a campus like this in working order is nothing short of a miracle half the time.
Rev. Shawn Carty:
Well, how many acres are we? We’re like-
Sue Lanza:
15.
Rev. Shawn Carty:
… 15 acres.
Sue Lanza:
Yeah.
Rev. Shawn Carty:
And this is a building that has how many residents altogether?
Sue Lanza:
Let’s see, if you minus, 130, 40 people in it. And then the staff. So you have-
Rev. Shawn Carty:
Any given day there are maybe almost 200 people in this building.
Sue Lanza:
Yeah, in and out, up and down.
Rev. Shawn Carty:
That’s a lot of light bulbs and bathrooms.
Sue Lanza:
Everything.
Rev. Shawn Carty:
And pipes and lawns and all kinds of maintenance that has to be done.
Sue Lanza:
It’s a lot, it’s a lot. We’ve been here a long time, since 1965. So we have some older parts of the building, which have maybe some more challenges, just like you have in a home that’s maybe a little older, you have to baby things along. And can’t just, “Well, I think I’ll just replace this.” “Well, no, you got to make sure you have the money for it.” We have a director of planned operations who does a great job of trying to keep all the balls in the air and keep it moving, because every day is a new thing. And then when you add on things like COVID and restricted wings, “And we need you today. Go put up a plastic in the hall because we’re setting up a unit. Or move these tables, move this, move that here, do this, do that.” It’s a lot of moving parts. You have the seasonal things like the snow. And like you mentioned, the grass. They’re working all night to keep us safe so we can get the staff in. And so as they’re going to pick up staff.
Rev. Shawn Carty:
Well, and I learned that last winter and we’re all hoping this winter doesn’t have quite as much snow-
Sue Lanza:
Please, please.
Rev. Shawn Carty:
… as last winter, but there were at least a handful of us who stayed overnight.
Sue Lanza:
Sure.
Rev. Shawn Carty:
Probably, I don’t know. Was it four or five nights last [crosstalk]?
Sue Lanza:
It was, we had quite a few, and a few in a row. We were here for two nights in a row one of those times, I don’t know, it’s a blur.
Rev. Shawn Carty:
I stayed over those nights, partly because of the length of my commute, but also just wanting to be helpful if I could. Watching that, it’s-
Sue Lanza:
It’s a whole process of what goes on. And I think the people who stay, and we have a lot of great people who just, they just automatically pack their bag. They know they’re going to stay, great. Many of our nursing staff and we have little nooks and crannies and places for people to stay. Or in your office, or I’ve stayed in some empty resident apartments that I think are haunted.
Rev. Shawn Carty:
Well, and I discovered quite interestingly that last year, because I stayed over those four or five nights that I was talking about. I just slept on the floor in the chapel behind the altar. And what I found out was that there were several people who were quite disturbed to see a shadowy figure in the chapel.
Sue Lanza:
Oh, I know.
Rev. Shawn Carty:
And it’s just the chaplain, don’t worry about it.
Sue Lanza:
Yeah, don’t worry about it. But we have fun too. First of all, everybody is tired by eight o’clock for some reason. Like if you were at home, you’d be up later. You’d just run out of energy from either trying to help them with the salting or bringing food or, and then we have pizza and I don’t know, it’s just a fun bonding experience in some crazy way.
Rev. Shawn Carty:
Yeah.
Sue Lanza:
I can’t even explain. Unless you’ve been through it, you wouldn’t know what it’s about.
Rev. Shawn Carty:
But again, let’s not hope for a really-
Sue Lanza:
No, we’re not hoping for those bonding. I’d rather just have a hamburger with somebody.
Rev. Shawn Carty:
Exactly right. One of the groups I think you’re going to talk about next is in some ways very much behind the scenes, but absolutely essential.
Sue Lanza:
Oh, yes.
Rev. Shawn Carty:
Tell us about the next one?
