We write of Culture Change often here, and for a reason. It simply makes sense to adopt to this newer model of caregiving. And, it saves many cents, too! McKnights LTC News has the scoop right here:

Nursing homes that have adopted aspects of the culture change movement, or at least strive to, are more likely to see benefits in resident satisfaction, staff retention, higher occupancy rates and improved operational costs, according to a recently released survey of directors of nursing.

In the report, which was conducted by The Commonwealth Fund, nursing homes were broken into three groups: culture change adopters (31%), culture change strivers (25%) and traditional nursing homes (43%). Of the adopters, 60% reported improvements in operational costs compared with 31% of traditional nursing homes. Additionally, staff absenteeism decreased in half of the homes that adopted culture change, according to the report. Roughly a third of traditional nursing homes reported any such similar decrease in absenteeism. Culture change is a movement emphasizing resident-centered care in nursing homes.

One of the things so many people like about the Culture Change movement is the upside down chain of command structure. Residents call the shots; next the CNAs have this “power”. Nursing homes that are seeking to change their culture often do a lot of window dressing but actually change very little of the management and leadership culture. Fear is the reason for this.

When a facility is looking to really change, actions do speak very loud. Pioneer Network has been working tirelessly to assist nursing homes and assisted living facilities with culture change. Matt over at Setting The Nursing Home On Fire found this gem of an article at the Pioneer site:

Low Cost Practical Strategies to Transform Nursing Facilities
it is a pdf report.

One of the things I noted quickly was the attention to the staff break room. When the staff are respected and trusted, it shows in many ways. Having a retreat style break room is a viable and cheap idea most nursing homes could manage. With the right motivational leadership, the nurses and aides would be more than willing to assist with creating this room.

Staff Amenities
Overall Goal:
Routinely staff members have been assigned break room space in the basement of a facility that is
furnished with cast offs, has equipment and appliances that often malfunction, and space that is expected to serve the dual purpose for staff who want to socialize as well as those who want a quiet time. Reverse this trend and provide staff with an abundance of spaces including tables in main dining room, a computer station and quiet space for reading or meditation.

Really now? Do staff need all this? DO we really care if our break room is nicely outfitted with decent working microwave ovens and fridge large enough to accommodate ALL our bagged meals and drinks? And who has a computer in their break room? Management would never trust the staff to go online because they might be wasting time, right?

Get with the times, management.

Examples of Improvement Strategies:
• Enhance the staff break room. It should have good lighting, comfortable chairs, conversation arrangements, appliances that work, flat surfaces for both eating and writing and a quiet corner

• Provide computer area or computer station for private staff use

• Designate a table and regular day as “give-away or exchange” where children’s clothes, extra produce from gardens, reading material, videos, and other items can be exchanged or given away

• Provide prayer corner or small meditation room designated for staff

• Encourage staff to use lounge or dining spaces to hold baby or wedding showers or other celebratory events. Invite residents to participate along with members of the community

A big bulletin board might be the only resemblance to the “old” break room.

Wow. Comfortable chairs and seating arrangements that mirror a living room more than a waiting room? Why not? When respected, staff deserve such spaces. Most of the furnishings for such spaces can be purchased cheaply through group purchasing associations, trade group memberships and, the old fashioned way- yard sales and thrift shops.

Another GREAT source of help is the resident families. I am quite sure most would donate a chair or small table; an area rug and some table lamps. The residents themselves could make wall quilts and other artwork. Bookcases and ottomans (YES- so the tired feet of CNA’s have a place to rest UP on);
everyone has a book or two they would be willing to give to the new staff LIBRARY located in the break room (same with DVD’s and the TV/Player to go with it).

Think outside the lead box. A transformation can happen within a week if it is truly wanted. Under the culture change movement every room has significance and front line staff have much more value and respect.

There’s a lot of buzz outside the world of nursing homes and other places CNA’s are employed at: It’s called THE NO JERK POLICY. Some people refer to this as Workplace Civility.

