Several hundred miles away from Tom Coble’s for-profit homes, Ted Goins Jr. has been logging miles in the car. For most of April, he was visiting the nonprofit Lutheran Services Carolinas (LSC) centers through North Carolina, checking in on the company’s 1,400 senior care employees. He’s got to be at each place no later than 6:30 a.m. because he wants to have breakfast with the overnight crew.

“I fussed and cussed because I had 12 days to do all this, but now I kick myself for taking 13 years to do this,” Goins says. “It’s the best thing I’ve ever done. What I’ve been trying to do is listen for five or six hours. Just shut my mouth—which I have a hard time doing—and listen.”

He’s calling his tour the “State of LSC.” He’s promising he’ll do it every year from now on because he wants Lutheran employees to know they matter, and he doesn’t want to give one of them up without a fight. The employees matter because they’re the ones who make it clear that the residents matter, Goins says.

“When you know that someone likes cream in their coffee, it’s a lot easier to address their problems before it gets out of hand,” he says, speaking into his car phone. “And you can’t do that when you have 120 percent turnover.”

Different Origins, Same Results

Unlike Coble and Elmbrook, Goins’ journey took him from the bottom up. He started as a nurse assistant. More than a decade ago, he and his colleagues embraced the principles of the Eden Alternative. As a result, they began monitoring their readmissions rate early in the process (just as Coble had done from a different angle).

For the past three years, Lutheran’s readmission rates have been below 13.5 percent. So far in the first quarter of calendar 2014, it’s down to 10.6 percent.

“We’re never going to be able to say we’re there,” Goins says. Indeed, one of the reasons he’s taken to the road this spring is because he’s convinced that readmissions, turnover, and just about any other quality metric are intimately linked.

“One of the things that we’re finding out now is that we did all this training at one time and yet we still have turnover,” he says. “Ours is pretty good, but it still is turnover.”

And the thing is, the lower level the employee, the more damaging turnover can be to quality of care, Goins says.

“Who in your facilities spends more time with the resident than anybody else?” he asks. “The answer is the housekeepers. They spend maybe 30 minutes in the room at a stretch. When they’re cleaning the sink, or wiping the cabinet, they’re talking to the resident. That housekeeper is going to be your first line of defense. Because they can walk out of the room and say, ‘You know, Mrs. So-and-So isn’t feeling well today. I can just tell.’ These are the people you really need to get involved in the care.”

Goins says he’s realized that for all the talk about open lines of communication, he and his colleagues have to do a better job of “institutionalizing” it. Lutheran Services’ turnover rates are around 35 percent. Goins says if he can convince employees that their voice counts, too, he can lower the turnover, and thereby reduce readmissions.

Keeping The Lines Open

If he needed any further reason for the importance of his recent tour, Goins had it driven home to him when a nurse’s aide approached him after a recent meeting. The aide, a longtime employee, had suddenly begun having discipline problems. He had sat quietly during Goins’ “State of LSC” speech (the figures, changes, strategic plan, etc.) but then sidled up. The aide said several fellow aides had been hired on more recently, but were making more money than the veteran fellow.

“And he said, ‘That doesn’t seem fair to me,’” Goins recalls. “And I said, ‘That doesn’t seem fair. I’ll be happy to ask that question.’ As soon as it was brought up to the administrator, the administrator said, ‘This ain’t right. This guy should have been moved up.’ And he did it right there on the spot.”

Goins hopes the nurse’s aide will turn things around, not just for the aide’s sake, but for the residents’ sakes, too. In the meanwhile, though, Goins says he’s learned a lot from his tour. And he’ll be back on the road soon enough.

“It took me 12 days to do it, but I came away so energized,” he says. “It makes me want to work harder for them. And all I have to do is shut my mouth and get in the car.”