Culture Change in Practice

Five Stars and a Blog

2008-12-22T11:46:00.002-06:00

So, how about the five-star nursing home rating system, huh? My first thought was that eating at a five-star restaurant doesn’t guaranty a good dining experience and that during one of my favorite dining experiences ever at a diner in New Orleans I saw one dead roach on the floor. I’m not saying that pest issues should be ignored or that a five-star rating doesn’t indicate some level of excellence, but that there are a lot of factors that effect a person’s experience that rating systems, such as the one recently released by Centers for Medicare and Medicaid Services, ignore.

I am, of course, not the only one who feels this way as the point is mentioned in the first few paragraphs of the many articles I have read on it. (Here’s one for example).

Interestingly, another sort of “quality indicator” recently showed up on the Web as well. The goal of Bob’s “Nursing Home Ninja Blog” is “to comment on conditions, care, and circumstances in Nursing Homes & Extended care facilities.” Bob is a resident in a long-term care facility and will be providing an “inside view” of the situation at his nursing home. Somewhere between these two new websites, and some personal investigation, perhaps people will find some aid in choosing a nursing home for themselves or a loved one. I think Bob will be able to bring up some good issues to think about and ask about that may not come to mind unless you’ve actually lived in a nursing home – some of those things that the five-star system doesn’t cover.

I encourage you to comment here on what you consider important indicators of quality of care so that with many view points we can all get a really good big picture of what quality life in a nursing home should be.

Power Struggle

2008-12-03T11:37:00.001-06:00

I had an interesting dream last night - I was in a large group being taught different movements that were meant to represent animals. The teacher asked us to break up into groups of three and put several movements that we learned together to make a routine. So, I went off with the other two in my group, a woman and a man both in their 50s, and we got started. The woman said, “I thought we could start with the crab” and demonstrated. I said “Wow! I was thinking the same thing! But I was thinking we could modify the movement at the end so that we could more smoothly move on to the next movement” and there the woman cut me off and said. “No, I think we should do it my way” and I said “But you haven’t even heard or seen my suggestion.” “It doesn’t matter, “ she said, “I want to do it my way.” “Well, I could just as easily say ‘I want to do it my way’ that’s not a convincing reason.” (The man, bless his soul, was keeping out of it.) She then said people my age (30s) thought they could just come in and tell people who had been doing their jobs for years how things should be done and she wasn’t going for that. I pointed out that in fact, we usually did what the more senior people in the organization wanted to do often only because they were the more senior people. At this point, I think my mind figured out what was going on and I woke up, mad and frustrated. I mean, she didn’t even want to hear my idea.

There are two things you should know: 1) the dream took place in the gym of my grade school which is never a pleasant place for the subconscious to visit, making everything that happened feel a little more hostile and 2) I’m working on some stuff on steering teams. I think this dream was telling me that I have to make sure to pay proper attention to the power struggles that happen as an organization moves toward self-led teams.

Obviously there are power issues linked to position and that is technically changed as the organization is restructured. But just because positions change doesn’t mean behaviors or feelings change. We have some pretty well ingrained feelings about whose say has weight…As in my dream, age can be a factor. (Though in a nursing home, power can be denied to someone who is “too old” as well as “too young.”) Part of the age factor has to do with experience, but there is also experience in the particular organization – that is those who have worked there for years having more power than those who have only been there for a few months regardless of overall experience. While those with seniority may know the ins and outs of the organization well, a fresh perspective can be equally valuable.

And then there is the issue of personality types within subgroups. There are those like the woman in my dream and me who are comfortable taking the lead but there are also those like the man in my dream who wait to see which way the wind will blow, uncomfortable with the responsibility that comes with power.
These power struggles are part of our general culture, not just nursing home culture, making them a little harder to overcome because they are reinforced outside of work. Please share with us what you have done in your organizations to level the playing field. I’d really like to share the power of this blog platform.

Peace and Love, Imy

2008-11-25T17:06:00.003-06:00

As Steve Shields said, “We lost Imy to the stars and the heavens.” Our dear friend and inspiration Imy Higbie passed away Friday, Nov 21 and I’m still trying to wrap my brain around the vast amount of love and wisdom she has passed on to so many of us. You may remember her from her presentation at the 2006 Pioneer conference or her contribution to In Pursuit of the Sunbeam wherein she shared the story of her own nursing home experience. Imy got her bachelor’s in journalism and went on to get her master’s in social work from Syracuse University. She later was a professor of social work at UW – Madison. An early and enthusiastic supporter of Barack Obama, Imy closely followed the 2008 campaign and election returns.

