Walking the line in service to older adults. Senior service providers in Illinois and Indiana work together to ensure mission drives business decisions.

U^JJ BY CONNIE S. MARCH Ms. March is chief executive officer, Provena Senior Services, Mokena, III. question that has been asked frequently is, "Do we have a margin because we have a mission or do we have a mission because we have a margin?" If mission is the driving force, how do we get a margin? Those are good questions for reflection. We care for older adults in one of the most poorly Medicaid reimbursed states in the nation for nursing home residents. Even so, it is intuitive to me that mission drives margin and not the other way around. Most people go into this ministry because they care deeply about those they serve and those that serve. We are passionate about the elderly, with whom we interact daily. We have purpose. Our work is worthwhile; we make a huge difference in their lives. The next question is, "How do you put this passion to work?" When you meet a barrier, you find out how to overcome it rather than letting it stop you. That happened in Illinois when all nursing home providers joined together for the first time in history to partner with the state to design, develop and test a new nursing home Medicaid reimbursement methodology that more closely aligns with the actual care given. Then, this same group met with legislators and the governor's staff to advocate for implementation of the methodology and a multi-year phasein of funding. Illinois is in the second year of phasing in funding for the plan. Money was given to this plan when most others received little or nothing. Why? When people tell their stories in a way that engages and energizes a broad coalition, the unimaginable can happen. Although Illinois is still one of the lowest states for nursing home Medicaid reimbursement in the nation, this crucial issue is receiving much needed attention from multiple parties that are making a difference. Listening to your constituents and following your mission leads to investigating and offering services that might not have otherwise been provided. Our organization listened to people who responded to our consumer surveys a few years ago. We increased the number of short-stay Medicare beds two to three years before most others in our states were offering this service as a major focus. In our two states, Illinois and Indiana, nursing home occupancies are low. Since the focus on short stay Medicare services began, we continue to have occupancies that average eight to 10 percent above the norm. Why? We listened and followed our mission statement by reaching out to compassionately respond to human need in the spirit of Jesus Christ. Consumers tell us they want to stay in their homes. If they can't do that, they want to stay with us a short time for rehabilitation, return to better health, and then go home. If they can't do that, they want to be as independent as possible in a home-like environment. Not only are our short-stay Medicare services true to these needs and desires of older adults, they also provide higher funding for us to continue our mission work. For those people unable to return home, it is our mission to make any setting they are in as home-like and as empowering as possible. That has led us to engage in approaching care in our nursing homes in an entirely different manner. We are educating staff, residents, families, regulators, communities and other important stakeholders about change processes moving toward resident-directed care. That means the nursing home environments are becoming neighborhoods instead of units and staff stay in one neighborhood as part of a team rather than providing services across the entire home as part of a department. Residents are encouraged to make choices about their lives daily — when to go to bed, when to get up, what they want to eat, how they want to participate in their care. Their families can bring in food and prepare it in the neighborhood kitchen or they can join their loved ones for a meal that is served, and sometimes prepared, in the neighborhood.