“We are US…A Healthcare Marathon Finish” by Dianne H. Timmering

It’s a year later and I still reflect on my time in the race. The race for what—healthcare’s idiosyncrasies of uncertainty, day to day where one word from Washington, whether it becomes regulatory discretionary review or legislative speculation still rings with resonance of possible impact shuttering those it impacts the most— the impoverished, the elderly, the disabled, the rich, the poor, the hopeless—you see everyone has their own healthcare story because I suppose any one rich, or even moderately so, could suddenly be poor if they encountered the worse that could happen in the navel of unscripted sickness.

But that is not what this blog is about. It’s about finishing the race—the New York marathon of 26.2 miles I mean, just, and I mean just under 6 hours—a miracle of sorts for someone who trained with a little bit of a little. —I hate to run, I mean I really do, but the little bit of practice that my mind would allow me to have, combined with the larger aggravated power of hot yoga gave me the breath and endurance of muscle and brain-conditioning to make it through.

Well that isn’t exactly the truth–because we had a plan, a cause, and a mental superpower called PUSH. It was my colleague who said we run 11 minutes and walk 3, run 11, walk 3, pace ourselves—never to deter, never NEVER to veer from this strategic plan—and he was right. And it was the people of New York city—the #Brooklyners, and the #Manhattanites, and the #Queenstown folks, and the precious child who handed us that slice of banana in the #Bronx for so much needed potassium, and the women along the 23rd mile who said did we need a chip with salt as music selection slid into our ears goading us on, fighting for us, pointing us toward the finish, as it seemed like every new Yorker was—those beautiful incredible amazing “citizens” and immigrants who they are—loving, pushing for a good finish. Americans all of them, no matter their legendary heritage, in melting pot fashion of hope—for we are a hopeful nation, rugged individualists. We can’t help ourselves—it is who we are. US.

  1. US. Us — the U.S.—the United States of America.

We are… US.

I finished—with 6 of my professional colleagues who inspired me every day in their deeper commitment to training than what I was willing to do—, knowing in the end, hoping, that I would fight no matter what even if I had to crawl across the finish line. Which is what my colleague and I almost did—he had a busted tendon and I just tired out—my muscles and his clenching up, believe it or not, 800 meters from the finish line. 800 meters was like running the whole 26.2 miles all over again. But we fought through it and we pushed and we pounded to get there—and we crossed that evasive — where are you!? –— line.

I suppose it’s like anything, or any “deal” worth finishing—business, civic, political or otherwise—as my colleague always says—it’s the last 5 yards. And it was the last five yards—and it seems there are no exceptions to this rule.

In healthcare, with its upside down uncertainty, the race is longer, I am finding out, even beyond the 5 yards. But many of the current healthcare business “deals” to try to even conceive of a future are at the 5 yard line— and even then that is only a new start.

But the good kind of one.

NOW, today, we have a chance to finish more than a marathon but re-create a brave new world of healthcare, and in our case long-term-care for the in-coming magnificent barrage of the aged and elderly, those who were conceived after the worst of times of WWII, who became the best of times, the best creations of life, to refill the “slots” of so many lost. But again life comes and it goes, and there is death, but there is also rebirth and they deserve what “US” can give them. They deserve our marathon finish, so that we can give them theirs.

So, if we can get the muscles moving right, the knees to cooperate, the insoles inside the shoes to stay put, the jellies, powders, and goopy proteins, combined with the rigor of a strategic plan, tenacity, ferocity, a little bit of blood, and a molecule of faith, we can finish any race, any deal, anything; and I mean anything. Let us finish the race…., so a new one can begin.

By DHTimmering

Revolutionaries Fight Back – Defending Those Who Can’t Take Care of Themselves

When a risky strategy is your only ally …. Business, Politics and the spiritual salve that holds it together.

Who will take care of those who can’t take care of themselves?

