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Covid19: Crisis Communications

Covid19: Crisis Communications April 15, 2020

Marketing, research and business development consultant in healthcare, human services and senior living.


Date: April 15th 2020
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    Long-Term Care Crisis Communications

    Irving Stackpole

    It’s a pleasure to talk with you. I should modify that word pleasure. I wish the circumstances were somehow different. I wish the topic the thing that the crisis that precipitated the topic hadn’t occurred, but indeed it has. Today, we’re going to talk about defining this crisis, trying to put it in context, as difficult as that may be. We’re going to talk about rules of what goes wrong and what goes right in the context of crisis communications. These are principles that you should be able to apply almost regardless of the situation in which you work. The nature of your operation. We’re going to talk about the importance of preparation. And for some of you, that may be a particularly impatient or bad timing piece of bad timing. But preparation is still important because this crisis is teaching us that it’s not if something bad is going to happen, rather when something bad happens.

    We’ll talk about crisis communications during and after. It’s not really over until it’s. Then we’ll talk about the importance of migrating toward digital channels just as we are on a digital channel right now with this webinar, and I’m sure so many of you are also participating in other webinars and other online meetings. Your consumers, many of your advisors, many of your audiences are also migrating toward digital and the digital channels will become progressively more important.

    The first thing I want to point out is that the myth of exceptionalism certainly should be over among the congregate care sector representatives on this program. I’ve taught this class many times before, for decades now and in the past, the difficulties been to set up the context and to really drive home that it’s not a matter of if, but when. There was always quite a lot of conversation about, well, what constitutes a crisis? Well, all of that is just exploded at this point because indeed it’s not a matter of if, it’s a matter of now. These this exceptionalism, I would hear through the years was in the form of it’ll never happen here. We have a great reputation. We don’t have to worry about our brand. We know what to do and my team can handle it. Well, I have lots of evidence that unfortunately, not only has it happened, but it’s also happened in the congregate care sector in a particularly difficult way. It’s a somewhat simplistic definition, it’s important to start with a definition of crisis is any unexpected or even expected event which has or can have an adverse effect on customers. The people who choose to use your service, consumers, the people who use your service, your employees and staff or your brand, anything that can damage your brand, your brand reputation. That’s indeed a crisis and needs to be treated with the basic principles that will review here. The start of this is to put into context two contrasting crises. One happened in 1989 and the other happened in 1988 one you’ll remember, and one you won’t.

    In the one related to the Exxon Valdez, there was about 11 million gallons of fuel oil spilled through a collision of a tanker in Alaska, and it created a huge ecological impact in Alaska. The other was an ecological disaster that occurred on the Mohegan River just upstream from Pittsburgh. 3.5 Gallons of oil was spilled. The reason you probably have heard of the Exxon Valdez and the reason you haven’t heard of the Ashland oil spill was because of how the executives in those two organizations handled the crisis. The Exxon executive, the CEO, sent a series of progressively more important basically low-level executives to deal with the problems in Alaska. He himself didn’t show up until quite late in the crisis, whereas the Ashland Oil CEO not only showed up, but he actually went to the site of the disaster, set up a media center and handled the crisis himself. How does how does an oil spill disaster compare to or connect with what’s happening in long-term care and congregate care?

    Well, this certainly is a different crisis. The first issue is that Mother Nature isn’t being endangered. Grandma is in danger. This is significantly different. This is very personal. The second point is that in the entire sector is under siege. The symbol or icon for this crisis is a nursing home in Washington state. Indeed, nursing homes have been appearing in the news related to this crisis regularly. Some of the news media has been a positive and constructive and some of it has been damaging. Later on, we’ll have we’ll have a case study of two examples that actually two stories that appeared in the same newspaper on the same day, which I hope will illustrate some of the fundamental principles and points I’m attempting to convey here in this webinar today, that the other element that makes this crisis particularly difficult is the latent guilt about not caring for grandma at home. In other words, there are consumers now. There are family members now who are wondering what grandma have gotten sick if I if she had been able to stay home. You read in the news probably questions out loud expressed by family members, should I go and get grandma or get grandpa out of the assisted living residence or out of the nursing home and bring him or her home? Would that be a better, safer outcome? This is doubly personal, so there’s latent guilt, there’s confusion, lack of clarity around whether to bring mom or dad home.

