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!