Increasingly, nursing homes are outsourcing their housekeeping duties to companies with extensive infection control experience. This decision helps protect residents from preventable illnesses and has other important benefits.

“Outsourcing housekeeping responsibilities to environmental service professionals is a good move from both a quality-of-care and a financial perspective,” explains Daniel Gravatt, business operations manager for ServiceMaster Clean, one of the nation’s leading janitorial service providers. “We have more than 60 years of experience to go along with a staff that is specifically trained in infection prevention in the healthcare environment. That level of expertise rarely exists with an in-house janitorial staff.”

Gravatt said there are four areas in which outsourcing environmental services benefits senior living facilities. Each overlaps the other to create a better, more sustainable business for nursing home management.

Clean, safe, healthy

Professional environmental services such as ServiceMaster Clean make a science of cleaning. Experienced trainers with knowledge of infectious diseases teach advanced cleaning and disinfecting methods and products to staffers whose performance is evaluated regularly to achieve best outcomes. This type of constant quality control helps ensure the surfaces and materials in your facility are free of harmful pathogens.

Cleaning methods have changed dramatically over the past several years. Old-fashioned mops and brooms are no longer recommended. Neither is bleach or cleaning products with strong fragrances. Instead, staffers use microfiber cleaning pads and vacuums with HEPA filters to capture dust and dirt particles and remove them, rather than stir them into the air.  EPA-registered, hospital grade cleaner disinfectants not only clean, they kill pathogens that cause illnesses.

“The level of infection control we can provide is up to the facility administrator’s preference,” says Gravatt, who has extensive experience in the nursing home industry. “Thorough daily cleaning and disinfecting will keep a facility clean, mitigate infection and eliminate odors.  In addition, we can offer services such as facility-wide deep cleans on a one-time or recurring basis,  and using electrostatic sprayers to supplement daily cleaning, disinfecting and odor control.”

More resident satisfaction

Residents and their families often judge the quality of a senior-living facility by its cleanliness.  Are the floors, tables and countertops clean? Are the linens fresh?  Is the facility odor-free? These are often the first observations guests make when entering your facility.  If you don’t pass the eye test, you may not get an opportunity to sell them on your personal services and care.

Cleanliness has a significant impact on patient and guest satisfaction, and not just from an aesthetic perspective. If infection spreads within a facility, you may lose existing or potential residents and your reputation will certainly suffer. Outbreaks also divert the time and energy of clinical staff so that they can’t provide the level of personal care that residents need.

“Administrators and staff want to protect the health of their residents, but a facility’s reputation will also suffer from repeated outbreaks of contagious diseases,” says Gravatt. “Residents and their families may cast blame on the facility if their loved one becomes ill because of an outbreak.  If not addressed properly, it also can lead to survey and liability issues.”

Costs controlled

It can be expensive to maintain an in-house cleaning staff. ServiceMaster Clean can help resolve your cleaning issues and help keep costs under control.  Some facilities choose to completely outsource housekeeping duties to an outside vendor. ServiceMaster Clean can, if you choose, supplement the services of your existing staff to provide a higher level of infection prevention. In some situations, ServiceMaster Clean can retrain an existing staff in new techniques and products to achieve the desired level of infection prevention.

Outsourcing can be flexible according to your needs and budget; it is not a one-size-fits all solution. Talk to a ServiceMaster Clean representative about your situation.

Regulatory compliance

In November 2016, the Centers for Medicare & Medicaid Services published new infection prevention requirements for long-term care facilities. The last of those new regulations becomes effective November 28.

ServiceMaster Clean uses only products and practices that have been approved by agencies such as the CMS, CDC, EPA, OSHA and other governmental and non-governmental organizations.  They can help you be in full compliance with all cleaning regulations the next time your facility is surveyed.

