Integrating Touch Into Our Daily Interactions

A while back I was walking along, my mind ruminating on negative thoughts and worries. I found myself getting a little stressed out, tensing up and getting even more worried. And then, I suddenly felt better. A load had been lifted and perspective returned. The cause of this relief? My 6-year-old ran up to walk with me, reached up and held my hand (he was singing a little too as I recall). Poof – the negative thoughts went right out of my head. I relaxed and began enjoying the walk and the things around me. Something about that simple touch gave me just what I needed. I am very lucky in this way. I am a jungle gym, a preferred seat and a transportation device for my young son. Occasionally his older sister might throw a hug my way and his older brother might too, in the right setting. I have a loving wife and good friends that provide me with many opportunities to give and receive some form of touch or another.

Not everyone is this fortunate. Some shy away from touch and deprive themselves of the connection that I feel is as basic a human need as we have. Some, like far too many elders living in nursing homes, find themselves longing for positive human touch that comes too infrequently. This is especially true for the very frail, as many people fear causing pain by touching them, not knowing how the lack of touch hurts in a different way. It is sad to think about how many people are deprived of this basic human need when all the ingredients for meeting it are literally at our fingertips.

Photo by Samantha Whitefeather
Photo by Samantha Whitefeather

But wait, you might say, some people have had horrible experiences in their lives with inappropriate and unwanted touch. Some simply avoid contact with others out of fear of rejection or other reasons. Are these folks best just left alone? In “The Importance of Touch” by Beverley Anne Star and Sara Joy David, Ph.D.,  there is some good info on how the benefits of positive touch can be relearned. The authors write, “All such touch must be exchanged in a manner that respects the boundaries of the persons receiving and giving the touch. In a touch-phobic society, where many individuals are unaccustomed to physical contact, it may take a while for touch to feel welcome and natural…… However, just as we can reclaim our taste buds – jaded by excess use of spices, sauces, and other stimulants – we can re-educate our nerve endings to enjoy gentle, appropriate touch.”

They make another point that is particularly applicable to those living in nursing homes with overhead paging, call lights and chair alarms: “The body registers noise pollution as assaultive. The automatic tightening of muscles to armor (protect) and defend themselves produces sensations that range from mild discomfort to extreme pain. Gentle, appropriate touch can help the body to relax without more intrusive intervention. Caring touch can restore equilibrium and balance.”

If we want people, especially those in nursing homes, to truly be well, we must work to meet the basic need for human touch. Here are some ways we can make it happen:

  • Dancing (Picture that dining aide who jumps out there with a resident when a good song comes on, holding hands while moving to the music.)
  • Holding hands to say the prayer before a meal
  • Massage sessions (Research this and use professional trained staff. Often our elders need light touch massage and not deep tissue massage.)
  • Hugs (One therapist cited in the article mentioned above suggests fitting in 12 hugs per day for everyone.)
  • Simple handshakes when greeting someone
  • A hand on the shoulder when talking

Sometimes I see alternatives to human touch being used – a dog or cat to pet, soft stuffed animals, etc. – but as the article states: “There is no substitute for the gentle, loving touch of someone who cares.”

What are your thoughts? What ideas do you have to make positive touch happen more? How do we assure the frailest among us are not deprived of touch?

Glenn Blacklock has a Master of Arts in Leisure Studies with emphasis in Therapeutic Recreation. As Administrator of Big Meadows Nursing Home he led the organization through their culture change journey. Glenn is the creator of the Action Pact workshop Unlock the Life Within and, in his current role with Action Pact, has guided nursing homes across the country through their transformation to households.

Journey of a Lifetime

The residents had every resource – medications, supplies, aides, nurses, wheelchairs and walkers – available to them that they always have at The Jewish Home for the Elderly in Fairfield, CT, when they made the journey of a lifetime to the Jewish home: Jerusalem. Continue reading “Journey of a Lifetime”

United Methodist Highlights Their Culture Change Efforts

We are excited to share United Methodist Homes of New Jersey’s newsletter focusing on their culture change efforts. The newsletter features articles on many aspects of their transformation; from a change to less medically oriented uniforms, to plans for a new physical environment, to their work through the stages to the Household Model with Action Pact, to culture change in Assisted Living. You can read it all here.

It Takes The Whole Team

Last week long-term care organizations around the country were celebrating National Nursing Home Week with a theme of “Team Care”. At Action Pact, we think every week is a week we should be concentrating on our teamwork. We have always said that it takes involvement from everyone in the nursing home to change its culture and the work of a team of caregivers to create home on a daily basis for and with elders. That is why in the Household Model decisions are made by the household team and not in departmental silos.