By Dianne H. Timmering

July 2017

Legislative victory!: Senate Bill 4 – Medical Review Panels! Kentucky gets tort reform! A form of civil practical justice to resolve frivolous unmerited litigation that elicits equity and fairness, and a professional determination of the facts alongside the truth of our intent.

 Excerpt: The truth is, at the core, compassionate imperfect care is the best kind of care and often very difficult care to give. We fought for both policy and legislative victories; not because we want “protection” from the accountability of care, but so that we can give it.

These two victories are about the freedom-filled rights of our U.S. Constitution and Preamble—we the people—as it was meant to exist with the fair distribution of logic, observant of rational considerations and judgement. For Medical Review Panels, our first step in the tort reform odyssey, litigation will now be considered by an expert panel, for both sides, the defendant and the plaintiff, the patient and the provider, with the right to a free trial! Tort reform in the form of panel equality, and urban-rural, in the form of accurate designation, are ultimately both economic issues of mightiness to expand healthcare innovation, retain patient fairness, restore caregiver confidence and keep solvent the industry that gives life and hope to the Least of Us. Dianne H. Timmering

July 2017 – Starting July 1, 2017, after years of a battle, a plan, a struggle and finally a revolutionary win, both Medical Review Panels and Urban-Rural reclassification took effect in the commonwealth of Kentucky.

The financial impact from unfiltered litigious cruelty is not yet known although as the first line of defense against unscrupulous carpetbaggers, its financial relevancy will reveal itself over time. Regardless of this critical point, perhaps it is the emotional breath that will follow our July first momentum, during our own national freedom of independence, which will be a beacon of hopeful relief for our Signature leaders and other “valiants” who take care of the elders of our times.

Policy victory!: Kentucky gets urban/rural re-classification after 14 years of inactivity –a significant change to meet the critical care needs of so many vulnerable aged Kentuckians and compete for wage competitiveness for the care-giver gifts of care.

The Rural to Urban re-classification, unchanged for more than a decade—a “material injustice” by a former governing body, is simply an issue of updating the system to allow providers to be reimbursed under the appropriate demographic area. For years, un-reimbursable care-ratio dollars have been unclaimed even though we have given the care anyway. Now dedicated long-term care providers can not only better care for our precious “consumer,” but find the beloved care-giver at a competitive wage rate that has turned out, the national shortage of care-givers, to be one our greatest nemeses of care delivery. We were an industry on the “brink of failure” not because of lack of supply and demand, or even operationally but because of litigious extortion and payment unfairness!

But neither of these revolutionary wins came without a cost: they took a fight, a strategy, a boldness and intentional risk, even without the assurance of any kind of win. The SignatureNation, and others, have been involved in both this legislative (MRPs) and policy effort (Urban/Rural) for more than a decade – in incipient development, maturation, and advocacy. As healthcare leaders of today must often do, we CHOSE the path of involvement for it was the only way to enact the change we needed for an industry almost on the “brink of failure” (the American Healthcare Association phraseology).

Both were decidedly long-term strategies because nothing short-term was working in the current legislative and executive branch governmental make-up. To get what we needed to battle industry pressures and unnecessary headwinds, we pivoted in 2014 from a strategy of defense to offense, deciding to get to the root of why nothing was happening, why such antiquated regulatory restrictions (urban/rural re-classification) and tort reform efforts were consistently meeting unmerited opposition.

We made the bold move to be out-in-front, to begin the effort to change the make-up of the governmental landscape. Not because of Democrat or Republican leanings, but because as “Health-o-crats”, we needed to change the foothold of inertia and old political ways which were driving our business to the edge of calamity.

We are fighting now for the same thing on the federal level even with an influx of baby boomers and a “sicker” patient population coming in. Where will our people go?

Fighting seemed right not only because of an expanding marketplace in Kentucky, but because of Signature’s more than decade old mission of hope and vision of “compassion-care” rescuing communities and elders who needed us. My precious mother passed away of acute Parkinson’s disease in a Signature center and I am forever grateful that they took loving care of her, because at home, we simply couldn’t anymore; and moreover, didn’t know how.

