Aurora Health Care is considering opening more community-based clinics in Milwaukee’s inner city to relieve the demand for urgent care in the emergency room of Aurora Sinai Medical Center.
Aurora president and chief executive officer G. Edwin Howe said Aurora is determined to keep Sinai open, even as the only surviving downtown Milwaukee hospital continues to bleed money.
Howe said the hospital, which serves patients from Milwaukee’s poorest neighborhoods, has recorded financial net losses over the last several years, including $17 million in 2002.
Over the past three years, Sinai has incurred cumulative net losses of $48 million.
Yet, Howe said Aurora is committed to maintaining a presence in Milwaukee’s downtown.
"There is no conceivable way that we wouldn’t be there," he said. "We’ve put a lot into that hospital over the last several years. It’s a nice, up-to-date hospital that offers wonderful, quality health care. But we do have to do things differently."
Aurora has invested $57 million in upgrading Sinai’s buildings and in purchasing new equipment over the past five years.
Aurora is looking into ways to expand access to health care so patients in the Sinai neighborhood are not routinely turning to the high-cost care available through the hospital’s emergency room.
"One of the things we need to do is give people alternatives when they have urgent care needs," Howe said.
An alternative might include more community-based clinics for central city and downtown area neighborhoods.
Howe expressed both optimism and concern for Sinai’s future.
Wisconsin Gov. Jim Doyle’s budget proposal to cut medical education funding to teaching hospitals would have dire consequences for Sinai. If approved as proposed, the budget would eliminate $57 million in Medicaid funding that pays for graduate medical education and physician training at hospitals with ties to medical schools, such as Aurora Sinai, which has an affiliation with the University of Wisconsin-Madison Medical School.
Doyle’s proposal would eliminate about $23 million of state general purpose revenue for a portion of the teaching hospitals’ costs.
Under the proposal, Aurora would lose about $8 million in Medicaid funding, with most of that coming out of the Aurora Sinai campus.
"Of course, the general medical education fund pays for the people who provide a lot of the charity care (at Sinai)," said Howe. "We are trying to convince the governor that if there are reductions – and there have to be to address the state budget deficit – they shouldn’t be against the hospitals that provide most of the medical education.
"Aurora Sinai, Froedtert, Children’s (Hospital of Wisconsin), Marshfield Clinic and University Hospital in Madison – those are the places that are taking the brunt of the Medicaid cuts. And that’s not fair. They need to be spread among everybody," Howe said.
However, Howe remains optimistic for the future of Sinai’s service area.
"My expectation is that Milwaukee is on the beginning edges of revitalization," he said. "When you look at all the new housing that’s going into downtown, our expectations are that it will be a growing market. But at the present time, we have a huge social mission. We are by far the largest charity in Milwaukee, as far as what we are providing at Sinai.
"What we have to do is figure out how to meet the needs of the downtown population in a more efficient and effective way than we do right now," Howe said. "There are going to be a lot of changes, but our total dedication is to make sure that there will always be good health care in downtown Milwaukee."

April 18, 2003 Small Business Times, Milwaukee, By Julie Sneider, for SBT

Question: When should experts be used to assist in the negotiation process?

Answer: Experts should be used anytime specific knowledge is needed to establish credibility with the other party or to strengthen the knowledge base of your position. Recognize that anytime you invite a third party into the negotiation, you risk losing control. Negotiations are volatile situations where every word and action is measured.

Choosing an expert – Experts have many faces. They can be company employees who possess specialized knowledge, such as engineers, controllers (CFOs), computer experts, etc. Or they can be people who have a recognized reputation. Their presence alone may be sufficient to shift the attitude of the other party so you gain a strategic advantage.
An example of such presence would be an offer from Donald Trump to attend a commercial real estate negotiation on your behalf. His perceived power in and of itself might cause the other party to rethink strategies without Trump ever having to say a word.
That is called legitimacy power. It is when the reputation, achievements, track record or credibility of one party influences the mindset of the other party.

The role of the expert – Be aware that anytime you invite someone to participate in your negotiation, you risk losing some control. That usually happens in one of two ways: Either the expert innocently reveals more information than what was originally agreed to or the other party asks questions you don’t want addressed, and the negotiation shifts focus.
In some cases, you might have an expert with a strong ego and, in the course of the negotiation, that person takes over the discussion. That’s difficult to control, especially when it is unexpected. One of the more frequent situations where this occurs is when an executive of a company enters a negotiation at the invitation of the salesperson.
The salesperson has been working to defend margin and needs some help finding some common ground. The executive enters into the discussion, takes a liking to the prospect and agrees to reduce the profit margin. The account executive is left holding the bag with little credibility in the customer’s eyes.
That sets up a terrible situation for long-term business development. The account executive is now at risk. Every time there is a price disparity, the customer feels comfortable picking up the phone and negotiating the agreement with the top-level executive. All power and authority has been ripped right out from underneath the sales person for trying to do the right thing.
The role of the expert is to add value – not to control the negotiation.
Never give the expert control over the negotiation unless the situation is emotionally charged (a divorce) or highly technical (certain types of contractual agreements e.g. buying or selling a business).
It is wise to seek the advice of experts in preparation for the negotiation but, whenever possible, negotiate your own agreement. No one knows the situation better than you. Turning your negotiation over to someone else may result in missing some of the finer points of the other party’s communications and strategic opportunities may be missed.

Leveraging the expert – When you anticipate the need to use an expert in the negotiation process, careful planning must be conducted in advance.
It is crucial to review as much of your game plan as possible beforehand if the expert will be participating in the entire negotiation. That includes what you want and need from the negotiation, your walk-away position, the anticipated concession demands you expect from the other party and your response, as well as the boundaries of what is appropriate to say and what is not.
Brainstorm the types of questions you expect the other party might field to the expert. Think out of the box during that exercise. Be sure to cover the sensitive information. It’s a mistake to underestimate the other party’s willingness to probe. It is to their benefit to gather as much information as possible.
Next, craft the answers based on what is acceptable and what is not. That will help your expert think under pressure, if the need arises.
The expert’s tendency will be to "talk" when put on the spot, but the negotiation is not the time to think out loud. Instead, it is the time for well-rehearsed language. In this case, having the right answer and knowing how to deliver it are critical.
There is no replacement for preparation. Short-changing this step sets you up for a wild-card experience where you can lose control and you are forced to surrender your initiative. The more information your expert has in understanding your position and his/her boundaries, the better your chances of achieving a positive outcome.

