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.