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 A New Day Dawns

Starting from scratch, one provider takes a unique journey to quality care.

 

 
Two decades ago, Solanges Vivens sat in front of a congressionally mandated panel, trying to convince its members that she wasn’t a crook. “There was so much cronyism at the time,” she recalls. “I had to sit in front of The Control Board to make sure they knew I was clean.”
 
The interview must have gone well, because Vivens’ company, VMT, was given the job of running one of the capital’s two government-owned nursing care centers. She was also handed $500,000—but not for herself. “The employees hadn’t been paid in months,” she says, smiling, but shaking her head slightly.
In one way, all of that was ancient history this past September, when Vivens and her colleagues hung their banners, laid out their cocktails and hors d’oeuvres, danced and jammed with a steel drum band, and celebrated Unique Residential Care Center’s fifth straight year as a Five-Star facility.
 
In another way, though, those first, crucial moments in front of that panel—known locally (and still ominously) as The Control Board—animate every step that Vivens and her colleagues have taken on the path to high-quality care.

‘People Can Hear If You Have A Smile’

The facts at Unique could speak for themselves. But they’re so spectacular, they bear repeating: The center, which only became a private enterprise in 2010, has achieved Five-Star ratings from the Centers for Medicare & Medicaid Services for each of its independent years. It has achieved Five Stars in health inspections and quality measures, and it hasn’t had a clinical deficiency for at least three years.

Vivens and WrightThis is astounding. That Unique has done all of the foregoing while managing 230 beds (nearly 90 more than D.C.’s average) — nearly 90 percent of them Medicaid patients — is something closer to a miracle. It was accomplished, Unique’s leaders say, from the bottom up.

“People can hear if you have a smile in your voice when you’re providing care,” says Rosalind Wright, vice president of VMT and Unique’s administrator. “And that’s a goal—for our staff to take ownership of our residents’ well-being. They then become involved in just about everything that we do.”

‘Circular Management’

Vivens calls it “circular management.”

“When you use triangular management, communication goes from one person to the next,” she says, slapping the table, then herself, for emphasis (nearly everything about Vivens is emphatic).

“The same message is not circulated from the source. When you use circular management, everybody sits at the same table, everybody hears the same thing. So when we go out, we go out as a team. We have found that really is one of the core values, that we support one another.”

If party attendance is an indicator, there is plenty of staff buy-in. While the Caiso Steel Band drummed out reggae classics (and even the odd torch song), staff and residents danced, joked, and laughed, mingling with the D.C. dignitaries who came in to pay their respects.

Outside, in the still soupy Southern weather, residents enjoyed either the younger staffers’ soul music or the younger staffers themselves.

(At least one of the residents, it is true, had a singular selling point: “Did you see they’ve got rum down there?” he asked his friends as he wheeled his way to the elevators.)

Everyone on staff, Vivens and Wright included, wore their Unique polo shirts. But they were not just for the party.

“Let me use the vulgar expression: ‘The fish rots from the head,’” Vivens said, in her rapid-fire, throaty, Haitian Creole accent.

“It’s very important for us to set the tone, even when we come to work. We’re not going to come to work in suits, and they’re going to wear the shirt. No, no.”

‘District Of Contempt’

VMT has managed Unique since 1995, but only as a government contractor until 2010. “We were subject to their rules, their regulations,” Vivens says.

Like the care center Vivens took over, D.C. was in ruins, then. Its homicide rate was in slight decline, but was still epic. Its services were awful where they weren’t nonexistent. Corruption, pelf, and incompetence were to be taken for granted. Its mayor, Marion Barry, had been a founder of the legendary Student Nonviolent Coordinating Committee, but by then was known to most as the man caught smoking crack in a seedy D.C. hotel room.

As the late, great Christopher Hitchens put it: “Welcome to Washington, where the unploughed snow at least helps to cover up the uncollected garbage. Where the official advice is that children, old people, and sick people should not drink the tap water unless they boil it.” (Hitchens would later suggest that “D.C.” stood for “District of Contempt.”)

By 1995, the District was literally bankrupt (a fate that may still beckon for the unfortunate people of Illinois—see sidebar, page 20). Congress created The Control Board, a panel of presidentially appointed bean counters, and tasked it with applying a tourniquet to D.C.’s hemorrhaging finances.