Cleanliness and infection control are essential in today’s long-term care business plan. It can enhance patient satisfaction, keep costs under control and keep your facility in full compliance with the new, stricter regulations. It pays to have a conversation with a provider like ServiceMaster Clean, which can help keep your facility clean, safe and healthy.

To learn more, visit www.servicemasterclean.com

Growing up in Sierra Leone, her parents made sure she always attended school because they knew how important an education was for her future. 

When her parents died when she was a child, Jalloh’s grandma took over raising her, becoming her “fantasy mom.” 

“My grandma made me feel at home,” Jalloh recalls. “She was always there for me growing up.”

After her grandma passed away, Jalloh and her husband, Samson, fled the war-torn country she grew up in to arrive in the U.S. in 2000. While living in a Chicago refugee assistance program, she continued her education and began pursuing nursing.

“[School] was always part of my journey and my life,” Jalloh says. “It was the one thing I could always run to if everything was falling apart. I can always hold on to that.”

She began her career as a certified nursing assistant at CJE Senior Life and was quickly convinced by her supervisors to forge further.

She did just that by working full time, going to school full time and raising her four children – Andre, Andrea, Steven and Isabelle. Eventually, she earned her LPN, RN and BSN credentials. 

And she found a place for herself through geriatrics. Caring for seniors gave her a chance to rekindle the love she had for Grandma.

“I feel like I’m giving back in some way,” Jalloh says. “It’s like they’re replacing her in my heart.”

Because of that love, she treats her residents and staff like family. She makes sure that her staff is always educated, just like her family did for her. She ensures they know the little details that make all the difference when providing care, like if someone prefers to take their medicine with coffee instead of water. 

One of her strongest relationships is with Nadia Giegler, executive director at The Admiral and an “Angela Jalloh Fan Club” member. Their working relationship is built upon a mutual respect and a great deal of trust in the other person that began from their early days working together. 

But what Giegler says stands out the most about Jalloh is how she manages her “huge, around-the-clock set of responsibilities at work, her family life, her educational and vocational pursuits and yet — somehow — she can always make the time to help someone in need.”

Aside from teaching her staff, Jalloh also is a part-time faculty member at Oakton Community College in Des Plaines, IL. 

When Jalloh – a self-proclaimed workaholic – can pull herself away from the job, she makes sure to give that time to the people who matter the most to her: her family. She lives north of Chicago in Skokie, IL, with her husband, two of their four children and their German Shepherd, Max. 

She looks fondly on family vacations and time spent road tripping across the country or lounging at a beach in Florida with a good book and family around her. 

Although Jalloh says she can feel guilty about how much time she spends working, she adds it’s all worth it when she can make a new resident feel at home.

“Then you know that, yes, my job is fulfilling,” she says, “because I made a difference in someone else’s life.”

Jalloh’s Resume: Comes to the U.S. with her husband Samson (2000); Begins working at CJE SeniorLife as a certified nursing assistant (2003); Earns her LPN from Dawson Technical School (2006); Becomes an RN after graduating from Oakton Community College (2011); Receives her BSN from University of Phoenix (2015); Joins The Admiral as director of nursing (2017); Wins the Joan Anne McHugh Award for Leadership in Long-Term Services and Supports Nursing from LeadingAge (2018)

Instead, all the money earned through their food stand at the annual Adams County fair — about $15,000 in a typical year — will go to shore up the North Adams Home in Mendon.

Watching news about operator struggles across the state over the last year, parishioners at the First Congregational Church decided to continue their long-running relationship with North Adams.

The church was instrumental in the 92-bed nursing home’s founding in the 1970s, and a nursing home staff member volunteers at the stand each summer, administrator Thomas E. Ohnemus said.

Exactly how the money will be spent has yet to be determined, but Ohnemus told McKnight’s the gift will be a morale booster for both residents and staff.

