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Crisis and values at Angel Crest Manor: a case study in long-term care management

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Crisis and values at Angel Crest Manor: a case study in long-term care management

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Content CRISIS AND VALUES AT ANGEL CREST MANOR:
A CASE STUDY IN LONG-TERM CARE MANAGEMENT
By
Raymond Alan Mattes
A Thesis Presented to the
FACULTY OF THE LEONARD DAVIS SCHOOL OF GERONTOLOGY
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF SCIENCE IN GERONTOLOGY
May 1995
Copyright 1995. Raymond Alan Mattes
UNIVERSITY OF SOUTHERN CALIFORNIA
LEONARD DAVIS SCHOOL OF GERONTOLOGY
University Park
Los Angeles, CA 90089
This thesis, written by
Raymond Alan Mattes
under the director of h ^ D Thesis Committee and approved by all its
members, has been presented to and accepted by the Dean of the Leonard
Davis School of Gerontology and the Dean of: Public Administration
in partial fulfillment of the requirements for the degree of
______Master of Science Gerontology and Master of Public Administration
THESIS COMMITTEE
- (ftku * _____________________________________________________________________________
Chairman
TABLE OF CONTENTS
INTRODUCTION 1
Case Summary 4
Objectives 5
Issues and Problems 7
CHAPTER ONE: LITERATURE REVIEW 13
The Evolution of Continuing Care
Retirement Communities 13
Non-Profit Organizations 17
The Role of the Mission Statement 22
Strategic Planning in Organizational Settings 25
The Teaching of Ethics and Value Based
Decision Making in Management 28
CHAPTER TWO: METHODOLOGY OF THE CASE STUDY 33
Types of Case Studies 36
CHAPTER THREE: ANGEL CREST MANOR 40
Background 41
The Campus 45
Organizational Structure 49
Changing Environment 50
The Most Recent Disaster - The Earthquake 50
Annual Board Meeting 55
CHAPTER FOUR: THE SWOT ANALYSIS 59
Strengths of Angel Crest Manor/
Gabriel Care Homes, Inc. 59
Weaknesses of Angel Crest Manor/
Gabriel Care Homes, Inc. 63
Opportunities for Angel Crest Manor/
Gabriel Care Homes, Inc. 66
Threats to Angel Crest Manor/
Gabriel Care Homes, Inc. 68
Conclusion 71
REFERENCES 73
FIGURES 75
iii
INTRODUCTION
In an era of downsizing, budget cutting, consolidation, and mergers, many
long-term care facilities struggle with the reality of rapidly changing times which
may cause tension between their original missions and the need for continued
survival. Many of these facilities were founded to address specific needs of both
individuals and society. Service to indigent elders, widows, those who lacked
family, and persons not able to properly care for themselves fostered the
development of such facilities. Community organizations, religious congregations
and philanthropic societies focused attention upon the needs of aging elders and
developed a means in which to provide for their care.
Times have changed, however, and the survival of such institutions
continues to become a concern in a society whose health care policies are shaped
and modified by a maze of special interest groups, politicians, and regulatory
agencies. The cost of providing medical treatment and care continues to rise
rapidly. Budgetary constraints, lack of adequate fiscal planning and unforeseen
crisis can all create havoc upon institutions who attempt to remain faithful to their
mission of service to the poor and the need for adjustment in order to survive.
Painful decisions and agonizing dilemmas will confront administrators, executive
directors, and boards of directors in custody of such facilities. Each must, at some
point, wrestle with the question of whether or not to forsake the past in the hope of
securing the future.
1
The case study Crisis and Values at Angel Crest Manor has been created as
a teaching tool to be utilized by both individuals presently working in the field of
long-term care and those pursuing professional education to prepare them for
entrance into the field. The case study presents a not uncommon dilemma faced by
numerous not-for-profit facilities. It requires the reader to actively engage in the
circumstances surrounding the fate of a corporation founded upon the premise of
providing care for poor elders. The reader is presented with the history of the
corporation, the philosophy of its founders, and the circumstances over several
decades which have resulted in the creation of the present corporate culture and
managerial style. It is intended that the reader become a part of the events and
issues presently faced by the facility. Ethical issues, value decisions, and
unforeseen crisis all lend themselves to the creation of a dilemma where no right or
wrong answers exist nor any easy solutions are to be found. Any decisions made
by the reader will create consequences that will shape the future of both the facility
and its parent corporation for years to come. The issues presented concern strategic
planning, endurance and survival. A long-term care facility, a corporation and a
sponsoring organization all have a great stake in what ultimately occurs and how
the issues are both presented and resolved.
The survival and well-being of the facility requires the development of a
strategic plan of operation, examination of the corporate mission, and value based
decision making. The facts of the case are presented in such a manner as to
provide basic information concerning the facility, the organizational structure and
2
historical events which have led to the current situation facing the organization.
One of the main goals of the case is to engage the reader and cause one to identify
areas in which uncertainty exists and clarification is needed. Therefore, parts of the
case contain ambiguities which are meant to be questioned and addressed by the
reader in an attempt to come to some decisions concerning the issues presented.
While the case focuses upon a specific religious denomination, it is by no
means meant to imply that only institutions sponsored by this denomination can be
affected by the issues presented within the framework of the case. No matter what
organization sponsors such long-term care facilities, they at some point will struggle
with issues raised within this case. The particular religious denomination chosen
was done so to illustrate the interconnectedness of the corporation with its sponsors,
thereby indicating that administrative decisions may not simply affect the
corporation’s policies and futures, but rather, have greater impact upon the
organization which sponsors the service.
The case, for the most part, is fictional. While several of the events did
occur at a retirement community, they have been enhanced and modified for
teaching effectiveness and classroom discussion. Names, titles, and location have
been altered in an attempt to provide anonymity for actual participants. In some
circumstances, events from other continuing care retirement communities, assisted
living facilities and skilled nursing facilities were interwoven into the facts of this
case. While Angel Crest Manor does not exist, the issues it presents are ones
which long-term care facilities have struggled with in the past and are challenged
with now. Some of the issues continue to present problems for the sponsors of
these facilities.
CASE SUMMARY
This case study focuses on the present issue confronting Gabriel Care
Homes, Inc., a not-for-profit corporation providing retirement living for older adults
since 1911. Gabriel Care Homes, Inc., has since its inception been sponsored by
the Roman Catholic religious order of the Sisters of St. Mary of the Angels. The
sisters, whose numbers have declined over the years, maintain sponsorship and
some decision making authority over the corporation, one of their members being
chairperson of the board of directors.
The main issue confronting the reader will be to decide the fate of Angel
Crest Manor, the corporation’s oldest retirement community. Issues ranging from
lack of financial planning, organizational structure, growth and expansion,
demographic changes, civil and natural disaster all confront the facility and have
had an impact upon its ability to adequately meet the needs of its elderly residents.
Options and directional statements are presented to the board of directors which
include selling the facility, maintaining the status quo, or investing in the creation
of innovative ways to work around the present problems and provide care to both
residents and the needs of the surrounding community.
4
The case ends with the annual meeting of the board of directors where, after
an intense examination of the issues, a decision as to how to resolve the problems
of Angel Crest Manor is to be made.
OBJECTIVES
Upon examination of this case study, the reader will be able to achieve the
following objectives:
1) Recognize the issues contained within the framework of the case and the
manner in which each issue is interconnected with the other.
2) Engage in problem solving skills and strategic planning as a means of
addressing the issues presented.
3) Recall previous work experiences, educational background and encounters
where value based decision making was required and apply such skills as a
means of resolving the issues within the case.
4) Analyze the issues presented in the case as they pertain to current trends in
long-term care administration and organizational management.
5
Develop a series of action statements in which to implement the decision of
the board as to the fate of Angel Crest Manor.
Develop a series long and short-term goals as a means of tracking the
attempts to resolve the problems presented in the case.
Gain insight into the complexity of the situation by taking ownership of the
issues presented through role playing.
Recognize the ethical and value dilemmas present throughout the case and in
each option before the board of directors.
Isolate the pros and cons of each issue. Through SWOT analysis, indicate
the areas in which the corporation has its greatest strength and those areas of
greatest weakness.
Compare and contrast the situations presented within the case with other
not-for-profit retirement corporations by placing special emphasis upon costs
of providing care and organizational structure.
Recognize the importance of a corporation’s mission statement and its
ability to enhance or hinder operations.
Address the issues presented through current research in the fields of
administration, strategic planning, long-term care, and ethics.
ISSUES AND PROBLEMS
The issues presented in this case are complicated and pose a challenge to the
reader. No one solution will be sufficient to solve every issue within the case.
Careful examination of the overall picture, the participants, and the costs and
benefits of any proposed solution will need to be undertaken. The complexity of
the issues is intentional and meant to mirror actual situations within the framework
of facility based long-term care settings.
In attempting to identify the issues within the case, it may be helpful to
break the case down into smaller segments. By narrowing the scope of each
segment and analyzing the pertinent issues, the reader will be better able to grasp
the complexity of the issues and the ways in which each situation leads to further
crisis and decisions. No one issue exists within a vacuum. Therefore, it is
important for the reader to understand each issue, its effect upon the facility, and
the circumstances that presently exist within the case.
The following are several issues and problems found within the case which
the reader should use as a framework when attempting to analyze the case.
1) Angel Crest Manor is a facility with a long tradition of service to the
elderly where conflict currently exists between its historical mission
and present reality. Founded strictly out of social concern for the
poor and indigent it has, over the years, grown and expanded its
service base. Is such expansion being hindered in keeping with a
facility’s past and its original operational philosophy? How might
the facility itself and its parent corporation work within the
boundaries of the founding philosophy to enact the needed changes
to ensure future survival?
2) The most well developed plans can be drastically altered by
unforeseen circumstances. This appears to have been the case for
Angel Crest Manor. On several occasions circumstances have forced
the facility to reevaluate its modes of operation. One of the
unplanned events was the changes which occurred within the
surrounding neighborhood. The demographic changes that occurred
within the surrounding community of Angel Crest Manor created a
series of issues which the facility and its parent corporation must
address. What are the issues the changing demographics present to
the facility? How can the facility adapt its present operational
system and goals to address these changes? Is the present
operational system adequate to address the demographic changes?
3) The facility as a forerunner to Gabriel Care Homes, Inc. was
established upon Judeo-Christian principles of providing for those
less fortunate. Over the decades the service to other populations has
served to move the corporation away from its roots. What problems,
if any does such a move create? How far should the corporation go
to attempt to maintain its founding principles? To what extent does
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the environment of the 1990s force the corporation to reexamine both
its philosophy and mission?
The parent corporation of Angel Crest Manor adopted a philosophy
and mission statement to stipulate their core beliefs and the
framework they propose to structure their corporate actions and
policies. Is the present mission statement adequate for a
contemporary corporation? What exactly do the words of the
