Touring Guidelines for Person-Centered Care Homes

A tour is a wonderful way to give a potential consumer an “inside look” at your home. If you have the added benefit of working for an organization that practices Person-Centered Care, you may find yourself in the happy situation where the community sells itself.

One of the first questions to answer is, “Who is responsible for giving tours?” In an organization with a typical, top-down management style, the admissions coordinator and the administrator are usually the two individuals most often expected to give tours. However, in a home that embraces Culture Change, every team member, and often even residents can be expected to provide the same service. Just as we advocate that team members give tours to potential employees, we do the same in the admissions process. After all—who knows the home better than the people who work in it everyday?

Remember, a tour is not the time to be collecting payor or clinical information. That takes place later, behind closed doors in a sit-down with the admissions coordinator, administrator or social worker. The tour is a time for your home to shine—and any member of your team should be educated on how to put the home in its best light.

We recommend that you choose three individuals who are not managers to give basic tours that are available on the day shift. It does not matter what their role in the home is—but they must be capable of the following:

* Possess a clear speaking voice
* Exhibit a friendly and caring attitude
* Demonstrate pride in the home
* Be familiar with the home’s Person-Centered Care assets
* Have some longevity with the home
* Possess current knowledge of recent survey results
* Know the names of all elders and team members in the home
* Keep the tour moving and on-time without appearing to be rushed
* Be able to answer questions easily without becoming flustered
* Know when to redirect certain questions pertaining to clinical and financial matters for the post-tour sit-down with the appropriate team member
* Listen to understand the needs of the person touring

In some cases you may want to reward a team member who has longevity, excellent performance evaluations and is highly-respected by their colleagues with the opportunity to give tours. This can be a wonderful way to thank your team members, and give them an added level of authority—by recognizing their expert knowledge with regard to Culture Change.

It is important to have three individuals ready to give the tours in case there is a need for more than one tour to take place at a time or in case someone is unavailable in a meeting or otherwise involved in an activity.

The preceding is an excerpt from our manual, "Marketing & Admissions for Person-Centered Care Organizations." The manual is available for purchase on our website, www.caregivereducation.org

Making a Choice to Enhance Life!

Choosing a Nursing Community for Your Loved One

Nursing communities of the past were often thought of by the public as cold, sterile, and unfriendly places. This is because, in many ways, nursing organizations were operated much like hospitals focused on medical diagnosis and treatment of injury or illness.

Today many nursing homes are embracing a new, social model of care giving that seeks to balance medical care with our social needs as human beings.

When a loved one requires long term care, the placement options available to families are often confusing. Making this choice can be one of the most challenging decisions a family must face. Advocacy groups have done a remarkable job in making sure families can be well informed of the clinical issues surrounding their available choices. However, there are many other aspects to take into consideration when making the long term care placement decision for a loved one.

Today, more and more nursing communities understand that they must place equal focus on enhancing the Quality of Life of each resident in their community in order to provide the most life-affirming experience possible.

While meeting clinical needs might consist of medication assistance, toileting and bathing, Quality of Life needs relate to basic human desires for comfort, emotional well-being, physical, mental and spiritual engagement and the ability to nurture.

One could think of this as a foundational shift in the philosophy of care giving; a shift away from providing solely a safe institutionalized existence to that of promoting a life worth living.

The Institute for Caregiver Education’s mission is to foster the highest Quality of Life for elders and caregivers through cultural transformation and professional development.

Our goal is to assist nursing care providers in enhancing the Quality of Life focus within their communities. We promote growth and change by empowering their teams to create holistic environments that care for the body, the mind, and the soul—for all whom they serve.

Further, we believe that this transformation can be successful only when families are empowered to understand the differences between a medical model and a social model of care and, thus, become advocates for change.

Five guiding principles form the foundation of the Institute’s work to assist communities in this transformation. When implemented together and woven throughout all areas of nursing community care a community can be truly transformed. These principles are: Choice, Community, Relationships, Respect, and Empowerment

We encourage families to look at the physical issues and medical concerns that accompany the need for nursing home placement and beyond—to seek a community that also enhances life and supports individuality. In addition to clinical daily care-related issues, family members should also seek indicators of social transformation that may include:

Indicators Present in the Physical Environment:
· Welcoming front porches and entryways
· Family living rooms, common spaces indoors and out
· Personal furnishings are encouraged
· Nursing stations are open and inviting
· Bathing spas with personalized bathrobes and heating lamps
· Comfortable and supportive furniture
· Resident rooms with a view of greenery of some kind
· Play areas for children

Organizational Indicators of the Social Environment:
· A great first impression
· A tour that includes the admissions director, team members, and residents
· Community calendars with age/gender appropriate opportunities
· Expansive menus, buffet or family-style dining options and open-ended dining times
· Family and friends support groups
· Absence of rigid bathing schedules

Indicators of Empowered Team Involvement:
· Team members happy, satisfied and engaged in their work
· Employees knowledgeable in resident-directed care
· Able to participate in mentoring program
· Genuine engagement with residents
· Availability of educational programs to further team skills and knowledge

Evidence of Resident Involvement:
· Opportunities for residents to participate in menu planning
· Resident self determination regarding preferences for bath, bed, meal and medication times and approaches
· Residents engaged in productive, dignified activities not limited to a posted schedule
· Resident mentoring opportunities offered and encouraged

It is important to have the confidence that you are making the best decision possible on behalf of your loved one. Make that decision easier by determining which community has excellent quality of care and enhances life through a vital nurturing and life affirming community.


Do you need more information about how to choose a community that has embraced Culture Change? Visit our website for additional guidance!

Pitfalls to Culture Change

Our team is often asked what some of the biggest pitfalls regarding management practices can be when transitioning to a social model of care. Overall, most challenges occur when management takes a dictatorial role and not a guiding role.

