“Never believe that a few caring people can’t change the world. For, indeed, that’s all who ever have.” – Margaret Mead

The medication pass in a nursing home is often a labor-intensive activity, taking up a big part of a nursing home nurse’s day. A number of homes are looking at changing this to allow more flexibility for activities, special events and sleep. By looking at individual medication plans, some of the nursing homes in Arkansas have been able to reduce their med pass time.

Some of our homes in Arkansas, especially those in the culture change program, have looked at their medication times and are able to individualize the plan of care for their residents. With new technologies, such as computerized medication records, some homes are changing the way they view the medication pass. This way, they begin to change the focus to more individualized care.

We saw last month that many homes are thinking outside the box with activities, community involvement and resident involvement. This innovative thinking brings with it a need to look at the medical model of how we give resident quality care and still have quality of life.

Fortunately, there are many resources available to our homes that want to look at different ways to individualize care for our residents. From sleep studies that encourage homes to change the way we assess our residents (www.ncbi.nlm.nih.gov/pubmed/8409176) to toolkits that are available to help change the way we assess our residents ( www.pioneernetwork.net/Providers/StarterToolkit/Step3/NightTimeTipSheet)

We have a lot of research and toolkits available today that will allow us to change the way we are providing health care for our residents. We have no excuses. We must look at the way we are providing quality care to our residents. Remember, evidence-based care equals quality care. Just as we are trying to decrease the use of some medications in our older population, we are also trying to change the way we give that medication.

If changing the way we think about care allows more flexibility, more resident time and better outcomes for our residents, why would we not change?

Here are some of the resources and ideas available to help us all continue to change our mindset to resident-centered care. These are just a few web sites that will point you in the right direction.





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“You have to have a canon so the next generation can come along and explode it. ” Henry Louis Gates

Studies show that active and engaged older adults remain in better health than those that are not active and that older adults who volunteer live longer and with better physical and mental health than their non-volunteering counterparts.

Even residents in nursing homes have better outcomes when they lead active and engaged lives.

Many Arkansas homes have intergenerational programs that allow the young and old to interact, resulting in residents feeling needed and connected to their community. Several of our homes have sewing clubs, “pack the backpack” programs and trick- or- treat programs. These are often resident-led activities supported by nursing home staff, providing valuable assistance to the local community.

Some nursing home administrators are thinking outside the box. They are developing intergenerational programs that are a departure from the old institutional mindset. Charlene Boyd, administrator of Providence Mount St. Vincent in Seattle and one of the original pioneers to help found The Pioneer Network, is one of these administrators.

This home is world-famous, for its many elder-centered practices and for its amazing on site intergenerational learning center.

Watch the trailer for the upcoming film about this program.

One of our culture change program homes, Ozark Health and Rehabilitation in Clinton, is the pilot home for the Music and Memory program in Arkansas. We’re beginning to see other homes around the state implement this program, which helps residents become engaged through music. Some of the homes are taking the program a step further and developing intergenerational programs based on music.

The Alive Inside Foundation is a nonprofit organization dedicated to using the power of music to expand intergenerational human connections and develop empathy between youth and elders. The foundation understands that kids are the best at implementing music and memory programs in nursing homes.  What about the kids?  Well, studies show that children benefit profoundly from the experience of interacting with older adults. Take a look at the foundation’s new documentary.

Are you considering an intergenerational program for your nursing home? Go to the Changing Aging website and spread the information.

Before you start any program remember, intergenerational magic does not just happen by bringing old and young together! Preparation, planning and training are necessary for any successful program.

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“Food is our common ground, a universal experience.” – James Beard

One fifth of all regulatory violations at New York nursing homes in the last quarter of 2011 were related to food service.1 In Arkansas nursing homes, we also see a lot of regulatory violations that are tied directly to dietary issues. But that number only scratches the surface. When researchers started asking nursing home residents about their food choices, their answers were telling:

  • One resident said he resorts to drinking nutritional drinks instead of eating the meals in the home.
  • Several residents complained that the high-carbohydrate meals made it difficult to manage their weight or diabetes.
  • Many residents complained they were rarely served fresh fruit or vegetables; in some homes, it was only when a state inspector was present.
  • Residents complained about inflexible meal times, strictly assigned seating in the dining room and not being allowed to invite guests to meals
  • Many residents said they use much of their limited incomes to purchase food outside the home.
  • More than a hundred residents of one home signed a petition to upgrade the quality of the food, which was described as “bankrupt.”
  • Residents of another nursing home got so fed up with conditions, they brought a class action lawsuit against the home. Part of the basis for the lawsuit were the unsanitary kitchen conditions and poor food storage detailed in violations from the state department of health.

