Conversations with Carmen webinar host still going strong after 10 years: ‘Culture Change is still the answer.’

Light the candles, it’s the 10thanniversary of Conversations with Carmen, the monthly culture change webinar hosted since 2009 by
Carmen Bowman, MHS, BSW, 
for Action Pact!

After 100 or so interviews over the past decade with some of the top innovators of culture transformation, “I’ve learned so much,” says Bowman.


On the third Friday of every month except December, she highlights one of a wide range of topics – e.g., integrating pets and children, involving elders in community volunteering, getting residents up and out of their wheelchairs, using Validation to communicate with those living with dementia, enhancing residents’ dining experience, complying with the latest CMS directives while maintaining normal life, and more.

“It’s reinforced my thinking,” she adds. “Culture change is still the answer… you will save money, make money, (and have) better compliance, satisfaction, recruitment, and (staff) retention.”

Bowman’s own wealth of experience as an activities director, state surveyor, trainer, author, and advocate brings a unique perspective to the conversations. It all started in college while she was volunteering as a social work student in a nursing home.

“I actually fed residents – this was back when a volunteer could do that without training – and I fell in love,” says Bowman. “I realized that a person could make a beautiful moment for people even while they’re eating… I discovered the power of dignity, how to talk with people and not at people, how to cover for embarrassment, and how to offer choice in every interaction. It came naturally.”

After college, Carmen was working as an activity director when she learned about Dr. Bill Thomas and the Eden Alternative. She read his book, Life Worth Living, and was immediately hooked, she says.  She began to develop the concept of “meaningful engagement” with residents to replace “activities” in her daily work, all while working on her Master’s Degree in Healthcare Systems. This would have been more than enough for most people, but Carmen went a step further and applied for a position as state surveyor in Colorado. Her hiring made her the nation’s first certified activities professional to become a state surveyor.

“Colorado should be commended because they had a well-rounded team that also included pharmacists, dietitians, social workers, and therapists at a time when many states hired only nurses as surveyors,” she says.

Bowman was a surveyor for nine years and then became a CMS policy analyst, helping to train other surveyors and develop new CMS interpretive guidance for activity professionals. Later as a contractor for CMS she co-developed the Artifacts of Culture Change measurement tool, authored background papers, and facilitated the two national Creating Home symposiums, co-sponsored by CMS and the Pioneer Network.  A third symposium focusing on Quality of Life is just starting to be talked about, she says.

Carmen co-founded the Colorado Culture Change Coalition, worked with the Pioneer Network to develop numerous educational resources, authored eight books with Action Pact relating to culture change, and founded her own consulting firm, Edu-Catering: Catering Education for Compliance and Culture Change.

In 2009, Action Pact Executive Leader, LaVrene Norton, invited Bowman to host a monthly webinar.

“What a blessing that she asked me, of all people,” says Bowman.  “Thank you, LaVrene!”

In choosing discussion topics for the webinar, Bowman keeps her finger on the pulse of culture change nationally and monitors news from organizations like Action Pact, the Eden Alternative, and the Pioneer Network. Sometimes there is an ongoing or developing issue that she wants to call attention to.

One unfortunate trend right now, she says, is “fake life” experiences, like giving elders robotic dogs or plastic babies to hold rather than real ones. “Why do we think a doll is what an adult needs?” she asks.  “I’m truly puzzled by it.”

Instead, let’s all work on getting real babies into long-term care environments, she urges. “Babies and children need the love of elders, and elders need the love and touch of babies and young children … Let’s be creative and do this together, it can’t be just the activity director.”

Though inspired by her webinar guests, she is disheartened by the overall slow pace of change which she fears is actually beginning to slide backwards.

“All too often, an organization’s culture change leader retires and a new one comes in and lets things stagnate, or in some cases reverses a lot of what the predecessor did,” she explains. Or, a new company takes over and reverts to the old, institutional way because it’s familiar and “easier to manage.”

What they don’t understand is that the hard work of culture change is the easiest way in the long run, she says.

“Let’s say you actually learn how a person likes to live their life … and then we serve her the way she likes. It ends up being more efficient … what we think is harder is way more efficient and creates a better life for the person as well as work life for the caregiver,” she says. “Individualized care and resident-directed life is what we are supposed to offer, what everyone wants, and what now sets a community apart. Wouldn’t it be something if a changed culture was actually the common practice? That’s the goal, we can’t give up and if a monthly conversational webinar about relevant topics can help, I’m proud to be a part of that.”


Grow A Culture of Critical Thinking to Calm Survey Angst

This article was written by Action Pact writer Keith Schaeffer for the Pioneer Network, and published on their blog on June 12, 2018

Anxiety over the new Mega Rule survey process that examines caregivers’ critical thinking skills may have some long-term-care providers on edge, but not at Garden Spot Village in New Holland, PA.

“Our focus on critical thinking and empowering staff over the years in working with Action Pact has put us in better position,” says Steve Lindsey, CEO. “Getting everyone involved, not just assigning tasks but helping them understand the big picture, the issues, and how to make decisions has created a high level of critical thinking throughout the organization.”

How to achieve all that is the subject of Action Pact’s intensive session, Navigating the Mega Rule; Building a Highly Involved Culture of Critical Thinkers, at the Pioneer Network’s 2018 Annual Conference in August.  Presenters include LaVrene Norton, MSW, Megan Hannan, MS, Gloria Blackmon, RN, Glenn Blacklock, MS, and Linda Bump, MPH, RD, NHA.