She was a champion of progress and kindness and human dignity and led by example. How could we not give our all for culture change after hearing or talking to Imy? Joe Angelelli has put together a beautiful tribute to her. It’s a wonderful opportunity to meditate on her smile and the determination in her face. Imy once ended an email to me with the following words: “In closing, let me say the word for today FORWARD!!!!!!! Peace and Love, Imy.” Indeed.

Collective Knowledge

2008-11-11T14:37:00.001-06:00

Perhaps you’ve noticed that when you do an Internet search, especially if it is on a somewhat general topic, there’s a good chance the first site that comes up is Wikipedia. Go ahead – type in “nursing home.” Is it the best source for info? Maybe not, but they try hard to have the info well cited and I appreciate that. The other thing I appreciate is that it is a symbol of collective knowledge – something we work for in the process of culture change. But here’s the thing, take a look a the Wikipedia entry for “nursing home,” particularly the stuff under “trend” and “ resident-oriented care.” It just doesn’t seem quite right. (If for nothing else than they refer to residents as “patients.”) Is it just me? Let’s submit some new info. What’s it missing? What needs to be changed?

Get Out the Vote

2008-10-20T12:52:00.002-05:00

I keep hearing things like “The most important election of our time,” “The worst financial crisis since 1929,” and “extraordinary times.” Things do feel pretty heavy these days, but I keep thinking that elders probably have a broader perspective on these claims. If you’re not doing learning circles or at least picking an elder’s brain about “these times” you could be missing out on information that could help you decide your vote or even bring you comfort about “getting through the tough times.”

And have you seen this news story about the 106-year old nun living in Rome who hasn’t voted since Eisenhower who jumped through all the necessary hoops to cast her vote this year? I guess that says something about this election.

I’m encouraging you to help elders who are interested cast their votes and even work with each other to vote early or arrange your schedule so that staff are able to make their voices heard as well. Culture change teaches us shared leadership, the power in taking part in framing the “way things are done” and the importance of being part of a community. Besides creating home for elders, I can’t think of a better way to do those things than voting.

Time to Reflect

2008-09-22T16:32:00.003-05:00

I saw a quote in a recent Newsweek article* about election strategy that had me thinking about why it is so hard to change and learn new things. Here it is:

“When FDR was making radio addresses, ‘people had the time needed for reflection, to mix emotion with facts and reason,’ says [Antonio] Damasio. ‘But now, with 24-hour cable news and the Web, you have a climate in which you don’t have time to reflect. The amount and speed of information, combined with less time to analyze every new development, pushes us toward the emotion-based decision pathway.”

“…a climate in which you don’t have time to reflect…” Any of you familiar with that feeling? So, we cling to “the way we’ve always done things” because we know it is, if not the best way to do things, at least a safe bet. It’s worked this far, right? We put a wall up to protect ourselves and the institution because we don’t have time to look at alternatives and learn new things. We barely have time to get everybody to the dining room, for Pete’s sake.

But we must find time, or at least slow down a little, if we are ever to realize that there is a better way to care for our elders and to work together as a team. We need to value individuals and effectiveness as much as efficiency and task.

I have previously posted blogs and handouts on the spiral of learning and debriefing - practices that can help us process exactly what’s going on besides our gut reactions. In time, these pre- and post-action tools can become the new “way things are done.”

Anyone have any good ideas for carving out time for learning?

* “Heard Any Good Stories Lately?” By Sharon Begley, Newsweek, Sept. 22, 2008

Life on Campus

2008-09-10T11:34:00.001-05:00

I haven’t been on my soapbox in a while, however, this time I’m on it so I can reach in and stir the pot. Basically, I’m looking for an answer to, “Why do you think that is? And why has nobody challenged it?” Here’s the issue at hand:

I’ve often thought life in a nursing home in many ways is like life in the college dorms and campus. They are environments constructed by an organization for people of a specific age group (generally) and a specific situation. Living in these environments, you have a roommate who you very likely did not know before you got there. There’s the dining room and cafeteria. And pretty much everything you need is right on campus: drug store, library, places for socializing and entertainment such as movie theater, coffee shop or recreation center, a place to worship, laundry, clinic, security, etc. The major stuff like taking care of the landscaping and green space, cleaning of common areas and general building maintenance are taken care of as well. (And talk about departmental silos- but that is getting off the point.) The idea is that the burden of the chores and errands of daily living are lessened so that focus, time and attention can be spent on other things. In college, it is studying, of course, and in a nursing home, it is the things that take a little more time and effort than they used to.