Outside experts – When the situation arises when you have to pay for expert assistance, be sure you know what you are getting. It’s not unusual to think you are paying for top talent and then have a lesser-experienced associate show up. To prevent that from happening, make sure any agreement contains provisions identifying who will be doing the work. Also, it may be beneficial to limit the number of hours that will be billed. An open-ended agreement is an invitation to run up unexpected charges.
Furthermore, you may want to consider inviting the expert to participate only in those parts of the discussion where his or her contribution is essential, after which the expert should be excused from attendance.
Be smart; use experts when their value enhances your probability for success. Take time to prepare. Be clear about expectations and boundaries. Rehearse answers to tough questions. Never relinquish your control. You have to live with the consequences.

Christine McMahon is the owner of Christine McMahon & Associates, a training and coaching firm in Milwaukee. She can be reached at 414-290-3344. Small Business Times readers who would like a negotiating situation addressed in this column can send a fax to 414-290-3330, or e-mail her at: ccm@christinemcmahon.com. Her column appears in every other issue of SBT.

April 18, 2003 Small Business Times, Milwaukee

As this article is being written, war in Iraq has begun. Hopefully, by the time you read it, our incursion will have been successfully concluded, or in that phase where its principle objective of eliminating Saddam Hussein’s regime as a threat to the free countries of the world has been accomplished.
TEC International has developed a well-respected index, The TEC Index, that is administered in survey form to more than 5,500 chief executives in the United States, 520 of whom are located in Wisconsin. This is done each quarter.
The results of the first quarter are in. This month I would like to detail how Wisconsin CEOs view our world compared with their colleagues nationwide.
The results are interesting, to say the least. I make this observation in the face of a commonly held belief that “we, in the Midwest, are different.” Also, I’m only reporting certain answer category highlights, so the percentages in response to each question will not total 100%.
In terms of the current economic health of the US, Wisconsin CEOs are no different than their nationwide contemporaries; 60% see the growth as stagnant, and 34% see it as slow and steady.
For the full 2003 year, again, there are no differences. Seventy-six percent see the numbers coming in between 1 and 3 percent. In terms of specific business plans for the remainder of the year, again, there are no differences. Fifty-two percent expect to further cut operating expenses, and 52% are modifying their business strategy. Only 17%, in both cases, do not believe that the economy will affect their business plans.
The picture regarding personnel staffing is more convoluted. Thirty percent of the entire survey sample expects to increase staffing by 1 to 5 percent over the next 12 months. However, half as many Wisconsin CEOs compared with CEOs nationwide expect to increase staffing by more than 5%. Thirty percent of both groups see no change in staffing over the next 12 months.
Decisions regarding capital expenditures are similar for chief executives in Wisconsin and nationwide. Thirty percent expect increases in the 1 to 10 percent range. Seventeen percent see decreases of similar amounts, and another 35% see no change from last year.
Projected sales revenues show some differences between the Wisconsin and nationwide sample. Forty-four percent of the Wisconsin group expects sales to increase by less than 10%, while 33% of the nationwide group expects this. Likewise, 22% of the Wisconsin group see increases in the 10 to 20 percent range, while 27% of the nationwide group expect 10 to 20 percent growth. Ten percent of both groups report no expected change in revenues.
Roughly 86% of both samples identify these two strategies as most critical to long-term success: repositioning the company to accelerate growth, and recruiting and hiring top talent.
There is no disagreement between either group in supporting President Bush’s efforts to cut taxes: 62% agree, 20% oppose and 14% are undecided.
Regarding economic stimulus actions, there are some similarities and differences. About 60% of CEOs nationwide and in Wisconsin want to see income tax reductions for all earning brackets.
Interestingly, 32% of Wisconsin CEOs voted for tax reductions weighted more to middle and lower income brackets, while only 13% of CEOs nationwide did so.
Likewise, and far more striking, only 8% of Wisconsin CEOs support payroll tax reductions compared with 33% of the nationwide CEO sample. About a quarter of both groups want to see estate and dividend taxes reduced.
Regarding the war in Iraq, 16% of both groups expect it to have a mild positive impact. However, 63% of the nationwide CEOs expect a mild negative impact, compared with 48% of Wisconsin CEOs. Not surprisingly, over two-thirds of both groups supported the war effort before it became reality! On a similar note, both CEO groups rank Iraq and North Korea as presenting the most danger toward the US.
Roughly 60% of both groups support an increase in government powers of surveillance. But in terms of preparing for a potential terrorist attack, three quarters of both groups see nothing other than “business as usual.”
The final question of the TEC Index Survey asked respondents to indicate which industry will rebound fastest in 2003. There was a close match between Wisconsin and nationwide CEOs: biotechnology was ranked first; information technology second; and retail, manufacturing and professional services third.
Let’s face it, surveys are surveys and just that. They give us a clue of the future, but only that.
I continue to be impressed by the fact, as witnessed by a recent international conference of TEC colleagues that I attended representing more than 7,000 TEC members from 15 countries, that we in Wisconsin are highly respected for our continuing ability to successfully compete in spite of adverse circumstances.
China notwithstanding! Until next month, good fortune to all our Wisconsin enterprise!
Harry S. Dennis III is the president of TEC (The Executive Committee) in Wisconsin and Michigan. TEC is a professional development group for CEOs, presidents and business owners. He can be reached at 262-821-3340.
April 18, 2003 Small Business Times, Milwaukee

Vermatic Products, a New Berlin-based manufacturer of single and multiple clamp assemblies for tubes, pipes and hoses, has been purchased by a new business venture and renamed Vermatic Inc. Cathy Kraatz has been appointed president to the woman-owned company. Terms of the acquisition were not disclosed. Privately held Vermatic Products (www.vermtic.com) was founded in 1975. Vermatic’s cushion-clamp assemblies are used to reduce shock and vibration caused by fluid surges in pipes, tubes, and hoses used in both mobile and stationary industrial applications. Industries served include railroad, agricultural equipment, material-handling equipment, refuse haulers, steel mills, forklifts and fire and rescue trucks. Vermatic plans to diversify its product line, immediately expanding it to include stainless steel hardware to meet much of the demand in the market today. The company is at 1785 S. Johnson Rd.

