Spring 2009

A publication for Wisconsin’s Long Term Care Profession by

Let’s Talk
About
Sex
PLUS:
• Get ready for the
47th Annual Spring
Conference and Expo!
• Sexuality and the
Non-Decisional Resident
www.whca.com • Workplace Romance:
Should It Get the Kiss-Off?
www.wical.org
• Making News is Good News
 welcome

THE “SEX ISSUE” of Continuum magazine is intended to raise awareness and stimulate a dialog on the sensitive
issue of sexuality in the long term care setting. You will fi nd several articles discussing the subject of intimacy
and relationships within the long term care provider community. We wrestled with some provocative cover ideas
that certainly would have caught peoples’ attention, but we decided to not make light of this serious subject that is
worthy of greater attention and discussion. These issues are important now and will only increase in the coming
years with the changing consumer attitudes and expectations.
Wisconsin has a proud history of being ahead of the curve in the provision of long term care services. Recogni-
tion that sexuality is part of the human condition, with varying levels of importance, is an idea that Continuum
hopes will be yet another area in which Wisconsin’s provider community takes leadership.
We hope that you fi nd this issue informative and
provoking of thought. We encourage comments and
Sexuality issues are important input on this and future issues of Continuum. Com-
ments are welcome at continuum@whca.com.
now and will only increase
in the coming years with the Sincerely,

changing consumer attitudes Brian R. Purtell

WiCAL Executive Director
and expectations. and WHCA Director of Legal Services

Advocacy, Education, Excellence

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• Advocacy: WiCAL is a leading and credible voice for within the legislative and regulatory area within Wisconsin. On the national
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SPRING 2009 CO NTINU U M 3

 contents Spring 2009

17 CROSSROADS: Sexuality and the

Non-Decisional Resident
Continuum is published for the This article will explore the ways that facilities
Wisconsin Health Care Association should engage in a careful, case-by-case analysis
and the Wisconsin Center for of the situation when confronted with the
Assisted Living question of whether a non-decisional resident
121 East Wilson Street, Suite L200 should be permitted to engage in sexual activity
Madison, WI 53703 within the facility.
608-257-0125
Fax: 608-257-0025 19 HR 4 LTC: Workplace Romance –
www.whca.com/www.wical.org Should It Get the Kiss-Off?
Workplace romance is a concern of nearly
Managing Editor all employers. Some employers have outright
Brian Purtell banned dating between employees; others have
instituted workplace dating policies; and still
Editorial Associate other employers require dating employees to
Erin Celello sign “love contracts.” What’s the best solution
for your facility?
page 7
Published by
12 LET’S TALK ABOUT SEX
Naylor, LLC Some of the more difficult and sensitive
5950 NW 1st Place situations in long term care settings involve
residents and sexuality. Given the delicate and
Gainesville, FL 32607
for some, uncomfortable nature of the topic,
800-369-6220
facilities and staff are often challenged by it. But
or 352-332-1252 it doesn’t – and shouldn’t – have to be that way.
Fax: 352-332-3331
www.naylor.com
16 MEDIA MATTERS:
Publisher Making News is Good News
Mark Migliore If the public, customers and elected officials
aren’t hearing anything about your facility, you’re
Editor missing an opportunity to build name recognition.
Saara Raappana Follow five easy steps to garner increased news
Marketing and Research Associate coverage for good things you’re already doing at
your facilities.
Zach Swick
Project Manager 18 CAPITOL BEAT: Can One Voice Make page 9
Rick Jablonski a Difference in the Legislative Arena?
Account Leader Because legislative decisions will have a critical
impact on your ability to provide the highest
Patricia Nolin
level of care to residents, providers must make
Account Representatives lawmakers aware of the issues and impacts
Denise Creegan, Janet Corbe, on the profession. Learn a few general rules
Steve Hall, Scott Pauquette, for the most effective communications with
Mark Verceles, Cherie Worley legislative leaders.

Layout & Design 19 BUYERS’ GUIDE PROFILES

Irene Pohoreçka
Advertising Art 20 STAKEHOLDER SPOTLIGHT: Otis Woods
Elaine Connell Otis Woods, director of the Division of Quality
Assurance (DQA), discusses the role of his
©2009 Naylor, LLC. All rights reserved.
Division and shares his thoughts on regulatory
The contents of this publication may not be
matters.
reproduced by any means, in whole or in
part, without the prior written consent of the
publisher. 22 ADVERTISER.COM/
page 12
INDEX TO ADVERTISERS
PUBLISHED MARCH 2009/WHC-B0109/8316

