Dear Mr. Jones,
I wanted to thank you one more time for everything you did for me when we were in South Florida trying to discern where the Signature Revolution should relocate to – between Nashville, Orlando, and Louisville.
It was a hard decision for me and our entire organization and many did not reach out like I hoped but you definitely did. When you called me, each time telling me why Louisville would be the best place for Signature HealthCARE, you were right. Our talks about how we could do more here than any other city held true!
Your advice was invaluable to our final decision and all that has transpired since. In that relocation process you promised me that you would meet with me regularly to be my mentor, to help me grow as a person, and help Signature navigate the complicated healthcare landscape.
The mentoring sessions were the ‘best one-hour sessions’ I ever had with anyone. You always started each session with a discussion on how to lead with integrity and faith.
I remember when you pulled your own “personal Peter Drucker notes” to show me management principles to implement into the Revolution that you knew we needed. And we put them all to good use.
The other sessions where you would go into your archives and show me your market segmentation notes from yours and Wendall’s prior working sessions decades back, helped Signature greatly see other ways to operate the organization.
Every complicated question I ever asked you, I was secretly hoping one time I might stump you, but that never happened because you always had the perfect answer that sometimes I had to unpack later.
The private discussions where you gave me personal advice about life resonated often in my own challenges, but they always held true. You were never easy on me, which made me re-examine closely held beliefs either way, so I knew where I stood.
Thank you for sharing your life principles with me every time on “how to live a meaningful faith-led happy life.” They are the true foundation to our optimal state here while we serve others. They are sometimes challenging to live by, but they helped me greatly even in my darkest hour.
I think what I loved most was that we always closed each session with a prayer just to remind both of us who was really in charge anyway.
My admiration started a very long time ago. When I was a very young entrepreneur struggling to try to find my way, you were the gold standard to me and hundreds of others around our great city. We thank you for making us all think bigger than ourselves, which we all needed, or we would have never found the path.
Your great impact on me was just one small thing you did of the thousands and thousands of great deeds because you did so much for everyone that ever asked for your help. In my opinion, your generosity and humility are unmatched!
As the whole city grieves today, and I know my thank you note is just one of a million, we all want you and your family to know how grateful we all feel about your relationship with all of us.
Lastly, I needed to remember what you said often about everyone being more Jeffersonian and giving back to your community at all times. We can still see you and feel your presence everywhere we look.
Thank you, Mr. Jones, for teaching us all how to “pay it forward” and inspire all of us to try to be the best our version of ourselves!
From the first time I saw a Ford Mustang I knew I found my car. I remember seeing it in my favorite movie scenes in “Bullet,” “Diamonds are Forever,” and “The Thomas Crown Affair” where I felt my first irrational urgency to someday get one. The emotional attachments for me were the sleek lines, the vibrant colors, and the convertible tops, but at my childhood home the link was something much bigger!
At Elmer Steier’s (my father) house it was about the American innovation behind it, led by Mr. Lee Iacocca, that made the car a dinner table topic at the Steier household. It was Mr. Iacocca who personally moved inside the Ford plant to create the iconic example of rapid engineering speed as a symbol of an American comeback at a time we needed to make a statement that inspired our conversations about that special car. Growing up as a son of an active labor union leader and former bricklayer who pushed BUY AMERICAN at an almost religious level like our Catholic roots, Mr. Iacocca was the first executive I remember being mentioned at the dinner table!
At this time, I remember that foreign-made cars were not allowed to be parked in our driveway no matter who was the driver, which tells you how much my Dad believed in American protectionism versus a global economy that we live in today.
After the first recession during the Carter administration, I remember the impact it had on our blue-collar neighborhood. My father became deeply concerned with the rise of foreign car companies coupled with the arrogance of the U.S. auto industry making inferior products and he often predicted a future downfall for the massive industry. Even as an active union organizer, he respected great leadership, knew organizations needed excellent management, and knew that sacred balance was needed between all vested parties to make anything a huge success!
