A recent New York Times article quoting award-winning author Dr. Al Power reminds us that people living with dementia have much to teach us about being fully present with one another.
“Empathy Without Boundaries” highlights how individuals living with dementia experience a heightened sensitivity to the emotions and non-verbal communication of those around them. Studies show that these individuals may have a stronger empathetic response; if you are agitated they will feel it, if you are stressed so will they be.
Dr. Power, author of Dementia Beyond Drugs, notes that “we have to be very aware of our body language — being centered, present, not being distracted” when we spend time with someone who lives with dementia.
This is yet another wake-up call around how we respond to so-called “behaviors” exhibited by people who live with dementia. Better yet, it gives us the opportunity to consider how our relationships with them call on us to really show up for them – to truly BE with them.
In our busy world, developing this skill is a gift offered to us by people living with dementia. We learn to pause, breathe, and let go of whatever it is we are carrying from our day and be in the moment with another human being.
Share this article with your care partner teams and consider discussing how we each grow when we open to the opportunity to learn from the people we care for. From this perspective, everybody wins.
The Eden Alternative and LindenGrove, Inc. are partners on a grant proposal to fund Dementia Beyond Drugs training based on the award-winning book by G. Allen Power of the same name, Dementia Beyond Drugs. The 2-day training from The Eden Alternative applies person-directed care techniques to promote growth, meaningful engagement, and improved well-being for people living with dementia.
Thirty-three people from across four Wisconsin-based LindenGrove, Inc. long-term care communities will participate in an interactive training experience recently approved by the Helen Bader Foundation and the Women & Girls Fund of the Waukesha County Community Foundation. These foundations see real value in this training, which supports a nationwide call to action to reduce the use of antipsychotics in long-term care.
A large number of individuals living with some form of dementia receiving antipsychotic drugs suffer from a quality of life that cries for an urgent answer. Too often, medication is used in attempts to modify challenging behaviors, in lieu of utilizing specific techniques that help identify the unmet need(s).
LindenGrove campuses at Menomonee Falls, Mukwonago, New Berlin, and Waukesha are all members of the Eden Registry, which recognizes organizations across the continuum of care for their commitment to improving quality of life for the people who live and work there. The Dementia Beyond Drugs training, which is scheduled for June 10-11, will prepare these four Registry Member communities to deepen their commitment to person-directed care, while playing a key role in the nationwide movement to reduce antipsychotics for people living with dementia.
This grant partnership is an excellent example of how The Eden Alternative can partner with members of the Eden Registry and other organizations interested in bringing our educational offerings to their staff. We have been successful in securing grant funds for a variety of projects including creation of the Dementia Beyond Drugs curriculum, Dementia Beyond Drugs training, Certified Eden Associate training, and Embracing Elderhood training.
With budgets getting tighter, we encourage you to look for opportunities to tap into funding from local foundations to support your training and education efforts. We would welcome the opportunity to partner with you to seek out grant funding. Please call us if you have any ideas!
“An Elder is someone who has lived the history that we can only read about in text books. Now is the time to honor their sacrifices and record their stories.” Marvin Maxwell Melbourne III.
One day recently on a Eden Registry Networking call we began to discuss ageism and its effects on society and our youth. Heather Hutchins from Mission Health Services was on the call and she told us the story of an Elder that was a true advocate and made a huge impression on the care partner employees and Elders at Hillside Rehabilitation Center in salt lake City, Utah. He made such am impression that Mission honors his memory by continuing his legacy and naming him as their their mascot. Here is their story:
Marvin was a real gentlemen that resided at Hillside. At first Marvin did not like living at Hillside and he exhibited certain ‘behaviors’ as it were. Over time he began to become a part of the community and played a role at Hillside looking out for others that did not have a voice for themselves. Marvin passed away over a year ago but lives on through his blog and his work as the Mission mascot.
Marvin was originally created as part of our Youth Ageism Awareness Education Program. This program educates the youth of the community about the negative effects of ageism. “Ageism allows the younger generations to see older people as different than themselves; over time, they cease to identify with their elders as human beings.”Wendy Taorina, 2012-9-12. Marvin also wants to make sure that the younger generations understand ageism when caring for the aged population. Senior advocates would argue that ageism contributes to negative stigmas against nursing homes. As part of the ageism awareness program, Mission is starting a new program called: “Take my Hand and Tell me Your Story.” Another tool to help bridge the gap between the elders and the youth and dispel the negative aspects of ageism.
Marvin’s blog is a journal he writes to his wife Millie. He talks about his experiences living in a culture change home, his struggles living with his wife’s Alzheimer’s, ageism, care for the caregiver, and his story, his history. Marvin believes the first step in bringing awareness is through the stories of the Elders. He is telling his story, his wife’s story, and he puts a little historical background into it.
Mission is dedicated to telling our story. Mission is dedicated to being the hero’s and advocates for our aging population. Each and every day, we do what is right for our Elders and in return they care for us. We honor them as human beings, as the carriers of great wisdom.
