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The Future of Healthcare: “Excellent care means looking at — and beyond — the basics of human touch” with Richard Schwalberg, COO of Menorah Park & Christina D. Warner

We believe excellent care means looking at — and beyond — the basics of human touch. It means meeting the needs of the people we serve, by focusing on families, clients and staff, and by focusing on technology, excellence, and measuring how we are doing so we can continue to raise the bar and do better. We never lose […]

We believe excellent care means looking at — and beyond — the basics of human touch. It means meeting the needs of the people we serve, by focusing on families, clients and staff, and by focusing on technology, excellence, and measuring how we are doing so we can continue to raise the bar and do better. We never lose sight of the basics of the people we serve, defining the needs of those under our care and including their families, the community and staff, to set lofty goals of excellence. We use technology, and excellent health care providers, and we welcome change. You cannot be afraid of change. It is necessary, and it’s a constant. And it’s been coming for years; embrace it as part of the real world. We know, life goes quickly, needs evolve, and we must be flexible and willing to change, while keeping the mother ship steady. And, while keeping both eyes on the mothership, adding other boats and islands as needed. Never lose sight of the basics of your mission, which is who you serve and why. We serve humans who very much depend on our care. You must be willing to constantly examine and re-examine best practices, and don’t be afraid to look beyond, to what may now seem insurmountable, but not impossible, all in the name of improving what care should really be. The great people help each other and get things done with a focus on the future, not the same old status quo.


Asa part of my interview series with leaders in healthcare, I had the pleasure to interview Richard Schwalberg, an award winning professional in Senior Health Care Administration for 34 years. Since joining the Menorah Park team, his primary responsibility has been operating Menorah Park’s long-term and sub-acute care, rehabilitation, diagnostic services, campus safety and security, and has highly respected specialized care pavilions for residents with memory care. Richard also oversees pharmacy services, an inpatient and outpatient rehabilitation and wellness center and medical clinics. It is because of Richard’s dedication to quality, attention to the human being, and persistence that residents, tenants, staff and board members know him as a strong advocate for all in our community and nationally. Menorah Park receives many letters of gratitude for excellent care and has enjoyed skilled-nursing deficiency-free state and federal inspections under Richard’s leadership several years in a row. Richard also has expertise and shepherds Menorah Park’s programs in Quality Assurance and Quality Improvement. He is the Board/Staff liaison for the Nursing Home, and the Government Relations Committees. Richard is actively involved with group purchasing, HMO contracting and managed care alliances. He has also developed several university and community-based affiliations. In his free time, he volunteers for the Regional Chapter Coordinator for the FBI National Citizens Academy Alumni Association for Region One , and has won the Pacesetter Award in that capacity. He was recently named Professional of the Year by AJAS, The Association of Jewish Aging Services, as well.


Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?

Mygreat grandmother lived to be 96, and at 14 years of age, it inspired me to volunteer to help make life better for other seniors so they can — and are inspired to — live to a ripe old age. So I gave of my time. As a volunteer, I ended up at some very bad nursing homes in New York, and that’s when it occurred to me that that instead of complaining, I would figure out a way to do something about it, to change it from within. That’s how I eventually became a nursing home administrator. My great grandmother inspired me to change the concept of the nursing home, to make it more like a home than an institution and treat the elderly as I would my own parents or grandparents, not as patients or just another filled bed, but as human beings, whose lives mattered.

Can you share the most interesting story that happened to you since you began leading your company?

Helping to start the FUNdamentals on-site child care center was monumental. We initiated the idea as a test on the weekends and it was so well received we knew we had something special to help ease the stress of finding daycare for our staff members. It also helped with recruitment, and retention of good employees. Having children on-site also created wonderful intergenerational interactions, taught young children to understand, respect and love the elderly, and helped them to not be afraid of apparatuses like oxygen masks or wheelchairs, or even bandages. The residents gain great energy from the children, and many who had extensive memory loss suddenly share memories of raising their children long ago. We’ve had many programs that include our children and our residents, from talent shows to art projects to high-five Fridays to a special garden where they can work together and get in touch with nature and growing fruit, vegetables and flowers…we knew from day one it was a win-win for all of us.

