Senior Living Story: Cutting My Teeth As An Executive Director

I was twenty-nine when I became an Executive Director. Overnight, I went from never having managed a single employee to hiring, training, and managing a team of forty-five. I had a Bachelor's Degree in Social Work and barely four years of Senior Living experience - all of which were spent in sales. I'd never been part of a State Survey; never handled an investigation; never hired anyone, fired anyone, handled payroll, written a schedule, or run a safety drill. I'd never worked the floor, been on-call, run a kitchen, handled HR, or licensed a new property. I was the "long-shot" candidate for the job. I'd never had the livelihood of working adults in my hands. I'd also never had the lives and well-being of senior citizens - nearly all of whom were suffering from some kind of physical ailment, if not also a form of dementia - in my hands. Suffice it to say, the learning curve was steep and the stakes were "sink or swim."

"Eventually, you're going to have to learn to trust your own judgement," my supervisor, Cheryl, a Regional Director of Operations, told me. At three months in, I had her number pretty much on speed-dial and had barely made a move without her input. "One day, you'll need an answer to something and I'm not going to be available to give it to you," she said. "You're just gonna have to make a call and live with it - right or wrong." The notion set loose butterflies in my stomach. She added, "The good news is, there's almost nothing you could do that we can't fix or, at least, learn from for the next time."

I stood in the middle of my office, a few months later, with the door closed and my phone pressed against my ear. I'd made some decisions on my own, by then, but this was a biggie - an abuse allegation against one of my nurses. It was three days since concerns had been brought to me and I'd just completed the last interview in what would be a state-reportable investigation.

"What do you want to do?" Cheryl prompted, waiting expectantly on the line.

I took a breath and rubbed two fingers into my temple as the last few days' events recycled themselves in my mind. I pictured Hillary and Susan - both CNA's - squeezed into the doorway of my office.

“Cortney, can we talk to you?” Hillary’s voice broke my concentration while I was eyeball-deep in variance reports.

“Sure.” I looked up from the computer screen and smiled, automatically, at the sight of them.

Fifteen minutes later, Susan and Hillary were in opposite corners of my office writing statements and detailed accounts of what they’d witnessed. I picked up my desk phone and called down to the nurse’s station.

“LaToya, I need you to do a head to toe assessment on Kathleen. Please take extra care to check for bruising, redness, or swelling - any sign of injury.” LaToya confirmed she would see Kathleen shortly. “Thank you. Please bring the paperwork to my office once you’re finished.” 

Next, I called Ovie - the accused nurse. She would already have punched out for the day and was at home when she answered my call. "Ovie, I need to inform you that an abuse allegation has been made against you," I said. I explained that I’d need to take her off the schedule while I investigated. “I want you to know that I'm not making any assumptions about what happened. I'm going to follow the evidence where it leads, and if it turns out the accusation is unfounded you'll be reinstated to your position." I thought how terrible it would feel to be accused of harming a resident - especially, if she was innocent. "Can you come by tomorrow to give a statement?"

I set a time to meet with Ovie, then sent notice to the Illinois Department of Public Health (IDPH), our governing entity, while my assistant began putting calls out to cover Ovie’s next few shifts. 

“So what do you think?” Cheryl prompted, again, as I paced back and forth in my office.

I sighed. “I think she’s a good nurse who made a bad call. I think she genuinely didn’t see anything wrong with her actions." I took a seat on the edge of my desk. "She told me exactly the same story that Hillary and Susan did.”

“We were trying to dress her but, you know, sometimes Miss Kathleen - she refuse,” Ovie had said during her interview. “She was swinging her arms, trying to hit us and I don’t want no one to get hurt, you know? So, I just grab her arms and put them back towards her. I say, ‘Hit yourself. Hit yourself.’ But I never hit her.”

I processed the details, out loud, to Cheryl. “There wasn’t a mark on Kathleen, thankfully, but everyone reported the same thing - that she did make physical contact with herself as a result of Ovie’s intervention.” My fingers found the place against my temple, again, and worked the soft spot, absently. “I don’t think there was malicious intent, and I understand wanting to protect herself and staff from someone who’s hitting - but this is a lady who weighs barely ninety pounds. She's low-risk for inflicting injury. And, Ovie should also have been thinking about Kathleen’s safety. She could have blocked her arms, or directed them away from all parties. Or, how about just letting her alone? Not forcing her to get dressed at all, right then? Re-approaching is a basic intervention for working with someone with dementia. They've all been trained on it. They could've just tried again, later." I sighed into the receiver. I could argue it either way.

I could issue Ovie a correction, I thought. I could in-service the rest of the team on what are, and are not, acceptable interventions with combative residents. Finding a way to keep Ovie was tempting. And, it wouldn't have been wrong, necessarily. She was a thorough, knowledgeable nurse and a good leader. Keeping her would also prevent me from being out a full-time position after just getting fully staffed. I really do think she just made a bad judgement call.

But, the memory of Hillary and Susan's faces, while they'd sat in my office, appeared in my mind. They'd recounted what they witnessed with calm - reservation, even. Neither was the type to go out looking for things to complain about, to create drama where there wasn't any, or to unfairly throw a fellow teammate under the bus. "Is this OK?" they'd asked me in earnest after explaining what'd happened.

And, that was it. That was the moment; the tipping point; the question that determined what I'd do next.

No, I thought. The way Ovie had chosen to intervene wasn't OK. And, no matter what I said about it, my actions were what would send the loudest message.

"Forcing a resident to hit herself is not something I want to set as an acceptable precedent," I said to Cheryl. "Thankfully, Kathleen wasn't injured, but I think that's all it was - luck. Resident abuse - even unintentional abuse - is not something I want to play around with. It's our responsibility to take their safety and well-being as seriously as we take our own. I really don’t want to let Ovie go, but I think it will send the wrong message if I don't.” 

“You have my support,” was all Cheryl said. That was that.

When I let Ovie go, she handled it with more grace than I could've hoped for. "I'm sorry," I told her. "This was a very difficult decision and I hope you understand why I had to make it."

"I do." Ovie said with a genuine smile.

I bumped into Ovie while on assessment for a potential resident a few months later. She had found work at a competing community and smiled when she saw me. The reaction caught me off guard, but I returned the grin and let her hug me. "This is a surprise," I said. "I wasn't sure how you felt after..."

Ovie shook her head - her dark, freckled face still stretched broadly. "You did the right thing. I have respect for you."

The impact of those words is difficult to describe. I felt awe - both, in Ovie as a person, and in the realization that it's possible for anyone to have that kind of reaction toward someone who's fired them. I also felt incredibly grateful - humbled by such an unexpected gift of reassurance. I knew it had been the right call - "unintentional" or "gray area" resident abuse didn't happen in my building following Ovie's departure - but, hearing it from her touched me in a way that felt different, and I'll never forget it. Deep inside, a part of me thought, I'm on the right track.

Dealing with allegations of abuse and neglect present very high stakes for trusting your own mind. When you can see both sides of a situation, or when you know you will only ever have partial information - and especially when other people stand to actually suffer from what you decide about whether something is "right" or "wrong" - learning to really tune in and follow your instincts is something you begin to take seriously.

I have a deep respect for people who think for themselves - probably because I know, from experience, just how difficult it is. My work in healthcare has certainly shaped me over the years - even bled over into the way I conduct my personal life - but learning to trust myself is one thing for which I'm particularly grateful.

Names and other identifying details have been changed or omitted in order to protect the privacy of individuals referenced in these stories.