Guest Post: Segue To Silver

Kathy Hagen Eden Alternative

Kathy Hagen
Eden Alternative

Good morning, ProviderNation. This month’s edition of the great glossy asks whether ageism is getting in the way of quality long term care. This morning, we feature a guest post from Kathy Hagen, on learning to love the look of aging. It was previously posted at The Eden Alternative Blog.

My partner, Tom, didn’t want me to do it. My best-friend, Rita, thought it was a bad idea. My friend Marie, 85, said she would never do it and encouraged me not to. “Why would you want to do that?” she asked. Last May, I did it anyway, and I’m really glad I did.

Now that the long process is mostly over, the comments I hear are, “I wish I could do that” and “wow, you really did it!” “I think all women should do I,” and my favorite, “Can I touch it?”

In May of 2013, I decided to stop coloring my long dark hair and let the natural grey grow in. It was a long process, first doing a heavy bleach to smooth the transition from dark to light, and then the somewhat awkward stage of having half and half hair. I called it my “segue to silver.”

Just before a vacation in November, I decided it was time to cut off the colored/bleached ends and have a full head of silver gray hair. It’s quite a change. People don’t recognize me. When Tom and I are out together and we see someone we haven’t seen in a while, they need to do a double take and think he is out with another woman!

How did I get here? A few years ago, I began thinking about it. I always disliked coloring my hair and wondered how I would get to the point of letting it go. I asked my hair stylist, Bill, how we would do it, and each time he ended with, “…and then you cut it short.” I couldn’t bear it. I loved my long hair. It really wasn’t about looking older or “transitioning into old age,” as one of my youthful colleagues suggested; it was about the transition itself–a year (or more) of not having the hair that I wanted to have. I had to let go of that.

I feel that hair is a part of our identity. People remember us and even recognize us by our hair. We think of ourselves as looking a certain way, and we build part of our confidence based on that look, a look we are comfortable with. It’s not who we are, but it is what we see in the mirror, and what others see. Our physical appearance is important in ways that are not just vain or superficial. It is our face to the world, and we need to be comfortable with that image. It’s healthy to want to look our best. I began coloring my hair for these reasons, and my hesitation to go through this process was based in these feelings.

I always admired women who never dyed their hair. I thought of them as strong and independent minded. I began asking them, in private moments, whether they ever dyed their hair and how they made the transition. They had the courage to let go of the societal expectations, to let go of the perception of someone with gray hair as old, and the perception that growing old is something to prevent or avoid.

At 50, I decided that my natural hair color is the right thing for me. It isn’t for everyone and I respect that. Since I have worked for The Eden Alternative, I have learned and loved the phrase, “Embracing Elderhood,” and I believe that in order for our society to change the perception of Elderhood, we must take it on as individuals and “be the change.”

I have one group of male friends in their 50s and 60s, whose “guy’s night” I crash once in a while. When I showed up with this new look, they didn’t say anything at first–they are all so kind and politically correct. Suddenly, Joe had the courage to say, “Kathy, I really love your hair.” Then all the guys chimed in with, “Yes, and we wish all women would do this too! Men don’t color their hair, and we don’t understand why women feel they need to.” I couldn’t agree more.

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What Does Your Resume Really Say About You?

Bernie Reifkind

Bernie Reifkind

Good morning, ProviderNation.A resume is the very first impression that one makes to an employer. A resume is a mirror reflection of who you are. Are you serious about yourself? Do you respect your career? Do you want to be perceived as someone who has their act together? Of course you do.

A resume is a very serious document with very serious implications and insinuations. Your resume not only speaks volumes to a prospective employer, it also has powerful implications in not so subtle ways. Now, more than ever, in the very competitive hiring environment of long term care, resumes are being judged by their very appearance. That in itself is a serious implication about how an applicant is perceived.

In the digital age, resumes are glanced at before even being read. How do I know this? I am privy each and every day to business owners, employers, decision makers, and human resource professionals whom I assist in filling their very critical job openings.

They tell me—quite often—why they choose to interview one person over another. And in many cases, it’s about the actual appearance of a resume that will encourage further reading. I understand this because I see hundreds of resumes each month, and it is amazing to me that many people do not take the time and effort to create one that is professional-looking.

For example, if an applicant is a registered nurse, the letters RN should appear right after one’s name. The same with any licensed professional in long term care. Someone with an advanced degree should also add MBA, MS, or PhD after their name. This is a very common mistake—to believe that the reader should assume delineation by what is written on one’s resume.