The other great achievement was opening the Peter B. Lewis Aquatic & Therapy Center in an age of nay-sayers. Twenty-sum years ago, people said we’d fail if we opened it here in Beachwood, a suburb of Cleveland. This is not Miami, New York, California, or even Boston; places thought to be more progressive for a better chance of success. But we showed everyone that there is a need; when people saw their rehabilitative needs could be met at the Center, they came and joined. Today, the Center has helped thousands of people from the community and on campus. The success stories are real. An 82 year old woman finally finds relief from pain after four surgeries and is able to attend her grandson’s college graduation, thanks to Dry Needling. A man who loves ice-skating is able to return to the rink within a few weeks after double knee surgeries and rehab at the Center. A 100-year old woman comes with her daughter and enjoys swimming 10 laps in the pool as her daughter gets rehab in the next room. A woman who has two strokes one month apart goes from not being able to walk, talk, or use her right hand regains most of her abilities with rehab in less than six months! The stories are endless; the successes are a testament to our well-trained staff of experts who truly care about our Center clients as individuals. The Center has morphed into a huge extended family, all recipients of Menorah Park’s Excellence in Caring.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

While it didn’t ‘feel’ funny at the time, many years ago, I made a mistake in letting my guard down when I was saying hello to a resident with dementia at a small home in Cincinnati. I was standing very close to her, and suddenly, she just reared back and punched me in the stomach! It took my breath away! It was a tough lesson, but it was funny that this little four and a half foot lady knocked the air out of me. Years later, at a different nursing home, we had an old school ‘Mafiosi’ fellow who had dementia. He was a former boxer and a self-professed ‘hit-man’ and he called me over, “Hey you! Hey you!” So I came closer to hear what he wanted to say to me, and suddenly, his huge hand, much bigger than mine, swung at me, and I realized he was trying to cold-cock me, but I ducked! I had already learned my lesson from the little lady in Cincinnati!

What do you think makes your company stand out? Can you share a story?

Excellence in Caring may sound like a tagline or part of a commercial, but this is a reality at Menorah Park. There are many aspects of Menorah Park that set us apart from other senior health care and residential organizations, aside from our 5-Star rating and being named Best Rehabilitation Center and Nursing Home by US News and World Report among other honors. We strive to always do what’s right, and what’s in the best interest of our residents, clients, staff, volunteers and the community, to help them live better, more empowered, and to be inspired. Our advocacy efforts take us all over the U.S., to the White House, to meeting with legislators, policy-makers, trade associations and doctor and hospital groups, and to ‘the people.’ We give our residents a voice as well. When one of our residents whose physical challenges kept her from being able to sign her name to a letter penned with the help of her son regarding Medicare cuts, she simply put on red lipstick and sealed it with a kiss. That one action helped me spread her message and motivate many other nursing homes throughout the country to get on board with a letter writing campaign, rallies, and community education, garnering much news coverage and bringing to light why we must protect Medicare and all adults as they age. When she was informed how her very special letter helped me spread the word and bring awareness to the issue and involvement from so many, she cried tears of joy. She was later photographed holding a sign that read, “My challenges don’t define me!”

We also respect that our residents are still full of life, and still have dreams, some of which may have never come to fruition. So, we created a D.R.E.A.M. Team to change this. Dare to Reach Every Amazing Moment is what the acronym stands for. The team is compiled of volunteer staff members who work diligently collecting residents’ dreams and helping to make them come true. A community of donors who strongly believe in the program help cover the financial strains that may arise from trying to fulfill a dream. Hundreds of dreams have been granted since its inception around 2004. We arranged for Rock Legend Steven Tyler of Aerosmith to call a woman with Lou Gehrig’s to congratulate her on her Bat Mitzvah, arranged for a helicopter tour of Cleveland for a woman dying of cancer, helped an entire group of residents go to Israel, and have helped several residents whose dream was to write their life story, or simply a book of poetry, prose or vignettes, to get published. We’ve granted dreams as simple as going on a fishing trip or enjoying a favorite meal from their favorite restaurant as well. No dream is too small or too large to try to grant. Having their dreams come true has shown to add an element of excitement, energy, and hope to the lives of the ‘dreamers’ and their families.

What advice would you give to other healthcare leaders to help their team to thrive?

Never lose sight of, or wane your focus on who you serve and why. What’s important is the human touch. If you lose sight of that — everything else is just fluff. Get your team on board with what matters most — the people who need your services, respect, and excellent care. Decide every day to do more than just enough. Go above and beyond to insure your residents, clients, and employees know they can count on you to go to bat for them. Teach them to thrive by helping make the lives of those you serve better; help them live longer, and be healthier, mind, body, and spirit. We won’t settle for less and that is what makes our organization 5-Star. That’s why we have an extremely high employee retention rate. Our employees, clients, volunteers, and our residents are like our extended family. We have employees who have been here nearly 40 years!

Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

It really doesn’t focus on wellness. For example, it’s a sick-model based on sickness vs. health, wellness and prevention. Our current system pays hospitals nursing homes, and doctors for things like surgeries and drugs, based on sickness, vs. encouraging health and wellness, and most important, prevention. If you don’t get rid of those assumptions, hospitals make their money on surgeries, on more doctors, on illness. Sick has been the money maker. Fix a sick system, by changing the assumptions that we can’t reward wellness. Don’t operate your organization or practice based on monetizing a sick model; base your goals on preventions, improving health, incentivize wellness, and preventative care. Don’t reimburse practitioners for procedures, but reward them for helping patients be healthy. Consider all the drug advertisements on television. Ask your doctor for this or that drug, and side-affects include…. more sickness, in short, that will need to be treated with more drugs. It’s a vicious circle.

You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

In short, changing what is wrong explained in the paragraph above. Prevention and more needed funding to incentivize doctors, healthcare organizations, hospitals and nursing homes to improve care, and change long outdated assumptions. Encourage competition among providers to give the best care, by using innovative models. They are hitting bits and pieces, but not tying the whole system together, like instilling use of more seamless technology systems. The Affordable Care Act gave money to hospitals to improve technology, but no money was given to nursing homes or home care agencies for technology, or to encourage more telemedicine, treatments for prevention, more competition, and, again, changing the assumptions from a sick model to a health promotion / prevention model. We need to increase collaborations, reduce inefficiencies and repetition, and get rid of fragmented and duplicated systems that silo the important factions of the medical, insurance, and caregiving fields. The Medicaid Care Coordination Pilot (MCCP) that I developed is a perfect example of how to insure standardized care and best practices on nearly all fronts.

Ok, its very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

Expanding my MCCP pilot model would be a first and very crucial step. It is a fundamental re-design in our healthcare and billing system. It shows that Medicaid care coordination and other collaborative efforts between health care providers has the potential to save billions of dollars that can be used for other important initiatives. Improvement in the health care system would incentivize the good, with a balanced approach. The pilot is already proving we can and are saving money.

The bigger issue at hand is the 95 percent of elderly out in the community, because, basically the elderly in nursing homes are getting good care, but we all hear of neglect going on and it needs to be addressed sternly. We need to reach people ahead of crisis, and in the long run, we would have a greater potential for a healthier nation, lower costs, and better health care as a whole.

What would you suggest to improve this?

The mental health system is lacking in this country, and has been since even before the 60’s and 70’s with the de-institutionalization of mental health patients. You have to separate that out, not assume combining it. The mental health system is poor in this country. Just look at active shooters with mental health issues, and look how the mental health system may have missed in helping them. At Menorah Park, mental health in the elderly is taken seriously and addressed as a major health issue. We have a neuro- psychiatrist and a geriatric psychiatrist, social workers trained as mental health counselors, all to help those who may otherwise fall through the cracks. Mental health issues have to receive the same support systems as physical health.

How would you define an “excellent healthcare provider”?

We believe excellent care means looking at — and beyond — the basics of human touch. It means meeting the needs of the people we serve, by focusing on families, clients and staff, and by focusing on technology, excellence, and measuring how we are doing so we can continue to raise the bar and do better. We never lose sight of the basics of the people we serve, defining the needs of those under our care and including their families, the community and staff, to set lofty goals of excellence. We use technology, and excellent health care providers, and we welcome change. You cannot be afraid of change. It is necessary, and it’s a constant. And it’s been coming for years; embrace it as part of the real world. We know, life goes quickly, needs evolve, and we must be flexible and willing to change, while keeping the mother ship steady. And, while keeping both eyes on the mothership, adding other boats and islands as needed. Never lose sight of the basics of your mission, which is who you serve and why. We serve humans who very much depend on our care. You must be willing to constantly examine and re-examine best practices, and don’t be afraid to look beyond, to what may now seem insurmountable, but not impossible, all in the name of improving what care should really be. The great people help each other and get things done with a focus on the future, not the same old status quo.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

As a student in Boston at one of the largest senior communities in the country, I presented an engineering maintenance budget to the engineering staff, but I didn’t prepare as I needed to, and I didn’t reach out to the right staff, and they tore it apart. So, I re-evaluated, and I worked closely with the accounting staff, and I learned to collaborate. I knew everything about it in the end. I was straight out of grad school, but I learned to recognize experts, (and that’s not always me) recognize my strengths and weaknesses — get the right people in charge, and rely on your team, because teamwork is a big thing. We all have strengths and weaknesses, learn from them and know when to ask for help.

