The following is a guest blog from Anthony Cirillo:  

In his latest book Warren Bennis raises questions about the nature of leadership. He asks, "Can a leader both act and be real?" Bill George, a professor at the Harvard Business School, in his book True North, contends that a "journey to leadership" cannot be made without "framing your life story, discerning your passions, finding your leadership purpose" and aligning it with that of your organization. In short he is saying that you cannot fake leadership, acting one way in the work environment and another way when away from work.  

Bennis contends that there are times when it is necessary to avoid being authentic. I disagree especially when it comes to healthcare. In this age of consumerism and transparency where you are dealing with people's lives and the emotions of caregivers and families it is paramount that you walk the walk of person-centered and patient-centered care in your personal and professional life. People will see through leaders who lead double lives. And given that most of our hospitals and long-term facilities are in small towns where "everybody knows your name" and your business, you better believe that they will be looking out to see if you lead your life with the same values you profess to lead your organization. Employees see through this as well and will not be motivated to authentic change following a Jekyll and Hyde leader.  

That could get to a more systemic issue about how we hire and promote leaders in healthcare. We always look at past accomplishments and metrics that have been moved in previous jobs. But what about how they lead their lives? Should that be considered? I believe it should though I am not sure how you screen for that. Tell me how you do that.  

I can tell you that to re-certify as a Fellow in the American College of Healthcare Executives, you need to show how you contribute to the community beyond work. So at least in one instance you know that when you hire a Fellow of the College you are probably hiring someone who walks the walk in all areas of his/her life. This is not a commercial for the College but rather one example where you can begin to see a person's whole life picture.   Are some able to lead without being authentic to their organizations or to themselves? What do you think?  

Anthony Cirillo, FACHE, ABC is a healthcare consultant, senior advocate and blogger for Wellsphere, Medpedia and others in the area of aging, person and patient-centered care and marketing. He consults with long-term care facilities and is available for management retreats and association keynotes. He is the author of "Who Moved My Dentures? His company, Fast Forward Consulting empowers organizations to change the healthcare experience and leverage it in their marketing.

To read more, click here for the AARP Bulletin and video on the announcement.

We all know that washing our hands is the best way to guard against the spread of germs. But there are several other measures that can also help protect us from contamination.

 In this Washington Post article, health care professionals share some other tips on how they stop the spread of infection.

A new study from PHI, a national non-profit organization working to strengthen the health care services workforce, reveals that less than one-fifth of Massachusetts direct-care workers (nursing home assistants, home health care aides and personal care attendants) are enrolled in employer-sponsored health insurance plans.

The primarily reason for the lapse in coverage is that it's too costly. The study found that most employers in this sector offered insurance but their direct-care employees did not enroll.

The reason: many workers are caught in a bind. If they are offered employer-sponsored health coverage, direct-care workers, whose wages primarily come from public programs such as Medicare and Medicaid, cannot access Massachusetts' less-expensive subsidized health insurance programs.

This scenario is all too common for low income workers. They don't make enough money to afford health insurance, but they make too much to qualify for public assistance. We all know that a strong work ethic is valued in American society, so why are these workers being left behind adn what can we do to change it?

"While considering proposals to expand access to health care coverage, Congress must heed what we learned from the Massachusetts model: it has done nothing to lower the cost of employer-sponsored health coverage, making it prohibitive for low-wage, direct-care workers and their employers," PHI government affairs director Carol Regan said in a press release. 

Nationally, there are 3 million direct-care workers and the number is projected to grow to 4 million by 2016, becoming thenation's single largest occupational group.

In Coverage for Caregivers: Lessons from Massachusetts Health Reform, researchers recommend the following provisions should be included in health reform legislation:

• Support the inclusion of a national, publicly operated health insurance option.
• Allow all eldercare/disability service employers access to the proposed insurance "exchanges" or "gateways" regardless of size.
• Ensure adequate federal subsidies to low- and moderate-income workers and their families.
• Expand Medicaid to include all individuals earning up to at least 133 percent of the federal poverty level.    

The CDC is just beginning to understand why so little H1N1 virus is available to Americans in need, reports National Public Radio. First, vaccine manufacturers didn't have the reagents to know how much active ingredient was in production. When they finally got them, they learned that they had far less than they thought. Then machine glitches caused a bottleneck in packaging. Next up, some vaccine manufacturers have had only one-fifth the viral yield from chicken eggs that they expected.