Here are some of the biggest pitfalls that we see again and again:

1. FAILURE TO SUPPORT YOUR TEAMS WILL RESULT IN A LACK OF CARING!

2. Stop and Start will not fly~ team members have “BEEN THERE/DONE THAT”

3. YOU CANNOT expect YOUR Team Members TO FEEL EMPOWERED ONLY WHEN IT IS CONVENIENT FOR YOU.

4. Employees will not remain ZAPPED when they are SAPPED

5. SUPPORT your team’s decisions

6. Turn down a team’s decision and you won’t have to worry about what their next decision will be because there probably won’t be one…

7. Walk the talk…Your team will be watching!

8. “Do as I say, Not as I do” philosophy will result in a home that is filled with resentment and anger

9. Adopt an open door policy and create an organization that is transparent. Secrecy builds walls, community breaks them down.

10. If you aren't the person to Champion Change in your home, that is OK--just step aside and empower someone else to lead the charge.

For more information about how to successfully lead your home through Culture Change, please visit us at www.caregivereducation.org

IfCE Practical Nursing School Breaks Ground

Assisted Living Conference

The Institute for Caregiver Education will be providing an exciting 2 1/2 days of education and networking at the APCA 2008 Fall Conference. This year it will be held at the Ramada Inn in State College, PA. Marketing, Dynamic Living and Dementia, Community Life, and Enhanced Dining will be some of focus for topics. Please visit www.apcaofpa.org for further information.

Pioneer Network National Conference

The 2008 Pioneer Network National Conference was a rousing, thought provoking experience. The chance to be able to share the PCC experience - the challenges, the passion, the possibilities, was for me, both about the chance to learn more about the pieces in the journey from other professionals, as well as an opportunity to get recharged. And it happened. I learned from leaders and new- comers; I learned from the questions I asked and heard; I learned from the answers and the questions that came from questions; I learned from listening to what came out of my very own mouth, (on my professional and personal journey - do I walk the walk, self?) and I brought away with me a sense of renewal and reflection. And my own focus for 'a call to action.'

The title and the mood of this conference was 'A Call to Action' - and it was fitting. It ain't just about the talk, but about the walk. And that's what it's all about, isn't it? The passion for life affirming action and the fact we ain't dead till we're dead. Learning and experiencing and bringing it to life - sharing the journey. Making an active difference, making choices that create possibilities and support PCC.

I also want to thank the PN and the volunteers who made this such a valuable experience: Cathy Lieblich, Rose Marie Fagan, Christie Dobson, Cheryl Ritzi, and so very many more who made this possible.

I would love to hear from others who attended the conference and their thoughts and experiences. What they came away with and what their call to action is now...

Rhea L. Schneiders, Associate Educator/Consultant IfCE

Orlando VA Celebrates Their Successes

The Orlando VA has been on their journey for over three years in a variety of ways. What I find interesting is the scoring I see in some of the “culture change surveys/artifact tools.” I don’t think the artifacts of culture change do them justice because as they create new ways to do things and do institute culture change as they understand it, it isn’t necessarily measured in the survey/artifact tools; because they are creating the mindset, the ways, the process of culture change that have meaning for their community. The tangible symbols aren’t necessarily available. They work at the process and have a focus on that rather than the cosmetic, for their culture change. What their chief nurse was eloquent in pointing out was that the cosmetic doesn’t sustain, unless the mindset is there…

Do they have issues? Well, heck yes. Are they human? Well, yeah – that’s why there are issues – proof that indeed where there are human beings there are issues! But given issues, speed bumps along the process of cultural transformation, challenges and barriers, comes the willingness to challenge themselves and the process itself, and grow as individuals and as a team. Is there anything else more important? Because it is never about me as a consultant, the VISN heads and their directives, or the VA system; it will always be about the people who make up the VA community itself.

What they show is a true transformational foundation related to their willingness to do the self examination, face the barriers that come up, resolve conflict; discuss the emotional impact of change. In the ways they listen to each other and the residents, in the questions they ask each other, and in the dialogue they create, a true foundation is created for affirming person centered experiences.

Cultural transformation doesn’t require “tasks” to be met (the focus some choose to have to create markers of “proof” of culture change) or perfection to be attained. It asks only to open the door to possibilities of person centered care for those who live and work in a community. Being human means being messy – accepting every individual comes to culture change in their own way in their own time, or not at all: culture change is a mindset and this defines each community’s journey…because it is THEIR own journey, created by those who live and work in that community.

The ripple effect – open the door to possibilities – and by simple virtue of that – things take shape. Maybe not the way expected, but in a way that happens. Change is inevitable – growth is optional; what you visualize today you either achieve or don’t but it creates movement one way or another. The Orlando VA has many successes to celebrate.

A female veteran was sitting in the dining room in a wheelchair with a staff person and another veteran, a man wearing a baseball cap adorned with many medals and pins. She called me over and told me, “When they bring me in here I ask to sit with the man with the red hat, because he represents my country, and that represents my God.” She went on to tell me she had been a staff educator at a VA hospital “back in the day,” and I could tell as she told me stories that those times remained important to her and I really liked that the staff encouraged her to share that sense of self and celebrate what that represented to her about her own identity (though I have a sneaking suspicion they had heard many of those stories before).

I was also humbled on this visit because I had a staff member who is one of the community’s biggest culture change supporters, suggest to me that the staff be asked what they felt would be the most effective next educational component!! Oh my! Didn’t that make the best sense? Here I was asking the leadership to decide the next educational step, and they were putting it back in the hands of the people who were the most actively impacted! And I had just done an educational piece on EMPOWERMENT!!! Oh my! It was time for me to re-listen to myself!!! Grasshopper had now surpassed the Teacher! Thank goodness! Because that is the point: define for yourself the journey, define for yourself the most effective steps, identify the barriers/challenges, the successes, parameters, expectations, and goals from the vision and mission as you created it.

Choose your next steps and use the resources at hand. Embrace the process! I loved it! Yes, I share my recommendations as I see what I see in the community, but I also am aware that this is not my journey. I just get to share a portion of it: for that I appreciate the Orlando VA. I will be a better educator because of that. And I also know that the daily life experience for the residents and staff will be better and more life affirming because of this process that they are making come to life. And isn’t that, really, the point?

