July 30, 2010
A Perfect Picnic
This past Wednesday 15 residents had a picnic at the beach out in Lahaina. Their picnic was complete with hot dogs and teriyaki beef right off the grill, music and dancing. A great time was had by all!
Treating Residents Like People, not Patients
I wanted to share this article that I read yesterday about Bethesda Home and Retirement Center. I thought it was worth sharing because the organization started their culture change movement much in the way that we did, by encouraging residents to wake up at whatever time they chose. I especially enjoyed the fact that the article detailed how what seems like a very easy, simple change, can face many challenges. I hope you enjoy this article as much as I did!
Nursing homes move toward treating residents more like people, not patients
The revolution at the Bethesda Home and Retirement Center began with sleeping in. Letting people sleep late may not sound subversive. But in the traditional world of nursing homes, which for decades have been run like highly regimented mini-hospitals, it is a radical change. And when Bethesda made that change two years ago, it was taking its first step to join a movement that hopes to transform the nation's nursing homes.
The "culture change" movement seeks to get these facilities to alter their physical layout and their caregiving practices to create homelike environments where residents are seen not as passive recipients of care but as individuals with control over their lives.
Nursing homes that embrace the new philosophy are letting residents decide when to bathe, eat and sleep; allowing them to organize their own activities; and redesigning nursing units into small "households."
Advocates say residents in such homes are happier and healthier; the employees have more job satisfaction; and giving care this way even costs less.
And baby boomers who need long-term care will expect no less, said Julie Boggess, chief executive officer at the Bethesda Home, on the Northwest Side. "I became an adult in the late '60s; I'm real accustomed to doing things my way, and I'm not very apologetic about it," she said.
She doesn't even like to speak of "allowing" residents to sleep late. "It's not for us to give them that freedom," she said. "They should have it."
But until Bethesda began adopting culture change two years ago, they didn't. And at many nursing homes, they still don't.
The idea is not new. The Pioneer Network, a national umbrella group of nursing home providers and consumer advocates, has been promoting it since it was formed in 1997.
Yet only 25 percent of the nation's nursing homes say they have "for the most part" embraced culture change, according to a 2007 survey by the Commonwealth Fund, and only 5 percent say they have done so "completely."
Nursing home operators, who are under tremendous pressure to cut costs, are often afraid that culture change would be too expensive, said Robert Mayer, president of the Chicago-based Hulda B. and Maurice L. Rothschild Foundation, which supports culture change. In fact, he said, flexibility is more cost-efficient.
And there is little pressure from consumers, he said; there are so few "culture change" homes that most people don't know they exist.
Even nursing home operators who want to make the changes find it hard. "Nursing home rules make it very difficult to do a lot of this stuff," said Kirk Riva, vice president for public policy of the Life Services Network of Illinois, a trade organization.
The experience of the Bethesda Home illustrates the challenges.
Janet Meyer, the home's director of nursing, had proposed a single change: letting residents sleep late. But "that's a bigger deal at a nursing home than you might think," she said.
Mealtime practices had to be changed to accommodate late risers. Housekeeping had to be done more flexibly to avoid waking residents for vacuuming.
Most challenging, the morning medication system had to be changed. Nursing homes traditionally give out medications during a two-hour period. But if residents were allowed to sleep late, Bethesda could no longer give morning medications only between 8 and 10.
So the home made another change: Residents could get their morning medications any time between 6 and noon, by individual request.
Nurses struggled to adjust. "We just couldn't understand how this could possibly work," said Mary Sobus, a nurse at Bethesda for 19 years.
Other practices were loosened too. At staff meetings, administrators told employees that they needed to be flexible and perform caregiving tasks like bathing when residents wanted them.
Staffers objected that some shifts were now doing more work than others. And they were so accustomed to being evaluated based on their efficiency that they were afraid of being downgraded for showing flexibility.
Even some residents and their families protested. Family members told administrators it was unfair to expect nurses and aides to accommodate individual schedules. Residents worried that if they didn't get their morning medications at the precise time they always had, their health would be harmed.