mission statement mean as they are applied to current policies of
Gabriel Care Homes, Inc.? How should the mission statement be
utilized by corporations in the course of their daily operations? Is
there a difference between a mission statement and a statement of
philosophy? Can the two be incorporated into one entity or do they
refer to separate methods of operating? How has the original
mission shaped the organization’s history? What are the visions for
the future of the organization?
The capacity to implement decisions depends upon the organizational
structure of a corporation. How might the current organizational
structure of Angel Crest Manor and its parent corporation foster
attempts to initiate change? How might it hinder such attempts?
What is the current chain of command within the organization? Are
there any problems with such a chain of command? What
recommendations, if any, would be made to enhance the
effectiveness of organizational communication for Gabriel Care
Homes, Inc. and its five facilities?
6) Ultimately, decisions for Gabriel Care Homes, Inc. are made by its
board of directors. The board, however, is divided concerning the
issues facing Angel Crest Manor. How effective can a board be if
its members are divided upon key issues? What exactly is the role
of a non-profit facility’s board of directors? Is the board of Gabriel
Care Homes, Inc. fulfilling such a role? What steps may be taken to
lessen the divisions amongst board members? How could the board
compromise its position to include aspects of each of the sides in its
final decision?
7) Financial constraints have led to the current crisis facing Angel Crest
Manor. What are the financial issues involved in case? How has the
Medicaid program affected the service to low-income elders? Has
the initiation of the Medicaid program in 1965 made non-profit
charity care less needed in contemporary society?
8) Recently, Angel Crest Manor suffered from the effects of a major
disaster which caused extensive damage to several of the facility’s
buildings. Although polices were instituted in the event that
emergencies occurred, they proved to be inadequate to meet the
needs of the facility. How could Angel Crest Manor improve its
disaster policies in an attempt to avert future problems? What and
10
who should be included in the preparation, development, and
execution of such policies?
9) The board of directors has been asked to consider three options
which will determine the fate of Angel Crest Manor. One of the
options proposes the development of innovative programs for current
residents of Angel Crest Manor as well as individuals within the
surrounding community. The proposal calls for expansion of the
assisted living unit, linkage with a nearby hospital, and the creation
of an adult day care facility. How could Angel Crest Manor finance
such programs? What are the risks involved with each initiative?
What does current research reveal concerning the effectiveness of
programs such as adult day care? What are the requirements,
liabilities, and benefits of developing subacute care?
10) The board of directors is considering selling Angel Crest Manor in
the hopes of avoiding further loss in revenue for the corporation.
Should the board decide to sell the facility, how would this affect
their financial status? Where would the revenue for the sale of
Angel Crest Manor go? What would happen to existing residents of
the facility? In light of the mission statement does Gabriel Care
Homes, Inc. have an obligation to the residents of Angel Crest
Manor even if they decide to sell the facility?
11
11) Being a multi-level facility, Angel Crest Manor provides numerous
services to its residents. How do the various levels of care relate to
one another? What is the balance between improving quality and
serving low-income individuals? How does the facility address
regulating and financing issues in each level of care?
12) One of the problems facing Angel Crest Manor is increased
competition from other retirement facilities. In which areas of
service is the competition most evident? Are other retirement
communities facing similar issues as Angel Crest Manor? How does
the demographic profile of Angel Crest Manor match the pool of
future supporters?
13) It is said that it takes years to build a reputation and only seconds to
destroy it. How could the reputation of Angel Crest Manor be
utilized to positively address some of its current problems? Could
emphasis be placed upon the facility’s tradition of quality of care in
an attempt to gain funding for future programs?
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CHAPTER ONE: LITERATURE REVIEW
This chapter examines the current research and literature surrounding the
issues raised within the context of the case study Angel Crest Manor. The purpose
of this chapter is to provide the reader with background information into the case as
well as establish the need for the development of such a case study focusing upon
values and ethics at a not-for-profit long-term care facility. Therefore, the chapter
examines the literature in the areas of housing, non-profit organizations, mission,
value based decision making, and ethics.
THE EVOLUTION OF CONTINUING CARE RETIREMENT
COMMUNITIES
According to the American Association of Homes and Services for the
Aging, a continuing care retirement community (CCRC) may be defined as "an
organization that offers a full range of housing, residential services and health care
in order to serve its older residents as their needs change over time (Somers &
Spears, 1992). CCRCs provide individuals with the benefit of a combination of
independent living, assisted living and skilled nursing which are designed to enable
individuals to "age in place". Contemporary CCRCs have been in existence for
over a century in the United States. While many such facilities, as noted by
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Regnier and Pynoos (1987), cater to middle to upper-income elders due to high
entrance fees and monthly charges, historically this has not always been the case.
The concept of providing care in such manufactured supportive environments traces
its origins over several centuries to community and religiously administered
institutions for the poor and mentally ill. Such institutions were established to
provide needed services to individuals who lacked support from traditional
providers, namely family members. As industrialization emerged, individuals
moved from rural agricultural settings and established cities. The need arose for
institutions which would provide care for individuals unable to function
independently and who were previously cared for by family. The development of
such institutions was meant to create specialized forms of care for the aged,
disabled, and children because of a breakdown in the cohesiveness of the family
unit, demographic changes, and social, technological and economic upheaval
(Chellis & Grayson, 1990). It was during the nineteenth century that the concept of
housing particular groups of individuals began to spread. Homes for the aged,
according to Chellis and Grayson (1990), offered the elderly, who were
psychologically or economically dependent, shelter and food out of charity. Many
of these facilities were administered by religious groups. Eventually, such
facilities began to offer more services to address the needs of their tenants.
Admissions agreements often included the stipulation that elders turn over all assets
in exchange for care. The numbers of such facilities continued to grow throughout
the 19th century with the involvement of secular organizations. The original room
and board concept of such facilities gradually gave way to the addition of medical
and personal services in an attempt to meet the needs of elderly tenants.
Due to increases in social mobility, the need for cost effective retirement
programs, improvements in the economic conditions of older adults, and increased
longevity, CCRCs fulfilled the needs of a society in search of housing for its
elderly members. The CCRC model evolved into a housing option which enabled
moderate to upper-middle class individuals to secure access to long term nursing
care (Wilson, 1993). Needs for security in later years which sought to maintain the
individual’s privacy and preserve independent living, the creation and maintenance
of supportive social environments, and the guaranteed access to long-term care
services contributed to the success and expansion of the CCRC industry (Somers &
Spears, 1992).
The CCRC industry created environments tailored to address the specific
needs of elders. These retirement communities promoted the goal of preserving the
individual’s independence by providing the elder with needed services in which to
balance declines resulting from the aging process. The CCRC model provides a
form of insurance for the older adult through the availability and accessibility of
long-term care services. In some cases, the CCRC model also provides
mechanisms to finance such long-term care services. According to Baggett (1989),
these housing and care options have developed to meet the needs of elders as they
reach various stages of dependency. As the elder moves from the stage of
independent living into more personalized care, the CCRC model provides the
individual with a continuation of social, psychological, and medical support. Such
continuation may spare the individual from experiencing anxiety over the
realization of increased declines in functioning.
Continuing Care Retirement Communities usually accept residents who are
healthy and capable of independent living (Gordon, 1988). Financial arrangements
for care vary among CCRCs but typically the individual resident pays a substantial
entrance fee as well as monthly fees which are subject to fluctuation based upon the
operational costs of the facility in exchange for services. In most CCRCs, portions
of the fees charged to residents are allocated to special funds for the purpose of
providing long-term care (Tell & Cohen, 1990). These funds enable the facility to
provide continuous care to the resident as he/she progresses through the varies
stages of dependence. The biggest risks involved in provided long-term care
coverage to residents centers on nursing home usage. While such usage may be
costly for the facility, steps may be taken to lessen the risks involved in providing
long-term care coverage. Such steps include the development of comprehensive
initial screening of residents, accurate morbidity and mortality projections as well as
emphasis placed upon close observation of changes in resident conditions, and the
creation of adequate plans of care (Tell & Cohen, 1990). The costs per resident for
nursing home care can be substantial. As noted by Tell and Cohen (1990), CCRC
residents are more likely to enter a nursing home than those older adults not
residing in a CCRC at some time followed by repeated nursing home entries.
Therefore, the average operational cost per resident is strongly related to the
16
proportion of residents who are receiving various levels of nursing and personal
care (Bishop, 1990). In an attempt to alleviate some of the financial risks involved
in providing long-term care to residents, CCRCs need to engage in strategic
planning.
NON-PROFIT ORGANIZATIONS
A not-for-profit facility may be defined as an organization that is formed
with the primary objective of providing needed goods and services with little
emphasis placed upon profits gained by engaging in such activity (Hay, 1990). By
placing emphasis upon providing services instead of making a profit, the
organization publicly states where its objectives and mission rests. Non-profit
organizations, however, do engage in profit making activity. The difference
between for-profits and non-profits rests in the fact that when profits are generated
non-profit organizations cannot distribute them to individuals within the
corporation. The funds generated must be dedicated to furthering the activities of
the organization as a whole. In order for organizations to be classified as non
profits certain criteria must be met and maintained. As noted by Hay (1990), the
following conditions must be satisfied: (1) the organization must be formed to
provide services not for profit; (2) no part of any net earnings can be distributed to
its members, trustees, or officers, or to any other private persons; (3) its assets must
be permanently dedicated to its major mission and must not, upon dissolution, be
paid to any private person or organization; and (4) it usually cannot engage in
developing or disseminating political propaganda to influence the election of a
candidate for public office.
Non-profit corporations usually have articles of organization which include a
charter that establishes the corporation’s mission of purpose and the powers such an
organization will execute in order to fulfill its stated mission (Hay, 1990). Non
profit organizations are provided with specific benefits which for-profit
organizations do not receive. The main benefit is that of tax exempt status.
According to Hay (1990), non-profit organizations may be declared exempt by the
IRS from paying federal income taxes; exempt organizations can receive
contributions which in turn donors may deduct from their personal income taxes; no
one within the organization may claim the ability to share in profits; and non
profits may receive subsidies such as reduced fees for operating expenses.
The non-profit organization is governed by a board of directors or trustees.
Members of this group carry out the duty of preserving the ideals and values of the
organization. A non-profit board of directors acts as the governing or policy setting
body that bears legal responsibility as well as maintaining a balance between the