Cover and feature story photography by Adam Senatori

SPRING 2009 CO NTINU U M 5

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 crossroads
Sexuality and
the Non-Decisional Resident
The Role of the Guardian or Agent
By Robyn Shapiro and Colleen O’Connor Patzer
IT IS GENERALLY accepted that an in-
dividual should not lose his/her right to
make decisions about his/her sexuality
upon entry to a nursing home or assist-
ed living facility. However, questions
as to whether and how a guardian or
health care agent may make decisions
related to a non-decisional resident’s
sexuality are complicated and difficult.
As discussed below, the law does not
provide concrete direction on these is-
sues, which leads to the conclusion that
facilities must engage in a careful case-
by-case analysis of the situation when
confronted with the question of wheth-
er a non-decisional resident should be
permitted to engage in sexual activity
within the facility.
HEALTH CARE AGENT’S DECISION
MAKING
Under Wisconsin law, an agent ap-
pointed in an activated power of attor-
ney for health care document is autho-
rized to make health care decisions on
behalf of the incapacitated principal.
“Health care” means “any care, treat-
ment, service or procedure to main-
tain, diagnose or treat an individual’s
physical or mental condition.” Whether
decisions about a resident’s sexuality
constitute “health care decisions” un-
der the statute, and thus can be made
by the agent, is open to debate.
As a practical matter, facilities often
look to agents to make decisions that
are not squarely “health care decisions”
within the statutory defi nition, but that
impact the psychosocial well-being of
the resident. Examples include deci-
sions about a resident’s involvement in
social activities or religious worship. If a
facility views decisions about sexual-
ity as relating to the psychosocial well-
being of the resident and, therefore, a
decision that the agent is authorized
to make, the question becomes: How
does the agent go about making that
decision? By law, the agent is required
to make decisions consistent with the
principal’s desires if known to the
agent (i.e., substituted judgment) or, if
unknown, in the best interests of the
principal. To know whether sexual con-
duct is consistent with the principal’s
desires and/or in his/her best interests
requires consideration of the person’s
lifestyle and values, and the impact of
such conduct on his/her current well-
being. To know whether
GUARDIAN’S DECISION MAKING
sexual conduct is
The recently rewritten guardianship
statute does not specifically empower
consistent with the
a guardian to make decisions related
to a ward’s sexuality. However, the
principal’s desires
guardianship statute does provide that and/or in his/her best
the ward retains all rights except those
that are not assigned to the guardian interests requires
or otherwise limited by the court, and
that a guardian must advocate for the consideration of the
ward’s best interests. In addition, the
statute provides that the guardian, in
person’s lifestyle
exercising his/her powers and duties,
must “make diligent efforts to identify
and values, and
and honor the individual’s preferences
with respect to…choices related to
the impact of such
sexual expression.” In making a deci- conduct on his/her
sion to act contrary to the individual’s
expressed wishes, the guardian is di- current well-being.
SPRING 2009 CO NTINU U M 7
 rected to take into account, among oth-
er factors, the individual’s understand-
ing of the nature and consequences of
the decision.
PRACTICAL APPROACHES
While the law currently lacks clear
guidance on the subject, it suggests the
need to carefully evaluate the following
cornerstone question in determining
whether a non-decisional resident may
engage in sexual intimacy: Does the
non-decisional resident who is engaging
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8 CONTI NUUM www.whca.com
412906_Mortenson.indd 1 • www.wical.org
in, or desiring to engage in, a sexual rela-
tionship have the necessary mental and
emotional capacity to understand and
benefit psychosocially from the relation-
ship, and is this relationship consistent
with the resident’s values? Consultation
with the resident’s physician, a psychol-
ogist or psychiatrist, and/or the facility’s
ethics committee may be indicated in in-
stances where the answer to this question
is not readily determinable, or if there is
disagreement among caregivers and/or
family members.
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It may be
advisable for
facilities to
develop guidelines
or policies
regarding sexual
expression
between residents.
If the answer to the cornerstone
question is yes, and nothing in the legal
documents confl icts with this conclu-
sion, the facility should seek the agree-
ment of the resident’s agent or guardian
and family members, provided that the
answer to the cornerstone question is
also “yes” for the other party involved.
All consultation, evaluation and con-
sent information should be well docu-
mented in the chart.
If the answer to the cornerstone
question is no, then it is reasonable to
conclude that the relationship is not in
the resident’s best interests and, there-
fore, may not be condoned. In these
circumstances, residents must be
protected from harm or coercion that
could result from sexual expression by
others or themselves.
It may be advisable for facilities
to develop guidelines or policies re-
garding sexual expression between
residents to assure that these sensitive
matters are addressed carefully and
proactively in a manner that protects
residents’ rights and well-being.
Robyn Shapiro,
Managing Partner,
Drinker Biddle & Reath
LLP in Milwaukee,
Wis., can be contacted
at 414-221-6056 or
Robyn.Shapiro@dbr.
com. Colleen O’Connor
Patzer, a partner at
Drinker Biddle & Reath
LLP in Milwaukee, Wis.,
can be contacted at
414-221-6058 or colleen.
patzer@dbr.com.
9:07:36 AM
 HR4LTC
Workplace Romance
Should It Get the Kiss-Off?
By Mindy Rowland
POP QUIZ: You just found out two co-
workers are dating each other. What do
you do?
a. Confront the couple and demand that
they stop dating or be terminated;
b. Contact your employment attorney
and ask her to draft a love contract
for the couple to sign immediately;
c. Review your handbook to ensure
your sexual harassment policy is up
to date; or
d. Think to yourself, “Great! Another
couple to have dinner with!”
Most employers assume the answer
is “a.” However, such a knee-jerk reac-
tion is probably not the right way to ad-
dress workplace dating.
Workplace romance is a concern
of nearly all employers. Many fear the
epitomic example of a supervisor/sub-
ordinate relationship gone sour, where
the subordinate files a sexual harass-
ment claim after the relationship ends
and the supervisor begins treating the
subordinate differently from other co-
workers. Out of concern, some employ-
ers have outright banned dating be-
tween employees, others have instituted
workplace dating policies, and still oth-
er employers require dating employees
to sign “love contracts,” a contractual
agreement between the couple and the
employer where the couple attests that
the relationship is consensual.
Interestingly, a study conducted by
the Society for Human Resource Man-
agement indicates that less than 4 per-
cent of individuals involved in a failed
office romance file a formal complaint.
Likewise, recent studies demonstrate
that workplace romances are proliferat-
ing. What is an employer to do?
1. BAN WORKPLACE ROMANCES
ALTOGETHER?
Probably not. Not only is such a
prohibition difficult to enforce uni-
formly, but employees may see such
a ban as an affront to their privacy
and out of touch with the realities of
the workplace. In addition, if you al-
ready have employees dating, it will
be difficult to retroactively require
those couples to end their relation-
ship. Moreover, your employees will
likely ignore any such prohibition,
setting you up to make a difficult de-
cision as to whether to enforce the
policy by terminating an otherwise
quality employee. Some employers
In addition, such a policy is still in-
herently difficult to craft. How do you require dating
describe the behavior you are seeking
to forbid? Do you intend to prohibit
employees
dating, socializing, a romantic in-
volvement or something else? An em-
to sign “love
ployment attorney can certainly draft
an “anti-fraternization” policy for you,
contracts,”
but often, the employer realizes the a contractual
futility in doing so and opts not to out-
right ban employee relationships. agreement
2. ENACT A NOTIFICATION POLICY? where the
Probably. A notification policy re-
quires employees to notify a company
couple attests
representative, often the EEO officer,
when a workplace relationship com-
that the
mences and when it ends. A notifi -
cation policy allows the company a
relationship is
certain level of protection from later consensual.
SPRING 2009 CO NTINU U M 9
 claims of sexual harassment, and also
provides the company information to
respond to any complaints by co-work-

Love contracts, or consensual ers of discrimination or favoritism.

