The Piper: Q & A with Steve Shields

The Piper is a new Household Model assisted living community near The Legends in Kansas City, KS. The Piper was developed and built by Assisted Living Associates, a partnership between PAR Development, Clarkson Construction Company and Action Pact, a Manhattan, KS based company specializing in senior living.  Action Pact pioneered the Household Model, an innovative philosophy that embodies person-centered care.  Their services include development and design of senior living environments, organizational transformation and consulting.  They are nationally known for their innovative work of transforming assisted living and nursing homes from institutions into warm, nurturing homes. Steve Shields, CEO of Action Pact, answers questions about what this model offers from a variety of folks with different needs.

Transformative Leadership: Reinventing How We Age

With emotions running high, Steve Shields, Action Pact CEO, shares his personal experience with his mother who was placed in a nursing home, and the devastating aftermath of her time there. Through his determined efforts, Shields has transformed the senior living industry, and his talk reflects the need to change how we think about our elders.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at

Culture Change – An Inside Job!

The following heart-felt piece illustrates what often happens to folks during their time at one of Action Pact’s intensive educational offerings.  Karmen Payne, of Fair Haven Retirement Community in Birmingham, AL, recently attended the Nurse Leader intensive, and a fire was lit.  These are her thoughts as she headed home.

The journey to understanding household models is more than learning a management style or philosophy to me. The vision is unique, individualized and as alive as the people living and working in the households. The characteristic “schedules” of the nursing home are absent and the resident is the driver of the pace, style and atmosphere in the home. The critical attitudes, noise and tension are gone. The hierarchy of departments melts away. Rather than entering a “hall,” households truly seem to offer residents, families, staff members and visitors like me, a piece of their home for a time.

At first, I expected to attend a nurse leadership intensive and get a “how to” experience. I had my pen, paper and standard three ring binder at the ready. I quickly put most of that away in favor of walking the hallways, sitting at tables and engaging with members of households to discover what made their household tick. The atmosphere was so shockingly different from my own experiences. The quiet, peaceful interactions were personal and calm. There was no running about by anyone. The residents of each house I visited seemed to come and go at leisure. Everyone was joyful and attentive from the nursing assistants to the licensed dietician serving at the grill. Even the families I encountered were happy!

Returning to the classroom for reflection and discussion, I discovered I was not alone in my shock. There were others on the same journey as my building. That is a trek to finding our pathway to creating home for our residents — the way the residents want home to be. However, rather than a “ten-step plan to compliance and home,” I discovered a guide to self-examination that challenged me to change. If we are to become a household, I was going to have to think differently, respond differently and lead differently. Ten steps were not going to fix the problem on the “floor.” No. The changes I needed were an inside job that would become contagious as we build homes, teams and families to care for our residents’ needs as our residents desire us to.

So,Heart inside person I am beginning the journey with a change of heart and a renewal of spirit. I want to serve my residents and my team by honoring them, empowering them and getting out of their way while motivating them to do what only they can do. Create home. Pursue life. Honor the spirit of each individual in each household in their own unique way. I realize the standard I have lived by for the last 20 years is going to change. I am not the decision maker. Every water pitcher won’t be sanitized on Tuesday any more. Yet, every resident will be honored, fulfilled and respected every single day. I am losing nothing and they gain everything, especially their right to pursue life in their later years on their own terms.

This change will not come without pain. There will be less gossip and more accountability. Confrontation and discussion will replace accusation and blame in our lives. I will have to be brave and bold. Trust will grow as a foundation and control will crumble under its weight. Character and principle will replace compliance and enforcement. Our number will shrink to only those with a heart to serve at first. However, in the end we will become a stable team of servant-leaders dedicated to our calling.

Each home will be different. Each schedule will not follow my best-laid plan. No longer will “my” team spend half their day meeting with me and others like me anymore. Silo jobs will die out. Assignment sheets may well vanish into the abyss with shower schedules and get up lists. Yet, at the end of this pathway of curves, valleys, laughter and tears, maybe we will have created something valuable and lasting to leave as a legacy. Maybe we will have transformed our facility into a home.

Would you like to Hear the Voice of Households? Click here to watch video clips with stories, testimonials and great ideas! 

Photo Op: A Lesson for All

This story comes to us from Sarah Bishop, Social Services Mentor/Household Coordinator at The Davis Community in Wilmington, NC.

The husband of a resident (“Mr. Smith”) was in the team room saying that what he appreciated most about the house was the fact that the staff cares so much for both the residents AND families. Here is what triggered this affirmation: Dana, a Social Worker, walked into Mrs. Smith’s room. Everyone knew she was in her final days, and Dana observed Mrs. Smith in a most peaceful state, holding Mr. Smith’s hand and rubbing his arm. She looked so contented and at peace, and after her struggles with dementia, it was awesome to cell phone-2see. Dana asked Mr. Smith for his phone and was able to capture that moment on video for him, and Mr. Smith shared it with his wife’s out-of-town family, to show how at peace and comfortable she was then. He said the family members were so appreciative of this captured moment, and he became a bit tearful, saying, “Not every place thinks that this is important, but you’ve all made it so. And I don’t know what to say to that, except thank you.” Sarah knows that other families at The Davis Community have similar feelings, and is sure such thoughtfulness happens throughout the community. She says that, “‘death with dignity’ has become such a customary way of doing things that we overlook how special this event is. When we’re looking at household progression and successes, I hope we focus on this one in a huge way. Talk about this in your learning circles, and the impact that everyone is making without even realizing it. Staff deserves to feel good about this because really… what better gift to give?”