Besides creating the famed Mustang, Mr. Iacocca turned around the entire Ford Motor Company and then also the Chrysler Company years later, which are staple reminders that we invented an auto industry that still thrives today, drives our Louisville economy, and a lot of our Kentucky regions are still dependent on the success of it.
At one time, I collected old Mustang rag tops before they were traded in for four crazy kids. I once ignorantly drove a new Mustang Cobra out of a dealership floor in 1995 as a moment of irrational immediate gratification inheriting a car payment that required two jobs. Equally important, I still have the Mustang bought on my 40th birthday as a gift that has now been successfully passed onto to my daughter who gets the history of this special car!
This being our July 4th holiday season, we should all take a moment and have a toast to Lee because it is a great example of a son of first-generation immigrant parents with Italian roots making a big splash in our American life in a tangible way. We can all still be touched by it as we sit at red lights and just watch, even though Mr. Iacocca passed away yesterday at age 94.
As we watch today with dismay what is happening along the Texas border that impacts all of us deeply regardless what side of the aisle you sit on, we know we must find a better solution than the one we have now.
In all of Lee Iacocca’s interviews, he talked about how much he loved the open arms of America that were provided to his parents at a time they had no place to turn and who later operated hot dog stands in Pennsylvania. He talked and rattled off other immigrant sons and daughters making a difference at the peak of his power because he knew what they all contributed to the United States that could never happen somewhere else.
After his amazing career and how his parents were embraced, Mr. Iacocca took his personal resources and leadership skills to restore the Statue of Liberty that was decaying to show the entire world that we are a collection of hard-working people with links to pioneering immigrants and anything is possible, only in AMERICA!
There are many times in life where we are reminded there are no coincidences, and nothing is random. My wife, Sony’s, leadership role as chair of the Leukemia and Lymphoma Society’s Light the Night is one of those moments where it all makes sense. When Sony lost her sister and best friend, Tina Avritt, to the horrific Leukemia disease 16 years ago, I witnessed the cruelty of the disease. I watched it kill her unborn baby (Ryan Christopher) and take Tina within the same year at age 30 with unimaginable pain and suffering. I don’t think I ever loved anything like Sony loved Tina. I struggled with my own faith, how to support her legacy that was ripped from her, and how to be nurturing in Sony’s long grieving process, but now I finally can.
When Sony decided to step out and take this challenging leadership role, I watched her passion grow at every encounter because she was with Tina again. Tina was a very strong protector of Sony and anyone else under her tent and now Sony is fighting for her and everyone else’s Tina. There is always something deeply inspiring when you see your spouse lead, go all in and raise the bar in the process, and to say that I am very proud of Sony is a great understatement. I am personally moved and see a side of Sony that is bringing people together that is quite rare. She is bringing people together, taking risks by leaving her comfort supporter role and becoming a true advocate of a devastating disease. She now believes in her own research, new learning, and intersections with the Leukemia and Lymphoma Society that she now has joined the long brutal war to eradicate something that crushes so many around us. I think in her heart she knows her Tina and your Tina can beat it now, not all the time, but we are starting to win way more than we lose.
During Sony’s amazing journey over the past two years as chair has been a transformative experience for me as I learn with her. Prior to Sony’s big move, I think I was becoming numb to hearing about blood cancers all the time because it continued to drop bombs all around me and right on top of several friends that I just tried to tune it out. Sony and her team have inspired me to become a witness to what is possible with the amazing work in research related to blood cancers.
During this supportive role, my long-term CFO, John Harrison’s son, Matthew, was diagnosed with a tough case of leukemia right in the middle of this, making me realize we are not going fast enough. I can walk down another hall at Signature HealthCARE and see Dr. Jeff Beaty, another long-term partner who has beaten his blood cancer and is now back to work with passion and joy knowing it is beatable. Jeff benefited greatly from the clinical research to have great clinical pathways to winning.
While at the same time, being with John often over 14 years, I see the pain of uncertainty and the toll it takes in his eyes to see his brilliant 23-year-old son fight daily and have a normal life ripped out of his hands during his senior year at Florida State University after doing everything right as a talented and ambitious young man. John and his wife, Anne, are on that blood cancer roller coaster of a shocking diagnosis, weekly chemo, painful radiation, the search for a donor match, the pain of “Will the transplant take hold?” and hip replacement surgery to endure sometime in the future.
