Guest Perspectives - Wartburg Adult Care Community - Interview

Nursing Homes, May, 2001

Observing his 10th anniversary as president and CEO of The Wartburg Adult Care Community in Mount Vernon, New York, Rev. Dr. Dale G. Gatz looks back on a period of rapid growth and diversification for the 135-year-old, Lutheran-sponsored organization. During his tenure The Wartburg has added home care, rehabilitation, assisted living, Alzheimer's care and an outpatient clinic, and has expanded its skilled nursing services. During his previous 20 years, Dr. Gatz had frequent involvement with long-term care facilities as a parish minister and social services administrator. Acknowledging that long-term care is going through a time of trial, he maintains a positive outlook, which becomes evident in this interview with Nursing Homes/Long Term Care Management Editor Richard L. Peck.

Peck: As a parish minister and social services administrator in the 1970s and '80s, what were your impressions of long-term care?

Dr. Gatz: At the time it was typical to see people lined up in hallways, tied to their wheelchairs and medicated--in short, these were not very nice places to be. On the positive side, though--and what probably helped draw me to the field--was the experience of my grandmother, who went into a religious-affiliated long-term care facility in Wisconsin, we thought to die, only to end up living some of the best years of her life for 10 years. She met a widower who provided great companionship; the facility offered lots of activities and the level of care she needed, and she actually improved. It was one of those places where, when you walked in, you smelled baking bread. It came out of a culture where people take care of people. I think this gave me the inspiration for what we do here.

Peck: What's your impression of the impact of OBRA '87?

Dr. Gatz: OBRA changed the world. I don't think it had much impact on facilities where there was already caring and a concern about quality--and some would say it hasn't done much for the uncaring facilities today--but overall, I would say that OBRA raised all boats in the water.

Peck: What other major change have you seen in the field over the years?

Dr. Gatz: Residents have much more intense, complex conditions today. The more we see home healthcare and assisted living becoming options, the more we see nursing facilities moving toward borderline acute care. That's not necessarily bad; if people can be cared for at home and don't need to go to institutions, that's better economically and is probably better care. But the people admitted to nursing homes now are quite ill.

Peck: What impact has this had on nursing facilities?

Dr. Gatz: It has strained our budgets. There are more intense staffing and training needs and more costs for delivering care. The funding has not kept up with this. It is becoming very difficult to recruit staff at all levels, because there isn't enough funding to attract people away from flipping burgers, which is easier and pays about the same. Another factor is the bad press the field has received, which has taken away the prestige that might attract young people.

This points up another major issue: our aging demographics. Someone said, "The Baby Boom is moving through our culture like a pig through a python." It's not at the tail yet, but it's getting there. With the funding being what it is, we're on a collision course.

Peck: Do you see anything happening in the near future to address this?

Dr. Gatz: The Clinton administration didn't have much of a positive impact, and very little changed. As for the Bush administration, I haven't even heard any conversation about this as yet. I'm not very optimistic that anything will happen soon to make our lives easier; I just hope they don't get worse, at least from the federal perspective.

Meanwhile, you can't pick up a newspaper or a magazine without seeing a negative report reinforcing the public's perception about what we do. I think that all of us providers feel that we're being tarred with the same brush.

On the positive side, though, what we're trying to do is address our own culture here at The Wartburg. We choose to maximize people's health rather than their illnesses. We want to address the needs of the whole person--body, mind and spirit--in ways they haven't been addressed before. We now have an array of services that are all directed toward emphasizing the positive.

Peck: Do you think that the campus approach you've adopted is a trend for the future?

Dr. Gatz: I'd say that any free-standing facility, such as assisted living, that doesn't have solid connections with other services does not have an optimistic outlook. The system should be set up so that people can direct their own futures and move from level to level, as needed, in a seamless fashion. The traditional system hasn't always given people that latitude. As we often say about rehabilitation, the goal is to try to help people get out of wheelchairs, not get used to them.

Peck: Is the fact that more and more Baby Boomers' parents are moving into the system having an impact on this?