Working document vol two of history of giving

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RESEARCH OF
THE HISTORY OF
SUBSTANTIAL CONTRIBUTIONS AND GIFTS
& BEQUESTS AND LEGACIES
TO THE
QUAKER HEIGHTS CARE COMMUNITY
FORMALLY NAMED
THE 1905 FRIENDS BOARDING HOME &
THE FRIENDS HOME OF THE OHIO VALLEY
YEARLY MEETING OF THE RELIGIOUS SOCIETY
OF FRIENDS, INCORPORATED
VOLUME TWO: 2009 ~ 2018
A DECADE OF CHALLENGE & TRANSFORMATION
April 2018
Karen S. Campbell, Researcher
1700 Penbrooke Trail
Dayton, Ohio 45459
© Quaker Heights Care Community, 2018

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2015 Short-Term Rehabilitation Addition to QHCC

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Phase 1 of private room renovation, begun in November 2016: All existing semi-private resident
rooms, with enough space to add a private shower, have been renovated and converted to
private rooms. The total number of rooms renovated was 37 in the skilled nursing areas. The
skilled nursing area now has 62 private rooms and 4 semi-private rooms.
Phase 2 is the second half of the renovation, begun in November 2017: This phase included the
creation of common spaces for memory care residents to enjoy with their families. It has new
dining areas, living room spaces, and a fire place. Additionally this area required the removal of
several walls to allow visualization by clinical staff of memory care residents in each area of the
expanded unit. This will increase safety and security for the residents. It will also beautify their
living spaces and improve their quality of life.

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ABBREVIATIONS:
ACA ~ AffordableCare Act (Obamacare)
AL ~ Assisted Living
CCRC ~ Continuing CareRetirement Communities
CMS ~ Centers for Medicare& Medicaid Services
CPASRM ~ Certified ProfessionalinAging ServicesRisk Management
CWA ~ CommunicationsWorkersofAmerica, AFL-CIO
ECF ~ Extended CareFacility
FFA ~ Friends Foundationfor theAging
FFC/FFB ~ FriendsFiduciaryCorporation/Board
FGC ~ FriendsGeneral Conference
FMHG ~ Friends MutualHealth Group
FSA ~ Friends Servicesfor the Aging
ILU ~ Independent Living Units
KCCN ~ Kettering CareCoordinationNetwork
LNHA ~ Licensed Nursing Home Administrator
LTC ~ Long Term Care
OASN ~ Ohio Aging ServicesNetwork
OPRS ~ Ohio PresbyterianRetirement Services (Re-brandedas Ohio
Living Corporation)
OVYM ~ Ohio Valley Yearly Meeting
PCCP ~ PeaceChurch ComplianceProgramofthe FSA
PCRRG ~ PeaceChurch Risk RetentionGroup
QAPI ~ QualityAssurance& Performanceof CMS
QHCC ~ Quaker HeightsCare Community

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SNF~ Skilled Nursing Facility
STC ~ Short Term Care
STNA ~ State Tested Nursing Assistant
THANK YOU TO:
Sydney McBride, LNHA, CPASRM, Assistant Administrator, Chief
Advancement Officer. Director of Marketing & Public Relations
Wendy L. Waters-Connell, RN, MS, LNHA, CPASRM, Executive Director/
CEO (Retired)
CONTACT INFORMATION:
Quaker Heights Care Community
514 High Street
Waynesville, OH 45068
Phone: 513-897-6050
Toll free: 800-319-1317
Fax: 513-897-6052
http://www.quakerheights.org/
https://www.facebook.com/quakerheights/?ref=aymt_homepage_panel
DISCLAIMER
This client’s report is the exclusive property of the Quaker Heights Care Community.
This work is considered a work made-for-hire and, as such, all copyright rights shall be
owned by and be in the name of the Quaker Heights Care Community. QHCC in turn
grants the creator (researcher/author) the right to reprint her work in any format that
she chooses without the payment of royalties, subject to giving proper credit to the
original publication for QHCC. QHCC permits information from the document to be
copied for non-profit educational use provided proper credit is given to the
researcher/author and QHCC.

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AN OVERVIEW OF
A DECADE OF CHALLENGE & TRANSFORMATION
QUAKER HEIGHTS CARE COMMUNITY
2008 ~ 2018
Waynesville, Ohio (Warren County)
“We acknowledge that all persons are children of one God,
whose love and care are shared by all,” p. 28, Book of Discipline
~ Ohio Valley Y earlyMeeting, The Society ofFriends, 1978.
Looking into the future through strategic planning (with the help of Whipfli CPAs and
Consultants1), it became clear to the members of The Quaker Heights Operating Board
of Trustees and The Quaker Heights Foundation, Inc. Board of Trustees2, and various
and sundry sub-committees3 that greater efforts would need to be taken to guarantee the
survival of the Quaker Height’s 113-year old ministry. It was clear in 2008, the
maintenance of the status quo in services provided by the Quaker Heights Care
Community (QHCC),4 a not-for-profit organization, would not be able to meet the future
expectations of potential residents nor fund the levels of care needed to maintain a full
census. The status quo could not compete with other comparable facilities targeting the
same audience. Merely maintaining the status quo would fail to provide sufficient
income. The established fundraising technics and the present revenues from the Skilled
Nursing Faculty (SNF), Assisted Living (AL), and two Independent Living Units (ILU)
would not be sufficient to continue the Quaker ministry to the elderly and chronically ill,
1 Wipfli LLP assisted in the planning process by conducting marketresearch;operational reviews;financial
assessments, and facilitation of multiple strategic planning working sessions of the Board’s Strategic
Planning Committee. The process started late in 2008 and has continued up through the present. The
Strategic Plan has been annually updated since 2010.
2 The QHCC Operational Board of Trustees governs the Care Community. The QHCC Foundation Board
is a privateoperational boardwhich has one duty:to raise funds for the QHCC. It does not issue grantsto
other organizations. The present board and committeestructureis based on “Best Practices ofNon-Profit
Board Governance,” a power point presented on September 6, 2012by Whipfli CPAs and Consultants. The
investment firm managing Foundation funds is Friends Fiduciary Corporation.
3 As of 2018, the standing committees of the QHCC Operating Board of Trustees are: The Executive
Committee, The Finance and Audit Committee, The Board Governance Committee, and The Strategic
Priorities Committee. The PresidingClerk ofthe QHCC Operation Board ofTrusteescan appoint necessary
ad hoc sub-committees as needed. The Presiding Clerk of the QHCC Foundation, Inc. Board of Trustees
can appoint ad hoc sub-committees as needed.
4 Both Quaker Heights Care Community and Quaker Heights Foundation are charitable tax exempt (501
c. 3) non-profit organizations. Quaker Heights Care Community, EIN No.:31-0538523; Quaker Heights
Foundation EIN No: 31-157 5048.

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which began in 1905 when the Friends Boarding Home was established. The Trustees
and committee members needed to adapt to be able to continue their Quaker ministry
which honors that of God within which makes, “Quaker Heights a place where love is
made visible by service.”5 This ministry had thrived for over a century in the village of
Waynesville. Ohio. QHCC has been a long living entity which must continue to grow and
mature as it compassionately responds tothe needs of those they serve while also dealing
with fiscal challenges. The constantly changing senior care market had tobe addressed as
well as adjusting to ever changing regulations. It is incumbent on QHCC to stay abreast
of all regulatory changes and their clinical and clerical application by receiving periodic
professional education on adapting to new regulations. Other Federal requirements can
also generate additional costs.6
Hopefully, careful planning and thework of foresight through discernment will guarantee
another 100 years of service. More ways to diversify services provided by the QHCC
campus were investigated and many adopted, from Adult Day Care to Hospice; from
Rehabilitation to Respite Care. Care would be expanded to all ages of adults living in the
fivecounty area.7 More waysweresought tostrengthenthe financial foundations of QHCC
to fulfill the diversification of the mission and firm up its financial future while Medicare
and Medicaid funds continued to decline. Ultimately, the vision was to provide a campus
with multiple servicestofit the needs of seniors (an increase in short-termpost-acutecare
and a reduction in long-term chronic care)and other adults seeking medical/neurological
or orthopedic rehabilitation.
One step taken in 2009 to get a handle on the financial challenges of the future was an
investigation of the past; a history of substantial giving from 1901 to2008. The results of
this study are found in the first volume of this work, “The History of Substantial
Contributions and Gifts and Bequests and Legacies to the 1905 Friends Boarding Home
and the QuakerHeights Care Community. 1905 - 2009.”8. This work illustrated how past
donations and bequests were an investment not only in the mission of the Friends
Boarding Home, but in the community of Waynesville itself. A gift to QHCC is an
investment in the common good. The past decade, 2008 to 2018, a decade of challenge
and transformation, is the theme of this volume.
5 As was said in the Quaker Heights Care Community Strategic Plan (2015), “FriendsHome, Inc. does not
wish to compete with existing services or providers. It does, however, re cognize that it is operating in a
highly competitive and fluid market. This means that it is committed to seeking out and acting promptly
on strategic challenges and opportunities. It will undertake strong initiatives to establish the presence
and qualities of its programs and place priority on developing positive relationships with other
organizations and institutions in the communities it serves.”
6 The breaker cabinets from the main corridors on 200 and 100 halls had to be moved to a space behind a
locked door underthe new NationalLife Safety Code regulations.Staffmembers attended an in-servicein
Columbus to gather education aboutthe New Life Safety Code requirements to help keep QH compliant.
7 Warren, Butler, Clinton, Greene, and Montgomery Counties, Ohio. Relationships are also nurturedwith
the hospitals and health care organizations ofCincinnati and Hamilton County.
8 A pdf. File of this book can be found on the QH website at http://www.quakerheights.org/support-our-
mission/our-contributors/.

