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”
This story about adjusting overnight practices to allow residents to sleep without being woken up throughout the night was originally published in our October Newsletter.
Mr. W. spent most of his days mostly asleep. He was sluggish, had a hard time getting up and ready for the day and required assistance eating. Then the folks of the Miller’s Crossing neighborhood at Rosedale Green in Covington, KY decided to individualize sleep plans for their residents Continue reading “A New Awakening”
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.
As the new millennium dawned, the household model introduced resident-directed dining. Visionaries in the field began to promote new approaches to dining in long-term care as part of the shift from institution to home, by focusing on relationship instead of task and offering point-of-service choice instead of tray service.
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. This year, one of the things I learned was from a CNA who is a Neighborhood Coordinator in a dementia specific neighborhood. It is the very simple and very powerful thing she says she teaches all of her staff: wait. Wait at least 90 seconds for someone who lives with dementia to answer or respond. Do not ask again, do not suggest, just patiently, wait.
This was such an easy thing to remember that is stuck with me. And I try to use it.
One morning recently, I was visiting a newly opened household. My mission was to find out how life and work was unfolding and to be able to offer any support or suggestions. To do this I talked with as many people living and working there as I could. The household I was in was nicely appointed, wide open spaces, the kitchen and dining area opening into the living area where here were comfy chairs, a table with chairs and a couch. At the table, Marge was sitting in her wheelchair. I introduced myself and asked her name. Then I explained my mission and asked, “What do you like about living here?” I then waited…30, 60, 90 seconds passed. I am not a patient person, usually. I am much better about it when serving those who live with dementia, but it is not my nature to be patient – but I waited.
After about two and a half minutes, Marge said, “It’s quiet here.”
“Oh,” I said, “What else do you like about living here?” And… I waited.
This time she answered in about 60 seconds, “The space.” Then she nodded her head and shut her eyes. I took that as a signal that she was, in fact, finished speaking with me.
I went on to talk with others who live and work in that house, moving around the space, until lunch time when I found myself back at the table in the living room with Marge who was still sitting there though now awake. I greeted her by name and sat down. Presently, the household leader came to remind Marge that is was lunchtime. She said, “May I take you over to the dining room?”
Marge replied, “No.” She then looked at me and asked, “Will you take me to the dining room?”
I was surprised, but mostly honored. What I think happened is that I waited…. and listened, and heard. Even people who feel in their hearts that they care deeply, at times do not recognize that interactions that may be slow, soft and quiet often grow a relationship. I did take Marge over to the dining room. We ate at the same table. She said little. I said little. Yet, we were together for that time.
Megan Hannan, MS, is an Executive Leader at Action Pact and has provided leadership in long-term care for over 25 years. Megan developed Action Pact’s signature train the trainer program, PersonFirst®. She serves on the Board of Directors of The Pioneer Network.
Written by Bev Cowdrick
As an organization begins to dig into culture change and the Household Model, we often hear the question “What about our short-term rehab unit? It’s different!”
It’s true. We’re not trying to create a home for people who come to us for rehab. People are with us to do the work and go home to somewhere else, not to cozy into a household. It’s a fast-paced environment with people coming to us for only a few weeks.
And yet the principles of person-directed care and self-led versatile work teams are as critical in the rehab environment as they are in the long-term care environment.
The following are three of the pitfalls of the institutional model in short-term rehab, and how culture change adds value for our guests.
Knowing the Person, Working Seamlessly
Staff members work in departmental silos and assignments may vary from day to day. CNAs, medication aides and floor nurses rarely know a guest’s rehab goals or full plan of care. Rehab therapists rarely know all the concurrent conditions that person is experiencing, how they are sleeping, or what social, emotional and spiritual needs might be impeding progress.
Culture change antidote:
Everybody belongs to a small-size rehab house. A permanent team is in place in each house. Everyone participates in knowing the guests and following their progress. CNAs cross-train as rehab aides, assist with assessments, follow guests into the gym, and help continue the plan of care 24 hours a day. Household teams work to understand and meet the needs of the whole person. Therapists and the rest of the team work shoulder-to-shoulder with each other and the guest as care managers.
The Environment for Friends and Family
The rehab unit rarely has adequate space or hospitality for family and friends to join a guest for a meal or visit outside the guest’s bedroom. The support of family and friends is often critical to the speedy recovery of a guest, and often there has been little thought to making room for this to happen.
Culture change antidote:
Create space at the table for family and friends. Make 24-hour hospitality centers with coffee, juices and snacks. Build in living room spaces for gatherings outside the bedroom. Have homemakers in each rehab house who are trained as certified dietary managers and hospitality specialists. Have household coordinators who assure that a welcoming and convivial environment is maintained.
Promoting an Upward or Downward Spiral
Practices used for the convenience of staff often do not promote independence and recovery of function. This includes unnecessary assistance with bathing, dressing and other activities of daily living, as well as the use of wheelchairs for staff convenience to speed transport of guests. Interrupted sleep also prevents optimal recovery. This includes loud paging systems and bells, late-night treatments and medications that could be given on other shifts, third shift entry into rooms to restock supplies and clean equipment, and frequent turning on of lights to check for guest safety and feel for urinary incontinence. Exhausted guests do not do well during gym workouts!
Culture change antidote:
Reorganize so that administrative nurses, recreation/life enrichment staff, social workers and administrative staff spend at least part of their time attached to one house to help with household duties. They sometimes cross-train in another job to free up CNAs and nurses to take the time to allow guests to “do for themselves.” Work to eliminate the use of wheelchairs as much as possible, and reassess this on a daily basis. Eliminate all unnecessary nighttime disturbances and practices.
Bev Cowdrick received her Masters in Public and Private Management from Yale and is a licensed nursing home administrator. While a consultant for Action Pact, Bev guided many nursing homes through their transformation to households. She is currently the Associate Director at Glenaire, a continuing care retirement community in North Carolina.
Welcome to the Action Pact blog! Those of you who know us know that Action Pact is committed to changing what it means to be a nursing home. We’ve learned a lot over the years and in an effort to keep the conversation going and current, we’re introducing our new blog: Neighbors. Continue reading “Insight on Culture Change and the Household Model from the Action Pact Team”