Landmark Credit Union reported growth in assets during 2002 of 17.5%, to $698 million. Ron Kase, president, said the year also brought the credit union a new business-lending department and new offices in Watertown, at Midtown Center in Milwaukee, and a student-run branch inside Waukesha North High School. Several new records were achieved, including first mortgage loan volume to $342 million, indirect loans to $131 million and new members, to 97,986. Due to the economy, loan delinquency increased slightly to 1.15%.

Frank Gentile Subaru in Racine has been awarded Subaru Stellar Performer Certification status. The program recognizes Subaru dealers nationwide who adopt operational standards established by Subaru of America in the areas of customer sales and service processes, facilities and systems. It focuses on improving overall quality and consistency in the ownership experiences of Subaru customers. "We are pleased to be recognized in this way by Subaru," stated Ralph Gentile, president of Frank Gentile. "Customer satisfaction is and always will be our No. 1 priority. Our goal is to exceed the expectations of each of our customers."

Lakefront Brewery has released Cattail Ale, a Wisconsin-style mild ale, the first to join the ranks of the Milwaukee brewery’s year-round beers in six years. "The Cattail Ale is a special formula we’ve been working on for a while to reflect a style of ale indigenous to Wisconsin," says Russ Klisch, president of Lakefront Brewery. "We recognize the demand for a handcrafted mild ale in our lineup to appeal to wider audiences. As such, we’re expanding into a new market and do not anticipate cannibalization of our existing products. This recipe is a true craft ale brewed with only water, yeast, hops and malted barley, in keeping with the Bavarian Purity Law of 1516." Lakefront Brewery shipped the first cases and kegs of Cattail Ale to Beer Capitol at the end of March. The ale will only be available in Milwaukee and Waukesha counties until inventories are built to allow wider-ranging sales, noted Klisch.

New Berlin Plastics has been awarded ISO 9001:2000 certification for quality system management by National Quality Assurance, USA. "Everyone at New Berlin Plastics is very proud of this important achievement," said Mark Siewert, chief operating officer. "By becoming ISO 9001:2000 certified, we have positioned ourselves as a leader in the injection molding industry, exhibiting our commitment to quality in all aspects of the organization. We are particularly pleased that our employees were able to achieve this important goal in less than one year." The company is a molder of precision components utilizing engineering grade thermoplastic materials. "Since Mark and I acquired New Berlin Plastics in 2001 we have worked with our employees, customers and suppliers to transform the company into an injection molding manufacturer which can compete in the 21st century," stated Jeff Held, president.

Susan K. Wehrley, president of Susan K. Wehrley & Associates in Brookfield, has released her new book called The Secret to I AM, an inspirational book intended to help people find peace and wisdom during chaotic and unpredictable times. "With the Four Secrets in the book: Embrace your Uniqueness, Embrace the Unknown, Embrace Intuitive Wisdom, Embrace the Love of Go Within, readers will be able to have the courage to live in the moment with an open-heart, yet have positive expectancy in the future," she said. The book is available on he Web site www.solutionsbysusan.com and will be available in the bookstores soon.

The Mail Boxes Etc. at 544 E. Ogden Ave. in Milwaukee has been purchased by Dean Koch and Erran Bennett, who have owned and operated the Mequon Mail Boxes Etc. since the mid-1990s. The Mequon store, in the Mequon Pavilions, has been the top-grossing Mail Boxes Etc. store in the Milwaukee area since 1997, according to Bennett and Koch. More than 3,000 Mail Boxes Etc. locations around the United States, including the 14 in southeastern Wisconsin, will begin re-branding to The UPS Store this month. The re-branding, scheduled for completion by September, will be the largest such effort in retail and franchise history. The unveiling follows UPS’s March 25 announcement of a global branding initiative featuring the first redesign of the UPS logo in more than 40 years. The owners of nearly 90% of Mail Boxes Etc. centers, or more than 3,000 of the approximately 3,300 U.S. locations, elected to re-brand as The UPS Store following a year of testing and a month-long series of franchise area meetings across the country. Mail Boxes Etc. is a subsidiary of UPS.

Jim Winistorfer has launched the Milwaukee office of Clarity Strategies, a partner of Clarity Consulting, a nine-year-old research firm in New York. Clarity provides market research, customer analysis and competitive intelligence studies. Winistorfer, a former client of Clarity, had been general manager and a marketing and sales executive with Waukesha Bearings (Dover Corp.), Johnson Controls and Cooper Power Systems.

Great Lakes Concrete Pumping has opened in West Allis, serving commercial and residential construction projects with Schwing concrete pumps and placing booms. "There has been consistent growth in construction in metro Milwaukee," said Dick Farrell, company president. "Because of that growth, we realized that this market offered an opportunity to expand our pumping business." Farrell most recently worked with Putzmeister America in Racine, and Construction Forms in Port Washington.

Seattle Sutton’s Health Eating has entered the Milwaukee market with a facility at 1233 N. Marshall St. on Milwaukee’s east side. Marian Topp is the independent distributor at the Milwaukee location. The company offers prepared meals for home consumption. "This is a great opportunity to provide people with freshly prepared, healthful meals that are affordable," Topp said. "It is not a fad diet, it’s a healthful eating plan, providing the food, in portion sizes, that people should be eating." The company provides customers with 21 meals weekly – breakfast, lunch and dinner for seven days. Target customers are people who want to lose weight as well as those with medical needs requiring a strict diet, and those who simply want such convenience. Topp, of Whitefish Bay, opened the Milwaukee location as an opportunity to teach her children about family business operations. "With kids ranging in age from 15 years to 9 months, I thought this was a perfect opportunity to provide them with hands-on experience," she said. "They help with anything from creating and distributing flyers, direct-mail marketing, banking, distribution, customer service, and organizing the office." There are also distribution sites in Elm Grove, Racine and Shorewood. The business (www.sshe.com) was founded in 1985 by Seattle Sutton, a registered nurse. Today, it has annual sales of approximately $16 million. Its headquarters are in Ottawa, Ill.

