Essential Elements of Households Transcend Long-Term Care

What can the Household Model, designed as an antidote to institutionalized senior living environments, do to improve how we care for the homeless, foster care children, and people residing in their own homes?

Plenty, as they’re discovering at Uniting in New South Wales, Australia. 

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Uniting, the largest provider of community and residential aging services in Australia, also assists the homeless, children and families, people living with disabilities, and those who need consistent support while residing in their own homes. Following a recent restructure and alignment of their Ageing and Children’s businesses, the organization is focused on bringing Action Pact’s Household Model philosophy to all of them.

Last week in Sydney, 45 staff members representing the diversity of service streams from all across Uniting participated in Action Pact’s The Choreography of Culture Change, an intensive designed to help leaders understand the why’s and how’s of culture transformation to Households through the lens of long-term residential care.

Initially, several candidly shared that they were a bit confused and even resistant to participating in the intensive – how could this possibly apply to their work in non-residential settings?

Yet, they found that it does. During a week of sharing ideas, listening to stories of transformation from their peers in residential aging, and working in diverse teams to learn and teach vital concepts, they were intrigued with thoughts of translating, migrating, and finding synergies in it all.

“Could we,” asked one home and community practitioner, “engage the client more specifically in deciding when services occurred?” Another colleague mentioned that clients living at home often complain that their possessions are re-arranged without asking by in-home care staff. Someone else explained that when a child moves into a foster home in an emergent situation they often arrived with nothing personal other than the clothes on their back – couldn’t we use the concepts of home as part of our intervention to help facilitate comfort in this critical time?

These are beginning inklings of how the principles of the Household Model for aged care can provide learning and context in non-residential services. Doors were opened, minds were stimulated, and new relationships were fostered. Excitement and innovation emerged from confusion and resistance. “This was more than we dared hope for and it provides a great springboard for us to progress on an even larger journey across all our services,” says Linda Justin, Director, Practice and Quality. Plans have been made to move forward and to intentionally learn from and with each other using the Essential Elements of Households, because it turns out these are truly elements of good life no matter where one lives.

The Essential Elements of the Household Model

  1. The household is each resident’s home and sanctuary.
  2. The people who live here direct their own lives, individually and collectively.
  3. The boundaries of the person and his/her home are clear and respected as a matter of
  4. Grace, a shared sense of what is sacred about the house and its people, is deeply valued, consciously created and preserved. Ritual, spontaneity, friendship, spirituality, celebration, recreation, choice, interdependence, art and humor are all manifestations of a culture of grace.
  5. The people who live here are loved and served by a responsive, highly valued, decentralized, self-led service team that has responsibility and authority.
  6. Leadership is a characteristic, not a position. Leaders support and are supported by values- driven, resource bearing principles and practices as a way for each person to actualize his or her full potential.
  7. All systems, including treatments, exist to support and serve the person, within the context of his or her life pursuits.
  8. We build strong community with one another, our family, our neighbors and our town. Each household is part of a neighborhood of houses, dedicated to continuous learning.
  9. The physical building and all its amenities are designed to be a true home. Institutional creep in design and culture is treated as a wolf at the door.
  10. The establishment of a healthy and sustainable home comes through the integrated balance of resident-driven life, leadership, organizational structure, physical environment and financial sustainability.

The two great stories below came directly from Uniting’s Illowra and Mullauna communities.

Illowra and the Kindy Kids

Residents at Illowra enjoyed their first Intergenerational Day with children from our local kindergarten. It was a great day. The residents and the children pl45843342 - looking forward for the elderlyayed games and sang songs, and the children gave a wonderful performance. Everyone shared afternoon tea and the children asked if they could come back. Illowra residents and the children will now have a regular play and performance day every other week.

It was wonderful to see smiles all round and the joy the old and young bring to each other!

From Cathy Riches

Quiet Time

Mullauna’s Pastoral Care Worker Jean has engaged with our residents emotionally and spiritually since she commenced with Uniting this year. While getting to know our residents, Jean realized that many would benefit from additional support, which she was happy to facilitate.

Jean began offering a “Quiet Time” each week for half an hour – held in our chapel. Based on residents’ needs and preferences, Jean has included

  • Scripture
  • Music
  • Reflection
  • Emotional support

These Quiet Times have had an enormous effect on participants’ well-being and stained glass_lighter with drop-shadowengagement with others. The residents support each other and have formed new friendships and attachments.

Our Quiet time today included songs about faith, love and blessings. Jean read a story/meditation, and Harry Bansal (PersonFirst® facilitator) joined the session and introduced the residents to Action Pact’s PersonFirst® concepts – sharing how we are all working with residents to make Mullauna truly Home for them.

At the end of the Quiet Time, our Service Manager reflected on residents currently in hospital.  We were all encouraged to count our blessings and know we have faith, support and love at Mullauna.

We ended by reciting the Lord’s Prayer together.