Practically speaking, it also allows the
relationship agreements, are gaining company to “keep an eye on” the status
of the relationship.
popularity among employers. While employees may consider this
policy intrusive as well, it is less so than
a complete ban on workplace dating.
Employees can be informed that the
existence of the relationship will not be
disclosed to anyone unless necessary.

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Possibly. Love contracts, or
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the company’s sexual harassment
policy and provides information on
how to report any complaints. It
also outlines expected behavior of
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the couple, such as refraining from
public displays of affection and no-
tifying the employees that neither
may retaliate against the other if the
relationship ends.
An employer requiring that dating
employees sign a love contract can
expect resistance. The couple may
view the contract as intrusive. There-
fore, a company considering institut-
ing a policy requiring love contracts
may want to determine whether it is,
in fact, necessary.
The company’s sexual harassment
and anti-retaliation policies can and
should cover the information pro-
vided to the employees in the love
contract, including how to report a
complaint. Likewise, the employee
handbook can prohibit unprofession-
al behavior, such as public displays of
affection in the workplace. The love
contract, then, really is simply requir-
ing that the employees attest to the
voluntary nature of the relationship
and requiring that the employees no-
tify the company if the relationship
ends. As to the former, the couple is
very unlikely to dispute the fact that
the relationship is consensual during
the pendency of the relationship it-
self. As to the latter, the company can
institute a notification policy without
having to require dating couples to
sign a contract.
1 SPRING 2009
4. DO NOTHING?
Probably not. At a minimum, a
company should review its sexual ha-
rassment and anti-retaliation policies
to make sure they cover the conse-
quences of consensual relationships,
and whether your handbook prohibits
inappropriate conduct, such as public
displays of affection in the workplace.
To be sure, a solid sexual harass-
ment policy, coupled with sound anti-
retaliation and reporting policies,
are the foundation for an employer
to defend itself against a claim based
on love turned sour in the workplace.
Better practice includes a notifica-
tion policy, if the company opts not to
require its dating employees to sign
love contracts.
So, what is the answer to the pop
quiz? The answer is “c.” With up-to-
date policies addressing sexual ha-
rassment, retaliation and a compre-
hensive notification policy, a company
can feel comforted that it will be ready
when and if its employees begin an
interoffice relationship.
Mindy Rowland is
partner at DeWitt
Ross & Stevens
S.C. She can be
contacted at 608-
252-9320 or mjr@
dewittross.com.
CO NTINU UM
1/13/09 11 AM
7:57:19
Let’s
Talk
About
Sex
Coming to terms
with the sexuality
of assisted living
residents.
By Brian Purtell
Photos by Adam Senatori

12 CONTI NUUM | www.whca.com • www.wical.org

 A nurse aide enters a room which she expects to be
unoccupied. To her surprise, she happens upon Robert
and Mary, two unmarried, fully decisional residents
engaged in an intimate act. She expresses surprise and
mild disgust towards the couple for their behavior. The
aide quickly leaves; the couple is mortified and embar-
rassed. Word quickly spreads among staff and residents,
leading to snickers and whispers. The residents become
withdrawn from each other and staff.
Jane and Gwen, residents of an assisted living mem-
ory care facility, develop an extremely close friendship
after several months at the facility. They are often seen
holding hands and holding each other close. Some staff
think it’s “cute,” while others, including the family of
one resident, do not approve of this new relationship.
At the insistence of the family member, the women are
redirected from further physical contact. Jane becomes
withdrawn while Gwen returns to her previous level of
heightened agitation.
Jim is a frequent user of the common area computer
made available to residents for internet access. A staff
member notices Jim viewing adult content sites. He is
confronted by a caregiver who tells him he shouldn’t be
doing this and mutters, “You dirty old man”. Jim is re-
stricted from computer use and so embarrassed that he
has made indications that he wants to leave the facility.