The First National Bank of Hartford has selected PULSE Online to deliver Internet-based services for its customers. PULSE Online is an Internet banking program introduced by PULSE EFT Association, an independent, national industry-owned and controlled electronic funds transfer (EFT) network. Bank Vice President Tony Andereck said the bank’s ability to control the Web-enabled messages, appearance and functionality, along with the ease of implementation, were key factors in selecting PULSE Online. "We will provide customers with a comprehensive online product that reflects the quality, image and reputation that our bank has built over nearly 100 years of service," Andereck said. He said that The First National Bank of Hartford would begin offering its account-holders online banking in June after testing is completed in April and May. Bank customers will be able to perform a wide range of operations online, including accessing and viewing their account balances and transaction details, transferring money between accounts, paying bills, reordering checks and contacting a customer service representative. The First National Bank of Hartford has served its community members since 1907 and currently holds $136 million in assets.

April 18, 2003 Small Business Times

You’ve heard of putting greens in the office. Now an Elm Grove company is offering a product that will let you swing an iron or a driver in the office, working with a desktop computer-based simulator.
Wisconsin Golf Marketing has been named distributor of the new E-Club Golf Game in Wisconsin, Illinois, Michigan and Minnesota.
"We saw the product at the PGA show in January and it looked very interesting," said Jeffrey Harrop, one of the partners in Wisconsin Golf Marketing. "We tested it and we tested it and we tested it, and we realized it is great."
The E-Club, a system developed in Spain by Champions Net, is a golf game that acts like a simulator running on a personal computer. The E-Club Golf Game allows a player simulated access to a variety of golf courses or to hit balls on the practice range with his own clubs.
With a sensor attached to a golf club, the player swings over a sensor pad. That pad reads the clubhead speed, swingpath and face angle, and translates that information into a shot on the golf course. "It’s incredibly accurate," said Harrop, who also has ownership in the Westridge Golf Course in Neenah. "With the popularity of golf in Wisconsin, we knew there was a huge market for this."
The technology allows the golfer to play courses available on Microsoft Golf and Tiger Woods EA Sports games. It is compatible with Windows-based PC systems.
Wisconsin Golf Marketing is just over a year old. It was founded to market golf cards – prepaid access to courses around the state. It currently has cards for courses in Milwaukee, Door County and the Fox Valley. Its Milwaukee card includes the Morningstar, Washington County, Broadlands and Kettle Moraine courses.
Wisconsin Golf Marketing is currently selling the E-Club Golf Game on its Web site www.wisconsingolfmarketing.com and also selling the game to golf shops and retail stores in the Midwest area. Originally priced at $499, it is now selling for $299. For more information, contact the Web site or call 1-888-550-6825.

April 18, 2003 Small Business Times, Milwaukee

A downtown Milwaukee marketing communications company was an apparent victim of a recent "hack job" in which its telephone system was programed to make about 20,000 phone calls to the Philippines.
Creatonomy Inc. founder Priya Barnes said she received a call on the weekend of March 29 from her long-distance phone company, Qwest Communications, warning her that someone had programed her system to make the calls.
"They called me at home because I was obviously not at work," Barnes said. "We use Qwest for home service as well. It was their fraud guy. At that point, 1,000 phone calls had been made. I had them cut off my international access at that point."
Representatives of Qwest’s fraud and public affairs departments declined to comment on the incident.
According to a principal of Intellicom Wisconsin, Creatonomy’s phone system supplier, hacking into the Panasonic phone system operated by Creatonomy is not a simple task.
The Creatonomy system included a password, according to Barnes.
"If somebody hacked into their system, they had to have broken some type of a password and maliciously hacked their system," said Todd Poniewaz of Intellicom. "But I’ve been working on these systems for 20 years, and I don’t even know the sequence you would go through to do that."
"They managed to get a hold of my administrative access," Barnes said. "They set the system up to autodial out to the Philippines. The system attempted about 20,000 calls. Most likely, it was a prankster. The guy from the police department thought it could have something to do with a porn ring."
However, Poniewaz has a different theory on the motive behind the outbound calls – and the identity of the perpetrator at Creatonomy, which is based at 1661 N. Water St.
"You have to ask why somebody would want to do this," Poniewaz said, speculating that the incident was the work of someone who possessed the administrative access code. "To me, it sounds like somebody at the company was unhappy, and they must have had some basic knowledge and hacked into it."
But Barnes said her company hasn’t had that kind of employee situation.
Poniewaz said he has never seen another case involving malicious use of a phone system to make outbound calls.
"I have seen customers come in and need us to reprogram their phone systems," Poniewaz said. "They had an employee who ended up leaving, and they must have called up and changed the programing on it. I’ve seen that, but I have never seen somebody hack into a phone system and start using the system to make outbound phone calls."
Barnes said the only employee to leave the 3-year-old company departed under good terms.
"That was the first question the tech asked me," Barnes said. "We work with a lot of freelancers, but none of them use our offices."

April 18, 2003 Small Business Times, Milwaukee, By Charles Rathmann, of SBT

In 1982, when Milwaukee-area architect Fred Poethig retired from the firm he and partner Bob Stuerwald founded in 1955, it was to the home he designed and built in Milwaukee. But as he and his wife entered their 80s, they had no family to care for them.
"We were doing well, but it got to the point that if something did happen to us, we only had each other," he says. "We wanted a place to live that also provides a broad spectrum of health care for the rest of our lives. After looking at a number of facilities, we chose The Village at Manor Park, and moved in November 1999."
Poethig is satisfied with his decision. "We have a two-bedroom unit in the independent living building called Wesley Park. We were actually able to move all our furniture here except our old kitchen table and chairs," he said. "We’ve got fine neighbors, I’m treasurer of the residence council and we’re happy here."
The Poethigs are among a growing population of people 60 years and older that has increased 170% in Wisconsin alone. While nine out of 10 of those people want to continue to live independently as long as possible, and most want to remain in their homes, many will need help to do so. That assistance most often falls on a close family member, such as a son or daughter.
"The National Alliance for Caregiving reports that family caregivers spend an average of 22 hours a week helping their elderly relatives or friends," says Jenny Rayl, president of Home Instead Senior Care, a nonmedical services franchise with almost 400 sites in America, Canada and Japan. Jenny and Steve Rayl operate three offices in southeastern Wisconsin (Wauwatosa, West Bend and Mequon).