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STRENGTHENING THE FINANCIAL POSITION OF QHCC
Plan your work, and work your plan.
The expansion of services, remodeling, and extension of the facility will provide the
pathway to fulfill the practical demands of marketability and strengthen the financial
underpinnings of the organization. Even with the previous Assisted Living (AL)
expansion (2001-2003), the Whipfli consultants reported maintaining the status quo will
lead to a loss of $65,000 each year; even possible failure of the organization, and the end
of services. However, taking the riskof debt in an expansion would preservethehistorical
tradition of the founding Friends to serve those in need. To choose to do nothing would
be disastrous. There would be nothing but decreasing funds and increasing costs. All the
professional consultants agreed. The mission to serve under-privileged seniors in the
local community was dependent on an increase of private pay residents with Medicare A,
Medicare HMO, or commercial health insurance to offset the increasing number of
Medicaid patients.9 More ways to solicit charitable donations was needed, too. Since
people are living longer, many may run out of retirement funds as they grow older. How
can they be supported? The increase in healthcare costs, the decrease in healthcare
reimbursements from both the government and private insurance, and expansion and
complications of government regulations, demanded more private charitable donations
for QHCC, a non-profit organization.
A short time after the trustees came to these realizations, the national financial crisis
would complicate the situation even more. They would need to deal with drastic cuts in
Ohio Medicare and Medicaid revenue, for example, by 6% in 2011. This cut amounted to
a $172,270.00 loss in revenues for QH. The following year 2012, the cuts were worse.
Therewasa 17%reduction in Medicare and Medicaid funding amounting to$372,000.00.
This necessitated “a leap in faith” by the trusteesand staff in the viability of their strategic
plan to build and expand services and their search for greater diversity in charitable
funding. However, going into debt seemed counter-intuitive to some.
The increase in nursing home and health care costs and keeping compliance to the most
recent federal, state, and local laws, regulations, and guidelines that govern healthcare is
continually challenging.1 0 The crippled economy of the Great Recession (2007-2009)
9 QHCC always is trying to find a better payer mix to receive greater reimbursements. Another way to
increase reimbursements is through joining the OASN Network which provides greater leverage in
negotiating higher rates and other payment arrangements
10
“The operations ofQH, LLC is subject to the administrative directives, rules and regulations offederal,
state and local regulatory agencies, including but not limited to HUD and the Department ofHealth and
Human Services (DHHS). Such administrative, rules and regulations are subject to changeby an act of
Congress or an administrative change mandated by HUD or DHHS. Such change may occur with little
notice or inadequatefunding to payfor the related costincluding theadditional administrative burden to
comply witha change,” Annual Audit Report(Board ofTrustees Meeting, 4/29/2015). An example ofsuch
change in regulations came on September 28, 2016 when the Centers for Medicare and Medicaid Services
(CMS) issued final regulations (aka, the Final Rule or the Mega-Rule) related to skilled nursing facility
services. The Final Rule is over 700 pages, and the changes affect most areas associated with the care of

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would extent throughout the upcoming decade. The Obamacare (ACA) expansion of
Medicaid and the ACA’snew mandate that nursing homes must havean activecompliance
program in place brought more need for adaption.1 1 The volatile nature of the health
insurance debate in the United States today also calls for ongoing creative innovations.
The initial assessment called for the enhancement and creation of services which would
increase the Medicare, Part A and HMO market share tooffset the reductions in Medicaid
reimbursements1 2 : The vision included:
1) An enhancement of the nursing facility’s rehab to include Physical
Therapy, Occupational Therapy, and Speech Therapy, for residents and for
potential in-and-out-patients. The square footage would be increased to
accommodate a separate entrance for in-and-out-patient accessibility.
2) The creation of more private rooms with private showers in the skilled
nursing facility (SNF), as well as private dining and common areas. A
related goal was to provide more choices with food variety, adding and
changing the arrangement of the tables, changing the floors, and adding a
fireplace to createa warmer feel. There was, also, the possibility of two meal
times instead of just one.1 3
QHCC residents. This will be implemented over a three year period and will probably cost QHCC
approximately $17 0,000.00.
11
The Peace Church Compliance Program (PCCP) provides the compliance oversight ofthe program
at Quaker Heights. It provides updates on current regulatory issues and education on implementation of
required policies and procedures and programs to address this ever changing compliance and regulatory
environment. PCCP worked with QH to assure compliance to the new mandate of the ACA. Another
example is a PCRRG program, the Short-stay Patient Collaborative Toolkit, implemented by the QHCC
clinical team. This toolkit was distributed by PCRRG with the intent of formalizing and improving the
management ofshort-stay patients in a skilled nursing facility. The toolkit provided sample tools, policies
and guides to improve processes from stay patientsin a skilled nursing facility.The toolkit providedsample
tools, policies and guides to improve processes from admission throughoutthe patients stay. The toolswere
reviewed by a team of staff and retrofitted to meet the needs of QH. The material covered specific areas,
such as communication, environmental and safety rounds, admission checklists, and delegation guides.
Competency testing is another component that specifically addressed areas such as conflict resolution,use
of a standardized communication tool with physicians and clinical nursing skill set (Administrator’s
Report, March 2015). The implementation of this program emphasizes QHCC’s understanding of the
importance of acute short-term care in the future.
12 The Assisted Living Waiver Program is an Ohio Medicaid program which is an example of how less
Medicaid pays for services. It does not cover the complete cost for an elderly or disabled individual to
reside in an assisted living community. Federal law bars the state Medicaid program from paying for
the cost of room and board in assisted living. Waiver participants, or their families, are expected to
pay for this portion of the monthly fee. But, Ohio’s reimbursement rate is much lower than
reimbursements from Medicare and private insurance for the same services. Many AL facilities are
reluctant to accept AL Waivers. QHCC will accept five.
13 Today QHCC has a Director of Clinical Nutrition (a registered dietician). Food can be prepared to a
doctor’s orders,but,QHCC is a “resident choice” facility which means thatultimately residents choose what

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3) The expansion/repositioning of the assisted living units (ALU) with new
construction for specializing in Alzheimer’s/memory care. The 800 wing
was chosen to be slowly transformed into the Memory Support Unit.
Ultimately, both wings of assisted living would be contain Memory Support
Units.
Another possible expansion, which could also increase funds from Medicare, Medicare
HMO, and commercial insurance, would entail increasing the number of Independent
Living Units (ILU) beyond the two already maintained if feasibility research indicated a
need for more senior housing in the area.
Revising charitable fundraising practices was essential since public funding was
decreasing. Fundraising was necessary in tandem with good public relations, community
building, within QHCC itself, the larger Waynesville community, and thefive county area.
This would require a full-time Director of Development beginning in 2011. At the
beginning of this process some trustees voiced concern about the success of charitable
fundraising because they thought Waynesvillians did not think of QHCC as the financial
anchor it really is for their community. Nor did most people realize that QHCC is a not-
for-profit organization.
A growing trend in long-term healthcare for seniors and the chronically ill is the
affiliation, partnering, merging, with, or being acquired by, a larger not-for-profit multi-
site senior care organization as a means of reducing the total amount of debt needed to
fund expansion and renovation while maintaining excellent care. There is also the option
of acquisition by a for-profit entity. This last option was the most resisted option for
QHCC because the organization could lose its Quaker identity and its historic mission.
Also, if QHCC becomes a for-profit organization, the mission of the trustees would
change. Their goal would be to nurture the dividends paid to the stockholders through the
profits made from providing service. Consequently, the options for QHCC articulated as:
1. Stay an independent faith based Quaker organization. However, this
option was becoming more and more impractical due to increasing costs
which threatened the financial health of QHCC.
2. Find a Quaker, or another Peace Church affiliate, to partner in elder care:
a. i.e. The Kendal System.14 (both FSA and Kendal were consultants
to QHCC)
b. i.e. The Friends Care Community in Yellow Springs, Ohio1 5
they prefer to eat.Lunch and dinner havea two hourtimeframe. There is roomservice. Breakfast is usually
served in the skilled health care resident’s room.
14 The Kendall Ohio Affiliates are Kendall at Oberlin, Kendall at Granville, and Kendall at Home
(Cleveland).
15 The Y ellow Springs MonthlyMeetingofFriends also belongs to Ohio ValleyY early Meeting and Friends
General Conference justas Miami Monthly Meeting in Waynesville does. However,the ExecutiveDirector
ofQHCC tried to negotiatea synergy with the Friends Care Community butthey resistedthis since they felt
a greater connection with the village of Y ellow Springs.

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c. i.e. Peace Church1 6 senior care communities of the Brethren and
Mennonites traditions. The Brethren Home Retirement
Community executives presented a power point to the trustees to
talk about the managing contract and services which could be
provided to QHCC on November 29, 2017.
3. Find a faith based not-for-profit partner in elder care:
a. i.e. the Ohio Presbyterian Retirement Services (OPRS), recently
renamed the Ohio Living Corporation17
b. i.e. The Otterbein Life Style Communities18
c. i.e. Mason Christian Village in Mason, Ohio.1 9 The parent
organization of The Christian Village Communities is the Christian
Benevolent Association (CBA) of Greater Cincinnati, Inc. CBA was
founded in 1960 by the Stone-Campbell (Restoration) Movement
independent Christian Churches and Churches of Christ.
4. And, only as a last measure, consider a for-profit sale in elder care.
Because of the slow recovery from the Recession, cuts in Medicare and ACA
reimbursements, the expansion of Medicaid, as well as the usual difficulty of fundraising
for stand-alone not-for-profit nursing homes, the above options of partnership became
increasingly attractive from 2008 on. Indeed, as will be seen in this overview of the
decade, by July of 2015 the trustees were afraid the end was coming to QH when part of
the building project of the new short-term rehabilitation center had to be paid for with
some operational funds. There was a very large loss in 2015. In response, to help pay
down the debt, another project was proposed and pursued to make private rooms in SNF
and the rooms in the new rehab unit private with showers and amenities which would
draw more private pay, Medicare A and HMO, and commercial health insurance
residents. A revision of the fundraising plan was also undertaken to encourage greater
charitable donations from the wider community. Emphasis was put on the “investment”
made by the donor. A donor’s investment toa non-profit is not one of buying into a stock
company with dividends. It is more intangible, of course. It is the building up of the future
of the QHCC/Waynesville communities by choosing to nurture the QHCC office
infrastructure, people, programs, or the Foundation’s endowment.2 0 Charitable donation
to a not-for-profit is relational-community-oriented, not merely a business opportunity.
16 The Peace Churches are churches, or groups, or communities advocating Christian pacifism or Biblical
nonresistance.
17 Ohio Presbyterian Retirement Services, headquartered in Columbus and founded in 1922, is the largest
providerofmultisite,faith based, not-for-profit elder carein the stateofOhio. They have12campuses from
Akron to Cincinnati, including Cape May Retirement Village in Wilmington, Ohio. OPRS also has an active
Foundation, and a 48-county home and community based service (home health and hospice) footprint,
employs 3,100, and serves more than 90,000 people annually .
18 Otterbein Home at Lebanon, Ohio is one of their communities.
19 Eventually, a synergy or partnership with Mason Christian Village was not feasiblesincethe organization
has been moving away from skilled nursing care.
20 QH is the largest employer in Waynesville (next to the school system) & biggest contributor to the tax
base.

