Norma Lesher is the executive director of the Glenburn Home in Linton, Ind. She is a nurse and former accreditation surveyor, with experience in the for-profit and not-for-profit worlds. Norma's well prepared for leadership in changing and complex times. Norma is Quality First in action and she's the kind of person that gives all of us hope for the future.

Norma recently made a presentation to our state executive forum, which is composed of the association leadership of our state partners and AAHSA's executive leadership. As part of those meetings, members present case studies in transformational change. To me, these case studies are the best part because they help us in association leadership stay in touch with our members' needs.

Norma has led her organization from being a 154-bed rural nursing home with 10 independent living units and a negative financial picture to a community service organization with a positive financial position. I'll say more about what Norma has done below, but at one point Norma referred to one of the important concepts she implemented as "Norma's Law — and everybody knows it's Norma's Law."

When I read my notes on her presentation, I realized she had offered several "Norma's Laws" into the discussion. And we can all learn a lot from each of them:

Norma's Law #1 — The best way to predict the future is to invent it. Norma read this somewhere, and she believes it. There is no passive position in the inevitabilities of badly-needed transformation of long-term care. To the contrary, Norma is an inventor.

Norma's Law #2 — If you aren't changing, you're dying. There's no question that the aging-services field is on the front end of enormous change, and Norma knows it. When she arrived at Glenburn, I surmise that it was dying. They were focused on how to cut more costs out of a shrinking reimbursement structure, which reaches a point of impossibility. The late Peter Drucker said no enterprise grows while focused on cost cutting, and Norma knows that too.

Norma's Law #3 — Community service is where we need to focus. Norma took stock of the needs of the 36,000 county residents and discovered high incidence of obesity with its inevitable outcomes. She began to design educational and rehabilitation programs around those broader needs. The program mantra became "wellness and prevention." She established relationships with adult day and senior centers in her county and now manages them as part of her organization's mission. She secured grant funding through a little known state program to expand one of them which led to a federal grant to expand a wellness center.

Norma's Law #4 — Inside our mission home, we changed the mission from being a health care provider to a community of elders. Norma had to change the cultural environment to one whose role is to help elders have a choice in their care. This meant breaking many well-established and comfortable routines. For example, staff don't rotate any more, especially nurses. Because aggressive rehabilitation is key to the new mission focus, trusting relationships are the key to good care.

Norma's Law #5 — Resident choice is the primary consideration of the nursing home program. For example, the old routine of meals at predetermined times is replaced by two buffets. Residents decide what to eat and when to eat it. Now, they "snack and yack!" At first, the staff said this would be unaffordable and couldn't work. But the results are weight stabilization, virtually no waste of food, higher satisfaction and lower costs. Yes, the buffet approach required a $35,000 capital investment, but it's paying for itself over time.

Norma's Law #6 — No mission, no margin. You heard that right! Of course, good stewardship requires margin, but Norma's experience is that without re-thinking the mission-based on looking at the needs of the community, margin was impossible. Now, because of the emphasis on wellness, restoration, resident and community needs, the Glenburn Home is viable.

Glenburn now has a community continuum of services. That continuum feeds on itself — pragmatically, financially and "missionally" — because of the broadened mission focus. Also the nursing home, once financially weak, is now the centerpiece of a vital and viable program for the entire county. In addition, Norma's staff turnover is 17 percent, and she has retained good people through this transition. Today, Glenburn is looking to recapitalize its old buildings based on success.

As an aside, we always ask members like Norma to tell us why they pay dues, what they are getting for their money and how we can help them better. Her response: "You're my voice. You give me ideas. You help me invent the future!"

That's our mission together — Creating the Future of Aging Services.

Norma calls all this "culture change." I call it "Norma's Laws." This is what Quality First is all about! Norma's personifies the leadership essential to our future.

Larry

Learn how you can create culture change.

William L. Minnix, Jr., D.Min.
President and CEO

AAHSA
2519 Connecticut Ave NW
Washington DC 20008