You can read Marvin’s blog here: www.missionhealthservices.org/marvin/
Marvin also posts on Facebook: history, care for the caregiver, caring for Elders at home, Ageism awareness, and awareness of the world or issues that may affect our Elders.
As we come upon National Nursing Home Week, the reality is that we aren’t likely to see a special section of the greeting cards aisle in the store dedicated to this theme. But who needs greeting cards anyway!
I encourage all of you dedicated professionals working throughout the nursing home industry to take time this week to celebrate the important work that you do every day. Your dedication and caring make life better for the Elders and your co-workers who share the load with you. You make a difference!
I especially applaud those of you who have embraced the Eden Alternative Principles, for your commitment to fighting the three plagues of loneliness, helplessness, and boredom. As Certified Eden Associates and Eden Registry Members, you are applying the Ten Principles in your work every day and improving well-being for everyone around you. You make a difference!
Personal growth and change are never easy. But every day, I hear examples of CNAs, nurses, administrators, therapy professionals, social workers, housekeepers, dieticians, etc. who are stretching themselves and learning new ways to do things using person-directed care principles. Not only are you growing, but you are helping those around you to grow as well. You make a difference!
You do hard work that is beyond the capacity of so many people, yet, you do it with a smile and a cheerfulness that brightens the day for others around you. You know why you go to work every day. You have a purpose… to serve the Elders and to keep the Plagues out of your home. You make a difference!
As you celebrate this week and enjoy the fruits of your hard work, I also challenge you to look ahead to see the future. Ask yourself what you can do to keep growing personally and to help those around you to keep growing? We have learned at The Eden Alternative that growth and change are part of our never-ending commitment to practicing person-directed care. How are you going to grow and help others to grow over the coming, year so you can continue to make a difference?
I thank you for all you do.
We are excited to announce the launch of the 2014 Eden Alternative International Conference website. Check it out and get pumped up for Strike a Chord, Resonate Well-Being in Nashville, the Music City, from April 30 to May 2, 2014! The conference theme highlights the power of the Eden Alternative Domains of Well-Being™ and how they help us create a life worth living for all members of the care partner team, wherever Elders live. Special guests will include organizational change visionary and co-author of Tribal Leadership, John King, Eden Alternative Co-founder Dr. Bill Thomas, and inspirational speaker and activist, Sarah Rowan. The unique conference framework highlights focus-specific break-out tracks and interactive general sessions, including a set of TEDTalk-inspired events designed to get you thinking. And fun? What do you think? Click here for a reminder about our penchant for fun.
Use the conference website to plan your trip and fundraising efforts and check it frequently for regular updates and new developments. Over the next year, site information will constantly evolve and expand, so bookmark it for easy access. You can also check out the conference website by clicking on the 2014 Eden Alternative International Conference on our home page at www.edenalt.org. Eleven months and counting….
Engagement with the broader community helps bring meaning and joy to elders living in The Eden Alternative-registered Sherbrooke Community Centre in Saskatoon, Canada.
Community involvement has been an ongoing and important Sherbrooke value since its inception and commitment to community is a core objective of our organization. We do this, not only because it is an essential tool for gaining community respect, garnering support and being a good corporate citizen but also because it helps the public reframe their views of long term care as a place where “old folks” spend their declining years.
In Canada approximately 5-7% of the population lives in a long term care home. For those that need this level of support we have the important job and privilege of bringing the world to them. Leadership in the community and a genuine desire to engage with the community makes our elders proud and surely pride in our work, our home, our community is one of the things that contribute to a life worth living. We encourage you to find in your community those institutions, organizations, groups, schools, clubs and people who can enrich the lives of elders.
Like everything that makes a difference these opportunities take work. So how do we make it happen? It is pretty simple, everyone in Sherbrooke plays a role. A spark of an idea can come from anywhere in the organization. If it is seen as a feasible idea based on available resources then we move forward. It is important to note that we can’t do everything and people in the community often ask us to get involved in something like a walk-a-thon and sometimes we have to say no. However, if elders are interested and we have the human resources to pull it off we will.
Usually one person takes the lead or coordinates a particular project or event. The facilitator could be from any area of the building including housekeeping, maintenance, food services or human resources. The facilitator makes sure that everyone completes their tasks and that the event is ready to proceed on time and on budget. Global events, those that involve the whole community are often led by the Manager of Global Events and Volunteers.
One example is our 40th Anniversary Celebrations. One of our goals was to plant 40 dozen tulips with elders. We wanted to make it a community event so we called one of our partnership schools and they organized a class of 6th graders who assisted elders to plant the tulips. The teacher talked about the value of community involvement and helping others and being a part of their neighbourhood. And then they went to work. Previously our master gardener and maintenance staff dug up the flower beds. The master gardener educated the class about how to ready the soil, using compost collected by elders, and helped them stake out the pattern for the plants.