The implication of a poorly drafted resume is that the applicant is not taking their career as seriously as they should. This, of course, may or may not be true; however, that his how it is perceived. And perceptions are powerful in the hiring business. Sometimes, I will see a resume so poorly written that I, too, will not bother to read any further. Nor would I ever submit such a resume to one of my clients. A great-looking resume means all the difference in the world in today’s competitive work environment.

Consider this: If a resume is not even appealing to look at, further reading is deemed unnecessary. This was the opinion of three of my longtime clients. What this means is that no matter what experience someone has had, the chances of an interview are greatly diminished with a poorly written resume.

A resume reveals and implies much more about a person than many are aware of. This is what poorly written resumes say about their authors:

  1. They do not take their careers seriously.
  2. They do not take the interview process seriously.
  3. They do not take themselves seriously.

Some employers feel insulted when they review a poorly written resume. Why? Having to read one is waste of their time. In addition, who wants to work that hard to read a resume? So it doesn’t matter who someone is or what they have done if their resume is hard to read, written backwards chronologically with employment dates overlapped, contains misspelled words, or is just plain ugly—the result is the same: It will not get very far.

Sometimes I receive resumes without a working phone number on it, only an email address. What if I want so speak with an applicant? An email address is not enough. Always remember to put your phone number on your resume if you expect to be contacted.

Not knowing how to create a great resume is no longer an excuse. There are plenty of articles on the Web that offer guidelines on how to create a good-looking resume.

As for the content of your resume, it is essential for the employer to easily and quickly identify what you have done, where have you been, and what have been your results. What kind of decisions have you made? A resume reflects your decisions. Are you a job hopper? Does your resume have holes in it?

Search the Web to see how others have created their resumes, or make the investment by enlisting a professional resume service to create a resume that highlights accomplishments versus job changes, if that is your case. This small investment in time or money just might pay huge dividends.

In summary, a well-written resume is a must. Your resume is all about who you are and how you feel about yourself. Perception is powerful. If you do not take the time and energy to respect yourself with a professional-looking resume, subtle and sometimes strong—though incorrect—messages are implied about you, whether or not this is fair.

Today’s guest blog is from Bernie Reifkind, CEO and founder of Premier Search, established in 1987, a nationwide talent acquisition firm in Los Angeles. He can be reached at or (800) 801-1400.

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New Season, New Hazards

Stan Szpytek

Stan Szpytek

Good morning, ProviderNation.

This past winter was certainly an interesting one, to say the least. Winter storm after winter storm has hammered the United States in what seems like the most extreme and deadly winter season in recent memory.

While spring can’t come soon enough, providers need to prepare for yet another seasonal treat– thunderstorms and tornadoes. Not to forget that hurricane season and another round of wildfires started by lightning strikes are on the horizon as well.

Weather preparedness is often addressed within the confines of “severe” events. As global temperatures appear to be on an upward trend, yet extreme cold and blizzard conditions have impacted the country for the past several months, it is difficult to plan for what will come next.

Long term care providers should consider an “all hazards” approach to weather in the same capacity they plan, prepare, respond, and recover to the other types of hazards and perils that can impact their communities. An essential component of planning is the utilization of reliable resources.

Here is a list of links to obtain critical information and concepts that should be reviewed and integrated into your community’s Emergency Operations Plan (EOP):

Additionally, a web search of similar resources for your individual state should reveal some regionally specific information pertaining to the unique weather perils that can impact your community. For example, here is a link to an outstanding resource from the State of Illinois: Illinois Emergency Management Agency- Severe Weather Preparedness:

Long term care providers need to focus on weather-related events of all types, not just the obvious events that customarily occur in your region of the country. Residing in the Phoenix-metro area, it is comforting to know that tornadoes do not typically occur in the Valley of the Sun. Yet, a tornado reportedly touched down in Mesa, Ariz., a few weeks ago, causing damage to a quiet residential neighborhood in the middle of winter.

Go figure. Be ready of all types of severe and extreme weather.

Stan Szpytek is the president of Fire and Life Safety, Inc. (FLS) and is the Life Safety/Disaster Planning Consultant for the Arizona Health Care Association and California Association of Health Facilities (CAHF). Szpytek is a former deputy fire chief and fire marshal with more than 35 years of experience in life safety compliance and emergency preparedness. FLS provides life safety and disaster planning consultative services to healthcare and senior living providers around the nation. For more information, visit or e-mail Szpytek at



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You Have The Power To Change Health Care

Scott Rifkin, MD

Scott Rifkin, MD

Good morning ProviderNation.

