Just one more question

Like Lieutenant Columbo, the great TV detective, 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.

This Month’s Victim:

Jennifer L. Mikula,


Palm Garden of Ocala

Ocala, Florida

In 2008, she was chosen Administrator of the Year by the Florida Health Care Association (FHCA). In 2009, she was one of Long-Term Living‘s “People Making a Difference.” In 2010, she was talking to me on the telephone. Three years-three significant achievements. Jennifer Mikula is definitely on a roll.

She has served the long-term care profession for more than 20 years, and is a recognized visionary, innovator, and crusader. Her successful journey toward culture change in her own building gained national attention, and she’s now the chair of the FHCA Culture Change Council.

Before I could get to my first question, Jennifer jumped right in with one of her own.

Why are you so serious in your picture?

It’s because I’m Canadian and we’re a serious people.

Ah ha. I see. Your articles always have a flavor of humor, so I keep thinking, “Why doesn’t he have a head shot with a nice big smile on it?”

I’ll try to work on that. One year ago, in this very magazine, in this very issue, you were recognized as someone making a difference in long-term care.

That was a wonderful honor.

But here’s my question: Once an athlete gets a big contract extension, they sometimes stop trying. Or when I won my Pulitzer, I didn’t get out of bed for 20 years. So, did you continue making a difference, or just sit back and bask in the glory of your accomplishment?

All it has done is motivate and inspire me. I know that every day my job is to try to make a difference, and I’ve been given many opportunities to go around the state and speak about the changes we’re making in person-directed care. I’m not going to let up, because this is the way things should be.

The correct answer was, “Wait a minute, Gary. I don’t believe for one minute you won a Pulitzer.”

Well, I didn’t want to step on your toes. I keep looking at that picture of you, and it’s intimidating me.

Let’s talk about culture change. That’s a phrase everyone uses, but not everyone achieves. How have you actually succeeded?

I think I’m selfishly motivated because I’m a Baby Boomer. I have five boys at home and we were sitting around the supper table one day. I had just come from a Pioneer Network conference where they were talking about this thing called “culture change,” and I decided I had to do something in my career that was going to make a difference.

So I told my kids, “I know one of you is going to put me in a nursing home someday, and I don’t want it to be what it is today.” I said I wanted it to be more user friendly. I wanted to decide when to get up, when to go to bed, and what I want to eat. So my kids encouraged me to look for some grant monies to help get me started. I did so and began educating others on my vision.

Did you encounter any implementation challenges in your building that threatened to wipe that smile off your face?

Well, there was a bit of resistance to change, as there always is. And yes, I would get disheartened once in a while when someone said it would never work, or we can’t do that, or the regulations say this. In fact, one of the greatest barriers was attitude. But slowly but surely, the changes began getting results. Our residents were taking fewer drugs, they were in less pain, and their lives were more fulfilled. Now person-directed care is accepted and everybody just knows we’re here to serve the residents-we call them members.

“We’ve shown that culture change is not just a nice thing to do-it’s the right thing to do to stay in business.”

-Jennifer L. Mikula

We’ve shown that culture change is not just a nice thing to do-it’s the right thing to do to stay in business. One of the sayings I have on my desk is by Maya Angelou. It says, “I long, as does every human being, to be at home wherever I find myself.” And that’s true. I wanted to turn this into a place where people want to be.

You’ve been in this business for 20 years. Is it more rewarding now?

My first job was in a traditional nursing home. And it was in the days of the restraints and residents just sitting very listless around nurses’ stations, not engaged in any type of activity, being passed by in the hallways, and not being spoken to. It was a very depressing atmosphere.

You’re describing my home life.

(laugh) I’m sorry.

I need culture change.

Don’t start crying on me. When I came to Palm Garden, it had some of those similarities, not too many things going on, families not visiting, staff not engaging, just going through the motions. So I said to myself, “It’s a three-year plan. Get the right staff on board, get the right senior leaders who believe in my philosophy and we’ll get this place where it needs to be.” And it’s been very successful.

What keeps you going? How do you rejuvenate yourself?

Well, at 5 p.m. I’m going to Zumba class.

What is that? One of those robot vacuum cleaners?

No, that’s a Roomba. This is a type of aerobic exercise with Latin fusion music. We do it every Monday night here at the therapy gym. I get together with my coworkers and sweat the stress out. I also love to cut grass and do the laundry, all that mindless stuff. That’s what supercharges me.

You’re not doing the landscaping and laundry at the facility, are you?

No, they don’t pay me enough to do that.

Any advice for young people considering long-term care administration?

I’m a preceptor, so I have a lot of administrators-in-training. When they come in wide-eyed and bushy-tailed, the first question I always ask is,“Why are you selecting this as your profession?” Because it’s a 24/7 tugs-at-your-heart job. Most of those who make it have a desire to be around older people and want to be able to go home at the end of the day feeling like they’ve done something wonderful.

I tell them that I don’t know of any other profession where you can push yourself away from your desk, and walk up and down the hallways and get hugs and smiles. If they come with a good satchel full of compassion, they’ll be successful.

It sounds like you feel privileged to do this job. I hear there’s a sign above your door that says “Blessed.”

Yes, there is. It’s still here. Another says, “Our residents don’t live in our facility, we work in their homes.” And over my window is a big wooden one that says, “Home,” because this is my family and where I spend most of my waking hours. I like to surround myself with those messages.

Has culture change translated into better quality results?

As I said before, it’s not just a nice thing to do. It’s got to be seen as a way to stay in business. It has improved our state surveys, increased our staff retention, and positively affected our residents, families, and staff satisfaction surveys. I have a very good census, and we’re clicking. Knock on wood, (knocks on wood) things are good.

That should be another sign on your office wall-“Knock on wood, things are good.”

Yes! I have room for one more.

Culture Change, by Dr. Seuss.

Long-Term Living 2010 October;59(10):62-64

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