“No problem, Winnie. I’ll explain what happened.” Once he figured that out.
After a brief appearance in physical therapy, he headed to Susanna’s office. She sat behind her desk, squinting at the computer monitor with a pensive expression.
He got right to business and explained the situation.
“I don’t understand, Jay,” she said. “Mrs. Harper thought I said she couldn’t have leftover bread anymore?”
He nodded.
“Oh.” Her mouth did the most distracting things when she was thinking. Lips parted around a breathy sound then tucked tight. She was perplexed. So was he. This woman was his ticket out of The Arbors. Nothing more. So why did he notice her sheer blouse stretched across her bosom as she sank back in her chair?
“I must not have done a very good job of expressing myself,” Susanna finally said. “I saw Mrs. Harper with all that bread and was curious. Little lady. Lots of bread. I thought it was a good opportunity to introduce myself, so I tracked her down in the dayroom.”
“She says her rosary there every morning. In the afternoon she goes to the south wing. Did she tell you her son brought those rosary beads from the Vatican? Blessed by the Pope.”
Susanna smiled. “She did. We chatted and I asked about the bread. She never actually told me what she did with it, so I’m not sure what I said to give her the impression she couldn’t have any more. I’m sorry there was confusion. Do you think I should address the issue with her?”
Susanna’s offer surprised him. Admirable, but Mrs. Harper probably wouldn’t remember by now. Susanna must not be familiar with the extent of Mrs. Harper’s dementia. There were a hundred and twenty residents here, each with a unique set of circumstances and a debilitating disease that progressed differently in each and every person. It would take time for Susanna to learn the nuances of each resident.
“Winnie calmed her down,” he said. “If her son calls, you could explain to him. Might be a good opportunity to introduce yourself. I’d be surprised if he called, though. He knows if there’s a real problem, I’ll let him know.”
Susanna’s big, blue eyes softened, and Jay thought she looked a bit relieved.
“So what does she do with all that bread?”
“Feeds the ducks. That’s where she goes every morning after breakfast before she says her rosary. Down to the lake.”
“By herself?”
While confusion was a standard state of affairs around here, Jay only expected to encounter it in the residents.
“I don’t think she has her own passcode, but if I find out differently we’ll reprogram the system,” he said lightly.
She made a face, clearly not amused. “Who goes with her?”
“One of the staff takes her. Usually Tessa or Shirley while everyone is at breakfast, but if they’re not available, then Amber takes her. Or Walter. I’ve gone with her, too. We send whoever can be spared.”
“Have you ever approached Mrs. Harper’s son about providing the services of a personal aide like Winnie? Winnie herself might even be available a few extra hours a week since she’s already here.”
For a suspended moment, Jay simply looked at her. Then it clicked. Susanna was worried about the payroll.
He cut her off at the pass. “Mrs. Harper is ninety-three years old. Half the time she can’t remember her own name let alone her son and daughter-in-law’s. But she remembers to bring bread to those ducks every morning because she knows they expect her. Not only is the exercise good for her, but Liz doesn’t have to waste bread that doesn’t get eaten. From start to finish the event takes thirty minutes at the most.”
She frowned, but Jay wouldn’t back down on this one. Mrs. Harper was more independent than most of the residents, and her family didn’t need the added expense of an aide for one daily trip outdoors.
Northstar was supposed to be in the business of upscale senior living. The property administrator they’d sent should know The Arbors wasn’t in the business of nickel and diming the residents. And a woman who ran a memory-care facility shouldn’t need a lecture about what Alzheimer’s cost its victims. Mrs. Harper had lost her family and friends, had lost herself on most days. Feeding the ducks was a big deal to her, one that put a smile on her face and made her feel good.
“I need a classification for the reports, Jay.”
He detected a hint of annoyance in her tone. “Classify it as physical therapy, then, but it’s really quality of life, Susanna. That’s what we provide at The Arbors.”
Period.
* * *
BY THE TIME SUSANNA had completed the financial review with Walter, she was not only impressed by that dear gentleman’s skill at integrating financial and operational measures, but at her own progress managing stress. To be fair, her progress likely had to do with long hours spent analyzing Walter’s performance measurement system and discussing how the acquisition would impact the financial structuring of The Arbors.
Walter possessed a lovely blend of modern and traditional financial leadership skills, balancing complex tasks of management and investment analysis while still acting as a conventional guardian and advocate of good planning.
Walter understood that certain things would change after the acquisition by necessity. He also corroborated her own suspicion about Jay’s concern about losing control.
“Boy’s between a rock and a hard place,” Walter had told her. “He’s alone running this place since his parents died, and inheriting the job is different than choosing the job.”