What if the facilities in the above sce-
narios had established policies to deal
with these sorts of situations? What if
staff members better understood that
older adults still need some form of
intimacy? How different could these
situations be if the facility had created
an environment where their residents’
sexuality was respected and treated
for what it is: an important element of
human nature?
It may be hard to imagine, but for
many elderly, sexuality and intimacy are
still vital parts of their lives.
Some of the more difficult and sensi-
tive situations in long term care settings
involve residents and sexuality. Given
the delicate, and for some, uncomfort-
able nature of the topic, facilities and
staff are often challenged by residents’
sexual needs. But it doesn’t have to be
that way.
Some would argue that intimacy
in the long term care setting should be
addressed right along with other needs
such as nutrition and hydration. It
should be understood that sexuality is
not limited to sexual contact, but rather
the entire range of intimacy; from emo-
tional connections and companionship
to non-sexual touching or closeness. It
is important to recognize and acknowl-
edge that adults, including the elderly,
maintain a level of sexual interest and
desire far into their golden years. While
this may not be high on the list of needs
for all long term care residents, some-
thing does not have to impact a major-
ity of residents before it deserves atten-
tion from providers. To be clear, while
we may speak of “addressing” resident
needs, this is not to be construed in any
way as providers having any obligation
to “fulfill” client needs. Though a resident
may express a need for sexual contact,
it is not the provider’s obligation to play
match-maker or affirmatively seek out
a partner.
What was once a “forbidden” subject
is becoming a topic that requires an in-
formed dialogue. As resident expecta-
tions and attitudes change, the time is
ripe – and it’s becoming increasingly im-
portant – to address the complex issues
of resident sexuality.
A FRANK DISCUSSION.
The long term care community is
overdue for a sit-down about sex. Sexu-
ality is a basic human characteristic and
while a decline in physical abilities may
impact performance, the need for inti-
macy does not go away simply because
of age. Opening a dialogue can bring
about greater understanding, create an
environment where desires and interests
are discussed openly and provide ideas
about addressing sexual situations in a
respectful manner.
While there has been significant at-
tention given to inappropriate resident
behavior, there has been less focus on
“... having an established policy on
resident sexuality and intimacy in place
can be a more comfortable method to
broach an often cringe-inducing subject.”
the positive aspects of companionship,
intimacy, self-gratification, and yes, sex-
ual contact between residents.
The emphasis on response to inappro-
priate sexual behavior may have exacer-
bated the taboo. When focus is placed on
stopping certain behaviors, healthy as-
pects of sexuality and intimacy become
lumped together with forbidden expres-
sions. Here we do a disservice to both
our residents and staff: the residents who
may benefit from intimacy, and staff who
are ill-prepared to address situations
that should otherwise be permitted.
This is not to minimize the obliga-
tions providers have to protect elders
within their facilities. Continued vigi-
lance must be paid to the role of protec-
tion. However, through the development
of anticipatory policies, staff education
and working with family members and
surrogates, we can ensure that elderly
residents have the very best quality of
life that we can give them.
THE MAIN MYTH:
SEXUALITY DISAPPEARS WITH AGE
Based on multiple factors, the sig-
nificance of sex will vary throughout
one’s lifetime. But sexuality does not
always go the way of taught skin and
supple joints.
SPRING 2009 CO NTINU U M 13
“What if staff
members
better
understood
that older
adults still
need some
form of
intimacy?”
We are only recently seeing reports
demonstrating the levels of sexual inter-
est and activity in the elderly population.
Some studies indicate that while fewer
long term care residents remain sexually
active (8 percent of nursing home resi-
dents reported sexual activity in the past
month), 17 percent expressed a desire
for sexual activity and as many as 70 to
90 percent of nursing home residents in-
dicated that they have sexual thoughts.
While less data is available for the assist-
ed living population, it can be assumed
that figures would fall between the data
of the community-dwelling and nursing
home populations.
This ever-changing demographic will
bring evolving beliefs. With recent phar-
macological developments and changing
attitudes towards their use, long term care
providers face a new set of circumstances
to which they must adapt. Sexuality and
intimacy is an important part of the lives
of many residents – with demonstrated
physical and psychological benefits – and
just as providers seek to meet clinical, so-
cial and psychological needs, they should
not allow embarrassment, ignorance or
their own beliefs to interfere with the of-
ten unmet needs of residents.
ESTABLISHMENT OF POLICY GUIDANCE
While most providers have policies in
place to address inappropriate sexual be-
havior, few provide proactive guidance in
14 CONTI NUUM www.whca.com • www.wical.org
promoting respect for the sexual needs
of residents.
The development of policy guidance
must be at the basis of a proactive frame-
work. Policies should initiate the gath-
ering of evidence-based information,
regulatory requirements and practical
implementation input from appropriate
staff leaders. Suggested elements for
such policies include: (1) staff education
on the unique expressions of sexuality in
the elderly, (2) affirming support for ad-
dressing resident intimacy needs, includ-
ing the establishment of communication
channels (3) the provision of appropriate
risk-related information to residents and
their surrogates, (4) and reasonable lim-
its and conditions on activity that may be
supported by the facility.
Policies should make it clear that,
while sexuality should be addressed in
an open manner, residents should in no
way be pushed toward sexual activity.
Having guidance in place establishes
that residents’ sexuality as an important
need. It provides an anticipatory frame-
work for staff to follow and improves the
staff’s understanding. Guidance will also
provide information that can be shared
with surveyors to demonstrate the facili-
ty’s efforts to meet resident needs within
regulatory dictates.
EDUCATING STAFF ON SEXUALITY AND
THE ELDERLY
The issue of intimacy and the elderly
is rarely included in staff training. So
it’s no surprise that studies have shown
that staff members often have only a
minimal understanding of elder sexual-
ity. This lack of understanding can lead
to negative or inconsistent attitudes by
staff. As a result, residents’ needs are
often neglected or even condemned.
Research also shows that staff edu-
cation and training on resident sexual-
ity can go a long way in demonstrating
the benefits to both staff and residents.
Training programs should include:
(1) the meaning and functions of sex-
uality for older adults, (2) identifica-
tion of barriers for residents’ meeting
sexual needs; (3) strategies to help
residents appropriately express their
sexual needs; and (4) inappropriate
sexual expressions and strategies
for response.
Incorporating education in these
areas has been shown to dispel miscon-
ceptions while reducing biases and anx-
ieties often based on a hazy understand-
ing. By providing staff with educational
opportunities, providers create an envi-
ronment where appropriate sexual ex-
pressions are recognized and respected
and staff members can comfortably
engage residents in non-judgmental dis-
cussions concerning these issues.
FAMILY AND SURROGATE
INVOLVEMENT IN RESIDENT SEXUALITY
Thinking about your elderly par-
ents having sexual needs is not easy or
comfortable. But it’s not an issue that
a resident’s family can – or should
– sweep under the rug. Rather, hav-
ing an established policy on resident
sexuality and intimacy in place can be
a more comfortable method to broach
an often cringe-inducing subject. Here
again, an educated staff may be in a
far better position to explain to family
members the diverse ways that elders
express sexuality.
When dealing with fully decisional
residents, issues primarily involve pri-
vacy, barriers, and certain risks, such
as resident health and sexually-trans-
mitted diseases. The issue gets more
coplex when dealing with individuals
of reduced decisional capacities. While
the legal analysis of when an individual
loses decisional capacity for sexual con-
sent is outside the scope of this article,
the development of a policy should in-
corporate this issue and the expectation
that the legal decision-maker (guardian
or health care agent) be involved early
by identifying sexuality issues as well
as responding to intimacy concerns of
the ward/principal.
Clearly, sexual contact involving
an individual with diminished deci-
sion-making capacity must be treated
with the utmost of attention to as-
sure that a vulnerable resident is not
exposed to contact without consent.
Equally important is that incapacity/