“The end result will be a greater sense of security as the residents and staff realize that the community is there for them in a time of need,” Ohnemus told McKnight’s. “North Adams Home, like all long-term care facilities, feels the stress when there is a lack of funding from the state level … The Church has given us hope and has reassured the Home that they are dedicated to our mission: providing quality care in a loving, family-like environment.”

Add in the fact that up to 75% of email these days comprises spam, junk and advertisements, it’s no wonder that many workers today say email is dead, or at the very least, passé, says Bruce Weintraub, CEO of HealthSignals LLC, which designs, deploys and manages medical grade Wi-Fi platforms for long-term care communities. 

“Where managers used to have face-to-face meetings with staff to issue instructions and gather feedback, email took over in order to be ‘more efficient,” he says. “But these days, that efficiency is gone, and many important messages get lost in the tsunami of emails received.” 

In addition, traditional forms of communication such as email are really designed for employees sitting at a desk and looking at a screen all day, so they often fall short for always-on-the-go workers in senior care communities, says Derek Holt, president and chief operating officer of K4Connect, which provides smart technology solutions for senior living communities.

Weintruab adds that as their email inboxes have become overrun, many managers have now moved to text messaging, either via cell phones or other instant messaging platforms, sometimes infringing on employees’ personal lives, or forcing them to carry multiple devices — a personal phone and a work phone. 

So what are some of the best ways for long-term care managers and staff to effectively and efficiently communicate with each other, while still respecting the importance of work-life balance? Experts share some of the best new communication technologies and software for making facilities more productive overall. 

Establish your pain points

Holt notes that the first step when it comes to establishing better employee communication is figuring out what is and isn’t working within the facility. This starts, he says, by taking a holistic view of its communication problems.

“I’m not saying to go rip and replace everything all at once,” Holt says, “but you do need to have a strategic plan in terms of how you’re going to use technology to transform your community.” 

Holt says K4 Connect works closely with its clients to understand the communication problems facilities are facing — be it unread emails, not receiving timely updates on projects or requests not being completed — and then work with them to build a roadmap for a future that works for everyone.

“We can’t make an isolated decision for the maintenance team’s communication and a different one for the care team and still another for the marketing team,” he says. 

During any communication plan development, it’s also crucial to get a technical assessment of the facility done, to ensure the infrastructure is in place to support any new systems being considered, says Mark McIntyre, EVP and GM of CareWorx Fully Managed, a provider of technology solutions and IT support for the senior care industry.

“Digital transformation is all about finding ways to work better and smarter,” he says. “But providers also need to ensure that their IT infrastructure and Wi-Fi can support these innovative new tools.”

Combining communications

Greg Robertson, senior vice president and general manager with Notify, says that often long-term care facilities muddle through with technologies and systems that are disconnected from one another, leading to employees walking around the facility with a “Batman belt” of different devices — walkie-talkies, pagers and smartphones — each of which serve a different function and are connected to a different system.

Vocera Communications Director of Emerging Markets Dave Bingham agrees, adding, “It’s incredibly inconvenient for caregivers to walk around with all of these devices and also be there to take care of residents.”

To address this, Vocera, Notify and other companies have developed handheld and wearable devices designed to help long-term care staff manage all of their communication with one system. 

It directly connects with anyone inside or outside the facility, offers the ability to record messages for employees to listen to at their convenience and helps caregivers respond to employee needs faster.

Improving engagement

One of the biggest needs in terms of communication in long-term care facilities is improving workflows and streamlining processes so that employees can focus on providing care rather than administrative tasks, says Kristen Wylie, senior product marketing manager, senior living for STANLEY Healthcare.

“Successful employee communication is no longer just about sending an email or broadcast message; more importantly, it’s about offering immediate access to information,” she says.

To help with this, Weintraub points to the availability of various operations platforms — many of which offer a mobile app component — to allow specific communications to staff for task-related activities, which are then maintained in a perennial database and can be tracked by employee, task, resident and other factors. 