Are you starting to see how important it is to pay attention to the food we serve in our homes? This all ties back in to culture change, too. It’s not just changing what we serve based on residents’ wants and needs, but it’s also running a tight ship in food preparation and storage. There are plenty of examples of Arkansas homes doing wonderful work in this department. We have homes growing their own food, offering flexible dining times, making healthy meals to encourage weight loss and decreasing the need for nutritional supplements. There are also homes holding picnics, barbecues and other celebrations centered around food, which helps grow a sense of community and togetherness in the home.

Still, there is always room to grow. Many of our surveys show food preparation is a key area for improvement in Arkansas. One of the best ways to show growth in this aspect is staff education. There are training sessions and food preparation resources available from our food suppliers at the links below. Remember, food is our common ground. Let’s make sure it’s also a key component of continuing our culture change journey.



1 http://www.mfy.org/wp-content/uploads/Emerging-Solutions-to-the-Failure-of-Institutional-Food-Oct-2012.pdf

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“From what we get, we can make a living; what we give, however, makes a life.” – Arthur Ashe


On June 23 in Little Rock at the second annual Culture Change Symposium, many people connected and networked on different topics. The title of the symposium Exploration of Change and Meaning said for many what health care workers were striving for in their workplace.

Attendees networked with nursing homes from around the state who had implemented changes in their homes to honor residents, staff and family choice. They talked with individuals who shared what helped them succeed and what created obstacles to their culture change journey. Carmen Bowman, the featured speaker, talked about eliminating alarms and lead discussions and Q-and-A sessions. Carmen has spoken before in Arkansas on changes in dining and new practice in dining.

Quality of life

Medicare.gov has information on how to check your nursing home’s quality of life. The website also has suggestions on what questions to ask of your nursing home. These questions were the topic of discussion at the symposium and the culture change gallery

Will I be treated in a respectful way?

Nursing home staff members in the gallery of homes showed how they interact with their residents and how the residents journal their lives at the home.

How will the nursing home help me participate in social, recreational, religious, or cultural activities that are important to me? Can I decide when I want to participate?

The gallery featured several homes that discussed examples of how residents made various special requests and what the home did in response, including how the homes balanced the “safety versus risk” question.

Do I get to choose what time to get up, go to sleep or bathe?

Speakers from two of our nursing homes spoke to the symposium crowd about ways to make resident choice a top priority.

Can I have visitors at any time? Will the nursing home let me see visitors who come to visit at early or late hours?

Several homes showed how they used activities and participation to make the home welcome not just for the residents, but for the entire community.

Is transportation provided to community activities?

Nursing homes in the gallery showed not only how to transport well, but also how to make the nursing home the center of their community, using the residents as the driving force in this effort.

Can I bring my pet/can my pet visit?

Paws4Seniors talked about allowing pets in the nursing home and how this can be a positive influence for staff and residents alike.

Can I decorate my living space any way I want?

Homes showed off how many residents used their own pictures and sentimental favorites to make their room into a real home.

How will the nursing home make sure I have privacy when I have visitors or personal care services?

Carmen led several talks and networking discussions that centered on resident choice and protecting resident rights.

We can go on forever about how we are “boldly going where no nursing homes have gone before,” but we’ll leave you for now ( with just some pictures of our exploration of our journey). The symposium was a huge success that is going to lead to a better life for both residents and staff. Make sure to keep visiting our website for information and future events, and keep an eye out for next year’s symposium!

0623151113                    trinity village

0623151113c          IMG_0788IMG_0796

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“Where there is no vision, there is no hope.” George Washington Carver

Vision: noun

1. The act or power of anticipating that which will or may come to be: prophetic vision; the vision of an entrepreneur.

2. A vivid, imaginative conception or anticipation:

verb (used with object)

1. To envision, or picture mentally: They tried to vision themselves in an institution at the end of their life.

People living in long-term care settings have been frequently left out of the conversation about how they think long-term care should be set up, changed or managed on a day-to-day basis. There have been many ideas on how to capture residents’ voice on assessments, surveys or care plan meetings.

The idea of person-centered or person-directed care has been an emerging vision in the long-term care field. This emerging vision is changing the way we “measure” quality.

This change has not just been the vision of older adults, but of young people who hope to change the way we set up health care concepts. One thought that is common to all the generations is innovation is the key to excellence. All over the news people are talking about innovation. There are a lot of questions about what innovation means in the long-term care industry.

One definition of innovation is that it is a process of finding novel solutions to important problems.  See more at  http://www.innovationexcellence.com/blog/2013/04/14/what-is-innovation-2/#sthash.LxvyiCZR.dpuf

The problems facing long-term care are very important. Everyone has heard of the vast number of baby boomers coming in to the health system. Many articles are being written about the increasing number of people with a cognitive disease process. In the above mentioned blog, the author talks about the models of innovation. Several are mentioned including disruption, sustaining and break-through innovation.