The team set up chairs around the area for viewing and planting. Staff, families and volunteers assisted elders to the site on the edge of our property. Because the school was in the neighbourhood no transportation costs were incurred. In our experience, people in the community are looking for opportunities to engage. It is important to build on the resources we have cultivated in the community and engage them in our events, creating a more interesting and diverse community experience. Everyone had a wonderful time and this spring we will enjoy the fruits of our labour; a new bed of vibrant, multi-coloured tulips.
Below we have included a list of some of the partnerships we have built and continue to nurture.
Where our residents volunteer, mentor and participate:
- Wounded Warriors, Veterans Groups, Remembrance Day Events
- Schools at all levels and community associations
- Local community garden, Berry Patch, they compost, recycle, garden and thereby reduce our environmental foot print
- Elders participate in Sherbrooke Secret Santa and Free the Children, adopting a village in Sierra Leon through the Me to We Program with our partnership schools
Elders volunteer with:
- Saskatchewan Jazz and Blues Festivals
- Sherbrooke Creative energy – Open Mike Night
- Mentoring at local schools
- Fund raisers
Sherbrooke gives back to the community that supports us:
- Exchange Program with Canada world Youth. We invite students from Nicaragua to Sherbrooke to participate in a cultural and volunteer exchange
- Katimivik another student volunteer and exchange program with youth from across Canada
- Practicum and internship opportunities for students (U of S, Technical schools)
- Art experiences for children using wheelchairs, canes and other mobility aids to paint and draw
- Building an accessible playground on our property for neighbourhood children
- Nature opportunities with ACTEL Students from a neighbourhood school
- Provide an enriched environment for the 36 space Oak Trees and Acorns Childcare Centre at Sherbrooke
- Sherbrooke Adult community Day Program
- Moving On Program for younger disabled people who live in the community
- The Mindful Café for family members living with a spouse with Alzheimer’s Disease or Dementia
- Tumbleweed Gift and Thrift Shop for Elders, staff and the community
- Annual Home Fires Newsletter delivered to 1400 Saskatoon Homes
- Encourage families to bring their children to Sherbrooke and staff to involve children in our community ( Bring your kid to work Day)
- Encourage staff to bring their pets to work.
- Create a welcoming and fun environment that invites the community to be part of our world
- Art and Music events
- Pet Rescue events for the community an environment that outsiders want to be in
It has been 10 years since Mississippi Methodist Senior Services in Tupelo, Miss., opened the first Green House project in the country. Throughout May, The Green House Project will celebrate this pioneering organization, and the revolution that they sparked. On Sunday, May 5, there will be a block party to celebrate this milestone, with Green House team members and Dr. Bill Thomas in attendance. Follow us on twitter at #Tupelo10 and join the conversation.
Steve McAlilly, the visionary leader who believed in The Green House model and brought it to his organization tells a story about its impact:
There was a retired methodist preacher who had Alzheimer’s. He lived in our Alzheimer’s unit in the old ward. He had an eight-year-old grandson who refused to come see him in that environment. His parents couldn’t get him to go see his grandaddy. His disease was so advanced he wasn’t awake but 4 hours a day. But he was one of the first people in the world to move into green house. People would ask what is he going to get out of it? He’s barely awake, has to be fed. But we believed that bringing him to the hearth, to the supper table, something would get through and it would make a difference.
So every day the Shahbazim would get him dressed and bring him to the table. Before too long he was awake again, and his grandson would come back to see him. He came to see his grandaddy so much he knew the name of every elder and every Shahbaz in the house. If that’s the only thing we did we can say it’s worth it. Whatever sweat and tears we had it was worth it.
“I have seen there is no more powerful way to initiate significant change than to convene a conversation… It is always like this. Real change begins with the simple act of people talking about what they care about.”
– Margaret Wheatley
As Margaret Wheatley says here, starting a conversation is the most powerful means we have for bringing about significant change. Groups may miss the mark, though, when it comes to structuring conversations in a way that each person feels truly heard and valued. When people are given a voice in the process, their resistance to change diminishes, and they begin to see themselves as a vital part of the solution.
As culture changers, we have Action Pact to thank for the gift of the Learning Circle, as an exceptional approach to engaging all stakeholders in effecting change. The simplicity of the tool can lead people to discount its effectiveness. Don’t be fooled, though, as its simplicity is the very thing that makes it so powerful.
As Westerners, we are not conditioned to be deep listeners. It takes time and a commitment to lead by example to shift our cultural tendency to speak first and listen later. In a society that typically talks fast and moves fast, the quieter, more timid personalities can get lost in the shuffle. As change agents, we know that each voice is a precious resource, and Learning Circles create a safe space to draw them out. Follow the Learning Circle Guidelines carefully and discover untapped potential you didn’t know you had.
