Blogger's Note: Below is Gracedale Administrator Michelle Morton's strategic plan for the home's future success, which she read into the record at last week's Human Services Committee after responding to several questions I outlined yesterday. Morton comes from the private sector and has only been at the home since March 17. She acknowledged that she has never read a performance audit of the home that was presented last year.
Morton strikes me as a dedicated professional and one of the very rare people who actually cares about residents, very much like her predecessor Jennifer Stewart King. But her plan is far from bold. She wants to reduce the county reliance on agency nursing from 59% to 30% by June 2026. Shouldn't the goal be its complete elimination? She is shooting for a three of five star resident satisfaction rating. Shouldn't she be shooting for five?
It strikes me that mediocrity, and not excellence, is the goal. The plan completely sidesteps the Big Beautiful Bill Act, which is going to affect both care and financing at nursing homes? That new law should have some positive and negative implications, and a real plan should address these changes. (I am going to discuss this law Wednesday).
Her plan, at least what she put on record, fails to consider any of numerous technological changes made to resident care which would reduce if not eliminate the falls that result in lower quality measures scores. It fails to project what the landscape will be like in 20-30-40-50 years.
And she's completely silent on the one area that probably means most to employee recruitment - the paycheck.
I do not fault her. She's paid to be an administrator, not a planner. But the county needs a plan for the home's immediate and long-term future. The Exec and Council should put their petty squabbles aside and jointly agree to fund a plan for Gracedale's future success.
Morton's Strategic Plan (I quote her as much as possible):
Gracedale has undergone many transitions since the property was first bought by the county in 1837. We started as an alms house for the poor, then eventually transformed into a more traditional nursing home in 1950. As a nursing home, our operations have significantly changed over the ensuing years. We now serve a more varied population with an increasing number of younger residents facing mental health challenges. In addition, we have faced numerous challenges such as implementation of the mega rule beginning in 2017. The mega rule was when our regulations were rewritten, and they're called the Mega rule because it's like over 900 pages. We're now number one in the country as far as regulations. We used to be second behind a nuclear industry, now we're number one. And that's just counting the nursing home specific Federal regulations. It's not counting any other regulations at any business has to follow, and it's not counting the Pennsylvania Nursing home. It's just the federal alone is huge. So that was a huge overhaul. And then, of course, came staffing shortages and the worldwide pandemic.
What hasn't changed is our mission to meet the medical, psychosocial, and spiritual needs of the residents of Gracedale while maintaining the highest possible standards of care in the most efficient manner.
Our leadership has changed greatly in the past year with at least eight members of our leadership team, being new to the organization or new to the role. So this May 2025 is a good time to evaluate what we're doing, and how best to position ourselves to address our current needs and challenges, as well as develop aspirational views for the future.
So our leadership team met together to begin the strategic plan, and our first step, we completed a SWOT analysis, [Strength, Weaknesses, Opportunities, Threats] We analyzed our strengths, our weaknesses, our opportunities, and our threats. I would say that even that process of developing the SWOT analysis was a change in our process. We were moving more from department head meetings that were more informational sharing to meetings that were collaborative and engaging. We did our swat analysis and when we looked at that, it became clear that we had four themes that we wanted to focus on.
And I think you would all agree with these from the conversations we've already had.
Our focus is our residents, our team, our community beyond our campus and our financial performance.
Before we finalized our goals and objectives for each of these four themes, it became important for us to develop core values. We already had a mission statement and a vision statement that served to define our efforts, but we needed additional guiding principles to solidify and sum up our identity and answer what is important to Gracedale. We collaborated on that. I asked that question, what is important? What things do we want to say, 'This is Gracedale?'
I collected all of those themes, and then we were able to group them into these categories that you see here that spelled out the acronym GRACE. Our values, our grace and kindness, respect and dignity, accountability, and integrity, collaboration and teamwork, and excellence and innovation.
So after we did our swot analysis and our core values, then we moved on to look at our strategic goals under each thing. Our goals are reflective of our mission, vision, and core values, and give us a clear direction for our future.
In spite of the many challenges we face, this direction is positive and reflects the collaboration and engagement of our leadership team with the coming focus of more collaboration and engagement of all Gracedale stakeholders .
I already went over our mission statement, our vision statement is to improve care outcomes such that Gracedale Nursing Home is a preferred facility for area referral sources and a facility of choice for prospective residents and employees .
Grace and kindness. - We want to treat others with compassion, empathy, and kindness. Foster connections and expect the best from everyone and don't make assumptions.
Respect and dignity. - Treat everyone as an individual, be person centered, take time to listen, prioritize the needs of people.
Accountability and integrity. - Conduct our work honestly with transparency at openness in all transactions. Follow not only regulations, but also best practices. Foster trust.
Collaboration and teamwork. - Work together on common goals, both within our campus and the community at large.
Excellence and innovation. - Be flexible and try new things. Take quality personally. Foster a culture of creativity and continuous improvement and incorporate fun into our work.
So next we have our SWOT analysis, so I'm not going to read all of that, but we've looked at our internal strength, so what's our competitive advantage, what res sources do we have? What are we doing well? We looked at our weaknesses, and that's internal as well. Where can we improve? Where are we lacking resources, and where are we underperforming? Then we looked at our opportunities, and that's external. So that's what new technology can we use? How can we expand operations? Can we form stronger partnerships? And threats would be, again, external, but unfavorable things, things like what regulations are changing, what are competitors doing, how are consumer wants changing. So once we did all that, we did come up with our strategic goals.