    I was very pleased to see recently the CEO of the American Health Care Association say finally that indeed it’s probably safer overall to let the residents of congregate care centers stay in the congregate care centers and not to try to bring them home for a number of good social and epidemiological reasons. The point is that this crisis is personal. This crisis strikes right at the heart of some of the things in our culture that we cherish. We need to treat our communications with our various audiences with that level of sensitivity. The final point is that, at least for the time being, there doesn’t seem to be an end in sight. Regardless of the political wrangling about when business will open up, there’s really no discussion about when nursing homes will open up. At least I’ve not seen it in the news, nor should there actually be any, at least for the time being. The very best things we can do is manage the situation as it is.

    What that means is that for families and for our staff, it’s tremendously important to have messages and to be taking a leadership role in delivering these messages and bringing the messages home. I often say in crisis communications training with executive teams, imagine the unimaginable, and that’s where we should start. Well, we don’t have to imagine the unimaginable. Whoever would have thought that outside of an assisted living residence? I frankly don’t know where this picture was taking, outside of an assisted living residence that there’s National Guardsmen in hazmat suits getting decontaminated. The scale of this crisis is tragic. It’s difficult. Nothing I’m saying or will say should in any way diminish that. I do want to focus on putting the best possible light on it and giving you the tools so that you can handle it with aplomb, with dignity and with the discipline.

    Question is, of course, what’s your response? What’s our response as as a sector? I’d like to talk a little bit about some of these rules, the rules of crisis communication and some failures. What can go wrong in crisis communication? The first rule is never leave communication to others. Don’t let anybody else carry your message for you. You as the authority, you as the leader, you as the manager, the CEO, the chief operating officer, whatever your title is, if you’re in charge, you need to step forward and step out, step out in front. The rule is getting up and get it out in front. Get out in front of it is the expression, which means putting your face, your position, your voice in closest association with information about what’s going on, what’s occurring, what’s on your audience’s minds and the rule.

    The second rule is using every channel available to you. That means live meetings with your team, with your staff, with your employees. That means using Zoom or in this case, go to go to a meeting, go to a webinar. There are dozens of video streaming applications. We’re all going to get we’re all going to get very good at this. I would say that’s a consequence, that’s a sequela of what’s going on and you will be using here’s what’s not to do, here’s the failure. The failure is when we try to blame people, the failure is when we try to sluff over or not be clear about things. The real failure is failure to respond.

    We’ll see that in the case study, the two case studies that we look at. The other failure is not prioritizing audiences. One statement does not fit all. We need to have tailored messages for each of our audiences with information, suggestions, instructions and insights that are distinct for each. Another rule and unfortunate failure is that don’t assume that anything is off the record if you don’t want to see it in the media, in print. Don’t say it and importantly, don’t write it. Don’t send an email message. Don’t send a Facebook post that your when you’re exhausted and tired, hungry. It’s two o’clock in the morning. You’ve been at it now for 18 hours. Just don’t do it, because if it can be, it will be used and it will be used in ways you can’t anticipate. It is a good media management rubric. If you don’t want it printed, if you don’t want it posted, don’t say don’t write it. The second thing that I want to drive home, and this is terribly important and very important, as we’ll see in the case study. Don’t hold your breath about what other people, especially your staff, will say. Tell them what to say. Give them the messages and also ask them not to say certain things, and there are reasons why there are good reasons why your staff should be saying certain things to people and should not be saying other things to people. And it’s not hiding behind. It has to do with reputation. It has to do with fear, and it has to do with how they are seen in their community, in their family as being constructive or not.

    What’s wrong about this? Well, failing to understand communications protocols. We’ll talk about that when we talk about auditing and your communications plan, the planning process. The other thing is speaking before thinking it’s just not OK to limit. It’s terribly important to have a script. It’s terribly important that you understand how you’re going to say what you want to say and what you need to say to your respective audiences and that you write it out, actually write it out. And to the extent you’re able to practice. The other rule and shortcoming of crisis communication has to do with making errors when we were in a situation like this and we’re in many different situations, it’s just. Not possible to be perfect in this webinar. I’m not going to be perfect. I’m not going to say everything exactly the way I’d hoped to say it and convey to you. Neither can you.