TheWorxHub by Dude Solutions, for example, is a cloud-based software that offers senior care communities the ability to manage work orders within the platform, and entirely eliminates the need for email, says Taylor Furst, an implementation specialist with Dude Solutions.

Similarly, STANLEY Healthcare’s Arial Emergency Call and Wireless Nurse Call solution is an example of a centralized event management, notification, reporting and analytics platform that employees can use to ensure resident safety and security. 

It includes a live directory displaying all caregivers and indicates those that are currently logged in and working at the facility so caregivers can easily use the app to reach out to peers for assistance, Wylie says. 

“Need a wheelchair brought to you? Need help with a resident? Connecting staff with this kind of anytime, anywhere access to information and collaboration helps to empower caregivers — and helps to bring communities one step closer to an engaged workforce,” she says.

Augmenting patient care

In an effort to empower workers to take a proactive approach to patient-centered care, some technologies even integrate with local hospitals, ACOs and payers to use the available data to support optimal patient care, workflow efficiency and financial success, says Jim Shearon, vice president of clinical solutions at Real Time Medical Systems, an interventional analytics platform.

“With technology being the driver of consistent, accurate and timely information, all parties involved don’t need to wait for an email to tell them what they need to do,” he says. “Rather, they can take action based on the type of data and analytics at their fingertips.”

Gaining real-time visibility into a patient’s current health condition, location and the services being provided to each patient can also help long-term care staff improve quality of care, says Subhashree Sukhu, marketing director for CarePredict, a senior health care monitoring company. 

The company’s wearable device, Tempo, includes sensors that track a variety of the wearer’s activities of daily living and provides two-way voice communication between residents and caregiving staff.

“This allows caregivers to triage alerts and coordinate amongst each other instantly on who will be assisting the resident,” he says.

Enhancing hiring

A productive work environment relies on strong communications, and technology can help managers improve their communications with employees from the very beginning, says Tommy Marzella, marketing manager with OnShift, a long-term care and senior living workforce management software. 

For example, software platforms that leverage artificial intelligence and automated texting can make the hiring process efficient and effective, replacing the outdated process of calling applicants and sending emails and waiting for a response. Or using even long-lasting, more ponderous methods.

Once an employee starts, technology also can help managers stay in touch with new hires — perhaps even reducing turnover and improving employee communication, Marzella says. 

“Given that senior care is a 24-7, often chaotic operation, it can be hard for managers to connect with their staff as much as they’d like, especially with third-shift employees,” he says. “While technology is never a replacement for face-to-face conversation, it can be used to enhance communications and fill gaps.”

Automated pulse surveys, for example, can allow employees to quickly indicate how they feel that their shift went and offer feedback, he says.

Technology also is improving the way facilities divvy up shifts among independent contractors, says John Nyhart, vice president at the healthcare scheduling and credential management platform shiftkey.

In the past, for example, facility administrators would need to contact various nurse staffing agencies by email or phone and wait for a return call or email, Nyhart says. Shiftkey allows administrators to post notices of available shifts, which are then sent out to the entire PRN pool in the immediate region.

Nyhart notes one of the software’s biggest benefits is its around-the-clock, everyday capability.

“When a nurse gets off a shift at 2 a.m., she can log on and see what shifts might next be available and put in a request before heading to bed,” he says. “When you have a system that gets things done when you’re asleep or not at the office, that’s key to being more productive.”

At the heart of the new Patient-Driven Payment Model (PDPM) is a comprehensive revision to the Resident Assessment Instrument (RAI), the set of rules upon which Medicare and Medicaid reimbursement decisions are made.

How the rules are changing, and how skilled nursing facilities can maximize reimbursement under this new payment system, have been the focus of hundreds of webinars and white papers over the last two years. On October 1, the new era begins.

RAI manual changes

The significance of the latest version of the manual (v1.17), which nursing homes first saw in late May, is the sheer number of changes to reimbursement rules. A list of them occupies 117 of the latest manual’s 1,300 pages.

