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!
In the household, every staff member shares responsibility for creating the best possible quality of life within. But primary accountability for molding their efforts and organizing household resources to achieve that goal lies with the household coordinator.
Much like the administrator’s role in the organization, the household coordinator is accountable for a broad range of operations in the household, requiring an equally broad set of competencies.
Building teams … fostering leadership skills in self and others … managing financial resources and HR functions … facilitating communications throughout the household and among community leaders … leading QAPI … overseeing the household’s implementation of the organization’s emergency plan … nurturing continuous learning among staff – it all lands on the household coordinator’s plate.
Plus, she or he must have a firm grasp of what makes a true home that honors resident-directed life while creating a rewarding work environment for staff.
It’s imperative that household coordinators have easily accessible and comprehensive training in all these areas if our transition to resident-directed life is to succeed. That’s why Action Pact has developed an interactive, online training program specifically for household coordinators.
“This course provides a path for growing and transforming committed staff into vital members of the organization’s leadership” — Linda Bump, Household Model Pioneer
“Our aim is to illuminate the role of household coordinators in creating the new environment, and help them develop the skills they need to lead, coach, guide, and problem solve along the way,” explains LaVrene Norton, Action Pact Executive Leader.
The curriculum includes four courses – physical environment, organizational structure, interpersonal relationships, and resident-directed life – with 21 online lessons that bring together expertise and insights gained from two decades of operating in the Household Model.
Learners will have the opportunity to interact directly with Household Model pioneers proficient in staff positions such as household coordinator, nurse, CNA, social worker, therapeutic recreation, dementia care, and administrator. They will receive one-on-one guidance, answers to questions, discussion to assist them in integrating their new knowledge into their work, and additional resources to address individual needs and concerns.
“It’s an experiential approach designed to bring new knowledge and confidence to both the leader in training and the entire household team … it will help infuse the household with new opportunities for resident-directed life,” says Action Pact Consultant Linda Bump MPH RD.
“Staff’s improved self-confidence and a more meaningful life for residents will reverberate through the entire household as it becomes an ever-learning environment,” adds Norton.
Much like a college course, the program includes online lectures, homework assignments, and tests. Interactive learning modules will literally put vital information at staff’s fingertips in the moment they most need it. Upon completion, learners will receive a certificate and an evaluation of their progress.
“The program presents vital information in a creative way that is highly engaging and easily absorbed by staff without the constraints of a classroom,” says Norton. “Self-directed, it is the most effective and efficient means of learning for caregivers on the go.”
To find out more about the learning program and how to acquire it, contact Action Pact.
414.258-3649 | email@example.com
by Keith Schaeffer
Thanks to emerging technology, long-term care staff across entire organizations are starting to take learning into their own hands, and that’s a big step toward enabling a good daily life for residents.
Staffing is a big concern at Pilgrim Place in Claremont, CA, as a strong economy lures caregivers away with more lucrative jobs elsewhere, while baby boomers in growing numbers still need care.
To get them to stay, “we’re having to excite these millennial and Generation Z” staff members, says Dawnyell Varela, Director of Assisted Living. After testing a new mobile learning system with a dozen co-workers, she believes getting them excited about growing in their jobs and creating home for elders may be as simple as picking up a smartphone.
“Today’s generation is always on the phone, on games, and on the internet clicking this and that,” she says. “This is how they learn.”
“A lot of people, especially the young, don’t read long, laborious stuff,” adds Angela Hunt, Administrator and Chief Operating Officer at The Cedars in Portland, ME. “They are used to cell phones and quick messages.”
Hunt and her steering committee are trying out the same mobile learning system as Varela, with an eye toward using it to prepare staff for The Cedars’ transformation to the Household Model over the next 14 months. The learning system, created by Action Pact, instructs in a concise and highly interactive manner that caregivers on the move can easily absorb, says Hunt.
Subject matter in the first series of lessons ranges from the basics of person-centered Care and the Household Model to food safety, hospitality, answering the doorbell, changing lives with toast, and more.