Are you working on any exciting new projects now? How do you think that will help people?

We are working on a care coordination pilot.

AJAS Updates Lawmakers on Care Coordination Pilot Members of the AJAS PPLG Committee visited lawmakers on Capitol Hill last month to present preliminary findings on its Medicaid Care Coordination Pilot project. A group of eldercare professionals participating in the pilot travelled to Washington, D.C., to deliver preliminary project results to Sen. Rob Portman (R-OH), staff from the Senate Finance Committee and Rep. Dave Joyce (R-OH). The MCCP was developed by Richard Schwalberg, chair of the AJAS PPLG and COO of Menorah Park, earlier this year.

The pilot involves a provider-directed program in four states — Ohio, Pennsylvania, New York and California. Pilot participants are six senior care organizations, an acute care hospital system and a managed care organization. Project results in the first quarter are excellent. Re-hospitalizations, falls, pressure sores, ER visits and patient monthly drug costs decreased and were under national averages.

Two important factors to note — re-hospitalization rates decreased by 5 percent, and drug costs decreased by 9 percent. Overall goals of the project are to improve care coordination of elderly nursing home patients on Medicaid and save Medicaid and Medicare dollars. The MCCP was developed in response to the fragmentation and duplication in current care systems in many states. In addition, there are no standardized care paths and best practices for nursing home patients. These preliminary results demonstrate improvement in patient care/quality and cost savings to both Medicaid and Medicare. Extrapolating for metrics and cost saving results nationally, care coordination could offer a potential savings of $750 million. This would occur through all nursing homes, reducing both re-hospitalization and drug costs by 5 percent.

Last year, the AJAS PPLG submitted recommendations about establishing the pilot project to Portman, who serves on the Senate Finance Committee, and Senate Finance Committee staff. MCCP Process- How the MCCP Works The MCCP is a centralized provider-driven model run by nursing homes. Care services collaboration occurs between multiple service providers. We developed 10 quality and cost metrics and measured these on a weekly, monthly and quarterly basis. All project participants also implemented standardized weekly patient reviews using care templates. On a monthly basis, all six organizations in the pilot conducted a joint project evaluation. During the December meeting in Washington, AJAS received unanimous support to continue the MCCP Pilot through February 2019. The legislators recommended expanding the pilot sample and time frame to include more nursing homes over a one-year time period. Specific recommendations for next steps are expected in January, including presenting project results to date to major CMS officials, and other Senate and House Committees.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

I’m reading a book on the Parkland shooting, and while it’s tragically sad, it’s also powerful, that it shows how these young people are advocating and speaking out loud, like we did in the tumultuous ’60s, to affect change…real change. They are saying to politicians and legislators, ‘we are the younger people who will vote, picket, raise our voices, speak out, share our stories, and extend our energies to make things better.’ The whole theme of the book is to ADVOCATE and reach the grassroots of the younger generation. Adults need to do that too. The Movements and the protests from the past showed us that it works; it does make a difference, to open your mouth, advocate, listen to the voices, speak up, and give solutions. While no one is seemingly doing anything about active shooters, the young people are saying what needs to be said. They don’t’ care about the NRA, politicians’ or lobbying money; they care about being pro-human, pro-decent, pro-caring, and pro-active and defining what that really means to our country, and to the world.

You are a person of great influence. If you could inspire a movement that would bring the most amounts of good to the most amounts of people, what would that be? You never know what your idea can trigger.

I want to use my Medicaid Care Coordination Program pilot to change assumptions in the healthcare field, locally, statewide and nationally; to challenge status quo, to not rely on lobbyist to influence models, to rely on caregivers to improve and coordinate care. We have to change the assumptions. Who has the guts to say, we need help, and to do something to actually help. Let’s stop protecting special interests and lobbyist and politicians, and let’s forge new ideas, better ways to do things, let’s think differently, because the old ways are just not working.

How can our readers follow you on social media?

Facebook/MenorahPark

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