That’s why this year really matters to me, Sony, her team, Matt, the Harrisons, Dr Beaty, and the new “Tina’s” because we need to fill our stadium, cheer hard for the fighters, scream with joy for the victories for the growing number of survivors, and speed up the research so the ugly world of blood cancers can be eliminated in our lifetime.
I am beyond proud of Sony! Excited to be celebrating with Jeff! But still just devastated by what our great friends the Harrisons are going through. We know Matt will win in the end, but it is an epic fight that takes everything he has to win! He is that special, but it is a fight in the future that I hope can someday can be avoided!
Let’s fill the stadium at Light the Night on October 10 and break some records! Kill Blood Cancers Forever!
For as long as I can remember, we wanted to completely revolutionize nursing homes because when I started as a high school volunteer in the mid-eighties, I could see there had to be a better way. This time period was painful for nursing homes that were being steadily expanded, coupled with growing sentiment that the care was often poor, triggering what we know as OBRA legislation (1987) to improve oversight by the government. It was massive regulations that have never really slowed down.
My team and I at Signature HealthCARE have always dreamed of a day we could transform an industry covered in negative perceptions related to what we all want it to be and what limited resources combined with excessive regulations that often hold us back. We can hold a long-term care history class later, but Dr. Thomas is why we have 57 Eden Communities today at Signature.
When we tried to find a framework to use to innovate around us, we learned about Dr. Bill Thomas’ body of work around culture change, wise leadership, and new designs to reduce institutionalization of elders. We all read his books and in particular used Second Wind to see a brighter future for both stakeholders and customers. In this process, SHC started to study Eden Alternative, use part of the Green House Project concepts in our older centers, and worked with the Pioneer Network to become one of the largest Eden Alternative milestone organizations in the U.S. Most of my inspiration came from Dr. Thomas; to be bold about change, embrace innovation like never before, and become a passionate life-long learner of what is possible to reduce my dependence on my own prior experiences.
I had a great opportunity to hear Dr. Bill Thomas speak at the amazing SABRA Operator’s Conference and catch up one-on-one personally, and we intersected again about future possibilities that we believe are plausible. What I have always loved about Dr. Thomas is that he expands our minds like very few others can do, and we were supporters, and preferred locations for his Bus Tour across America on aging, which was a needed game changer in so many ways!
He gave his usual thought-provocative interactive talk to a room of great operators, so I wanted to share my interpretation of his most current message about the aging care future, senior housing hopes and needs, caregiver experiences, his view of life, tiny houses and true independence as defined by Bill.
Dr. Thomas started with one question that he believes defines our current and future success or failure: “What is optimal independence for your customers defined by highest autonomy possible that we can provide and get them to their preferred place of choice?” His question is hard for the traditional nursing home crowd but we get the point because at Signature HealthCARE we know we can’t change fast enough!
He sprinkles in the famous Dutch quote, ”We take care of them by turning our back on them (which can maximize independence) as way to reframe what is compassionate care just to stretch the audience a little verses optimal independence.”
Here are his Top 20 future visions for all of us to consider as potential mental modes to innovate around:
- We must establish Network Value over Brand Value defined by how many and what volume of nodes has your organization activated? (Airbnb vs Hotel Names)
- It is the slow end of Licensing Revenue related to revenue guaranteed and related to healthcare designations such as SNF, IRF, LTAC, etc. replaced by universal network of care transitions.
- Get out of the nursing home business because there are no profits, too many regulations and too big labor shortage and start to deliver age-friendly acute care as fast as you can.
- Don’t test regulations in micro ways or name them your constraint – do the opposite and exploit them by going far enough that they don’t transfer so you can get the room you need to innovate.
- Alzheimer’s won’t get cured in our lifetime but the incident rates will drop steadily due to exercise, diet, and better understanding of wellness, so incorporate prevention in your vision.
- Food is the real story and the second biggest thing – own it, spend time in it, change it, think about it 24/7, make it transformative now – it will be your biggest gain available!