Still, as expert observers note, the really salient changes beginning Oct. 1 can be counted on one hand. While the manual will introduce new assessment formats to learn, fewer assessments are now required. CMS has touted a “lower administrative burden” as a key benefit under PDPM by dropping the number of assessments to just two during the entire course of a resident’s stay, admission and discharge, unless special circumstances occur.

While many view the change as a mixed blessing, fewer assessments mean fewer chances to fix mistakes and more chances to be saddled with a resulting under-reimbursement. The pressure to accurately assess and code each resident is much greater, and there will be certain financial perks for getting things correct, right from the start. 

There is a third, optional assessment, the interim payment assessment, or IPA, which could tweak the reimbursement rate, should providers choose to pursue it.

Accurate coding under Section GG, a big new part of the MDS data collection process, will reflect the elder’s function performance at the time of admission and at the time of discharge.

“Accurate coding of Section GG is, by necessity, a collaboration between therapy and nursing,” observes Karolee Alexander, RN, RAC-CT, director of clinical and reimbursement consulting for Pathway Health.

“Under RUG-IV [PDPM’s predecessor], we have often overlooked the nursing component because it hasn’t mattered, as long as you have your rehab and ADL scores,” notes Jim Shearon, vice president of clinical solutions for Real Time Medical Systems. “In the PDPM model, the nursing component will matter every single time.”

Coding accuracy

Jessie McGill, RN, curriculum development specialist for the American Association of Nurse Assessment Coordination, points out the changes in ICD-10 case-mix codes (I0020b) used for the primary diagnosis in the initial assessment and the range of codes (J2100-J5000) indicating “major” surgical procedure during an inpatient stay just prior to admission will be essential to get right. As McGill states, key RAI manual chapters to bone up on include Chapter 2, which clarifies the PPS assessment schedule under PDPM and provides additional definition and guidance regarding the new interrupted stay policy and the IPA, and Chapter 6, “the go-to section for Medicare SNF PPS reimbursement.”

To capture therapy delivery information over the course of a patient’s entire Medicare Part A stay, as it relates to the concurrent and group therapy limit under PDPM, CMS added items providers will report in terms of the amount of therapy minutes received by the patient, says Patricia Howell, RN BSN, WCC, CFCS, clinical support manager for McKesson Medical-Surgical. 

“If the total amount of group/concurrent minutes combined comprise more than 25 percent of the total amount of therapy for that discipline, a warning message will be issued on the final validation report,” she adds.

Section GG impact

The most prominent role of Section GG is data mining, centered heavily on the functional status of assessed residents at the beginning and end of their stay. 

“Per the RAI Manual, Section GG is intended to reflect baseline, usual function for a resident over the three-day lookback period — not the highest level of performance and not the lowest level,” notes Kathleen Weissberg, MS, OTD, OTR/L, CMDCP, CDP, education director at Select Rehabilitation.

Howell says the scoring methodology for the items used in calculating the GG-based functional score is reversed from the methodology used for the section G-based functional score. “Under Section G, increasing score means increasing dependence,” she says. “Under Section GG, increasing score means increasing independence.”

McGill adds that Section GG is pivotal in the payment process: “Section GG now has multifaceted potential to impact Medicare reimbursement — with one function score being used for the physical therapy and occupational therapy component and another for the nursing component. And [providers] risk having a two-percent reduction to their annual payment update (APU) for an entire fiscal year if they fail to submit eighty percent of the required Section GG data for the SNF Quality Reporting Program (QRP).” 

Perhaps even more significantly, McGill adds, the four Section GG outcome measures are slated to be publicly reported on Nursing Home Compare in calendar year 2020, “giving more opportunity for consumers to see and use section GG outcome data to make referral and admission decisions, all of which can impact the bottom line.”

Keeping tabs on mobility

Functional scoring will be an important exercise in the overall documentation and billing going forward.