The question now is whether the vaccine will be ready in time to do much good. "It's hard to make an argument that the vaccine is going to protect very many people at the rate it's coming out," says Dr. Marc Lipsitch of the Harvard School of Public Health, a CDC consultant. "Much of this wave will be over by the time most Americans have access to the vaccine." Other experts disagree and suggest that the vaccine will help prevent waves of disease that could arrive as late as January.

In the meantime, no one can predict how much vaccine will be available or when it will arrive. Reports of people waiting in long lines only to be turned away are becoming commonplace. Nothing like taking people in a bad economy with unstable jobs and making them take off work to spend time in line with no reward. Let's just hope no one is already infected and spreading it to all of the people around them.

Kimberly Broffman is the little girl at the center of it all. She lives in the retirement community with grandparents Jimmy and Judie Stottler because they are her legal guardians.

The community's homeowner's association wants Broffman out because the bylaws of the community clearly state that residents must be 55 years or older. Apparently the Stottlers were willing to leave: They've been trying to sell their home, but the housing crisis has prevented them doing so, even after they decreased the asking price by almost $100,000.

Pretty soon, a judge will have to decide whether Broffman can stay or if she must go.

Click here to see the Today's show coverage of the story.

What do you think of this debate?

Two new studies from The New England Journal of Medicine indicate that nursing home residents may be receiving futile care measures at the end of their lives.

In one study, doctors examined health records of 3,702 nursing-home residents across the nation who started dialysis between 1998 and 2000. While the average age was 73, many had other health problems, including diabetes, heart disease and cancer. Within the first year, 58 percent died and 29 percent declined in their ADL ability.

The second study followed 323 people with advanced dementia from nursing homes in the Boston area. Their average age was 85 and they could not recognize loved ones or walk or talk. One out of four died within six months and half died during the 18 months they were followed.

As this article points out, experts agree that these two studies point back to the need for more palliative care in nursing homes.

With the H1N1 virus lurking in our office (so far, one confirmed case), experts agree that aside from vaccination, the best defense is thorough handwashing. Check out this video from the Washington Post that shows proper handwashing technique.

We hear these messages all the time, but truthfully, we could all probably do a better job following through. In fact, a recent Australian study found that three out of ten men and one out of ten women didn;t wash their hands after using the restroom.

On a related note, did you know yesterday (October 15) was Global Handwashing Day? www.globalhandwashingday.org

A study published in The New England Journal of Medicine questions whether dialysis is the best treatment for nursing home patients. As reported by USA Today, more than half of older nursing home residents die within a year of starting dialysis and "nearly another third experience a significant decline in their ability to perform simple tasks, such as feeding themselves."

Study authors said they hope the results will encourage health care professionals to engage in "open and honest discussions" with residents about the risks of the treatment.

For frail elderly nursing home patients, permanent kidney failure "is like metastatic cancer with rapid deterioration and short life expectancy," [says Peter Aronson, Yale University nephrologist]. "The results of this study should inform end-of-life planning for such patients and encourage consideration of alternatives to dialysis, such as palliative care" to relieve symptoms.

 Read the full article here.

Given the recent push to vaccinate, this statement is sure to become controversial. One of the points mentioned is the pre-existing H1N1 immunity that some elderly people may have.

To those of you who work in senior living facilities: What do you plan to do about vaccination?

Not only does my doctor's office not have any, but they don't even know if they'll get any at all. Off I went to the Dept. of Health to investigate.

Each provider must put in a request to the state and wait to hear if they're approved. The state is looking for risk groups as well as the ability to house the vaccine with sufficient refrigeration, and distribute it efficiently. Here in Pennsylvania, all vaccine is going to pediatricians right now, and the priority is five to nine year olds. Though my kids got it even though they're only 3 and 4. There's no word on when my baby can get one-she needs the shot and only the mist is currently available.

Every week, the state will distribute a group of doses with instructions on who is to be prioritized. But no one knows who will be next in the priority list. The person I spoke to at the health department-who was suprisingly unfrazzled-said that the only thing for people to do it watch the Web site (http://www.h1n1inpa.com/ for local folks) and call in a few weeks. She also reminded me that the flu is being a bit overblown.

What has your experience been?