However, we know that for college students, time spared from daily tasks is also spent on those “new life experiences” and, well, having a good time! Why should it be different for those living in nursing homes? Of course, new experiences and having a good time means very different things to people in their twenties as opposed to folks in their eighties, but it seems so odd for me that in these very similar environments, one inspires activity and growth while the other centers on function (or dysfunction). I don’t think it is the age of the people living within. I think it is the expectations we all have about what is supposed to go on there. In fact, it seems the expectations should be reversed. College kids are going to grow and be active on their own, they don’t need a special environment for that. What they need to do at that stage in life, is learn to function in the “real world.” Whereas, elders are pros at functioning in the real world, but are not in a time of life we generally think of as full of activity and growth like our twenties.

What do you think? How can we change the expectations of what living in a nursing home should be to match the richness of the college experience?

Culture change around the world

2008-08-27T10:54:00.002-05:00

The ever-tenacious Emi Kiyota is at it again, or should I say, still at it - her passion for improvement of eldercare. You may remember that last summer she and some colleagues went to Sri Lanka to help design a new living environment for the local elders. Well, they went back for part two of the project and Emi has once again shared her insight, challenges and learning from the project on her blog. Think culture change is tough in middle-America? How about trying to change institutional culture in a different culture all together?! From language to landscape, Emi details the trip in candid journal entries and video.

Pioneering the Household Model

2008-08-15T12:08:00.003-05:00

Ah, it’s that time of year again when folks who sometimes feel like they are swimming up the status quo stream alone can really see that they are part of a phenomenon that rivals the salmon mating migration – time for the Pioneer Conference.

Action Pact folks at the conference will be focused on the phenomenon within the phenomenon – the Household Model. With at least 100 facilities operating under this model it is quickly becoming the standard for culture change in long-term care.

LaVrene Norton will facilitate a preconference on the Household Matters Toolkit in which leaders who have utilized the tool kit to create deep change in their organizations will share insight on and discuss their experiences with the Household Model. Presenters include: Annie Peace of Meadowlark Hills,  Sheri Workman of Mennonite Home, Vonda Hollingsworth of Pennybyrn at Maryfield, Todd Lundeen of Elim Care and Rehab Center, and  Lorna Gartzke and Therese Trebitowski of Shorehaven – Lutheran Home of Oconomowoc .

A special Household Edition of Culture Change Now magazine will make its debut at the conference. In addition to articles by culture change leaders Steve Shields, Carmen Bowman, Marilyn Oelfke, David Green, Steve Lindsey and Vernon Feather, this issue features the Household Model directory – information on organizations across the country operating in the model. Action Pact has been following leads for the last year to compile this list and plans to keep adding to it with a forthcoming Web edition of the directory. And, of course, the Household Edition will be available in our webstore after the conference.

Culture Change in Zoos?

2008-08-05T11:41:00.004-05:00

In the 70s, while all over the country cold, institutional nursing homes were being built to warehouse elders, zoos were discovering that animals do better in habitats that mimic their natural environment than in the cold, institutional environments of cages. How is it that we recognized the importance of familiar home-like environments for Bobo but not for Grandma?

WNYC public radio show Radio Lab did a fantastic show on the culture change of zoos. In it, the hosts interviews zoo director David Hancocks who pioneered the change. He said, “[There was a time when I thought] Do I want to go and work in zoos and try to change them or do I want to stay outside zoos and work to close them down and I came to the conclusion that there is no way you are going to close zoos down.”

So, what did he do? As host Robert Krulwich says “He decided to take a look at the entire philosophy of the zoo and change everything.” Wow, right? It gets better…the zoo staff had all the worry that comes with systemic change and anxiety about how the animals would react to their new environment. The kicker…in just four weeks in an improved environment, the animals showed improved brain activity.

Once you get over the retro-frustration about the fact that a need for culture change in zoos came about 20 years before the need for culture change in long-term care, you can take heart that these more natural environments for animals are now “the way things are done” in zoos. If they can accomplish that for animals, we can certainly accomplish that, and more, for our elders.

(In the podcast of the show, you may want to listen up to minute 23-ish as the first segment is the one I am talking about and the second deals with letting zoo animals eat what they would have in the wild – an excellent case for refrigerator rights but not the sort of thing to listen to around meal time, if you get my drift.)