In the business community this term refers to businesses that have a zero tolerance for hiring, and keeping on staff, people who exhibit rude and mean behaviors. Customers and vendors are often expected to abide by the policy as well.

Let’s face it, nursing homes and most medical/nursing facilities are chock full of people who can be described as jerks. Managers, doctors, nurses, techs, aides, dietary and housekeeping employees- administrators, DON’s…AND, our customers- the residents and their families are very often the sources of JERK like behavior.

Read the rest of this entry »

From Setting The Nursing Home On Fire:

Nordstrom’s is a chain of upscale department stores famous for their customer service. They only have one rule for employees: “Use your best judgment”.
[…]
Residents would be able to participate in the activities of their choosing, and it wouldn’t just be groups like church and bingo. Nurses wouldn’t have superfluous charting, aides wouldn’t be assigned useless tasks like putting ice in water pitchers that everyone knows are never drank out of. Aides would pretty much run the place, in fact, and nobody would have a problem with it.

Indeed.

Are we seeing a trend here?

PRESTON, MN — It’s not easy telling an 82-year old woman the place she calls home is closing its doors for good.

But today, that’s exactly what the Good Samaritan Center in Preston is doing.

Not only a tough decision, but unfortunately one that’s becoming more and more common and not just in Preston.

The entire state is seeing this “slow death” of nursing homes, as senior citizens are choosing home care or assisted living over nursing homes.

But for the residents and employees at the Good Samaritan Center, it’s an unexpected shock.

Bernadine Redalen, lives at Good Samaritan says, “I was kind of surprised in a way; I mean, it’s been home for ten years.”

Home is here for Bernadine Redalen - at the Good Samaritan Society in Preston.

Bernadine says, “I’ve met some beautiful friends here; everybody is real good to us.”

But 60 days from now, on March 8, she’ll have to find a new place to call home.

Officials here told Bernadine and 34 other residents Tuesday evening that the center will close its doors for good.

Tom Syverson, Good Samaritan Regional Director say, “It is a very difficult day sharing that a home that a home that people have lived in for many years is no longer going to be here in Preston.”

Here - on Kansas and Winona Street, partly because of financial struggles, but mostly because of a growing shift in elder care.

Tom says, “Seniors have many more choices, which is a good thing - through assisted living and other home and community-based services.”

Are nursing homes on the way out? I must say: I hope so. At least nursing homes as we know them. Other community living situations are better, offer more choice and freedom and have superior outcomes. Maybe the traditional nursing home is indeed on the way out.

Fitness and nursing homes…now this is different!

None of the two dozen men and women sitting in wheelchairs or perched on chairs with their walkers next to them volunteered to stand and try a few mini-squats while holding onto a chair back.

That did not deter Linda Thurston, who is mounting an effort to improve the fitness of residents in nursing homes and assisted-living facilities.

She soon had nearly everyone in the dining room of Athenian Village in North Royalton doing foot circles, toe taps, hip flexes, leg lifts and shoulder squeezes.
[…]
Studies show that exercise helps people build muscle and improve balance and posture. It also improves arthritis and other conditions and promotes healing of wounds.

But assisted-living centers and nursing homes are not required to provide exercise.

Physical fitness for many residents consists of mimicking action on videos, said Thurston, a certified fitness instructor.

Thurston, of Twinsburg, formed the Senior Fitness Movement, which includes a Web site, classes for residents and activity directors, and information on exercise. She also wants Ohio to change its administrative code to require exercise in the facilities.

I think it would be great to have, on staff, a fitness instructor at nursing homes. Why NOT? We all know the benefits of movement, exercise, stretching…and who can best help residents with all this?

Over at the Network54 Message Board, several weeks back a reader asked this:

Is there anyone familar (sic) with a “blended role” such as a C.N.A./activity Asst.? If indeed we are moving in the direction of “culture change”. I feel this could be a new job description in which to explore!