What leaders need to remember is that Learning Circles are not lip service. You need to be prepared to take what is learned from these powerful conversations and empower your teams to put it into action. Employee care partners learn very quickly whether leadership is truly committed to creating a participatory environment or not. Break their trust, and you derail their belief in the change process. Don’t just talk; walk that talk.
Learning Circles are integral to any phase of a change initiative, but they can be particularly powerful as teams embark on their culture change journey. They create a strong foundation for building the collaborative culture that person-directed care requires to thrive. Leaders can’t just tell teams how they are going to change. To be successful, teams need to make change their own. Learning Circles provide the ideal container for this vital sense of ownership to grow. Skip them, and you stunt that growth.
Consider any of these Learning Circle questions to get started, or come up with your own:
- What does mean to be care partners to one another?
- Is our organizational culture warm and affirming?
- Does our organizational culture build on strengths?
- Are we creating a truly collaborative environment?
- Focus on one particular Eden Alternative Principle at a time and during the discussion portion, explore how folks would like to see that Principle come to life in your organization.
 The Learning Circle, Copyright 2001, Action Pact, Inc. Permission to reprint for use by The Eden Alternative.
Researchers from the Rand Corporation recently published a study that found medical costs of treating dementia totaled $109 billion in 2010. This is more than was spent on heart disease or cancer! What can be done now to slow increases in expenses and improve care? The Wall Street JournalReal Time Economics Blog highlights the financial impact of The Green House model:
RWJ and a nonprofit, NCB Capital Impact, have also funded the Green House Project. Each Green House accommodates 10 to 12 seniors with medical help provided by certified nursing assistants.
David Farrell, The Green House Project director, says the small homes allow for less administrative costs and allows residents to remain ambulatory, even with a walker, rather than depending on wheelchairs.
Plus, the nursing staff develop a closer relationship with a small number of [Elders]. “The [CNAs] can pick up on subtle changes in the elderly,” which leads to preemptive care rather than medical emergencies, Mr. Farrell says.
In a Green House home more money is spent on care and less on administration. The Elder to staff ratio makes for better care and less hospitalization of Elders. To learn more, read about The Green House Project’s cost saving summary. Read the full Wall Street Journalarticle here or learn more about The Green House model.
This article was originally published on The Green House Project blog.
A recent article in McKnight’s Long Term Care magazine highlights a study that concludes it is safe in most cases to eliminate antipsychotic drugs without risking adverse outcomes for Elders. This study supports the current initiatives from CMS, AHCA, and Advancing Excellence to reduce the use of off-label antipsychotics, which is great news. Let’s hope this study helps to reduce fear to take action and adds fuel to the fire to eliminate these powerful, life-altering drugs wherever possible.
Eden Alternative will continue to do its part with our Dementia Beyond Drugs training developed in collaboration with Dr. Al Power, a leading international authority on person-centered dementia care. We have trained several hundred direct care workers representing hundreds of nursing homes with plans to train many more in the coming months. We are positively impacting the well-being of thousands of Elders living with dementia and their care partners.
We know this is difficult work, but the results are well worth it. Got any success stories to share that might inspire others to take on this challenge? Please share.
LakeWood Care Center in Baudette, MN is taking “becoming well-known” to new heights. They figured out a fun, innovative way to decorate their home, entertain Elders and visitors and become well known to each other. (Principle Three and Five) So after many team and Resident Council meetings they came up with a way that makes excellent use of technology. They have installed TV’s throughout the home that display slideshows with pictures of care partner employees, Elders, family members, activities, the daily menu and current events.
This was a joint effort put on by the Resident Council, the Activity Department and one super fabulous volunteer Carl Breske. The project began by connecting with the IT department to see what equipment would be needed to complete the project. They got a complete list made up of one central computer, several TV’s with wall mounts and electrical wiring.
Once the list was complete they got to work on raising the funds. The Activity Department along with Resident Council raised $800 with bake sales, rummage sales and silent auctions. (Principle Eight) They were able to purchase the TV’s, mounts, and a modulator (for the computer to work correctly with the TV’s). Thankfully they were able to get the wiring donated by the local cable company, and LakeWood Care Center took care of the electrical wiring and hook-up.
The Activity Department creates slideshows using MS PowerPoint. Photos are easily uploaded on the day of the event so everyone can enjoy them almost immediately. (Principle Five) They take great pride in making sure that the photos are updated often throughout the week to keep it fresh. Slideshows are updated every day with new menu choices and the daily activity schedule. They find it is a fantastic way to get the word out each day about birthday’s and special anniversaries. (Principle Six)
An extra special gift came from family member and volunteer, Carl Breske, who is now LakeWood’s official photographer for larger events. He promotes the Eden Alternative Philosophy further with a TV and computer slideshow of his own. He has created an “Eden Area” near the entrance of the home with their Eden Tree plaque, a TV and display cabinet that contains Elder crafts they are being sold by the Resident Council. With some direction from Family Council, and with Carl’s assistance, they are now looking at creating advertisements for the items that Resident Council has for sale in the display cabinet to increase sales and awareness. (Principle Six and Nine)
This is a home that really understands the Eden Alternative Ten Principles and knows how to take an idea and put it into action using a little elbow grease, innovation and technology. If you would like to know more contact Carrie Claybundy 218-634-3461 or firstname.lastname@example.org.