Sue Lanza:
The business office. Every place has a business office. You might, if you’re part of a bigger corporation, which we are not, you might have a smaller one because the home office does a lot of these functions, but you always have to have a face-to-face part where we collect money from residents, we dispense money from personal needs accounts. We do the payroll, we do the accounts payable. We have to pay our bills and we have to collect our money from people. And one of the places that you may not think that we have to collect from is from the government. We provide Medicare, Medicaid, other services here that we bill a third party, like managed care like Aetna or Cigna or whoever. We have contracts with quite a number of managed care organizations. And we have to build them.
But there’s a process because you have to build, then you have to wait to be approved or denied. And if you’re denied, then you have, and they say, “Well, we need two weeks of therapy notes.” And then you have to go dig those out and mail those out. And so there’s the accounts receivable is a big factor because it impacts our cash flow here. So we’ve had to stay on top of it. So we’ve got somebody who’s a business office manager who helps us and kind of oversees what’s going on. And then we have folks that do our payroll. So we make sure our employees are paid and we move the money around so that we have money in the accounts. So when they cash their check, there’ll be money there. And then also to pay the bills, we want to stay current with our things. And we have a great team in there who does all that for us.
Rev. Shawn Carty:
Well, and I think some of the, actually a number of the groups you’ve already mentioned, as I was saying are kind of behind the scenes, whether it’s keeping the plumbing working or cleaning or keeping the bills paid. And I think, for example, that image that somebody shared with me once about when you see a duck swimming across a pond.
Sue Lanza:
Oh yeah.
Rev. Shawn Carty:
Looks very calm on the top just swimming along. But underneath there are two webbed feet paddling furiously.
Sue Lanza:
Right. Feet, don’t fail me now.
Rev. Shawn Carty:
To keep things moving in the right direction. I think number of the folks you’ve talked about who do their work in very quiet and unassuming ways behind the scenes, but absolutely essential.
Sue Lanza:
No, and I think that’s a very good point because they interact with people, but they are much further afield and that doesn’t mean that their contribution isn’t as important as anybody else’s. And when one area isn’t functioning, it does impact the other area. It’s always like a big balancing act to keep everybody afloat.
Rev. Shawn Carty:
The next group, I know you have a personal history, some of your background-
Sue Lanza:
Yes.
Rev. Shawn Carty:
… in this area. So tell us about the next one?
Sue Lanza:
So activities are recreation. So this is what we do to meet everyone’s needs, not only for leisure and recreational things, but educational, diversional, spiritual, and that’s where chaplain helps us out with that. But there are so many aspects of someone’s enrichment that they need. And yeah, I was an activities director for six years. It was a great experience, because I was hands-on with the residents and learned all their likes and dislikes, what they like to do and tried to bring that to them the best way possible. So we have a director and like many places, we have activities assistance and they go about the business of doing group as well as large groups, small group, and then individual activities based on the level.
And we do cater to folks who may have some different needs socially or cognitively. So we might have some different groups that can work better together. We do the best we can to meet everybody where they are. We also work with volunteers. Now we can bring volunteers back, but for a while we couldn’t, and they read letters to people, they read books, they just help us gather people for programs. There’s a lot of things that can do, but boy, activities often feels like they’re a neglected part of things, but they were another group during COVID that was extraordinary.
Rev. Shawn Carty:
They’re the point of connection between residents and families.
Sue Lanza:
Exactly.
Rev. Shawn Carty:
When we’re under some of the most severe restrictions.
Sue Lanza:
Exactly.
Rev. Shawn Carty:
They’re the ones who are holding up the phone with the video so that residents can say hello to family members, things like that.
Sue Lanza:
Yeah, or the window visits and just keeping people connected. And they also, another group that volunteered and went on the COVID unit and they really extended themselves and thought outside the box on how to deliver activities when you couldn’t come out of your room.