Well yes…several years ago I worked two jobs; the weekend job was at an assisted living facility that served people with dementia. The facility was divided into four neighborhoods, with 20 beds in each section. Two neighborhoods were for higher functioning relatively independent residents; another unit was for mid to late stage residents and the fourth neighborhood was for all late stage residents.

I worked in the fourth neighborhood. Most assisted living facilities don’t employ many CNA’s; they are not required to employ CNA’s and instead hire and train people to work as Resident Assistants. This is fine for less medically needy residents; the RA is more than qualified to assist people with few needs. For those with late stage dementia though, trained nursing staff should be expected.

When they hired me, I was told part of my responsibilities would include delivering activities for my assigned residents. At first I almost declined the position because I couldn’t see how it could all be done: Cares, supervision AND activities. I’d worked the nursing home beat and knew the drill: 10 to 15 people on my list, crazy expectations that were almost impossible to meet; dealing with families and overstressed charge nurses, and of course the always understanding management team…

The DON of this assisted living home must have been reading my mind: She reassured me the facility supports the blended role of CNA/Activity Assistant. To prove it, she took me on a tour to the neighborhood I would be working..and sure enough, the aides were quietly providing activities, in many different ways:

One aide had a group of four ladies sitting at a table in a small alcove like area, serving them coffee and cookies as she read from an old magazine (which wasn’t really OLD but a reproduction book);

Another aide had some men in the dining room painting little wooden plaques for some craft project they were working on;

In the main sitting room two aides had a lively group of residents doing exercises and ball tossing.

Way down in the end of this neighborhood another couple aides were doing some sensory stimulation activities with three obviously very frail, wheelchair bound residents: Scented lotion hand massages, neck massages, a CD player playing quiet Celtic tunes in the background; and to my surprise, a resident was in a recliner with a special massager pad under him- thoroughly enjoying himself.

Everyone appeared to be having a good time. The aides were not rushing and running around as I expected them to be; the residents were being tended to in very personal and productive ways. And it was ONLY 10AM.

HOW DO THEY DO THIS? I asked the DON:
The place had one Activity Director, and she was best suited working with the higher functioning residents, this left the lower functioning people with little to do. Management came up with the idea of a blended role for the aides working within the lower function unit: All the CNA’s would be responsible for resident activities as well.

The ratio for the CNA/Activity Assistant is 5:1 in this neighborhood for day shift; 7:1 for evening shift. When a resident is admitted, an aide is assigned to him or her, on a permanent basis. The facility follows the principals of consistent staffing/assignments. The aide is expected to partake in the admission process and a big part of this includes gathering information about hobbies, likes, dislikes- and plan activities for the resident. Aides from both shifts are included in this expectation.

The aides are given lots of Dementia Care Training, including the value and importance of activities…so much that activities are considered JUST AS IMPORTANT as nursing care. And at some times, MORE IMPORTANT.

The aides develop the Activity Calendar each month, based upon each resident’s likes and needs. Actually they do this two months in advance; preparation is KEY to a successful program. Many outings are planned, on both day and evening shifts- coordination is vital to make sure the trips happen. Activities are provided on both shifts as well, not just during the hours of 7 to 3…typical evening shift activities included personal care and pampering activities: Nail care with nail polish; foot soaks with a massage; Ladies Night that might introduce the women to the new face masks and latest hair care products…for the guys it often meant watching a war movie and then having a discussion after; another night it was going out to the local bowling alley…

The facility was brimming with activities…and much laughter, enlightenment and good cheer. The residents, even in their declining stages of dementia, seemed very content. There was little wandering; little exit seeking. Change of shift wasn’t at a set hour for all the aides; some came in at 6:15am and worked until 2:15pm; another couple worked 6:45am to 2:45pm- solely for the purpose of keeping this hour as distraction free as possible. They staggered the shifts and I have never seen another facility do this. This helps keep the residents from noticing an entire group of staff leaving (via hanging out at a nurses station) and the lapse of attention waiting for the next shift to arrive, get report and tend to them. There is no shift report per say- aide to aide reports are given and later if nurses need to share info, it is passed along.