incompetence is not an all or nothing
proposition. While an individual may
have lost capacity to make some deci-
sions, this does not forever preclude
their ability to make all decisions, in-
cluding decisions concerning intimacy.
SCENARIOS REVISITED
Let’s return to the opening examples
and see how these situations may have
differed in a setting where the facility has
a clearly articulated policy that antici-
pates intimacy issues, where the staff is
trained in understanding elder sexuality
and where residents are encouraged to ex-
press their needs and preferences relative
to sexuality.
Robert and Mary (whose tryst was
interrupted) may feel comfortable dis-
cussing with staff their desires for
some privacy together if such issues are
brought up early in their admission and
assessment process. Asked in a profes-
sional manner about the importance of
their respective sexuality by an educat-
ed and responsive staff, Bob and Mary
could have addressed their interest in
some alone time. Staff members could
discuss options and barriers, make sure
that both parties understand risks and
a convenient and private space could be
arranged for them. The staff may further
appreciate the importance of respect-
ing these adults’ privacy and refrain
from gossiping.
For Jane and Gwen, proactive edu-
cation would provide staff with an un-
derstanding that it is not uncommon for
“While most providers
have policies in place to
address inappropriate
sexual behavior, very few
provide proactive guidance
in promoting respect for the
sexual needs of residents”
same-sex relationships to develop late
in life. Jane and Gwen’s contact may be
a response to loneliness or the grieving
process, regardless of their sexual ori-
entation. Staff may have been better able
to explain to family members this new-
found relationship and its possible mean-
ings. Staff members may also understand
that they are not to project their personal
beliefs and opinions towards a situation
that clearly provides comfort and benefit
to Jane and Gwen.
Jim may have been able to articu-
late his frustration towards his lack of a
sexual partner. It could have been better
understood that his viewing of pornog-
raphy provides a private outlet. A policy
of acceptance and exploration of this
subject might have identified a more pri-
vate opportunity for such an outlet and
could have trained staff to reserve their
judgment towards individual needs. With
a policy that serves as the basis for an
initial discussion tool, staff could more
comfortably discuss this situation with
Jim’s son, who assists the facility by pro-
viding adult magazines containing pic-
tures and articles of interest to Jim.
These scenarios only scratch the sur-
face of current and future situations that
providers face in responding to sexuality
in the long term care population. Devel-
opment of policies that anticipate these
types of situations, along with staff edu-
cation, will allow providers to better ad-
dress common issues and prepare for the
unique and diverse manners in which in-
dividuals express their sexuality.
SOURCES AND RESOURCES
In developing policies and educational train-
ing, providers are not without authoritative re-
sources to assist them. Examples include, but
are not limited to, the following sources that
were utilized in this article:
Arena, J. M., & Wallace, M. (n.d.). Geriatric
Nursing Resources for Care of Older Adult:
Sexuality Issues in Aging. Retrieved Janu-
ary 3, 2009, from http://www.consultgerirn.
org /topics/sexuality_issues_in_aging /
want_to_know_more
Considerations Regarding the Needs of
Long-Term Care Residents for Intimate
Relationships and Sexual Activity. (n.d.).
Retrieved January 3, 2009, from www.prac-
ticalbioethics.org/FileUploads/Intimacy
percent20Guidelines percent20Updated.
Aug percent2007
Everett, B. (2008). Supporting Sexual Activity
in Long-Term Care. Nursing Ethics, 15(87).
Hajjar, R. R., & Kamel, H. K. (2004). Sexuality
in the nursing home, part 1: Attitudes and
barriers to sexual expression. Journal of
the American Medical Directors Associa-
tion, 5(2 Supplemental), S42-S47.
Lindau, S., Schumm, P., Laumann, E., Levinson,
W., O’Muircheartaigh, C., & Waite, L. (2007).
A Study of Sexuality and Health among Old-
er Adults in the United States. N Engl J Med,
357(8), 762-774.
(2003). Sex and Sexuality in Long Term Care:
A training program for staff. Washington
DC: American Health Care Association.
(2008). Sexuality in Nursing Homes, Educa-
tional module to Promote Excellent Alter-
natives in Kansas Nursing Homes (PEAK).
Kansas State University Center on Aging.
.
Brian Purtell, WiCAL
Executive Director
and WHCA Director of
Legal Services, is also a
partner at DeWitt Ross
& Stevens S.C.
He can be reached at
bpurtell@wical.org, brian@whca.com, or
brp@dewittross.com
SPRING 2009 CO NTINU U M 15
 media matters
Making News is Good News
By Erin Celello
NO NEWS IS good news. We’ve all
heard that saying, but public relations
professionals everywhere resounding-
ly disagree.
In public relations, no news means
that the public isn’t hearing anything
about you, and you’re not doing much
– if anything – to build up name recog-
nition with consumers or elected offi-
cials. That’s where “earning media,” or
publicizing good news, comes in.
But what is news?
According to former executive edi-
tor of The New York Times, Turner
Catledge, “News is anything you didn’t
know yesterday.” More particularly,
news is anything of interest – an event,
new idea, or new information – to
your community.
Easy enough, right? Now for the
Take a long- hard part: How do you even begin to go
about letting people know what your
term approach news is? Luckily, the hard part isn’t
so hard.
to generating Below are some easy-to-follow steps
to garner increased news coverage for
coverage; the good things you’re already doing at
your facilities.
best PR plan
is a series KEEP A MASTER CALENDAR.
There are good things – good news-
of small worthy things – already going on at
your facilities. You just need to spend
steps with a very little bit of time thinking ahead
to what is going to happen when. Hold
occasional quarterly or monthly brainstorming
sessions with your activities, market-
bursts of ing, and administrative staff to get
events on the calendar and ready to
exciting news. be publicized.
16 CONTI NUUM www.whca.com • www.wical.org
CONVEY WHY YOU’VE “GOT IT GOING
ON.”
You need a hook, or a reason, for
media coverage. Are you celebrating
an anniversary? Are you expanding or
remodeling and offering new, improved
services as a result? Are you imple-
menting a culture change? Recognizing
residents or staff for accomplishments?
Are you celebrating or recognizing a
holiday or special day in a unique way?
If so, make sure to give your local me-
dia – either via e-mail or a quick phone
call – the 5-Ws: who, what, when, where,
and why. Especially in smaller media
markets where reporters and editors
are often desperate for news, few an-
nouncements or events are too small
to publicize.
START CULTIVATING RELATIONSHIPS
WITH LOCAL REPORTERS NOW.
Take a long-term approach to generat-
ing coverage; the best PR plan is a series
of small steps with occasional bursts of
exciting news. Plan ahead, keep your fa-
cility information and announcements
in front of reporters, and the stories will
happen over time.
Likewise, acknowledge that not ev-
ery event or announcement you call a
reporter about is equally newsworthy.
Saying something to the effect, “I know
this isn’t front page-worthy, but if it’s a
slow news day, you might want to cover
this because…” will go a long way to-
ward building your credibility with a
reporter. When you do have front-page
news, they’ll be that much more incline
to believe you.
 Finally, follow the work of your
local reporters. If they do a particu-
larly interesting piece especially well
– even if it’s not related to long term
care – drop them a note to tell them
so. Reporters get plenty of mail tell-
ing them about all the things they
didn’t get right, but it’s those rare
notes that say, “Thank you for doing
this story; it was a great service to
our community,” that really stick with
them. The next time you call, they’ll
remember you.
way to do that is to ensure they know
what great things are happening inside
your facilities. Erin Celello is the
In addition, look for the WHCA Media WHCA Director of
Communications. She
Toolkit in the “Media Room” section of
can be reached at erin@
our Web sites: www.whca.com or www. whca.com
wical.org for tips on drafting media ad-
visories, news releases, and more.

