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.”


Contemplating Person Centered Care in the Expanding Continuum

This article was originally published by The Beryl Institute.

by Steve Shields

We know how it is. 

Anyone with a complex medical condition knows the feeling: Your doctor refers you to one or more specialists and therapists, and with each comes a new round of appointments to schedule, forms to fill out and recitations of your medical history, current diagnosis and the medications you’re on to a stranger focused only on one part of your total wellbeing. Continue reading

Creating Home and Poetry

Through our PersonFirst® trainings, Action Pact has long promoted community circles as a tool for meaningful engagement with residents living with dementia. An open-ended question is posed to the group and each resident, sometimes with encouragement from staff, answers the question or comments on the topic. In this way, staff and residents get to know each other better and build community with the side benefit of gaining a better understanding about how best to serve the residents in their daily lives.

The residents of The Village Court, the memory support neighborhood of Asbury Place Maryville in Maryville, TN, recently took their “fun circle” (as they call it) in a creative direction. Continue reading

Noise in Nursing Homes

We know a nursing home can be a noisy place and many organizations have been working to reduce the noise, especially of overhead pagers, for example, in an effort to create a calmer environment. But according to a recent study by Dr. Laura Joosse, Assistant Professor in the College of Nursing at the University of Wisconsin – Milwaukee, elevated sound levels can also add to the agitation of those living with dementia. Continue reading

Residents Become PersonFirst® Trainers at Assisi House

High involvement is at the core of Action Pact’s PersonFirst® training. After all, it is a train the trainer model wherein Action Pact consultants train folks in an organization who then train others on the principles of putting the person first. Traditionally, PersonFirst® is a program for staff. Sometimes residents from Independent Living or spouses of those living in the nursing home will be trained. The community of Assisi House in Aston, PA, the retirement convent for the Sisters of St. Francis of Philadelphia, has really taken the high involvement to heart and included resident sisters among the first to be trained. Continue reading

An Environment Where Elders Living with Dementia Make Decisions

Megan Hannan, creator of PersonFirst®, addresses the need to create an environment where people living with dementia can make decisions and experience life like an adult.

When Communicating with Someone Who Lives with Dementia: Wait.

I love growing PersonFirst® teams. For many reasons, it is highly satisfying to collaborate with caring, willing people to really think through and then take action to empower those who live with dementia. And what I love most is how much I learn every time I engage with a new team. Continue reading