Rev. Shawn Carty:
That’s right. I’m curious, how did you get interested in recreation and activities? And we used those terms interchangeable-
Sue Lanza:
Yeah, they’re interchangeable. When I was a kid, I did camp work with younger kids and I just said, “Wow, this is really very enriching to work with different age groups.” And then I decided to take a job in a nursing home and I really fell in love with it. And just like that population and felt like I related well to that population. And then next thing you know, I said, “Hey, maybe I’ll become an administrator.”
Rev. Shawn Carty:
This could be a career.
Sue Lanza:
Yeah, so it’s, but it’s good I think when any staff member has worked in another role at a lower level, like this nurse who was formally a nursing assistant. Or just like your, I know your daughter has been down that pathway. I just think it gives you such availability of information of what people tell you things and you could say like, “That’s spot on. Or nope, you’re not telling me correctly.”
Rev. Shawn Carty:
Yeah. Well, and I think in terms of say restaurants, for example, you start out washing dishes. Then you move your way up. You would hope that when you’re you’re the chef, you’re keeping in mind how many dishes are going to have to be washed.
Sue Lanza:
Right.
Rev. Shawn Carty:
Because you know it from the bottom up as opposed to just-
Sue Lanza:
The bottom up, yeah.
Rev. Shawn Carty:
… coming in just at the top level and saying, “Here’s how things.”
Sue Lanza:
You have more credibility, for sure.
Rev. Shawn Carty:
Right. What’s next in your?
Sue Lanza:
A similarly connected department is social services. And sometimes those two, I remember when I was in activities, we had a social service consultant. I was in a small place. We didn’t need a whole big department, so I became the social service liaison.
Rev. Shawn Carty:
Oh.
Sue Lanza:
That has more to do with someone’s, where they’re coming from socially, do they need family connections? Do they need aging services? Do they need books on tape? What about their financial situation? Connections about maybe a Medicaid application or other things that they need. Just connecting them back to the community in a lot of different ways. And also from a counseling standpoint too, what do they need in terms of maybe their end-of-life counseling or plans for themselves? What do they want to do? And that’s why there’s a lot of connections between activities and social services. They kind of work hand in hand, but here we have a director, we’re small enough that we don’t need much beyond that. But often you’ll have a director and a couple of social workers who work under the director and they divide out the caseload based on what it is. We’re small enough that for right now we’re fine with just a director.
Rev. Shawn Carty:
The next group we actually contracted out to another group. But tell us about the next one?
Sue Lanza:
Yeah, and people do different variations of this. Some places-
Rev. Shawn Carty:
You should say what it is first?
Sue Lanza:
Oh, you want to know that? Come on. You’re so difficult to work with. All right, it’s therapy, and this is rehab-
Rev. Shawn Carty:
Rehab.
Sue Lanza:
Rehab. Places might say, “I’m going to do it in-house.” And The House of the Good Shepherd has done it in-house. And sometimes it makes more sense to contract that service out. At the point that I came in, and believe it or not, it was March 1st 2020, not when I came in, but when we made a change and went from in-house therapy to contracting out the services. So March 1st 2020, does that mean anything to you?
Rev. Shawn Carty:
The world changed a week later.
Sue Lanza:
The world changed and they have been great. They service all our levels. So anyone here either in the skilled level where they would get more acute therapy, somebody comes in, they had a hip replacement, they come to us for a short-term rehab stint. Therapy’s going to pick up and do PT. So that’s physical therapy, OT, occupational therapy, maybe they even need speech therapy. They need some help with some cognitive situations or swallowing or something like that. So, that’s what they’re going to do. And they’ve been instrumental also in helping us when we needed some in caregiving in different areas. They have pinched it, filled in and really been integrated into our situation here in such a great way. And they do see people unskilled as I mentioned, but also assisted living, comprehensive personal care. And they also see our independent living residents. They’ll do not only part B, Medicare part B rehab, but they’ll also do some educational things or special exercise training. They help in the exercise room with folks and they do drum therapy.