At the home's annual inspection, surveyors initially objected to the new medication system, Boggess said, but ended up approving it, along with Bethesda's elimination of nursing stations. Removing nursing stations is another common element of culture change; the stations are reminiscent of hospitals.
There are regulations in place that make such changes difficult or impossible, said Melaney Arnold, spokeswoman for the Illinois Department of Public Health. But the department is willing to waive some regulations - like the requirement of a nursing station - as long as a home conforms to their intent.
And the department is trying to ease the burden, Arnold said; officials are going through the regulations to see which ones can be changed.
"We are open to and support the concept of changing nursing homes to be more homelike environments," she said.
The new system at Bethesda prompted several nurses to quit. But Sobus became a believer.
Giving out medications individually can be more time-consuming, she said, but "you're relating to people on a little different level," she said. "You're actually consulting with the resident."
Bethesda resident Tillie Ohl, 91, a confirmed late riser, is delighted. "They used to call me to wake up at 6:30," she said. "I wanted to kill them."
But on this day, "I just got up at 11 o'clock," she said happily. "I really slept like a log."
Several other Chicago-area nursing homes have adopted aspects of culture change. Three Crowns Park in Evanston redesigned its units into small households with common kitchens and living areas. At Sunny Hill Nursing Home of Will County, a group of residents interviews and helps choose new hires. If the residents turn thumbs down, "the department head has to go out and get somebody else," said Becky Haldorson, the home's assistant administrator, who is also president of the Illinois Pioneer Coalition.
Such homes are in the minority - but not for long, advocates say.
The Health Reform Act passed in March calls for conducting demonstration projects at nursing homes to establish the best ways to effect culture change. So many organizations and government agencies are now working toward culture change that "everything is in place for widespread dissemination," said Bonnie Kantor, executive director of the Pioneer Network.
Boggess hopes so. "Let's see if we can make it better for my generation," she said.
Nursing homes that embrace the new philosophy are letting residents decide when to bathe, eat and sleep; allowing them to organize their own activities; and redesigning nursing units into small "households."
Advocates say residents in such homes are happier and healthier; the employees have more job satisfaction; and giving care this way even costs less.
And baby boomers who need long-term care will expect no less, said Julie Boggess, chief executive officer at the Bethesda Home, on the Northwest Side. "I became an adult in the late '60s; I'm real accustomed to doing things my way, and I'm not very apologetic about it," she said.
She doesn't even like to speak of "allowing" residents to sleep late. "It's not for us to give them that freedom," she said. "They should have it."
But until Bethesda began adopting culture change two years ago, they didn't. And at many nursing homes, they still don't.
The idea is not new. The Pioneer Network, a national umbrella group of nursing home providers and consumer advocates, has been promoting it since it was formed in 1997.
Yet only 25 percent of the nation's nursing homes say they have "for the most part" embraced culture change, according to a 2007 survey by the Commonwealth Fund, and only 5 percent say they have done so "completely."
Nursing home operators, who are under tremendous pressure to cut costs, are often afraid that culture change would be too expensive, said Robert Mayer, president of the Chicago-based Hulda B. and Maurice L. Rothschild Foundation, which supports culture change. In fact, he said, flexibility is more cost-efficient.
And there is little pressure from consumers, he said; there are so few "culture change" homes that most people don't know they exist.
Even nursing home operators who want to make the changes find it hard. "Nursing home rules make it very difficult to do a lot of this stuff," said Kirk Riva, vice president for public policy of the Life Services Network of Illinois, a trade organization.
The experience of the Bethesda Home illustrates the challenges.
Janet Meyer, the home's director of nursing, had proposed a single change: letting residents sleep late. But "that's a bigger deal at a nursing home than you might think," she said.
Mealtime practices had to be changed to accommodate late risers. Housekeeping had to be done more flexibly to avoid waking residents for vacuuming.
Most challenging, the morning medication system had to be changed. Nursing homes traditionally give out medications during a two-hour period. But if residents were allowed to sleep late, Bethesda could no longer give morning medications only between 8 and 10.
So the home made another change: Residents could get their morning medications any time between 6 and noon, by individual request.
Nurses struggled to adjust. "We just couldn't understand how this could possibly work," said Mary Sobus, a nurse at Bethesda for 19 years.