-- Rhea L. Schneiders, Associate Educator/Consultant, IfCE

Announcing the IfCE / Cargas Collaboration

INSTITUTE PARTNERS WITH CARGAS TO UNVEIL HUMAN RESOURCES
SOFTWARE FOR LONG TERM CARE AT PIONEER NETWORK CONFERENCE IN AUGUST

“Cargas Competency” Software Outlines Job Competencies Based in Person-Centered Care

WASHINGTON, DC –The Institute for Caregiver Education team is pleased to announce that they will be unveiling a dynamic partnership with Cargas at the 8^th Annual Pioneer Network National Conference in August. Over the last year, the Institute has been working with Cargas, a technology company to create a software product specific for long term care organizations seeking to integrate Person-Centered Care competencies into their job descriptions and evaluations. The two companies are co-sponsoring the Pioneer Network bookstore at the conference, at which attendees can purchase a myriad of Culture Change-related resources.

Cargas approached the Institute while researching organizations that could provide them with the necessary competencies required for long term care communities that were transitioning from a medical model to a social model of care. The Institute has long been viewed as a national expert in Culture Change, and already had competencies written that are actively in place in many client organizations.

“Cargas Competency is software that aligns the behaviors needed to succeed in specific roles at individual, functional, and organizational levels. The tool enables homes to consistently identify the skills and qualities that mesh with Person-Centered Care standards and expectations regarding resident care. With built-in industry specific dictionaries and hundreds of prewritten job descriptions, the system is easy to use and customized for Long Term Care organizations.”

To learn more about Cargas, please visit www.cargas.com, or stop by the IfCE/Cargas booth at the Pioneer Network Conference bookstore.

This year’s Pioner Network Conference will be held at the Omni Shoreham Hotel in Washington, DC. For more information about the conference, please visit www.pioneernetwork.net.

The Institute for Caregiver Education is a nationally-recognized leader in Person-Centered Care education. For more than 15 years the organization has provided quality caregiver education to nursing homes from California to Maine. Over the last seven years the IfCE team has educated hundreds of long-term care professionals on a myriad of Culture Change topics at such national conferences as ASA, NADONA, AAHSA, AHCA, ACHCA, The Pioneer Network, the VA Summit and numerous state associations. The Institute for Caregiver Education is currently a leading Culture Change educator for a number of state QIO organizations as they work with the 8th Scope of Work and CMS.

Choosing a Nursing Community for Your Loved One

Making a Choice to Enhance Life!

Nursing communities of the past were often thought of by the public as cold, sterile, and unfriendly places. This is because, in many ways, nursing organizations were operated much like hospitals focused on medical diagnosis and treatment of injury or illness. Today many nursing homes are embracing a new, social model of care giving that seeks to balance medical care with our social needs as human beings.

When a loved one requires long term care, the placement options available to families are often confusing. Making this choice can be one of the most challenging decisions a family must face. Advocacy groups have done a remarkable job in making sure families can be well informed of the clinical issues surrounding their available choices. However, there are many other aspects to take into consideration when making the long term care placement decision for a loved one.

Today, more and more nursing communities understand that they must place equal focus on enhancing the Quality of Life of each resident in their community in order to provide the most life-affirming experience possible. While meeting clinical needs might consist of medication assistance, toileting and bathing, Quality of Life needs relate to basic human desires for comfort, emotional well-being, physical, mental and spiritual engagement and the ability to nurture. One could think of this as a foundational shift in the philosophy of care giving; a shift away from providing solely a safe institutionalized existence to that of promoting a life worth living.

The Institute for Caregiver Education’s mission is to foster the highest Quality of Life for elders and caregivers through cultural transformation and professional development. Our goal is to assist nursing care providers in enhancing the Quality of Life focus within their communities. We promote growth and change by empowering their teams to create holistic environments that care for the body, the mind, and the soul—for all whom they serve. Further, we believe that this transformation can be successful only when families are empowered to understand the differences between a medical model and a social model of care and, thus, become advocates for change.

Five guiding principles form the foundation of the Institute’s work to assist communities in this transformation. When implemented together and woven throughout all areas of nursing community care a community can be truly transformed. These principles are: Choice, Community, Relationships, Respect, and Empowerment

We encourage families to look at the physical issues and medical concerns that accompany the need for nursing home placement and beyond—to seek a community that also enhances life and supports individuality. In addition to clinical daily care-related issues, family members should also seek indicators of social transformation that may include:

Indicators Present in the Physical Environment:

• Welcoming front porches and entryways
• Family living rooms, common spaces indoors and out
• Personal furnishings are encouraged
• Nursing stations are open and inviting
• Bathing spas with personalized bathrobes and heating lamps
• Comfortable and supportive furniture
• Resident rooms with a view of greenery of some kind
• Play areas for children

Organizational Indicators of the Social Environment:

• A great first impression
• A tour that includes the admissions director, team members, and residents
• Family and friends support groups
• Expansive menus, buffet or family-style dining options and open-ended dining times for meals
• Community life calendars with age/gender appropriate opportunities
• Absence of rigid bathing schedules and options for bed-bathing

Indicators of Empowered Team Involvement:

• Team members engaged in their work
• Knowledgeable about resident-directed care
• Able to participate in mentoring program
• Genuine engagement with residents
• Availability of educational programs to further team skills and knowledge
• Team members appear happy and satisfied with their work

Evidence of Resident Involvement:

• Opportunities for residents to participate in menu planning
• Resident self determination regarding preferences for bath, bed, meal and medication times and approaches
• Residents engaged in productive, dignified activities not limited to a posted schedule
• Resident mentoring opportunities offered and encouraged

It is important to have the confidence that you are making the best decision possible on behalf of your loved one. Make that decision easier by determining which community has excellent quality of care and enhances life through a vital nurturing and life affirming community.

We wish you well, and please call on us if we can assist you with more information!

Symptoms of Reluctance to Implement Culture Change

Many who hear about Culture Change are reluctant to embrace this journey to change. They find it more comfortable to continue in known patterns of interaction and care delivery that perpetuate the medical model and institutional life.

If you find yourself or others making any of the following statements, you may have discovered symptoms of resistance to change.