I recently discovered a rather interesting awards ceremony, the IG Nobels. Hosted by the Harvard-based journal Annals of Improbable Research , the awards honor less-than-traditional research and are handed out by real Nobel laureates.

Highlights from this year include:

• The veterinary medicine prize went Catherine Douglas and Peter Rowlinson at Newcastle University's school of agriculture for discovering that cows with names give more milk.
• The peace prize went to Stephan Bolliger and colleagues at the University of Bern in Switzerland, who found that empty beer bottles are sturdier than full ones, but either can fracture the human neurocranium.
• The medicine prize-my personal favorite as a knuckle cracker, went to Donald Unger, a doctor in Thousand Oaks, Calif. He cracked the knuckles of his left hand, but never those on his right, every day for 60 years to investigate whether it caused arthritis. (He concluded that it does not.)
• The chemistry prize was awarded to Javier Morales who heated 80-proof tequila blanco in a pressure vessel to create diamonds.

Read more at http://improbable.com/ig/winners/.

The following is a guest blog from Anthony Cirillo:

Recent Harvard articles have been consistent in their insistence that a different mode of leadership will be required in all businesses going forward. Business as usual got us into the predicament we are in so we can't simply go back to it when the economy recovers. New leadership will be about facilitating, collaborating and empowering. I write a lot about person-centered care. When readers write back, they pin a lot of the stagnation in implementing person-centered care on leadership. People change because they want to change. Leadership has to create that context. Albert Einstein said "No problem can be solved from the same level of consciousness that created it." With that in mind, here are some leadership qualities I believe are necessary to overcome the present stagnation.

Leaders must be committed to:
1. Creating exceptional experiences for everyone - staff, patients, residents, caregivers and family members.
2. Fostering a collaborative leadership style focused on empowering and energizing employees and adopting and acting on ideas that flow from bottom upwards.
3. Being an innovative thought leader, continuously exploring, experimenting, learning and sharing not afraid to have a point of view and take a stand on it.
4. Evolving into a change agent for Person Centered Care by walking the talk.
5. Educating the public about aging issues by sharing stories that in turn enhance their brand and contributes to operational success.

Is this you? Who do you know who exemplifies these qualities, and what has been your experience with them? Are you in? If so let's talk!

Anthony Cirillo, FACHE, ABC is a healthcare consultant, senior advocate and blogger for Wellsphere in the area of aging and senior health. He consults with long-term care facilities and is available for management retreats and association keynotes. He is the author of "Who Moved My Dentures? His company, Fast Forward Consulting empowers organizations to change the healthcare experience and leverage it in their marketing. To read more, go to http://community.advanceweb.com/blogs/ltc_1/archive/2009/09/04/guest-blog-new-leadership-methods-needed-if-person-centered-care-to-blossom.aspx and http://community.advanceweb.com/blogs/ltc_1/archive/2009/08/05/guest-blog-putting-person-centered-care-in-perspective.aspx.

After examining life expectancy and mortality data from 1920 to 1940, University of Michigan researchers José Tapia Granados and Ana Diez Roux found a surprising boost. Over that time, they found U.S. life expectancy increased by 6.2 years during the Great Depression-from 57.1 years in 1929 to 63.3 years in 1933, according to this article posted on MSNBC.com.

In fact, the researchers found that while overall population health (as measured by life expectancy) rose during the Great Depression and other recessions between 1921 and 1938, mortality increased during periods of strong economic expansion, such as 1923, 1926, 1929 and 1936-37.

The researchers looked at mortality rates for specific age groups and as a result of six specific causes that accounted for about two-thirds of total mortality in the 1930s: cardiovascular and renal diseases, cancer, influenza and pneumonia, tuberculosis, motor vehicle traffic injuries and suicide. Mortality for all ages due to all the causes declined in periods of economic downturn, except for suicide.

The researchers acknowledge these findings seem counterintuitive, but they still say they may apply to the current recession. Still, there are significant economic and societal differences between now and the 1930s, Granados told LiveScience. While overall population health and life expectancy may improve during down times, that might not be the case for any particular person, especially someone who is unemployed or worried about getting laid off and suffering attendant stress, he noted.

The overall rise persists, though despite potential health declines in those who have lost their jobs, because the majority of the work force is still employed (or retired and receiving benefits), he explained.