Other practices were loosened too. At staff meetings, administrators told employees that they needed to be flexible and perform caregiving tasks like bathing when residents wanted them.
Staffers objected that some shifts were now doing more work than others. And they were so accustomed to being evaluated based on their efficiency that they were afraid of being downgraded for showing flexibility.
Even some residents and their families protested. Family members told administrators it was unfair to expect nurses and aides to accommodate individual schedules. Residents worried that if they didn't get their morning medications at the precise time they always had, their health would be harmed.
At the home's annual inspection, surveyors initially objected to the new medication system, Boggess said, but ended up approving it, along with Bethesda's elimination of nursing stations. Removing nursing stations is another common element of culture change; the stations are reminiscent of hospitals.
There are regulations in place that make such changes difficult or impossible, said Melaney Arnold, spokeswoman for the Illinois Department of Public Health. But the department is willing to waive some regulations - like the requirement of a nursing station - as long as a home conforms to their intent.
And the department is trying to ease the burden, Arnold said; officials are going through the regulations to see which ones can be changed.
"We are open to and support the concept of changing nursing homes to be more homelike environments," she said.
The new system at Bethesda prompted several nurses to quit. But Sobus became a believer.
Giving out medications individually can be more time-consuming, she said, but "you're relating to people on a little different level," she said. "You're actually consulting with the resident."
Bethesda resident Tillie Ohl, 91, a confirmed late riser, is delighted. "They used to call me to wake up at 6:30," she said. "I wanted to kill them."
But on this day, "I just got up at 11 o'clock," she said happily. "I really slept like a log."
Several other Chicago-area nursing homes have adopted aspects of culture change. Three Crowns Park in Evanston redesigned its units into small households with common kitchens and living areas. At Sunny Hill Nursing Home of Will County, a group of residents interviews and helps choose new hires. If the residents turn thumbs down, "the department head has to go out and get somebody else," said Becky Haldorson, the home's assistant administrator, who is also president of the Illinois Pioneer Coalition.
Such homes are in the minority - but not for long, advocates say.
The Health Reform Act passed in March calls for conducting demonstration projects at nursing homes to establish the best ways to effect culture change. So many organizations and government agencies are now working toward culture change that "everything is in place for widespread dissemination," said Bonnie Kantor, executive director of the Pioneer Network.
Boggess hopes so. "Let's see if we can make it better for my generation," she said.
July 28, 2010
July 23, 2010
Yay for Spa Day
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| Helen getting her nails done. |
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| Betty having her hair styled |
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| Nancy gets her feet moisturized and massaged while lounging in a chair. |
Today many of our residents were preened, polished and pampered with spa-like treatments including manicures, facials and massages. Many ladies also mini makeovers complete with hair styling and make-up.
July 22, 2010
Resident Portrait Series
Tip from the Eden Alternative: Entering Elderhood
In the Eden Alternative, we have created a unique language. The purpose of transforming the words we use is to help us gain our "Eden Eyes," so that we not only see the world differently but are inspired to change it as well. One of these words we use in the Eden Alternative, and all of culture change, is the word Elder.
In the Eden Alternative, we define an Elder as someone who by virtue of life experience is here to teach us how to life. In our society, because of our views on aging, Elder is often mixed up with elderly which is not often used as a term of respect. It is not unusual to find people very resistant to the word Elder simply because of this confusion.
It is time in our society to honor and re-establish the role of Elders and Elderhood. That is why the word Elder is so important as we work together to transform the experience of aging. In Dr. Thomas' book What are Old People For? he speaks to the different phases of life we all pass through. We begin in infancy, then childhood, then adulthood, and if societal views have their way, this is the ultimate phase of life and where we stay until we pass on. So we admire the person of advanced years, who is actively "doing" the things of adulthood. On the flip side, we tend to diminish those who have moved beyond adulthood and chosen to move into Elderhood by valuing "being" more than "doing".
The movement into Elderhood can occur at any age in our life. It is a sacred and important step in our life's journey. Those who are partners in the care of someone of who has moved into their Elderhood know the important gifts it brings to their lives. Now, it is our turn to share it with the world. Do not be reluctant to speak to others about Elders, Elderhood and what it means. Educate and involve everyone in the discussion. When someone chooses to move into this phase of life acknowledge and honor their choice. This is just one more way we can work together to create a life worth living for everyone.
