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”
Brewing Up LIFE!
The photo shown here represents an amazing transformation for one resident of Uniting Caroona Yamba, and his story brought joy and tears to a group of staff there.
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 His conversation was disappearing and he was withdrawn – never joining in activities.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.
There 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?
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.
“Evidence that person-centered care is making a difference.”
So wrote Gavin Kerr, Inglis CEO, in an email he forwarded to his executive team last July. In the original message, a physical therapist praises long-term care staff at Inglis House in Philadelphia for the remarkable progress made by a resident with severe physical disabilities.
“They (staff) did the impossible,” the therapist wrote. One resident “told me she got out of bed and ate in the solarium yesterday. This is something that has not been done as far as I know, ever. She is now agreeing to get out of bed three times a week to eat lunch in the solarium… We talked; ‘New room, new life,’ she said.” Continue reading “Residents with disabilities find new life in Inglis Neighborhoods”
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!
The following story is from The Piper Assisted living and Memory Care in Kansas City, KS. Steve Harman, a Household Coordinator, is working on his CNA, and during a recent clinical at another community, he had this great experience.
Bologna Song Whets one Appetite!
Recently I spent a few hours with Mrs. B., who has pretty severe dementia and is known for not eating her meals. Usually when Mrs. B. sits down to eat, she is “full” before the meal is even served. The more people try to get her to eat, the more she refuses to eat. My experiment was to ask her about anything but her meal. My niece and I used to sing songs at the dinner table, which kept her from getting bored, so I tried this with Mrs. B. “Mrs. B., do you know any songs?” She replied, “Yes, all of them.” That being the case, I chose a musical masterpiece, the Oscar Mayer Bologna song. “Mrs. B., do you know this song? My bologna has first name...” She sang back to me, “it’s O-S-C-A-R!” “My bologna has a second name…,” I sang, and she replied with a full mouth. She had taken a big bite of food! So I patiently went through all the songs I knew the words for (5 commercials, Jessica by the Allman Brothers, and You Are my Sunshine). Somewhere in the middle, Mrs. B. started making up her own songs about the food on her plate. One was the word Gravy sung repeatedly to the tune of Happy Birthday. Another was a song about how good vegetables would be if they were cake. When she finally finished, she had consumed half of her plate, doubling her intake from the last three meals combined. Throughout this experience, she would occasionally ask to be taken to the front of the room where people congregate to watch television and other things. That was when it occurred to me: Mrs. B. was bored. She never asks to go home, or simply to leave the facility. She wanted to go to the front of the room because that’s where she can be entertained. I took her to the area where a volunteer had started playing guitar. On our way up there, I overheard one of the staff say, “I’ve never seen Mrs. B. so lively or excited like that. She seems to be excited about music.” I’ve only spent a small amount of time with Mrs. B., but several people have informed me that this was very different from her usual behavior. She was deemed difficult or grumpy. This was such an encouraging experience.
Shared by Stephen Harman, Household Coordinator
The next four stories are from WindsorMeade in Williamsburg, VA
The Tide is Changing….
A few weeks ago I worked on an evening shift as a CNA on the HealthCare unit. When I came on to the shift, which wasn’t my regular shift or job duties, I was very task oriented. I was focused on what needed to be done: who needs vitals taken, who gets a shower, what time is the meal, etc. After dinner I went to give a shower to one of our residents. The resident, Mr. W., was not happy about me interrupting his evening; he was quite happy just flipping through his magazine. This resident usually doesn’t speak words, and if he does speak them, it is normally just a few that don’t make a complete sentence. Many times he communicates only with sounds like bee-bops. It had been a few days since his last shower, though, and he needed one. I was too focused on what I had to do next and the tasks of the evening, but then I just stepped back, looked at his blue eyes and smiled. The tide had changed… I started singing “ I got the whole world in my hands….” He started humming and by the third verse he was singing with me, teary eyed. I have never heard him sing before. Then I quickly thought about what other songs he might know. So I started singing Amazing Grace, and he began singing with me — and we sang all the way to the shower. We sang during and after his shower until he was all clean, dry and cozy in his pajamas, under his warm blankets and off to sleep.
Shared by Angela Peay, LPN, AL Nurse Manager
Working in the Health Care dining room, I have had the pleasure of witnessing many beautiful moments. This one brought tears to my eyes.
Mr. D has both memory and hearing loss. His wife, Mrs. D, is an independent living resident, and comes to visit him regularly. I have heard her say many times that she knows he recognizes her as his friend, but she isn’t sure if he remembers the life they made together.
Recently, WindsorMeade installed a new piano and placed it in the resident lounge next to health care dining. On the weekends, we have volunteers come and play the piano during lunch and dinner services so the residents get to enjoy music while they dine.
A few weeks ago, Mr. D was already seated in the dining room and Mrs. D was walking up the hallway to join him. The pianist was playing a song that I don’t know the name of, but Mr. D certainly did. As he listened to the music, he stood up and called Mrs. D out by her nickname. I had never before heard him call her by any name at all. As she answered him from across the room, she stopped, looked at the pianist and said, “They played this song at our wedding 65 years ago.” As they hugged each other, it was obvious that in that moment of clarity brought on by a familiar song, he knew exactly who she was.