- With growing income disparity heading into the baby boomer explosion, there will be a massive shift to flexibility, fluidity, and transferability in personal homes because it is emotional, only real asset often, and new solutions will provide many new options. Start now.
- Don’t be afraid of offering housing on site for clinicians in training because segregated age-related living is dying, so add ways to offer housing options to enhance the intergenerational possibilities.
- Don’t forget about the bathrooms because we have missed it several times – sacred space that needs to be uplifting, simpler, safer, and therapeutic – start redoing them. Big win potential.
- Household linguistic logistics will be the next big thing but we are too late already. Amazon will own it like everything else.
- Customer focus needs to be on independence but judged by developmental opportunities, physical and mental strength services, and wholesome belonging.
- Innovate healthcare advance directives and personal choice early with full transparency and consider an added value service because it really matters.
- Reduce compassion because it can build too much co-dependency. Dr. Thomas believes we do too much and give too much – get them doing again even at half the output.
- Skilled Nursing is dead because they will never pay you enough so you better change now because we are at the end of an antiquated era of limits.
- Universal care workers still will work but it must have a new management model above it or they will kill for control purposes. It must be self-autonomous teams with peer accountability to work.
- Most of you have 50% turnover because employees have much better options to consider now and you must change your options in all ways to compete.
- Home health is the big monster going from the hang your shingle, buy your van with magnetic tag, and passing out brochures as small operators, to a roll up phase ending soon to the most networked powerful healthcare delivery system in the world.
- Automated assistance will have a big impact through digital support, artificial intelligence voice interface, and tele presence robots that are becoming affordable but don’t believe the hype on sensors because too evasive and limited use in the end.
- Understand that the baby boomers are four groups in one. Watch Latitude Margaritaville development – who wants that kind of a waiting list?
- We are in first phase of senior care deconstruction in many ways that requires capacity reductions due to obsolescence, the need to establish new independent consumer-directed networks, reduction in pre-determined paths linked to regulated licenses, and new ways to operationalize the home.
You never have to agree with all of Dr. Thomas’ Futuristic Predications because he wants to push the audience to where we are all uncomfortable — which he has mastered — but there is real invaluable insight into how much change we need to bring to our own worlds to be here next decade.
Many of us in the crowd would love to try it all but we are all too busy trying to meet payroll, stay open and be the best version of ourselves and survive the day!
I never believe our post-acute care facility business is dead or over but I know we have to change faster sooner than later, embrace the discomfort he brings to the conversion and self-reflect on his ultimate question: Are we providing the optimal state of independence for our customers as defined by Dr. Thomas?
Thanks to Rick and the amazing Sabra team, we loved the conference!
Flying home from Miami with Ava, my 13-year-old daughter, from Dwyane Wade’s last home game as an NBA player, I had much more emotion than I expected. The amazing memories, watching my kids growing up over the many Miami HEAT seasons, cheering our hearts out, the great night with friends year after year over the holidays, and now the realization knowing it was finally over for good. It was a special season of life for both of us, me and Dwayne, yet he never knew my name.
I could see my memories racing through my mind of all the great Dwyane Wade nights in American Airlines Arena over the past 15 years that filled an entire arena up to the brim with screaming fans all the way up to the nose bleed seats in Miami. I knew the whole time this was a once in a lifetime opportunity for a crazy basketball fan like myself from Louisville, Kentucky, to feel a part of the five NBA championship runs we had in just 13 years that my family and friends enjoyed like religious holidays. Both may never happen again in my lifetime!
But what really surprises me is the deep emotional attachment to someone (like Dwyane Wade) that I really don’t know at all, and yet my life feels intertwined with his in a very personal way that matters to me more than I realized. When I was unpacking these feelings, I started to reflect on the very beginning of our connection that seems like a lifetime ago.
First, I relocated to South Florida full-time from the Midwest in 2002 with great apprehension. Dwyane followed me there from the Midwest two years later as well, as the fifth pick in one of the best and deepest NBA drafts of all time! Many in Miami were not excited about this Riley Selection but I had watched Dwyane torch my beloved Louisville Cardinals several times. But his national rise came from the NCAA game against Kentucky where he single-handedly beat a solid UK team by himself. I knew what was coming to South Florida by Riley’s bold selection – a new era – something they had never seen since the franchise started in 1988.