various entities of the organization (Burgess, 1993). The board of directors or
trustees create, develop and implement policies and procedures to be carried out by
the organization in meeting the needs of its constituents. The board of directors
serves to maintain stability among the various departments, the administrators of
the organization and the interest of those individuals the organization was
established to serve. As noted by Ingram (1990), the board of directors assumes
and implements responsibility in the following areas:
1) Select, support and evaluate the chief administrator;
2) Review and protect the mission of the organization;
3) Drive the organization’s planning efforts;
4) Serve as fiduciary representative of the organization;
5) Ensure the financial solvency of the organization;
6) Serve as ambassador and spokesperson for the organization;
7) Evaluate the organization’s program regularly;
8) Communicate the community and lay perspective to the organization;
9) In internal conflict, serve as a final court of appeals; and
10) Engage in periodic self-assessment.
In essence the board of directors is the pulse of the non-profit organization.
It sets the pace and direction as to where the organization will go and how it will
get there. The board controls the interplay between the chief administrator and the
constituents the organization serves. The chief administrator becomes an agent of
the board, charged with its mandate and empowered to fulfill it.
The board of directors of non-profit organizations differs from those of for-
profit. The role and impact of the board’s influence in for-profit organizations is
low-key. In non-profit organizations the board of directors acts as the agent of
19
continuity, strategic planning and change. Decisions made by non-profit boards are
filtered down throughout the organization and impact its operations significantly in
a very short period of time. The boards of non-profit organizations assume an
active role in the entire decision making process. Once a decision is reached, the
non-profit board undertakes the necessary steps to implement the decision and
monitor its impact on the operations of the organization. In for-profit
organizations, the board acts as facilitator to the decision making process. After a
decision is reached, the for-profit board removes itself from the implementation
process by relying upon the chief administrator to devise strategies and procedures
in which to operationalize its decision. As noted by Burgess (1993), decisions of
non-profit boards tend to penetrate the organizations more deeply and quickly, and
carry more specific ramifications for day-to-day procedures; for-profit boards make
decisions that many employees may never hear about.
Other differences between non-profit and for-profit boards include the
financial agreement between the organization and each board member. In non
profit organizations board members are chosen for specific contributions made to
the community, organization, or its constituents and agree to serve as members on a
voluntary basis. In for-profit boards, the members are paid with emphasis being
placed upon the expertise the individual brings to the organization instead of
interest in the activities of the organization or furthering its mission. The chief
administrator or other staff members in non-profit organizations are given no voting
power at board meetings and serve as ex-officio officers. In for-profit
organizations, however, the chief administrator may vote upon the decisions made
by the board (Burgess, 1993).
The leadership component of non-profit boards is comprised of the
chairperson, committee chairs, and the chief administrator. The role of the board
chair serves a central function in the overall functioning of the board as well as the
organization. The board chair becomes the voice of the organization and its
champion. The chair in essence personifies the mission of the organization and
illustrates throughout the course of his/her tenure how such a mission can be
achieved. The board chair presides at functions for the organization and in doing
so declares the board’s approval for the event The board chair serves as the final
say when speaking on behalf of the organization. He/she gives a voice to the
organization by the actions, statements and gestures performed shaping the
organization’s attitudes, interests and involvements. The hardest work of the board
chair involves the activities of spokesperson for the entire organization and top
executive (Burgess, 1993). In assuming such a role, the individual chosen must
demonstrate qualities that will be advantageous to the organization and provide it
with a positive and purposeful demeanor.
Decisions, however, are not made by the chair alone. The individual board
members also contribute to the decision making process. Non-profit boards
typically have a number of committees which provide strategies and develop
initiatives to achieve organizational goals and objectives. These committees govern
such areas as finance, development, operations, and public relations. The ground
21
work for any project or idea is constructed through such committees and then taken
to the full board to be debated and voted upon. As noted by Burgess (1993), there
exist two basic types of committees. The first is referred to as the "standing
committee" which permanently functions to provide guidance on an ongoing basis.
The second type of committee is referred to as the "ad hoc committee" which is
established to address specific short term issues which may arise within the
organization. The individual committees oversee specific areas of the organization,
develop new ideas, and strategize their implementation.
THE ROLE OF THE MISSION STATEMENT
The mission statement of a corporation is a public proclamation of its goals,
values, and objectives. As such, the mission statement contains the essential
elements for the corporation’s existence. All policies, procedures, and practices of
the corporation revolve around its mission statement. In essence, the mission
statement is a statement of purpose, intent, and direction. It is a declaration of an
organization’s basic goals, characteristics, and philosophies that serve to
strategically mold the organization (Graham, 1994).
The mission statement serves as a call to action for the activities of the
organization because it helps to define the activities an organization should pursue
as well as those which should be avoided. The mission statement may also serve
as a means of generating popular support, financial resources, and personal
22
involvement on the part of individuals in the activities of the corporation. This
occurs because of the beliefs, values, and philosophies stipulated in the mission
statement. Individuals who find they are in agreement with such items may
become more involved in promoting the activities of the organization.
As stated by Graham (1994), the process of developing a mission within an
organization must be rooted in the following core beliefs: (1) the service provided
by the corporation can satisfy consumer needs which are not being currently met;
(2) with hard work and with the support of others the organization can go beyond
mere survival and thrive in meeting its financial objectives; and (3) the service
offered by the organization is one of quality and can more than adequately meet the
needs of consumers. Once these beliefs are understood and internalized by the
various members of the organization, they will be able to define the mission in a
clearer and more concrete manner.
In defining the mission of any organization, the first step which must be
undertaken is a thorough examination of what the organization ultimately wishes to
accomplish, how it plans to reach that goal, and which resources will be necessary
to achieve that end. Laycock (1994), provides the following key questions to be
answered during the mission development process:
1) Whom does this organization serve?
2) What are the basic needs that this organization fulfills?
3) Broadly speaking, how does this organization meet the needs
of those it serves?
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4) Is the area served geographically limited? If so, what is the
area served?
5) What makes this organization unique?
6) What values does this organization seek to promote?
7) Who are the individuals who make up this organization? How
does that affect purpose?
The above questions are meant to serve as a guide for the organization as it
conceptualizes its mission and formalizes it by placing it into words. According to
the National Association of Bank Women, Inc. (1988), in order for a mission
statement to be effective it must contain the following ten items:
1) It must be both clear and understandable for all personnel to
understand.
2) It must be brief enough to commit to memory.
3) It must include clear statements about:
What needs are attempting to be met?
Who are the primary customers?
How will the organization conduct its business?
4) It should focus on one strategic plan of operation.
5) It should reflect the competence of the organization.
6) It should be broad enough to ensure flexibility.
7) It should serve as a reference point for decision makers in the
organization.
24
8) It reflects the values, beliefs, and philosophy of operation and
its culture.
9) It reflects obtainable goals.
10) It should serve as a rallying point for the organization.
Once written, the values, goals, beliefs and ideals of the mission statement
are not just words, but rather, they become the guideposts for the thoughts and
actions of the organization and its employees (Falsey, 1989). Similarly, the mission
statement can function only if it is empowered to do so. Adherence must be given
to its stated ideals in order for it to properly guide the organization. Therefore, the
mission statement is only as useful as the individuals who follow it. A mission
statement has to be operational and must focus on what the institution really tries to
do and begin the task of doing it (Drucker, 1990). Mission statements, by their
very nature, can never become static. They must be permitted to evolve, adapt and
change just as do the conditions in which the organization functions. The mission
statement is the most important tool in the process of strategic planning for an
organization because all activities flow from it (Laycock, 1993).
STRATEGIC PLANNING IN ORGANIZATIONAL SETTINGS
The non-profit institution is not merely a service delivery system, but rather,
it uses a service to bring about changes in society and in the lives of individuals
(Drucker, 1990). The manner in which the institution conducts itself in the delivery
25
of such services will determine the effectiveness of the organization’s efforts. In an
attempt to deliver its services, the organization engages in the process of strategic
planning in order to address the needs of its constituents. William F. Glueck
(1980), classifies a strategy as follows:
A strategy is the means used to achieve the ends. A strategy is not
just any plan, however. A strategy is a plan that is unified: it ties all
the parts of the enterprise together. A strategy is comprehensive: it
covers all major aspects of the enterprise. A strategy is integrated:
all the parts of the plan are compatible with each other and fit
together well. A strategy is a unified, comprehensive, and integrated
plan of relating the strategic advantages of the firm to the challenges
of the environment. It is designed to ensure that the basic objectives
of the enterprise are achieved. A strategy begins with a concept of
how to use the resources of the firm most effectively in a changing
environment.
A number of items should be considered by the corporation when
developing a strategic plan of operations. The first item to consider is the
environment in which the corporation exists. The environmental factors
surrounding the organization will impact its ability to develop and deliver services
to its constituents. The external environment provides the context from which the
organization is capable of operationalizing its services. In the development of a
strategic plan, therefore, it is important for the organization to understand the
cultural factors in which it operates and the manner in which those factors impact
the delivery of services.
Another area of consideration for the organization is to define exactly who
26
their constituents are who will receive the proposed services. In identifying the
constituents, their needs, and desires, the organization is better equipped to develop
a means in which to meet the constituents where they are, instead of developing an
inadequate agenda which proposes innovative services but produces few individuals
in need of such services. The organization, therefore, must familiarize itself with
the world of its constituents and their needs. In an attempt to achieve this end, the
organization engages in the process of stating and clarifying its dreams - the
ultimate goals of the organization’s activities. The process, however, cannot be
complete unless, in the course of focusing on the ultimate goals of the organization,
it focuses attention on the reality of the proposed goal. The dreams or goals of an
organization may be viewed as merely reality left untapped. However, that reality,
unless understood in the context of the various factors confronting the organization,
will remain untapped and consequently be useless for the organization as it begins
to develop its agenda. Therefore, as noted by Hay (1990), strategic planning is
determined by: 1) the CEO’s perception of his/her philosophy; 2) the mission and
objectives that he/she wishes to accomplish; 3) an appraisal of external