Number one was to achieve consistent staffing and decrease agency usage by decreasing our staffing vacancy rate from 59% to 30% by June of 2026. So those, again, were real numbers. That was our current vacancy rate at the time we did this. So we have a clear goal. We wanted everything to be clear. As that time approaches, we'd be able to look at it and say, did we meet your goal or didn't we? And they would add that with all over our goals under this, you know, things are flexible because as we go through each month, we'd be looking and say, how are we doing? Are we on target or do we need to readjust ?
We want to develop a recruiting and onboarding program that hires for behavioral characteristics. So we want to look at, you know, not just as someone qualified, but what is their character like, hiring those right people? We want to provide support to new hires so that they successfully transition from probationary employee to standard employee. So many times we hire someone and they, you know, don't finish their probationary period before they move on. So we want to stop that and say, okay, how are we supporting them so that they move on with us ?
We want to provide education to our staff, so that they are better able to meet the needs of our residents and to perform their essential job staff. This includes supporting staff to participate in training so that they are relieved of their duties and can attend training, which is one of the things we do with that mental health first aid. We made sure that there was someone filling in so that the staff who attended the training were able to attend. We'll be continuing things like that.
We're working with staff development to do more trainings that are short little, I call them training huddles. We may gather a group together for 10 minutes, because you can't always release someone for a full day. You know, there's times where we want to do that, but we also want to provide more on the job, like, okay, let's do this training and do it frequently. We get a lot of training in.
We want to develop an employee engagement program that supports employees in thriving at work, as well as incorporating a sense of joy and fund and for work. So we actually have started at that committee, so we have a group of team members that meet, and they plan events for our team members again to make it a fun place to be.
To recognize the good work that employees do through an official recognition programming, honoring employee contributions to our mission. We also want to grow our mentor program, and we went to adopt an anti bullying campaign.
Here's an example of how we're adjusting under number one with the staffing. Our engagement committee has developed an employee satisfaction survey, and they decided to send that out in October because they wanted everyone to be back from summer vacation and things like that. That's going to go out in October. That way we'll be getting feedback from our team members that we can use to add to our plan. Then we can also see improvement, because we'll have a baseline number.
Number two, to improve service and care outcomes so that we score at least an average of three out of five on resident and family satisfaction surveys. To get a three out of five on resident and family surveys, we run to improve our environment for residents living with dementia by offering specific programs and environmental amenities to meet their unique needs. We do already have a committee for one of our neighborhoods, for residents living with dementia, and that's been great so far. We've had, I believe, that's four meetings. We have a nurse's aide in that program, a housekeeper, because sometimes people forget housekeeping, they're in and out of resident rooms every day. They know our residents. So we have a housekeeper and she's awesome. She's actually taking on a leadership role with in that committee. [discusses different employees]
We want to improve our quality measures, especially with decreasing falls with injury, improving function scores. Function scores are how residents are able to do for themselves. We want to see those scores go up because that's an area where we could be better and reduce hospitalizations.
We want to begin the person- center journey to decrease institutionalized [?] and increase home likeness. We talked about that already.
And because this was important to our residents, it comes up frequently a resident councils, we want to improve our Wi Fi, to accommodate growing demands on our systems. We have more and more residents that are using, you know, wireless devices and streaming and things like that. So it's taxing our system. ...
Number three, we want to increase our involvement in the larger community, so meaning outside our campus, within the Lehigh Valley. We want to be involved in at least two community events per quarter.
We want to become involved in area groups such as Lehigh Valley Aging in Place, which we're already doing. We want to work with our county community development, so identify and become involved in appropriate community events. We've already started that and have been involved in some things through them.
We want to develop on site campus events to bring people onto our campus. We do already have some of their schedule that will be coming out this fall. We want to implement an interdisciplinary committee to work on committee engagement initiatives. We already do have that committee put together and it involves multiple disciplines, so it's not just marketing now, it's other disciplines are involved in saying, how can we get involved and become an important part of our community?
Number four, financial stability, we want to achieve financial stability on an ongoing basis, and you will see when we do our budget presentations later this year that we are presenting a zero budget. Our budget is balanced .
We want to implement lean operations and I've talked about this at a previous meeting. Evaluate and identify opportunities to operate following lean principles, not just in fiscal operations, but also our operations and practices. What are we doing? Is it efficient ? Are there processes that are redundant that we could eliminate all these kinds of things that go into lean principles?
We want to implement new PDPM [patient driven payment modules] guidelines to optimize financial reimbursement. The patient driven payment models is something that had come out with our guidelines on how we get reimbursed for our short term rehab. It used to solely be reimbursed on the number of therapy minutes. That had changed where it's more about not just therapy minutes, but also how clinically complex the resident was and how much time they need it from staff. Well, that's moving on beyond just short term rehab now. So it's a whole different reimbursement model. We obviously want to successfully implement that.
And we want to continue to develop census, to surpass our census goals and develop partnerships and become preferred providers with area hospital networks and other referral sources. As I said, it's a working document that we've already implemented the beginnings of the majority of that, and we'll continue and we'll also adjust as we go along.