• We tried that
• Our nursing home is different
• It costs too much
• We are already doing that “stuff”
• We’re all too busy for that
• It’s too big a change
• We don’t have time to do this
• We’re short staffed
• The employees will never go for it
• We’ve never done it that way
• We’ve always done it this way
• Why make a change? Things are okay.
• We don’t have the money
• We don’t have the equipment
• We have great surveys, so why should we change what we are doing?
• We don’t have the staff
• You’re years ahead of your time
• It sounds like it will be too hard
• It isn’t in the budget
• We don’t need culture change; we are great clinically
• You can’t teach an old dog new tricks
• Let’s just think about it
• The residents won’t like it
• The staff will buck any changes we make
• We have to get Board approval, and that will take too long
• We believe in TQM, not culture change
• Maybe that will work in your department, but not in mine
• The Finance Director will never approve the start-up costs
• Our management staff changes every 6 months, so how could we possibly do it?
• We are too busy preparing for survey
• Families won’t understand it
• It can’t be done
• It’s impossible

Culture Change can be creatively implemented for little additional cost, because it predominantly involves a change in how we think. The key to spreading the message and empowering employees to embrace Culture Change is training.

Create an environment of well-planned education for all departments and all levels of responsibility, and you will prepare your staff to understand and implement Culture Change for the benefit of all.

Allison Lantieri

Becoming Comfortable with Discussions around Sex

“Sex. Sex. Sex.” Why in this oh-so-modern day and age and in my ever so pervasive hipness, as well as with years in the health care profession behind me, would a little three letter word, repeated three little times, instill my heart with a cold “Oh, dear me no!” ?

Well, because instead of it being a punch line to a joke, or a friend and I having a personal conversation, or an ad on a movie billboard, it happened to be in my office where I was working as a Social Services Director. The repeated word was from one of the residents I visited with regularly in the nursing home. Ok, I thought. Here is an opportunity to really show how culturally transformed I am!

Oh, yeah, right. Here I am, talking with a 24 year-old gentleman who is raging at the losses he is faced with due to a severe head and spinal trauma. I got to live through my 20s being young, wild, foolish, and at that time thinking I knew it all. I got to live, mostly intact, and certainly by his standards – absolutely intact – to grow old enough now to realize I don’t know nothin’. And how could I possibly know the depth of the sorrow he is sharing by those three little letters – spelling out a word that speaks volumes in regard to what it represents to someone? This can represent the loss of many things--the loss of spiritual, emotional and physical intimacy and the loss of love, fun, closeness, hope, children, power, communication, hunger. There are infinite possibilities for what it represents to this individual – this young person. And goodness knows; it morphs as we age, with what our moods are, and as our relationships change. It is expressed for a myriad of reasons, and then throw in physical and physiological changes and environmental constraints – talk about bringing life to a community!

As we work with a growing generation of younger people in long term care; as the baby boomers come into our communities, as Viagra is a common prescription, we are going to have to become comfortable with sex. Yep, I said it. That word that shakes every nursing home administrator to the core, the un-discussed and mostly un-care planned challenge that residents who are still feeling the sexual feelings and the emotional feelings that they physically want to express – deal with and are embarrassed to discuss. The thing that staff don’t want to have to confront, despite handling death, disease, illness, anger, sorrow, “behaviors,” and having the training and education – sex remains no man’s land. Bedrooms aren’t private when you move into a nursing home. Attitudes about sex are displayed like a peacock in all his glory when sex is brought up in a community.

No one wants to take it on – so welcome, tah – dah – the Social Services Director. Sex is more than a “behavior,” more than an “activity,” more than something to dissect and attempt to “control.” It is as personal and as private as something can be. Here is the perfect example for cultural transformation in a community.

As a Social Services Director I was really fortunate to build relationships with a widely diverse group of individuals. Because of that I was allowed the difficult gift of having to get out of my own way – and remove any pre-conceived ideas I might have had.

Same sex, sex between people who are ill or have physical challenges, safe sex education, “appropriate” sexual encounters (privacy challenges, sex between consenting adults, etc.) – and I discovered that discussing the most intimate details with another human being is humbling. Social Services is more than handling Medicaid/Medicare/Insurance issues, doing MDSs, or doing care plans or assessments. The individuals in this department are more than a resident liaison. They in fact are modeling behavior, modeling culture change – walking the walk, if you will. Because it is all about individuals. All about people as people – not as their diagnosis, not as residents, or patients, or “disabled.”

It is being an advocate at all times for residents and speaking for and educating staff, residents, and families at a highly charged time in health care. I found that this transitional period of health care enjoys more possibility and more potential than I ever thought possible.

With the financial impact related to the cuts in monies allotted to long term care – now we can focus on the thing that we should be all about: people. How to integrate culture change into staff team building, relationships, choices, etc., can be our focus now. Value-based health care can now be created in our communities. This will create the communities that provide home – not merely “homelike.” Indeed, this shift will also generate revenue by creating culturally transformed systems and processes.

Sex is here to stay folks. It’s just one piece of life. How we choose to provide for these special relationships is going to be indicative of how we are going to promote growth for the future for our residents in the larger sense. Supporting and promoting the ability to discuss “uncomfortable” topics, and create an atmosphere based on choice, relationships, dignity and respect is really the simple thing that it boils down to. Sex isn’t the issue – just the example.

By the way, he got a girlfriend who moved into the community. I got the education.

Rhea L. Schneiders, Regional Educator and Consultant

AAHSA's Joan Anne McHugh Award for Leadership in LTC Nursing

Celebrating Nurse Leaders in Long-Term Care

Call for Nominations
To acknowledge and encourage long-term care nursing leaders
and honor the late Joan Anne McHugh’s leadership and
dedication to the field, the American Association of Homes &
Services for the Aging (AAHSA) is pleased to announce a call for
nominations for the 3rd annual Joan Anne McHugh Award for
Leadership in Long-Term Care Nursing.

Award and Recognition
The winner will receive a $1,000 award to be used for professional
development opportunities. The award will be presented at
AAHSA’s Annual Meeting & Exposition, attended by thousands
of aging-services leaders.