environmental factors, forces, and events; and 4) appraisal of the internal
environment of the organization.
Strategic planning converts a non-profit organization’s mission and
objectives into performance (Drucker, 1990). The strategic plan serves as a map
for the organization’s activities. It provides guidance as to the appropriateness of
one action over another and highlights the direction in which the organization must
27
embark in order to meet the perceived needs of its constituents. The strategic plan
begins with the mission, leads to a work plan, and ends with the right tools to
implement it (Drucker, 1990).
THE TEACHING OF ETHICS AND VALUE BASED DECISION MAKING
IN MANAGEMENT
Ethics may be defined as a discipline which examines good and evil in light
of moral obligation or duty. Ethics thus becomes a conglomeration of a variety of
principles in its quest to accomplish its task of examination. Ethics traces its origin
to the individualized values which have been normalized by a society or culture.
Values are not merely the things one desires or wants, but rather, they are the
conceptualizations of those desirables (Enz, 1986). Such values, then, are abstract
standards that remain over time and dictate what is correct for a specific culture.
These directives give individuals structure which in turn impacts their personal
decisions and actions. Those actions and decisions deemed important by a specific
culture are defined as norms. They confirm acceptable behavior by individuals
within the society. Linked to such acceptable behavior is the personalized agendas
of each individual which results in judgements on the part of that individual in
respect to societal expectations. These personal judgements are referred to as
morals. All of these principles contribute to the overall development of ethics
which ultimately is the idealistic perceptions of the culture’s accepted norms of
28
behavior (Boling & Dempsey, 1981).
Throughout life, individuals are indoctrinated into the acceptable means of
action in a given situation. Because individuals are creatures of habit they
internalize those actions which they perceive society to revere. Those actions
which are frowned upon by the society are discarded by the individual in an
attempt to assimilate within the prevailing culture. One of the best places to begin
this process is in the classroom as individuals learn the various aspects of
administrative professions. Since individuals are continually being influenced by the
culture, situations, and interactions which they encounter, it becomes a difficult task
to instill an ethical mind-set solely based upon the duties of a specific career path.
In many ways, however, the inclusion of ethics in formal educational curricula can
be both an easy task as well as a most difficult one. Its easiness is derived from
the fact that individuals, for the most part, desire to praise good actions and
downplay the bad (Mainzer, 1991). Ethics becomes difficult due to the inability of
the instructor to determine whether or not the ethical mind-set made a difference in
the ways in which individuals conduct themselves in their jobs (Mainzer, 1991).
Awareness of the importance that both ethics and values play in the daily
duties of administration provides a foundation upon which to begin the task of
change and incorporation from a value-free environment into one rooted in an
ethical mind-set. Problems, however, are generated in the development of such
courses due to the fact that ethical thought is derived from the values already
present in a social context. Each student then would have been indoctrinated into
29
his/her own set of values. Therefore, the concepts presented in the course work
may need to be considered in reference to the values each student brings along.
The dilemma manifests itself in the uncertainty of whether any course should stress
the importance of individual codes of conduct and choices or rather stress the
overall organizational codes of conduct one will be surrounded by in the duties of
administration (Mainzer, 1991).
There exist several areas in which an individual administrator will find
ethical issues problematic during the performance of his/her job. The first area
deals with the policy arena and the proper decisions to be made in specific
situations (Boling & Dempsey, 1981). Serving as a policy maker, the administrator
will be forced throughout his/her career to weigh decisions based upon the best set
of outcomes. Each individual will need to examine the amount of benefit a specific
decision will have and who will be the recipient of that benefit. Consideration
must also be given to the negative results of the decision as well as those
individuals who would not be the beneficiaries. The administrator must then
decide, based upon his/her own sense of value as well as that of the society in
which he/she belongs, the most rewarding decision with the least amount of cost to
any one group.
The personal standard of ethics each individual has ingrained within him/her
may work in conflict with the prevailing standard of ethics held by the organization
in which the administrator works. Yet, without the presence of personal ethical
standards, the administrator will fail to function fully in his/her duty which is to
30
develop and maintain the trust of the people to which the administrator has an
obligation. The maintenance of personal ethics affects not only the individual
administrator but also affects those individuals over whom he/she has control
(Boling & Dempsey, 1981).
The demands placed upon the administrator by the organizational culture in
which he/she functions may become problematic. The organizational setting
develops over time "its own" philosophy, set of values and ethical frameworks
which serve to manipulate and direct the activities of the organization as well as
those employed by it. These ethical frameworks allow little room for compromise
on values which the organization does not perceive to be beneficial to its overall
development. In areas where an administrator may not fully internalize the
prominent values of the organization, the result could be problematic for the
individual who must then choose to exit, voice his/her concerns, or remain loyal to
the overall organization (Boling & Dempsey, 1981). The individual will be forced
once again to examine his/her own value system and determine the appropriate
course of action to be taken.
Ethical decision making is not limited to a particular moment or event in the
life of the administrator. Issues which require value based judgements continually
arise. The ability of the administrator to recognize this fact and respond
appropriately is central to the overall duties of the position. The ethical
environment of an administrator demands that an individual not simply be an
expert, an efficient leader, fair, honest and responsive, but rather, the administrator
31
is expected to be all of these at once (Worthley, 1981). Attempting to be
everything at once is an impossible feat. The administrator must discern which is
the best course of action in a given situation. Such discernment arises from both
training and past experience. The administrator who has developed a sense of
personal integrity, personal responsibility, prudence, effectiveness, and
commitments to the general good will be better equipped to handle ethical issues
and value judgements when they arise (Dobel, 1990).
The development of such items as personal integrity and responsibility
cannot be adequately accomplished in a structured and controlled environment such
as a classroom. Their development occurs over the course of an individual’s life
and is affected by the culture and societal norms in which he/she has been
indoctrinated. The classroom setting can be a means of introduction into the
development and sustaining influence of organizational ethics that function
separately from an individual’s personal value system but are still influenced by it.
As stated by Rastogi (1988), a common identity for individuals can emerge only on
the basis of a universally shared value system which elicits the individual’s
commitment on the basis of one’s "will to meaning," motive for "self realization"
and the desire to have an "inner feeling of life’s fulfillment." In fact, the need of
human beings for incorporation into something which transcends and transfigures
their individual existence provides the basis for the existence of a central value
system.
32
CHAPTER TWO: METHODOLOGY OF
THE CASE STUDY
A case study may be defined as an in-depth, multifaceted investigation using
qualitative research methods, of a single social phenomenon (Feagin, Orum &
Sjoberg, 1991). Case study methodology allows the reader to engage one in a
specific context and series of situations that are in need of resolution. In short, the
case study method presents a snapshot view of real world situations in which the
reader is asked to analyze and discern the appropriate courses of action. Instead of
merely presenting descriptive information, theory, theoretical techniques and
research results, the case study method permits the reader to become a participant
within the framework of specific issues as they developed over time.
Case study research is an appropriate method for examining managerial
issues. Readers engage in the processes of analyzing and conceptualizing real life
situations from their own perspective of the issues presented. The case study
permits the reader to role play within the context of the case. Readers may explore
the variety of options available to each character in the quest to develop adequate
solutions to problematic situations. By analyzing realistic situations that call for
objective discernment of the issues, reflecting on the opportunities for resolutions,
and applying theoretical concepts and reasoning, the reader is in a position to
further develop problem solving skills. Engaging in action and analysis enables the
33
reader to learn experientially from involvement in the case. The reader is thereby
empowered to solve complex problems by examining the interplay between facts,
actors and organizational structure. As noted by Feagin, Orum and Sjoberg (1991),
case study methodology conveys the following lessons to the reader:
1) It permits the grounding of observations and concepts about
social action and social structures in natural settings studied at
close hand.
2) It provides information from a number of sources and over a
period of time, thus permitting a more holistic study of
complex social networks and of complexes of social action
and social meaning.
3) It can furnish the dimensions of time and history to the study
of social life, thereby enabling the investigator to examine
continuity and change in real world patterns.
4) It encourages and facilitates, in practice, theoretical innovation
and generalization.
Situational events in real world settings most often contain both ambiguity
and uncertainty. For many of these issues, no easy solutions exist. It is often
discovered that an action taken in one area will have both positive and negative
consequences in another. Assistance with observing the total picture, isolating
problem areas, generating possible options, and implementing a solution can be
provided through utilization of the case study method. The case study, therefore,
34
can permit the investigator to examine not only the complexity of life in which
people are implicated but also the impact on beliefs and decisions of the complex
web of social interaction (Feagin, Orum & Sjoberg, 1991).
The case study methodology is a vehicle for students of management to
expand their analytical and interactive skills. No issues exist in a vacuum, but
rather, organizational dynamics are interrelated and interdependent upon a number
of circumstances. Issues are influenced by corporate structure, human behavior,
communication style, values, and the prevailing culture at the time. A case study
seeks to capture people as they experience their natural, everyday circumstances.
Thus, they can offer a researcher empirical and theoretical gains in understanding
larger social complexes of actors, actions, and motives (Feagin, Orum, & Sjoberg,
1991). Each of these illustrate the issue and demand appropriate attention in order
for resolution to take place. The effective manager, administrator, or department
head must be aware of these items, learn how to objectively discern their impact,
analyze them, and utilize interactive skills in order to implement change.
The case study method, therefore, simulates real life situations and events,
which demand attention and often quick resolution. For the individuals with little
professional work experience or those entering a new field, utilization of the case
study method permits one to experience the reality of a world where easy solutions
are few and far between and values, culture, structure and individual personality
shape issues.
35
TYPES OF CASE STUDIES
Case studies may involve retrospective analysis, ethical dilemmas, problem
solving, and decision forcing (Cohen, Fink, Gadon & Willits, 1992). Individuals
are engaged in the case by exploring issues from within. Case studies, therefore,
center upon problem based learning strategies. Such a learning style encourages the
individual to interact with others, network and develop working groups as a means
of discovering solutions to complex problems. Interaction with others results in an
increase in options and solutions as well as further exploration of emergent themes
within the case. Case studies allow issues to be viewed from a diversity of
viewpoints. Interaction prompts individuals to realize that a variety of ways exist
in which to examine problematic situations.
Basically, case study methodology focuses upon both exploratory and