Complete with buttons to push, questions to answer, and praise for correct responses and completed courses, the system aims to hold the learner’s attention with short videos and dramatizations, pithy text, music, and colorful graphics. “They use a little bit of everything,” notes Hunt.
Learners can relate to the people portrayed in the new system’s videos who “wear today’s clothes and use today’s verbiage and slang – like someone I might see walking through my door at this moment,” says Varela. Characters in previous learning videos and DVDs used at Pilgrim Place were clearly out of the 1970s, she says.
Varela knew the new system would work after using it for staff in-services. Some staff members are now requesting it for future trainings. “They like it, it’s exciting for them, and the fact they’re asking for it shows we really do have something here,” says Varela.
Staff also use e-learning when they have just a minute, she says. “If they’re not sure how to do dining or something else involving our work here, they can watch a short learning module… we are fortunate to have a lot of self-directed learners.”
People learn more on their own rather than being force fed.Socrates (469-399 BC)
In fact, we’re all self-directed learners – everybody has the drive to learn more, says LaVrene Norton, Action Pact founder and Executive Leader. Think of the times we’ve gone on the internet to learn things like how to make hummingbird nectar or change our car’s oil, she says.
It’s been known since at least Socrates’ time that we learn and retain information better by grabbing it when we want and need it rather than being forced to sit in a classroom. Self-directed learners often exhibit superior critical thinking, problem solving, and leadership skills and higher job satisfaction.
Perhaps I buy an old house that needs a garbage disposal, a kitchen sink, and tile on the bathroom floor. So I search the internet for the best garbage disposals and sinks to buy, the tools needed, and how to tile the floor – all the instructions are complete with video on YouTube, including for the specific brands of disposals and sinks I buy.
And then I’m so proud of myself!
“We need to create for our staff that same kind of curiosity and excitement that drives people to learn on their own,” says Norton. “If I’m self-directed, I’m going to take the initiative, not just in learning, but also helping elders have a good day every day in their home.”
Long-term care organizations often fail to prioritize learning among staff, she says. Nurses learn critical thinking skills in college, but CNAs and staff in dining services, housekeeping, activities, and maintenance aren’t given the opportunity and time to develop their own analysis, judgment, and decision-making abilities.
E-learning enables staff in all positions to develop critical thinking, adds Varela.
A nurse may know how to respond to a resident living with Alzheimer’s who is angry and lashing out, she says. But a housekeeper walking into that kind of situation may not know to redirect the resident and not take his or her anger personally.
“So when I’ve seen that – and I have,” says Varela, “I’ve had them watch a learning video, and they told me, ‘Thank you so much Dawnyell, now I understand.’”
Self-learning on the internet is less scary than in the classroom, she adds. As a 40-something studying for a new career in long-term care, she felt awkward going back to class after 20-plus years as a restaurant staff trainer. “I felt a little intimidated. I didn’t want to raise my hand; I didn’t want to look foolish,” she recalls.
Now she goes on-line to fulfill her annual requirement of in-services. “I can learn at my own pace, and if I mess up, I mess up with just me and my computer and not in front of a big class,” says Varela.
Managers in organizations often fall into the trap of assuming people don’t want to learn, says Norton, simply because they aren’t strong readers or they didn’t go to college. It seems most reasonable for those reasons and because of the turnover to just give them a list of repetitive tasks to complete every day. As a result, opportunities for growth are minimal.
“People don’t need to be told what to do, they just need to have permission and encouragement to grow and learn, plus the resources and time to make it happen,” she says.
The old incentives for retaining staff – a slight pay raise, a modest change in job title – aren’t working, she says. Instead, we need to ignite the desire for self-directed learning so staff can find meaning and satisfaction in their jobs.
“We want to create hunger for knowledge and skills. The internet and mobile learning offers a way that’s fun, exciting, and interesting so that staff want to learn more,” she says.
People who aren’t strong readers can learn from creative graphics and videos. A single, still image can convey a complex idea, enabling large amounts of data to be absorbed quickly. When that picture and its story is shared with everyone in the organization over the internet, person-to-person, and in group meetings, it sparks a new culture of self-directed learning, says Norton.