“The function scores are based on responses in Section GG, and as a result, the importance of Section GG can’t be overstated,” says Jayne Warwick, director of market insights for PointClickCare, noting how the emerging PDPM system removes ADL scores in favor of functional scores to drive reimbursement.

“The functional score derived from questions in section GG of the MDS has been catapulted to the forefront of the calculation of PDPM reimbursement,” says Jennifer Leatherbarrow, RN BSN, RAC-CT, IPCO, QCP, CIC, manager of clinical consulting for Richter Healthcare Consultants. In fact, the functional score is used in the calculation of three of the PDPM component case-mix groupings.

Mobility is a significant part of Section GG; MDS items represent about two-thirds of its entire content.

“There is a lot of specific coding and assessment activity around mobility required in Section GG,” says Leah Klusch, RN, BSN, FACHCA, the executive director of The Alliance Training Center, an educational foundation focused on geriatric care and coding issues.

“We will need to coordinate more around how we are looking at the elder’s mobility between nursing and therapy. Nursing has many more clinical requirements for documentation than the current system. Therefore, therapy and nursing have to be on the same page when they are documenting mobility,” she says.

Some advice on coding

As Jacklyn Brown, a clinical consultant for Richter Healthcare Consultants, notes in a recent blog, many ICD-10 diagnosis codes will trigger a “return to provider” status on claims if selected as the primary diagnosis. This includes “diagnosis codes that lack specificity, as well as some commonly used treatment diagnoses,” Brown adds.

To illustrate then and now, consider how Shearon describes the change:

“Since the implementation of Section GG in October 2016, providers have focused on making sure that the Section GG items that impact the 80% compliance threshold for the SNF QRP are coded, but they often haven’t paid much attention to the quality of the data being submitted,” he says.

To maximize on all of the changes in Section GG, experts advise the following:

Collaboration

“Providers often struggle to gather the assessment data needed for accurate coding,” says Shearon. “The best practice is an interdisciplinary approach — morning meeting/stand up — where you obtain information from therapy and the nursing staff, and then have a conversation with the resident and the family members.” 

This includes the residents themselves.

“The RAI process was designed to be interdisciplinary, yet we often conduct discipline-specific assessments in silos,” notes Alexander. “The RAI manual directs us to consider information directly from the resident as well as documented information from staff. We often overlook the resident as an important source of information.”

Qualified staff

As Shearon observes, even a prior version of the RAI manual updated the Section GG coding guidance more than 20 times in order to emphasize that the clinician making coding decisions definitely should be “qualified. Providers need to make sure that a qualified clinician who meets those laws and regulations pulls together all of the information and makes the final ‘pen to paper’ coding decisions.”

Usually it’s joy-dispensing dogs or cats that wander facilities, though I’ve seen a llama led from room to room and even eat a carrot held in a resident’s mouth. I don’t recommend this, I just report the news. 

An administrator friend says she once, to her residents’ delight, allowed a horse to be led down a hall, through the lobby and out the front door. This seems risky and extreme, and wasn’t she worried about the need for clean-up on aisle seven? Nope. “Like we’re not dealing with that already?” she responded.   

Looking to the future of animal therapy, goat yoga is now a thing, I’m told. The sure-footed critters enhance the practice by crawling on people’s backs. If that’s not a good fit for your activity program, baby goats are surprisingly as affectionate as puppies, and I’ve seen a beaming resident feed one from a bottle.

At this point, most of the good therapy animals have been chosen, and the bad ones weeded out. Crocodiles, grizzly bears and wolverines aren’t sufficiently soothing. Same with therapy cobras, as no one wants Samuel L. Jackson running through the building shouting, “I’ve had it with these gosh-darn snakes in this gosh-darn post-acute rehab facility!” 