Clinical Excellence. Outstanding Leadership.
Commitment to the Long-Term Care Profession.
The Joan Anne McHugh Award recognizes nurses who provide
excellent clinical care to their residents, while demonstrating
leadership and a commitment to the field of long-term care
nursing. Nurses working for AAHSA member organizations
and meeting other eligibility criteria may be nominated for this
award.

Recognize your rising nurse leader today!

Download the PDF Nomination form here!

Casual Conversation Creates a Culinary Delight

Dietary Manager Agnes Puricelli’s office is located right next door to the beauty parlor in the nursing home in which she works. One day she overheard some elders in the beauty parlor discussing some of their favorite recipes. This sparked an idea, and Agnes approached the therapist and suggested that they put together an impromptu shopping trip so that the women could make a meal of their choice.

Later that day they took the women out to a local produce stand to buy fresh vegetables; a peach orchard to purchase fruit for the meal’s dessert, and even had time to stop for an ice cream cone. When the group returned to the home the elders directed the food preparation, peeling peaches, making salad, husking corn and cooking on the grill outside. The little spontaneous gathering was a great success.

Agnes decided to invite the six women back to cook with her on a Saturday afternoon. Their first adventure together was making apple crisp. Together, the six peeled apples, made the crisp topping and enjoyed a wonderful treat. When Agnes saw that all of the dessert dishes came back clean, she immediately began planning the next cooking group gathering. One of the women indicated that her favorite recipe was for “hamburger soup,” and so Agnes worked to adjust her original recipe from serving 8 to serving 100. The soup was listed on the menu and all of the women were wide-eyed when they saw that the soup bowls all came back empty, and that such a huge pot of soup only lasted for one meal!

Next came a Valentine’s Day buffet for the family members of the elders, which included planning the menu, making table centerpieces, and setting the room for the meal. The women also had their hair and makeup done for the special event by the home’s beautician, Becky. She and her husband took pictures of the women and placed them in photo frames for the families. A unanimous decision was made to include Becky and her husband on the guest list.

Since then, the group has planned two additional parties for group members. These were elders that seldom came out of their rooms. All it took to engage them in the community was to overhear a casual discussion about recipe sharing, and look what has become of it! These elders are now fast friends, they visit each other regularly, they attend community life events together, and they have developed a deep, mutual understanding with Agnes about how dining brings people together. “I have had the wonderful opportunity to hear some great stories about their cooking experiences, not to mention learning some great cooking knowledge,” Agnes says. “Now, when one of them complains about food to me, I understand where they are coming from.”

Some may wonder where the additional money comes to fund such gatherings and the time to facilitate them. Agnes points out that you don’t need a lot of money—just a little extra petty cash. She adds “It’s simple—it comes from the heart.” She says that her team members have watched the group grow, and have started to join in on the fun. They will often volunteer their own time to join the group because they want to—not because they have been asked to. And when asked how she manages her time to include these “extra” responsibilities she says, “It’s easy—when you experience their smiling faces, the growing friendships, the caring, not to mention the food—you will find the time.”

Agnes Puricelli is the Dietary Manager at Governor’s Center in Westfield, Massachusetts. This article was reprinted from the Institute's newsletter Momentum, Volume I Issue IV.

Skills4Care Offers Online Nursing Home Administrator CEU Training

Long term care administrators are mandated to complete an average of 24 hours of continuing education annually. Completing this training can be challenging since administrators are generally burdened with heavy workloads, high turnover of facility staff and budgetary constraints. Currently, many administrators are forced to meet these requirements by attending off-site conferences with such dour session offerings as “Surviving in a Tight Cash Flow Environment,” and “Documentation to Prevent Elder Abuse Litigation.” These sessions can entail high conference costs and precious time away from the facility. Quality of training varies and many administrators wait until just prior to licensure renewal to complete the requirement.

Recognizing that long term care administrators are finding it more and more difficult to get off-site to attend conferences and that culture change-based training can be the key to thriving in these difficult times, Skills4Care.org has been responding by offering a Culture Change 101 course as an introduction for administrators who are new to the philosophy. This course, NAB approved for three CEUs, is the only course of its kind available on the internet today.

In addition to the Culture Change course, Skills4Care.org offers federally mandated training, skill building exercises, e-networking, career resources, and index of F-Tags and long term care related product information. Combining subscription-based services and e-learning reduces certain barriers (e.g. time constraints; time spent away from the job) faced by more than 50,000 administrators trying to fulfill comprehensive and license dependent continuing education requirements.

The mission of Skills4care is to “operate a sustainable on-line community for long term care professionals that provides education, networking opportunities and resources that promote professional development and improved quality of life for workers and residents.” The free offering of the Culture Change course is the first of a variety of initiatives that Skills4Care will be undertaking to promote accessible culture change education for nursing home administrators.

Culture Change has been a growing phrase in the long term care industry since 1992 when a group called the Pioneer Network first started to assemble and share revolutionary concepts in care delivery with like-minded individuals from across the country. Initiatives in resident-centered care, individualized bathing, liberalized dining and a non-hierarchical management style have grown out of this movement with fantastic results.

The downside? Currently the only ways to learn about these initiatives is to A) attend off-site conferences (which can cost over a $2,000 per person once flight, hotel accommodations, meals and conference registration fees are included), B) costly videos and published “How To” training materials ($299.00 and up) or, C) even more costly on-site consulting services. How does the most well-intentioned administrator, struggling to meet payroll and still deliver outstanding quality of care, reconcile these expenses? The answer? He or she doesn’t.

The key to reaching out to these dedicated individuals is finding a way that is inexpensive, accessible, and available to a large group at one time. Skills4care.org was created with just that intention in mind. Developed by a team of long term care professionals at the Institute for Caregiver Education, Skills4Care’s Culture Change course offers individuals new to the concept an intense overview of the philosophies behind culture change, practical applications on how to get started in their own homes, and even better, resources to connect with professionals currently engaged in culture change initiatives in their own homes.

The long term care industry has been slow to embrace the internet. While some forward-thinking homes now have internet-accessible computers available to residents in a common area, most still do not offer a similar service to their employees. And, while administrators may have access to a computer in their office, in some cases it is just a dummy terminal hooked into the company’s server so that MDS and census information can be reported to the corporate office.