Where to start
If you don’t have 22 hours to spare, there are places to turn. And most resources will point you to other services if theirs don’t meet your relative’s needs. One complete source of information is Senior Resources, a Germantown firm that publishes free guides on health care for older adults and senior housing options. You can call 262-253-0901 or visit its Web site at www.seniorresoucesonline.com. The guides are specific for different areas in Wisconsin.
The health care guide, for example, lists adult day services, care coordination firms, homemaker/companion services, home health and medical equipment resources, hospices, hospitals and skilled nursing facilities, and provides useful articles as well. It also has informational phone numbers for agencies, a national eldercare locator, and county departments on aging and benefit specialists.
A needed first step, however, is to determine what your senior relative’s needs are. Ideally, that can be done in a family conference where the older parents and their adult children can openly discuss:
— Whether all paperwork (insurance policies, will, durable powers of attorney, household inventory, etc.) is order and where it can be accessed;
— The parent’s wishes for living arrangements, now and in the future
— Finances available now and down the road;
— Any help required and acceptable to all parties;
— Medical conditions and how they’re currently being handled, plans if those conditions worsen, preferred doctors, clinics, hospitals, etc.

"These matters all need to be discussed and clarified over time or in one big session," suggests Miriam Oriensis-Torres, co-founder of Geriatric Support Associates (GSA), a care management firm in Milwaukee. "The trouble is, it’s difficult for adult children to switch roles and begin looking out for those who cared for them for so long. Understandably, older adults don’t want to admit they need help and often are resistant to accepting it. Sometimes a neutral third party can come in, assess the situation and make suggestions with more impact and acceptance than the adult child’s ideas."
Assessments by geriatric specialists are usually done at no or little cost and provided by care coordinators, such as those at GSA or non-medical service providers such as Home Instead.
County human services or elderly services departments also do assessments to qualify people for county benefits and/or for the state-funded Community Options Program (COP), but waiting lists can be long.
"The goal is to create a plan the older person will accept," Oliensis-Torres says. "We’ve found expectations vary. The son or daughter might have higher standards about the parent’s housekeeping, diet or social interaction, while the parent is perfectly happy. A neutral but knowledgeable ‘outsider’ can create a plan that may not cover everything the adult child or the caregiving firm thinks is needed, but act as a beginning. Change must be incremental; there’s no quick fix to alleviate all of the family members’ anxiety and concerns. Any first plan can be amended over time, and often is as the older adult gets more comfortable with having someone new come to their homes and a trust relationship is established."
She points out that it’s important to call in an experienced, well-trained person.
"In some situations, the older adult can’t perceive her real needs or the reality of the situations," Oliensis-Torres points out. "You need someone who can understand if the older adult is expressing his preferences and values or displaying a cognitive impairment."
If the initial assessment does point to a situation where the older adult’s welfare or health is threatened, people doing the assessments will act aggressively to find help for the person.

The next step
Once you understand what your parent needs and is willing to accept, financial and health factors will probably dictate if you can rely on volunteer organizations, often run by religious groups, or go with a paid service.
The Family Caregiver Support Network, which offers interfaith older adult programs, may be a good resource. You can reach it at 414-220-8600, and
find it and other such agencies at:
— www.living-options.org
— www.caregiversupportnetwork.org
— www.eldercare.com
Those sites also can be a wealth of information on elder care.
If you determine your parent only needs help with daily tasks, a care service like Home Instead may be the way to free your time and get the assistance your loved one needs.
"After our initial meeting with the older adult and family, we develop a plan of care, how many times a week a service is required, what things should be documented for the family, and specific services to be performed," Jenny Rayl says. "We match the person with one of our well-trained caregivers from that neighborhood, who knows the banks, stores, clinics, parks, etc."
Services vary from companionship, grocery shopping, transportation, meal preparation and light housekeeping to coordination of lawn care or home maintenance people, assistance with pet care, respite for the primary caregiver, or supervision while the primary caregiver is on vacation. "Some of our not-so-typical services are provided within a care facility to give the older person some needed one-on-one attention," Rayl says. "We can provide overnight care for those who may be in risk of falling, get people ready for bed, drive the senior to an adult day care facility, or do something simple like help put together photo albums, or take the person for a drive by the lake. Because we’re in the home frequently, we’ve even uncovered mail and phone schemes, and foiled the ‘con man’ from praying on a senior citizen."
For one of Home Instead’s families, the care services have stopped nightmares and tears for the primary caregiver, who is the wife of a Milwaukee area law firm’s senior partner.
A Glendale woman, who prefers not to be named in this report, was really concerned when her mother-in-law stopped going to the beauty shop, lost weight and was sleeping all the time.
"We knew we had to do something, so we called Jewish Family Services. They highly recommended Home Instead," the Glendale woman recalls. "Now Lorraine comes in from 10 a.m. to 1 p.m. every day. She does light housework, feeds Mom breakfast and puts out simple, explicit directions for preparing supper, grocery shops and finds bargains with Mom, and takes Mom to the beauty parlor. Mom thrives on the companionship. She looks better, takes the medicine I organize for her weekly, and is eating so well she’s gained back the weight she lost."
The Glendale woman believes the arrangement is a good compromise. "Mom is almost ready for an assisted-living facility, but she loves her apartment and doesn’t want to move. My nightmares and tears whenever I thought of Mom are a thing of the past. When I pop in to see Mom and Lorraine, they both get a hug now. And unlike many bills, Mom never balks about writing out a check to pay the reasonable tab for Lorraine’s services."
For more information on how to select a caregiving firm, see the adjacent box.

