Four Ways to Build the Culture You Want to See in Your Senior Community

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”

Flying High with Self-led Teams


One of the most unifying and powerful accomplishments of self-led teams is realizing that no job and no person is viewed as greater than another. The equation itself is simple: no greater than or less than, only equal to. So every job is just as important as the next. All the jobs that need to be done in a household are done to help the members of that household have a better day. It doesn’t matter if it is wiping the table or taking out the trash or helping with medications. Self-led teams do not get hung up on titles, you simply get in where you fit in that day. Continue reading “Flying High with Self-led Teams”

Residents with disabilities find new life in Inglis Neighborhoods

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”

Vacationing Residents Seek Adventure

Why should the possibility of going on an adventure end when you move into a nursing home? One of the best ways to engage in life is by having new experiences, especially experiences that fly in the face of assumed personal limitations. With this in mind, five residents (two from the health center) and four staff from Hearthstone: A Ministry of WesleyLife in Pella, IA set off on a real vacation, prompting one resident to say, “Maybe it’s been too long since I’ve been out of town, or even my room.” Continue reading “Vacationing Residents Seek Adventure”

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.

Why We Do Learning Circles


The learning circle is the handy hammer of culture change – anyone can use it, it’s simple, it’s intuitive and it’s the tool you come back to, over and over, with each new piece of home life you build. For the Household Model to function at its potential, the organization must be reconfigured, doing away with traditional silos and hierarchy. The learning circle is the tool that can assist the organization in that work. Continue reading “Why We Do Learning Circles”

Challenging Ourselves to Be Strong

In our July 2012 newsletter we shared a story from Household Coordinator Janet Fleming at Samaritan Bethany in Rochester, MN about a special Memorial Day in their brand new households. Here she continues the story of how residents and staff were motivated to do more exercise and walking in memory of their loved ones:

Challenging Ourselves to Be Strong

Last fall, we had our first household initiative challenging ourselves to be strong, walk, exercise and choose active events that promote balance and dexterity. We called any activity that was more, well, active, a “Strong Choice,” and worked with our restorative nurse to plan more activities like that.

As an afterthought, we decided to post a piece of paper in our dining room for each resident and nursing assistant with their name on it and a line for each day of the week. Each time a resident or nursing assistant made a “Strong Choice” they each got to put a green dot sticker on their paper. We went through lots of dots. Residents tried new activities. More open discussions began with residents about their active life. We discovered that some residents did not have as much planned restorative activity as they wanted. We learned a ton.

My co-workers enjoyed seeing public evidence of their hard work with the stickers on the sheets. Open evidence of which staff had lots of dots and which had only a few dots generated good discussion. There was no prize. It was not a contest. It was just effort made visible. It took a lot of energy, and at the end of the second week we took a happy break from the dots.

We had such good results that the next month Samaritan Bethany promoted this challenge throughout the building. Using the same idea, they made a contest for staff. In order to emphasize documented restorative activity, Samaritan Bethany chose only to use dots for documented restorative activities.  Residents and staff in Essex House struggled with the new rules. It was as though only part of our previous efforts counted, when all of them mattered to us.

With the contest, we also saw that it was possible to overemphasize the role of staff in the residents’ restorative life. We spent time thinking and talking about the difference. Could a strength challenge just facilitate the resident’s active life? If we are all on the same page, is it possible for us to just enable their active choices?

Memorial Walks: Combining the Ideas in 2012

In early March this year we began discussing a new idea for challenging ourselves to keep up our strength. We wanted to do something very different, but still keeping the best parts of our green dots challenge. With Memorial Day’s approach, an opportunity became clear. We decided that each day we would dedicate our “Strong Choices” to the memory of a loved one. Each day we put up a poster with a person’s name on it and for each “Strong Choice” instead of a green dot we would use flower stickers with our names on them.

I visited with residents to ask about people they would especially like to remember on Memorial Day. When I spoke to the first resident, I reminded him of our green dot strength challenge. He told me that he knew he needed to walk more, but sometimes it was just easier to sit.

I said, “Me too. We are all looking for something that will get us up and moving.”  He told me about watching another resident get stronger, and told me he would like to be able to walk unassisted into the dining room. I said, “I think it is possible.”

The next man I spoke with had been weakened by illness over the winter. With tears in his eyes, he said, “I don’t walk anymore.”

I said, “We will help you. You can do it.” He was walking by that afternoon. It was his own choice to stand with his walker, rather than transfer himself into his wheelchair.

Once we started walking, it was easier to understand. The poster of the day hung in our dining room, and in the morning we would read about the person we were honoring. The next morning we would look at the huge floral tribute we had created together, and hang the poster honoring another person. Most of our residents have those tributes to their loved ones hanging in their rooms to this day. Our memorial walks went on for six weeks as day after day we honored the loved ones of both residents and staff.