ANTICIPATE WHAT THE REPORTER WILL

NEED TO KNOW AND HAVE THAT INFOR-
MATION READY.
Reporters are overworked, under-
paid, and have short deadlines. The
more work you can do for them, the
more likely they are to cover your
news. Do you have pictures (with cap-
tions) that you can supply? Say so! Do
you have a FAQ sheet that you can
hand out? Type one up! Will it be valu-
able for the reporter to know certain
numbers? Have all of those figures
available in advance! The reporter
will thank you by covering your story
or covering your story better.

BE AVAILABLE.
Once you’ve pitched a reporter on
an event, make available a contact per-
son to fi ll in any information before,
during, and after. There is nothing that
frustrates a reporter more – and noth-
ing that will ensure the story ends up
in the trash folder faster – than not be-
ing able to get information to complete
a piece. Let the reporter know when
and where they can reach the contact
person to answer any and all questions.
And always ask a reporter’s deadline so
you can work within that timeframe.
With these few simple steps, your
facility could be well on its way to mak-
ing a name for itself in your local com-
munity. With tight state and municipal
budgets, you need all of the support you
can get from your elected officials and
local community. And the most sure-fi re

SPRING 2009 CO NTINU U M 17

 capitol beat

Can One Voice Make a Difference

in the Legislative Arena?
By Jim McGinn

LEGISLATIVE LEADERS OFTEN re-
mind audiences that, from a legislative
standpoint, if representatives receive
as few as four letters from constituents
on a particular issue, they will recog-
nize this to be an issue of significance.
With the state legislature in the midst
of negotiating a biennial budget and at-
tempting to address the $5 billion-plus
budget deficit, it is all the more impor-
tant that providers take steps to com-
municate to their legislators to make
sure that they are aware of the issues
and impacts on the profession.
They need to be made aware of the
affect that legislative decisions will
have on your ability to provide the
highest level of care and services to
the residents you are proud to serve.
Moreover, it is imperative that the

Joint Finance Committee Members 2009-10

SENATE ASSEMBLY
Mark Miller, Co-Chair (D-Monona) Mark Pocan, Co-Chair (D-Madison)
It is imperative Dave Hansen (D-Green Bay) Pedro Colon (D-Milwaukee)
Lena Taylor (D-Milwaukee) Cory Mason (D-Racine)
that the provider Judy Robson (D-Beloit) Jennifer Schilling (D-LaCrosse)

community John Lehman (D-Racine)

Julie Lassa (D-Stevens Point)
Gary Sherman (D-Port Wing)
Tamara Grigsby (D-Milwaukee)
develop on-going Alberta Darling (R-River Hills)
Luther Olsen (R-Ripon)
Robin Vos (R-Racine)
Phil Montgomery (R-Ashwaubenon)
relationships and Some of the 2009-10 COMMITTEE CHAIRS who are responsible for issues impacting
the long term care profession include:
dialogue with its Aging and Long Term Care: Representative Peggy Krusick (D-Milwaukee)
Health and Health Care Reform: Representative Jon Richards (D-Milwaukee)
legislative leaders. Insurance: Representative Dave Cullen (D-Milwaukee)
Jobs and the Economy: Representative Louis Molepske (D-Stevens Point)
Labor: Representative Christine Sinicki (D-Milwaukee)