This works great for assisted living facilities. I’m not sure how it work, though, for SNF- which have stringent regulation regarding activities and who can provide them. Some of these rules really go against the best interest of residents, when we think about it. Does it really matter who is tossing the ball- an activity professional or an aide? Do all games of bingo have to regulated by the government? With more and more nursing homes going through real and true culture change, these issues are being dealt with successfully. The OBRA regs are being tweaked to best suit the changes so needed in long term care. One way to do this total change is to have as few staff as possible delivering as much care and programing as possible. So, the CNA/Activity Assistant is a great role to consider.

The daughter of a nursing home resident forms a family support group and gets grief for it.

As soon as Rose Guyer suspected quality might be slipping at the nursing home where her mother lives, she took action.

She created an advocacy group at Spring Creek Rehabilitation and Health Care Center, where her 90-year-old mother has lived for three years. She formed the group in January, inviting Spring Creek residents and family members to join.

As Guyer envisioned, the group quickly became a forum for serious concerns, such as complaints that staff failed to notice medical problems, and that activities for highly disabled residents have declined significantly, with the residents left in front of TVs or windows.

Other recurring concerns include late meal deliveries and caregivers talking on cell phones during work.

According to Guyer, the home’s administrator, Matt Rohman, reacted positively when she told him of her plans for the group. He said the group could meet in the home’s library and attended the first meeting, saying his door was always open to questions and concerns.

But over time, Guyer says, her relationship with management has cooled.

Of course it’s cooled…management doesn’t want to hear the negatives. They want to believe all is perfect and could care less about the mundane boring aspects- things families call problems. I realize management’s hands are often tied when it comes to fixing so many of the problems…but they should be more open to group concerns and should try hard to work with the customers here. There is much more to this article- 4 pages worth. Have a look…

You should read this. And be thankful for how some people handle such things with grace and composure.

Former Justice Sandra Day O’Connor’s husband, suffering from Alzheimer’s disease, has a romance with another woman, and the former justice is thrilled — even visits with the new couple while they hold hands on the porch swing — because it is a relief to see her husband of 55 years so content.

The article is much longer and goes into depth about how older people value love and relationships. This is a very positive story.

Men who reside in nursing homes often have no activities geared just for them. It’s too bad- men have different hobbies and likes than women. Activity professionals are working to rectify this situation.

Men may no longer be an endangered species at nursing homes — but they certainly aren’t social butterflies, either.

As the male population hovers around 25 percent, staffers are trying to get men out of their rooms and involved in activities.

While women have no trouble making new friends and organizing knitting and book clubs and shopping trips, men often must be recruited to attend programs designed specifically for them.

“The biggest problem is many of the men of this generation are not the type to get together socially,” said Shawn Fink, program director at Menorah Park in Beachwood. “We are trying to break down those barriers that men put up. It’s the manly man thing — I don’t sit around and talk.’ ”

But that’s all many men in nursing homes can do. Their lives, which once revolved around their jobs, home projects and family, are now focused on maintaining their health.

Manly man thing?

At Menorah Park, men are organized into groups to play poker, go to Indians games and relax with whiskey or bourbon. They bowl, golf and play baseball on the Nintendo Wii video game.

About two dozen men also meet twice a month in a men’s club. Davidson said they have discussed topics such as sports, old westerns and the military. And men who may not have gone to synagogue when they were younger now regularly attend.

Have they asked the men what activities they would like to participate in?

I have worked in nursing homes where men have a lot of activites planned just for them:
Weekly Men’s Groups: Coffee, beer or other drinks, a topic of discussion, props designed for the guys; they watch a movie or documentary and hold a discussion after…Trips to museums, car shows…one group went to a local gym three times a week to workout! Building models; painting objects for gifts; gardening (yes men like this); one home actually purchased an old beat up car and the men fixed it up…

The ideas are endless but many barriers exist within the walls of nursing homes. Break down the barriers and men can and do thrive among their peers.