A revolutionary strategy must be bold and resolute.

With intention, we supported a dark-horse gubernatorial candidate as well as legislative candidates who supported our issues; we built relationships, educated politicians about our vulnerable patient population, invited them to our facilities, discerned ebbs and flows of underlying opposition, and pivoted at key junctures which significantly increased the odds for a win regardless how risky the strategy had become.

When, for example SB4 (Medical Review Panels) finally hatched out of the House in late February 2017, we, among others, were a part of it until last minutes of the final vote. We co-led the umbrella consortium with the KY Business Chamber, the Kentucky Hospital Assoc., Leading Age and the KAHCF (SNF Assoc.), co-drafting legislation, fighting back against dilution, drawing a line in the sand when we thought the strength of the review panel was dead. Signature leaders and CEOs from across the state battled for a strong bill with courage, fortitude and collaboration, pivoting when needed, holding resolve when demanded.

The Kentucky team was not afraid to get involved in the future of its own destiny!

It was time. We fought for a structure for fair and equitable judgement as the ubiquitous nature of healthcare engagement is based on human ethics, social determinants, expanding sickness of co-morbidities and good human intent. The truth is, at the core, compassionate imperfect care is the best kind of care and often very difficult care to give.

The MRP vote, tenuous when it finally happened – 51 – 46 passing via a simple majority—was a zenith moment, a penetration of time, when business, God and politics all worked together for a common good.

What stood out to me of course was the first amendment right of spiritual freedom, when Jason Nemes, one of the bill’s architects and an ally, who in the end wanted a good bill and one that would withstand a constitutional challenge, but give fairness to both sides with expedited “pay-outs” for someone found to be indeed injured or neglected, it was his invocation of something sacred to me, something I co-founded and built with my co-partner, Joe Steier. Jason said that long term care companies are good, do care for a vulnerable population, and are targets. He then singled out Signature Healthcare for our spiritualty pillar – the caregiver beauty of soul, united with the SHC chaplain corps, unique to our industry, focused on whole patient well-being—in volume and reach, in width and depth for a deeper sense of human wellness. That we were a company, “trying to do right.”

Maybe through our model and vision to change the landscape of long-term care forever, our trials of purpose forge a trail for those who follow behind. We are perfecting the model of equal parts – business, God and politics to make it a whole, for healthcare is not driven by these buckets in single domains. Good policy drives productive business strategy with the ethereal iron impact of spirituality, tying the salve of patient possibility and the infrastructure of sustainable business with real hope in healing.

Mistakes do happen. We know this and own it. Our community is frail. Our framework of care for the elderly resident is through the core of Sacred Six engagement, state of the art clinical training combined with spiritual hope in medicine against growing chronic sickness and the highest levels of frailty. We love our residents, and our intent is to take the best care of them. The MRP does two things – it elicits equity and fairness, and a professional determination of the facts alongside the truth of our intent. It allows the facts to come out, for the unemotional truth to be told and considered. We just want the fairness of what a Medical Review Panel could and will bring to the discussion beyond the automatic lever of accusation, but the relevancy of the good intent of care and the full details around the situation. And it doesn’t preclude the plaintiff to due process and the right to a trial.

As the fourth of July coincides with the enactment of this legislation, these two moments are about the freedom-filled rights of our U.S. Constitution and Preamble—we the people—as it was meant to exist with the fair distribution of logic, observant of rational considerations and ultimate judgement. For Medical Review Panels, our first step in the tort reform odyssey, litigation will now be considered by an expert panel, for both sides, the defendant and the plaintiff, the patient and the provider. Tort reform in the form of panel equality, and urban-rural, in the form of accurate designation, are ultimately both economic issues of mightiness to expand healthcare innovation, retain patient fairness, restore caregiver confidence and keep solvent the industry that gives life and hope to the Least of Us.

These are RevolutionaryTimes.