This is changing. With the aid of the internet, long term care professionals are getting hooked into their state and national associations. They are becoming members of message groups in their particular areas of interest. They are communicating with family members about care planning times and just to touch base.

Skills4Care’s unique mission, audience and educational offerings were recognized when the organization was a Top 10 Finalist in the Yale School of Management-The Goldman Sachs Foundation Partnership on Non-profit Ventures National Business Plan Competition. In addition, the American College of Health Care Administrators has recognized Skills4Care and its Culture-Change infused educational offerings as a necessary part of their members’ training.

The response from administrators who have signed up for subscriptions has been positive. Says one survey respondent, “Skills4Care simplifies my life as it is not always possible for me to leave my organization. It allows me to fit training into my schedule versus having to block out time for travel. It is an easy way to obtain continuing education—I can do it anytime.”

For more information about Skills4Care’s free Culture Change course offering, visit www.skills4care.org and click on “New User.”

Has Spring Sprung for your Residents?

Spring has sprung in the area where I live and Mother Nature is truly putting on a show this year. Everything is brilliant green--the dogwoods are in full bloom; the honeysuckle is sharing a wonderful aroma and the nurseries are doing a brisk business. My community is busy following spring traditions of spring house cleaning, planting flowers, preparing vegetable gardens, cleaning and setting up outdoor furniture, washing windows, mowing grass and opening windows to let the fresh air flow in. I smell the backyard grills, hear the laughter of children playing and see the farmers in the fields as they prepare for the new crop.

The arrival of spring changes dining habits as well. Instead of the heavy winter meals, we grill outdoors and include picnic items including potato salad, baked beans and great vegetable salads. With the arrival of spring comes the desire to be outdoors, to take a walk, get our hands dirty in the earth, spend time with the neighbors or simply linger outdoors during the evening hours. As we become aware of environmental impact more people are turning to the trends of their grandparents and drying clothing on outdoor clothes lines, growing their own vegetables and enjoying the companionship of neighbors.

As I revel in the joys of spring I pause to think about those living in nursing communities across the nation. How are we incorporating their traditions of spring into their day-to-day life? Have we talked with our residents or their families to learn what was important to them during this time of year? What did spring mean for them? Have we empowered those who enjoy gardening to plant flowers or vegetables? What would stop the residents from planting a large community garden?

I worked with a home in FL that had a garden that any farmer would be proud of. They planted and tended green beans, potatoes, tomatoes, peppers, peas, cucumbers and much more. The old belief that elders are unable to participate in extensive gardening is a myth. That home had a 102 year old resident who gathered greens from the garden several times a week. She would bring them into the dining room and she and several other residents would clean them as they talked, laughed, shared memories and had a ball. The home would use the produce the resident grew and incorporate it into meals and snacks.

Are we changing menus to reflect spring traditions? When was the last time our residents were out for a drive to witness the arrival of spring in all its glory? Has community life moved outdoors? Is the patio furniture out and are they spending time in the fresh air? Are we empowering and encouraging residents to do the spring chores and activities they have always enjoyed? Have we opened the windows to allow the spring smells to fill the home? Are there bird houses and bird baths out for those who enjoy bird watching? When was the last time the residents went outside for a back yard cook-out (no…, not sitting in the dining room and eating what was cooked outside and brought in to them!)?

Life History Assessments help us to understand the traditions our residents hold dear. We believe that we have fulfilled the needs of our residents by having them sit in a 2pm activity while the staff cut out paper flowers and hang them on the wall. That is not meeting the quality of life for many of our residents who desire more involvement. However, how can we know if not for thorough Life History Assessments and relationships?

We are Our Life History

To be complete emotionally, physically, socially and spiritually,
our life histories must be acknowledged, celebrated and
incorporated in our day-to-day life.

What seasonal traditions are important to you? Will you be willing to live with just the memory of those traditions as you age? Memories brought to life are powerful. When we survive on memories alone, it can lead to depression and sadness. Let’s make this spring the one that identifies, respects and incorporates the traditions of our residents into the life of the community.

--Teresa McCann, Senior Consultant/Director of Development

Transformation at Clearwater Center in Florida

Adventures in Transformation: Stories from the Journey

(reprinted from Vol I Issue III of Momentum, the Institute's newsletter for eldercare professionals engaged in Person-Centered Care)

Does a change from an institutional appearance to one more reflective of a home really make a difference to our residents? The Clearwater Nursing and Rehabilitation Center in Clearwater, Florida had been on a journey to include their residents in all decisions that would affect them or their home. The home wanted to move away from their institutional appearance and create the reality of home. Initially, they invited residents to meetings related to paint colors and décor. The residents offered ideas for colors and decorating themes but wanted to see paint swatches so they could pick exact colors. After these initial meetings, the residents began to get very involved in the daily developments for the changes they planned. Once the excitement was there, they had little patience for delays and excuses. They were ready for change and could hardly wait for their vision to become a reality.

As the residents’ excitement was building, the Institute for Caregiver Education initiated education for Neighborhood Development, Neighborhood Teams and Neighborhood Meetings. The residents were very involved and liked what they were hearing. As the physical changes began to happen, the residents were right there inspecting and offering their comments throughout the process. During this time, the home’s administrator, Steve Kelly, was involving the residents in a Food Committee and having frequent meetings to learn more about what they wanted and desired. The residents responded and change began to happen. The transformation of the residents’ demeanor was obvious. They would greet people at the door and offer to show them around their home. When entering the home, visitors would be greeted by multiple smiling residents. During the home’s open house, many residents volunteered to be part of the groups giving tours. The residents mingled with the guests and discussed their experiences and excitement.

Steve Kelly shared the following story:

“After all the painting and decorating was completed on each neighborhood, a female resident approached the Social Service Director. She told the Social Worker that she needed some things from Wal-Mart. The Social Worker told her she would be happy to take her the following week. The resident insisted that she needed to go that day. The Social Worker was curious about the sudden urgency and asked the resident why she needed to go that day. The resident told her that since her home looked so pretty, she wanted to start looking good too. She wanted to go to Wal-Mart to buy make-up and nice things for her hair. She told the Social Worker that she wanted to start doing her hair and putting on makeup every day when she got up.”