    The important thing is that we are able to admit an error, especially to our staff and to the outside world, so if there’s been an error, what’s terribly important is that you take responsibility for it and yet you admit that you state I regret that such. And so I regret that I failed to communicate the urgency of the situation. I regret that we weren’t able to share this information with you in the past. However, here is the information. Now, take responsibility for something. Even if you can’t take even if you can’t share everything at a given moment, take responsibility for something.

    Don’t hide behind others. Don’t be hide. Hide behind. Don’t hide behind your boss. Don’t hide behind corporate. You get the message, take responsibility and take responsibility for something. And then the other one is. Don’t delay your response as soon as you’re able. Sit, speak the messages, make the email communication, write the Facebook post, record the Facebook live message, whatever it is that you can do, do it as quickly as you can with a script and as responsibly as you can. The reason for this is that we are responsible as this image shows an elderly woman inside a congregate care center and that’s apparently her daughter or a family member or friend.

    We’re responsible for both sides of the glass and we need to take that responsibility and develop communications to both sides in this and I would argue in every crisis. Another rule and failure are we need to be flexible, we don’t we don’t always have the information when we speak to people, we need to be flexible. We don’t always hear rumors quickly, but we need to have our antenna out so that when we hear them, we can confirm them, we can refute them, we can create a message about them and reply to them.

    What’s absolutely essential is that we don’t be dismissive if we appear to be dismissive. We’re going to look like we’re talking down to people and that’s not the position. We want to be in a crisis. We want to be shouldered to shoulder or on the same side of the table as our key audience is. That includes not only our residents, but our staff, family members and the board of directors. And what’s also important is that we understand people’s communications needs. It absolutely doesn’t hurt to ask people, are you getting what you need? Do you understand what’s going on? Is there some information that I can provide to you that you’d like to have? If someone asks for information that you can’t truly provide and there’s a good reason for that, it’s fine to say. I understand that you’d like to have that information. I’m not able to share that with you at this time for this reason. As soon as I’m able, I will, because I really want you to know I want you to be fully informed and understand what’s occurring during this crisis.

    The other issue in communication is timing. In a crisis, especially a crisis like this, the crisis is never over for someone. There’s someone who’s been tragically and painfully affected by the crisis and to think to yourself, well, let’s wrap it up and go home or do a victory lap with the staff, that’s absolutely. The wrong thing to do. There’s someone who’s still hurting and, in your communications, nothing you communicate should diminish or show a lack of respect or compassion or empathy for those peoples but that person’s pain. Please don’t be dismissive. If there’s a breakdown in internal communication, identify it as quickly as you can and address it. If you don’t have enough feedback, that’s a failure of your communication system, which needs to get addressed. We’ll talk about systems and planning. In addition, there is a very common misunderstanding about. Admitting or confession or exposing liability and saying we’ve committed this error.

    There is a very there are many environments that are highly litigious. Few environments are as litigious as nursing homes in a crisis such as this, the usual rules or the usual restrictions may seem to be less relevant, and they probably are, but the basics are still true. Talking about what occurred is not admitting culpability, responsibility or guilt, talking about something that’s occurred is just that, talking about something that’s occurred. When we did a study of the reasons why individuals sue nursing homes, we found that 55% of the responding population, this was a study done by the CNA insurance company. 55%percent of the people who sued nursing homes said that they did so because nobody took responsibility. Nobody talked to them about what happened to their family member or their loved one or the person for whom they were responsible in the congregate Care Center. The message there is that you can say something, find something to say to key audiences and say saying something that happened is not the same as accepting culpability and responsibility. When you don’t say anything that seems to imply that you don’t understand what people need, they need to hear from a person in authority and that you’re not listening to their feedback, you’re not listening to them say, I don’t want I don’t want this to happen to anybody else.

    The key to crisis communication, I hope, is being conveyed is preparation, preparation, preparation, because in many regards, when the water hits the fan, it might already be too late. I want to talk about a little bit about before understanding that what we’re really trying to do here is we’re trying to saddle the horses were galloping along, these messages are nevertheless important. First of all, it’s terribly important that you have a plan in your congregate care center about who says what and to whom. In other words, who in your organization is authorized to speak to the media. Who in your organization is authorized to post something on Facebook? Who in your organization answers the phone? Because I’ve seen too many cases where too many situations where somebody from the quote unquote media calls under the ruse and it manages to extract from a second shift, some information that’s later used in a very damaging way against that congregate care provider. The question is, who is authorized to speak about what’s occurring in the center? That’s the who says what and to whom. The second thing is that this is going to seem simplistic.

