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!