Principle Two of The Eden Alternative tells us that the creation of a Human Habitat is the most effective cure for the plagues of loneliness, helplessness, and boredom. By definition, a Human Habitat is “an environment where different species live in supportive and empowering ways, eager and able to thrive, not just survive.” A rich Human Habitat involves an array of close and continuing relationships and spontaneity and variety as the spice of daily life. Diversity, then, clearly lies at the core of a healthy Human Habitat and the life worth living that it supports.
While this may come across as a no-brainer, diversity awareness is often dismissed as politically correct mumbo jumbo or something that an in-service or two can cover. Successful change agents, however, know that a deep and ongoing commitment to celebrating diversity is the cornerstone of building meaningful relationships and creating an inclusive team environment, where each voice is heard and honored for its unique contribution.
Let’s face it. Care that is genuinely person-directed can’t exist without a dedication to diversity awareness. How can we truly know people well, if we aren’t digging more deeply and taking the time to develop a more complete understanding of their cultural heritage and how it influences their preferences and choices? When diversity awareness becomes a vital part of the organizational culture, culturally-specific communication barriers dissolve, new relationships are forged, and opportunities to grow and learn from each other expand exponentially.
This said, facilitating an appreciation for diversity in your organization is a multi-layered endeavor that requires thoughtful attention, creativity, and finesse. On April 10th from 3 to 4 pm ET, two inspiring leaders, Sandra Place and Arif Padamshi, will share how promoting diversity awareness has deepened and strengthened their culture change journeys. As a part of the Facilitative Leadership Webinar Series, “Facilitating an Appreciation of Diversity” will focus on how the creation of effective teams requires an organizational culture that respects, honors, and appreciates the unique differences, qualities, and values of each member of the care partner team. Click here to register.
To explore this issue in your teams, consider the following Learning Circle questions:
- How are we doing when it comes to building diversity awareness?
- What are the current barriers to deepening awareness of our cultural differences?
- What access do we have to educational resources to build our skills around this issue?
- What are some creative ways that we can promote learning and growing between different care partners on the team?
Being an empowering facilitative leader is the single most important aspect of the culture change journey. For person-directed care to become a reality, facilitative leaders must create an environment flexible enough that teams can make decisions on the spot and adjust to the needs of the moment.
Care partnership, as The Eden Alternative defines it, really supports the idea of empowerment. In the traditional caregiver/care receiver dynamic, individuals who identify as caregivers often define their role exactly as it is described – to give to and “do for” the care receiver. This often reinforces helplessness on the part of the care receiver, who, over time, is conditioned to give in to this passive role. The result is a burned out, depleted caregiver and an unempowered care receiver.
Care partnership calls on everyone involved in the care relationship to see themselves as partners in care. As care partners, we learn to recognize that every individual has something to offer another, no matter what challenges they may live with. We also begin to recognize the many ways we can receive from others, that perhaps, we didn’t see before. This evens the playing field and acknowledges that care is really about the subtle dance of giving and receiving alive in every moment between two people.
Empowerment, then, is about all kinds of teams – care partner teams in nursing homes, in assisted or independent living, in small homes for people living with different abilities, or a care partner team that includes an Elder who lives in her own home. No matter where we live, how can we empower each other, as care partners? Feeling empowered is vital to our continued growth and development, no matter who we are, or where we live or work.
All this said, facilitative leaders may find themselves bumping up against some team anxiety or resistance to develop their own leadership skills and take on more responsibility. Facilitative leaders might feel discouraged or even waver in their commitment to create a participatory environment when teams push-back. But it’s important to remember that push-back is a natural part of the growth process. Hanging in there will be well worth it.
If teams struggle with being empowered, leaders need to:
- Create a safe space for discussion and sharing of the concerns, through Learning Circles or other means.
- Affirm discomfort and make sure team members feel heard and understood.
- Clarify/identify what conditions need to be in place for team members to feel comfortable with more responsibility.
On Tuesday, March 19th from 3 to 4 pm ET, three culture change leaders who work in three distinct care environments will come together to explore empowerment of teams in different settings. As a part of the Facilitative Leadership Webinar Series, “Facilitating Empowerment” will explore qualities and approaches unique to facilitating empowerment in different care environments and the ultimate goal that each of them shares: empowering the individual accepting support. Click here to register.
Published first at The Eden Alternative Blog
Spring is on the way! Now is the time to start dusting off the garden tools. Jack Carman of Design for Generations reminds us that gardening can play a powerful part in care plan development. An Eden Alternative value-added partner, Design for Generations specializes in the development of outdoor environments that promote engagement, empowerment, and well-being for all.