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From the beginning, everyone acknowledged the implementation of these plans would be
a long termproject necessitating continual trustee education concerning the complex and
always changing health care service delivery to seniors and the chronically ill as well as
the regulatory demands of senior care. Developing an orientation program for new
Trusteeswasessential. Annual evaluations of the strategicplan would include advice from
hired consultants, many feasibility studies, self-evaluation surveys,2 1 and deep reflection
on Quaker values and the Quaker decision making process by the Trustees and Staff.
Throughout the process QHCC would need to strengthen its financial foundations while
maintaining its clinical excellence, developing more effective charitable fundraising, and
by strengthening Board governance.
STRENGTHENING BOARD GOVERNANCE OF BOTH
THE OPERATIONAL TRUSTEES AND THE FOUNDATION TRUSTEES ~
BECOMING “CHAMPIONS,” “STAKEHOLDERS” & “AMBASSADORS” FOR QHCC
“Pursue the work of foresight as a consistent practice. The rapid and relentless
pace of transformation means the time to look ahead is all the time.” ~ “The
Board’s Duty of Foresight” by Jeff De Cagna22
TheQH Operational Board of Trusteesand theFoundation, Inc.Trustees began on-going
self-evaluations to measure their adjustment to the new plan and the challenge to take on
greater responsibility. The work of trustees on the boards and on the sub-committees
depended upon a continual and progressive conversation conducted with respect.
Education about Quaker governance was required for any new non-Quaker member.2 3
Non-Quakers would need to be fully integrated into the process of Quaker decision-
making and customs. QHCC has been, after all, a church sponsored, mission driven, and
independent provider of services. Also, Quakers and non-Quakers already sitting on the
Boards were adapting to fulfill the professional mission of the new strategic plan. The
integration of Quakers and non-Quakers, of various religious traditions or no tradition,
21 These internal board member surveys were conducted after each board meeting and reviewed by the
Board Governance Sub-committee, and, a more comprehensive annual survey also was reviewed by the
Board Governance Committee.
22 https://associationsnow.com/2016/02/boards-duty-foresight/
23 The Peace Church Compliance Program (PCCP) of the FSA requires a majority of Quaker board
members. Friends Services for the Aging (FSA), along with the Brethren, Mennonite, and Quaker
organizations involved in providing servicesto theelderly, haveestablisheda collaborative Complianceand
Ethics Program known as the Peace Church Compliance Program (PCCP).

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into an inclusive organizational culture2 4 illustrates the unity achieved through good
education and the Quaker discernment process,2 5 admittedly a lengthy one.2 6
Some of the educational topics for reflection developed by the Board Governance Sub-
Committee, included:
1. How to Maintain Excellent Service on a small, human scale serving
people of modest means.
2. Fiduciary Duty: What are the legal requirements for Trustees? The
ethical duty of the trustees is to be good stewards of the funds
supporting the services provided without any self-interest. Money is
a tool to use to fulfill the mission of QHCC.
3. Fundraising: This includes fundraising among Friends and other
people of good-will in the community, and not fearing a prudent
indebtedness to prepare for future needs.
4. Community Relations: The relationship with the wider community
builds the strength of the organization. This emphasis in 2012 led
to a bus tour of Waynesville and the north-east corner of Warren
County, Ohio which included Corwin, Caesar Creek Lake and Park,
and Harveysburg for the trustees. Basically knowing the history of
the area, as well as its present strengths and weaknesses, helps to
advance the mission. Familiarity with other civic organizations is
necessary, too.
5. Union Negotiations Process and collective bargaining. Understand
the negotiations with the Union focused on fairness (i.e. good
healthcare and retirement fund) and also attempts to reduce costs
for QHCC.
6. Self-Development: The trustees need to grow in their professional
understanding of senior care and their responsibilities to the
organization.
7. Understanding and Appreciating Silence in Quaker Meeting.
Silence is not merely individual meditation in isolation. Silence in
Meeting is becoming aware of “we,” the community; a community in
the Light. “That of God” in the group binds everyone is unity and
trust. Decisions are made in the Light. Holding a business meeting
in the Light entails standing aside to make way for the Spirit of God,
the real leader of the decision making.
8. The Quaker way of “Standing Aside.” How to disagree without
stopping a decision from moving forward.
24 The QHCC organizational culture reflects a culture of compassion and safety, a culture of gratitude and
philanthropy, and a culture of inclusion and diversity.
25 One issue that created disagreement between Friends and other Board members of an Evangelical
background was the issue ov er extending healthcare to same-sex partners in the union negotiations.
26 Every yearthe boards attended an education presentation given by a representative from PCCP.

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9. What is the difference between management and governance?
What is policy oversight by the boards versus micromanagement?
The staff of QHCC, as management, is responsible for developing
operational plans with actions steps under the guidance of the
governing trustees.
10.Corporate Compliance and Conflicts of Interest. The ministry of
trustees is selfless; a sacrifice. They must maintain their personal
integrity and the organization’s integrity.
11. Reading and interpreting financial reports and continual updating
on Federal, State, and local procedures.
12. Strategic Planning: It will undergo continual revision. TheStrategic
Plan is a living, perpetual, working document.2 7
13. Knowledge of Risk Management which is the application of
economic resources to minimize, monitor, and control the
probability and/or impact of unfortunate events or to maximize the
realization of opportunities.
14. Surveying the effectiveness of trustee meetings and engaging in
annual evaluations of the trustees’ performance.
15. Issuesof Leadership Transition and Relationship withthe Executive
Director. The Executive Director is the liaison between the
governing boards and management; the staff. Maintaining a list of
the director’s duties and also a CEO Replacement (Succession) Plan
are essential to maintain confidence in the viability of the
organization when the time comes to replace the Director for
whatever reasons.
16. Issues of leadership Transition: Tools to Search for Prospective
Board Members (Officers and New Members): “A succession
planning tool kit” which is inclusive and takes into consideration a
person’s talents and experience, needs to be maintained.
Some members often felt too much time was used up in Quaker education and reflection.
But after a forthright discussion during the meeting of the Board Governance Sub-
Committee (1/25/2012), it was concluded:
“All agreed the sense of truth in balance with mission focus and the work
at hand are necessary. Discussion also emerged about the healthy tension
between Quaker and non-Quaker Board members and a respect for the
diverse faith traditions and business experiences which inform board
member practices.”
27 It is important to consider the Strategic Action Plan as a “living, working document.” It should be
reviewed, and progress assessed, at least on a quarterly basis, and more often as events and developments
might suggest. Additions or deletions ofcertain objectives can occur, whenever developments warrant. A
formal review to update the Plan also should occur annually (QHCC Strategic Plan, 2015, p 10).

15
It was admitted the Quaker way of deliberation is time consuming and patience is an
important quality of a committed trustee. It was decided meetings should begin with a
spiritual query, using queries from the OVYM Faith and Practice28 regarding business,
followed with a time of silence worship. Also, Mission Moments would continue to be
shared during meetings. Everyone shakes hands in unity at the close of the trustee
meeting.
Any handbooks or documents produced to educate trustees would be available through
the QH online portal. After each meeting, members were expected to fill out a Survey
Monkeyevaluation form. Eventually, an excellent “Quakerism 101” coursefor both board
trustees and staff by Quaker minister and fellow trustee Donne Hayden was produced
which explained the history and development of the Society of Friends. Still concerns
arose about how to measure and track the growth of Quaker values throughout the
organization. Great emphasis had indeed been placed on the education of the trustees
but questions also arose about the inculcation of Quaker values in the staff. It was
suggested in 2015 that twoseparate survey tools be developed to measure the practice of
Quaker values by the two groups: governing trustees and managerial staff.
During the early part of the decade, concern was often expressed about the Quaker
method of decision making; whether it was compatible with the requirements of the IRS
and other organizations. Quaker consensus is expressed in the phrase “discerning the
sense of the meeting.” It is believed that out of the expression of everyone’s opinions in a
respectful way, even when at odds, the Truth will emerge; a way/a path will reveal itself
and an action can then be chosen. The role of the clerk is to write a minute that will
encapsulate ‘the sense of the Meeting,” a clear summary of the discussion held and
decision make in the Light of God. This does not necessarily mean 100% agreement. A
member or a few members may object but can graciously “stand aside” to facilitate the
decision making process so a minute can be written and action taken. Unlike voting,
which can be quite divisive due to extreme ideology and political manipulation, seeking a
unified path of action through Divine guidance helps to keep the board members in unity
and harmony. As explained by Executive Director Wendy L. Waters-Connell:
“The Quakerdecision making waskept throughout the decade to honor the
Friends’ values which underpin the mission of the organization. It was a
highly functional way of gaining complete support for the decision and to
keep the board unified in vision.”
An educational resource given to the trustees was the booklet, “Principles of Good
Practice for Friends School Boards and Every Friends School Trustee of QUAKER
ORGANIZATIONS” by Arthur Larrabee to learn more about Quaker theology and
28 The Book of Discipline of the Ohio Valley Y early Meeting Religious Society of Friends,
http://www.quaker.org/ovym/pubs/FaithandPractice.pdf.

16
principles; especially Quaker business principles.2 9 This booklet would be used in 2012
by the Board Governance Sub-Committee to develop an Annual Board Effectiveness
Survey. The results of that survey indicated there were still members who were
uncomfortable about Quaker ways and the liberal progressive values of Friends General
Conference (FGC30) such as the Quaker testimony of equality rooted in the belief “that of
God is in everyone,” especially concerning same sex orientation or transgender, and the
Quaker appreciation of diversity.3 1 QHCC is called to celebration and live a culture of
inclusion and diversity within the community (staff, residents, board, and volunteers).
“We resist programs based on artificial distinctions such as race, class,
physical abilities, and wealth.We believe in the concept ofa “single human
family” whose members are equally important and equally connected.”3 2
More prayerful discussion revolved around the Quaker belief that different opinions can
be held in mutual respect in the Light. Everyone speaks and everyone listens. This is
Quaker “spiritual listening” which includes taking the time for openness, transparency,
and contemplation.
“We honor the divine in others through honest interactions. We take time
tolisten and understand in order tobuild “family” with our residents, their
families and friends and with each other.”3 3
It was found in the 2013 yearly survey, in spite of educational efforts, there was still some
questions about the advisability of the strategic plan to take on more debt and the
responsibility of the Board concerning charitable fundraising. By the middle of the
decade, trustees were wondering if they should re-brand the organization, i.e.,
“Waynesville Heights Care Community” toencourage more charitable donations.3 4 Even
29 Other books used in the board’s education were by Dutch Catholic priest, theologian, and author Henri
Nouwen, i.e. The Spirituality of Fundraising. See: https://bookstore.upperroom.org/Products/1044/a-
spirituality-of-fundraising.aspx. Fundraising is a ministry to invite others into our mission.
30 Friends General Conference is an organization of 15 American and Canadian Y early Meetings who
worship is the “unprogrammed” tradition; silent meetings for worship.
31 By 2015 Quakers had decided to actively recruitmembersofthe Pentecostaland otherChristian faiths as
a means to strengthen the QHCC connection to the Waynesville community. “TheTrustees asked theBoard
Governance Committee to review the by-laws and consider amendments to remove the Quaker majority
from the by-laws to reduce the burden of the mandate. Trustees expressed a desire to have a focus on
strong leadership which supports Quaker values instead of mere majority of Friends on the board”
(Operational Board of Trustees Meeting, 7-29-2015). Eventually various professional studies wouldshow
that the Quaker “brand” was positive and not the cause of low donations to QHCC. QHCC no longer
requires a majority of Quakers on the Boards but the organization continues with its Quaker mission. A
non-Quaker trustee must be accepting of Quaker business values and be knowledgeable about Quaker
testimonies. The first non-Quaker Presiding Clerk of the Operation Board of Trustees was Tom Isaacs.
32 “Our Mission and Values”webpage, http://www.quakerheights.org/about-us/our-mission-and-values/.
33 Ibid, “Our Mission and Values” webpage, http://www.quakerheights.org/about-us/our-mission-and-
values/.
34 It was readily admitted the number of Quakers and Quakers with wealth in the area was diminishing.
Consequently, there was a greatneedto solicitcharitablefunds from non-QuakerWaynesvillians and other
local people.