    So, forgive me, where are the phone numbers? Where are the police? Where’s the fire department? Where are the phone numbers for you, for the leadership? Where are the phone numbers? Are they close to every phone? Are they close to every phone on every shift? Are they easy to get to? These are. Simple, seem simplistic, having been in thousands of nursing centers across the United States, I can tell you that too often they’re nowhere to be found. So this is a great time to do that, to do a walk through, to do an audit and see where they are and to see if people know, especially in the second third shift, where the information is. The other piece that is here on the screen and we’ll talk about when we talk about creating messages is the scripts, we have to be able to script these messages. Crisis communication is not the time to make it up or go on the wing. You see here I’ve got a draft script of a message that a clerk or an attendant or somebody who answers the phone at 11 o’clock in the evening might say, thank you for calling on, unable to comment. Please give me your contact details and I’ll be sure to pass them on to Mrs. Flynn hypothetical, who will be in touch with you as soon as possible. Thank you for your patience. In other words, everyone in the organization should understand that the media, while needs to well, it needs to be vetted, is not to be considered as the enemy also beforehand. How are your lists of local media, radio, press?

    Don’t forget the freebies, the penny papers, whatever they call them in your marketplace area. These are extremely useful channels of information, in part because a lot of your target market, a lot of your prospective consumers, a lot of your family members look at these penny papers, the newsletters. Do you have any newsletter? This, this now we’re getting into the digital sphere and many of you have yet to be dragged kicking and screaming into the digital arena. But I hope this this will prompt you inspired you to do that. Social media, Google alerts. These are simple things, easy to set up that can keep you apprised of what’s going on and give you important channels that you can use it in the middle of a crisis right now.

    It’s important to try to build relationships beforehand and to do this to practice. I’ve heard of many stories of active shooter drills in nursing centers, but I hadn’t heard before the recent events. I hadn’t heard of active pandemic drills, but I suspect we will have now. Families rely on these digital communications tools more so than ever before your website, Facebook, email channels, newsletters, etc. I want to point out that those of you who are boomers or Gen Xers that aren’t perhaps as comfortable with some of the newer social media channels, I know I’m not. I’m a digital immigrant, not a digital native. The important thing is not what we’re comfortable with, but rather what do our audiences use? We need to be using those channels, whether it’s WhatsApp or Instagram or whatever. We need to be using what they’re using. OK, so this is a Segway into what we can do during a media crisis. These are the principles. Principle number one is to vet. Screen every media inquiry, if somebody calls, somebody sends you an e-mail message. Saying I’m from the Boston Globe, don’t assume that they’re from the Boston Globe. If somebody calls and says, I’m from the local CNN affiliate, don’t assume they’re really from the local CNN affiliate. We have a longstanding client who regularly gets poked by a patient’s rights crusader. It’s nothing against patient’s rights crusaders. What this person does is she disguises herself on each subsequent attempt as somebody from a media outlet seeking dirt about some particular subject, the overuse of antipsychotics, the cleanliness of the bed linens, some subject of the subject du jour. So, it’s critical that we vet every media inquiry. You can be very polite. You can be very professional. What paper outlet did you say you were with? Write it down.

    That’s terribly important, is that you reply to everyone, even the ones that you think are bogus with some general confrontation. It doesn’t appear as though I’m able to secure a confirmation of your credentials. Are you able to send me some further information? What’s terribly important, and we’re going to see an example of this in the case study, what’s terribly important is that the failure to reply invites speculation of the worst. What my crisis communications coach taught me was that failing to reply is like a vacuum and into a vacuum. Anything will move. What will move into that vacuum is rumor, innuendo, misunderstanding, half-truths, truths that are conflated, facts that are somehow attached to one another in an awkward and inappropriate way. You can always you can always say something. In a crisis, that’s what we need to do. We need to we need to. We need to say things. External messages versus internal messages. For external messages, I’m going to propose that this is the tried-and-true structure of a message and this is the structure for virtually every external message, the internal messages are a little different, not terribly, the external messages should be structured like this. One, two, three. It’s like a sandwich one.