Shared by Brian Eck, Health Services Dining Supervisor
Happily Lost in Music
I worked upstairs today in the HCU and ALU areas for the first time again in about two weeks. During lunch, a woman named Mrs. Kathy came in to play the piano. She started in the HC dining room and ended in the AL dining room. In HC, a few of the residents nodded their heads as she played. Mr. W. was one who stood out to me the most. He was nodding his head with his eyes closed, tapping his feet, and lightly tapping a fork on the table, enjoying the music. To be quite honest, I haven’t seen him this happy in such a very long time. His mood nearly brought tears to my eyes — tears of joy that is. Mrs. Kathy’s music generated so many smiles today that I asked her to return to us soon and to come more often.
Shared by Marquera Delk, Lead Server
Music Makes the Body Move
One of our residents loves music! Whenever he hears music, he is clapping his hands, moving his feet, and sings a long. We have purchased an Ipod shuffle for him and have downloaded music (Elvis is one of his favorites) onto the device. Family members have also brought in CDs for us to download music. Throughout the day, we give the resident his Ipod and he absolutely loves it! When he hears the music come on, he gives you the biggest smile and hug. When you walk onto Healthcare you will see him with his Ipod just dancing away. We are in the process of becoming “Music and Memory” Certified, where we will receive Ipods for the residents to listen to their preferred music. When that happens, I will sing, dance and clap, too!
Shared by Caroline Kaliris, Recreation Therapist
Dancing: It’s not just for feet!
The following story is from Uniting Wontama Orange in NSW, Australia
Love for Dancing Remembered and Shared
Last Friday evening we held our Annual Cocktail party with the theme of ‘Mad Hatters’. All of our residents across the site were invited along with their families and participated in making a hat to wear. We had a wonderful turnout and brought many smiles to many faces. We also had our Old Time Dancers come along and dance for and with our residents. It was heart-warming to see our residents enjoy themselves so much, and to watch those people who either have limited mobility or changed cognition ‘come to life.’ Once the music and dancing started, a gentleman who faces some of the more challenging aspects of living with dementia, was on his feet and danced the night away. The conversations that were possible with him during this time were both insightful and emotional, especially his ability to talk about his love for dancing in his younger days. An important objective we have been working towards focuses on making every moment count, even in the smallest of ways. This felt like a big success.
Shared by Helen Mobbs, Service Director
This sound of life – music – is SO IMPORTANT for us all. The common thread in these stories is that someone took the time to notice. The observations shared and then more people notice and are encouraged to provide music, share in the joy of music, or use it to help someone feel better and/or engage in a way they might not otherwise. So go out and look, listen and find ways to share music with those folks you serve. You will make life better in big and small ways, as Helen says above!
I was recently interviewing a team member at a CCRC campus, and I asked for her thoughts on what she felt the organization does well. Her answer was tea. Wait… what? Turns out they had a new client moving in, and when the admission interview was done, a few things were learned, one being that the woman was English and that she had a customary love of tea. Upon returning to the facility, this information, along with all the medical needs, was shared with the nursing team. Move in day came, and as the woman was settling in the nurse came in to see her and introduce herself. Normal stuff, but instead of a clipboard or a blood pressure cuff, this nurse was carrying a shiny silver tray with a fancy tea set full of piping hot water. I’m not sure what words were spoken in greeting, but I don’t think she had to say anything. Her actions spoke louder than words, and those actions offered the warmest welcome possible.
A cup of tea. Now mind you this cup was served in style and with forethought; imagine the difference in the story above had it been a Styrofoam cup with a tea bag soaking in it. How powerful though, that this affinity for tea was something that the nurse grabbed onto and followed up on. Sometimes in our rushed worked day we complicate things too much – we get tied up in our tasks and our documentation and…and…and. Stepping back and taking the time to honor another person like this nurse did is the real heart of the matter. The old saying is really true – It is the little things that matter the most. What opportunities are there in your normal day to seek out and then follow up on making someone’s day in some simple way? What do you do in your organization to encourage and recognize staff who routinely act in ways that make life better for those around them? Challenge yourselves to take some time to work on building stronger relationships with those around you – staff and resident alike. Use tools like Action Pact’s Daily Pleasures interviews to discover the little things that would put a smile on someone’s face – and then follow through on it. Be bold and visible, be anonymous if that is what you prefer, but work to create a climate where random acts of kindness become the norm rather than the exception. And remember – it can be as simple, and important as a cup of tea.
“…the generations must find ways to share daily life. Elders need the stimulation of young people … elders need relationships with middle-agers, whose challenges are not so far removed from their own at that age. Children and young people need first hand contact with elders so that old age is not a strange, foreign country to them.”
— Carter Catlett Williams, 2013 Pioneer Network Conference keynote address Continue reading “Pioneer Conference Keynote Inspires ‘Living Our Values’ at Jewish Senior Services”
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 “Creating Home and Poetry”