Yet he didn’t want to abandon the people in his care. That said so much about the man Jay was. Walter’s comments hadn’t left Susanna any polite way to ask how Jay’s parents had died without conducting an interrogation, and Susanna didn’t want Walter to think she was gunning for inside information. But understanding his sense of obligation to The Arbors certainly explained his rigid and sometimes unrealistic expectations.
Trying to understand Jay was becoming a full-time preoccupation. She could never quite tell how he would react to some procedural suggestion she might make to bring operations more in line with what Northstar would require. He seemed to bounce between cooperation and stubbornness without any consistency. At least any that she could pinpoint yet.
There was still time. And the more she managed her stress, the clearer she could think. A positive step that suggested she was finally settling into her new position.
Sleep helped, too, and she’d almost managed to sleep through the nights with some help from melatonin, a natural mineral Karan’s husband, Charles, had recommended.
Feeling rested would definitely come in handy, because she faced a demanding day. Today’s meetings would implement a transfer of information into Northstar’s systems for daily, weekly and monthly reports from all departments.
She wanted to check in with the duty manager first before sequestering herself in her office to go over her notes for the meetings. Reaching for the radio, she flipped the switch and said, “Good morning, Pete. This is Susanna. Where are you?”
The radio crackled and his voice shot back, “Outside Kimberly’s office. Mr. Jankowski had a rough night.”
“On my way.”
Susanna found Pete outside the office at the CareCharter, previewing the display. “So what’s up with Mr. Jankowski?”
Pete had a boyish face that made him appear younger than his mid-forties until one got close enough to realize what appeared to be blond hair was gray. “Trouble breathing.”
“He started a new medication.” Kimberly turned to the display where Mr. Jankowski’s medical chart was visible. “He had his second dose after dinner then rang for the PCT around two o’clock this morning. I took a baseline and have been monitoring him since.”
“A lot of trouble?” Susanna asked.
“I’m administering oxygen.”
“What did Jay say?”
“Haven’t called him,” Pete said.
Susanna naturally assumed they’d notified Jay since they hadn’t contacted her. There were specific procedures in place to handle emergency situations with the residents.
She was missing something. “Then where are we on this?”
“Debating whether or not to wait for the doctor to make rounds.” Pete met her gaze.
Susanna saw the indecision in his expression, which offered only one solution. “Mr. Jankowski should go to the emergency room.”
Pete frowned. “Actually, we were thinking of calling the doctor to advise us.”
Following Kimberly’s gaze, Susanna scanned the display to assess the extent of Mr. Jankowski’s respiratory distress. “You think waiting for the doctor to make rounds is adequate?”
“Dr. Smith is usually in before nine, so it won’t be much longer.”
She glanced at the time on the display: 6:15 a.m. “When do you think you’ll see a change in his condition if the problem is the medication? When the effects of the last dose wear off?”
“The side effects might linger,” Kimberly explained. “He might need another medication to counter those effects. This also might be an episode relating to his heart condition if the new medication the doctor prescribed isn’t working. Only the doctor can make that determination.”
“Mr. Jankowski really hasn’t been here long enough to evaluate with any certainty,” Pete added. “He arrived a little before you did. We’re still in the process of getting to know him and becoming familiar with his needs.”
All of which took time, as Susanna well knew. She also knew the policy regarding the handling of medical situations was in place for a reason and didn’t understand why there was so much hesitation about taking Mr. Jankowski to the emergency room. Especially since they didn’t know him well.
As much as she didn’t want to second-guess the staff or give the impression she didn’t trust them to do their jobs, she was a firm believer in erring on the side of caution.
She respected liability, and explaining to a resident’s family that every measure had been taken to care for a loved one was often the only consolation the family would get.
“Do you think the doctor will order tests?” she asked.
“If this is an episode, he’ll likely order an EKG and an echo,” Kimberly said.
“Which means the emergency room will be the most comprehensive place to administer those tests.”
Kimberly frowned. “We administer those tests here.”
“There’s lead time involved with getting the mobile units. You believe that’s in Mr. Jankowski’s best interest?”
“I’m reassessing every half hour, Ms. Adams. Ryan’s on the second floor, and I’ve got him peeking in, too. Mr. Jankowski is fairly comfortable at the moment. He needs to be evaluated, but he’ll be so much more at ease here. And less compromised with all the airborne viruses this time of year.”
Fairly comfortable?
Susanna wasn’t particularly reassured. Mr. Jankowski’s original heart condition remained untreated if he wasn’t responding to the new medication. She wanted the man comfortable, too, but not at the expense of his health. Which brought her right back to erring on the side of caution.
“I’m not sure I understand what the problem is,” Susanna said honestly. “Is there a reason you’re both reluctant to take him off the property? If so, what is it?”