Having been a physician for the past three decades and a long term and post-acute care provider for nearly a dozen years, I believe there really is room for SNFs to take the lead in changing the health care world.

But before I get into why, here’s a little background on me: Twenty-five years ago, I slapped a sign on an office door and opened my medical practice. Having no patients and needing to provide food for my expanding family, I took a part-time job as the medical director of a nursing home. At the time, I wasn’t smart enough to know that seeing the Maryland Secretary of Health walking the hallways was a bad sign. It was a regulatory nightmare.

Fortunately, I was smart enough to follow the lead of a very smart DON, and despite me, the facility got back on a good footing.

Over the next 15 years, I developed a sideline reputation of being the emergency medical director for troubled facilities, and I plied the trade up and down the East Coast. I was once hired by the city government of Nashville as the medical director of their municipally owned nursing home that had been occupied by sidearm-carrying agents of the U.S. Department of Justice as part of a federal CRIPA (Civil Rights of Institutionalized Persons Act) survey.

In 2003, I had the opportunity to buy a sleepy skilled nursing facility on the eastern shore of Maryland for $8.8 million. My bank account was laughable, so I checked under the pillows of my sofa and only found 63 cents and half a sandwich. The owner, a very sweet elderly lady, was kind enough to lend me the money to buy her facility, and I was in business.

Eleven years later, Mid-Atlantic Health Care owns and operates 16 facilities with 3,000 beds. We specialize in buying nonprofit and county-owned buildings, and we pride ourselves on being a clinically driven company with little regulatory trouble, strong ratings, and a focus on cutting edge technology and products. We lead clinically and invest heavily in our centers and in our people.

In the past two years, we have developed our own data-mining software, opened high-acuity units, and were chosen as a “convener-episode initiator” by CMS in its Bundled Payment for Care Initiative (BPCI). Simultaneously, we’ve grown beds and revenue by 40 percent annually for the past four years.

Five years ago, we guessed that being the best partner of the health system would be a positive thing and someday someone would pay us for that. We started a program to reduce hospital usage by our patients by finding innovative ways to keep them healthier. We hired nurse practitioners, opened high-acuity Step Up® units, invested in IT, and developed a data-mining system that tells us, in real time, when our patients are about to become sick.

The end result is that all hospital admissions are down—not just readmissions. For comparison, readmissions in Maryland dropped from 25 percent to 11 percent. In Philadelphia, where we operate 1,700 beds, readmissions dropped from 45 percent to 19 percent and continue to fall.

With our bundled payment program going live last January, we are focused on making sure that our patients stay healthy and out of the hospital. But don’t get me wrong—we have plenty of problems, too.

Having said that, I come from the absolute belief that SNFs are in a unique position to be key players in responding to this new focus at CMS. The hospital systems will have a very tough time trying to implement population-based cost reductions. They are being asked today to reduce readmissions—a concept that is totally foreign to their corporate cultures. They will soon be pushed to reduce admissions—not just readmissions—and to be responsible for the cost of care of their local population at the community level. I will take a look at the Maryland waiver experiment in future posts to illustrate this point.

However, I believe SNFs can help hospitals achieve these goals and share in the savings to the system. The BPCI program is a perfect example. In bundled payments, SNFs can take the lead and become the “convener” and offer a “gain share” payment back to their local health system. We all know that we can reduce readmissions with focus and effort. This ability to reduce readmissions effectively brings leverage to SNFs as well as the ability to create new revenue streams.

Making your SNF the best partner to the health system will result in moving the payer mix needle and improving your financial status. I will discuss all of this, including our successes and failures, in future posts. In addition, I will try to feature other companies that I see that may have experiences helpful to you.

Feel free to tell me what you think. I enjoy a good argument, so if you think I’m clueless, don’t hesitate.

Scott Rifkin, MD, is CEO of Mid-Atlantic Health Care. He can be reached at



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Play Ball…

The Senate will take up the doc fix "patch" today.

The Senate will take up the doc fix “patch” today.

Happy Opening Day, ProviderNation.

The Senate is scheduled to take up the “patch” to the doc fix today around 5:30 p.m. Eastern time. You’ve already heard that House leaders pulled a bit of their own Fake Out last week with an argument-free voice vote. The House text merely extends the current law (including therapy cap exceptions) until next year.