This weekly meeting is so special, and today I heard comments from our residents like, “We feel blessed to be here.”


We all want to feel a sense of meaning and purpose in our lives – to be part of something bigger than ourselves and aspire to a higher moral purpose. Many of us find this meaning in our work and implementing the Household Model enables us to do just that because even on difficult days we feel fulfilled knowing we are enabling a better life for our most vulnerable…

The takeaway from my last 10 years is that culture change work is fulfilling, morally uplifting, and hard – it is especially difficult for direct care givers. But there is no doubt it is “worth it” in the end. Continue reading

Airing of the Quilts

This story was shared with us by Susan Clark of Uniting in Australia

Airing of the Quilts quilt

Recently our home, Caroona Kalina, hosted a two-day event showcasing a large selection of quilts. Our residents had expressed how much they love quilts and would love to have more involvement. This involved inviting residents, staff, families and the public – including our local Quilting Club – to air their quilts. In the end, we had nearly 200 handmade quilts on display! Many of our residents spent weeks preparing for the event during their art and crafts sessions. Our local Mayor officially opened the evKalina Car Quilt2ent, and we had an overwhelming response from the public, with people traveling significant distances to attend.



Our residents were extremely proud to show off their home and could not believe how popular the event was. It was also an opportunity to showcase our newly opened ‘Splash Café.’ As a result of the quilt show, relationships have been established between the community and our home, which will continue over time.  All money that was raised went to Kalina’s Creative Ageing Program. Kalina quilt 1


The event made the local newspaper and received lots of positive press from our Mayor. We are very proud of our home and the smiles it brought to those we serve. The event brought the community, family, friends and residents all together for a bright, colourful, happy weekend.  Enjoy the photos!!!

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BITS & PIECES from here, there and all over

Telling Your Story

When good things are happening in your community, it’s a great idea to share the story with the wider communityThe benefits are numerous. You become familiar in the area, with positive associations; employees feel proud, and it’s an opportunity to share the message of culture change. It’s good all around! Here are some examples of campuses or larger organizations telling their good stories. See what they’re doing:

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  • Sentara Rehabilitation and Care Residence, Chesapeake, VA: Sentara is replacing their current building with a brand new household model community, which will open in November. Irvin Land, Administrator, tells the story to the local newspaper. Read all about the project
  • Fair Haven and Wesley Manor, sister communities within the Methodist Homes of Alabama and Florida, have announced major expansion and construction projects as they move to the Household Model.  Read the press releases.

Remember — you can always tell your stories by posting a comment on our blog.  All you have to do is “follow” us. 

“Caught” doing the right thing. Has it happened to you?

This story was shared with us by Alison Scott, a Choreography of Culture Change graduate with UnitingCare in Australia. (Note: Terminology in Australia can be a little different than ours in the U.S.)

Community Circle at Narla
Yesterday the Accreditation agency visited for a no-notice site visit. Nothing unusual you say, except that at the exit meeting she spoke about this ‘amazing’ interaction she witnessed between several residents and a couple of staff members – a Lifestyle Officer and the Pastoral Care Worker whilst doing her ‘sophie’. She clearly described a Community Circle, observing that the residents in the circle were of mixed cognitive ability, and those with a cognitive deficit took an active part and could easily follow the process of the discussion. 

The community circle was not a planned event. Residents had cancelled the trivia game originally planned, so the circle was a spur-of-the-moment change of program.

Events like this confirm that what we do on a daily basis makes a difference.

A Hard-Hat Chorus Line?

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Decked out in hard hats are staff of Jewish Senior Services in Connecticut who are
standing in one of the 23 household kitchens of the 
Harry and Jeanette Weinberg campus, now in the final stages of completion, with an expected opening in Spring 2016! The new campus will offer the first household model of care in Connecticut with 14 private bedrooms and baths, shared kitchen, living room, den and patio in each household. The campus also has 28 private rooms for short term care with indoor and outdoor courtyard therapy centers and aqua therapy in the new indoor pool. Assisted Living Residences will offer one bedroom and studio apartments with meals and membership to the new 18,000 square foot fitness center complete with a 25-yard four lane swimming pool. The campus will also offer a host of community services including: Home and Hospice care, Out Patient Therapy, Center for Elder Abuse Prevention, Institute on Aging, Senior Choice at Home Program and Child Development Center.  

Ed:  Now you know why they look so happy!

New WNYT_MUSIC-blog427ays Into the Brain’s ‘Music Room’

If you read the blog article about the “magic” of music, and are fascinated by brain research and what scientists have learned about music, here is a mustread article just published in the New York Times!  Amazing things are being learned.         Read it here.


Read all recent posts here

The Magic of Music

Enjoying and appreciating music may still appeal to persons living with dementia, but music may offer a lot more than pleasure: a connection to memory and emotional expression that might not be otherwise accessible. Read these simple but powerful stories to be reminded of the myriad ways we might incorporate music into daily life, to both entertain and ENGAGE! Continue reading