Kimberly didn’t get a chance to explain anything because Pete said, “Jay’s here. Let’s hear what he has to say.”
There was no missing the relief in his voice, and Susanna tried not to take it personally. She was still working to earn the staff’s respect. That process would take time, as the caregivers acquainting themselves with Mr. Jankowski’s needs took time.
Pete didn’t wait for Jay to enter the passcode, but took a few quick steps ahead and pressed the door release.
Jay strode through the opening doors, a man with a purpose, and Susanna was surprised by how relieved she was to see him.
One look at them, and the smile faded from Jay’s face.
“What’s wrong?” he asked in his throaty morning voice, joining their huddle and overtaking it with his broad-shouldered presence. Suddenly, he was all Susanna could see.
Pete explained the problem, and Kimberly beat a hasty retreat. “Time to check on Mr. Jankowski.”
Jay nodded then tapped his radio. “Let me know how he’s doing. We’ll go from there.”
Kimberly nodded then took off.
“Can’t do a thing until Kimberly gets back, so I’m going to get started on the end-of-shift reports,” Pete said.
Having been a duty manager herself, Susanna knew Pete wasn’t going to get much done. She’d been abandoned.
Jay didn’t need a crystal ball to realize that he’d walked in on some tension. “Anything I need to know?”
Susanna backed against the wall as a dietary aide approached, maneuvering a tiered meal cart through the doors.
“Good morning,” she greeted the woman, dressed neatly in the standard black slacks and white button-up shirt.
“Good morning, Ms. Adams.” She smiled at Jay while passing.
“I didn’t think we had policy discrepancies with emergency procedures,” Susanna admitted. “But Pete and Kimberly were reluctant to consider the emergency room as a viable option.”
Jay arched an eyebrow curiously. “Since when is the emergency room the first course of action with Northstar? I don’t remember reading that anywhere. Did I miss the fine print?”
“Not first course. But Mr. Jankowski started having difficulty breathing at two this morning. I know Kimberly has been monitoring him, but that’s quite a while.”
“The determination to send a resident to the emergency room is made purely by the duty staff, as it should be,” Jay said.
“I agree. They were reassessing when I showed up. I appreciated the chance to appraise their performance firsthand.”
“Then you’re questioning Kimberly’s assessment?”
“Only the reluctance. I was surprised they didn’t notify either one of us that Mr. Jankowski was in distress.”
“They must not have thought he was in that much distress or we’d have heard about it. Trust me. I don’t have minimum wage workers. Everyone is well compensated for their certifications and all the ongoing education. Kimberly is extremely qualified to assess medical situations.”
“I understand, Jay. I’m conservative. Given the situation, I thought the emergency room should have at least been considered.”
“Susanna, I’m not sure I understand the problem.”
That made two of them.
“Maybe we just had difficulty communicating. Maybe they thought I was overly cautious and weren’t sure how to tell me.”
Jay folded his arms over his chest and considered her. “Do you think so? No one ever has any problem telling me what they think.”
That almost made her smile. “As long as we take care of Mr. Jankowski I don’t have a problem. I haven’t had any problems communicating with
anyone before now, so if I run into a problem again then I’ll have to look at the issue.”
Jay inclined his head, trying to be as diplomatic as she was. “That sounds like a good plan, but tell me something. How long would you typically monitor a resident at your last facility? Was there a guideline?”
“Not really,” she admitted. “Each situation is so individual. But we always erred on the side of caution, so we had more flexibility in the nursing center, where we were outfitted to handle more demands than we did in the ALF or independent living.”
Jay blinked. “Independent living? Really?”
One really and the world shifted.
Suddenly Jay was drilling her with a stare as hard as emeralds. “Independent living in a separate facility?”
Susanna suddenly felt as if she were standing under an interrogator’s lamp. “Twelve hundred units. We also had an active senior community. Two-bedroom, two-bath villas.”
“Sounds like quite a place.” His gaze didn’t budge. “I know Northstar manages several memory-care communities, but that place you came from—what was the name?”
“Greywacke Lodge,” she provided automatically.
“Greywacke Lodge wasn’t one of them, was it?”
That’s when it hit her. She wasn’t sure why it had taken so long for her to put two and two together.
Northstar hadn’t provided Jay with her detailed and specific work experience. He hadn’t a clue that her experience was in senior living and not exclusively in memory care.
But he’d figured it out. Had Pete and Kimberly? Is that why they’d vanished?
Susanna jumped in with evasive maneuvers and tried not to sound defensive. “Greywacke Lodge consists of several facilities that cover all areas of senior living, including memory care. We had Harmony House within the ALF.”
The Time of Her Life Page 8