So how do we create a culture that values learning?
Start from day one
Stimulate learning from the moment prospective staff walk through the door by giving them internet links to training on person-centered care so they can decide if they really want the job, says Norton. And then proceed after hiring with ongoing, in-person training to quickly integrate them into the workplace culture.
Focus on growing self-awareness of the person’s own ability to learn and prepare them for participating in functional teams where learning develops naturally. Hold deep conversations with every staff member at regular intervals – perhaps at 90 days after hiring and every six months thereafter, she urges.
Make learning available 24/7
Pilgrim Place and The Cedars provide laptops and iPads for staff to access elearning modules and other resources on the internet and from training videos acquired by the organization. These and other mobile devices can be used for virtual discussions among staff and for sharing ideas and information with other organizations.
Consider keeping an iPad on the kitchen counter in the household, so that staff can access cooking websites to learn how to prepare a resident’s favorite childhood meal.
Encourage staff to sit down with a resident or two in the living room to watch an interesting learning module, followed up with discussions about daily life in the household. Result: an activity for the residents at the same time staff is learning! Other self-learning techniques like community and learning circles and work team huddles could be held daily.
Be creative! Richfield Retirement Community in Salem, VA, established a “transformation center” open 24/7 where bulletins, posters and always available videos chronicle the community’s progress toward the Household. Staff, residents, and visitors can enjoy a moment of respite in comfortable chairs with coffee and snacks provided while learning about culture change.
Make learning fun
Scavenger hunts, either on-line or within the physical community, are effective and entertaining ways to engage staff and residents in learning. Try giving everyone a list of the Essential Elements of the Household Model and ask them to search for examples of, say, how a household demonstrates home as sanctuary, or how the dining room fosters a sense of grace. Follow up all such activities with group discussions in learning circles about what was learned.
Reward learning with praise and encouragement
Staff thrive on being told when they do well, says Varela. She maintains a “Wow!” board for posting “praise reports” for everyone to see when a staff member accomplishes something noteworthy.
Often, staff members with little formal education feel they can’t learn like more successful people. “Let them know they can; that they can be in charge of their own learning,” says Norton. “Asking them what they would like to learn more about in order to be the best they can be will help them see themselves as self-directed learners.”
“Our residents are very curious about how we are learning and they want to see,” says Hunt. Elders participate on the steering committee that is reviewing the Action Pact mobile learning system.
At Pilgrim Place, staff plug their electronic gadgets into the living room TV and watch training videos with residents. “There’s not a single video in the new mobile learning system I’ve seen that residents could not participate in and learn from,” says Varela.
But think critically about what is appropriate to discuss with residents, cautions Norton, and then work and create learning activities together while chatting with residents at the dining table.
“Try to get a sense of what it would feel like if this were a good day at home and a dear friend stops by. How would that look and feel? If we engage staff in talking and thinking about that, we can begin to grow critical thinking skills in self-led teams,” says Norton.
Giving staff the tools and encouragement to pursue self-directed learning empowers caregivers to be successful and find satisfaction in their work, and that translates to better care for residents.
“It’s a parallel process,” says Norton. “If we want a better life for residents, we must want a better life for our staff. If we want the staff to ask the residents, ‘What do you need?’ or ‘What do you want to do today?’ then we have to ask the staff, ‘What do you want to learn?’ or ‘What resources do you need, and how can we help?’ ”
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.
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.
# # #
I had a conversation with a leadership team recently that was incredibly frustrated by the initiative being taken by aides in the building. The complaint was that they were sitting around at the nurse’s station when they weren’t busy with cares. Leadership wanted them to be engaging with residents. But in most traditional nursing homes, this is not what CNA’s understand as their job. To get to this place we have to create a culture where engaging with residents is everyone’s job. Continue reading “Four Ways to Build the Culture You Want to See in Your Senior Community”
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”
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”
MARVIN’S PILOT GOT IT RIGHT!
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”