Rev. Shawn Carty:
I was going to say, drumming is one of the-
Sue Lanza:
I know. This is one of their best activities that everybody loves. We got these big balls and they have drumsticks and they pound on them to music. And it’s a great way to release stress. So our therapy department’s pretty amazing. I have, there’s a director and all the complimentary staff that we need based on our needs. And because they come from another company, if we need, all of a sudden we need much more help in independent living, let’s say. They can import somebody in temporarily to help us with that. It takes the burden off of us. And there is one other one, one other very important department. And I didn’t know if you were going to be twisting around in your seat, waiting for this and thinking, “Has she forgotten me?”
Rev. Shawn Carty:
Oh.
Sue Lanza:
The all important chaplain. Now, every place doesn’t have one, but we do. So I figured I’ll let you pontificate in this.
Rev. Shawn Carty:
I’m not going to pontificate.
Sue Lanza:
Oh, you’re not. Oh.
Rev. Shawn Carty:
But I am a department of one and-
Sue Lanza:
You are.
Rev. Shawn Carty:
And I find that kind of an interesting experience in this context, because as you’ve just done, you’ve described how many different departments, different people, different roles that we have. And I am quite literally the only person in my department, so.
Sue Lanza:
You are. How do get along with yourself,
Rev. Shawn Carty:
We seem to get along okay. Although as I’ve joked with you, I sometimes have staff meetings at 3:00 a.m. when I’m not able to-
Sue Lanza:
Oh no, I have those two.
Rev. Shawn Carty:
Think about, “Well, how should I approach this? What should we do with this?” Yeah, it is unusual, I suspect. And you can say more about this, obviously, because you’ve been in other senior communities, but to be here and to be full time, I’m very much like some of the folks you were describing earlier who wear a few different hats.
Sue Lanza:
You do.
Rev. Shawn Carty:
And you know this because officially I’m the chaplain, but I also edit our newsletter. I also am sort of one of the unofficial photographers.
Sue Lanza:
Yeah, we kind of just threw you in there.
Rev. Shawn Carty:
Chronicling things, working on podcasts and history. Being able to do some other things. I love that aspect of my work, because I get to be involved. And I will say one thing too, my work, I’m the chaplain for the whole house. So I’m not simply in one area of the house.
Sue Lanza:
No.
Rev. Shawn Carty:
And I really am grateful for that because it means I get to engage with residents and family. The other thing too, and this was something of a surprise. I think you know what I’m about to say.
Sue Lanza:
Yes.
Rev. Shawn Carty:
Is being chaplain to the staff.
Sue Lanza:
Yes.
Rev. Shawn Carty:
Because gracious the last couple of years-
Sue Lanza:
Oh my goodness.
Rev. Shawn Carty:
… has not been easy on our staff. And as chaplain being someone that people can come talk to, and I joke that I get paid to keep my mouth shut.
Sue Lanza:
You sure do.
Rev. Shawn Carty:
You can say what you need to say, and I will listen and be able to provide perhaps some reflective thought what you might struggling with or working through, and I appreciate doing that. My work, I sing, I get to preach. I get to lead services. All of that kind of comes into the picture for me. And I will say the other aspect of it I was not quite prepared for, because I’ve been a parish priest for 20 something years. This is an environment where you, I can’t, let me just put it in my own voice. I can’t assume that we all share a common religious background or understanding or perspective.
Sue Lanza:
That’s true.
Rev. Shawn Carty:
And I actually appreciate that, because in some ways it’s easier if everybody does, kind of like we all sing from the same hymn book. That’s not the case here. We have an amazing range of folks. Probably the largest single group would be folks who are Roman Catholic. Our roots are in the Episcopal church. That’s actually one of the smaller groups here in terms of numbers of residents.
Sue Lanza:
It’s true, it’s true.
Rev. Shawn Carty:
And also staff. But I think, I’d like to thank that the Episcopal roots of this place are gracious and open. Those are words that I like to use a lot.
Sue Lanza:
I would say so.