Lobbying-American types doubt that the Senate will scuff up the bill, because this thing has been in extra innings since 2003. So look for Lobbying-American types to make a call to the pen. Because they could use a little relief.

Play ball, indeed.

Bill Myers is Provider’s senior editor. E-mail him at Follow him on Twitter, @ProviderMyers.

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The Paradox Of Brain Fitness Products

Does everything we do have to accomplish something?

Does everything we do have to accomplish something?

Good morning, ProviderNation.

Brain fitness has gradually worked its way into our vocabulary, and for good reason. It’s common sense that we should keep our brain active and engaged, and it’s fundamentally not that different than physical exercise. Use it or lose it! But brain fitness is starting to remind me of how our society turns everything into a contest of wills—an obsession with having to accomplish something.

I’m 54, in that part of life where I can still remember what it was like to be young, but I’m also starting to figure out what getting older feels like—good and bad. (I’m personally enjoying the journey, I never could dunk anyway.) And brain fitness is now a thing for a baby boomer generation that sometimes (arrogantly) assumes it’s smarter and more sophisticated than its predecessor.

But doesn’t it feel like fun and spontaneity can get lost in the puzzle? I remember being a kid: I loved sports. Some of my fondest memories growing up were the pickup games that would spontaneously occur with my buddies in a beat-up dirt-covered baseball field, or a park full of trees that we would turn into a gridiron.

Today’s youth, and their parents, deal with club sports, Sunday and holiday games, $200 pairs of shoes, coaches driving for perfection, and impeccably manicured baseball fields that are grandiose in nature but unapproachable as a random, unplanned activity—the gates are locked and bolted shut unless you are a part of an organized, insurance-paying league.

So, instead of randomly playing baseball with your buddies in the sunshine, you’re forced to hang out inside, playing video games because the field is inaccessible. The adult-driven structures in kids’ sports compromise the sheer joy and value of spontaneity.

It’s happening again in brain fitness. I make my living selling technology that I hope will engage aging brains. But when I’m talking to potential customers and the only thing they are looking for is brain fitness, I cringe.

Can’t joy and spontaneity, on their own, be enough of an experience that a senior living community wants to offer its residents? Does it have to be another monitored contest to showcase quantifiable improvement?

So whether you’re running a senior living company or just hanging out with your aging parents on a Saturday morning, absolutely run with brain fitness activities. But run freely.

There are lots of cool companies out there—not just mine—that offer exercise and fun. Dakim, Posit Science, Happy Neuron, Lumosity, etc., etc. There is no downside to this.

Measure your success not by the number of “reps” your resident has done, or the number of neural connections you’ve made, but by the number of smiles you’ve created, the number of personal connections you’ve help make.

That, ultimately, is more important than helping to improve the time it takes someone to complete a crossword puzzle. Just ask your mom.

Today’s guest blog is written by Jack York, founder of It’s Never Too Late. He can be reached at

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Gloves Off, Fourth and Fifteen…

Eric Cantor says the doc fix is a "must do."

Eric Cantor says the doc fix is a “must do.”

Good morning, ProviderNation.

The gloves are off, and the Lobbying-American community is playing hard ball. It’s fourth and 15, and they’re looking at a full-court press.

The Senate is readying a vote (perhaps as early as today) on its own version of the doc fix. The House passed its own version earlier this month, but used the bill for (yet) another assault on the GOP’s arch-nemesis.

That, of course, won’t fly in the Senate.

But the other reason the bill is being closely watched is because it (so far) has some sweeteners for long term and post-acute care providers, including repeals of the dread therapy caps.

That means, essentially, that the Senate has a real chance to frame discussion in conference between the two chambers. Last week, House Majority Leader Eric Cantor, R-Va., sent a letter to fellow Republicans and told them that a doc fix is a “must do” before the March 31 deadline.

Handicappers say that the most likely course is that another patch will a-come because the job is just too complicated. Even if some version of a permanent reform passes Congress this week, it will still leave wide open the question of who gets the check.

Still, a lot of eyes will be on the Senate today.

In other news, a bill that would protect nursing home capital investors from personal-injury suits has cleared Florida’s Judiciary Committee (and Florida Health Care Association honcho Emmett Reed thinks it should go further than that); and writer Gerda Saunders sends a dispatch from dementia’s hellish dateline. (Bill Myers is Provider’s senior editor. Email him at Follow him on Twitter, @ProviderMyers.)

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