In Arkansas we are using all these innovation models to change the long-term care setting. Music and memory projects using the latest research on music and its link to the brain is one model. We’re also seeing pets in our homes and the amazing way residents respond to them. Another is the idea of sleep being the basis for healing and how if we do not get the quality of sleep we need, we may have poor outcomes in our homes. And we’re looking at how in an effort to prevent falls, we may be causing more harm than good with use of our alarms. This list goes on and on.

If you would like to hear about these wonderful visionary ideas and the people who are finding novel solutions to important problems, check out AIPP’s 2nd Annual Culture Symposium scheduled for June 23.


You, too, can “boldly go … and change the world of long term care.”

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“You know, food is such – it’s a hug for people.” Rachael Ray

Proper nutrition is important to keep you healthy. Many people with memory disorders or cognitive function decline cannot maintain the same nutritional intake over the progression of their life.

Providing meals is an important part of a care partner’s routine. Often the meal time is a busy, stressful time for the care partner and the resident. How can we as care providers provide that “hug” for our residents? Many of our homes have used educational programs to give care providers the knowledge they need to assist our residents to have a wonderful meal experience.

Several websites have excellence sources for information:

The Alzheimer’s Association provides excellent tips and education on the Alzheimer’s and Dementia Caregiver Center page for care providers on why the resident may have a poor appetite.  The person may no longer recognize the foods you put on his or her plate to the decreasing senses of smell and taste. This site also provides excellent ideas to de-stress the dining room.

Another useful website is the National Institute on Aging’s Alzheimer’s Disease Education and Referral Center, where you can find simple ideas for implementation for a plan of care for residents.

All the research and tips have a common theme: change the culture of your dining experience by knowing the resident. Encourage staff to provide food that is adapted to each resident’s individual need and stage of cognitive loss.

Many of our homes in Arkansas have changed from large dining areas to smaller home-like environments for their memory units. The nursing homes and their food suppliers often plan together for the special needs of their home. The presentation of meals and the successful addition of new dining experiences are implemented with a team approach.

As more and more research points to the evidence of food, music and activities being the key to a quality of life for all of us, more education will be needed to assist staff.

Continue to follow us at www.afmc.org  for events related to food, dementia and the quality of life.


Wednesday, May 20 9 a.m.–4 p.m.

Conway Expo Center and Fairgrounds

2505 E. Oak St. Conway

Registration begins 30 minutes prior to the start of the session. Lunch will be provided by Sysco.

A free workshop presented by the Arkansas Innovative Performance Program

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“Sometimes Ya Gotta Laugh” Karen Stobbe

Person-centered care has become a common term in the long-term care field.  CMS regulations and guidelines more and more mention the importance of person-centered care. It is often the topic of lectures at most senior living conferences. Many providers say they are doing person-centered care. Many use it as a platform for advertising.

At a recent conference in Louisiana, person-centered care was on everyone’s mind and the major topic of conversation.  

Researchershealth care workers, social and activity directors gathered to discuss current topics in senior care. Person-centered care was the major topic at the LEADER conference this year.

Leader (Louisiana Enhancing Aging with Dignity through Empowerment and Respect) is an organization “committed to helping providers, consumers, regulators and policymakers move toward providing person-center care to Louisiana elders in every healthcare setting.”

Every year members come together to share ideas. This year the conference’s main speaker was Karen Stobbe. Karen speaks about caring for dementia and assisted with the development of the training material series “Hand in Hand.” We have had the great fortune to hear Karen speak at our culture change symposium in 2014. Each time Karen speaks, everyone hears the message of person-centered care.

What does person-centered care mean to us? Are we getting close to having our nursing homes provide true person-centered care? These are questions that are being asked all over the United States. Now that we are focused on dementia and medication, and as our population becomes older, these are very important questions to continue asking ourselves.

Now more and more regulatory agencies and senior advocate groups are looking at other areas in our nursing homes, not just nursing care. Activity and socialization are now seen as important factors in the quality of life.  We ask, “Are these areas being addressed?”

Activities that are offered in our senior living homes are being scrutinized for meaning. Do we know what our residents really like? We know we try to return our residents to a maximum level of health, but do we try to return their social, activity level to a maximum level of participation?

Do we look at who likes to read in his or her room, and who truly is the social butterfly? Or is this information just gathered for documenting a plan of care – a piece of paper for compliance.

Enhanced activities and the reduction of anti-psychotics took prominent place on the leader agenda this year. For many of the attendees, person-centered care was about activities, socialization and dementia care based on new knowledge.   There are many resources for information on how to bring person-centered care to our senior living homes. Homes that are making changes are often the best resource. Take a look at some of the information and contacts from around the country:

www.in-themoment.com/  Karen Stobbe




And at home in Arkansas:




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“A failure is not always a mistake, it may simply be the best one can do under the circumstances. The real mistake is to stop trying.” B. F. Skinner

In 1987, the federal Nursing Home Reform Law (OBRA 87) set forth certain standards of care for nursing homes receiving Medicare and Medicaid funding.