Getting more help
Care coordinators can help sons and daughters in a variety of ways. They’re typically trained as social workers experienced in eldercare.
"Some people ask us to act as a consultant to make recommendations about what the elderly person needs," Oriensis-Torres relates. "Other families want us to introduce services, monitor progress and tweak the plan. We work with everyone involved in that person’s life, too, to find appropriate resources, whether that’s financial, legal or medical; in-home and community-based care such as caregivers, delivered meals, transportation and adult day care programs; and a wide range of alternative living arrangements."
Time frames also vary. "If we assess the situation and put a plan of care in place, it may stay that way for six months to three years without our further intervention," she explains. "Then if something changes, the adult child will reinvolve us to find the additional services their parent needs. We can provide the continuity and background to whatever service agencies are required, saving the client family stress and time."
She adds, "Part of our service is emotional support for the family. For those in the area, we co-host a monthly discussion group on caring for an aging relative. If the family lives elsewhere and can’t visit often, they know we’re here to monitor the situation and respond to emergencies. We don’t have a financial relationship with any providers and won’t accept placement fees, so families can trust us to act on their behalf based on our judgment of what’s best for the older person."
To find a care manager in your area, the National Association of Professional Geriatric Care Managers maintains a Web site (www.caremanager.org). For more information, call 520-881-8008.

April 18, 2003 Small Business Times, Milwaukee, By Kay Falk, for SBT

Realtors poll shows desire for leader with integrity, focus on taxes, crime education

By David Niles, of SBT

Milwaukee residents want their next mayor to be a strong leader with integrity, and someone who will help bring jobs to the city, reduce crime and improve schools.
That’s what the Greater Milwaukee Association of Realtors (GMAR) found out in its Spring Survey 2003, conducted March 3 and 4.
The results were similar to those of a Small Business Times mayoral poll which was reported on in the paper’s April 4 issue.
Milwaukee voters next April will select a mayor to replace John Norquist, who first took office in 1988 but who is not seeking re-election.
When SBT readers with businesses in the city of Milwaukee were asked about the characteristics the next mayor should possess, there responses included relationship skills, strength/vision and integrity.
The GMAR polled 400 likely voters in the city, seeking to gauge the political environment in the city. What the organization found was a city facing change and voters who are preoccupied with their pocketbooks, according to a report prepared by Public Opinion Strategies of Washington, Denver and Los Angeles, which conducted the survey.
The GMAR will use the survey as a benchmark for further analysis of the mayoral race, said Mike Ruzicka, president of the organization. The group will have two more polls conducted prior to the election. Additionally, the survey results will be used as GMAR officials determine how the candidates stack up to the poll findings and to GMAR goals, he said.
"I think we have a good basis of issues we want to see addressed in the campaign," Ruzicka said. "We’ll be able to dial down and see where the candidates stand on our issues."

The GMAR survey summary says:
— The Milwaukee political environment is very negative and indicates that voters are looking for a change. Only 33% of voters say things are heading in the right direction in Milwaukee, while almost two-thirds of voters say things in Milwaukee are on the wrong track.
— Some important conservative leaning and swing coalition groups are leading the "wrong track" sentiment: conservative independents (76%), soft Republicans (74%), women 18-54 (66%), working women (64%) and Republicans (63%).
— The two top issues for voters are the "economy" (25%) and "holding the line on city taxes" (23%).
— Voters are very aware of the budget problems facing the city, and when faced with the prospect of cutting spending for critical programs or raising taxes, a slim majority of voters chose spending cuts, even if it affected critical programs (51%).

When SBT’s Milwaukee readers were asked about the top issues, the leading responses were taxes, transportation, infrastructure and crime.
When GMAR survey respondents were asked to list the priority the next mayor should have, 25% said job creation and economic development, 23% said holding down city taxes and spending, 16% said fighting crime and improving public safety, 13% said improving the quality of public education and 9% said making health care affordable.
But 62% said the next mayor should have integrity, while 61% said he should be a strong leader. On the other hand, only 30% said the new mayor should be a "fresh face in Milwaukee politics," while just 19% said he should be a reformer.
On the city’s financial situation, while the conservative groups and African Americans support spending cuts, municipal employees, union members and homemakers support raising taxes. Those results came when survey participants were asked if, in response to a projected $10 million city budget deficit, cuts should be made in critical services or taxes should be raised by $100 to $200 on average per property owner.
Ruzicka said the survey team noted it was very significant that there was a 10-point discrepancy between those who want services cut and those who want taxes raised.
Ruzicka added that the GMAR believes Norquist has been good for the city, with the mayor’s efforts leading to greater property values, a resurgence of downtown residences and initiatives to improve schools and fight crime. "John Norquist, in our eyes, has done a very good job," Ruzicka said.
The schools and crime issues are vital issues to homeowners, he added. "You always hear ‘location, location, location’ in real estate," he said. "But if you scratch the surface of that, you find the issues of crime and schools – they are the two big drivers of where people live."
While the GMAR survey did not ask respondents about potential candidates, Ruzicka said the organization has worked well with aldermen Tom Nardelli and Marvin Pratt, and that former Congressman Tom Barrett is appealing. Milwaukee County Sheriff David Clarke "appears to be good, too," Ruzicka said.
The Small Business Times poll, conducted by Business Development Directives of Eagle, did pose names to survey respondents.
When asked about their familiarity with names of people who say they will run for the mayoral post and those whose names are mentioned as potential candidates, the following responses were given, with 5 being the most familiar with the name and 1 being the least familiar: Barrett, 4.2; Nardelli, 3.6; Pratt, 3.6; Clarke, 3.4; Alderman Michael D’Amato, 2.2; Milwaukee County Clerk Mark Ryan, 2.1; State Rep. Pedro Colon, 1.8; developer Randy Roth, 1.3; Municipal Judge Vince Bobot, 1.2; businesswoman Sandy Folaron, 1.1.
The entire Public Opinion Strategies report on the GMAR survey can be found at www.metrorealtors.com.