Secondly, I joined an organization, as an executive, that was really struggling at the time and had great uncertainty and needed a winning attitude and a new culture immediately. Dwyane joined the Miami Heat when his team was at a crossroads in many ways because seats were empty (I was there). The previous solid team of the past was becoming a distant memory and yet he took this challenge and made it a turning point to never look back. We all tried the same thing in our professional lives in our day jobs just up the road. I think everyone started dreaming bigger from this point forward – the Miami Heat and my healthcare leadership team.
Then we started to grow and learn to win as well while watching Dwyane win big down the road and that was my time and our place to celebrate – run down to AA arena and celebrate knowing we were all in His House for the night and we finally brought an NBA Championship to Miami!
The professional achievements we witnessed are staggering to process because his initial billing the day we drafted him in 2003 was not the next Kobe, LeBron, or Michael, but it was the personal side of Dwyane that made this different for me and all of us who were part of this epic time and run. Over these years we all got to know him personally because he allowed it while he shared his vulnerability with all of us, which was really the best part.
The personal growth we all witnessed in Dwyane Wade season after season made you relate to him in a multi-dimensional way, which rarely happens in sports. His humble basketball beginnings, trying to beat his brother/father in his driveway, we could all relate to. His deep loyalty to his family we all know is the foundation of our own values that we try to live today. His early academic struggles that he fought through had an impact on me, as I struggled greatly in high school with dyslexia. I see the impact of this in the screaming young kids at every game believing they can overcome learning obstacles too. His loyalty to a first-class organization like the Miami Heat, where he took big pay cuts to create the BIG 3 and never really wanted to leave, is a dying quality in the workplace that I still personally cherish as I received my 20-year pin last month at my organization. His painful divorce made you want him to find true love like he did with Gabriella Union, and we all felt part of as well.
As you watch the last dance with Dwyane Wade this year, you feel it all around you if you allow it – redemption, legacy, God, hope, love, loyalty, commitment, excellence, teamwork, family…….
As the loud speaker introduced Dwyane Wade for the last time in AA arena, I got chills because this was it…the end of a once in a lifetime era in South Florida…coming to a glorious and yet very sad close!
From the first big shot of his rookie year against Byron Davis, we were all in, no matter what the outcome was, for nearly 15 years. We were all part of Wade Country that brought great and beautiful diversity together like no other NBA arena in America that made us see how the world should be, not as it is!
As Hemingway, (with deep South Florida roots as well) once said, “These are the best of times and the worst of times.” It’s fitting because we all cared, we are sad, we know it will be different after the final horn sounded this night.
This is a football town with very limited historical basketball roots (this basketball phenomenon may never happen again in Miami – if you don’t believe me just ask the Dolphins fans about the last 20 years since Dan Marino retired – they have never recovered).
I did renew my HEAT season tickets knowing it will not be the same in my lifetime and loyalty matters to me like it does to Dwyane!
Anyone who was blessed to be up close and personal with Dwyane Wade knows that we were all impacted by him as a leader, player, father, community activist, teammate, and a MAN who was willing to grow with all of us, lead us to our promise land (NBA Champions), share himself with all of us the whole time, and profess his faith in the Lord in good times and in bad!
Thanks Dwyane Wade, can we finally get together for lunch since things are slowing down a little and let me tell you about what Dan Issel and the NBA2LOU movement are doing in a Midwest town called Louisville, KY, that you know pretty well already – we need you because we dream of bigger things here, like Miami did, and you know we know basketball like no other city in the world!
When there is so much to say, so many aspects to write about on this topic, where do I begin? I myself did not even know what the term “Corporate Reset” meant before surviving through one — but I do now.
The unraveling of the nursing home industry. The unrelenting series of events that nearly paralyzed Signature HealthCARE. The storms that hit us from all directions. The Signature team members who, like me, were worried and shaken to the core while trying to survive.
