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Becky Bartle

Inspiring HOPE in Indiana

By Laura Kuhn

Becky Bartle has a few words for anyone thinking about getting into long-term care: "This isn't a career. It's a cause."

Bartle is the Regulatory Affairs Director for Hoosier Owners & Providers for the Elderly, or HOPE. HOPE strives to advance the interests of long-term care facilities that are owned and operated by Indiana residents. The organization collaborates with legislators, regulators, advocates and other organizations that provide services to the elderly.

As passionate as she is now about long-term care, Bartle didn't start out in that arena. The first two years of her career were spent as a hospital nurse. "While I do believe that the foundation of nursing skills that comes with med-surg experience is crucial, I soon found out that there was no long-term connection with your patients. They were in and out," she said. "Somehow I desired, and people in general deserved, a better connection with their caregiver. I found that I was getting a positive response in the hospital for simple acts of kindness, which told me those were things they weren't getting on a regular basis. From there, I had to make a decision about whether I would continue with hospital nursing or seek another avenue where I could have a greater connection with the people relying upon me for their care."

A friend of Bartle's persuaded her to look into long-term care. Bartle was hesitant to do so because the general feeling of the public at that time was "real nurses work in hospitals." Still, she took the leap and found that a lot of her preconceived notions about long-term care weren't true.

"I crossed into long-term care under false impressions that it was going to be easy and that there wouldn't be near the complexity or the stress that I was feeling in a hospital setting," Bartle said. "I found that regulatory requirements were stringent and there were quite a few more regulations than I would have anticipated. I had not given long-term care the credit it deserved for the tenacity it took to oversee the care that residents in long-term care need. I never looked back from that point – I tell people they find in very short order that they love the industry or it's not for them and it doesn't take long to make the determination. If your heart's not in it, you shouldn't be in it."

Learn more about HOPE at

A passion for teaching

Bartle's first job in long-term care was working as a staff development coordinator. "I was to be a teacher in an industry I didn't understand!" Bartle laughs. She began digging into how rules were written and applied. "What I found was that everyone thought they knew the rules, and everybody learned from somebody who thought they knew the rules. They didn't understand the rules, but they thought they knew what the rules were." A need for education became evident.

Over the years, Bartle has held many positions, all of which have afforded her the opportunity to educate others. She's also served on a number of industry committees, helped write rules and co-authored both the Qualified Medication Aide curriculum for Indiana and a long-term care management course directed toward nursing. She also obtained her master's degree in nursing with a focus on nursing education.

Three years ago, Bartle began teaching the Health Facility Administrator Course for Indiana residents who want to become licensed nursing home administrators. "I took the opportunity because I'm a teacher at heart and I believe that you have to have experienced things firsthand to really understand them," she said. "There's nothing like hands-on experience, and that's what I feel we're able to offer through this course."

Collaborating for quality

HOPE works closely with the Indiana State Department of Health and other key stakeholders in a collaborative effort to improve quality. The combined group meets on a monthly basis in an effort to address any problems before they get out of control. "We're doing things I don't believe other states are doing in an effort to build a collaborative team," Bartle said. "Overall, it's the residents who benefit."

Bartle is especially proud of a pressure ulcer prevention initiative developed by the group that targets facility-acquired pressure ulcers via training sessions conducted throughout the state. The group also recently launched a healthcare-associated infection initiative that will focus on preventing the spread of CAUTI and C. diff.

Long-term care leaders in Indiana also join forces for twice-yearly Long Term Care Leadership Conferences. At these conferences, caregivers, surveyors and academics spend a day focusing on a single issue that is critical to long-term care. For example, severe flooding in Indiana two years ago supported the decision for a Leadership Conference on emergency preparedness planning. "I'm proud of Indiana and our accomplishments and the fact that I truly do believe that the stakeholders in this state are making an active effort to improve quality," Bartle said.

Educating a new generation of administrators

In the years that Bartle has been teaching the administrator course, she's seen a broad variety of students. In addition to a large number of nurses, her pupils have also included pastors, accountants and factory and automotive workers. "I always caution them that it would be best to work in some capacity in a long-term care facility to understand whether their hearts are there prior to becoming an administrator," Bartle said. "It's not just a vocation, it's a personal commitment."

The course is taught through daily lectures over a seven-week period. Bartle smiled when she shared that students tend to have the most difficulty when learning about budget and finance. "The majority of people who want to be administrators are there for the people and the caregiving, not the business of the business," she said. "However, students have later come back and told me that the information was valuable, although it was painful!"

Given the constantly evolving nature of the long-term care industry, Bartle says she's never taught the course the same way twice. "I don't know that I've ever taught two educational offerings of any type with the same material, and that is because guidance changes, language changes, ancillary rules and regulations change. I've said ‘You can't take a sabbatical from long-term care because you'll come back and be lost!'"

Although online education is carving out an increasingly large presence across the country, Bartle doesn't see it as a good fit for the administrator courses. "There's value in the interaction. The rest of your career is going to be spent in a social environment. Working through scenarios and problem-solving in a social environment sets the stage for the future and instills professional camaraderie," she said.

The administrator's role in accident prevention

During the administrator course, Bartle spends ample time discussing tag F-323, Accidents, to ensure that her students have a firm understanding of expectations. The group focuses on root cause analysis and is encouraged to never view an accident as a one-time occurrence – if it happened once, it has the potential to happen again.

"What I specifically address is to approach every incident with a plan of correction," Bartle explained. "Correct the issue for the individual involved, identify other individuals who could have similar concerns or risks and implement across the board intervention and monitoring. Whether you're cited or not, you've implemented preventive measures to mitigate the risk of recurrence. It's the right thing to do."

Bartle criticizes what she calls the industry's "knee-jerk reaction" to accidents, a tendency to be so wrapped up in doing something that there's a failure to contemplate whether what is being done is the right thing. "We throw an answer at the problem before we've really contemplated the question," Bartle said. "That's where we're missing the boat."

Despite moving at a breakneck pace, Bartle has no plans to retire or even slow down. "I'm preparing my caregivers – that's what I see that I'm doing," she said. "I'm preparing the standard of care that I would want.

"I believe that there are some professions where you do achieve greatness, or some level of accomplishment," she continued. "However, in caregiving, you are a lifelong learner. Every experience, every interaction provides some learning if you're willing to listen and to learn."