17
so, greater efforts to support the Quaker identity and historic mission were made to
educate trustees and staff about Quaker values.3 5
Beginning in 2010the By-Laws of theQH Board of Trusteesand the Foundation and sub-
committees were being revised with help of Friends Services for the Aging (FSA). There
were a number of revision of the by-laws over the decade.
QHCC was honored when it was chosen by FSA to participate in an update of their
orientation video, “On Being with Friends.” Wendy Waters-Connell, during the Board of
Trustees’ meeting on June 27, 2012, reported that digital videographers had been on
campus on June 4, 2012 to tape segments of resident life that would be featured in the
updated orientation. . .
“The original video, produced in early 2002, has been used for new hire
and new volunteer orientation and features elder care under the guiding
values and testimonies of the Religious Society of Friends. FSA decided it
was time to update the information to more accurately reflect the
geographic diversity of its members. The new video was scheduled for
release by September 2012 for the annual meeting of FSA in Philadelphia.
Wendy stated it was a remarkable opportunity to reflect, through the
lenses of a camera, on the live mission of Quaker Heights. Wendy stated
the videographers were impressed with the articulation of the Quaker
values and mission. Further, Lisa Gooding the Director of Marketing and
Development was able to negotiate ownership and use of all video taken
on June 4th for organizational use on the website and for other purposes.
This experience was a wonderful example of sharing resources and
Quaker faith tradition as it relates to elder care.”3 6
Wendy Waters-Connell, Executive Director of QH, attended the FSA annual meeting in
Philadelphia every year. In early September 2010, Jay Marshall, PhD and Dean of
Earlham School of Religion lead the FSA attendees to think about the challenges of
Quaker consensus leadership. Specifically, Dr. Marshall proposed an action-
orientation to leadership as opposed to a traditional process-orientation under
historical Quaker models (such as Servant Leadership). Dr. Marshall stated that
leadership within organizations should employ the principals of Quaker process, but
not at the expense of action and deployment of strategies to progress an organization.
The Quaker process is not necessarily passive, but, should be active because of the
Quaker emphasis on living and acting one’s faith.
35 One such measure was the development of an Evidence of Quaker Values in Action study (QAPI
Compliance Standard) to help the governing trustees and the management staff to fully manifest Quaker
values in organizationallife in 2015.This projectwas given to the Executive Director. The survey tool listed
“benchmarks” that trustees and staff should both understand and be able to discuss. Another suggestion
was to ask Earlham College’s SchoolofReligion in Richmond,Indiana, a Quaker college, to develop a more
scientific study to judge compliance to Quaker values by the organization by measuring knowledge,
perception, and behavior. However, the Earlham study was never developed.
36 Board ofTrustees Meeting, June 27,2012

18
The relationship between the QHCC Board of Trustees and QH management would be
continually examined and discussed at length. The rule of thumb became:
1. The QHCC Operational Trustees’ role is primarily oversight. They
oversee the planning of the Strategic Plan in cooperation with the
Executive Director.3 7 They have the responsibility for the maintenance
and yearly review of the “strategic plan.” The Trustees would provide
philosophical support for the plan and they would model the “culture of
gratitude and philanthropy” required for successful fundraising.
Continuing education about trends in professional senior care and fiscal
oversight would be ongoing. The yearly review of the strategic plan
would include adjustments focused on:
a. revised time lines
b. additional actions
c. budget figures for consultants
d. software aides
e. positions
f. measures for success
g. specific goals of fund raising and board development.
Micro-management of QH by both theBoards is discouraged. Management
is the role of the staff.
2. The management staff of QHCC has the responsibility for the
implementation of the “operational plan” toreach thestatedgoals of the
“strategic plan” developed and overseen by the QH Boards.
Management has also been schooled in Quaker principles.
The QH Foundation Board of Trustees would be challenged to change from a board that
managed the funds and assets of the Foundation and approved grants to QHCC, to a
board that was much more actively involved in planned fundraising. The bylaws of the
Foundation Board needed revision, too. The number of Foundation Trustees would be
increased. The number of Operational Trustees would be decreased with much of the
preparation work done by ad hoc committees before trustee meetings. This was done to
increase efficiency.
The Board Governance Committee, as part of the revision, would in a pro-active way
search for potential board members and match a member’s talents and experience (in
professional or community ties) with the needs of the boards. Members should believe in
the mission and have the time to promote and fundraise for the organization.
An ethical concern addressed by the QH Board of Trustees early in the decade was an
examination and revision of the statement concerning Conflicts of Interest in the bylaws,
specifically in light of the IRS’ new regulation 990 (Federal Return of Organization
37 The Executive Director is the mediator between the QHCC Trustees and the QHCC Staff; between those
who govern and those who implement the policies.

19
Exempt from IncomeTax& Schedule O) concerning Conflicts of Interest.Board members
of a not-for-profit (501(c) 3) must focus at all times on the needs of the organization and
its integrity and not their individual needs. The concern was whether business
relationships between board members, staff, and employees could create conflicts of
interest. The issue of “Conflict of Interest” is examined in detail in the present “Code of
Conduct” which is posted on the QH website. Members of both boards are also required
to sign annual conflicts of interest forms disclosing any conflicts they might have.
A policy was also adopted toavoid any suggestion or any actual referralto a specific entity
or provider of investment management services for residents and families from the QH
staff. Requests from residents for help or support regarding financial matters were to be
directed to the Warren County Department of Human Services. The resident or his/her
family should be advised to seek the counsel of a legal professional. QH does not help
with applications for Medicaid.
MONITORING CLINICAL EXCELLENCE ~
A CULTURE OF COMPLIANCE, SAFETY, RISK-MANAGEMENT, & ACCOUNTIBILITY
QHCC also is a “culture of safety” and proactively works to avoid system-related errors
and potentially hazardous conditions for residents, employees, and visitors, as well as
minimizing clinical, business, and operational risks.
One of the great strengths of QHCC has been its quality of service and resident
satisfaction. MyInnerView™ Healthcare Satisfaction Surveys consistently rate QH high
by employees, families and residents. The surveys of all three groups are sent to
MyInnerVeiw38 for analysis and the survey results are shared wilh QHCC.
Top “Leading Age Ohio”™ Resident Satisfaction Survey Performance for QHCC in 2012
was 98.1.
The 2014 Ohio Department of Aging Family Satisfaction Survey score for Quaker
Heights Care Community was 90.1 which is the second highest over-all score for Warren
County. The average state score was 85.8 and clearly we exceeded this score within the
county. This satisfaction score is critical for success, from a marketing and financial
perspective. QHCC receives a quality incentive point that contributes to a higher
reimbursement rate if we are at or above the state average score. Potential residents and
families look at these scores when they are looking for placement for themselves or their
loved ones.
38 https://www.myinnerview.com/index.php

20
The Peace Church Risk Retention Group (PCRRG) insurance company provides
educational seminars and they alsoconduct a mock comprehensive compliant assessment
in preparation for the Ohio Department of Health annual inspection. TheQHCC Resident
Safety and Risk Management Program is modeled on the PCRRG principles.
All employees are required tocomplete FEMA Active Shooter emergency training. QHCC
and the Waynesville schools cooperate as reciprocal evacuation sites.
The State of Ohio Department of Health unannounced inspections of the Skilled Nursing
and Assisted Living have consistently produced excellent ratings. QHCC is rated one of
Ohio’s Top 25 facilities of assisted living resident satisfaction and scores very high in
health care.
QH strived for three year toattain the 5 Star Quality Rating of the Centers for Medicare
and Medicaid Services (CMS). In December of 2013, the Board of Trustees approved a
contract with Plante Moran39 to consult and educate the stagg for achieving a 5 Star
Rating not toexceed $15,000.00 with the understanding the 5 Star will be sustainable by
the staff after the intense training period by Plante Moran. The 5 Star Quality Rating
was attained for a short time from September 2015 through 2016 and QH has maintained
a 3 and then 4 Star Quality Rating since then while striving to regain a 5 Star Rating.
The 5 Star Rating means that Quaker Heights was among the top 10% in the nation for
quality performance indicators
MORE EFFECTIVE FUNDRAISING COUPLED WITH
INTEGRATED DEVELOPMENT & MARKETING
(COMMUNITY BUILDING)
To raise funds is to offer people the chanceto invest what they have in the work of God.
Whether they have much or little is not as important as the possibility of making their
money available to God. . . . God's Kingdom is a place of abundance where every
generous act overflows its original bounds and becomes part ofthe unbounded grace of
God at work in the world. ~ “The Spirituality of Fundraising” by Henri Nouwen
Past fund raising techniques would be inadequate to meet future need. So more funding
opportunities would need tobe found and a culture of gratitude and philanthropy would
have to be nurtured within the QHCC family itself and with the larger community. There
would also need to be an increase in revenue diversity. One stipulation generated a lot of
discussion. It was the requirement that therebe 100%participation by the Trusteesin the
annual appeal for the Foundation Fund.4 0 Consultants had advised theTrustees todonate
annually to show their faith in the mission of QHCC. This lead to a discussion on the
39 https://www.plantemoran.com/
40 The Annual Appeal letter from the Trustees goes outthe week ofThanksgiving or the following week.
All unspecified donations are placed in the Foundation Fund.