Does a change from institutional appearance to one more reflective of a home really make a difference to our residents? It certainly made a difference in the lives of the residents of Clearwater Center!

Person-Centered Care Training in Oklahoma City, OK

The Institute was asked by the Oklahoma Association of Homes and Services for the Aging to present a full-day conference on Person-Centered Care for their members on May 8th. Teresa McCann and Allison Lantieri teamed up to offer five sessions, including:

• An Introduction to Person-Centered Care
• Person-Centered Care in the 1st Year of Implementation
• Retention & Workforce Development Based in Person-Centered Care
• A Transformative Approach to Human Resource Leadership
• Making the Business Case for Person-Centered Care

There were about 75 attendees on-site in Oklahoma City and another 45 in Tulsa who participated via a live video-feed. The day was sponsored by the Oklahoma Foundation for Medical Quality, which is the state's Quality Improvement Organization.

We were pleased to receive great feedback throughout the day and afterwards from attendees who are excited about adopting Person-Centered Care practices in their organizations.

Some of the feedback included:

"I attended the culture change seminar that OKAHSA presented yesterday in Oklahoma City. You did an excellent job. It was one of the most informative seminars that I have attended."

Peggy Mitchell, Administrator, Community Health Center—Wakita, OK

“The seminar was wonderful; one of the best I have been to. As a new administrator (1 ½ years), I have been fortunate enough to work at a home where the “idea” of person-centered care is welcomed and I am excited to really put into place a long-range plan to transform our community completely. We have the right attitude in caring for our elders but I never thought as much about the HR possibilities that complete the transformation. Thank you for a wonderful learning experience!”

Casey Garrard, Administrator, Crestridge Place—Watonga, OK

The Institute team is pleased to offer full-day conferences on Person-Centered Care that are customized to meet the needs of your organization. We are able to provide training that meets the needs of non-profits, for-profits, multi-home organizations and independently owned single homes. If you would like more information about our services, please e-mail us at training@caregivereducation.org.

An Aging Perspective

Youth is the gift of nature, but age is a work of art.
~ Garson Kanin ~

Introducing a New Leadership Workshop!

The Person-Centered Leadership 3-Day Workshop

A New Focus for Today’s Eldercare Professional

This is a new, three-day workshop offered by the Institute for Caregiver Education!

Effective leadership training is an essential ingredient for healthcare organizations that are beginning to adopt Person-Centered Care practices. In this three-day workshop, Institute for Caregiver Education trainers will guide session participants through a highly-focused and challenging set of modules that will prepare them for management in Person-Centered Care environments.

Eight modules will be covered in the three-day Leadership Workshop, including:

• Leadership & Change
• Leadership & Communication
• Leadership & Conflict
• Leadership & Customer Service
• Leadership & Employee Motivation
• Leadership & Management
• Leadership & Teamwork
• Leadership & Temperament

Using a combination of lecture, group work, facilitated discussion and team-building, the Institute for Caregiver Education’s 3-Day Leadership Workshop is the only professional education offering focused on Person-Centered Care in the industry. At the conclusion of the workshop, your management team will be re-energized, re-focused and ready to guide their departments through the many challenging aspects of Person-Centered Care adoption.

The Institute for Caregiver Education team is pleased to be able to offer this 3-Day Person-Centered Care Leadership Workshop directly on-site at your organization. This effectively reduces costs associated with travel, hotel stays, dining and rental cars. In addition, our trainers are able to guide your leaders on your organization’s home ground, in a place where they are comfortable and ready engage in the principles behind Person-Centered Care Leadership.

If you are interested in learning more about the training opportunity, please contact Allison Lantieri, Director of Communications, at 717-263-7766 ext. 303.

Culture Change—It’s about Relationships

A couple of months ago a colleague sent an email asking the team what “relationship” meant to us. I spend considerable time educating on the importance of relationships, so, I was surprised when I hesitated before shooting back a quick and easy explanation. I really gave thought to her question. What does it mean to have a true relationship? What are the basic needs of a relationship? What clicks between people who are close? I’m not talking about romantic relationships here, but, those deeply satisfying personal connections that are so important to our over-all well being. Let me share a portion of the email in which I responded to her inquiry.

“When I open up and give of myself, it means the other person has earned my trust. If I develop a relationship with someone, I believe that sharing ‘me’ is safe. Conversely, I want to make sure the other person trusts and feels safe with me and that I never do anything to destroy their trust and feeling of safety.

That said, part of trust and safety involves compassionate honesty. When a true relationship has been formed, neither party is put off by compassionate honesty because they know their best interest, their personal growth, their professional growth and/or spiritual growth can only happen with that feedback.

I believe we respond and reveal ourselves in varying degrees depending on the type of relationship we are involved in. There are pieces of ourselves that we give depending on the type of relationship. A person only opens completely and shows their true and real self if they sense trust and safety (on both sides).”

Person-Centered Care requires a willingness to lay aside old ideas and beliefs. One of the first things we change is the way we interact with each other in the work place. Traditionally, we have intermingled with each other based on “position” or “level” within the organization and we interacted with residents from a stand-point of authority. Neither did much to advance trust and safety!

In the past, relationships were the last thing a company wanted because it was viewed as wasted employee time and led to unrest among the “troops.” I remember going through Leadership Training as a young Director of Nursing. We were told never be friendly with staff and NEVER socialize with them. The rationale was that discipline was a large part of the position and it was impossible to provide necessary and needed discipline if we were friendly. The belief at that time was that staff must be disciplined frequently and harshly.

I remember also that the instructor spent significant time explaining why a nurse should never have a relationship with a patient. We were taught never to address a patient by their first name even if they ask us to, not to discuss personal affairs with them and never to ask them a question personal in nature. The rationale? A nurse needed to be objective and with personal relationships, objectivity was lost.

Today we know that quality of care and quality of life for elders and job satisfaction for the team is all about relationships. It’s time to lay aside these old beliefs and build productive and satisfying relationships among elders and within the team. How do we begin to do this? 1) Get to know each person 2) Build an environment that is based in trust and safety 3) Embrace diversity and individuality 4) Allow people to contribute and become involved. When we view staff and residents as complete individuals it is impossible to interact with them in the same old non-relational way.