Coordinating Neighborhoods

2008-07-03T14:17:00.003-05:00

A number of years ago, having “neighborhoods” in a facility often meant that people named their hallways and perhaps had a few special activities just for the group of residents that lived there. But we’ve found that once folks step onto the path of change, they find themselves hungry for the next step. They create an undeniable momentum to move forward and are inspired by other organizations' Household Models and more advanced Neighborhood Models. But what to do first?! We know that any change must be led and supported by teams of front line staff. In those teams a new position of Neighborhood Coordinator can do much to help the team organize, grow skills and knowledge and move through change. A recent Ask Pact l sheds some light on this pivotal position.

The Language of Culture Change

2008-05-15T11:53:00.003-05:00

A big part of any culture is its language. Nursing home culture is no exception. So, in terms of culture change, there has been an effort to change the undignified language used in nursing homes. A resident is not a “dementia patient” but “an elder living with dementia.” We don’t refer to residents by their ailments or room numbers but by their names. In the dining room, there may be people who need assistance with eating wearing clothing protectors but not “feeders with bibs.” And, the preferred term for those who live in nursing homes is “elder.”

We’ve changed language to fit the new way we look at things, but we also need new words for the new concepts we are using in the new culture. I’ve found, however, that people use some of these words interchangeably, or have preference to one word over another.

After writing countless words on the subject of culture change, I’ve found myself with a preference for different words in different situations and my own rough definitions for them. I offer them here in hopes of hearing your thoughts on these words and the language of culture change.

person-centered – This is the broadest term of these first four that I use most often to describe culture change. It of course honors elders, but it also focuses on the staff, relying on their humanity working to run the organization. Also, this recognizes the relationships between elders and staff, elders with each other and staff with each other as the glue that holds everything together. Institutional practices are not the center of life in the nursing home, people are.

resident-centered – I use this more specific term when talking about “the way things are done.” For example, a system of med distribution that is worked around how the resident orders his or her day, instead of the med pass dictating the resident’s schedule, is resident-centered. Choice in dining, bathing, rising and sleeping are also resident-centered.

person-directed – I don’t generally use this one because all organizations are directed by people and this term doesn’t give an understanding of who those people might be. I see it as more confusing than enlightening.
resident-directed – This is really the ideal – that the residents are really running things. But, at this point, it seems only the most advanced culture change homes are using this method and then only in certain areas of operation. I find “resident- centered” more accurate.

PersonFirst™ - Action Pact’s signature culture change training process that creates
an in-house team of front-line staff, families, and leadership to learn, practice, and teach how to put the person first through training and community building. It does focus on those living with dementia because often those are the folks we ignore and depersonalize the most.

facility – Many people don’t like this word because it is too “institutional.” In general I agree, but I use this term when referring to the physical building(s) and property or when talking about separate facilities under the umbrella of a larger organization.

organization – A term for the nursing home and its systems, it is made up of people and what they give and do.

culture change – a term for the overall movement and any of the work being done by nursing homes to move toward person-centered care and organizations. Some people do not like the “culture” part of this phrase, but I think it is important because the culture goes beyond the nursing home doors to the way elders are regarded in general in our society and our attitudes about nursing homes in our communities.

nursing home vs. home – We are trying to change the institution into home for elders. However, I find it confusing to refer to a nursing home simply as “home” especially when used in context with the place elders lived before they came to the nursing home. It is also problematic to talk about the place where people work as “your home” when meaning “your nursing home.” If I am an employee and somebody says “your home,” I think he or she is talking about the place where my family and I live. However, I do like to use “home” as a word for a concept and ideal as in “creating home for elders.”

institutional model vs. medical model – At Action Pact we have moved to using the "institutional model" over the "medical model" a) because it encompasses more than just the clinical aspect of an organization...the departmental silos, schedules, one-size-fits-all and b) “doing away with or moving away from the medical model” is a phrase that some interpret as meaning being lax in clinical care, which is certainly not the case.

What do you think? Are there other words you struggle with?

Technojoy for Elders

2008-03-12T14:41:00.004-05:00

Isolation is obviously a huge issue for elders living in nursing homes. Of course, there are mobility issues in getting from one room to another in the facility, but even residing in a nursing home keeps elders from the rest of the community. Many residents don’t have phones in their rooms and therefore don’t have the opportunity to pick up the phone to say hi to someone whenever they want. Then there are cognitive impairments that further isolate them by breaking the bridge of communication and understanding with others.

The thing that has made all of our lives easier may be just the tool to address all these isolation issues: the computer. I’ll first say that the gender gap in technology has, itself, caused some isolation for elders in the same way I feel out of the loop with text-messaging teens. It is quite possible that someone living in a nursing home had not even used a computer earlier in life. However, for starters, email makes communication with friends and family more frequent and common than visits, especially from those who live far away. Checking email has become part of daily life for many of us. It can be part of elders’ daily lives too.