18 CONTI NUUM www.whca.com • www.wical.org

provider community develop on-going
relationships and dialogue with its leg-
islative leaders to make them aware of
the issues that face the provider com-
munity. In doing so, you may become
a resource for these individuals who
are expected to be versed in such a
wide variety of issues ranging from the
mundane to the incredibly complex.
There are certain general rules that
make for the most effective communi-
cations with legislative leaders:
Direct communication with your
elected representative is the most ef-
fective method to get your message
across. Invite your representatives to
visit your facility, staff, and residents.
This allows you to be able to discuss
many issues and demonstrate the im-
pact and worthiness of consideration
of your issues.
Written communication in the form
of a letter directly from a constituent
to the legislative offices does make an
impact. Avoid lengthy treatises in fa-
vor of succinct individualized letters
stating the issues and your position,
with an offer to meet with the official
or staff should they need additional
information. Letters should be mailed,
faxed or attached as e-mails to the leg-
islative offices.
Avoid simply putting your name on
a petition or fi ll-in-the-blank postcard
communication that evidences little or
no effort on your behalf. Such commu-
nications have far less impact and per-
suasiveness and can be seen as not be-
ing important if you did not even take
the time to write an individual letter.
While it is important that you be-
come known and visible to your indi-
vidual elected officials, attention also
should be paid to those legislative lead-
ers who have increased ability to impact
your issues. Typically, legislators in the
majority party have far greater ability
to impact the issues that you seek to
advance. Committee chairmen have the
greatest impact on your issues.
Do not be offended or think that
your issues are being minimized if you
are unable to meet with your legislator
directly. Given time schedules and the
magnitude of issues facing these indi-
viduals, it is not uncommon that you
PROFILES
would be asked to speak with their
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SPRING 2009 CO NTINU U M 19
 stakeholder spotlight
A focus on individuals who are influential in the Wisconsin long term care community

This edition: Otis Woods, Administrator, Division of Quality Assurance (DQA)

Regulating to Improve Quality

OTIS WOODS HAS served as the director of the Division of
Quality Assurance (DQA) for about three and a half years.
Given the DQA’s oversight responsibilities for Continuum
readers, we recently sat down with Woods for some
insight into the role of his Division and his thoughts on
regulatory matters.
CAN YOU DESCRIBE YOUR REGULA- that quality is good and that people
TORY PHILOSOPHY AND GOALS FOR THE are safe.
DQA?
First and foremost, it is necessary HOW WILL THE ROLE OF DQA CHANGE
We have an that we ensure a consistent application IN A FAMILY CARE ENVIRONMENT?
of state and federal rules no matter the DO YOU SHARE PROVIDER CONCERNS
obligation and provider type, as a lack of consistency THAT THEY WILL HAVE ANOTHER SET

a responsibility leads to an ineffective system. I am

proud of the work DQA has done in the
to ensure we quality improvement arena. That is my
overall goal…to improve quality but
are acting to do so with effective enforcement of
state and federal regulations. We have
responsibly an obligation and a responsibility to
ensure we are acting responsibly in
in ensuring ensuring safe practice in our health
care facilities and to see that consum-
safe practice ers of health care services are safe.
OF RULES AND OVERSIGHT BODY TO
SATISFY?
The DQA’s role in implementing
Family Care is minimal, with the ex-
ception of the continued expansion of
the assisted living provider commu-
nity and the oversight that will be re-
quired. Our most significant role, how-
ever, will be sharing the results of our
reviews with the Managed Care Orga-
nizations (MCO) as they are an exten-

in our health I expect to be held accountable for

DQA responsibilities.
care facilities My regulatory philosophy may be
summed up through effective, effi -
and to see that cient enforcement of the regulations
and continued involvement in public-
consumers private and public-public quality im-
provement partnerships/collabora-
of health care tions. Please note, however, that we
cannot be a partner with the regulat-
services ed community. We have a distinct role
sion of the Medicaid payment arm.
Regarding my concerns for another
set of rules, the only comment I have is
comparing the MCO standards to that
of being accredited. We have, in other
regulated entity settings, accredita-
tion standards that licensed and cer-
tified providers meet, although these
are voluntary. The focus of the MCO
is very different from our focus, and
we try to explain that as much as pos-

are safe. as regulators, and this must never be

confused. We will collaborate on qual-
ity improvement initiatives because it
should be everyone’s goal to ensure
sible. Since this will be new to many
providers, and to ourselves, we will
continue to look at any similarities
there may be.

20 CONTI NUUM www.whca.com • www.wical.org

It should be
everyone’s goal to LEADERSHIP
T ur n To Your Long-Ter m Car e Leaders
ensure that quality is For Your Anti-Harassment T raining
good and that people
are safe.

Brian R. Purtell Mindy J. Rowland

Health Law, Labor, Employment
Compliance and Appeals and Litigation
brp@dewittross.com mjr@dewittross.com

WHAT IS YOUR FAVORITE PART OF YOUR JOB?

Knowing that what we do as an agency makes
a difference in the lives of vulnerable people;
seeing the successes achieved through the many
quality improvement efforts (collaborations and
partnerships), and talking with DQA staff at all
levels about their jobs. It’s important to know
what’s going on and to whenever possible, par-
ticipate in positive change.
LEAST FAVORITE?
hen Wisconsin’s long term care providers face
unique legal and compliance issues, you can count on the
attorneys at DeWitt Ross & Stevens. Our knowledgeable
and resourceful attorneys can help you navigate through
complex issues, including personnel training, regulatory
compliance and enforcement, handbook audits, policy
reviews and other compliance concerns.
Capitol Square Office
Two East Mifflin Street, Suite 600, Madison, Wisconsin
608-255-8891
Metro Milwaukee Office
13935 Bishop’s Drive, Suite 300, Brookfield, Wisconsin
www.dewittross.com 262-754-2840

Having to read about and followed up, from

a regulatory perspective, on the unfortunate
and preventable events that cause pain, harm
or, even worse, death, to a vulnerable person
that has occurred in one of our heath care
settings. The state should always be looking
for ways to improve and learn from prevent-
able adverse medical events that happen to
vulnerable individuals.

