Mention Flint, Mich., to most anyone inside the “rust belt” and the responses could range from “sad and empty” to “crime-ridden and hopeless.” The city that gave birth to General Motors and the United Auto Workers now evokes images of blocks of boarded-up homes, parades of for-sale signs, and abandoned strip malls.
Not surprisingly, the statistics behind these images are bleak: double-digit unemployment rates that are higher than the national average, a poverty level of 34 percent (more than twice the national average of 14.3 percent), and a crime rate that ranks among the highest in the nation.
According to the Federal Bureau of Investigation, Flint now holds the dubious distinction of being No. 4 on its list of the most crime-ridden cities in the United States.

Making matters worse, thousands of denizens have fled the city in recent years, causing the population to drop by 18 percent between 2000 and 2010, according to the U.S. Census Bureau.

A Bright Spot

This story is not about Flint alone, however. This story is about a bright spot in the city: Willowbrook Manor, an award-winning 102-bed skilled nursing center located a few miles west of the city’s center.
Willowbrook shines as an example of how the human spirit, along with some persistence and hard work, can endure economic hardship and adversity.
On a cool day shortly after Thanksgiving, its lobby is festooned with a Christmas tree, festive lights, and sparkling decor. In contrast to the surrounding blight, staff members at Willowbrook emit cheerful, positive attitudes.
“I know everyone is down on Flint, but I think it’s making a comeback,” says Ryan Michelson, Willowbrook’s administrator, who was born and raised near Flint and attended the University of Michigan-Flint.
He says his experience with the embattled city has been mostly positive. “I went to school in downtown Flint, and I never had any brushes with crime,” he says.
Michelson brings this sanguine attitude to his job, which likely contributed to his facility’s success in receiving a Silver National Quality Award from the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) last year.
Based on the Malcolm Baldrige Performance Excellence Program, a public-private partnership housed at the National Institute of Standards and Technology within the U.S. Department of Commerce, the AHCA/NCAL Silver Award is not an easy feat to achieve.

Therapy Program, Staff Longevity Help Cause

According to the Silver Award application, criteria “focus on results and the conditions and processes that lead to results.”
For Willowbrook, successful rehabilitation programs, staff longevity, and customer satisfaction are some of the accomplishments that helped them garner the Silver Award.
The facility’s rehabilitation program, dubbed Home Express, sends more than 80 percent of its skilled therapy residents home or to less acute care settings.
Also noteworthy is the longevity of its staff (see Table 2, below). The director of nursing, assistant director of nursing, and Michelson have been with Willowbrook for 13 years. The minimum data set coordinator is a 14-year veteran of the facility, as is the environmental services director. Turnover is also low among Willowbrook’s 120 employees (see Table 3, below). Compared with Willowbrook’s owner, Ciena Healthcare Management, turnover is dramatically lower. In 2010, the rate for Willowbrook was 13 percent, while the Ciena turnover rate was at 40 percent.

Keeping the facility humming at such a high level, says Michelson, means constantly evaluating and analyzing data, which come from several sources. Customer surveys, discussions with family members and employees, concern forms, and suggestion boxes are some of the methods employed.
In addition, SWOT (strengths, weaknesses, opportunities, and threats) and environmental analyses are utilized. “Analysis of data sources helps us plan and prepare to meet the needs and expectations of future customers and to ensure their satisfaction,” says Michelson.
He also credits the facility’s commitment to its mission, its code of ethics, and code of conduct for its success.
“These things have helped us keep employee turnover low and create a successful rehabilitation program,” he says.

Union Challenges Present But Minimal

Michelson also points to Willowbrook’s “aesthetically appealing environment” and high quality of care as reasons for its recognition as a provider of choice in Michigan, “despite the disadvantage of location and unionization,” he says. Aside from location, being a “union shop” presents a challenge to Willowbrook’s management. All employees, except management and licensed nurses, are unionized at Willowbrook. Given that Flint has been dominated by the auto industry for decades, unionization has become part of the fabric of the city’s culture.
“Unions present unique challenges to employers,” says Michelson. “Willowbrook’s union contract dictates equal pay for equal work, which prevents us from rewarding employees with bonuses or raises based on performance.”
Michelson says this policy also prevents the promotion of unionized employees to management levels while maintaining their union status.
“Health care facilities need to remain focused on the care of customers, and unionization tends to divert that focus in alternate directions, which has the potential to decrease effectiveness,” he says.
Despite these challenges, Willowbrook has scored consistently high marks on its employee satisfaction surveys, and union-filed grievances have declined steadily over the past decade.
The secret ingredient to this success, says Michelson, is that “we are fair and consistent with all staff members.”