Obviously computer skills and access can be the hurtle for elders but HP makes a “printing mailbox” that along with service by Presto, allows people to receive email and photos without a computer and with very little technical knowledge. The system only receives (you can’t reply or send from it) messages from approved email addresses, which means no spam. Imagine one on every hallway, neighborhood or household. If you ever lived away from your loved ones for a period of time, you know how much “mail” can make your day. It is such a simple, and inexpensive, way to bring joy to elders.

Taking elders and computers to the next step is It’s Never 2 Late, a company started by Jack York in ‘99. Using adaptive hardware including touch screens and modified keyboards, the software is designed specifically for nursing homes. It offers engaging activities for elders from puzzles and games to a flight simulator. But, it also has many applications for perpetuating person-centered care. Staff can create power point type presentations to profile each resident in a “get to know me” fashion. One facility made a short video to show other staff members a way to transfer an elder from wheel chair to bed in a way that did not agitate the particular resident. The content can be personalized to meet the needs of individuals and community. Computers have enhanced our lives in many ways and it is exciting to see the possibilities they can offer in nursing homes as well. Contact glenn@actionpact.com for more info on It's Never 2 Late.

Meet me on the Web

2008-02-14T18:28:00.001-06:00

Social networking on the Web is not just for kids anymore. For elders, a virtual community is suited to best serve the real need for social interaction. In the late stages of life, and of course when one is living in a nursing home, there’s a good chance that family and friends are scattered geographically. Limited mobility leaves elders dependent on others for initiating visits. With email, suddenly no one is so far away.

While it’s great to be in touch with loved ones, it’s also nice to meet new people and the Web can help there as well. Inspired by the idea of MySpace – meeting new people around the world with whom you share interests – but finding it quite youth slanted, Marian Van Eyk McCain started ElderwomanSpace for social networking for women of the “third age.” It’s an offshoot of her Elderwoman site Just like other online social networks, there are discussion groups, photo sharing, blogs and comment boards. It’s easy to lose track of time this way and while it is still a screen and not a face you are facing, humanity and discovery still comes through. The women on ElderwomanSpace talk about everything from gardens to their families to the issues facing elderwomen.

So, how can we get folks in nursing homes on the Web? Do elders have access to computers at your facility? Any ideas about getting folks interested activities on the net? The Web is really the most immediate tool we have for combating the isolation elders face in nursing homes and it is right in front of our faces, literally. How can we put it to good use?

Elder Storytelling on the Web

2008-02-04T17:54:00.000-06:00

It is easy for us to get to hear the stories of the famous people and events in history, but I think the combined stories of ordinary folks are the ones that can best paint a story of our past and our humanity. I’m not alone in this. Anyone ever heard of Ken Burns?

Can you imagine what a nursing home would look like if we could see the stories of our elders projected on the walls and floating around in the air? Such a wealth! Taping into elders’ wealth of stories can make the day more enjoyable and rewarding for everyone. Elders have an opportunity to give of themselves and staff get to know them better giving all involved a greater sense of meaning and purpose.

Friends and family know each other’s stories. It’s one of the reasons we find story telling essential for creating home in long-term care. We get to know each other this way. We can also help facilitate relationships when we recognize a common bond between residents and staff members.

Person-centered care focuses on the individual, but a lot can also be gained from understanding the shared history of elders and the years that shaped their lives. Since history often repeats itself, you may be struck by similarities to current events to those events that have shaped our elders’ lives and world earlier in time. This is a great way to start a conversation with an elder about something you both have experienced. It is a way to recognize shared humanity.

There are some great websites dedicated to elder story telling. You could get lost for days in them, reading snapshots of people’s lives. I hope they will give you understanding and inspiration. These sites also have ways for readers to contribute stories. Pull yourself and an elder up to a computer and share a story with the rest of us! You could also use a story from one of these sites as an ice breaker or learning circle to get folks to share their own stories.

I, Witness to History was founded in 1996 by the residents and staff of Larksfield Place retirement community. They had their eye on the means as well as the end: “The process of writing one’s story, promotes personal insight, provides an added sense of self-worth, restores a measure of self-control in one’s life, and provides much-needed social interaction.”

The site is a huge library of stories that you can search by author or topic or just browse. There’s some great tips and info about collecting stories and creating a program like I, Witness to History. You’ll also find info on their inter-generaltional program.