Check out what Jack has to say about the unique impact gardening can have in care environments in his article, “Incorporating Gardens Care Planning,” and make sure you catch a free webinar event featuring Jack on this subject on March 20th from 3 to 4 pm ET!
I just saw the results of an interesting survey published in the March print issue of Provider Magazine. The source is the My Innerview Skilled Nursing Employee Engagement Satisfactions Surveys collected in 2012 by National Research Corporation.
The question from the survey that is highlighted is “Would you recommend this facility as a place to work?” Interestingly, the CNAs and Nurses surveyed responded that they would recommend their facility less than 65% of the time. In contrast, Administration and Nursing Administration responded that they would recommend their facility about 85% of the time. I think a 20% difference between the responses from CNAs and Nurses versus Administration and Nursing Administration is significant.
What does it tell us? Maybe it tells us that the folks with the power and control think things are just great while the folks in the trenches who may be feeling disempowered aren’t so happy? My gut tells me that this is more evidence that many nursing homes still have a long way to go in moving away from the old disempowering hierarchical management model and moving toward an empowering person-directed care approach to improve staff engagement, satisfaction, and well-being. The results we’ve seen from Eden Registered Homes over the years certainly shows the many benefits to be gained by making this transition.
So, how big is the gap in your organization? More importantly, what are you doing to close the gap?
Because the needs of the senior population are different from the needs of younger patients, hospitals should make changes to create an emergency department geared to the needs of seniors, says William Thomas, MD, an elder care expert who is working with Livonia, MI-based Trinity Health on geriatric issues and development of the senior emergency departments.
The physical environment should be altered to accommodate the physical needs of older people, Thomas adds. The staff in the emergency department have to receive specific training in the care of elders, and the way care is provided should be reorganized to include an emphasis on pharmaceutical issues such as medical reconciliation and social issues that could interfere with the patients’ living independently in the community. The organization’s culture also must change to ensure that the needs of older people are a consistent part of the care process, he adds.
Senior emergency departments should have no-glare lighting with dimmer switches in the rooms, non-slip, non-glare floors, hand rails, and grab-bars throughout the entire area to accommodate the needs of seniors, Thomas adds. Pressure-reducing mattresses, blanket warmers, and clocks, calendars, and telephones with large buttons all create a senior-friendly environment.
Because of noise buffers, the senior emergency department is much quieter than the main emergency department, says Sue Penoza, RN, MA, strategic planning director for Trinity Health. Materials the staff give the patients are in large print, and reading glasses and hearing devices are available for people who need them.
“When we began developing our senior emergency departments, we reviewed the skills and knowledge the staff needs to take care of the elder population and developed recommendations for the education of nurses and physicians, as well as for other caregivers such as patient care assistants,” Penoza says. The health system offered educational sessions around ageism, created videos, and offered workshops on working with the senior population.
The hospitals included the education in the hiring and orientation process. “Our senior emergency departments focus on delivering evidence-based, patient-centered care to elders who are relying on us to help them achieve the best possible outcomes,” Penoza says.
Source: Hospital Case Management
Copyright © 2013 AHC Media LLC. All Rights Reserved.
When patients who are over age 65 come into the emergency department at St. Mary Mercy Livonia Hospital in Livonia, MI, they are triaged to a 14-bed dedicated senior emergency department unit designed to meet the special needs of the senior population.
“When we opened the first senior emergency department in Michigan, the staff knew immediately that it was the right thing to do. The senior population is different from younger adults. In addition to a range of medical issues, many seniors have chronic conditions, take multiple medications, have cognitive deficits and other behavioral health issues, and may be living in an environment that puts them at risk,” says Michelle Moccia, RN, program director of the senior emergency department at the 308-bed acute care hospital. St. Mary Mercy Livonia is a member of Trinity Health, a health system that includes 47 acute care hospitals as well as outpatient treatment centers, long-term care facilities, and home health and hospice programs in 10 states.
Trinity Health’s first senior emergency department was established in 2008 at Holy Cross Hospital in Silver Spring, MD. “It was so positive for patients and family members that the Trinity Health leadership decided to create a model that could be replicated in other hospitals,” says William Thomas, MD, an elder care expert who is working with Trinity Health on geriatric issues and development of the senior emergency department initiative. Taking the lead from Holy Cross’ senior emergency department initiative, Trinity Health and Saint Joseph Mercy Health System started implementing the model in 2010, opening the senior emergency department at St. Mary Mercy Livonia, and following quickly with seven more senior departments in eastern Michigan. To date, Trinity Health has developed 19 senior emergency departments in four states.
The senior emergency department is staffed by a core team trained to work with seniors, with other clinicians rotating through the area. Patients who are 65 and older who come into the emergency department receive the same assessments, even if the senior emergency department unit is full. The hospital is building a new area that will accommodate an additional 14 seniors.