21
amount of the donations and types of acceptable giving beyond financial support, i.e.
volunteer participation on the Boards or volunteer services tothe residents both of which
could include time and talent. Other ways of donating were also recognized: specifically
the “charitable giving of Time, Talent,41 Treasure, Prayer, and Advocacy” (The Quaker
Heights Monthly, Volume 2, Issue 3, April 2016).
It was decided that Trustees needed to donate financially whatever amount they could.
The donation itself was more important than the actual amount. Donating was also
encouraged with the staff and employees. Between 2008 and 2012, the amount of
donations doubled. The sources of donations included: cash and in-kind, trustee giving,
residents and family giving, Friends Monthly Meetings and OVYM giving, QHCC Staff
giving, and donations from other organizations. By 2015,thegroup with thelargest giving
would be the employees of QHCC.
Another form of increasing funds would be the refinancing of the HUD insured loan
(November 23, 2011). This would save approximately $130,000.00 in 2011. In December
2011, a large insurance disbursement was received from the Peace Church Risk Retention
Group.4 2
In June of 2010,Wendy attendeda fundraising seminar in Columbus, Ohio. Thefollowing
fundraising ideas were emphasized:
1. Philanthropy begins with the creation of a “culture of gratitude and
philanthropy.”
2. Philanthropy needs to thrive in the entire organization: Trustees,
CEO, staff, and employees as well as with residents, residents’
families, and local supporters whether individual or corporate. Ohio
Valley Yearly Meeting4 3 is itself considered part of the larger
community and through yearly QHCC reports at the OVYM annual
41
Donated art work was given by Rick Riegerand Eugenia Mills and is in place on the walls in 200 Hall and
in each resident room. The photo art is beautiful and all are encouraged to view this incredible gift. Rick
and Eugenia have agreed to add more art and photo donations for the remaining halls. This is an amazing
gift (Finance and Audit Committee, 6/28/2017 ).
42 PCRRG is a member owned provider of general and professional liability insurance for Peace Church
(Brethren, MennoniteandQuaker)aging servicesorganizations. Formed in2004,PCRRGnow has47 member-
owner organizations in 19 states. As a result of careful governance and management and the support of highly
effectiveriskmanagementstrategies, PCRRGmembers have received ratereductions in 9outof11renewalyears
and more than $14 million in returned premiums over the life of the program.
43 The administrative structure of Quaker meetings is quite simple. A “Monthly Meeting” is the local
meeting for worship on the first days (Sundays) ofthe month which also conducts a business meeting once
a month, hence the name “Monthly Meeting.” A number of monthly meetings can belong to a “Quarterly
Meeting,” a quarterly gathering of local monthly meetings every three months for business. The monthly
meetings and the quarterly meetings all belong to a “Y early Meeting,” a gathering of all its member
meetings oncea yearfor business. Various Yearly Meetingsbelong to national associations ofFriends. For
example,Miami MonthlyMeeting in Waynesville belongs to Ohio ValleyYearly Meeting which is affiliated
with Friends General Conference (FGC).

22
meeting was introduced to these fundraising techniques. This
hopefully encouraged greater donations from members of OVYM.
3. Philanthropy is human-need oriented, not institutional-need
oriented. From QHCC’s perspective, fundraising is not only
humanitarian but also a spiritual calling to a sacred mission.
Philanthropy is rooted in developing relationships; building a caring
community within the organization and the larger community.
Clearly, this kind of philanthropy, fundraising, and community
building is time-intensive. There needs to be mutual involvement
between partners. For example, QH representatives participated in
the Progressive Women’s Club annual auction, monthly eventsof the
Waynesville Garden Club, the monthly luncheon at the Museum at
the Friends Home. It will take time before these efforts are rewarded
by increased donations.
An opportunity to bond with the Waynesville School System came in
April 2012 through a partnership with education providers to lease a
life skills training classroom in one of the independent living
apartments which was becoming vacant. The building, a triplex,
previously known as the “Medical Building,” apartment B was rented
out to the Warren County Educational Services Center for their
Transitional Living Classroom Program. Participants would be
high school adults with disabilities or developmental delays who
need additional support to attempt independence. There would
always be teacher and aid oversight in the class room. The hours of
operation would only be during the school day, with no overnights.
It was reported at the Annual Corporation Meeting, May 29, 2013,
the Transitional Living Classroom Program during the first year
exceeded everyone’s expectations. The high school adults
participated in dietary, laundry, Housekeeping, and activities at QH.
This was also an example of two diverse groups working well
together.4 4
4. Those who benefit from services or give, in any capacity (“Time,
Talent, Advocacy, reassure, and Prayer”), are “stakeholders” in
QHCC. For example: residents/renters, their families/guardians,
44
Board member Tom Isaacs gave a Diversity -themed presentation to the annual meeting of Friends
Services for the Aging in 2014. He highlighted the successful blending ofcultures, the Transitional Living
Classrooms whereadult high school students with developmentaldisabilities learn life skills andwork skills
as they interact with QHCC residents on campus through dietary, laundry, housekeeping, and activities.
Wendy added that the presentation was well received by the audience and there have been questions sent
about how to develop like programs in other Quaker retirement communities (Board of Trustees, 10-29-
2014).

23
employees, vendors, community groups that meet at QHCC, funders,
local government, public at large. Increasing satisfied “stakeholders”
increases QHCC’s Development opportunities.
5. Professional fundraisers emphasized the increasing importance of
electronic donating to build a wider constituency, i.e. the growing
popularity of electronic/social media political fundraising.
Marketing strategy and the QH website would need to be revised to better promote the
services available to potential residents and invite opportunities to donate. This will be
achieved through intentional, directed fundraising. The revised website came online in
October 2010 with electronic options for giving. The website, with its monthly electronic
newsletter, would be revised and expanded again in 2013. In 2012, a Trustee portal was
opened online for those with the appropriate user-name and password. This allow
publication online of important documents and saved time and money copying and snail-
mailing information to the Trustees. The Board Governance Sub-Committee developed
orientation folders for the portal entitled: The Religious Society of Friends, Governance
Matters, Financial Matters, Clinical Matters, and Philanthropy Matters and Reference
Material. These materials would be continuously updated.
In early 2009 a search began for a professional Development and Fundraiser Consultant.
Farr Healy LLC, which had previously worked with other Quaker organizations, was
chosen in May of 2010 as the Fundraising Consultant for a year. Representatives of Farr
Healy on August 25, 2010 would present the full set of findings and made their
recommendation from their assessments.
A dietary consultant was engaged in 2010 tohelp develop fine dining at QH. But, in mid-
2011 this position was discontinued, as well as the dietary, housekeeping and laundry
departments due to cuts in state Medicaid funding. Difficulties finalizing negotiations
with the Communications Workers of America, AFL-CIO #432245 also sealed the layoff
of these employees. These services were outsourced to Healthcare Services Group.4 6
Because of the cuts in the State of Ohio budget, there will unfortunately be many
unavoidable reductions in expenses at QH in 2012. This financial crisis would lead to
intense reflection on the financial vulnerably and the future of QH. The trustees had to
juggle austerity measures to reduce expenses with a prudent debt to expand service,
throughout the decade, and, after 2015, a capital campaign to help support more
expansion as well as the Foundation endowment.
Expanding the Independent Living level of care at QHCC was seriously considered.4 7
Other kinds of new care service delivery, which could help in the increase of revenues,
45 The CWA Union represents all serviceand maintenanceemployees, including nursing assistance,License
Practical Nurses, Companions, Dietary, Maintenance, Laundry/Housekeeping, and Activities employees
working for QHCC.
46 The outsourcing ofthese departments was done to avoid unilateral wage freezing.
47 During the 1970s, Friends Home, Inc. purchase two houses to begin the Independent Living Units
program (99 Edwards Road in September 1973and 39 Edwards Road on October 1975). The Duplex Units,
located at 549 and 547 North Street,were also builtand are still in use. The plat houses were sold by June

24
were also accessed for possible adoption. Some popular examples are SMART Houses,
Green Houses, Small Houses, Home Health Care (personal and skilled care), Life Care
at Home,4 8 and Continuing Care Retirement Communities (CCRC).4 9
An example in Ohio of a provider of both communities (CCRCs) and life care at home is
Ohio Living, previously known as Ohio Presbyterian Retirement Services. Ohio Living
operates 12 retirement communities and also Ohio Living Home Health and Hospice and
provides palliative, hospice, and home health care. Another local provider of such
communities and varieties of home health and hospice is Otterbein Senior Life Style
Choices. Otterbein has 6 communities, 9 “small houses,” provides home health care in
Warren, Butler, Clinton, Hamilton, Montgomery, Greene, Highland, Fayette, Preble, and
Clermont counties, provides “wellness services,” home health services, and hospice.
Otterbein lives by United Methodist tenets but is not funded by the church.
Diversity of services is the future of senior care. Seniors want greater choices, the major
choice being between CCRCs and the variety of Life Care at Home services. The goals of
in-home care and keeping seniors at home for as long as possible need to be compared
with the benefits of a care community for safety, service, and a sense of belonging for
elders who will eventually be in need of several level of care. When living in one’s own
home thereare increasing financial demands caused by home maintenance, but, activities
of daily living can be aided by unskilled services and skilled home health care. These
services are in high demand, for elders 85 years and older who remain in their homes.
CCRCs, on-the-other-hand, provide a sense of community for elders to reduce loneliness
and isolation in frail years. The burden of home ownership is lifted off the elderly in
CCRCs.
In 2009 QHCC considered the purchase of three properties for sale in Waynesville which
could be used in the future expansion of independent living (ILU) options. In 2010, the
purchase of 24 acres of land on Lytle Road, .08 miles from the main campus of QH, was
considered. A study was undertaken to satisfy the requirements of HUD which asked
them to have a clear understanding of how this purchase on Lytle Road would help to
fulfill the QH mission. Spectrum Marketing and Research Consultants were engaged to
of 2000 sincethey werenot suitable for the elderly. QH acquired the “Medical Building” aka the Clinic, at
581 North Street in February 1972. The building was originally the residence and office of Dr. Stout. The
south end was rented by a dentist for his office and three other bed rooms were rented to people who took
their meals at the Friends Boarding Home.
48 There are a number ofexamples of“Life Care at Home” in Dayton, Ohio. One is Comfort Keepers Home
Care for the Greater Miami Valley. This form of service delivery in the home provides the same levels of
care that a CCRC provides in a retirement community.
49 Continuing Care Retirement Communities (CCRCs, aka Continuing Care, aka Life Plan Communities),
give residents the chanceto 'age in place'knowing they will never be required for health reasons to move.
Whereas most retirement communities offer ILU and AL only, CCRCs provide a continuum of care that
includes independent and assisted living, secured memory care for residents with Alzheimer's o r dementia
and skilled nursing care. For this reason, CCRCs are also known as Life Care Communities. Each level of
care is provided in a separatebuilding orarea ofa campus and nearly all residentsmove in to thecommunity
living independently. Otterbein Home at Lebanon, Ohio and Bethany Village in Centerville, Ohio are
CCRCs. Ohio Living at Cape May in Wilmington, Ohio is also a CCRC.