We’ve created a podcast for you to hear more about this philosophy and how it works in real nursing homes across the country. We think it is kind of fun, especially since it features participants from our Choreography of Culture Change intensive sharing their stories.

Helping Out and Staying Active

Geurt Van Sant is a man who likes to work, likes to be helpful. His move to Hearthstone: A Ministry of Wesley Life in Pella, IA  was not going to change that. “I’m going to be doing something until the day I have to crawl to get out to the yard to help,” he said. “I enjoy doing that kind of work – work that just has to be done.” Continue reading “Helping Out and Staying Active”

Rice Is Not Just Rice When It Comes To Resident’s Rights

Hopefully, your organization has by now embraced the New Dining Practice Standards introduced through a CMS-cosponsored process in 2011 and is firmly committed to honoring residents’ choices. You as the dietitian dutifully interview them about their food preferences and try to give them what they say they want.

So what’s up with Mrs. Chu? She said she wants rice at every meal and you make sure it is always on her plate. Yet she never touches it. Why not?

Simply put, a bowl of rice is not just a bowl of rice when you truly honor residents’ rights to autonomy and self-determination. Had you gotten to know more about Mrs. Chu ’s life at home, her rituals, her daily pleasures, you may have learned that she likes to spice up her rice with a little vinegar or soy sauce from a small carafe on the side; that she uses a particular type of grain of rice cooked a certain way and served, sticky and steaming hot, in a decorative china bowl. What comes on her tray in the nursing home bears no resemblance to the rice Mrs. Chu enjoyed at home.

riceI can relate to Mrs. Chu’s disappointment (which is based on an actual resident’s experience) through my moments with coffee while traveling. At home, my day doesn’t start right without a first cup of coffee served just the way I like in my favorite cup and lightened with a little whole milk. For me, the ritual is at least as important as the coffee, which I drink with the morning paper spread before me, the cat in my lap and my feet warmed by the rising sun filtering through the east window. The lukewarm, barely palatable coffee served on the airplane in a small plastic cup with little containers of artificial creamer simply doesn’t measure up. But that’s okay because I know I will soon be home and can enjoy coffee the way I like.

But the nursing facility is Mrs. Chu’s home, and we’re mandated to honor her preference and choice as laid out in the OBRA regulations implemented in 1987. Until now, most nursing homes have taken that mandate to only a very superficial step. The New Dining Practice Standards call for a more meaningful effort, stating: “Residents’ individual choices are actively sought after, care planned and honored, as Tag F 242 requires, based on life patterns, history and current preferences (italics added).

To know details like Mrs. Chu’s rice preferences and my coffee ritual, the dietitian must learn how we live(ed) at home, and that usually necessitates changes in staff behavior, operational systems and social environment.

But it need not require an additional step in the process we already undertake to learn residents true desires – we already interview and assess residents and observe their eating habits in the dining room (or we should). Rather, it’s about adding depth to that process. It’s about building personal relationships to the extent that staff members know the resident’s patterns and moods; what he truly wants and when. When she lived at home, what time in the morning did she normally take her first bite of breakfast? Did he have coffee before, during or after eating? Black or with milk or half-and-half? Sugar or honey? Did she eat alone or in fellowship? Did he watch TV or read the paper at breakfast? What were his favorite recipes? Being this well known by her care providers allows the resident to achieve the same degree of autonomy and self-determination (key words in the OBRA regulations) she’s always enjoyed at home.

Of course, we should not assume that Mrs. Chu won’t someday change her mind and choose something else in place of rice. But we need to know how she did things in the past, and continue working with her to see if she wants to continue in the future. That leads into the issue of the dietitian as advocate on behalf of the resident’s right to self-determination, which is the subject of  a future post.

Linda Bump, MPH is a Registered Dietitian and Licensed Nursing Home Administrator with a passion for resident choice and quality of life with a particular focus on the kitchen as the heart of the home.  As an administrator, she has guided four organizations through transformations to a social model of care.  She has extensive experience as a consultant on the Household Model and has provided education on culture change to 60+ nursing homes through her work with Action Pact since 1999.

CMS Supports New Dining Practice Standards

The Centers for Medicare & Medicaid Services recently published a memorandum to surveyors regarding long-term care organizations’ implementation of the New Dining Practice Standards. CMS also provided a training video to its surveyors on new recommended nursing home dining practices that focus on resident choice and limiting the use of restricted diets. Continue reading “CMS Supports New Dining Practice Standards”

The Bus Between Two Realities: Meeting Elders Where They Are

One of the best parts of my job as a writer for Action Pact is getting to hear all the great ideas folks have to enhance the lives of the residents in their organization, especially those living with dementia. These often require thinking outside of the box of the way things have always been done. Continue reading “The Bus Between Two Realities: Meeting Elders Where They Are”