“Most emergency departments are geared to treat adult patients for their chief complaint. In the senior emergency department, we go beyond that complaint, assessing and addressing additional issues affecting health and visits to the emergency department,” says Michael Calice, MD, FACET, emergency department medical director at St. Mary Mercy Livonia.
The team looks at the patients’ medication regimen, living conditions, and support system at home. As part of their assessment, the nurses take time to listen to the patients’ stories and determine their functional status. They conduct a depression screen and evaluate the patients for memory loss or cognitive issues that will need to be addressed when the patient is discharged. “We were surprised at the rate of depression among senior patients. But if we didn’t ask, we would never know,” Calice says.
If the nurse identifies any needs, he or she calls in a case manager or social worker to work with the patient. “We want our patients to live the best lives they can and stay resilient. Many times, it takes more than just treating them and sending them home with prescriptions,” says Sue Penoza, RN, MA, strategic planning director for Trinity Health.
The staff in the senior emergency department go beyond taking care of patients’ chief complaints, adds Julie Denomy, RN, care coordinator for St. Joseph Mercy-Port Huron senior emergency department.
“When we develop a care plan for a senior patient, we consider not only the disease, but look at the whole patient-mind, body, and spirit. This is a vulnerable adult population, and it takes spending time with them and their caregivers to find out what they need. We don’t just treat them and send them home. We do whatever is necessary to make sure the patients will do well when they go back into the community,” she says.
The staff in the senior emergency department take a team approach to patient care, Denomy says.
The case managers call the patients’ designated family contacts to get as much information as they can and to report on the patients’ emergency department visits, sometimes alerting them that their loved one may need a different living situation.
“Everyone on the staff is a transition coach. We try to help the patients and their caregivers learn to navigate the healthcare system and make sure they have everything they need,” Denomy says.
The senior emergency staff call back the majority of patients the next day to make sure they understand their discharge instructions and have been able to get their prescriptions filled.
“We want to make sure they understand their discharge instructions so they won’t come right back to the hospital. Often patients are confused about their medication and how they are supposed to take it. Some patients don’t schedule a follow-up visit with their physician or fail get their prescriptions filled for various reasons,” Denomy says. Case managers may call the caregivers or patients’ primary care physician if they or the patients have any concerns.
The expanded assessment has not increased patient length of stay in the emergency department, Moccia says. “At first, it took longer until the nurses became accustomed to the new assessment, but now it has become a habit as they talk to patients-even those who are under the age of 65,” Moccia says.
The hospital has partnered with the local emergency medical service to proactively identify problems with patients’ living situation. “When they go into the home of a senior, they take a quick look to see if there are safety issues, if there is food in the refrigerator, and if the house is heated or cooled. They report to us on what they find, and we work with the community agencies to get these patients the services they need,” Moccia says.
The emergency department team is working with a local home care agency who will contact the patient’s primary care physician for a referral if the emergency department staff feel it’s necessary.
The hospital has worked with local assisted living facilities, senior housing developments, and independent living facilities to ensure that when their residents need treatment, emergency department staff have all the information they need.
“We are working with these facilities to make sure that we can provide seamless care,” she says.
Source: Hospital Case Management, March 1, 2013
Copyright © 2013 AHC Media LLC. All Rights Reserved.
In May of 2005, Jude and I hosted a gathering at Summer Hill Farm convened by Second Journey with an extraordinary and diverse group of people. We set ourselves the task of imagining new models for the second half of life and powerful ideas emerged.
One of those ideas was “Aging in Community” — a concept, a vision, a new way of seeing things that proved powerful enough to inspire my good friend Janice Blanchard to focus much of her energies over the next seven years on teasing out its potential. Janice’s efforts culminated in the release last month of Aging in Community, a superb volume of 23 thought-provoking essays by visionary architects and planners, academics and social scientists, social entrepreneurs and elder pioneers helping forge new models for creating community in later life. I am pleased to have co-authored with Janice the lead essay in the book, Moving Beyond Place: Aging in Community. Here is a link where you will find more information: www.SecondJourney.org/AIC.htm.
We’ve always known most Americans would prefer to “age in place” rather than being forced into an institutional long term care. “Aging-in-place” has even become a cottage industry of sorts, advocated by many well-intentioned people, including some in our audience.
The reality is that aging is a team sport, and focusing our efforts on services and strategies to keep elders living “independently” creates a hollow victory at best. Kristin Bodiford captured the essence of the problem in a recent blog post:
Often the home we have lived in for many years and to which many fond memories and deep relationships attach poses significant physical, financial, or emotional challenges and makes connection with family, friends, neighbors, and the community difficult or impossible.