UPDATE!: But the fight goes on. The MRP bill is a good one—with measured and fair authority for both sides (the plaintiff and the defendant) with no 7th amendment violation; the right to a free trial is NOT in jeopardy – the designated time periods allow for the facts to be heard—a visceral wall against frivolous litigation. Medical Review Panels not only expedite the evaluation of a patient’s claim and help detect whether it has merit, but can expedite a “pay-out” for someone found to be indeed injured or neglected and does not stop access to a fair trial or the courts. But still the fight goes on…..

“Too Fast, Too Soon, But Exactly the Right Plan – A Commentary”

by Dianne H. Timmering


The recent strategy from the Governor’s administration, while ideal and brilliant as they reached into the inner-workings of the legislative process to determine procedurally what they could do with a supermajority in both chambers in the first five days, it was simply – too much, too fast, too soon.

But it wasn’t wrong.

And reasons for tort reform, namely Medical Review Panels, not passing this week, because it will during the regular session in February, we strongly believe, had to do with other “powers,” I see that now, rather than totally having to do with complications of understanding its “language” as currently written. First of all, in an unprecedented Saturday move, seven bills passed the House, and as we understand it, the Governor will sign them all or already has, in the 10 day period to follow. It was just a lot. read more »

“An Inaugural Two Week Reflection”

 by Dianne H. Timmering

As I reflect back on this past inauguration weekend, I specifically remember four White House transitions. The first when President Herbert Walker Bush won the White House in 1988, the next, a Republican to Democratic transition with President William Jefferson Clinton in 1993, and then in 2001 when President George W. Bush, Jr. won the White House (with the “hanging chad” debate), and again in 2008 when President Barak Obama captured it back.

And now this one, another, although one that I viewed on and off as millions did, from the television set, like it was the sixties again, and the first man was landing on the moon.

At first crack of trying to express my emotional response, it felt very much the same, even though the news media may give the impression that there are first times for certain momentous inaugural moments. The protests were always brisk from the opposing team who had lost, the loss still so raw in the sinews of the mind that the heart had to protest like a purging of pent-up fury. Like before, like now. read more »

“The Truth About Tort Reform” – #WeAreKY

By Dianne H. Timmering

The truth is – tort reform is a not even a healthcare issue (although you could make the case that it is life or death depending on access to the right care and insurance rate affordability); it is so much grander, it is a pro-business indication of a thriving community allowed to innovate, set prices (another reason we need it – bc SNF can’t even set our own prices to overcome litigation unfairness), contain costs and operate within the parameters of set strategic mission and passionate cause.

Let a measure of supply and demand do its job as an organic indicator of good and bad business. Let our quality of care speak for itself, or not. At the end of the day, tort reform is a pro-business magna carta – a form of freedom and definitely an open portal for “life-rafts” to not only survive but cross streams through the opening doors of Kentucky—no longer needing to be pried open, but with a swan-like grace, opening, welcoming, and ready.




“Poetry Memoir of a Warm Day on December 26, 2016 in Louisville KY”

By Dianne H. Timmering

2:20 p.m.

I walk in shorts.

The sky is busy. The clouds race across using the stable blue for a sweeping canvas. So much to write. It roars and the wind carries it sounds. I am listening but I can’t make it out. The pines blow and wave and add to the shouts of the hemisphere. Listen out loud. A warning? Or a beckoning that life is ready to be lived in. 

A day stuck in time. The trees claw at the sky. Give me the fruit of my arms so I can live again. 

No portals today but smashed heavens one a top of the other knowing it is close and a good place to be. For those who have gone before us. To emulate its same rules and passions on this planet.  Thy will be done. On this earth as in the heavens. 

The leaves dance on her asphalt path-guided floor. Skip. Every sound is a note, every note a word. Decoding the earth. I value her.

The sounds are coming from inside the portal – waste no time, He says. El Shaddai – He is the boss

This particular cloud portal moves. Like a giant hand – the earth like its own pod or time-castle. A lunar capsule to a new land. Where they come from it or we pass through. I am not sure.