Hear more voices from households

Staff Get a Feel for Person-Centered Service at Camp Culture

Camp Culture

There is no getting poison ivy or lost at this camp: Self-contained for six hours in a comfortable room away from all distraction, 10 staff team members and their facilitators relax and share about themselves, thoughts on home, and ideas for making life better for their residents at this CCRG. It’s proving to be an exhilarating means of introducing staff to the fundamentals of person-centered service. Continue reading

Brain Game: Tendency to Mimic Behavior Can Lead to Positive Change

A recent episode of “Brain Games” featured a social experiment on human behavior. They staged a waiting room where everyone (except one person, the subject) was instructed to stand up every time they heard a beeping noise.Brains

After only a few beeps, the subject began standing up with the rest. She was not rewarded or instructed to do so, but she did it anyway. Slowly all the other participants left the waiting room, leaving only the subject. She kept standing at the beep. Then as new subjects entered the waiting area, all but one person mimicked her behavior and stood at each beep.

We humans are funny creatures. We have a natural tendency to go along with the crowd. Perhaps wanting to fit in is a survival mechanism, or maybe it is a social thing. Regardless, the fact is that even without logical reason we will conform to the environment and behaviors around us. We see it in residents demanding clothing protectors, even thought they never used them before. We see residents head back to their rooms after the evening meal and, at the call light, race to go to bed even though they used to enjoy staying up in the evenings. Could this be an anchor that has held long-term care in its institutional mindset?

Doing what everyone else does is a powerful human trait, but maybe we can use this tendency to create positive change. If people are so strongly driven to replicate the behaviors they are exposed to, then let’s give them some positive behaviors to grab ahold. And this goes for staff, families and residents alike. Look at an objective in your daily environment. What behaviors are mimicked by others? Are they positive ones? Are we building people up or tearing them down? The good news I see in the Brain Game experiment is that even when just one person exhibited a behavior, those around joined in. So it only takes one person to get something positive started.

We have the opportunity to use this human trait to make change, to plant seeds for positive behaviors and actions. If those around join in and behave the way we behave, then we can be a catalyst for change. However, we must be very consistent and aware of how others see us. If we are positive and supportive sometimes, and grumpy and talk about others behind their backs at other times, which behavior will others most likely repeat? Try playing some brain games of your own, and present those around you with positive behaviors. At the same time be very conscious of any negative behaviors you may be conforming to and speak up about them.

Home Advocates — A Stitch in Time!

From UnitingCare in Australia comes this piece by Chidananda Kamath, which describes how his community, Annesley House, has begun the process of culture change following the kickoff with Action Pact in November 2014.

At Annesley, we decided to focus more around culture change rather than the infrastructure due to the physical limitations of the home. In consultation with our staff and residents over two months (Nov – Dec 2014), we decided to introduce a concept of shared leadership to kick off our efforts towards culture change. All staff, may it be RN or RAOs or care staff, were paired with a small number of residents. All the staff members were called ‘Home Advocates’ and were introduced to their group of residents. Home Advocates were encouraged to build relationships with their resident group while attending to their normal duties. This enabled Annesley to not only provide care but also discover new stories about each resident. Then these stories becaSlaters-quilt4ame part of their care plans. Recreational activities were designed around their interests and past experience. For example, there is a resident in our home who is originally from Burma and used to be a tailor when he lived there. Since moving here, he has struggled with social interactions. When his Home Advocate heard his story and realised that he used to be a tailor, she requested our Leisure and Lifestyle team to find a way for him to demonstrate his strengths. A sewing and knitting group was initiated as a result and this resident was invited to lead the activity. He became noticeably happier as a result. There are many more such examples and pleasant findings from this initiative.

One of the key things we tried to address and focus on is our language during this culture change process. For example, calling Annesley ‘home’ instead of ‘facility’. Staff were also encouraged not to pass on the blame when an incident occurred, rather identify the root cause that was at error in the process, which then would assist the whole team. This helped us design better processes with existing resources. Example: Annesley is now using calendar software to record resident appointments, GP clinic due dates, etc., instead of a diary where errors can happen just because of poor handwriting.
We also designed a simple monthly feedback process for Home Advocates which offers them ten minutes with a senior team member, giving them an opportunity to share their experiences or any new ideas.

My personal realisation through this initiative is that culture change is not a project but a process… And we intend to keep it going. :)

New Nursing Home Designed to Make Seniors Feel at Home

This article was previously published by Connecticut Post.

by Keila Torres Ocasio

In Bunny Kasper’s travels across the U.S. looking for ways to improve the lives of people in the care of Jewish Senior Services, there was one nursing home model that stood out from the rest — the “household model.” Continue reading