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Spring resolutions (sort of)

April 1, 2007
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What some people blame on global warming, I prefer to call spring—and this year, I could hear it coming long before I could see it. What I thought at first was an approaching army of angry tap dancers marching down Main Street turned out to be a 1987 Plymouth Reliant still wearing studded snow tires.1 It was 60 degrees and sunny at the time, and the car clattered past like a soldier who hadn't been told the war was over.

I took this as a clear sign, the last drumbeat at the seasonal changing of the guard. I went straight home and pulled the cover off the barbecue. I hung a hammock in a tree. I dared to reconnect my garden hose to the outside faucet. I lifted the patio umbrella back into its base, feeling like I had just planted a flag on Iwo Jima. All in homage to the certainty of impending renewal.

I find it's hard not to be reflective at this time of year. After months of cold and fog, the sudden bombardment of light and warmth permeates the darkest corners of the psyche and breathes new life into all the dreams and self-doubts that lie dormant through the winter. It's a dangerous time, and one should always think twice before recklessly throwing open the windows of one's soul and rearranging the room. But somehow, I can never help myself.

The resulting hours of sun-induced introspection lead inevitably to my annual springtime list of resolutions. Most people do this on New Year's Day. I do not, mainly because no one should be expected to keep promises made when we're freezing, miserable, and full of tryptophan. And actually, I don't use the word “resolution” either. That's way too much commitment. Instead, I call them “generalized targets of attempted improvement (GTAI).” It's my own Quality Initiative, although without the pressure of bankruptcy, media humiliation, or imprisonment if I fail.

While I'll resist the urge to reveal my personal goals,2 I feel compelled to share five GTAIs that are highly relevant to you, the long-term care professional and loyal reader of this fine publication:

1. In 2007, I will get serious about long-term care.To prove it, I plan to memorize all nursing home–related federal legislation, back to and including the Balanced Budget Act of 1997.3 I'm thinking the best way to do this will be to read and record them, add New Age music, and listen while I'm sleeping.4 If everything goes well, I'll be available to perform this feat of memory at national conventions, mall food courts, or even your facility. My stirring performance of “Highlights From HIPAA” would be a great addition to your next morning stand-up. Next stop: Broadway.

2. I will find the art in nursing home regulation.Sometimes in the course of a busy day, with our minds immersed in the perpetual quest for quality and compliance, it's easy to miss the poetry hidden in the CMS Program Manuals. Here's one of which I'm especially fond. I call it “Accordingly.”

Accordingly, under section 410 of the MMA of 2003, services otherwise included within the scope of RHC and FQHC services that are also described in clause (ii) of section 1888(e)(2)(A) are excluded from consolidated billing, effective with services furnished on or after January 1, 2005

Read it again, slowly and with feeling. I promise you'll be moved like you haven't been since Leaves of Grass.5 And remember, art like this is everywhere if we just take the time to look.

3. I will establish myself as a real investigative journalist.The truth is, I don't get nearly enough respect from my fellow long-term care writers. They seem to think I'm some sort of comedy monkey, performing my linguistic tricks without a serious contribution to make to this profession. So for starters, I'll be going undercover to ex-pose the hidden link between daylight saving time and resident hip injuries sustained while springing forward or falling back.

4. I will serve as a healing intermediary between harried administrators and punitive regulators.I believe this can be best accomplished through the restorative power of laughter. So the next time regulators show up at your facility, I suggest you engage them with a simple interactive joke. This is certain to break the ice and yield a new, collaborative partnership. Here's one you could try, and I offer it to you absolutely free:

Them: “Knock, knock.”You: “Who's there?” Them: “The survey team.” You: “The survey team who?” Them: “This door is not in compliance, and we're shutting you down.”

The moment of genuine mirth that is certain to follow will pay off exponentially down the road. Unless one of them suffers a laughter-related neck injury, in which case you'll receive an F-638 for unprofessional conduct.

5. I will become a positive force for change.This will be a multipronged initiative. First, I'll attack global warming by supporting the development of a hybrid med cart. Next, I'll push congressional representatives to adopt the “one breath” guideline for the creation of all new regulation—if a rule is so long that it can't be read without pausing to gasp for air, no one should have to understand it, or obey.6 Finally, I'll help solve the workforce crisis by lobbying the President to deploy a “caregiver surge.”