I also love Time Goes By: What It’s Really Like Getting Older blog/site by Ronni Bennett. Time Goes By features great elder issue pages like Elder Video (links for clips featuring elders on YouTube). Ronni’s blog is fantastic and there are links to about a gazillion blogs by folks 50 and older and even a page of photos if the actual rooms where related bloggers do their blogging. There’s also info on setting up your own blog. It’s not for everyone, but I bet you could find a resident or two or four who would like to do their own blog. Not ready to commit to a blog? The Elder Storytelling Place –an offshoot of Time Goes By – is a great place to read and submit one-off stories by elders.

Know of other great places on the Web for elders to share their stories? Let us know in a comment.

The Future of Culture Change

2008-02-04T17:52:00.000-06:00

There’s no denying it, the future, and frankly the present, of almost everything is on the Web. “Oh, certainly not elders and nursing homes,” you may say. But, yes! And here’s why: A)The Internet is a fast, effective and cheap way to spread information on things like, say, culture change. B) The Internet is a fast, effective and cheap way for people, like elders in nursing homes, who are separated from their families and the world in general because of limited mobility, to participate in community.

Over the next few weeks I’ll be blogging about the web and elders. Presenting elder centered websites, ways to be involved in the culture change movement on the web and ways and reasons to get elders in front of a computer. Plus, Action Pact has some great online tools coming down the pipe because the capabilities of the Web offer great learning opportunities.

I’d like to start things by saying while I am a member of Generation X, my computer skills are a bit of an embarrassment and even though the virtual dictionary is a click away, I usually find myself reaching for the bound Websters on my desk. I can think of five Baby-Boomer-and-beyond friends off the top of my head who spend more time on the net and are more comfortable with it than I am. I’m telling you this so you know we will be learning together. Because, let’s face it, our culture has changed the way it sends and receives information. Let’s hope the way we give and receive care in homes instead of institutions will catch on as quickly and well.

politics of change

2008-01-11T16:38:00.000-06:00

I bet I'm not the only one whose ears have been perking up a lot lately because the word "change" has been popping up so much because of the presidential primaries. There's a great story about it from the Associated Press by Erin McClam titled 'Change' in the air, once again.

From it, a quote:"We're obsessed with it. We can't let it go, can we?" says Marian Salzman, chief marketing officer for advertising titan J. Walter Thompson. "It's the word of the day, minute and hour, and I don't even know what it means."

Ah, but we do! Doesn't it feel nice to be ahead of the curve? The culture of our country has a lot to do with the way we treat our elderly.The culture of the 60s and 70s that valued youth, productivity and efficiency is the culture that created an maintained institutional living for our frail elders. I'm hoping that our current culture that seems to value change and progress will support us in our need to find true home for elders. As a country and as the world of long-term care, can we really back up the talk of change with action? Are we as ready for it as we say we are?

Resolution

2008-01-02T11:31:00.000-06:00

Anytime is a great time to make changes in the culture of a nursing home. But, of course a new year and the feeling of a clean slate that comes with it can give you an extra push. One of the hardest things about making a change is the attachment we feel to the old way. Behavioral habits are hard to break, but making a change also means we must realize the way we have been doing things for so long has not been the right or best way. That can be tough to swallow. Making changes in the name of "New Year's resolutions" can give us a pass on the stigma of old habits. We can move forward by simply declaring, "Out with the old in with the new!"

I saw this paragraph in a story about resolutions that can increase our longevity (5 great ways to care for ourselves and elders):

"But don't let these bad habits of the past discourage you - it is never too late to make new choices. What you did in the past can be changed, and your body will respond in kind. What matters is what you do from this moment forward."

I love that line: "What matters is what you do from this moment forward." My resolution this year is to make that my mantra to remind myself every minute is a new opportunity to accomplish something good.

Best of luck on your journeys in this new year. May the best of 2007 be the worst of 2008.

Home for the Holidays

2007-12-11T14:33:00.000-06:00

Around Christmas, when I was a little girl, we used to turn off the lights at night, turn on the tree lights and christmas music and just watch the tree and the snow falling past the window behind it. All of us on the couch just relaxing and taking it all in. Well, our tree is up and it is snowing great big Hollywood flakes outside (stunning if you don't have to drive in it) and I can tell you what I'll be doing tonight after the shoveling. I've brought a tradition from my parents house to my house. Later in the week we'll make Sandbakkles, a Christmas tradition from my husband's Norwegian heritage taught to him by his grandmother. What will you do?