It was a giant snowball rolling down a long hill. It was unstoppable.
My nightly routine included two or three hours – beginning around midnight – staring at the bedroom ceiling wondering if the next day would bring a miracle, or more bad news.
With so much to say, where do I begin?
I begin with a thank you to the thousands of team members throughout the organization who helped this company survive. Some of you were here as the storm clouds approached, and darkened, yet you stayed. And some of you climbed on board during the storms and never blinked.
All of you made a difference.
The corporate reset
As an organization, Signature looks a lot different than it did two years ago. The changes were drastic and often painful. Many were reactive and implemented as a means of survival. Others were more proactive … designed to prepare us for the a “new normal” in the industry.
It was a “corporate reset.”
Perhaps I should’ve known it was coming. But the Signature organization that we all believed in, and had a hand in creating, began to crumble.
I was humbled. It seemed as though everything I learned in my professional life – things that had always helped me in the past – no longer worked.
The quality of our work was strong and improving, resident satisfaction and quality of life was high. Most of our individual Signature facilities were doing well. Yet, it didn’t seem to matter. Industry factors were creating insurmountable, dark headwinds.
There was not one tipping point. There were many: a surge in malpractice cases (surpassing 350, with a high concentration in Kentucky); reimbursement rates declining faster than we could absorb; shorter stay residents; aggressive managed care; unexpected wage inflation as the economy heated up; brutal regulatory changes; the millions of dollars in legal fees to address allegations by the U.S. Department of Justice (the same therapy allegations that have confronted 80 percent of U.S. nursing home chains).
Though the nation’s long-term and senior-care companies have experienced difficult industry and regulatory challenges in the past, the issues of recent years are unprecedented. The impact has been industry-wide. Some great companies, including some of our competitors, have closed their doors.
We almost didn’t make it. Despite having a great Signature team, a dedicated board, great vendor and other business partners, it seemed at times the challenges would be insurmountable. Yet, today the Signature team is blessed once more with the opportunity to live our mission.
Valuable lessons learned
No matter how good and strong we think we are, we can never stop learning. Below are 10 lessons we learned during our hard times. Others in our industry, and perhaps anyone who owns or manages a business of any size, might find them useful if times get tough:
- If reorganizing is necessary, hire the absolute best reorganization and restructuring experts. We did that in hiring Ankura Consulting, and Klee, Tuchin, Bogdanoff & Stern LLP.
- Assemble a team of believers within your company, because a major reset requires teammates who have faith and trust one another.
- Understand that the journey will be brutal, uncertain and will hurt like hell. But don’t give up.
- Listen. Like never before. Because you will need to learn new things. As you learn, be patient with yourself and those around you, as they are trying to help.
- It will get personal. But don’t let fear overrun you. And maintain your emotional intelligence, always.
- Be transparent to both internal and external parties. Without critical information, internal people will assume the worst. And external parties need to feel your passion.
- Be positive and remain positive. It’s contagious.
- Stay focused on your business and trust your hired experts to do and lead the reset because they’re good at it.
- It’s like a baseball game … you can lose some innings but still win the game.
- Everyone – even your critics or detractors – will rally around a good, honest, hard working team with a great mission and vision.
As strong as ever
Today, we’re back to work, as strong as ever. We’re grateful for the many amazing people who had a role in Signature’s reset – allowing us the opportunity to continue our mission.
Our recent difficult times will make Signature a stronger, better company moving forward.
We have many partners to thank, including: our real estate investment partners (Omega Healthcare Investors, Inc., and Sabra Health Care REIT) who never gave up on us; our long-term capital friends from Sector Financial INC. and all of our strategic partners, like Pharmerica; our board whose diverse areas of expertise helped us navigate through countless complexities; the many plaintiff attorneys who settled hundreds of cases with us; and the government officials who worked with us to resolve a three-year, intense therapy investigation in our Rehab division, which was a must for the reset to move forward.
Winston Churchill said: “If you think you’re in hell, you better keep going and not stop.” We didn’t stop. And we’re here today to live another company life with more passion than ever and with the intent to revolutionize long term care.