    At Stackpole & Associates, our key concern is for the preparedness and responsiveness of our clients in every communication situation. That’s why during this extraordinarily difficult time in covid-19, we’re developing free information, free tools for our clients and others that can be used to effectively manage their audiences at this difficult time. We believe that it’s our responsibility and our mission to deliver these tools to better manage communications with critical audiences at this and every time. I just modeled it for you. It’s once you’ve got the rhythm, it’s pretty easy. It’s not to be done just once. It’s to be done every time you speak, every time you write, even when you think it’s trite or repetitive or boring, it’s not by the time you get to the point where you’re thinking it’s trite and repetitive and boring, you’re just getting through to your target audience at a level that they can remember.

    Their mission really is to be transparent and to be helpful in a crisis that’s you can customize this sandwich to meet virtually any situation. That’s the structure for the internal statements. The structure is very simple, it’s actually takes a little bit more. It’s like a club sandwich instead of a simple sandwich. You repeat our first concern is the safety, well-being of the residents, consumers, our customers here at the senior center. Whatever the situation is, whatever your mission is, it’s OK to repeat it. The terrible events that have occurred, the Covid-19 illnesses from the new coronavirus have been difficult for everyone, including you, our staff. During this difficult time, please come to us, to me, to Harriet, to whoever the authoritative person is or resources. Now, if you’ve set up a good page on your website or you set up a good Facebook activity stream or you’re using some other tool like WhatsApp, refer people to that stream and make sure that that stream has the same messages that you’re giving to your staff members. You’re empowering your staff messages, your staff with the messages that, first of all, you care. Second of all, you’ve got a plan. Third of all, you’re showing them how to get the information that they will need. Refrain. The next part to this, this is a club sandwich and not a simple sandwich.

    My request is that you refrain from commenting to family, media or others about certain circumstances, the identity of people who died, the nature of how we’re handling things internally in this regard because of their nature, because of the confidential and sensitive nature. I know that you will want to say things if you want to say things, I want you to come to me or look at the website for the information or the WhatsApp stream, whatever you’re going to use to get the authoritative, the best information, the best up to date information that’s available. And if you have any questions, contact me personally.

    I’m paraphrasing a conversation that you would have with your employees. This conversation, please, needs to be scripted. That gives them the information they need. Then you finish with your employees. I don’t and I hate to be late on any law or to be somewhat directive. Even if you think it seems silly, I want you to repeat at the end of the conversation with your staff, whether it’s a meeting in the lunchroom, I want you to repeat the mission at the end of the conversation. I know that you all know that our first concern here at Cupcake Nursing Center is the care and well-being of our residents. And with your help, we can make it through this difficult time and deliver on that mission and on that promise and end with. I want you to know that you can call me, contact me at any time. What you’re doing is you’re wrapping up what’s critical there, the information in what’s also critical, which is the qualitative nature of your concern about the information and about them. You’re making it clear to them that they are critical and that you are the most authoritative resource. Now, that means that you are talking to through the camera that you’ve actually identified yourself or that you your organization has identified many selves in many different organizations, in many different operational units, and that these individuals are able to and equipped to stand up, get it out and get in front of it.

    Let’s take crisis communications, case studies. I’m going to use these not because I want to point fingers. I’m going to use these because stunningly they appeared in the same newspaper on the same day and there are two stories about congregate care. The framework, the context, the frame of this, of this these messages, these media messages, this rhetoric, the frame is the same. So, it’s messages about congregate care in the context of the novel coronavirus covid-19 crisis. It’s about congregate care.

    The first one is, and you can see here that happened was it was appeared in the Boston Globe on April 4th. Yes, as many of you know, I’m from Boston. This is a case study, No.

    You can see here what the headline says, the headline says, Isolated from their families. Children and adults in group homes struggle for normalcy. Now, in those words, there are some harsh, clear. Terms isolated, no one likes to be isolated, less least of all from the members of your family. Children, do we feel tragic when children are isolated and we see a struggle for normalcy, struggle for normalcy, we all can identify with that. That keyword has been around now in these thirty-eight or thirty-nine days that I’ve had social isolation, the physical distance, these terms are clear. The headline uses difficult but accurate words to describe the situation in the article. I would commend the article to you. If you all need copies of it or you need the link, I think we can provide that.