--Teresa McCann, Senior Consultant & Director of Development

An Aging Quote to Smile About

"Beautiful young people are accidents of nature, but beautiful old people are works of art."
	Eleanor Roosevelt 1884—1962

Culture Change: A Consultant’s Experience

“We don’t need no stinking Culture Change!” “We didn’t get any deficiencies that were important.” “It’s not something that is mandated by the State!” “Did you hear the one about the Consultant?”

My first visits to a senior living home were met with these comments. The thing I respected most was the fact that I knew right away where I stood. There was no guesswork, no anticipating an open environment, no attempt at detouring by fogging the conversations with pretense of schmoozing the consultant.

By virtue of being “A Consultant” one already has a strike against oneself. Pompous to assume that one knows so much as to be called into a situation to ‘tell’ others how to proceed in any given area. And CULTURE CHANGE! Might as well come bearing a scepter and a scroll and in a booming voice decree what is to be in an alien land. So much for being Queen for a day! That said, I listened to the comments, chuckled at the jokes, observed the body language which was hostile and closed and confrontational from everyone sitting in that room. And thought, yep, this is why I became a Consultant—to be admired for my experience, respected for my knowledge, liked as a passionate proponent of elder care, and to work with like minded individuals to move forward in providing the best of care. Talk about pompous! The wonderful thing I received from this situation was the ability to learn more than you could ever imagine from running into wall after wall.

Culture Change…it isn’t simply “doing.” It is about becoming: Live it and it becomes.

It should be such a simple thing—bring relationships and individualized care to a home. It should just be a natural extension of a life and those relationships that come into being from sharing an environment. But, people are people. Barriers and a false sense of control are difficult to dissolve. The idea that medical care is only one small component of a human being’s life and not the totality of that individual is for some reason threatening to some staff.

For some Administrators there is the fear of crossing regulatory boundaries and being “more open” for lawsuits. False thinking that “more control” is safer. Some nurses think that they “know better” and in wanting to “fix things” take away the individual’s right to live and make those choices that define themselves as persons—not as how they are viewed by others as a group or disease. Your more convoluted issues arise with the staff who need to define THEIR self worth by being overly involved in the decision making process for a resident. These are coming from perhaps a “caring” but misguided outlook.

Allow yourself to see the person first. The environment is an artificial placement, an extension of where the person is and not WHO the person is. They still own their own destiny. We must remind staff that this is the home of the resident and that we are lucky to be invited into their home and to be a part of their community.

To answer the many questions I received from staff relating to Culture Change, I did so over time. Words do little to affect Culture Change. Action and seeing the outcome is what brings programming, education, and Culture Change to life. Simply put, in my opinion, it is about Life—the “Big L,” life for the residents, their families, the teams and the community outside of the home. Those precious 24 hours in a day of communication with others and communing with one’s higher power, and with oneself is what it is really all about.

Take a moment and consider your co-workers, and all of the sub-cultures and all the experiences that you are relating with each day. Place them in the home setting and then each resident and family and their cultural, religious, and life experiences and you can understand where the fear and barriers can grow from. You can see how convoluted the dynamics can become. Culture Change removes the institution and creates a community from this diverse population.

Culture Change provides an environment that is life affirming and accepting of this truth: All individuals are different while sharing some commonalities. It is making it home for and with the people who live there. It builds on the fundamentals of relationships, risks, choices, and creates an atmosphere of being with, not doing TO someone.

Removing the institution and creating home and community is an action. In home and community, staff interacts with, not controls the residents. Administrators listen to their residents and staff and interact. Families are allowed to interact and be a part of what makes up the home. The residents are the home. Community is what is created. To use that maxim referring to a different population, “It takes a village…”

Be a member of that village. Create that home and community.

Obviously, the group I worked with NEEDED Cultural Transformation. Not because I said so as their Consultant, but because their distrust of their own dynamics; the control they exercised vs. relating with the residents; the disallowing of personalities in their residents; forms of punishment for those they didn’t “like” or who “weren’t easy;” the medical sense of superiority vs. letting a resident be their own person and make their own choices; all of these elements were causing residents to be fearful of the staff and of the “nursing home” area. There were unhealthy dynamics with the residents in response to the staff control issues including acting out behaviors, increased falls, weight loss, incontinence, depression, and increased psychotropic use. The sense that a resident went there to die and never “got out” was pervasive. “Death’s Waiting Room” was the healthcare area’s nickname.

Deficiencies are easy to address as well: regulations are guidelines that one cannot go beneath. Just because a community meets the lowest criteria and passes a survey doesn’t mean that the standards are true quality. Raise the bar. Heck—open the bar! It is time to become what the standards shoot for, not to meet the lowest possible criteria. Create the atmosphere of life and your regulations will not only be met and become a natural part of the home, but the improved quality of life as staff focuses on building relationships with each resident will become stronger and make for better care and ultimately fewer problems.

As for mandated by the State? Humanizing programs are becoming mandated. But is that a reason for Culture Change? Doing the right thing shouldn’t have to be mandated. Individualizing the care, allowing choice, and creating a Community brings rise to a happier and more genuine environment, better dynamics and relationships, healthier residents, lower staff turnover, is fiscally sound, and provides each person their own destiny. What is so radical about those qualities?

As for the jokes? Maybe some days my role is that of the Village Idiot, but I learned that not taking myself seriously but bringing humor to my passion for Culture Change was a big part of my personal journey in Culture Change itself!

• Remember it takes time and action to assist in Culture Change
• True change requires total team support and involvement—one person alone can’t effect change
• When met with adversity ask questions, and keep in mind there is no “winning” but a possibility for knowledge and growth
• Those that get on board in a community are your best cultivators for the positive “contagion” of change
• Keep your humor and keep your focus
• Remember that cultural transformation is like eating an elephant…one piece at a time
• It is a process

By the way, did you hear the one about the Consultant???

Rhea L. Schneiders,

Associate Consultant and Educator