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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Nursing Home Residents Find Purpose Through Service and Community Commitment

Every month, hundreds of nursing home residents across California board shuttle buses on their way to their local homeless shelters. They arrive with pans full of meals they’ve prepared themselves, and enough food to feed crowds that often exceed 100 hungry neighbors.

Heart to Serve logo

In 2016, Rockport Healthcare Services became the first organization to involve every nursing home and assisted living community they serve in fulfilling community service through its A Heart to Serve program . This community service-centered program presents service opportunities to every resident, including those who have physical and cognitive challenges, such as dementia, stroke, MS, Parkinson’s disease, or vision impairment, so that they can experience the transformative power of purpose through service. Continue reading “Nursing Home Residents Find Purpose Through Service and Community Commitment”

Manor Park Sees Greater Staff Retention with New Households

The “Wall of Fame” at Manor Park, Inc. is likely to get a lot more crowded now that person-centered care and the Household Model are leading to less staff turnover.

The wall is lined with photos of staff members who have worked five years or longer at the Life Plan Community (LPC) in Midland, TX. With turnover plummeting from 44 to 30 percent for all employees over the past four years, more photos are sure to be added as more staff reach the five-year threshold. Continue reading “Manor Park Sees Greater Staff Retention with New Households”

Secret Santa Makes Their Day

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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”

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.

Short Stories That Make Us Feel Good!

Brewing Up LIFE!

The photo shown here represents an amazing transformation for one resident of Unitcarboy-brewinging Caroona Yamba, and his story brought joy and tears to a group of staff there.

Why?

This gentleman was deemed as having a rapid decline in cognition, being lost and not doing well in the open Household. Pressure was being applied to relocate him to a smaller more secure Household, as he was not enjoying the one he was in. He was never doing anything purposeful, only moving from sleeping in a lounge chair to table and back to sleeping in a chair. He hadn’t initiated any outdoor activities for months. His conversation was disappearing and he was withdrawn – never joining in activities. Sad, lonely and lost are the words that come to mind.

And then the miracle-working staff went to work. After only a couple of weeks of focus on him, persuasive staff were having success involving him in the village garden, picking the new beans, watering plants and then, “Let’s get the beer-brewing up and running.” He slowly joined in more and more until he decides where he wants to be and what he wants to do. And there’s no fooling him now. “Hey this is yesterday’s paper. What about today’s?” Picture this: a quiet man watching the first fermenting bubbles in a beer brew kit he helped set up yesterday. Tonight was a first! He went on his own to make sure the beer was bubbling as it should. He was observed by staff who were overjoyed at this new interest in life after many months of solitude and inactivity. A real transformation!

This man had been declining rapidly, but now has interest and enjoyment in his life. Two staff in particular fought to keep working with him, as they believed they could retrieve him from his decline. They literally prevented his relocation to what we now know would have been an inappropriate household.

Both of the staff members involved in the resident’s renewed interest in life have recently won awards for their work. They are wonderful examples of inspired care giving that is infectious among the staff.

This story was shared with us by Debra Smith of Uniting Caroona Yamba, a community within Uniting in Australia


 

Just a Few Knick-Knacks…

The following Community Circle occurred during recent dinners with the residents…

Several residents laughed when Joyce Jackson called the figurines around the dining area ‘knick-knacks’. The figurines were then brought to the tables and the residents examined them, asked questions, and expressed their like or dislike of them.

pig-unicycle-2-editThere was a pig riding a unicycle, a rooster also riding a unicycle and a ceramic horse with a clown riding on his back. The horse had dogs on each side.

Mrs. A. said, “When a horse’s ears are pinned to his head, he’s agitated. You better not mess with him.” Mrs. W. then asked Mrs. A. if she likes horses.  A new conversation was started.

Mrs. A. talked about her brother loving horses and she pretended to like them. She admitted she learned a lot, the hard way.

Mr. K. declared, “I wouldn’t want them in my house.”

There were also two dolls, Amish, with no facial features. Mr. K. said, “Where is the face? They don’t look right without eyes.”

There was laughter and smiling faces during the conversations.

We continued the activity the following week during dinner. Residents were asked about the earlier discussion on the figurines. Mrs. A. stated, “If I had a clown riding on my back, I’d be agitated, too!” And then she told this story. “One time my brother was walking a horse with me on its back. My brother got distracted and let the reins go. The horse started running and my foot got stuck in the stirrup and dragged me. I was only 8 years old. I think that’s when my back troubles first started.”

Mrs. K. shared another horse story. “A horse bit my shoulder when I was young. My father had horses and once a horse was being stitched up after jumping a barbed wired fence and he bit me. The vet poured a quart bottle of Methylate on my body. “ (Ed.: Yeow!)

Everyone enjoyed the sharing of the objects and the good conversations around the dinner table.

This story was shared with us by Joyce Jackson of Windsor Meade, a community within Virginia United Methodist Homes


Diet Liberalization Program Makes a Positive Difference for Residents

Sentara Chesapeake Nursing Center has embraced New Dining Practice Standards by initiating a diet liberalization program for its residents as part of their culture change journey. Research has shown that providing more options in long term care settings provides positive resident outcomes. It can also lead to a better quality of life by allowing residents to choose the foods they enjoy eating. Lastly, this initiative can lead to improved nutritional status and a reduced prevalence of weight loss that ultimately is a better experience for our patients.

How does it work? 

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Choices, choices…

Once a resident who was receiving a modified diet is identified as a candidate, a Bedside Swallow Evaluation is performed by a Speech Therapist to ensure that a diet upgrade is clinically safe for the resident. Over the last three months since Chesapeake began diet liberalization in the facility, therapeutic diets have decreased to less than 27% of residents as compared to an average of 51% in other Life Care sites. Conversely, the number of residents receiving regular texture diets have increased from 49% to 77%.

The new diet option has been well received by Chesapeake residents and their families. The new dining practice standards have also allowed the opportunity for Sentara Life Care to move away from other more typical institutional nursing homes practices that limit resident choice. Liberalized dining enables a culture that fosters resident’s right of choice, by allowing residents to eat what they want. This program is only the beginning of Life Care’s culture change journey as these initiatives will be rolled out to other Life Care sites very soon.

Story shared with us by Sentara Rehabilitation and Care Residence – Chesapeake, VA. From their November newsletter.