Under the regulations two of the standards are listed as:

  • Promote each resident’s quality of life. (42 CFR §483.15)
  • Maintain dignity and respect of each resident. (42 CFR §483.15)

These standards are listed first in the regulations and are some of the areas that we struggle with every day in the nursing home. As our culture changes, so should the way we meet these regulations. Part of our struggle is the fact that each of us defines “quality of life” differently. Each of us has different definitions of respect.

We often have a gap between the caretakers and the residents of our nursing home based on age, culture and knowledge base. Our goal in our nursing homes is again, to promote each resident’s quality of life and maintain dignity and respect for each resident. This sounds like a simple goal, but is often lost in our daily struggle to get “things done.”

We make mistakes, often when we start new programs. Does this mean we have to scrap that program?  No, especially if we are implementing a program that has been shown through research to enhance “the quality of life” for many residents. We have to go back and look again at some of our basic elements.

  1. Who are our residents?
  2. Who are our staff?
  3. Do we have staff buy-in to our programs?
  4. Do we have staff?
  5. Does everyone understand the program?
  6. Have we really done the proper training/education?

As more and more “memory units’ are opening in our nursing home, it is very important that we continue to try to meet the needs of our residents.  As more research is done and different programs are shown to enhance the quality of life of our residents, we need to continue to try.

Many of our homes working for change in our nursing homes continue to do just that, try again and again. Look at where we can change. Maybe more community involvement. Maybe more education. Obtain grants for new programs. Work with a national program.

We like to help our homes with change and promoting “quality of life,” so take a look at our upcoming event.


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“It is what we know already that often prevents us from learning.” Claude Bernard

In the Last blog we talked about “are we ready to change the way we our caring for our residents?”

Are we as healthcare providers ready to take on care driven by a new culture of education?

Are we ready to provide education and resources to our staff to engage and understand our residents with dementia?

These are some of the questions that we asked ourselves, as we prepared to start a new year.

We talked about what we would be doing in Arkansas, how we would be using many resources to help us provide quality care to our residents.  We were going to try to unlearn some of our behaviors that have become so ingrained in Long Term Care.  Many of our homes will be using special tools for training and sending staff to specialized training.  Some of our homes continue to use music and memory programs, computer programs and special in-service programs to lower the use of medication in our residents

It is working, data is showing a gradual decrease in the use of anti-psychotic medication in Arkansas long term care homes.  More and more people are talking about going to a local home for rehabilitation and how we are encouraging them to return to community. Letting them know that the home is there for them, if they need to come back at a later date.  This mindset change is helping homes, like General Baptist of Piggott, change the way we see our elderly residents. This thought that we can help others to grow and change through the aging process, makes employees feel good.

Next month a direct staff training will be available around the state to help us change our mindset and behaviors.  The thought that we can change our behavior to improve our residents’ quality of life, is a true culture change idea.

See the schedule for training at http://events.afmc.org/Home.aspx

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“What we have, first and foremost, is a crisis in care.” Dr. Al Power

In his blog highlighted in, www.changingaging.org, Dr. Power talks about it is time to get serious with real culture change.  Healthcare workers need to change the way we view behaviors in dementia residents.  He goes on to point out that as we reduce medications with side effects that produce sedation, we will have to start changing our organizational structures.

The crisis he talks about is not the increase in behaviors of residents, but in us, are we ready to change the way we our caring for our residents. Are we as healthcare providers ready to take on true person- centered care, person-directed care or care driven by a new culture of education?

Are we ready to provide education and resources to our staff to engage and understand our residents with dementia?

Dr. Power asks if we have the courage to change our way of care, to meet the crisis by steady shifts in change, slowly turning down the fire under our crisis.

In Arkansas, we are going to try! With assistance from many resources, including Dr. Power.  Many of our homes are opening memory units, using special tools for training and sending staff to training.  Some of our homes are using music and memory programs, flexible staffing and activity programs.  We have many links and tools on our website.  If you would like to read Dr. Power’s blog and see some of the innovators in care, visit his page at,       Time to Get Serious

Many of our homes are joining with community providers to help raise money and awareness for disease process that may cause dementia and behaviors. Joining with other’s to encourage education for staff.  Together we can meet this crisis with courage and not blame.

As always we are thankful for the pioneers of change, like Dr. Power and Dr. Thomas who’s courage to promote innovative ideas have inspired other’s to slowly reach for low-hanging fruit, then move on to the next level.


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