Their purpose isn’t to tell attendees how to develop critical thinking among their staff, says Hannan, but to give them the information and understanding needed to chart their own course.

“We really appreciate that Action Pact’s is not a cookie cutter, pre-formulated approach,” says Lindsey. “It’s a journey of learning together and shaping something that is different for each organization’s culture.”

Garden Spot Village operates six skilled nursing households, each with its own culture shaped by those working and living there. Staff’s critical thinking abilities enable them to weigh carefully what they want to do while understanding it within the context of the regulatory environment and the lives of the people they serve, says Lindsey.

But most care homes leave critical thinking to the leadership,middle management, and nurses, says Norton. CNAs and others are simply told what to do, often without understanding the importance or context of their tasks within a person-centered, resident-directed culture.

But now, CMS expects hands-on caregivers to be critical thinkers, as well. Brains

All staff must know about the new survey requirements and their organization, residents, and services provided, and how to use that knowledge to better serve the residents. Do they know what to do when an incident occurs … that pudding should not be offered to Vivian because she is allergic to eggs … or that serving George dinner in his favorite nook outside the usual dining areas still requires proper hand hygiene and food safety practices?

Nurses develop critical thinking in college and in clinical training while going through a process of study, discussion, practice, feedback, reflection, further study, and more discussion. CNAs and other hands-on caregivers rarely get the opportunity.

“If we really expect them to think things through, know how to collaborate as a self-led team, and make decisions, then let’s give them the time, information, and education to develop critical thinking,” says Norton.

Person-centered environments with permanently-assigned, cross-trained staff working in teams to serve small groups of residents naturally enable caregivers to know the elder’s needs and desires well.

But staff’s capacity to contribute becomes much higher when they also are taught critical thinking skills … how to analyze, develop good judgement, and make decisions, says Norton.

For instance, CNAs know to inform the nurse when something doesn’t seem right. But what if the nurse fails to follow up after being told?

Rather than letting the matter drop or complaining to peers that “I told the nurse but nothing was done,”a CNA trained in critical thinking understands it’s important to follow up to ensure the nurse got the message.

“A sense of responsibility grows along with a more integrated understanding about how to serve the resident, and thoughts and actions toward her become more accurate,” says Norton.

As information is shared, the whole work team gains a deeper understanding and capability. They think through challenges as they arise, day or night, “determining whether to take the initiative and deal with it in the moment, or knowing when they shouldn’t take the initiative and call in resources from outside their team,” says Norton.

“It bubbles up in different ways in how life is lived and the sense of empowerment that residents and staff have … to live life on their own terms,” says Lindsey.  That and a CMS Five-Star rating has come from growing critical thinking skills at Garden Spot Village, he concludes.

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Secret Santa Makes Their Day

90762896 - cartoon secret santa on the pink background

Garden Spot Village opened its doors in September of 2001 and from the beginning we have always enjoyed the holiday activities planned by staff. When we built our new households in 2006 and renovated our original building into households, we started to think about how we could have a more meaningful experience for residents, staff and families. We brainstormed with the team and came up with a day that could be enjoyed by all. Continue reading “Secret Santa Makes Their Day”

Highlighting High Involvement at The Cedars

The Cedars, a retirement community in Portland Maine, has long held and worked toward a vision for person-centered life. They have been engaged in learning, practicing, stumbling and achieving minor and major feats moving away from institution toward home.

Lately they have been working hard at High Involvement – engaging a Steering Team and several Action Teams, as well as holding a variety of circles — some for fun, some to work step-by-step through large and often complex decisions. One of the action teams focuses on getting the word out. Continue reading “Highlighting High Involvement at The Cedars”

Flying High with Self-led Teams


One of the most unifying and powerful accomplishments of self-led teams is realizing that no job and no person is viewed as greater than another. The equation itself is simple: no greater than or less than, only equal to. So every job is just as important as the next. All the jobs that need to be done in a household are done to help the members of that household have a better day. It doesn’t matter if it is wiping the table or taking out the trash or helping with medications. Self-led teams do not get hung up on titles, you simply get in where you fit in that day. Continue reading “Flying High with Self-led Teams”

Life Soars at St. John’s New CCRC in Albert Lea, Minnesota

Eagle crop2Residents will have eagle eyes watching over them when they move into one of the new households at Fountain Lake in Albert Lea, MN – especially if it’s nesting season.

“We didn’t know a bald eagle’s nest was on the property until about a year after we purchased it,” says Scot Spates, Administrator at St. John’s Lutheran Community.

Continue reading “Life Soars at St. John’s New CCRC in Albert Lea, Minnesota”

Ride Again: Rickshaws Bring Freedom

Not to mention a welcome breath of fresh air!

Action Pact has watched with delight as our friends at Brewster Village in Appleton, Wisconsin, have continued to learn and grow while they pursue excellence in the household model and person-centered care. A PersonFirst® organization, they demonstrate their commitment in many ways.  Here’s one.

J on rickshaw-2During her work day as a registered dietitian at Brewster Village, Rikki Profant keeps a small brown notebook with her to jot down notes. It’s not a diary or journal of her own thoughts, but rather quotes and stories from residents she takes on bicycle rides via a newly introduced program aimed at getting the elderly occupants of the rehabilitation and nursing home back outdoors. She keeps the notebook “somewhat selfishly” to remember nuggets of wisdom, but more importantly, to recognize the impact that the
Cycling Without Age program has brought to Brewster Village since it was introduced last summer with its first rickshaw.   
We share this excerpt courtesy of USA TODAY NETWORK-Wisconsin. Read the full story and watch a great video here.