Heart Palpitations: Praying for Myself In Original Words of God – Aramaic

by Dianne H. Timmering

I was having heart palpitations…

Does true healing or emotional freedom require the right words with intentional presence? On this occasion I said them in Aramaic – an original language of God and the angels…

Itlabbabi brati amar-na qum!

Take heart, my daughter, I am saying to you, rise!

The power of the Ask and the right words of prayer.

Let me explain – Most recently, after finishing the New York marathon last month, I have had some of my more irregular heartbeats, an occurrence that I have had for years even with an assuredly healthy heart. I tend to hold my breath when I am thinking about something, like I am on a plateau of a mesa in an Arizona spring, in a different realm of air, where I don’t think I need any, like I am okay in any depth of the ocean. But then suddenly I find myself without, and I realize I’m not breathing, but gasping, and an angry heart erupts.

Sometimes it’s intercession for someone, or flat out stress – The day of the marathon, for example, just before the race, I had a bad one. Now the stress of running a marathon, training, preparation, worry that you are ready, enough “goos” in my running belt?, have I had enough protein to endure, fear you won’t make it …, is an easy indicator that that was the cause. But the last one I had had while previously training was so beat against my chest that I had to stop running and almost crawl back to my house.

I know how to calm a heart. Breathing through it. Big gulps of what is given freely. Coaching myself.

A couple of weeks after the race, I was in hot yoga and had to leave the studio because of such an event. I suppose stress is a direct impact of influence on just how fast it flutters and how long it is, but then one day this past week, it felt as though someone was stomping across the sternum climbing up a hill, spikes in the snow.

In a study of miracles we are researching, I decided to employ one of the miracle patterns we have de-coded – the power of the Ask, the right words of prayer, how said, what prayer language, when, even the essence of the healing touch, trying to hear God on what to do about a hammering heart …

Zeli baSlama wahwaiti xalima

Go in peace, and be healed… He said.

I said those words over myself – a tap to my sternum, an Ask for healing, an affirmation in Aramaic that I was…. Itlabbabi brati amar-na qum!

With a rise (qum!) of suddenness, the pressure was gone and I could breathe. Gone, no more compression at all, and with immediacy. Only healed. Maybe it was physically and emotionally calming or both, but regardless the pain was no more and I could leap again.

To sustain my “miracle”, I discerned to continue to breathe deeply, meditate (working on this as a practice), be present to the condition, and take the supplement of turmeric – a miracle spice on so many different levels including brain health, mind clarity and a functioning heart…qum!

If more people understood they could pray for themselves, would we see more healings, more understanding of where to seek help, especially with the “right” words spoken over the need?

Aramaic words give me the control of peace. qum! Rise!

Salu witiheb ikon b’au wtiSkxun Mt7:7-11 Luke 11:9

Ask and it will be given to you, seek and you will find Mt:7-11 Luke 11:9


Stay tuned for more – Fighting disease with the patterns of scripture and the words of God to harness miracles?!

“The Constraints Of Time”

A silhouette – a girl awakens; the woman free of old constraints; the relevancy of time to get there until the shadow fades.


“Thank You To Our Veterans”

To Our Veterans:
How do you say thank you to the men and women who fought for freedom, who risked not just a life but your time, purpose, even hopes and dreams in order to fulfill a mission, a spiritual call to defend the fruits of a nation built on the tenets of for, by and of the people. We are “those people” who you protected, fought for and in some cases, for whom your comrades gave their life. And in this explosive world of healthcare, we find ourselves energized and in full admiration of your heroic efforts, both in preparation and in battle. You symbolize what it takes to be tough, to endure, to understand that the foxhole is a place to replenish, to protect, to strategize and defend, and the battle line is the place to fight. And now it is our turn to fight for you, and with you.

We have a resident at Summerfield, Marion Carter, who is The Veteran of the Year in Kentucky! Local news stations are there now getting the whole story. Congratulations again! We have royalty among us. All of you are.