explanatory analysis. The case becomes the framework through which the
individual views specific events and situations. Problematic situations are presented
and issues raised which the reader must analyze in terms of complexity,
significance, and impact. The exploratory case study presents the reader with a
series of facts which he/she is expected to analyze using appropriate organizational
theories and techniques to determine the most appropriate course of action to be
taken. The reader is presented with information that presents a particular situation,
event, or series of events which have occurred. It is the task of the reader to utilize
conceptual skills in determining the scope of the issues presented.
Case study analysis requires both perception and insight. In order to fully
understand the issues, the reader must assume the role of participant within the
framework of the case study. As participant, the reader questions his/her responses
to a series of actions as described by the facts of the case. Through the utilization
his/her analytical skills, knowledge of the issues, outside research, and peer
consultation, the reader is able to generate educated responses to the problems
presented within the case.
One of the most important aspects of utilizing the case study method is the
opportunity for the reader to become personally involved with the issues presented.
He/she is asked to take ownership of the issue, choose a strategy for understanding
the intricacies which exist within the case, and make informed choices concerning
future actions. The case, therefore, is not something devoid of action; rather, if
utilized properly, it can become an animated teaching tool in which the reader
experiences the perplexity of real world decision making.
The main advantage to case study methodology is its ability to present
situations in a real world context. The reader is, therefore, able to engage in the
case, utilizing cognitive and analytical skills while attempting to solve issues that
mirror actual situations. The case study method affords the reader the opportunity
to further develop his/her problem solving skills. The reader is free to devote time
to the examination of each issue, its relevance to the case and its subsequent
consequences. The case study thus permits the analyst to uncover the historical
dimension of a societal phenomenon or setting (Feagin, Orum, & Sjoberg, 1991).
The limitations of case studies stem from the limited amount of information
provided to the reader. By zeroing in on specific facts, events, and situations, case
studies may present issues out of context. The reader is limited by the information
presented and is not privy to previous situations which might have contributed to
the issues of the case. Another limitation of case studies develops from the
idiosyncratic and specialized focus chosen by each reader for analysis. Each reader
may focus on a different aspect of the case which he/she feels to be problematic.
The analysis of the case could then differ from the original intention of the author.
In analyzing a case study, the reader may first wish to identify as many
issues and facts as possible. By isolating the issues, the reader can begin the
process of breaking the case down into smaller segments which in turn make
analyzing the entire case easier. The reader’s goal is to understand how the issues
presented in the case interact with each other. A useful technique to employ is the
SWOT analysis. SWOT is an acronym for the internal strengths and weaknesses of
a business and environmental opportunities and threats facing that business (Pearce
& Robinson, 1985). The reader searches the facts of the case in order to determine
their strengths, weaknesses, the opportunities they present, and their proposed
threats. It is based on the logic that the effective strategy maximizes a business’s
strengths and opportunities while at the same time minimizes its weakness and
threats. By utilizing this technique, the reader’s ability to analyze each issue is
enhanced.
38
The following case, Crisis and Values at Angel Crest Manor, is designed as
a teaching tool on how an organization’s mission, value based decision making, and
strategic planning impact a corporation’s history and provide a foundation upon
which to build its future.
39
CHAPTER THREE: ANGEL CREST MANOR1
Wesley Johnson, chief operating officer of Gabriel Care Homes, Inc.,
slouched in his chair deep in thought. His eyes solemnly surveyed the small
needlepoint plaque hanging on the wall opposite his desk. It had been given to him
by a 96 year old resident shortly after he began working for the corporation. Over
the years, its message, "Care - In All Ways For All Time" had become his personal
motto. This message also reflects the organization’s Mission Statement (Exhibit 1).
Today was the annual board meeting and a decision was expected concerning the
fate of the corporation’s oldest retirement facility, Angel Crest Manor (ACM).
The preceding months had been filled with uncertainty and turmoil. The
most recent disaster was simply another crisis in a series of events that challenged
the facility in recent years. Angel Crest Manor was the corporation’s birthplace.
Service by the Sisters of St. Mary of the Angels to those in need of extended care
began on that small campus in the heart of the city over 90 years ago. Today
would determine whether or not that service would continue at ACM. Having
spent over two years examining corporate records, financial statements, and
reimbursement projections, conducting feasibility studies, and reviewing
demographic reports, Wesley Johnson wrestled with the reality of an organization
struggling to stay true to its original mission in a rapidly changing environment.
lFictitious names of both the organization and individuals are used to assure anonymity.
Facts and issues were modified to enhance teaching value.
40
BACKGROUND
In 1902, "Angel Crest Home for Aged and Infirm Women" was founded by
the Sisters of St. Mary of the Angels. The first administrator, Sister Mary Gabriel,
established as its mission the provision of compassionate care and shelter to poor,
aged, and infirm women. In 1925, the name was changed to Angel Crest Manor,
the mission was revised to broaden the definition of those in need, and the first
male resident was admitted. In 1950, the facility was incorporated as Gabriel Care
Home, Inc. One of the sisters was named president of the new corporation and a
board of directors was established, made up of a local banker, a businessman, the
owner of a local department store, an accountant, and a contract lawyer from the
surrounding community.
Over the years, the facility slowly expanded to accommodate the increasing
number of older persons in need. New buildings were constructed with money left
to the sisters by grateful families and supportive community members. Because the
facility was growing while the number of sisters in the community dwindled, lay
persons became more predominant in the staffing of ACM. In 1965, out of
recognition of the need for further expansion and the reality of a continued shortage
of sisters, the sisters withdrew from managing the facility and empowered the laity
to fill this role. The sisters, however, maintained sponsorship of the facility and
kept some decision-making authority.
41
Angel Crest Manor was the first of six facilities now owned and operated by
Gabriel Care Homes, Inc. The goal of the parent corporation is to provide senior
adults comfortable surroundings, supportive services, and maintained independence.
Currently, all accommodations are available to residents through a fee-for-service
plan. This was not always the case. Until 1950, the corporation supported
residential care through bequests, the family estate of one of the sisters, and
fundraising proceeds from efforts of the board of directors and the sisters. Over the
years, the facility developed a reputation for the high quality of its residential care.
After incorporation, life-care contracts were introduced to residents at ACM through
which residents paid an entry fee to ensure care during their lifetime.
In the late 1960s, expansion of the corporation began with the acquisition of
other retirement facilities in California, Nevada, and Arizona. Rapid growth and
poor actuarial projections yielded financial difficulty in the mid 1970s, which led to
a drain on cash reserves for operating expenses. In 1979, over-extension and
diminished assets nearly forced the corporation to file for bankruptcy and resulted
in major corporate restructuring and several lawsuits by residents. A financial
settlement required the corporation to sell its out of state facilities and take out
several loans to honor existing life-care contracts.
As part of the restructuring, the first lay president was named, replacing the
former president, Sister Mary Elizabeth, who directed the corporation for 12 years.
The new president, Ian Newman, was a business executive with an extensive
background in the for-profit nursing home sector as well as the hotel and hospitality
42
industry. He had developed a reputation for his belief that form follows funding,
his attention to the bottom line, and his ability to turn around a floundering
enterprise. The Sisters of St. Mary of the Angels were given 5 of 13 votes on the
restructured board of directors, thereby hoping to maintain the mission and
philosophy of the organization "and assure value based decision making.
By early 1980, life-care contract residents in all six facilities were affected
by the corporation’s financial difficulties. The most affected, however, were
residents of ACM where, during the last decade, the average age had increased by
6.8 years and the average number of impairments in activities of daily living had
increased by 30 percent The corporation eventually struck an agreement in which
the corporation agreed to charge each resident holding a life-contract a reduced
monthly rate for continuing care. The charge was actually a loan to the corporation
until full financial restructuring could occur. Residents or their heirs would be
repaid these additional funds with interest upon withdrawal from the facility or
death. By 1984, the corporation was back on solid financial footing and pursuing
means to ensure its continued survival and obtain a competitive edge in the
increasingly competitive long-term care market.
The five facilities acquired by the corporation during the 1960s and 1970s,
which were once privately owned retirement communities, served primarily well-to-
do residents. The largest, Orange Grove, was founded as a nonsectarian "restful
haven for gentle folk." Another facility, a former luxury hotel, which was
converted into individual apartments, targeted the independent and assisted living
43
markets.
The corporation’s restructuring in 1979 had the greatest effect on its oldest
facility, Angel Crest Manor. Angel Crest Manor always differed from the other
facilities owned by the corporation. Its institutional brick and concrete buildings
allude to a past where the service to elders was seen as a mission of altruism, love,
and compassion, a way of repaying the years of work and dedication that older
individuals had given to the community, family and church. Originally, in order to
be eligible for entry into the facility, a person simply was required to have
"financial need." Over the years, demographic and philosophical changes
encouraged the corporation to expand its service base from solely low-income
individuals to include all older adults.
During the 1980s, the supportive environment, where concern for the overall
well-being of each resident had been an essential component of every day life,
appeared to be giving way to a push for market competition and strategic
expansion. Emphasis shifted from providing philanthropic service to running the
company like a business. A strategic plan was designed through the use of a
consultant, a capital campaign was launched, and assets were directed toward
remodeling to increase the visual appeal of the facility. Marketing efforts depicted
"a home for loved ones in an elegant environment."
Although the physical structure remained the same, parts of the facility
began to resemble a hotel instead of a long-term care community. As a result,
morale of some of the long-term employees suffered, while other staff appeared to
44
delight in the improvements. Several long-term employees left in frustration over
the drastic changes. One of the nurses, who had worked for the facility for over
seven years, commented on how she previously worked for a large health care
provider but quit because it pursued the dollar over the needs of the clients. After
the restructuring, she commented that the corporation had become just another
bureaucratic, greedy, and uncaring place. Other employees seemed to believe that
restructuring had brought significant improvements to the facility. Several asserted
that the emphasis placed on remodeling was a refreshing change from the time
when available funding went primarily to supplement care for needy residents. One
employee remarked, "the new changes make coming to work a nice experience and
the residents and their families love it"
THE CAMPUS
The physical layout of Angel Crest Manor evolved over the years as the
needs of residents changed. Originally, the facility consisted of a large two-story
residence which housed 20 older women. As the number of residents increased,
small cottages were constructed around the central building. Over time, larger
buildings were added. Each building was designed for specific needs of the time,
with little consideration given to future needs of the facility or of its residents.
Despite well-meaning intentions of the leadership, the end result was a campus