April 18, 2003 Small Business Times, Milwaukee

War call-up brings no boost for temp agencies

By Heather Stur, of SBT

Although the war in Iraq has pulled many workers from their jobs, local staffing agencies have not been hit with a large demand for temporary help.
As of March 18, about 2,250 members of the Wisconsin Army and Air National Guard were listed on active duty, said Ann Peru Knabe of the 440th Airlift Wing Public Affairs office at Milwaukee’s General Mitchell International Airport. That’s about 23% of the Guard’s 9,800 soldiers and airmen in the state.
Soldiers and airmen from units in 24 Wisconsin communities currently are serving on active duty with the Army and Air Force.
But with the economy still in a slump, some companies are not replacing employees who have been called to military service, said Joel Schneider, president of SEEK Inc. in Grafton.
"A lot of companies are in a standstill or lay-off mode," Schneider said. "The economy is still tough, so employers aren’t filling positions left by those in the military. Also, many of the people being called up are in supervisory roles, and you don’t replace those with temps."
Not all companies tell staffing services the reason they need temporary employees, Schneider said. Still, SEEK has not had an unusually large number of requests specifically for military replacements.
"If we have 50 temps out there specifically filling the jobs of workers in the military, I’d be surprised," Schneider said.
Express Personnel Services, a Racine-based agency, also has not received many requests for the replacement of employees who have been called up to active duty, said owner Jeff McKeown.
The military issue has hit Express Personnel directly, however. One of its employees, Trever Brehm, was called to active duty with the Army just days after he received a promotion to a lead position in the company.
To help companies that do need workers to replace military personnel, Express Personnel has established its Express Freedom Worker Program.
As part of the program, Express Personnel provides existing clients with replacement workers at a reduced rate. Freedom Workers are provided at Express Personnel’s basic cost, with all temporary and contract staffing fees waived.
The Freedom Workers program will be in effect for at least the next 90 days.
"In today’s tumultuous economy, many employers do not have the time or money to stop and train employees to fill positions temporarily left by armed forces personnel," McKeown said. "With uncertainty about the length of time military personnel might be gone, employers are reluctant to fill vacated positions permanently. And they are obligated to maintain an opening when the military personnel return."

April 18, 2003 Small Business Times, Milwaukee

Today there are 16 million employed caregivers. A1997 study by the National Alliance for Care Giving and AARP put the loss of wages and productivity due to employees taking time off work to deal with problems of their parents or older relatives at $11 billion per year.

Miriam Oriensis-Torres, co-founder of Geriatric Support Associates in Milwaukee, puts that figure closer to $29 billion annually.

"We’ve seen studies that report 42% of full-time employees expect to be providing eldercare by this year. Employers don’t have to feel helpless, however," she says. "Care management firms, county elderly services departments, agencies on aging, community outreach groups and other care providers are willing to help educate you and your workforce. This makes your employees more productive on the job and saves your business money."

Tom Henley, community relations outreach coordinator at The Village at Manor Park, in West Allis, agrees.

"The time to make a critical decision is not in the middle of a critical crisis," he says. With more people in America turning 60 than there are babies being born every day, the time to get started is now."

Talk it over, over lunch

There are several ways to help employees prepare for their own old age (or incapacity) and deal with their parents’ needs, but an effective way, Henley suggests, is to offer a series of brown bag discussion groups. Topics to cover include:

— Why paperwork should be in order (wills, durable powers of attorney, financial records, insurance papers, etc.).

— What you should know if something happens to a parent (where papers are, health history, medication list, names of doctors and preferred hospitals, etc.).

— The importance of having long-term care insurance, what it should cover, when to get it, and questions to ask of suppliers.

— Government programs for the elderly – "There are a lot of misconceptions about what Medicare covers and a lack of understanding of how Medical Assistance (Title 19) works," Henley pointed out. "There are also county-administered Community Option Programs that can subsidize housing expenses, and many county services for the elderly many people don’t know are available."

— Services — non-medical and medical — available that allow people to remain in their homes as long as possible.

— The difference between housing options (independent living, life-care, assisted living, community-based residential facilities, nursing homes, etc.) for when at-home care is no longer desirable or possible.

— Transition to new housing – senior real estate specialists can discuss their services, explain how property liquidators and moving companies can help relieve the burden of moving/disposing of 30 to 50 years of "stuff."

— Safety issues to be alert for, helpful health aids (such as grab bars and raised toilet seats) and even the growing telemedicine field where people can interact with their doctors over the Internet.

— Respite and adult day care options.

— Support groups for caregivers and/or the person beingcared for.

— What a care manager does.

— How to be an advocate for the elderly (or for just your parents).

— Signs that point to the need for intervention.

— How to talk with elderly parents and what you should discuss about their wishes, plans and health care.

— Alzheimer’s disease and other dementia.

Other solutions

Henley also says his facility and others specializing in eldercare can provide training to human resources staff so they can assist employees.

"We can help you develop an eldercare employee assistance program, set up a resource library, provide on-line resource information and give referral assistance," he explains.

Henley notes that "the people most affected by aging parents and older relatives are the 40- to 60-year-old managers – employees you can least afford to have missing work or quitting because they need time to deal with their loved ones’ problems."