Living in the midwest, we have a culture built around winter, not just Christmas and I think the dark days and cold have us looking for Christmas joy for most of December. Honestly, I think I love all the little things leading up to Christmas at least as much as the holiday itself. December is a time for rituals and comfort. I bet your residents have all sorts of ideas as to what that means to them. Activities for the month of December can be sort of a no-brainer: Christmas concert from a local choir, putting up a tree and decorations, making cookies, religious services, etc. Most of us partake in all those things to some degree, but it is the specifics about the way we do those things that make them our personal traditions. Talk to the residents about their own personal spin on the holidays and personalize the holiday activities in your organization. And then, for Santa's sake, tell us about it! Leave a comment on how you went about getting input from residents and how you incorporated that input into your festivities. Sharing traditions is a great topic for a learning circle or breaking the ice(pun intended) to get to know someone better.

Slow But Sure

2007-11-26T11:38:00.001-06:00

I think all the makeover shows on TV have made us believe big change can happen overnight. Changing your hair or painting a wall is relatively easy to do – but even that can take some serious coaxing and time. How many of us know someone who is clinging to the hairstyle they had in the mid-70s and the avocado green and harvest gold wallpaper from the same time.

Culture change can be like that. It took 30 plus years for long-term care to become the institution it is. The transformation to home will take awhile. Action Pact consultant Megan Hannan knows only too well. In a special guest blog she talks about the role of “slow” in culture change and that speed is not as important as continuing to take the next step:

I was recently co-facilitating a session on listening and barriers to communication in a nursing home that has been working hard toward the Household Model for over a year. After the session, my co-facilitator, Kim a medical technologist at the Hillsboro Medical Center, said she was so surprised at how much people were willing to talk, share, and come up with solutions and ideas. I asked her, “Do you think things are changing?”
She said, “Well, yes. It is slow but sure.”
That phrase really stuck with me and I think it is such an important description of the way we feel change happens best – slow but sure. It is the sure part that we all want. We want people to “get it.” However, it is the slow part that many of us struggle with.

The staff member in this story is a member of the High Involvement team in her organization. Their team has been through some S...L...O...W.. times. There were times when they tried something that did not get good responses and when others in the organization were just not as excited as the members of the team. But eventually, they started to have more response, positive reactions, and spontaneous questions and suggestions.

It was painful to go through the slow times. In some organizations the philosophy might be get it or get out. However, this process of personal transformation, which is necessary for organizational transformation, takes time and lots of opportunities for people to see, here, feel and discuss what the change might be. This High Involvement team didn’t give up – painful as it could be – and found other ways, asked different questions, created new opportunities and kept at it. Their tenacity puts the “sure” in “slow but sure.”

Poetry at Home

2007-10-29T12:56:00.000-05:00

Frankly, I can’t believe I didn’t come up with this blog sooner. I’m smackin’ myself on the forehead. I’m always begging folks to share their stories with me so I can in turn share them with the readers of this blog and our newsletter (and because I personally really like reading them). Well, I just got a great story from Perham Memorial Hospital and Home in Perham, MN about a household that got together with their Household Coordinator, who writes poetry, to write a poem about home. What a great idea, I thought, and what a great poem! So, I decided I’d share the poem here and ask for others to send in their poems and stories about home collected from residents. Suddenly, my brain got a little tickle, you know like when you know you’ve forgotten something but don’t know what? As I was trying to figure out how to format the poem in HTML it dawned on me! There is already a site publishing short stories and poems about home – none other than the NPR radio show, Prairie Home Companion. For those of you not familiar with it, well, just put on your public radio station on Saturday evenings. I’m betting your residents will really enjoy it. It’s charming and nostalgic and completely relevant.

Anyway, on their website, PHC has a feature called First Person (not to be confused with our own, PersonFirst) where you can submit your stories and poems and read those other folks have sent in (including one from yours truly ). I think this is a great and entertaining way to underline the value of home in our nursing homes and to share the fruits of culture change movement outside of the “industry.”

Before and After

2007-10-09T09:57:00.000-05:00

Our friends at Huntersville Oaks in Charlotte, NC have recently crossed that line into the "after" - that is after culture change, after institution and after lots of hard work. Their move into new households has drawn local media attention. I'm pointing out these two articles from Charlotte Medical News and Charlotte Observer because they do a really nice job of showing the difference between before and after and highlight some great improvements in person-centered care. Make sure to click on the "slide show" on the photo from the Observer to see the drastic differences in the old building and the new. Congrats to residents and staff at Huntersville Oaks!

