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Just one more question

June 1, 2008
by Gary Tetz
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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?

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