    There’s a there’s quotes from multiple providers and representatives, as well as affected family members and from consumers themselves, residents themselves. One of the quotes. Yet, despite efforts that have been described as heroic by parents and administrators, covid-19 has spread to staff and residents at some group homes, state officials said. That’s one quote. Keep that in mind, another quote, Unfortunately, we are going through an unbelievable crisis, said one person who’s a chief executive at an ARC, which is an organization responsible for congregate care.

    Unfortunately, we’re going through an unbelievable crisis. That’s the truth. The other, quote, Operators of group homes and residential schools across the state said they have made every effort to keep residents and staff healthy while trying to maintain some normalcy. Well, where did they get those goods, they didn’t get those clothes by calling into the group homes and trying to scalp a quote from an unbeknownst Clark, operators of group homes and residential schools across the state said the authoritative source for the operators of group homes and residential schools. They made themselves available to the media and the media converted that quote, this crisis, this information and this picture. I mean, I want you to look at the picture. It looks stressful, but remember, that’s a mother looking at her son in that tablet.

    So, they the reporter has taken this information and turned this into a story, into a story that made it to the front page, I believe it was on the front page of The Globe that day. That’s one story. The other thing I’d like you to remember is that at this time, mainstream media, the ranks of reporters have been decimated. We’ve all learned about the shift from printed media, printed newspapers to digital channels. What that has meant is the loss of reporting staff. At this time of crisis, sometimes very inexperienced reporters are attempting to pull together stories that they believe will have heft and importance to their audiences. It’s something there’s some responsibility we have not just to sit back and wait, not to wait for them to construct the story and then to try to parry and thrust or trim and redirect them, but to actually manage the story. I suspect that that’s what happened in this story.

    Because the next case study is profoundly different. I’d like you to look at this. Residents and families angry and helpless. As coronavirus overwhelms nursing homes. Now, there’s nothing untrue about any of that, but the choice of words is particularly.

    Residents and families are angry and helpless, these two words, angry and helpless, are loaded, they’re culturally they’re loaded, they’re extraordinarily powerful, negative terms that we should strive not to have in a headline about our audiences inside the story as coronavirus at this particular nursing center. Three staffers told The Globe they believe the virus contributed to twenty-one deaths in less than two weeks, although not all of those people were tested. When the mail arrived Friday, there were 20 greeting cards for patients who had recently died in the time they mailed the letters that one staff member. These people are gone. Well, this is tragic. It’s sad. It’s poignant and the reporter loves that kind of message because it makes everybody it prompts everybody tweaks everybody’s sense of guilt and urgency to say, oh, but where did they get that? They got that from a staff person who is willing to give the reporter that, quote, that staff person wasn’t coached, wasn’t trained about what to say and when to say it or to also in the same article, poor preparation and communication that led to missteps and hasty decisions. Well, who told them that? Three staffers blamed poor communication, low staffing levels for so many issues, for so many workers being sick. Finally, the awful, awful line that I hate to read. This particular nursing center declined to respond to questions. It released a statement confirming it was grappling with infections and said it was following state guidance. That’s, ladies and gentlemen, is what I referred to as bunkering.

    What can we do after the crisis? First determine the extent of the damage and how do you do that? You do that by asking people develop a repair plan similar to in service area recovery, what we call a recovery plan or a recovery plan. Get feedback from your key audiences. Correct misinformation. What sources work for you? What didn’t work? How could we have provided you with more immediate and more accessible information? Over what channel? How did you learn what you learned about what was going on inside the property? Execute the repair plan and say thank you. This goes to the issue of the audit.

    In conclusion, we now know what to expect. We know the unimaginable is on our doorstep. We know and we cannot any longer pretend that we don’t. We know that we need to be better prepared. The overwhelming majority and I don’t need to take a survey on this one, the overwhelming majority of congregate care centers were not prepared for this level of challenge and difficulty. I know you’re going to get defensive and say, well, who could? This is a once in a lifetime event. Well, if I’ve got lots of examples of previous crises and we didn’t learn from those either. My prayer is that we do learn from this one. We need to execute, need to execute on a on a good plan, need to get digital. We need to get digital now. We need to develop this acute listening for our audiences and to our audiences.


    Stackpole & Associates is a marketing, research & strategy consulting firm focused on healthcare and seniors’ services markets. Irving can be reached directly at

    Marketing, research and business development consultant in healthcare, human services and senior living.

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