Do Not Go Gently

2007-09-28T12:19:00.000-05:00

Have you heard about a new documentary called Do Not Go Gently: The Power of Imagination in Aging? It’s out on DVD and in showings around the country. It shares stories of some creative people who just happen to be in their 80s, 90s and one is even 109. Now, most of these people have been pretty amazing all their lives – a woman from the Gees Bend quilting community, a famous composer, a career ballet dancer – but of course we find them more so for continuing to do it in their late years. For them, it is just continuing to do what they’ve always done – what they have dedicated their life – their whole life to.

However, the backbone of this movie is the importance of creativity in later years, even if it means shaking a tambourine for the first time in your life while you’re living in a nursing home. We know how important it is for elders to be able to contribute to their community – to have meaning and purpose – and the thing is, being creative is one thing, even on the smallest cognitive or physical level, that every elder can do. They can put something out into the world that wasn’t there before, even if it is just a smile.

One of the folks from Arts for the Aging, a group out of Washington D.C., says about a poetry group for people with early Alzheimer’s in the movie, “They don’t have to remember, they can imagine something in this moment.” Others in the film mention how aging seems to give a person more liberty to be creative. Elders are more in tune with themselves and tend to care less about what people think of their creative expressions.

So, I’m recommending the movie. Here’s the site. It is interesting because of the stories of the artists involved, but I think it is most helpful, or inspirational in the way that it reminds us of how important creativity is in our communities and our lives, no matter what age.

"I'm 86, not 8"

2007-09-24T10:08:00.000-05:00

I saw this little story on the web today - "Seniors balk at ban on free doughnuts." You'll see that there are many factors contributing to the refusal of baked goods donated to senior centers. However, the thing that really stuck out to me is the tone through which the new policy expressed. It sounds like they are talking about children, not adults. Choice is taken away from elders even before they move to a nursing home. Why do we do this?! Ideally, they would have healthier snacks donated too, but instead of offering more choice they are eliminating the choice all together.

Neighborhoods

2007-08-29T13:10:00.000-05:00

We’ve heard some great news from Town & Country Health and Rehab in Minden, LA. Their National Night Out celebration won a first place award from Minden’s City Council. Each of Town & Country’s five neighborhoods had its own celebration. Their participation in National Night Out is a reminder that even if you live in a nursing home, having a sense of community both within the nursing home and in the greater community is essential for identity, meaning, purpose, relationships and, yes, fun.

It has me thinking about neighborhoods. Truth is, for many nursing homes, the Neighborhood Model is the way they go. The Neighborhood Model focuses on community, relationships and a sort of graceful living that comes when the stage is set for spontaneous gatherings and activities. People know each other and look out for each other. (In fact, those operating in the Household Model should not ignore the neighborly relationships between households and with the greater community outside the facility.)

The Neighborhood Model is more than just calling a hallway a “neighborhood.” A neighborhood pools its resources to make positive things happen. John McKnight and John Kretzmann of Northwestern University and the Asset Based Community Development Institute have developed a system for neighborhoods to get the most out of what they have. From the website: The ABCD Institute spreads its findings on capacity-building community development in two ways: (1) through extensive and substantial interactions with community builders, and (2) by producing practical resources and tools for community builders to identify, nurture, and mobilize neighborhood assets.

Once all the resources are out on the table, interdependent relationships can start to take form. This means that everyone – staff, elders, family – both give and receive care and friendship. The Pioneer Network’s Declaration of Interdependence says this: “As human beings, we live by and through cooperation with others- it is out destiny. In spite of the emphasis placed on being independent, in reality we are all interdependent. The nature of our cooperation withy and relationships to others changes as we grow, mature and age. These relationships form the basis of all true communities. Therefore, we seek to understand and possess the skills necessary to be interdependent in healthy, productive ways.”

I would also humbly recommend the information and activities in the Good Neighbors Action Pact workbook . I wrote it because I happen to live in a thriving neighborhood, Washington Heights, on Milwaukee’s west side. I have come to depend on and treasure the people in my neighborhood even though we are acquainted just because we happen to live in close proximity. Some of those people are now my dearest friends. If it is possible here, where people leave the neighborhood for hours or even days at a time and can hole up in their own houses for similar periods of time, it can certainly happen in a nursing home.

Here are just a few facilities operating in the Neighborhood Model:

Levindale and Jewish Convalescent Baltimore, MD

Elizabeth Seaton Pediatric Center New York, NY

Provena St Joseph Freeport, IL

Provena Sacred HeartAvilla, IN

Kateri Residence New York, NY

I really encourage you to make community or neighborliness a priority and corner stone in your culture change. It’s one of the easiest things you can do to change your culture because it is already there, you just need recognize it and put it to good use. Start with the elders, they’ll show you how it’s done.