July 19, 2010
Volunteer Makes a Difference in the Lives of Residents
July 12, 2010
Resident Portraits Series
I snapped this photo of Shigeko Nemoto while she was playing the card game Toilet Bowl with fellow residents and a volunteer last week. I thought it really captured the intentness of the game and Shigeko's concentration on the next player's move. Shigeko only has one card left in this photo, which she placed in the "toilet bowl" on her next turn to win the game!
Eden Alternative Tip of the Week: Understanding Care Partnership
When we begin to focus on Elders as people who continue to "grow and become," we open to what they have to offer us. Seeing Elders as mentors with something to give helps us make the leap from caregiving... to care partnering. When those usually described as care receivers learn they have something to give - and there is always some way that they can, no matter how subtle -and those usually described as care givers deeply acknowledge the ways that they receive from care receivers, some amazing shifts occur in the care dynamic. They become Care Partners."
Instead of seeing the needs of 'caregivers' as separate from the needs of 'care receivers,' we need to focus on the well-being of the whole care partnership. At the Eden Alternative, we firmly believe that words make worlds. Like the term 'Elder,' the phrase 'Care Partner' is an excellent example of the transformative power of choosing our language carefully. As a concept, care partnership evens the playing field, as it is often easy to get trapped in a one-dimensional experience of care. With this in mind, teams must fully appreciate what it means to be a care partner team. The term "care partner" should never be used simply as a politically-correct replacement for the words "staff" or "aide" or "caregiver/care receiver." Care partnership encompasses so much more, both in nursing homes and out in the larger community.
Instead of seeing the needs of 'caregivers' as separate from the needs of 'care receivers,' we need to focus on the well-being of the whole care partnership. At the Eden Alternative, we firmly believe that words make worlds. Like the term 'Elder,' the phrase 'Care Partner' is an excellent example of the transformative power of choosing our language carefully. As a concept, care partnership evens the playing field, as it is often easy to get trapped in a one-dimensional experience of care. With this in mind, teams must fully appreciate what it means to be a care partner team. The term "care partner" should never be used simply as a politically-correct replacement for the words "staff" or "aide" or "caregiver/care receiver." Care partnership encompasses so much more, both in nursing homes and out in the larger community.
By our definition, a care partner team is composed of the following care partners: the Elder herself; those care partners who work with her, whether they work in a nursing home or through home health support; her family members, friends, volunteers, and any other health professionals that collaborate with her. Care partnering implies a balance of care, that opportunities to give as well as receive are abundant and experienced by everyone involved in the care relationship in every moment. To deepen the experience of care partnership, consider holding Learning Circles on the subject that bring Elders and all of their care partners together.
July 8, 2010
Having Fun Playing Games
This afternoon residents gathered in the Aloha Cafe to enjoy a variety of different table games including the Japanese card game, Hanafuda; a card game called Toilet Bowl; and Dominoes. Pictured above is volunteer, Michelle Soga, dealing cards for the Hanafuda table, with resident Vilma Sanchez to her right, and resident Rose AhSam in the foreground.
2010 Seedling Award Nomination
The below application was submitted by Denise Hyde, Eden Alternative Community Builder.
Hale Makua Health Services joined the Eden Registry in August 2009. This home is being nominated because they took some very thoughtful first steps to get themselves on the Eden Alternative journey. They learned quite a bit about the Philosophy and Principles before they jumped in with both feet and held a large Eden Associate training for formal leaders and care partners from both of their homes on Maui. They have named their Eden journey, Luana which means “to live in comfort and ease”. They consistently blend the diverse cultures represented by the Kupuna living in their home. Kupuna in the Hawaiian culture means teacher. They have developed a great mission statement: “Those who live, work and visit Hale Makua share the spirit of Aloha and ‘Ohana in a community of compassionate caring that is inviting, intergenerational, educational and a valued part of the journey of life.” ‘Ohana means family.