lacking cohesion among its physical structures.
45
The physical layout of ACM is a self-enclosed campus housing independent
living, assisted living, and a skilled nursing facility. Most of the 200 residents live
in the independent living section. The average age is 84 and a large percentage of
residents have never been married or are widowed with no children. At present, the
facility has a higher occupancy rate than its sister facilities, the highest percentage
of individuals on Supplemental Security Income (SSI) in its independent and
assisted living sections, and the highest percentage on Medicaid in the skilled
nursing facility. It has always maintained high visibility in the community, most
recently as a result of the marketing office’s advertisements in local independent
newspapers, word-of-mouth, and alliances with several philanthropic groups and
senior citizen organizations. Members of these organizations have made numerous
referrals over the years, and some have even chosen to move to Angel Crest Manor
themselves for retirement living.
Gradual change in the demographics of the surrounding community is
reflected in changes in the resident population, which has become increasingly
ethnically and socio-economically diverse. While marketing efforts are centered on
the community surrounding Angel Crest Manor, the five other corporate facilities
engage in nation-wide marketing strategies geared toward luring private-pay
individuals primarily from the east coast to experience "gracious retirement living
in a caring and compassionate environment" in the sun belt.
The skilled nursing unit is in the Health Center, a three-story structure (see
Figure 1). The skilled nursing administrator’s office, medical records, business
46
office, and the facility’s clinic are located on the first floor. The clinic operates
each day until 3:00 P.M. and serves both independent and assisted living residents.
The clinic is staffed by one LPN and two nursing assistants (NA). In the event of
an emergency or accident, clinic staff are the first to respond with medical
attention. Some assisted living resident rooms are also located on this floor. The
second and third floors contain 51 skilled beds.
The assisted living unit is housed in a separate building, Ariel Hall, across
the campus from the nursing unit. This two-story structure is home to residents
needing assistance with activities of daily living as well as those suffering from
dementia related disorders. The second floor is designated as the Alzheimer’s Unit
and was hailed as the first of its kind in the area. Residents living on the second
floor must walk up two flights of stairs or use an elevator in the main building, and
walk across a cat walk to their rooms.
The main building, Michael Hall, is a four-story residential apartment
building, housing a council room, gift shop, library, and central lounge, and
connects to the stately chapel. Other buildings on the campus include Gabriel Hall,
a six-story independent residential apartment building; the dining hall; Rafe Cottage
which houses the activities department, exercise room, residential laundry facilities,
and beauty salon; and Administration Cottage, which houses the administrator’s
office, the marketing, business, accounting and personnel offices.
As an inner-city retirement community, ACM has seen many changes. The
surrounding neighborhood, once the hub of social life for the most affluent
47
members of the area, is now home to a large number of recent immigrants from
Korea, Russia, Armenia, Mexico, and Central America. Check-cashing stores and
pawn shops are intermingled with businesses catering to specific needs of new
immigrants. Billboards, street signs, and shop windows are filled with
advertisements written in several languages. Many of the facility’s employees are
drawn from the local community and from other low-income neighborhoods
accessible by bus.
In addition to ethnic diversity, there has been a dramatic increase in the
number of residents requiring personal care assistance, creating unexpected conflict
within the facility. Some of the independent residents, particularly those who have
lived at the facility for a number of years, resent the presence of frail new residents
and those in assisted living, and view the changes as a reflection of the facility’s
overall decline. As the pool of private pay residents decreased, the marketing staff
recruited residents from the surrounding neighborhood, many of whom are on SSI.
A waiting list exists for assisted living. Increasingly, residents are admitted
to independent living only to be evaluated several months later as incapable of
functioning alone. In many cases, the resident remains in independent living and
receives personal care services until a room is available in the assisted living
section. Waiting time ranges from several months to a year.
48
ORGANIZATIONAL STRUCTURE
Angel Crest Manor is a division within Gabriel Care Homes, Inc. Reporting
to the board of directors and the president is the chief operating officer, Wesley
Johnson (see Figure 2). He has an MBA and was the first lay administrator of
ACM. The vice president of residential living, Alice Williams, oversees all
residential and assisted living units of the six Gabriel Care Homes. She holds a
bachelors degree in hospitality/hotel management and has been with the corporation
for 15 years. Formerly, she was the administrator of the corporation’s Orange
Grove facility. The vice president of skilled nursing, George West, oversees the
corporation’s three nursing facilities. (The other three facilities do not offer skilled
nursing care.) He has a doctorate in pharmacy and has been with the corporation
for eight years.
Within ACM, the residential facility and skilled nursing facility have
separate co-equal administrators supervised by their respective corporate officers.
The administrator of the residential section oversees independent living, assisted
living, pastoral care, maintenance, the clinic, housekeeping, dining services,
business/accounting office, personnel office, marketing, and activities. The
residential administrator, Thomas Clayton, who has a masters degree in english
literature, has been at ACM for 12 years.
The administrator of skilled nursing oversees nursing services and medical
records specifically for the skilled nursing center. The administrator, Eric Phillips,
49
has been with ACM for 8 months. He holds a bachelors degree in nursing home
administration. Phillips is the third administrator of the skilled nursing facility in
the past two years. There are no assistant administrators. The director of
marketing reports to the residential administrator; the director of nursing reports to
the skilled nursing administrator.
CHANGING ENVIRONMENT
Several years ago, ACM found itself in the middle of urban rioting. Civil
unrest took its toll on staff and residents at the facility. Residents stood by their
windows and watched as shops were looted and buildings burned only a block
away. Several tense days brought fear and uncertainty. Since then, fear for their
personal safety and well-being has forced many residents to give up outside
activities. Because the visible presence of street gangs and frequent sounds of gun
shots, police sirens, and surveillance helicopters are now a part of everyday life,
many residents prefer to remain within the familiar confines of the campus.
THE MOST RECENT DISASTER - THE EARTHQUAKE
Recently, yet another crisis occurred. A major earthquake jolted residents of
ACM awake at 4:31 A.M. Because the earthquake damaged power lines, electricity
was out and emergency generators supplied power only to the skilled nursing
50
facility.
In the event of such an emergency, a resident volunteer is designated by the
administrator to serve as "floor captain," responsible for assuring each resident on
his/her floor is safe and out of danger. Training for floor captains consists of
familiarizing them with emergency exits and the location of emergency supplies.
Staff members are to assist in any areas where they are needed until the emergency
is resolved. Disaster policy states everyone should, "Stay calm and stay away from
windows. Get under a doorway or crawl under a piece of steady furniture such as
a table or desk (Resident Handbook)."
Night shift staffing consists of one licensed practical nurse (LPN) and three
NAs for the skilled nursing facility; two NAs staff the assisted living unit and one
security guard patrols the four acre campus.
The uncertainty of the event, the early hour at which it occurred, lack of
emergency drills, and the inability to see in the darkened buildings prevented many
floor captains from performing their duties. A few residents wandered the halls,
others nervously chatted while waiting for instructions. Most, out of fear, did not
venture out of their apartments.
Shortly after the main shock, the guard and a nurse’s aide from assisted
living began to make rounds. The director of marketing, the charge nurse for
skilled nursing, the business office manager, the housekeeping supervisor, and the
food services supervisor arrived within several hours of the earthquake. They set
about the task of examining the campus and the condition of the residents. With no
51
electricity, only a cold breakfast was prepared in the dining hall. Resident
volunteers were brought in to help prepare breakfast and feed residents in the
skilled nursing facility. By 12:30 P.M., only half of the residential apartments had
been checked for damage. Constant aftershocks were unnerving for everyone.
Given the high levels of anxiety, staff attempts at resuming normal operation were
marginally productive.
Many windows in the skilled nursing facility and the large solarium window
in Gabriel Hall were shattered. Structural damage was evident in the stairwell
leading to the third floor of the skilled nursing unit as were cracks throughout the
facility. Shattered windows, many in rooms occupied by residents, were left
unattended until late the following afternoon.
Neither administrator could reach the facility the day of the earthquake.
Eric Phillips arrived two days after the quake to meet with corporate
representatives. Wesley Johnson, accompanied by Alice Williams, toured the
facility on the day of the earthquake to assess damage.
The most severe damage occurred in Michael Hall where the third and
fourth floors connect to the chapel. Residential apartments were located in this
area, which had not been part of the original construction of the building.
Apartments on both floors were damaged. The apartment of one resident who had
been admitted to a rehabilitation hospital before the earthquake revealed a vast
amount of structural damage. Parts of a supportive pillar had fallen onto his bed.
Large wooden bookcases and shelves lay in pieces on the floor. An eight-inch
52
crack in the solid concrete wall spread from the fourth to the third floors. Shifting
caused the floor to buckle in several areas. Residents living in damaged areas were
moved to vacant apartments throughout the facility. Two days after the earthquake,
the last resident with a damaged apartment was moved to safer quarters.
The hours immediately following the earthquake were filled with confusion.
News reports warned of contaminated water, continued loss of electricity and
interrupted phone service. Residents were uncertain of how to react to the often
conflicting directives of the news reports. Several continued to wander the halls
attempting to resume a normal schedule of activities. Some began cleaning up the
damage caused by the earthquake. Others discussed their feelings concerning the
event. Uneasiness and fear reinforced with each aftershock continued for days after
the initial earthquake. One resident remarked that she was terrified to get into the
shower and could not fall asleep at night without having all the lights and television
on. For several residents who immigrated to the United States during World War
n , the earthquake brought back terrifying memories of the bombing and destruction.
Others, who had escaped violence and revolution in their countries of origin, shared
similar horrifying experiences.
Conflicts and outbursts of anger became common occurrences. Residents
lashed out at employees, especially those with whom they had the most contact,
such as housekeepers and maintenance personnel. Some staff lacked the language
proficiency and communication skills to respond adequately.
Four days later, counselors were brought in to conduct seminars, in English,
53
to assist employees to confront any fears or anxieties they might have because of
the earthquake. Three sessions were held. One was available for residents, twelve
of whom attended. A general feeling of uneasiness among residents about these
counselors kept many from attending sessions and expressing their fears and
anxieties. Instead, they chose to share their concerns with employees they trusted,
primarily those they saw on a daily basis.
One week after the earthquake, corporate engineers surveyed the buildings
of Angel Crest Manor. Thomas Clayton accompanied them on his first day back at
the facility. Yellow caution strips cordoned off the area directly in front of the
chapel where the most serious damage occurred. The remaining buildings were
structurally sound. New windows were ordered for the skilled nursing facility and
the solarium. Fortunately, the facility had adequate earthquake insurance to cover
the preliminary damage estimate of $1.7 million.
Over the next few weeks, life slowly returned to a normal pace at ACM as
the facility began preparing to host the annual board of directors meeting. Staff
returned to normal work schedules; activities and resident outings resumed. Yet