A Positive Outlook

Ciena Healthcare Management, headquartered in Southfield, Mich., owns and operates Willowbrook in addition to a stable of 35 long term care properties in Michigan and Connecticut. Kristine Halsey, chief operating officer for Ciena, notes that the company is expanding. “While others are retreating, we see the coming years as a time of opportunity for expansion,” she says.
Halsey reports that although the Medicare and Medicaid funding climate is poor, Ciena has not made any staff changes.
Expansion for Ciena means that it is building skilled nursing centers throughout lower Michigan, as well as hiring staff to oversee a new dining program that will eventually be implemented throughout the entire company.
Ciena recently broke ground on a new skilled nursing community in Grand Blanc Township, just east of Flint. The 68,000-square-foot facility, known as the Grand Blanc Care Center, will be a “state-of-the-art facility with 74 short-term rehabilitation and long term care suites with private baths in each,” says Halsey.
At a cost of more than $8.5 million and expected to create more than 120 full-time and part-time jobs, Grand Blanc Care Center is slated to open next summer.
In addition to six bariatric rooms, a rehabilitative therapy room, and a spa, the community will feature several dining venues, including a main dining room, a restorative dining room, a private dining room, and an a la carte 24-hour room service menu created by an executive chef.
Ciena will open a new skilled nursing community in Ann Arbor, Mich., this fall. Regency at Bluffs Park, was renovated at a cost of more than $5 million.The 71-bed facility will feature 37 private rooms and 17 semi-private rooms, all with in-room showers and baths.
According to Ciena’s website, the new center is “designed to have the look and feel of a boutique hotel.” In addition to other amenities, each resident bed will have its own flat screen TV.
The 37,000-square-foot building is also expected to receive a Silver LEED Certification, as granted by the U.S. Green Building Council.
Also part of this project, Ciena donated more than one acre of land to the city of Ann Arbor to be used as a public access point to Bluffs Park.
A third Ciena community will open soon in Canton, Mich. The Regency at Canton will offer short-term rehabilitation and long term care, which includes 40 private rooms and 80 semi-private rooms.
dining next on list for upgrade.
Next on Ciena’s list of priorities is fine dining. Halsey says the company is revamping its entire dining program so that residents can enjoy better food and a more pleasant dining atmosphere.
“We hired a corporate chef from a well-known Detroit restaurant to train the cooks in all of our communities,” says Halsey, who notes that they will start with basic sauces and work their way up.
Many of the facilities will keep their existing cooks and take classes with the corporate chef. The overhaul includes menu planning and dietary requirements for all Ciena chefs.
A “quality dashboard” created in-house by Ciena enables facility staff to see, on a daily basis, how the residents are doing on a number of indicators.
“It’s really about data,” says Halsey, “and giving them the information and tools to provider the best quality of care possible.”
This support is evident in the fact that eight of Ciena’s care centers, including Willowbrook, recently received five-star ratings from the Centers for Medicare & Medicaid Services’ quality rating system.
In addition, Willowbrook was recognized by U.S. News & World Report as one of America’s best nursing homes in 2011.
What’s more, Ciena selected Willowbrook as Facility of the Year three times over the past five years.

Don’t Count Flint Out

At press time, Flint’s troubles continued as Michigan Gov. Rick Snyder (R) appointed an emergency manager to oversee the city’s shaky finances. Although the move appears to be the latest indicator of Flint’s downward spiral, the city still has many supporters.
Richard Karp, a developer who specializes in historic preservation, is bullish on Flint’s prospects for a successful revitalization. He was instrumental in rebuilding the Durant, a once-legendary downtown hotel named for the founder of General Motors, William C. Durant, a grandson of Henry Crapo, the 14th governor of Michigan.
Built in 1920, the Durant thrived for nearly 50 years as a symbol of the city’s success. After sitting empty for more than 30 years, Karp began refurbishing the hotel in 2008.
Since its reopening as an apartment and commercial leasing space last January, interest in the project has exceeded Karp’s expectations.
“The apartments are 100 percent leased, and we have one commercial suite left,” he says. In addition, the project has won five awards thus far, including the Governor’s Award for Historic Preservation.
Karp says he was attracted to the Durant project for several reasons. “The expansion of the University of Michigan campus, a strong revitalization effort in the downtown area, and the lack of housing for students” pointed to its potential for success, he says.
Karp confirmed that he is eyeing two more projects for development in the downtown area in the near future.
In the meantime, Michelson remains upbeat about Flint’s comeback. He points to the city’s cultural establishments as examples of endurance: The Flint Institute of Music, the Institute of Arts, and several colleges and universities with campuses downtown are all thriving amid the city’s turmoil.
Flint has weathered much hardship over the years, and it could get worse before it gets better, but Flintoids are an enduring lot.
After all, it was built on steel and grit by the largest automobile manufacturer in the world.
And so, as the city wrestles with its ghosts, Willowbrook hums along efficiently, business as usual.