25
assess the independent living market in the Waynesville area as well as the future of QH
Skilled Nursing Facility (SNF)and Assisted Living (AL). Their report on August 25, 2010
stated there was possibly a small independent living market in the immediate area.
AdCare Health Systems, Inc. was engaged to conduct an analysis of QH capacity to
finance and sustain a larger IL project. AdCare had been hired as the consultant project
developer for the previous Assisted Living facility project at QH in 1999.
QHCC also recognized the need to provide spiritual support for its residents and their
families. Part time chaplain Violeta Angele Gwynn was hired using Foundation funds.
The presence of a chaplain was much appreciated by the residents and their families, but,
the demand overwhelmed her part-time status. Ministry to grieving families often took
her off-campus and away from direct resident spiritual care, which was her primary
mission. The amount of need called for a full time position. But, as with all additional
services, this created a financial problem and it was suggested a fund raiser be held
specifically for the chaplain’s salary. However, it was pointed out, a special fundraiser for
the chaplain’s salary might find objection from the union employees of QH.
In August of 2010, the QHCC Board of Trustees requested funds ($48,000) from the
Foundation to cover a full-time salary for the chaplain for one year. The grant was
approved by the Foundation Board of Trustees in October 2010. If the position became
permanent, the salary could be funded by a yearly grant from the Foundation, or, by a
special fundraising campaign for the salary, or, it could be incorporated into the budget
as it stood, but, in that case, benefits could not be covered. This full time position would
only survive for one year. Sadly, because of a radical decline in revenues in 2011, the full
time chaplaincy had to be eliminated as well as other full time and part time positions.
The attempt to fund the chaplaincy through fundraising amidst local Quaker meetings
and other denominations failed.5 0 Miami Monthly Meeting in Waynesville has tried to
provide a Meeting for Worship at last once a month.
The old Quaker Concerns Committee was continually focused on Cultural/Diversity
activities, conflict resolution between management and union staff, yearly Memorial
Services,51 the Chapel/Quiet Room dedicated in 2009, and creating a sacred space for
dying (a Hospice ministry).5 2 Later, after the revision of the Board structure and their
committees, the Board Governance Sub-Committee,went togreat links to ferret out gaps
in diversity among board members. They actively sought out possible board members
outside of the immediate area, of different faith traditions (directly recruiting members
from other faith backgrounds to add diversity in theology), of different ages (young adult
50 As of 2018, the local churches are invited to offer a service on Sunday (30 -45 minutes) once or twice a
month as part of their outreach ministry.
51 The memorial services are Meetingsfor Worship withattention to Memorial and residents, family, staff
and volunteers attend the Meeting which is held in the manner of a Friends worship service.
52 The “Quaker Concerns Committee” was revised into the “Quaker Values in Action Committee”whichwas
an advisory committee to support the staffof QHCC in articulating Quaker values in daily operations. The
“Quaker Values in Action Committee”revised the “Philosophy ofCare” documentin 2012 by emphasizing
stewardship in the daily activities of QHCC, i.e. simple décor, recycling, use of supplies and equipment
without unnecessary waste.

26
to mature adult to elder adult), of different gender, races (ethnic diversity), experience
and skills (such as finance, clinical, law, human resources, as well as exposure to skilled
nursing care/long term nursing home care/assisted living/independent living/home
care/hospice care).5 3 Distinctions of race, class, or wealth were to be avoided. No one
group was to feel entitled. Another growing concern was focused on the diversity of the
residents of QHCC. For example, it is necessary to avoid stereotyping residents with
Medicaid; not as financially well off as Medicare or private insurance residents. There
was a growing awareness that the celebration of all kinds of resident diversity can be used
as a marketing opportunity for QHCC.
In May of 2010, four architects visited QH and were invited to submit proposals for the
new short-term rehab wing and updating rooms in the nursing facility (SNF) and also
updates to allow for level competition for all payer types (dining room, hospice rooms,
smaller parlors, spas, etc.).
During the QHCC Board of Trustees Meeting on July 28, 2010, the reports from two
architectural firms were examined. The cost of renovation was estimated from between
four to five million dollars including the following:
1. New private rooms for short term rehabilitation care with all the modern
amenities offered by competitors (spacious rooms, generously appointed,
private showers, flat screen TVs, Wi-Fi, etc.),
2. New and expanded therapy center which allows for separate and distinct
entrance for outpatient services to draw in the wider community to the
campus as well as state of the art facilities for the short term rehab unit
needs
3. Renovated private rooms in SNF with newly renovated spaces to create
more home like settings including smaller private dining areas in each wing
4. More dementia memory care beds
5. 6-8 distinct hospice units,
6. Strive to be LEED certified (Leadership in Energy and Environmental
Design, the most widely used green building rating system in the world) if
possible and reasonable,
7. Renovation of the internal courtyard if possible and reasonable.
JMM architectural firm of Columbus, Ohio was hired for the cost of $5000.00 to begin
phase 1 of the design process. This contracted work will help determine a budget for the
capitol expansion and renovation under the strategic plan goals for financial strength. A
known commodity, JMM had been hired to design the earlier Assisted Living facility at
QH in 1999.
53 Minutes from the Board GovernanceCommitteeMeeting, March 26, 2013.

27
In December 2010 the plans included:
1. A new skilled nursing unit of 15 beds with a specialized rehabilitation
center,
2. Renovation of the existing nursing home to add small private dining
rooms and more private rooms,
3. The addition of an 8 bed hospice unit.
4. The board began to discuss hiring a contracted Medical Director for
orthopedic cases which might increase the average daily census of
Medicare A residents.5 4
The cost estimate for the expansion was $6.4 million. Lancaster Pollard of Columbus5 5
was contracted to help discover sources for fundraising.
Spectrum, on July 27, 2011, presented its report to the QH Board of Trustees on the
affordable housing market in the local area. Spectrum affirmed the viability of a QH
increase of its affordable independent living units (ILU) with some cautions as follows: 1.
Waynesville-Warren County is a conservative market area. 2. Target market is OK. 3.
Target market is growing in its demand for short and long term care. They suggested the
development of 35 new affordable independent living rental apartments with services.
The residences would range in size from 550 to900 square feet. 16 residences would have
one bedroom, 12 would have a bedroom with den, and 6 would have two bedrooms and
two baths. In the end, however, QHCC today has only five units for Independent Living
(ILU) found in the duplex building and the old “Medical Building” with the two duplex
units being used.
By mid-2011,thenation and the stateof Ohio werefacing a fiscal crisis which lead todeep
budgetary cuts and instability. Medicaid funding was drastically cut. This led to a crisis
among QH board members concerning their support of the Independent Living project
and projected fundraising projects. Once again Trustees, who were already deep into
revision of the bylaws of both boards and the creation of a “community of gratitude,”
questioned whether the Quaker method of decision making was appropriate during such
a time of crisis. Some members wanted to back out of the decision for expansion and
fundraising. They thought it was too risky to continue under the circumstances. Wendy
and the fundraising consultants emphasized that there must be total commitment of
Trustees for fundraising efforts to work, and, and the survival of QH was dependent on
taking the risk. The deciding of actions by “discerning the sense of the meeting,” was
defended. TheLight had been involved in the decision making and members need to trust
the guidance of the Light. Toundo the decision to proceed would mean the divine was not
present in the initial decision to proceed. On June 29, 2011, the QH Board of Trustees
decided to continue with the strategic plan. They also decided, even in such unstable
54 It was hoped the addedMedical Director,an Orthopedic Surgeon, wouldcreate programmingand policies
for the new short term care unit in 2014.Unfortunately,the Ortho Med Director contract was discontinued
in late 2016 due to budget reductions.
55 Lancaster Pollard is also the investment bank for QHCC HUD loan.

28
times, to continue looking for a professional development person to hire. They had first
wanted this to be a part-time position, but then, trusting in the Light, decided to make
the position full-time. In October 2011, Lisa Gooding was hired as a certified Director of
Development.
In March of 2012, the issue arose again about the feasibility of taking on so much debt
with a major building project. However, advisors again encouraged Trustees to accept the
debt even though it seemed counter-intuitive to them. Every effort had to be made to
make the projected Development Director more than just someone “wanting something
from someone.” Found in the minutes of the Operation Board of Trustees, was this clear
united statement of intent:
“Difficult decisions to cut costs in balance with risk based decisions to
expand services are the lifeblood of the mission. Without this level of
constant attention and accountability, the mission would cease to exist.”
They were also aware the general public, both Quakers and other people of good will,
might misinterpret taking on greater debt as a sign of the wealth of QHCC and so be
uninclined to make charitable donations. They might not understand this action as a
survival strategy for QHCC. One of the major tasks of the trustees is to be ambassadors
to the public to explain the need to increase services for the survival of the organization.
Wendy and Lisa began working on community presentations and memberships. A big
effort was made tointroduce Lisa to local organizations in Waynesville tohelp her develop
the necessary local connections to initiate mutual conversations and become
friends/partners/investors. This included charitable actives on the part of QH as an
expression of Servant Leadership for the surrounding community: i.e., donations to the
local Waynesville Fire Department, donations toa college scholarship fund, the donation
of QH’s meeting space for use by other non-profit organizations, the support for local
health and wellness initiatives, support for teachers and educational endeavors, and the
use of QH’s handicap van during the Sauerkraut Festival.56 The major connections
between QHCC and the surrounding community are:
1.) QHCC is the second largest employer in Waynesville after the school
system and consequently contributes greatly to the income tax base of
the community, and,
2.) QH employs over 100 local citizens.
QHCC contributes to the social and economic well-being of Waynesville. Because QHCC
has a stake in Waynesville and the surrounding area, Waynesville and area has a stake in
the continuance and excellence of QHCC.
Another technic in soliciting charitable donations is tonever ask for funds for operations.
56 Charitable cash donations madeby QHCC in 2013 was $9,500.00 and in 2014was $7,500.00. Donations
to the WaynesvilleSauerkrautFestivalSenior High School Scholarships and yearly sponsorship fees given
to the festival by QHCC from 2005 to 2018 was $38,395.00.