signs of strain and discontent persisted. Six private pay residents moved to other
facilities. The families of several others threatened to remove their loved ones if
changes to the facility’s approach to emergencies and assurances of its safety and
repair were not adequately addressed. At the monthly resident council meeting, the
administrator suggested that, due to the poor response during the earthquake, more
extensive training would be required of floor captains. In response, two residents
54
on the council resigned in protest over the lack of proper guidelines and directives
in disaster situations. They charged that economic factors were the reason so few
staff members were on duty during the night shift.
ANNUAL BOARD M EETING
In the face of growing uncertainty among board members as to the
feasibility of maintaining Angel Crest Manor, its fate was given priority on this
year’s agenda. Wesley Johnson, with the results of his study in hand, walked
across the street. Although he was well acquainted with the various proposals that
would be offered, what would happen at the meeting was anyone’s guess. Records
indicated that, while ACM maintained an occupancy rate of 98 percent, endowment
funds were increasingly needed to offset annual operating deficits. Angel Crest
Manor’s reimbursement rates had dropped significantly below the other five
facilities. The feasibility study conducted by the corporation focused on remodeling
floors in Michael Hall and Gabriel Hall, currently containing one- and two-bedroom
apartments, into studio apartments in anticipation of increasing numbers of low-
income residents.
Several options face the board of directors. Angel Crest Manor could be
sold to another private corporation, thereby alleviating any future problems for
Gabriel Care Homes, Inc. This option was supported by some members of the
board, particularly those from the business community, but was poorly received by
55
the sisters. Another option was to restore the facility with earthquake insurance
funds, making the facility as attractive as possible, and hold out in hopes that the
future would yield community development projects to enhance the surrounding
neighborhoods. Some board members felt that this would be a fair and reasonable
middle ground. They suggested that the earthquake had been a blessing in disguise,
permitting some modest modifications to the existing facility.
The third option was promoted by Sister Mary Francis Fisk, the chairperson
of the board. She was adamant that the board champion the original mission by
concentrating its resources on the community and low-income individuals. Sister
Mary Francis had argued repeatedly that the corporation had weathered its financial
crisis in the late 1970s by drifting away from its original mission. She was not
about to let this happen again and stated that, "it is unconscionable to deny our
elders the care they need simply because they lack the means to pay for it."
Sister Mary Francis had tirelessly worked to ensure that people who shared
her philosophy would be represented on the board. The reputation not only of the
corporation but of her entire order was at stake. Her proposal included using the
earthquake insurance money to begin to make modifications in the physical plant
while continuing to subsidize ACM until it was able to become more self-sufficient.
She believed that innovative programming and sound, no-frills management would
pay off. She advocated expansion of the assisted living area for low-income
individuals and those suffering from Alzheimer’s related disorders to serve the
unmet needs of the immediate neighborhood. She also proposed expanding the
56
services offered by the clinic to the surrounding community and development of a
state-of-the-art adult day care program. The clinic could be utilized by individuals
in the neighborhood who were in need of in-home care. Day care would provide
respite for local caregivers as well as serve older persons who lived alone. A
recent needs assessment contracted by the Area Agency on Aging had indicated
strong need for these services.
Sister Mary Francis suggested the board consider several strategies to
increase revenue at the facility including investigating the development of a
contract with a local hospital to provide subacute care, aggressive fundraising to
increase the facility’s endowment, and a state grant to support day care. According
to Sister Mary Francis, the core mission is on-target, but the mission must adapt to
meet changing long-term care needs.
The meeting is scheduled to begin in a few minutes in the council room of
ACM. Pausing in front of Michael Hall, Wesley Johnson gazes at the barricaded
chapel area where the structural damage is still very apparent and contemplates the
irony of the situation. Would this recent crisis mean opportunity or catastrophe for
the original facility, its residents, and staff?
57
Exhibit 1.
Mission and Philosophy Statement of Gabriel Care Homes, Inc.
At Gabriel Care Homes, Inc., we believe we have a duty to respond to Gospel
values of serving our neighbor in justice, charity and good-will; therefore, in the
spirit of our foundress, any elderly individual who approaches us for care,
regardless of race, creed, nationality, sex, handicap, or economic status is entitled to
share the fruits of our ministry in comfortable supportive surroundings. We pledge
to provide elderly residents with CARE - IN ALL WAYS FOR ALL TIME.
58
CHAPTER FOUR: THE SWOT ANALYSIS
STRENGTHS OF ANGEL CREST MANOR/GABRIEL CARE HOMES, INC.
The history of Angel Crest Manor provides its greatest strength. Having
served elders since 1902, the facility has gained an impressive history of leadership,
dedication, and care for its residents and employees. The involvement of
philanthropic and charity organizations whose membership have supported the
facility over the years bears witness to the respectable position the facility holds
within the surrounding community. The fact that the facility traces its roots to a
religious organization with an established history of service to those in most need
creates a strong foundation upon which the facility can depend in uncertain times.
The sponsorship of the Sisters of St. Mary of the Angels provides both credibility
and respect for Angel Crest Manor and its parent corporation Gabriel Care Homes,
Inc. The dedication of its founding sisters and their continued presence simply
serves to reinforce the original philosophy of care to needy older adults. The
support and loyalty of the corporation’s chief operating officer, Wesley Johnson,
toward preserving the mission of the corporation and its original facility indicates a
recognition of a past steeped in quality and care for those it was established to
serve.
The corporation’s emphasis upon compassionate care as expressed in its
59
mission statement, provides a framework which serves to direct the corporation’s
actions in meeting the needs of elders. Such a framework provides assistance in
directing policies and procedures by presenting the reasons for the corporation’s
existence. The words of the mission statement declare that the corporation has
discerned what its role is to be and how it will direct its efforts to fulfill that role
through the course of its corporate actions, policies, and procedures. The presence
of the mission statement indicates that the corporation has made a conscious
decision concerning those areas in which it wishes to invest its energies and
resources. Through the mission statement, Gabriel Care Homes, Inc. publicly
professes its goals and objectives which are to provide care for its residents.
Another one of the corporation’s strengths stems from the presence of a
qualified staff in upper management levels as well as a board of directors
representing a diversity of professional occupations. The corporation has benefited
from the presence of a president who has experience in rescuing floundering
enterprises, who acts cautiously towards the allocation of resources, and has a
background in both for-profit and non-profit organizations. The chief operating
officer, who became the first lay administrator of Angel Crest Manor, has a
background in business as well as having served the coiporation for the past 15
years. The vice president of residential care has a background in hotel/resort
management and previously served as administrator of one of the corporation’s
facilities. The vice president of nursing services has a doctorate in pharmacy.
Each of these individuals brings to the corporation a diversity of backgrounds and
experiences which, if properly focused, could be utilized to strengthen the
corporation and direct it towards an uncertain future. A key element in
strengthening the corporation is creating a clear delineation of the authority of the
board and its managers, plus an implementing mechanism structured around
regularly scheduled meetings, clear lines of communication and a structure that
supports policy orientation and precludes any drift in the direction of
mircromanaging the institution (Goldsmith, 1994).
Gabriel Care Homes, Inc. has survived past adversity. The financial crisis
in the late 1970s caused many changes for the corporation. But through its
restructuring efforts, the corporation was able to face the crisis, restore a strong
financial footing and begin efforts to improve living conditions for current
residents. The fact that Gabriel Care Homes, Inc. was able to weather its financial
difficulties, reorganize its structure, and continue operations provides insight into
the corporation’s ability to learn from its mistakes and proceed forward in the quest
to maintain its mission. Through the selling of out of state facilities, Gabriel Care
Homes, Inc. centralized its operations thereby making it easier to administer. No
longer did the corporation have to work with differing state regulations concerning
operations but they could now concentrate on the facilities within one state.
Through the use of a consultant, the corporation demonstrated ability to
launch a successful marketing and fundraising campaign which depicted the
facilities as "a home for loved ones in an elegant environment." The campaign
focused upon drawing middle and upper-middle class retirees from eastern states.
61
The campaign also focused upon strengthening the corporation’s position with
charitable organizations and philanthropic groups. At Angel Crest Manor, these
organizations had always been active in the promotion of the facility both among
their members as well as the surrounding community.
On the individual facility level, the fact that Angel Crest Manor is part of a
large corporation provides both security and stability. It does not have to face its
financial difficulties alone but has the resources supplied by a corporate structure
and network on which to rely. Unlike the other facilities owned by the corporation,
Angel Crest Manor was the anchor. It established the foundation and gave birth to
the corporation, its mission, and philosophy of care although both care and mission
at the other facilities changed considerably. Its position as flagship for the
corporation provides an advantage for the facility as it struggles to weather the
recent crisis.
The fact that Angel Crest Manor has the highest occupancy rate of any
facility of the corporation illustrates that a specific need is being met for its
services within the facility’s surrounding community. In spite of the demographic
changes taking place within the neighborhood, Angel Crest Manor has continually
been able to draw new residents. The need for elder care is present and the facility
is attempting to meet that need. Due to the physical layout of the facility it is able
to provide for all the needs of its residents, thereby providing added safety and
security from a neighborhood that continues to change. The self-contained campus
provides a haven from the reality of the surrounding community.
62
WEAKNESSES OF ANGEL CREST MANOR/
GABRIEL CARE HOMES, INC.
There are several weaknesses indicated in the case study. The most
prevailing one centers on the corporate structure of Gabriel Care Homes, Inc. The
policy of having co-equal administrators at facilities which house both residential
and skilled nursing units causes both communication and organizational difficulties.
While each facility is run as a single entity, the presence of two administrators may
cause tension. The health center is in need of the services provided by
maintenance, housekeeping, and dietary staff. But if problems develop within these
departments, or between the two administrators themselves, care to the residents
may suffer. While the current corporate structure yields its greatest effects upon
the individual communities, it also may be seen as affecting decisions at higher
levels of management. The current policy assumes that both the residential and
skilled nursing divisions of the corporation are in cohesion and collaboration with
each other. Each facility administrator reports to his/her respective corporate
representative concerning operations at the various facilities. This method may be
effective in situations where the issue is isolated to a specific unit of the
corporation. It becomes problematic, however, when issues arise in which both
corporate units are involved. In such cases, the lines of communication are easily
broken down and decision making ability is impeded. For example, during the
earthquake, Eric Phillips, administrator of the skilled nursing unit was the only one
able to arrive at Angel Crest Manor within a few days of the earthquake. His area
of the campus was not the only one affected, but rather, the most extensive damage
occurred in areas of the residential living units. Yet, quick decisions had to be
