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.

Programs of All-Inclusive Care for the Elderly- AKA PACE- has set up services in the state of Virginia. This is very good news.

Kirby Turner uses a walker to get around, but that didn’t stop him from doing a spirited dance to celebrate his 66th birthday recently.

Turner, who also has a mental disability, might have ended up in a nursing home, away from family and friends. But he’s able to live with his nephew, thanks to a day center that provides him with transportation, home care, meals, doctor visits, and yes, even a birthday cake.

The center, called Sentara Senior Community Care, has been around since 1996. Next month, it will become Virginia’s first official site for PACE - Programs of All-Inclusive Care for the Elderly.

There are 40 other such sites in the country.

The federal designation will mean expanded services for the 130 people at the day center, and will help Sentara Life Care Corp. launch a second center in the region next year.

The second center could provide as many as 130 more people with an alternative to institutional care.

The PACE model is considered to be the wave of the future, as interest in “aging in place” grows among the elderly and the baby boomers coming behind them.

“Our research shows that 80 to 85 percent of older Virginians want to stay in their homes as long as possible,” said C.D. “Tony” Hylton III, communications director for AARP Virginia, which advocates for people 50 and older.

The participants at PACE centers are frail enough to qualify for nursing home care. But rather than pay for services in institutions, government funds the necessary tools - transportation, health care, home-health aides and recreational activities - to help participants stay at home.

Riverside Health System is awaiting approval for a PACE center to open in Hampton in January. The health system also plans to open a center in Richmond in late 2008. Three sites in the western part of Virginia are in line to become PACE centers next year as well.

The programs are funded by Medicare and Medicaid, government’s two main insurance programs for the elderly, poor and disabled.

There’s lot more to read HERE.

PACE Web Site.

The alternatives keep making news:

“We’re creating a new niche with a more intimate form of care,” and one that helps seniors maintain neighborhood ties, said Al Norman, executive director of Mass Home Care, an association of nonprofit agencies that launched the initiative.

The model is similar to group homes for the mentally ill and mentally retarded that helped thousands move out of institutions. In this case, it is designed to serve seniors too frail or disabled to live safely on their own or in assisted living, but who don’t need - or want - the round-the-clock nursing of a large facility.

It is part of a nationwide movement to give seniors more choices, driven by baby boomer advocacy for their parents and by new laws, including one Massachusetts passed last year, requiring government to allow disabled seniors to choose the “least restrictive” environment to obtain taxpayer-supported services. Prior to these laws, many states directed nearly all money for senior care to nursing homes. Now, states are paying for more home-based services for low-income seniors who would otherwise be in a nursing home.

Utah advocates for elderly citizens are starting to educate others about the alternatives to nursing homes.

MIDWAY — Home is not only where the heart is for aging Americans; that is where they are better off and state funds for senior care programs are better spent — six times better at least.

So say Utah senior advocates, government-agency representatives and care providers. They are so sure that promoting independence of individuals is healthier to both seniors and to state coffers that they want a freeze imposed on any public funds spent on long-term care facilities.

A special panel of lawmakers reviewing state spending on Medicaid and other programs for senior and disabled Utahns will receive the proposal at its next meeting Oct. 3. The lawmakers will make a recommendation by November, and the full Legislature would still have to act on it during the 2008 general session beginning in January.

“This is simply recognizing that the traditional skilled nursing at a care center model of caregiving is on the way out,” Alan Ormsby, director of the state Division of Aging and Adult Services, said Tuesday. “I would never say there isn’t a place for long-term care centers. But when you can provide safe and often more effective services at home and at less than a sixth the cost for most seniors, we have to at least begin moving in that direction.”

I like that statement: …”traditional skilled nursing at a care center model of caregiving is on the way out”– and I think it’s starting to come to reality. Almost everyone would benefit from a change of this model; nursing homes are not a HOME no matter how hard they try. The culture changes we see within nursing homes, the Eden type models, are good. But nothing replicates being at HOME. In control of your own destiny and in charge of your own life. The more resources that are fed into this the better off we all are.