Rev. Shawn Carty:
And accommodating everything from folks who are Roman Catholic to the more Protestant. And then people of no faith at all. And I think that’s, we know from demographic studies that’s simply, it’s a growing area. There’s a group, and from the Seattle area, the largest single group when you do surveys of people and you ask them, “What’s your religious affiliation?” From my part of the country in the Pacific Northwest in Seattle, the single largest group is none of the above.
Sue Lanza:
Really?
Rev. Shawn Carty:
And that is more and more common around the country.
Sue Lanza:
Oh.
Rev. Shawn Carty:
So folks who maybe didn’t even grow up in a religious tradition, which for some of us is kind of almost unthinkable because it was such an important-
Sue Lanza:
Right, it was ingrained in part of everything.
Rev. Shawn Carty:
That’s significant. And I know from my own conversations with residents, but more so frankly with staff, because they tend to be younger. There are more and more folks who like, “Hmm, no, I really didn’t grow up in a religious tradition. Tell me about, what are the roots of this place? Why are you here as chaplain? What’s that about?” I find that, those are kind of interesting conversations. I know colleagues of mine who kind of yearn for the old days, the good old days as we might say, but that’s not, I don’t think that’s why we’re going. I think we’re in a place where we have to kind of accommodate and be understanding.
Sue Lanza:
It’s true. It’s very true. Interesting points. I didn’t think of it that way that for you being with your background, you have such a small constituent of the people that are in your group. So you have to be very flexible.
Rev. Shawn Carty:
I think if I were the chaplain and my only focus was the residents who were Episcopalians and staff who were Episcopalians-
Sue Lanza:
Oh my goodness.
Rev. Shawn Carty:
That’d be a group of about 15.
Sue Lanza:
Yeah, that would be a problem.
Rev. Shawn Carty:
10%, 10% of this place, but that’s not, that’s obviously not my role. So I will say it makes it harder to keep everybody happy. And of course that’s not always what you strive for anyway, you’re trying to do your work and not. Somehow we all managed to do it together, and I’m grateful for that.
Sue Lanza:
Yeah, having a chaplain is a wonderful addition. And I know being here during this time you came at that incredibly auspicious time, just right, almost right.
Rev. Shawn Carty:
One month before.
Sue Lanza:
A month before the rehab people came, or yeah. So it’s been quite a journey, but we’re grateful for you being here.
Rev. Shawn Carty:
Thank you.
Sue Lanza:
Yeah, and I think just an understanding of how all these departments work is people just don’t have a clue how things get done. Sometimes I wonder how things get done when I see behind the scenes the calamities that go on, but we do pull it together.
Rev. Shawn Carty:
Well, and again, from my perspective, because I wonder around the building, just seeing folks doing their work quietly, faithfully, and sometimes the most important work that gets done is the work that never gets seen.
Sue Lanza:
You’re right. You’re right.
Rev. Shawn Carty:
Or if it doesn’t get done well, then you see it’s a problem. And so, I think that’s part of, from my perspective of this being in this place is watching and seeing everybody in all these departments that you’ve talked about doing their work and taking care of the people. And we’re here for the residents. I think that’s the phrase I hear, or the saying I hear most often from staff is, “I’m here for the residents.”
Sue Lanza:
That’s true. And people have had to step outside of their comfort zone a lot in the last couple of years and take on more things when we’re needed. We were asking people of all departments to help us deliver meals or bring things up to the units or do whatever they needed to do, and people stepped right up. So that was a great thing to see. Well thank you for this. I appreciate you probing into the daily grind that goes on here and finding out a little bit more about it.
Rev. Shawn Carty:
There’s a lot there.
Sue Lanza:
There is a lot there. Well, thank you Shawn. As always, I’m signing off. This is Sue.
Rev. Shawn Carty:
And I’m Shawn.
Sue Lanza:
Thanks again. See you next time. Thanks for listening to this episode of House Guest, the podcast which is dedicated to all great things about The House of the Good Shepherd, a retirement community in Hackettstown, New Jersey. To learn more about us, please visit our website H-O-T-G-S.org. Thanks for listening. See you next time.