But just when I thought all the boundaries had been tested, the New York Times reports that therapy cows are gaining acceptance. They’re apparently calm, good listeners and enjoy being brushed, petted and embraced. With the Pasture-Driven Payment Model (PDPM) looming, maybe every nursing home will soon have one in the lobby. 

Is cow therapy best delivered as group or concurrent? It’s too early to say. But at least you’ll have a head start on a modified holiday nativity scene. 

Why aim so low, its leaders figure. The pay rate is $17 per hour for certified nursing aides at the rapidly growing operator.

When last we checked on the eager turnaround specialists, they had only nine of their current 24 facilities and were intent on solving long-term care’s employee turnover problem. The $17 wage, which went into effect last fall, has made a distinct mark, though initial commotion from taking over numerous distressed buildings initially inflated the churn.

“It was good, certainly, for morale,” founder and CEO Yair Zuckerman told me. “The thought behind the wage increase was it would allow us to start getting selective. And it was important for them to see even before the turnaround could get successful we’re investing in the team.”

Zuckerman said the company’s goal is to offset the higher wages by lowering other costs with higher quality care. 

While the high CNA wage admittedly caused some frustration — among better educated nurses, for example — it also created unexpected waves of competition.

“People working in social services or the kitchen are saying, ‘I want to be a CNA,’” Zuckerman explains. “Whereas before a lot of people said, ‘I’m making the same money with a mop or a skillet,’ now they’re saying, ‘That’s hard work, but maybe it’s worth my getting certified.’”

Frontline workers “make or break” a facility, he believes. “We put them on a pedestal. If these people do a great job, we’ll have a quality building. Now we’re beating the Whole Foods and Walmarts and Targets. We’re getting a different breed, so to speak.”

In addition, “borderline” employees who might have been left in place are changed out more often. A nursing home operator getting to be selective about which aides it hires? All but unheard of. 

But maybe not for long. See pages 12 and 13 of this issue to learn how another provider, Christian Living Centers of Englewood, CO, has knocked down turnover while pumping up CNA wages. (On page 43, State News notes other places with wages above $15 per hour, though the Northeast generally has higher numbers.)

Successful operators, it seems, know that change is a constant.

The angels in our midst are easy to spot, as their effervescence and glow gives them away. As for what unites them? That’s easy: They are all givers.

In “The Second Mountain,” author David Brooks writes about those who have moved on from a life of self-centeredness to one of commitment. His words might also be used to describe long-term care’s angels:

“They know why they were put on this earth and derive a deep satisfaction from doing what they have been called to do. Life isn’t easy for these people. They’ve taken on the burdens of others. But they have a serenity about them, a settled resolve.”

Perhaps you have a few of these folks in your community. Maybe you are one yourself. If so, congratulations.

At first glance, Brooks might appear to be an unlikely proponent of such selfless behavior. A New York Times columnist and notable journalist, he readily admits to being a workaholic prone to the trappings of elite status. But the book is really a story about his slow climb toward faith.

“My first mountain was an insanely lucky one,” he notes. “I achieved far more professional success than I ever expected to. But that climb turned me into a certain sort of person: aloof, invulnerable and uncommunicative, at least when it came to my private life. I sidestepped the responsibilities of relationship.” 

He is hardly alone.

And if we are going to recognize the givers, we shouldn’t ignore those with the gift of the grab. They range from indifferent workers whose job is little more than a transactional relationship — to those with a breathtaking capacity for hubris, greed and even larceny.

Takers are not so difficult to spot, either. They may appear happy on the surface, but their joylessness and behavior expose them soon enough.

I don’t know what it is about long-term care that attracts such diametrically opposed personalities. But there’s no denying givers and takers are well represented. 

Claybaugh, 36, used the facility’s company credit card for nearly $149,000 in charges, officials said. He also allegedly exploited company checks, which were recorded in an accounts payable system.

 The stolen funds, which allegedly included $18,000 in petty cash, were discovered when Claybaugh resigned to take another job. He was due in court in mid-August.