29
The facility should be successful enough to pay for its operations. Ask for funds only for
growth, capital projects, and benevolence. Dipping into operational funds is very serious
mistake.
In January of 2013the Foundation Board approvedthe following four strategic plan goals
of fundraising, for givers“to connect, buy, or invest”:
1. Build a thriving and dynamic Annual Giving program.
2. Build a Major and Planned Giving program that provides significant
project and endowment support for Quaker Heights Care Community’s
critical work.
a. The expectations is to increase donors and the amount donated
by 20% or more for three years.
3. Establish and continue the Foundation Giving program that seeks
annual and major gift support.
a. The goal for 2013 was $44,000.00, then increased by a third in
2014 and 2015.
4. Create an Integrated Development Program that provides engagement
with other Waynesville and Warren County area organizations and
supports fundraising efforts, decision-making, and institutionalizes Best
Practice.
a. This includes special events, annual giving solicitations, and
outreach programs to build awareness of Quaker Heights as a
suitable beneficiary for philanthropy. Building a community of
gratitude and philanthropy within QH and the larger community
is crucial. Initially, the Director of Development would also direct
outreach projects which will integratecommunity building events
and philanthropy. Nurturing this kind of community helps to
build a culture of mutuality in Waynesville itself and area.
b. This also includes nurturing relationships with area hospitals in
the contiguous counties as well as other health care providers to
promote QHCC for STC and LTC.
The action plan included advertising and a variety of giving opportunities:
1. Media ~ partner with other organizations to distribute QH news in both
paper and electronic modes; i.e. county/regional newsletters,chamber of
commerce newsletters, local5 7 and regional newspapers, i.e. the Dayton
Daily News Neighborhood Section. This includes nurturing a Facebook
webpage, Google ads and analytics, email, and the updating and
expansion of the website to make it more interactive. Also, included are
traditional paper handouts and flyers, ads, news articles, web articles,
and, direct snail mailings. Also, commercials on ThinkTV PBS.
57 The “Miami Valley News” newspapers are The Springboro Star Press, Miamisburg West Carrolton
News, The Germantown Press, The Franklin Chronicle, and The Centerville Dispatch.

30
2. Advertising on a local billboard on SR 73 as well as the QHCC name on
free merchandise like gift bags, brochures, flyers, pharmacy bags, and on
the QH “Among Friends” cookbook (2007). The QHCC bus received a
colorful advertising “wrap-around” in late 2016.
3. Cultivate closer relationships with local hospitals to increase referrals.
There is a growing tendency for hospitals to send patients home with
home health care. Visits are made to the referring hospital to promote
QHCC’s Short-stay Rehab.5 8
4. Cultivating Planned Gifts using information from the Crescendo Pro
planned gift program.
5. The Trustees’ Annual Giving Campaign via snail mail in November
6. A three-year long capital campaign asking for $1,800,000.00 starting in
2016 for significant financial assistance for the first time since QH
opened in 1905. The funds will be used for the remodeling of 37 semi-
private rooms into private rooms. The capital campaign was under the
supervision and training of Becky Drumm of Advancement Associates.
7. Other Giving Opportunities (See, Appendix for fund reports):
a. Qualify for both Miami Valley CFC and Ohio River Valley CFC
(The Combined Federal Campaign workplace charity
campaigns). Federal employees will be able to donate funds from
their paychecks to QH.
b. Family Funds/Memorials and Tributes59. Memorial funds can be
created for a resident cared for at QHCC or for an employee.
These funds can be designated for specific purposes.
c. Donations to the QH Foundation make up of unspecified gifts.
d. Donations to construction of the new therapy wing “Wish List.”
Because some like to leavea legacy of a building, room or a garden
named in their honor, QHCC developed these opportunities and
others for the new structure. Funds donated could also go toward
paying off the HUD loan. This would develop into the “New
Building Fund” begun in 2014.
e. The Linda Gilbert Memorial Fund founded in 2003 for financial
assistance to QHCC employees, a benevolent fund. Linda Gilbert
was a beloved nurse’s aide who died in 2003.
f. The Resident Assistance Fund for the development of activities6 0
58 Examples ofhospital visits are: On 1-21-15 Stacy Miller,Wendy Waters-Connell and Amanda Yauger met
with the entire case management team at Bethesda North Hospital in Cincinnati (Hamilton County) where
they were ableto givea ten minute commercialregarding ourcampus.On 2-25-15 Amanda Yaugerhad the
opportunity to meet with all of the case managers at Jewish Hospital in Cincinnati providing a similar
presentation regarding our campus to increase our referral base (Administrator’s Report, March 2015).
Also, Sydney McBride visited the Care Management Team at the UC West Chester Hospital.
59 An example of a Family Memorial is the Billie Owens Memorial Music Fund given by her childrento the
QHCC Foundation fund to make musical programs possible for the QH residents.
60 To become familiar with all the wonderful activities offered at QHCC, see QHCC facebook page:
https://www.facebook.com/quakerheights. Activities include coffeeklatches,craft times, games, current

31
and services for residents or financial assistance to needy
residents, a benevolent fund.
g. In-Kind Gifts which are items a donor can buy which will be
distributed by the staff when needed.
h. Special funds, i.e., “The Market Study Fund” designated by the
donor to pay for the cost of the LJR Market Custom Strategies
study in 2015.
i. One of the charitable/benevolent functions of QHCC is the writing
off of “bad debt” which is the debt of residents that can no longer
pay for services. From 2007 to 2017 the average of bad debt was
1.45% of revenues.
j. Charitable Gift Annuities (CGA) managed by Friends Fiduciary
Corporation (FFC)
k. The development of a capable, dependable, and “professional”
Corps of Qualified Volunteers, The Friends of QH. Through an
initial interview and by filling out a “Skills and Interest” profile,
the volunteers’skills will be matched to the needs of QH. They will
be trained and oriented6 1 so they will feel appreciated and will feel
invested in the organization for many years. They can help in
lifting time consuming burdens off thepaid staff and can help save
money. It was hoped a volunteer might be trained to lead,
coordinate, nurture, and organize the gifts of the Friends of QH.
Volunteer jobs can be found in the Activities Department,
Business Office, computer work (input of data), and the
Marketing/Advancement Office. However, to facilitate this high
level of competency, the job of Development Director and
Activities Director would be combined in 2014. TheDevelopment
Director had to participate in a 12-month certification process so
QH would be compliant tothe Ohio requirementsfor an Activities
Director. A volunteer assistant to the Director was still sought to
accelerate “person-power.” Long-term volunteering is a way tobe
a donor/an investor/a stakeholder. A happy and fulfilled corps of
volunteers can also lead to more monetary donations. Successful
volunteers, whose opinions and creativity are regularly solicited
and are shown appreciation for their work, are happy
events discussion, musical groups and soloists, elementary school class performances, movies and more.
Some residents tend to gardens in our enclosed courtyards. There are also seasonal events, including but
not limited to holiday dinners, a Mother’s Day Tea, and cookouts during warmer weather. Residents who
are able may go on weekly outings via our bus. Residents reach consensus among themselves about where
they want to go on these outings.
61 Volunteers are required to take four online classes at Silverchair Training at Relias/Learning Co.
Silverchair Learning Systems,LLC providestraining and education programsfor employeesin senior care
organizations in the United States. Its courses include long term care, assisted living, home healthcare,
Alzheimer's/Dementia, hospice, medical, and therapy; and various courses for families. See,
https://www.relias.com/blog/topic/silverchair-learning-systems.

32
ambassadors for QH. Volunteers must have TB/flu shots and
background checks and be finger printed. There are two types of
volunteer work:
i. Direct activities with residents
ii. Program Development and Support
1. Clerical work, data input
2. Volunteers with high level of media production
skills
8. Talking Points with the larger community:
a. Community-wide quilt project; the creation of a virtual quilt to be
displayed on QH website (2014).
b. Discussion of short-term care/out-patient therapy and purchase
of Memorial/tribute bricks, pavers, stones, tiles.
c. Providing tours of the facility
d. Promotion of “The Friends of Quaker Heights.”
9. Contacts with which to develop co-projects, i.e. Educational programs:
a. Local churches, i.e. Grief Program for ministers and interested
folk
b. Clinton County Senior Citizens, annual fair
c. Progressive Women’s Club membership
d. Health Networks/partnerships, i.e. with Ohio Masonic Home
and with Premier Health (Miami Valley Hospitals and Atrium
Hospital) as a Gold Standard Provider
e. School personnel and students who want to volunteer
f. QH Team for the 2015 Walk to End Alzheimer’s, Dayton, Ohio
(Miami Valley Chapter)
10.Grant Research, i.e. FSA grants emphasize collaboration between the
facility and thelarger community possibly in the form of serviceextended
into the community and greater contact between generations.
a. In 2015 Friends Foundation for the Aging (FFA) offered a grant
to Earlham College in Richmond, Indiana and QHCC to promote
the education of future senor care administrators who would gain
practical experience at QH; an Administrator in Training
internship. The recipient of that internship was QHCC’s Sydney
McBride, now a Licensed Nursing Home Administrator
(LNHA).6 2
62 “When asked why shedecided to take a chanceand accept this fellowship Sydneystated,‘It was Wendy
(Waters-Connell) that sold me. Just from the brief moments talking with her I knew she would be an
extraordinary mentor from whom I would learn so much. To me there is nothing more important.’ She
brings with her an endless amount of energy and thirst for knowledge,” (The Quaker Heights Journal,
Vol. 1, Issue 1. p. 5).

33
A second grant from Friends Foundation for the Aging was
received for another Earlham College Graduate to start an
Administrator in Training internship. Jordan Matthews started
on June 6, 2016 at QHCC. This is a nearly $32,000.00 grant with
the goal to encourage Earlham graduates to consider elder care
as a career choice. Another Earlham student was also sponsored
by FFA for an internship at QHCC. He was Timothy Noninga, a
neuroscience and biochemistry major.6 3
b. A grant from the Friends Foundation for the Aging helped to
finance the QH story quilt.
c. Seeking possible interns from the Miami University’s Scripps
School of Gerontology and the University of Dayton.
d. A grant was sought from Crossroads Hospice for free webinars
and seminars for local clergy concerning death and dying.
e. Grants were sought from the Dayton Foundation, Greenlight
grants for music and memory programs.
f. Grants were sought from The Physicians’ Charitable Foundation
g. A staff member was accepted in theinaugural class for the Friends
Services for the Aging Leadership Institute in 2013. 6 4
11. QH attendance at local and national professional programs, i.e.
University of Dayton Center for the Integration of Faith and Work
annual event for businesses in 2014, https:// www.
udayton.edu/business/ academics/ centers/cifw/ index. php . Other
programs, conferences, and events attended:
a. Attendance at the Area’s Progress Council’s Economic Outlook
Breakfast in November 2015.
b. Dayton Mall Miami Valley Senior Expo, Thurs. Sept 25th , 2014
c. Attendance at the annual FSA Annual Meetings.
d. Attended Junior Achievement Breakfast at UC West Chester
63 New fellow Timothy Toninga hadsubmitted his application to the Board ofExaminers for Nursing Home
Administrators in Ohio and would start his internship at Quaker Heights on October 1, 2016. This follows
the loss ofthe previous applicantfrom Earlham who could not access the necessary VISA approvals dueto
being out of country for more than a year.
64 Taken from the FSA Leadership Institute website: “The FSA Leadership Instituteoffers unique and in-
depth experiential learning opportunities for current, emerging and new senior leaders to enhance and
deepen an understanding of leading in a Quaker affiliated organization. The experience is designed to
give leaders ways ofthinking and practicing that are congruent with Quaker Values.” Those values are:
the importance ofrecognizing that everyone has value and the capacity to contribute, actively seeking the
minority voice, community voice and building community, consensus decision making, continuing
revelation, egalitarianism/ distribution of leadership, transparency, and managing differences.
http://www.fsainfo.org/2018fsaleadershipinstitute/.