The Control Board then inherited the city-owned nursing centers, which were run about as well as one would expect them to have been run. Taking over, Vivens bided her time, fixing what she could, building for the future.
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‘We’re Going To Turn It Around’

A decade and a half later, the opportunity finally came. The Control Board had faded out, D.C.’s budget was balanced, and the city was undergoing a Renaissance, as—for the first time in decades—its population began increasing (it is now one of the wealthiest and most expensive cities in the United States). 

Then-mayor Adrian Fenty decided it was time to get out of the nursing center business. Vivens and VMT put in their bid and won.

“We said, ‘Okay, it’s ours now. We’re going to turn it around,’” Vivens says. “We’ve been Five Star since then. We practically rebuilt this place from the inside out.”

Indeed, Unique doesn’t just offer its residents the Bingo room (although that’s there, too). There are state-of-the-art fitness rooms, entertainment centers, a dance floor, and, perhaps most famously, Unique’s “Man Cave,” where a television the size of a Buick broadcasts the latest sports, and residents can enjoy their beers, surrounded by jerseys, pennants, and other swag of the capital’s local heroes.

There are trips to the beach, tickets to Wizards and NFL games, and plays at the Kennedy Center, too.
“You name it, we do it,” Wright says, speaking at a conference table in Unique’s administrative office, one of the few quiet places on the main floor.

‘This Is Who We Are’

That reminded Vivens of “a big one,” a story to tell.
Unique Residential Care Center
“We had a resident who had never been in an airplane,” she says. “All he talked about was that all he wanted to do was to fly. And then our social worker made a deal with Delta Airlines. He sat in the cockpit with the pilot. And then he came back and talked about how he had flown. When he died, he died happy. This is who we are.”

That doesn’t mean that the journey has been easy. Wright, for instance, regularly starts her days around 5:00 a.m.

“But I find that it provides an excellent opportunity to end up talking to all the shifts,” she says. “It gives you a chance to get your day organized and see what’s going on so you can kind of know what’s going on in the facility.”

It has helped that Vivens and Wright “complement each other,” the pair agree. Each started their careers as nurse assistants and have steadily worked their way up through the ranks.

“We think alike. So it helps,” Vivens says. “It helps when we’re doing something to put our heads together to move the facility forward.”

The critical component, though, they say, is staff buy-in.

Quality First

“We established a quality first program for the CNAs,” Wright says, referring to certified nurse assistants. “We met with CNAs on all three shifts and did additional training … with the key being that they not only know what they’re doing, but they understand their value, because they are the first-line caregivers. We want them to know how important they are to us.”

Wright attends every training session, on every shift. She wants staff to see that the emphasis on quality “is coming directly from me.”

Here, too, Unique puts its money where its mouth is. For every good survey result that comes back, part-time, frontline employees are each given a $150 bonus, and full-time, frontline employees are given $300, Vivens says.

“Each year, there is no reason we can’t be deficiency-free,” Wright says. “I try to get people to see that you can set the tone—the expectation is that we’re going to be able to do that.”

The efforts have paid off often when it matters most, Vivens and Wright say. A few years ago, Unique’s basement flooded. Wright was at a church retreat in rural Maryland when she got the call. By the time she arrived, literally every manager from every shift was already waiting for her.

‘Loved What You Said, But…’

It has not always been sunshine and roses, though. D.C. remains a union town, and the staff unions here will occasionally target Vivens personally, representing her as something between Satan and a used car salesman. Vivens, her eyes in perpetual twinkle, shrugs it off.

“You still don’t have 100 percent buy-in, because people are people,” she says. “We have one guy on one of the units who is going around the unit telling the aides, ‘Well we need to get more money. If they have enough money to do all this partying, they should have money to give us …’”

Earlier that September morning, Vivens had shared a few thoughts about Unique’s history, and why its fifth straight year as a Five-Star center mattered so much.

Later, she was passing through the rabble-rouser’s unit. “He says ‘Doc, I loved what you said, but, you know? You know?’” Vivens says, laughing and holding her hands out and rubbing her thumb against her fingers. “I said, ‘What do you want me to do, break the wall and add more beds?’”

For now, that’s probably not necessary. Vivens has lived through the bad old days. If nothing else, they’ve given her a kind of guidance—and resolve—to push on.

“We’ve survived so much,” she says. “This is our business. It’s also our home.”
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