made as to what was required to secure the buildings and resume normal
operations. In an already chaotic incident there exists a need for clear direction and
guidance in order to alleviate undue stress and turmoil.
Another problem is the apparent lack of awareness on the part of Gabriel
Care Homes, Inc. to the uniqueness of its original facility. The corporate policies
are designed for the needs of the other five facilities. The emphasis on "elegant
living" does not fit into the reality of Angel Crest Manor’s needs. As indicated in
the case, there is a waiting list for admittance to the assisted living unit. Fewer
individuals are capable of moving into the independent living section and those who
are able remain there for shorter lengths of time. The other facilities of the
corporation attract retirees from the east coast and provide for their interests by
developing programs geared toward remaining active. The other facilities deal with
populations of young old while increasingly Angel Crest Manor must grapple with
the needs of the oldest old population. People of means would most likely be
reluctant to move to Angel Crest Manor considering its physical location.
The changing demographics pose a problem to Angel Crest Manor. The
neighborhood used to cater to the most affluent members of the surrounding area.
Over the years, however, the surrounding neighborhood has become home for
numerous recent immigrants. The ethnic diversity of the neighborhood has resulted
64
in reductions in the number of residents in the independent living area as well as
increased demand for assisted living services. Increased incidence of crime, the
presence of street gangs and frequent sounds of gun shots cause both fear and
anxiety for current residents. Perspective residents of affluent means are reluctant
to move to such a neighborhood, thereby forcing Angel Crest Manor to seek out
prospective residents from within the surrounding community. Many of these
individuals are low-income, frail and incapable of performing activities of daily
living without assistance. As a result the average age of residents at Angel Crest
Manor has increased by 6.8 years and the average number of impairments in
activities of daily living have increased by 30 percent
The period of civil unrest as well as the earthquake created further changes
for Angel Crest Manor. AJthough both situations were unforeseen, the absence of
adequate disaster policies to handle the situations resulted in both confusion and
turmoil. Lack of emergency drills, proper training, and back up strategies caused
tension among the residents and staff. Uncertainty in how to handle the crisis was
a problem with regards to the earthquake. Delays in response time, inspection of
the facility for structural damage, damage control and the use of an outside
counseling service to alleviate fears was for the most part inadequate to address the
issues raised by the earthquake. Far too much reliance was placed upon resident
floor captains to perform initial inspections of the facility. Without proper training,
sufficient lighting and emergency instructions the facility placed its resident floor
captains in jeopardy of accidental injury as they attempted to fulfill their
65
responsibilities.
Another problem area for Angel Crest Manor results from the apparent rapid
turnover rate for administrators of the skilled nursing facility. The present
administrator has been on the job for only 8 months and has been the third
administrator in the past two years. Although he has adequate professional training
in nursing home administration, his limited time on the job could prove problematic
for a facility in crisis such as Angel Crest Manor. This brief tenure provides little
time for an individual to observe the mode of operations of the facility, acquaint
oneself with corporate policy, detect problem areas, and begin to implement
solutions. The turnover rate in administration as well as the numerous physical
changes may be viewed as contributing to the noted fluctuations in employee
morale and tension among residents. Administrators of long-term care facilities play
an absolutely critical role in the lives of both employees and residents by setting
the tone for the entire facility (Goldsmith, 1994).
OPPORTUNITIES FO R ANGEL CREST M ANOR/GABRIEL CARE
HOM ES, INC.
Although the earthquake created serious problems for Angel Crest Manor
and its parent corporation, the natural disaster could be seen as an opportunity to
institute needed changes, expand current services, and initiate innovative programs.
The earthquake could be viewed as an opportunity in disguise for a facility facing
66
an uncertain future. The monies received from earthquake insurance could be
utilized to begin needed repairs on the facility while initiating innovative programs.
The proposal supported by the chairperson of the board includes a series of options
that, if adopted and successfully managed, could serve to strengthen Angel Crest
Manor’s position within Gabriel Care Homes, Inc. and insure its future survival. A
facility which once teetered on the verge of extinction could become a model and
driving force for corporate renewal, innovation, and strategic planning. The
suggestions of Sister Mary Francis promise to not only improve operations at Angel
Crest Manor but also reach beyond its campus into the surrounding community. By
expanding the assisted living section to other areas of the campus, the waiting list
for such services would be eliminated, new residents would be brought into the
facility and new programs would be instituted. As noted in the case, a recent needs
assessment contracted by the Area Agency on Aging indicated a strong need for
services for individuals suffering from Alzheimer’s disease and related disorders as
well as those in need of personal care assistance. The proposal also includes
expanding services offered by the existing clinic and making its services available
to individuals in the surrounding community by providing home health care.
Respite services were mentioned through the sponsorship of an adult day care
facility.
Each of these proposals presents opportunities for the corporation to expand
while maintaining its reputation of quality care. In adopting such proposals, the
corporation and Angel Crest Manor especially will be in a position of leadership in
67
an increasingly competitive environment. The goal of maintaining their original
mission and the philosophy of care would be fulfilled. The corporation would be in
a greater position to live up to its motto of providing care in all ways for all time.
The proposals of Sister Mary Francis and the board members that support
her agenda illustrate the willingness of the board to confront adversity with
creativity and strategic planning. According to Goldsmith (1994), the process of
strategic planning will generally not change the purpose of the organization,
however, the goals and objectives set by the organization to accomplish the mission
will change as the environment changes. The history of Gabriel Care Homes, Inc.
demonstrates that the facility can weather numerous crises and survive. The issues
presented to the corporation through the earthquake, societal needs, and
demographic shifts should not be seen as devastating occurrences marking the end
of a facility, but rather, as opportunities for change, growth, and increased
longevity.
THREATS TO ANGEL CREST MANOR/GABRIEL CARE HOMES, INC.
Along with the opportunities are threats which Gabriel Care Homes, Inc. and
Angel Crest Manor must take into consideration. One such threat is the continued
division on the board of directors. Without the existence of both collaboration and
cohesion on the part of board members, no changes will take place and the
corporation could risk losing not only a facility but its core mission and philosophy.
68
Cooperation among board members is only one area necessary to induce change. A
threat also exists if those in upper management who maintain the power to
implement the decisions of the board are not adequately trained to do so. As noted
previously, one of the key weaknesses of Gabriel Care Homes, Inc. rests in its
organizational structure. The existing structure presents opportunities for
breakdowns in information flow and chain of command. In order to take advantage
of any of the proposed opportunities it will be necessary to examine the current
corporate structure. However, as noted by Goldsmith (1994), although organizing
and reorganizing seem to be in the blood of managers, it should be recognized that
reorganizations are often not the solution to deep-seated organizational problems.
Not only will it be necessary for individuals in upper levels of management
to be knowledgeable of the proposed changes, but more importantly the
administrators and department heads at Angel Crest Manor will have to be both
knowledgeable and capable of implementing the proposed innovative programs.
Consideration as to the ability of the administrator of residential living as well as
the administrator of skilled nursing at Angel Crest Manor to carry out decisions of
the board will be crucial to the program’s success or failure.
A crucial element in any strategic plan adopted by the board of directors is
its flexibility in both implementation and projected outcome. A strategic plan that
contains too much rigidity could be harmful to the corporation by not providing
room for additional unforeseen crises or unintentional consequences of those which
have already occurred. The role of strategic planning in a long-term care
69
organization is to deal with the realities of the present and anticipate which changes
will occur in the future (Goldsmith, 1994), The proposal of Sister Mary Francis
contains both innovation and risk. The threat exists if, in adopting the idea to
develop innovative programming, projected increases in revenue, the contract with a
local hospital, and receipt of a state grant, prove to be inadequate to offset the
expenses of maintaining the proposed programs. Such a situation could compound
the issues currently faced by Gabriel Care Homes, Inc. and deplete the
corporation’s endowment funds to the point of hindering service at the other five
facilities.
Finally, the corporation must be careful not to introduce so much change at
one time that chaos and uncertainty result. If changes occur too quickly, the
morale not only at Angel Crest Manor but at the other facilities could suffer.
Unfounded fears could be fueled by hasty decision making accompanied by
inadequate time for those affected to process the changes. The greatest casualty to
such quick action could very well be Gabriel Care Homes, Inc.’s greatest strength,
namely its reputation. Overemphasizing change could result in undermining a
reputation established on quality. Those in positions of authority should attempt to
change only those areas in need of repair while leaving other areas alone until
change is necessary for progress.
70
CONCLUSION
In an era of downsizing, budget cutting, consolidation, and mergers, many
long-term care facilities struggle with the reality of rapidly changing times which
may cause tension between their original missions and continued survival. The
case study Crisis and Values at Angel Crest Manor illustrates this struggle.
Founded with the goal of meeting the needs of poor elders, Angel Crest Manor and
its parent corporation currently face an uncertain future. Demographic changes,
economic conditions, and unforeseen crises have impacted the ability of Angel
Crest Manor to deliver cost-effective services. The present circumstances at Angel
Crest Manor threaten to jeopardize the fiscal stability of the corporation’s other
facilities. Gabriel Care Homes, Inc. is at a crossroads. It must engage in strategic
planning in order to adequately deal with the issues it now faces or risk the
possibility of further decline.
The issues presented in this case are not uncommon to many non-profit
long-term care facilities. No simple solutions exist as to how to reconcile the
organization’s mission with the realities of contemporary society. Strong
leadership, creative options, and sound fiscal planning are needed in order to
achieve a positive outcome.
The interplay between the various levels of administration, the established
corporate culture, the constituents and the sponsoring organization demonstrates that
administrative decisions cannot be made in isolation, but rather, must be derived
71
through careful consideration of the costs and benefits to the various entities of the
organization. Organizations function in complex environments where compromise
and collaboration are needed in order to function effectively. Therefore, individuals
in the field of administration must be aware of the impact their decisions have upon
the organization, its employees, constituents, and benefactors.
72
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Asset Metadata

Creator Mattes, Raymond Alan (author)

Core Title Crisis and values at Angel Crest Manor: a case study in long-term care management

School Leonard Davis School of Gerontology

Degree Master of Science in Gerontology

Degree Program Gerontology

Degree Conferral Date 1995-05

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag business administration, management,education, adult and continuing,gerontology,OAI-PMH Harvest

Language English

Contributor Digitized by ProQuest (provenance)

Advisor Wilber, Kathleen H. (committee chair), Pynoos, Jon (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c18-2871

Unique identifier UC11356731

Identifier 1376481.pdf (filename),usctheses-c18-2871 (legacy record id)

Legacy Identifier 1376481-0

Dmrecord 2871

Document Type Thesis

Rights Mattes, Raymond Alan

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA