Arkansas Culture Change

The future of resident center care is bright in Arkansas. We are creating many ripples across the state.

Change usually starts on a very small scale. People see a better way of doing something, or begin to question the basic way things have always been done in nursing homes. These leaders begin to experiment, try new approaches, and then share their successes with others. A few more will try the changes and join the movement. The movement begins to gain momentum.
We have been looking at changes across the state in our nursing homes. Now there are so many exciting changes happening, it is overwhelming!

Traditionally, nursing homes have been focused on the delivery of physical care to residents. Now we can also focus on the quality of life to individuals. We have moved forward not only in our thought processes, but also in the use of technology to improve the lives of our residents.

Many of our homes in Arkansas are using monitoring systems that allow increased freedom for residents, silent paging systems and new communication tools. We are embracing the technology of change to improve the quality of life of our residents.
“Quality of life” is a hard measure to define. Many people feel that quality of life relates to choice and control, positive and meaningful interactions, and quality medical care. (That works for us!) The regulatory process has started trying to quantify quality of life care.

Last month we talked about changes in the environment that allowed residents to keep their beloved pets, next month we will look at some of the new technologies that nursing homes in Arkansas are using to improve their residents quality of life!

If you were following last month’s blog you know we were talking about a teacup poodle and how the poodle is changing the way we are looking at long-term living.

Yes, the poodle’s name is Domino. This poodle has not only changed the life of her owner, but has changed the way Lonoke Health and Rehabilitation is solving issues in their home.

Domino has come to live at Lonoke Health, and so has her owner Mrs. Bonnie.   Living with Mrs. Bonnie, has meant aging with Mrs. Bonnie. Aging has meant changes for the dog and owner, which include moving to a long-term care home, together.

Domino’s mistress talks about how the poodle came into her life and has become a very important part of her daily activities. Domino was her daughter’s poodle and she was only supposed to watch him for a week! That was ten years ago. When the daughter came to collect the poodle, well, let’s just say Domino decided to “age in place” with Mrs. Bonnie.

Today this means living with Mrs. Bonnie at Lonoke Health, sleeping on her bed at night, and greeting visitors at their door with a once over sniff. However, the most important activity is watching the people in the hall!

How do you do this in a community setting? Did we mention Domino is a teacup poodle? That means small. The institution’s response could have been, “Sorry, let’s leave the dog at home,” or, “Sorry the dog can stay, but we have to leave the door closed at all times.” Instead, we looked at the problem in a new way. This meant a team effort. This meant regulatory guidance and carpenter skills. This means you can have a screen door (made to a special size) for viewing the world from a different perspective.

See the world through a our perspective.

                                                                                                                                                                                    I live here now.

Hey can I get in on this?

Flora Permelia Sterrett Whittemore was often called “Gramma Whittemore.” Mrs. Whittemore passed away at the age of 102 at the Caribou Memorial Nursing Home in Idaho. She had a column called “Gram’s Corner” in the Idaho State Journal and reported for the Post Register in Idaho Falls. At the age of 100, she took a correspondence course in geology from Utah State University while living in the nursing home.

Growth has no age limit. This is an example of what leaders in the culture change movement are talking about right now.  In his blog, Dr. Bill Thomas, founder of the Eden Alternative and the Green House Project, talks about coming of age and growth:  http://changingaging.org/blog/coming-of-age-again/ .  Growth is what the Centers for Medicare & Medicaid Services (CMS) is encouraging in our Medicare and Medicaid providers — giving health care workers reminders that we should never stop learning or changing the way we provide care for our nursing home residents. The Administration on Aging is encouraging us to give older Americans the opportunity to teach, mentor and help the less fortunate.  They are calling on us this year to unleash the Power of Age!

We talked last month about changes in some of our Arkansas nursing homes.  To provide quality of life for a resident, one home is looking at a problem in a new way.  The problem: How to keep a teacup poodle safe and allow others to enjoy its cute little face. The solution: A screen door — not just a regular screen door but a special door.  Due to the width of the door and regulations for safety, a special door will be made for the resident and ______ (can you guess the name of the poodle?) Pictures of ­­­______ and the screen door will be in next month’s blog, along with an interview from the resident on what ______ means to her and how her pet represented a time of growth in her life.

On March 6, another leader spoke to us about growth and change. Karen Schoeneman, former deputy director of CMS’ nursing homes division, encouraged us to grow and change with knowledge. Many laughed and cried during her presentation, but everyone came away with the knowledge that change is needed in health care. Karen Schoeneman is one of the leaders helping us to open a new door in resident care. View Karen receiving the Picker Award for Excellence at http://www.youtube.com/watch?v=G3rr7Vs15Ng.

This is Karen receiving the Arkansas Award for Excellence. She received a standing ovation!

An increasing number of care homes — places that once would not let dogs, cats or birds even visit — now welcome companion animals. Many homes have a house pet, and some allow residents to room with their four-legged friends.

When the first culture change ideas and the Eden Alternative movement began to spread, the presence of pets was thought of as a hallmark difference between an institutional environment and one that was more home-like.  An “Edenizing” home adopts the Ten Principles, which include “surrendering the institutional point of view” and adopting the “human habitat model that makes pets, plants and children the pivots for daily life in a nursing home.  (For more information, visit http://www.edenalt.com/.)

Some homes today still think that having a bird, dog or cat is all it takes to have culture change.  But culture change is more than simply having an aviary or a pet.  Culture change homes understand that having pets is a way of life for some residents. Even though state regulations still talk about not having animals in the home, it’s always possible to find solutions that provide resident satisfaction.

Our homes in the culture change project often are on the forefront of problem solving.  Lonoke Health and Rehabilitation is just such a problem solver.  The staff there has been working to find a way to allow a resident to keep her teacup poodle, while making sure both the dog and other residents are protected. They contacted a specialist with the Office of Long Term Care’s environmental section and are in the process of making some changes to the building that will allow the dog to stay without violating any state codes. Check back next month for more details about what the home did and how it’s helped the resident.

Long-term care professionals know how to write care plans, so why not write one for our furry friends? Plan who will take care of the home’s pets:  Residents, staff and family, the nursing home community (yes, the nursing home community), neighbors … get the idea?  That is true change — residents may not have all aspects of their old way of life, but they can start a new life in their nursing home community with their pet.

This is change: Our perception of how to encourage growth and responsibility in our nursing home environment — for residents as well as staff. Change means we must always be learning and problem solving rather than just doing things the way they have always been done.

Join us as we continue to promote growth and learning at a workshop featuring a true change leader, Karen C. Schoeneman, MPA. The workshop, titled “Person-Centered Dementia Care Techniques: The CMS Hand in Hand Toolkit,” is scheduled for 9 a.m. to 4 p.m. March 6 at the Crowne Plaza hotel in Little Rock.

Coffee is a drink that many of us enjoy, especially in the winter months. For some it is a simple pleasure that starts their day. For others, it is a necessity that provides wakefulness and mental clarity for work. A study published in the New England Journal of Medicine found drinking coffee to be inversely associated with total and cause-specific mortality. What?

I think the professionals are trying to say coffee is good for certain people. Elders who blog (yes, there are many elders who blog) talk about how research is showing that coffee is good for people with Parkinson’s disease. :   http://parkinsonsand5htp.blogspot.com/

We have a dilemma in long-term living based on our need to keep our residents safe while still providing the autonomy they need to blog, drink and grow.

So where does that leave us in long-term care trying to provide internet cafes, social gathering groups and resident-run activities? This is a (no, I am not going to say it) topic that nursing homes in the culture change project have been working with over the past year. Coffee temperatures across the United States? We got them! What is the correct answer? We don’t have it! Are we finding solutions? Yes!

Ozark Health Nursing Center continues to be a leader in finding a solution to the problem of safety versus autonomy. The team at Ozark Health has tackled the coffee issue and many more projects concerning the balance between resident safety and life enhancement. Their solution was to find a way to continue to provide hot coffee for their residents in their Rusty Bucket Café.

They are also implementing learning circles as an assessment tool for falls (what a way to get good ideas from all areas of care) and following residents’ routines for medication times, not institutional routines. That means medication times for life enhancement, not institution enhancement. They are taking a step up the staircase by asking potential software providers to look at medication management based on resident times before they will consider using their product. Arkansas needs leaders like Ozark Health as we climb the culture change staircase. Can we all say woohoo!

“Walking with forgetfulness…”
This is how Sarah Rowan (pictured above) described her husband’s Alzheimer’s disease. A large group of CNAs listened to Sarah talk of her husband and his battle with forgetfulness. Sarah lived the life of caregiver for her husband as he slipped further and further into Alzheimer’s. The people in the audience cried, laughed and shook their heads in agreement with Sarah’s quiet stories. Many of the CNAs were very young and yet spoke with a voice of wisdom. These were the hands-on staff, who at times are the most forgotten workers in long-term care. Sarah spoke to them about courage and the need for living with the disease. She spoke of making each day caring for residents with dementia a day of joy and discovery.
Sarah has been called the “The Heart Whisperer,” and the people who attended that seminar would certainly agree. She touched the hearts of those who at times feel overwhelmed with the day-to-day care of residents. Thanks again, Sarah, for not only touching our hearts, but renewing our courage to be leaders in long-term care. Thanks for inspiring the CNAs who spoke of becoming mentors to others in their homes. Thank you for making us excited about spreading ideas on how to understand the behavior of our residents. Those residents who “walk daily with forgetfulness” will be seen in a whole new way.
How truly wonderful it is to start improving the lives of others. There is no need to wait any longer; we have many programs – the Eden Alternative, Spark of Life, Alzheimer’s tours, the Pioneer Network, the Consumer Voice – to help us improve our world of long-term care.
And of course we have Sarah!

Several medical newsletters in the past month have focused on dementia, due in part to a push by the Centers for Medicare & Medicaid Services (CMS) to reduce the use of antipsychotic medications in nursing homes.  Many of the recent studies involve interventions for behaviors. More and more evidence is emerging that shows not only are interventions helpful, but that they can be targeted to different symptoms.  Research has shown that non-pharmacological interventions produce results and don’t have physical side effects. These interventions can be simple and practical.  Some interventions are social interactions and pleasant activities. These interventions have been shown to improve agitation. Other activities have been shown to improve depression and mood.

Research on behaviors has shown that residents of nursing homes have too much stimulation from bells, noise and overhead paging.  Many culture change homes are breaking up their halls into neighborhoods and using mobile pagers.  Person-centered care/person-directed care is a common theme in culture change homes.  Many of the nursing homes in Arkansas are trying different behavior interventions for their residents with dementia.  We have highlighted in our blog several homes in Arkansas that are using new and innovative programs to provide quality individualized care.

Join us on our journey to provide quality care to Arkansas residents of nursing homes.  Come learn with us as we try to assist people affected by memory loss.   Join us Dec. 5 for a culture change workshop called Alzheimer’s —From Diagnosis to Living With.  We can all learn to be change stars!

There is no substitute for the love of an Alzheimer’s caregiver.

— Bob DeMarco, founder of the Alzheimer’s Reading Room, and an Alzheimer’s caregiver.

http://events.afmc.org/home/tabid/424/ctl/viewdetail/mid/1078/itemid/152/d/20121205/AIPP-Culture-Change-Workshop-Alzheimers–From-Diagnosis-to-Living-Wit.aspx

According to the Centers for Disease Control and Prevention (CDC), in the United States, the proportion of the population 65 years and older is projected to increase from 12.4 percent in 2000 to 19.6 percent in 2030. The number of people ages 65 and older is expected to increase from approximately 35 million in 2000 to an estimated 71 million in 2030.

The CDC says “to address the challenges posed by an aging population, public health agencies and community organizations worldwide should continue expanding their traditional scope from infectious diseases and maternal/child health to include health promotion in older adults, prevention of disability, maintenance of capacity in those with frailties and disabilities, and enhancement of quality of life.”

We continue in Arkansas to enhance the quality of life of residents living in our nursing homes. On October 3, several nursing homes participated in a culture change exchange, or as we like to call it, a “communication connection.” These homes shared some of their ideas with people who were attending an AIPP  seminar by Dr. Bryan Williams. These homes had displays, project boards and, more importantly, one-to-one interaction. This connection demonstrated the wide variety of life enhancement projects going on in our state. Even more importantly, it demonstrated our desire to share information with others.

Dr. Williams, during his lecture on Owning the Outcome of Your Actions, said, “To have knowledge and not share it with others is, in my opinion, immoral.” He was addressing the problems with health care and the service industry. We can all identify with poor communication between providers!

The communication connection is a way to share our culture change knowledge. We will be having more communication connections by telephone in the next few months. Keep a look out for nationally known change speakers, like Dr. Power, Dr. Taylor and Karen Schoeneman (recently retired deputy division director for the Nursing Homes Division at the Centers for Medicare & Medicaid Services). These calls or communication connections will be open to everyone in the state. Visit our calendar at http://events.afmc.org.

We all have a stake in owning the outcome of the future of health care. We all hope to have a good quality of life as we age. As I have explained to other health care professionals, culture change is not just about dining and pets. Sometimes it is about…fishing.

“CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions.”

The Centers for Medicare & Medicaid Services (CMS) has enhanced its Nursing Home Compare public reporting site to include a set of quality ratings for each nursing home that participates in Medicare or Medicaid. The ratings take the form of several “star” ratings for each nursing home. CMS supports nursing homes embracing the concept of culture change and offering resident-centered care. However, currently the definition for culture change and resident-centered care is not well established, so facilities are left to self-proclaim this characteristic. CMS  …”would consider adding culture change and resident centered care to Nursing Home Compare when the terms are defined objectively.”  CMS encourages consumers to visit facilities and ask staff if the organization operates in a culture change environment and how the facility is implementing resident-centered care.

http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/FSQRS.html

 The health care business is becoming more aware of the link between consumers’ ideas about quality and their choice of caregivers. Providing quality care is not only the right thing to do, but the financially sound thing to do as well. 

For now, five star ratings can be tricky for some homes to obtain due to the way the measures are calculated by CMS.  But often nursing homes are well known in their community for providing good quality care and excellent customer service. Customer service is an area that everyone in health care needs to put more work into. Let’s just say that sometimes we forget that the task we are focused on is for the purpose of resident satisfaction.  We sometimes tell the resident — the customer that we serve —that he or she needs to work around our schedule. 

Resident-centered care or customer-centered care — both are individualized service.  Join us this October for a look at how we can improve our quality of care by changing the way we think about our care.

http://events.afmc.org/home/tabid/424/ctl/viewdetail/mid/1078/itemid/146/d/20121003/AIPP-Culture-Change-Workshop.aspx

On Aug. 5, Dr. Al Power joined a line-up of speakers for a day-long intensive entitled “Relationship, Engagement and Purpose:  Living Life with Dementia,” which kicked off the three-day Pioneer Network national conference. This conference was a meeting place for innovative thought and transformative practices.

Dr. Power is no stranger to Arkansas, and his lectures on dementia and the need to reduce drugs have been well received by Arkansans.

The conference highlighted other programs that are making an impact on the way we treat dementia in long-term care. Attendees watched the documentary “Alive Inside: A Story of Music and Memory,” which follows one man’s quest to transform the lives of people living with dementia through the power of music. Both Dr. Power and Eden Alternative co-founder Dr. Bill Thomas made appearances in the film.  A clip of this video has been used for training in Arkansas by the AIPP team. The front-line staff — or, as we should be saying, the hands-on staff — were excited by the ideas in this video. http://www.youtube.com/watch?v=NKDXuCE7LeQ

Caregivers have been trying to find ways to enrich their elders’ lives for many years.  With changes in mindset come new ideas.

One of the most damaging stereotypes of aging is that the final stage of life is marked mostly by decline and decay.  The way we view dementia is worse, because we see it as a hopeless spiral of loss.

In Arkansas and in the nation the young and the old are gathering to make changes in long-term living.

Why not join the change team?

Would Albert?      

“I have reached an age when, if someone tells me to wear socks, I don’t have to.” — Albert Einstein (1879-1955)