April 18, 2003 Small Business Times, Milwaukee, By Kay Falk, for SBT

Data: Hospital-owned clinics charge more

By Charles Rathmann, of SBT

Health care provided by clinics associated with hospital groups in southeastern Wisconsin is significantly more expensive than care provided by clinics with no hospital affiliations, according to data gathered by Independent Physicians Network (IPN).
The Milwaukee-based group coordinates care for patients on behalf of health plans.
The cost data covers a variety of health care institutions and also reflects actual payments made by public insurers such as Medicare and Medicaid, as well as by private insurers.
The data compares the costs of providing care in hospital-owned facilities with the costs of care in freestanding clinics in the region during 2002.
Most available health care data, including information collected by the State of Wisconsin Department of Health and Family Services, reflects only published rates. Just as a manufacturer’s suggested retail price might not reflect what consumers pay for a new car, insurers negotiate discounts on the standard rates for clinical and hospital care.
Figures on what is actually paid for care are protected by confidentiality agreements. However, according to IPN chief executive officer Charlette Heyer, the group, which includes 1,000 physicians in southeastern Wisconsin, is still able to break down cost figures by type of institution.
According to the figures released by Heyer’s organization, payments made for the same procedures can cost almost four times as much in a hospital-owned clinic than in a freestanding clinic.
While figures compiled for release do not encompass every condition or procedure, figures released in previous years covering a variety of different medical procedures exhibit a consistent pattern of higher costs at hospitals and hospital-based clinics.
Industry insiders point to a variety of reasons for the significant disparity, including the greater leverage major hospital groups have in negotiating compensation from insurers and higher overhead.
"Yes, hospital-based services have higher prices than clinic-based," St. Joseph Regional Medical Center chief operating officer Rick Hart said. "MRI, for example. In a clinic, you will treat outpatients who arrive on time and only during business hours and who may have very special types of testing. In a hospital setting, you may need to have 24-hour call, seven-days-per-week service. You need to treat patients who are unconscious, who need IVs, etc. Many will be inpatients for whom no extra payment is given, so the payment from outpatients may need to be subsidized."
Health care consultant Sara Stanton of Waukesha-based Stanton Healthcare Management said the limited scope of the data makes it difficult to make conclusions, but she agreed with Hart that the different overhead structures are a factor in care costs.
"Hospitals and managed care agree on prices for services," Stanton said. "Volume of patients is a determinant in those discussions also."
Dr. Susan Turney, medical director of patient financial services for the Marshfield Clinic, offered an outsider’s view of the data. The northern Wisconsin entity is the largest private group medical practice in Wisconsin, with 591 physicians and 4,365 other employees. The group does not serve the southeast Wisconsin market.
Turney, who serves on the board of directors for the Wisconsin Medical Society, said the selection of procedures and services covered in the data released by IPN may reflect a bias.
"Obviously, by presenting this data, they are trying to make some sort of point," Turney said. "It is very difficult just seeing this sheet alone. It is hard to compare costs when they are provided at different types of facilities."
Turney stressed that hospitals and clinics bill very differently for their services, and often, historical relationships with insurance organizations can influence payments made for various procedures and services.
"The billing mechanisms and the payment mechanisms vary by the site," Turney said.
According to Heyer, the figures reflect all payments, including facilities charges. Hospitals have a greater degree of leeway in determining what to bill for services, according to Heyer.
"For a physician, you can only bill for what services that are performed," Turney said. "With hospital billing, a lot is already bundled into the payment mechanism. At a physician’s office, I am not going to bill you for an ACE wrap and a bandage and taking your blood pressure – that is all part of the office visit. In a hospital, they still have the opportunity to recover some of their cost by billing for other, extraneous things."
According to the IPN data, payments to hospitals have not come down as hospital groups have gained the ability to perform basic procedures in a clinic environment.
"Some of the cost is based on historical precedent," Turney said. "Care has transitioned from an inpatient to an outpatient setting. We know that many people have cataract surgery used to be a week in the hospital. They now go through the procedure and are released same day. There is a lot more cost with an inpatient stay."
According to Turney, reimbursement levels have in some cases not dropped to reflect the lower costs of procedures.

April 18, 2003 Small Business Times, Milwaukee

You and your parents need a Plan B for care

By Kay Falk, for SBT

A very important question you need to ask yourself and the elderly relatives you’re close to is: Who’s going to make decisions about your health care and finances if you can’t?
According to Julie Short, an attorney with Vance Wilcox Short & Short who specializes in elder law for clients in Jefferson and Walworth counties, you can save money and reduce stress and heartaches if you plan ahead.
"At a minimum, you need to set up both health care and financial powers of attorney," she stressed. "For example, if a parent or you suffer a stroke or if you are in an accident that even temporarily results in legal incapacity, someone else will have to make health care and financial decisions for you.
"If you have no durable health care or financial power of attorney designated, someone close to you has to get a court order to be appointed as a guardian. That process is time-consuming, stressful at an already stressful time, and costly, often more than $1,000," Short said.
Short points out that Wisconsin has a statutory health care power-of-attorney form you can download from the Internet, and that many hospitals and even doctor offices have the forms, as well as lawyers.
"This form is readily available at no cost, and includes provisions to address life-sustaining procedures," she notes. Because it is a legal document, she recommends that you consider reviewing the form with an attorney.
To establish a financial power of attorney, someone who can make financial decisions if you’re incapacitated, you definitely need an attorney.
"There are many strategies to fit various financial situations, and you want to be very careful about designating a trustworthy person," Short notes. "A specialist in elder law can be very helpful in seeing that your wishes can be carried out if you’re not able to be in charge."
Some of the services an elder-law attorney offers include:
— Making you aware of the pros and cons of annuity, long-term care and Medicare supplemental insurance plans. "There are many options and increased flexibility in today’s insurance offerings. Most elder-law attorneys have low or no-fee first appointments that you can use to discuss these options," Short explains. "Too many people are scared into buying a plan by insurance sales rhetoric. It’s often wise to let an independent person explain options and evaluate the plans before you sign."
— Alerting you to state and federal government benefits. For example, many people don’t know they could qualify for SeniorCare prescription drug assistance. A good elder law attorney is familiar with those benefits.
— Helping with estate planning to reduce tax consequences and more easily transfer assets following death.
— Creating a contingency plan for small business owners. "If you die or are temporarily incapacitated, are you comfortable having your business partner, spouse or child make decisions for you?" Short asks. "It’s important to establish a plan, a clear tool that lets all parties understand what you want to happen. Succession planning can set up a buyout or repurchase formula for survivors. This makes it easier on who’s left, and allows them to concentrate on continuing the business."
— Assessing contracts for various living options, such as those required by assisted living or nursing homes. "You need to know your rights," Short says. "If your loved one has Alzheimer’s, you don’t want to have the care facility kick he or she out because of new symptoms that require more attention and care. There are state codes that address these issues, and an elder care attorney can help you make sure all steps have been taken. Sometimes it’s just as simple as assuring special diets and other needs are included in the contract."
— Clarifying the law on transfer and sale of assets. "There’s a lot of misinformation that, if you follow it, can lead to tax penalties, regarding selling assets to obtain state and federal benefits," Short said.

For a referral to an elder law specialist in your area, you can contact the Wisconsin State Bar Association at 608-257-4666. Other resources are available at its Web site at www.wisbar.org.

April 18, 2003 Small Business Times, Milwaukee