34
Hospital
e. Attended Miami Valley Long Term Care Association Golf Outing
f. Attended Sinclair College Health Sciences Focus Group in 2016.
g. Participation by ExecutiveDirector, Wendy Waters-Connell in the
LeadingAge National Conference in Boston, Ma in 2015 as one of
speakers on the panel focused on Board Governance, specifically
to talk about the Quaker method of decision-making. See,
www.leadingage.org/2015-annual-meeting-highlights.
h. Attendance at the Kettering Health Network Extended Care
Facility (ECF) Community Forum. QHCC gained access to the
Kettering Home Health portal online so they could keep track of
referrals and see if there are any re-hospitalizations of residents.
12. Targetedmailings to specific audiences: trust officers, elder care lawyers,
tax attorneys; short stay audience at QHCC, Assisted Living families and
potential families, long term families, families of the diseased or
discharged, Quakers, Trustees/Past Trustees and Sub-Committee
members, QH staff, local organizations and their members.
13. Community Building Activities which “fundraise and friendraise”:
a. QHCC hospitality booth/tent and rides up the hill with the golf
cart at the Sauerkraut Festival in October
b. Participation in Clinton County Senior Health Fair
c. Memberships to local community organizations with mutual
participation: i.e. The Waynesville Historical Society, The
Museum at the Friends Home65, and the Waynesville Garden
Club. Local civic organizations are invited to host their meetings
and eventsat QH in the community room so QH residents areable
to attend.
d. The Waynesville Garden Club Christmas Bazaar, part of the
“Christmas in the Village” event.
e. Maintain relationship with Boy Scouts and Girl Scouts
f. Deepening relationship with the Chamber of Commerce, i.e.
attendance at their Christmas planning meeting, and the
Waynesville merchants.
g. Maintain relationship with local funeral directors. Many families
ask that QHCC be listed in the obituary and that in lieu of flowers
a donation be made to QH.
h. QHCC sponsoring a Sportsmanship End of the Year Award at the
Waynesville High School. QH was one of the sponsors of the first
65 QHCC gave a donation to the Museum at the Friends Hone to help refurbish their front porch in 2008.
The museum hosteda Mother’s Day tea with a silent auction for a teaset. All theproceeds wentto the Linda
Gilbert Memorial Employee Assistance Fund.

35
football game at the new WHS football field.
i. High School volunteers at QH66
j. Tours of the facility for 8th graders on “8th Grade Career Day” to
learn about careers in Senior Health Care.
k. Pumpkin Bowl at the J.D. Legends Strike Zone was the first large
community event hosted by QHCC which was very successful.
l. Sponsorship of the CarFit and Vehicle Inspection Program for
seniors held at QHCC in 2014 with antique/vintage car display in
association with Cincinnati AAA.
m. Wendy Waters-Connell, was a QHCC ambassador to the
Progressive Women’s Club with a Native American
demonstration at the LeMay property in Waynesville in 2016.
Wendy was also invited by Philadelphia Friends to give a
presentation at a Diversity Celebration Meeting on 9/27/16. The
subject of the presentation was how Native American culture and
Quaker culture intersected to influence Wendy’s leadership.
n. Concierge Program67
14. With the anticipation and advent of construction of the new therapy and
short stay wing in 2014, there was the development of a “Naming
Opportunities” program for “Legacy” givers; an official Naming Rights
Policy. Theseopportunities werefor naming rooms in the new wing and
other parts of the existing building as well as a Donor Wall display (Tree
with Leaves). A donor wall has not, as of this writing, been installed.
2013, 2014, and 2015 were pivotal but financially difficult years for QHCC, the biggest
problem being the slowness of donations. 2015 would prove to be one of the worse
financial year in QH history. It was reported in the updated QHCC 2015 Strategic Plan
dated January 19, 2016:
“The goal to strengthen financial position was not met in 2015. MyCare
Ohio dual eligible program continued to result in dramatic cash flow
reductions due to the increased utilization of Medicaid services under the
66 As of the publication ofthis report four high school girls come to QH Monday-Friday for about 1.5 hours
a day. This is an “internship” program for students in the National Honors Society at Wayne Local High
School.
67
The Concierge Program designed by the Development Director in 2014 was not implemented. Later
Sydney McBride, LNHA, CPASRM, Assistant Administrator, Chief Advancement Officer and Director of
Marketing & Public Relations, developed and implemented another Concierge Program. It was developed
in 2015 and revised in 2016. The present program is in-house. This program beginseven before admission
and makes sure that the staff is assessable to the resident and his/her family at all times. It is a program
that says “hello” to a new resident and family but also says “goodbye” when the time comes. In Octoberof
2017 QHCC was awarded a grant of $47,800 from Friends Foundation for the Aging (FFA) to further
develop its Concierge program. See QH website: http://www.quakerheights.org/friends-foundation-for-
the-aging-awards-qhcc-grant-for-new-service-model/

36
ACA. Census declined in 2015 despite increases in short term care
referrals. Revenues were lower in 2015 due to Medicare resident mix and
lower census trends. The organization continued to aggressively manage
expenses from operations but this could not offset the deficits in revenue.
One of the worst financial years unfolded in 2015. The expectation is that
the new short term rehab wing will drive up admissions and better payer
mixes in 2016.”
With the new Short-Term Rehabilitation Center construction, starting in the summer of
2014,a plan toengage a professional advancement specialist toassess the efficacy of QH’s
programs and QH’s capacity to improve the financial outcomes in 2015 was seriously
considered by the trustees. It would be another re-examination and updating of the
Strategic Plan. The contract for the assessment would not exceed $1500.00 per month
and the assessment would not exceed a total of three months before a formal assessment
analysis would be presented to the full board. Director Wendy Waters-Connell was
authorized toengage Advancement Associates tocomplete the work (Foundation Board,
1-26-2015). Their report was presented on March 27th, 2015. The essence of their report
was positive even in the face of the financial shortfall.
A good infrastructure of charitable giving had been developed but therehad been a failure
in relationship-building with donors; aka investors/stakeholders. There needed to be
dedicated time-consuming donor visiting time every week. Donors need to feel included
and need to be thanked for their contributions whether their gifts are of Time, Talent,
Treasure, Prayer, or Advocacy. The combination of the positions of Director of
Development and the Director of Activities had not worked out. Consequently, there was
a re-structuring of the staff and the responsibility for fundraising was placed squarely on
the shoulders of the Executive Director, Wendy Waters-Connell. Wendy would spend
most of her time off-campus to meet with potential donors/investors/stakeholders and
nurture those relationships under the mentoring of Becky Drumm. Wendy’s primary
mission became to raise significant monetary support for QHCC. Wendy also was helped
by “administrator in training” Sydney McBride who was working toimprove marketing,
community relations, advancement and fund raising, and was visiting local physicians’
offices. Sydney also maintained the donor database (Donor Perfect). Lisa Gooding was
retained as an independent consultant acting as an agent for the Story Quilt for QH. The
new activities director was Tami Linville, who had previous worked at QH as an activity
aide. She left QH for a while but came back as Activities Director in 2015.
Results from the Advancement Associates feasibly study interviews revealed concern
about the proposed amount of the capital fundraiser, $1,800,000.00, to remodel semi-
private rooms into private rooms to attract more Medicare A residents. Some
interviewees in the study felt it was too much to ask for and the campaign should be for 5
yearsinstead of 3 years. It was pointed out that capital fundraisers by other organizations
in Waynesville had never been terribly successful. Some people doubted the village could
sustain such a high level of giving. It was felt that the capital fundraiser should start with
a silent phase until around 75% of the funds were collected. After the first silent phase, it

37
would be opened to the general public for donations. This was, indeed, what happened
while discrete cuts in the budget and the completion of the private rooms, which drove up
the census and revenues, helped financially.
Advancement Associates encouraged QHCC to have the capital fundraiser. It was also
hoped HUD would approve the funds received from selling 28 of QHCC’s licenses for
skilled nursing beds for the renovations of the semi-private rooms. Advancement
Associates would continue to advise QHCC during the capital campaign.
LIR Custom Strategies was also engaged to investigate whether the Quaker “brand”
negatively affected the number of and amount of the donations.6 8 The two boards had
discussed whether the name of QHCC should be changed to broaden the base of possible
stakeholders; whether Quakerism should be de-emphasized to encourage donations from
non-Quakers. LIR’s final assessment, after their extensive phone survey, was clear. The
Quaker “Brand” was not the problem. The problem, it was revealed, was the general
public’s lack of knowledge that QHCC was a non-profit organization and was dependent
on charitable giving. Also, there was another perception problem: It was probably more
difficult, while building the short-term rehab wing, to overcome some people’s stereotype
vision of a nursing home: a vision which did not include different levels of short-term and
full-term care for people of different ages.
LIR emphasized QHCC was suffering from low recognition, not from dislike because of
its Quaker affiliation, or the perceptions of elitism (not accepting non-Quakers residents)
or great wealth. There is a chronic lack of realization that QHCC is a non-profit facility.
A major task would be to make people aware of the location of the facility. QHCC is quite
a distance from the urban and suburban hospitals making referrals. They suggested
QHCC emphasize the following items in its advertisement and fundraising:
1. QHCC has a 5 Star Rating ( as of this writing, a 4 Star Rating)
2. QHCC is a non-profit affordable facility
3. QHCC is open to all denominations; to all people
4. As a not-for-profit facility QHCC relies on charitable giving
5. QHCC has deep roots in the area since 1905 (read vol. 1 of this work)
6. QHCC is itself a charitable organization and has given a high degree of
charitable help to members of the wider community over the years
7. QHCC is supportive of other social organizations in the wider community
8. All donations to QHCC will remain in the local area
Promotion should focus on QHCC’s backyard; the five contiguous counties. It should
68 ACTION MINUTE (Foundation, 7 -27 -2015):
1.) The Foundation Board ofTrustees approvedthe engagementof Advancement Associates to begin
the feasibility study to determine the success opportunity to raise funds for the private room
renovation in a formalized capital campaign.
2.) The Foundation Board ofTrustees approved the engagement of LJRCustom Strategies to test the
reputation and branding of the organization to determine if a name change would improve the
admissions volume and donor generosity.

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