Aging in community presents a viable and appealing third option to institutional long-term care or “aging-in-place.” Aging in community fosters and draws on reservoirs of social capital. In comparison, institutional long-term care and trying to “age-in-place” rely heavily on financial capital and expensive professional services, while offering older people little or no opportunity to create or deploy reserves of social capital. As Kristin points out, “the concept encourages a proactive strategy to create supportive neighborhoods and networks. Thus, the well-being and quality of life for elders at home becomes a measure of the success of the community.
Aging in community advances the concept of being “a darn good neighbor” — and, as a result, promotes social capital, a sense of trust and mutual interconnectedness that is enhanced over time through positive interactions and collaboration in shared interests.
The gathering at our Summer Hill Farm five years ago was one of a series of Visioning Councils Second Journey conducted at venues across the country. It was a powerful process which sparked conversations that were truly transformative. I’m pleased to announce that now, five years later, Second Journey is reviving and updating this initiative with a gathering that will be held April 11-14 in Chapel Hill, NC. You will find more information about it here: www.SecondJourney.org/VC.htm.
I heartily recommend this program. Please pass this information on to your friends and colleagues.
Goal #2: Increase Person-Centered Care Planning and Decision-Making
Description & rationale: Person-centered care means that each resident of a nursing home has a choice about his or her daily routine, activities and healthcare. Staff places value on listening, learning, and knowing each individual’s background and personal preferences – regardless of the individual’s cognitive ability or length of stay. Using the MDS 3.0, Artifacts of Culture Change and similar tools, the nursing home staff works with the resident and family to develop a care plan, so that a person’s daily routine mirrors the individual’s aspirations, and can adapt to changing needs as they evolve. Working on this goal will ensure that a resident’s needs are met according to personal preferences.
How The Eden Alternative strengthens this goal: A core belief of The Eden Alternative is that all decisions belong to the Elders or those closest to them. Each of the Eden Alternative Principles drives person-directed care through personal and operational transformation. Principle Eight specifically speaks to Elder-driven decision-making. The Three Plagues of loneliness, helplessness and boredom cannot be eliminated, if the daily rhythm of life is not designed to facilitate the preferences and choices of the individuals. Principle Six emphasizes that meaningful daily activity is essential to human health and should be based on the preferences of each individual. Principle Nine states that human growth should never be separated from human life. Therefore, organizations practicing The Eden Alternative foster environments that promote ongoing growth, regardless of what phase of life an Elder is in. The Eden Alternative also encourages a change in language from “care plans” to “growth plans,” and that every care partner (employee and Elder) deserves to have an individualized growth plan. The use of the term Elder, widely used by The Eden Alternative, indicates a desire to shift assumptions and honor each person for the unique contributions they bring to the care partner team, regardless of their phase of life. The Domains of Well-Being™ offer further motivation for organizations to deepen their integration of person-directed practices and create care (growth) plans that fit the unique needs of each individual.
All of the Eden Alternative’s educational offerings discuss and provide tools to assist in the development of person-directed care environments across the continuum of care. Here are some to consider:
- In the Path to Mastery, the care (growth) planning process is specifically addressed in Milestones 2 and 3 with several tools that provide examples, templates, and ideas on how to personalize the process and format it for the individual. In Milestone 3, a particular tool guides leaders in empowering teams to drive the care (growth) plan process and maintain it wherever the Elder lives.
- The Eden Alternative Paradigm Buster, “The Role of Job Descriptions in Person-Directed Care” offers examples of growth plans for employees that are very similar to what is shared through the Path to Mastery Milestone Toolkits.
- The Eden Alternative Paradigm Buster, “The Role of Policies and Procedures in Person-Directed Care” has a template and examples focused on how to write a person-directed care (growth) plan policy and procedure.
- The Eden Alternative Paradigm Buster, “The Role of the Therapist in Person-Directed Care” provides examples of how to shift from treatment-driven care plans to individualized growth plans including goals set by the Elder.
- “Revolutionizing the Experience of Home by Bringing Well-Being to Life,” a white paper featuring The Eden Alternative Domains of Well-Being™, defines each domain and how it can be woven into different systems and processes across the organization. The related Well-Being Assessment Tools can be used to track the well-being of individuals and teams over time.
- Decision Rings is a tool that helps leaders understand the process of empowerment and how to move decisions closer to the Elder. It is featured in Certified Eden Associate Training and Certified Eden at Home Associate Training, and instructions are included in The Eden Alternative Handbook and Haleigh’s Almanac.
- “The Art of Creating a Caring Community with Dr. Bill Thomas” is a DVD that covers over 50 topics focused on person-directed care, surplus safety, and the wisdom of Elders in general.
Since its conception by Dr. Bill and Jude Thomas in the early 1990’s, the Eden Alternative Philosophy has been an important part of the culture change movement. The Eden Alternative has never swayed in its commitment to person-directed care, the growth of each individual, and Elder-driven decision-making. The stories and experiences of Elders and their care partners, not to mention the journeys of many Eden Registry Members, demonstrate just how crucial this goal is to reshaping the experience of aging for all of us.