ANY PEARLS OF WISDOM OR SUGGESTIONS

YOU WOULD WANT TO IMPART TO THE NURSING
HOME AND ASSISTED LIVING PROVIDER
COMMUNITY?
Focus on systems improvement as a means
of being innovative and improving the quality of
care provided in each setting. Continue to share
information across settings, especially because
the vulnerable person that was previously
served in the nursing home setting is now an as-
sisted living resident. The key is ensuring that
there are professional nursing, social services
and other therapies available to the assisted liv-
ing consumer. However, this by no means dimin-
ishes the significant importance of the nursing
home; quite the opposite. Nursing homes remain
an important component in the long term care
continuum and will always be needed. The types
of customers they will serve will differ greatly
than in previous years.

SPRING 2009 CO NTINU U M 21

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enhance overall patient and resident
satisfaction.
Call us at 1-800-421-4478 and find out
how we may help you polish your image.
FLEXIBLE SOLUTIONS FOR HEALTHCARE’S CHALLENGES.
THE COUNTRY’S LARGEST PROVIDER OF HOUSEKEEPING AND
LAUNDRY SERVICES TO THE LONG-TERM CARE INDUSTRY
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22 CONTI NUUM www.whca.com • www.wical.org
Hillyard Peoplefirst Rehabilitation
n/a ...............................................................................10 www.peoplefirstrehab.com ........Inside Front Cover
HPSI Purchasing Services The Samuels Group
www.hpsionline.com ................................................11
www.samuelsgroup.net.............Outside Back Cover
JT and Associates, LLC
n/a .................................................................................6 Security Insurance Services Inc
LifeTec Inc. www.securityins.net .................................................11
www.lifetecinc.com ......................Inside Back Cover Senior Care Realty, LLC
Mortenson, Matzelle & Meldrum, Inc www.seniorcarerealty.com ........................................6
www.m3ins.com..........................................................8
Spring Valley Health Care Center
MPRO
n/a ...............................................................................10
www.mpro.org ............................................................6
Park View Home, Inc. UHF Purchasing Services
www.parkview-cc.com.............................................10 www.uhfpurchasing.com .........................................10
index to advertisers
CONSTRUCTION MANAGEMENT
The Samuels Group .............................................. Outside Back Cover
ENVIRONMENTAL SERVICES
Healthcare Services Group ................................................................ 22
FINANCIAL SERVICES
JT and Associates, LLC ........................................................................ 6
GENERAL CONTRACTOR/DESIGN BUILD
The Samuels Group .............................................. Outside Back Cover
GROUP PURCHASING ORGANIZATION
UHF Purchasing Services .................................................................. 10
HEALTH CARE FACILITIES
Spring Valley Health Care Center ..................................................... 10
HOUSEKEEPING & LAUNDRY SERVICES
Hillyard ................................................................................................ 10
INDEPENDENT INFORMAL DISPUTE RESOLUTION SERVICES
MPRO..................................................................................................... 6
INSURANCE
Mortenson, Matzelle & Meldrum, Inc ................................................. 8
Security Insurance Services Inc ........................................................ 11
LONG-TERM HEALTHCARE FACILITIES
Geneva Lake Manor............................................................................ 11
Park View Home, Inc.......................................................................... 10
MARKETING MATERIALS/NAME BADGES
Cream City Marketing ........................................................................ 10
MOBILE X-RAYS
2/10/09 10:33:23 AM
Accurate Mobile Imaging ................................................................... 19
Alliance Pharmacy Services, LLC ..................................................... 19
PURCHASING SERVICES
HPSI Purchasing Services ................................................................. 11
REHABILITATION SERVICES
Golden Living Center Riverdale ........................................................ 10
Peoplefirst Rehabilitation ...................................... Inside Front Cover
REHABILITATION/THERAPY EQUIPMENT
LifeTec Inc................................................................ Inside Back Cover
SENIOR CARE REAL ESTATE
Senior Care Realty, LLC ....................................................................... 6
 “The Clinical Advantage”™

Help Older Adults Thrive

Ask about combination leasing

Reduce falls,improve mobility

with strength, endurance and balance exercise.

BioStep® Semi-Recumbent Improved mobility and

Balance System SD™ Elliptical Cross-Trainer overall well being

Mobility-Specific Exercise
with products designed specifically for older adults
www.biodex.com/mobility

Manufactured by: Distributed by:

LIFETEC
BIODEX
INC

SPECIALIZING IN PRODUCTS FOR

ORTHOPEDICS, REHABILITATION, AND FITNESS

www.biodex.com www.lifetecinc.com
1-800-224-6339 1-888-459-2711, ext 319
Int’l 631-924-9000 llemberger@lifetecinc.com

FN: 09-031 1/09

 From conception...
to construction...
to completion...
The Samuels Group Corporate Headquarters
LEED® Registered Facility
Constructed by The Samuels Group

The Samuels Group and

Stone Office Group are
combining their expertise in
healthcare construction and
interior design to provide our
Our Healthcare Construction teams are continually
trained, accredited, and/or certified in such clients an easy solution to
Healthcare Constructor programs as: ASHE, OSHA,
Indoor Air Quality, LEED®, and others being ‘green’.

View our work portfolios at

www.SamuelsGroup.net
www.StoneOffice.com

Authorized Dealer

Call us today to see how our Innovative,

Over Achievers will bring you Smar t Solutions.
The Samuels Group Stone Office Group
311 Financial Way 311 Financial Way
Suite 300 Suite 302
Wausau, WI 54401 Wausau, WI 54401
715.842.2222 715.842.5654

CONTRACTORS. INNOVATORS. OVER ACHIEVERS. S m a r t S o l u t i o n s