The homes have subdivided into neighborhoods with consistency in care partners assignments. They are working on more open dining and room service options. They developed a two-day compassionate care workshop which is about taking care of self and the Kupuna, using empathy and compassion. It is provided to all employees regardless if they are involved in direct resident care to set the tone for the type of care environment they are nurturing.
On their Luana journey they have taken great strides in letting residents decide what and when they want to eat. Their continental breakfast program enables residents to make their own breakfast selections from an assortment of breakfast foods, and allows them to eat at whatever time they choose in the morning. While continental breakfast originally got its start at Hale Makua Wailuku, it is now available in all of the neighborhoods. In addition to continental breakfast, their short stay rehab residents have a room service amenity where call the kitchen anytime and order off a special room service menu. Lastly in the food service area, both locations have started monthly resident food committees to review potential new menu items, share food likes and dislikes, and give feedback on the existing menu items.
They have developed a blog site where regular updates about their Eden Alternative journey are posted along with pictures and stories. The idea to start a blog came about at in September 2009 at a Luana Core Team meeting as a way to keep other people informed about Hale Makua Health Services Luana' journey, our challenges and goals as a Core Team, sharing of neighborhood best practices, a forum to share thoughts and ideas, etc. They thought that this would be a great way to keep track of their journey, replacing the scrapbook that they kept leading up to becoming an Eden registered home. With this blog they have the ability to share with care partners, Kupuna, their families, other organizations, and the public what they are doing on the Luana Journey, something we could never do with just one scrapbook. Having a blog also allows them to give more real time updates to readers, and is much more environmentally friendly.
Most recently Hale Makua Health Services has taking on the daunting task of training all 512 employees on the Luana journey and the Eden Alternative principles. They prepared an Introduction to Luana PowerPoint presentation for staff and the Core Team, plus additional staff members, all took turns training the various groups of staff, from nurses and housekeepers, to the business office, maintenance and purchasing staff. The presentation can also be viewed online at: http://www.slideshare.net/denisethayer/introduction-to-luana. They have been working on something to symbolize and remind everyone about the journey they are on. Through much discussion, they decided on a message on a t-shirt with the antidotes to the three plagues: companionship, giving & receiving care, and variety & spontaneity. The shirts will be given to each Kupuna, employee, volunteer, and family member that completes the introductory Luana education. If you want to see what the tee shirt design looks like, you'll have to take the class!
In developing a simple tee shirt design they selected the below logo as a symbol of Luana. The vibrant blue and green colors were selected to reflect the vitality and life that resides within the Hale Makua communities, as well as the lush green courtyards and beautiful blue skies that are seen almost daily on Maui. The flower mark has a feeling of motion moving from the center outward, representing the continuous change and growth of Luana within the communities. The flower shape pays tribute to the Eden Alternative concept of growing a garden.
July 6, 2010
Eden Alternative Tip of the Week
Remember how the People of Kallimos (In the Arms of Elders) were prone to break from their daily work for brief celebrations, songs, and dances? The People are hard workers and, like those who care for Elders in this world, they make their living by the sweat of their brows. Success with this Principle is tied to your ability to accomplish three things:
You must establish and nourish the formal leader's ability to model variety and spontaneity. This does not include the practice of dropping bad news and additional tasks in the daily lives of the care partners. It is about seeking out and developing methods of enriching the lives of Elders and care partners.
The ability of the care partners to weave variety and spontaneity into the lives of the Elders is dependent on the ability of formal leaders to role model this behavior.
The Elders' ability to bring variety and spontaneity into their own lives is dependent on the care partners ability to role model this behavior. Your ultimate success comes when Elders begin to find variety and spontaneity creeping back into their lives. Listen to them talk about their lives. How often do you hear, "The darndest thing happened the other day ..."
Like all the plagues, boredom kills. That is true for the formal leaders, care partners and Elders alike. As with other aspects of the Eden Alternative, the formal leaders needs to go first, but they cannot do it alone. Neither can those who have the word "activities" in their job description. Everyone needs to work together to find ways to weave variety and spontaneity into the fabric of life in the home. The kind of variety and spontaneity that fills up people's hearts and spirits. It will bring sparkle back into eyes that have long lost their luster.
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