We think about all the emotions it must have taken, the self-discipline, the inner strength to overcome doubt, the courage to step out in battle, the decision to strike down the enemy, the ability to trust the plan.

Whether you are a veteran stakeholder or resident, we honor you – our thousands of veterans who kept and keep the bells of freedom singing, to ensure that this nation could vote and protect its democratic ways in this recent election, that choice is still ours, that our borders are impenetrable and that because of you, we are the greatest nation on earth, and we are free.

God bless each of you, and God bless our land!

Joe Steier and Dianne Timmering

“Why Louisville Is So Great” …. By Dianne H. Timmering

The interoperability of Louisville—a boast for best city for jobs and the Kentucky Museum of Arts and Crafts: We are a full-bodied movement—restaurants, life quality, home uniqueness, neighborhood simplicity, city art, brilliant theatre, healthcare metropolis, UPS hub to the world, and 16,000 job openings … good ones.

Another reason why Kentucky boasts Louisville as one of the best U.S. cities for jobs is our cultural “reachings”, our budding artistry ….

Recently, I went to a most unexpected glorious celebration of the human element—one of triumph and dedication, one depicting the loneliness of an artist in their creation of the soul, knowing they could bend and create something out of a material that was never meant for or discovered for such a thing as a “wearable.” The art of the heart was worth the suffering to get from the soul and into the crafted pleat of a skirt, the still of a sleeve, the lift of a collar, the bead of a shoe. But these were no ordinary sleeves, or skirts, ruffles or shoes.

This was #KMAC Couture 2015—the night sponsored by the Kentucky Museum of Arts and Crafts, a title not worthy enough for the display of creative freedom that I witnessed as art lived in the embodiment of the dress, the construction of materials that were never meant to glide along the mellifluous elegance of the human curve or press into the sensuous skin.

The audience was us, the women of Louisville (and a few brave and stylish men). The “us” was gorgeous, clad in the clash of white, the din of expectation, a sea of lightness, airy like we were a pillowed cloud and whatever was coming through the curtain was going to float.

And float it did. The show started; it was a fashion show unlike any I had seen before.

Angst was in the tulle, hope in the sleeveless, bare of the vulnerable arm. Every cloak had a story, every piece a design the eye simply couldn’t get enough of. Details as exquisite in the front as they were in the back. Art from such unexpected mediums worn because they could be. Art reflected in the embodiment of the dress. The greatest expression of self.

The art of canvas, the harshness and lack of dexterity in the material and yet with truffles and waves molded into an elegance that became a most decorous evening gown; one that would find the party in the evening and could possibly dismantle into enough of a tent that if a young hangover got old, warmth and forbearance could be found in the heat of the bundle.

A gown made of broken teacups, time owned in a past era interwoven, sitting on the ledge of fabric, like they might on the edge of a cupboard shelf, but polished, vibrant and used.

Elegant beauty reminiscent of the 17th century English dress made out of duct tape. A Cinderella gown made of mini-marathon medal ribbons, of no value except to the individual who flees through 13.2 miles, but collectively make an invaluable moment.

A skirt made of matches.

A ball gown of mop heads, plucked from cores, flipped, dismantled, dyed into elegant threads along the husk of cardboard which carried the slight frame of the model, whisking her down the dusty path, a shine of elegance, its full skirt never forgetting where it came from and where it was going.

Centuries of style replete in silent materials of the day to day but repositioned to power up this glorious night in the city of many jobs and endless hope.

Every piece with worth, the eye of appeal. And then it was over and I knew I had seen more than a fashion show, but an exhibit of artistry that moved, flowed and flourished down the path of must. Because an artist, for we all are in our own capacity of depth, must be, or an artist dies. We must try, even if the piece fails because there is peace in the piece of attempt and then we try again. And that is good.

We are a city capturing the artistry of self where one can be unbridled in the brilliance of simply being.

Dianne H. Timmering, MBA, MFA, CNA
Vice President of Spirituality and Legislative Affairs
Signature HealthCARE Consulting Services, LLC
Twitter: @Dhtimmering