“Education is the most powerful weapon which you can use to change the world.” ― Nelson Mandela

Knowledge Will Improve Care

Despite a nationwide push by the Centers for Medicare & Medicaid Services (CMS), we are still not seeing the reduction in antipsychotic medications in older adults with dementia.
The Interim Report from the National Partnership to Improve Dementia Care in Nursing Homes: Q4 2011 – Q1 2014 was recently released by CMS. It outlines the history and current use of antipsychotic medication in older adults with dementia living in nursing homes. It concludes that “alternative, non-pharmacological approaches to optimize care for people with dementia living in nursing homes have not been widely implemented to date.”

Over the past two years, CMS and its partners have developed numerous resources and made them available in the public domain.
One of these resources is the “Hand-in-Hand Toolkit,” a series of six training DVDs. This toolkit is available at http://www.cms-handinhandtoolkit.info/Index.aspx

The toolkit was distributed free to every nursing home in the country and many facilities in Arkansas are using it. In June, one of the creators of this toolkit will be coming to Arkansas to speak. Watch for more information about this learning opportunity on our web site: http://aipp.afmc.org

“Toolbox for Improving Behavioral Health in Nursing Homes” is another toolkit for healthcare partners that is available to download at http://www.nursinghometoolkit.com

Another learning opportunity is to read the Minutes from the monthly conference call, held on April 8, 2014.       They have been posted to our website http://aipp.afmc.org/AIPPResourceCenter/MonthlyConferenceCalls.aspx
The topic was “Antipsychotic therapy…then and now,” presented by Anthony M. Hughes, BS, PD, FASCP.

The recent and very successful AIPP Culture Change Workshop “Demystifying Resistance-Addressing Unmet Needs,” was presented by Teepa Snow on May 1. Handouts from the workshop will soon be available in the AIPP Resource Center at aipp.afmc.org

Many other free tools are available to download at www.afmc.org.    These tools were developed to help care partners and families improve the quality of life for nursing home residents living with dementia.

We have the tools, so why is it taking so long to make the changes that CMS wants us to report? The answer may lie in an article entitled “Slow Change,” by Atul Gawande, a surgeon and a public-health researcher. The article explains how and why some innovations spread fast in the medical community, and others are slower to be implemented by healthcare workers. He says part of the problem with the spread of innovative ideas may be “the technical complexity.” Read the article at http://www.newyorker.com/reporting/2013/07/29/130729fa_fact_gawande?currentPage=all

“Slow change” is definitely part of the problem with attempts to reduce the use of antipsychotic medications in nursing homes and in the community. Dementia has a complicated disease process. The care of dementia patients can be a very complicated process, often exhausting for caregivers and facility staff.

With education and support, Arkansas care partners will continue to implement new ideas and innovative programs to improve the quality of life for nursing home residents.

Posted in Uncategorized | Leave a comment

“You can design and create, and build the most wonderful place in the world. But it takes people to make the dream a reality.” Walt Disney

Create the Culture Around You
Training helps us move toward creating a better health care environment for our elders and for ourselves. “Defining and Creating the Culture Around You” is the title of our latest regional training that will be completed this month. The response has been very positive.
Our speakers have encouraged audiences all over the state to build a dream and then make it a reality. Speaker C.W. Miller made us think and respond to ideas on how we can change our culture. He reminded us that the health care industry is similar to other organizations. In order to change an environment you must have a vision and create, not stay the same and stagnate.
The message from our training flyer says it all: “We hear the terms ‘culture change’ and ‘person-directed care’ used so frequently. Do we embrace these ideas with a full understanding of their true meaning, or do we view them as merely the latest catchy phrases?”
Speakers Melinda Davis, OTR/L, CEE director of Rehabilitation, Arkansas Health Center; and Shelley Muscovalley, RN, CEE Eden mentor, Department of Human Services, Division of Medical Services, Office of Long Term Care, encouraged us to continue on our journey with support from others in Arkansas.
As we networked, we also learned about new research that shows changing our culture is making good business sense.
These links provide information that was discussed during our networking sessions. See our calendar for time and location of the final training on “Defining and Creating the Culture Around You.”


The following will link you to data on change research to start your own discussion:

Posted in Uncategorized | Leave a comment

“Come on Steve, we’ve got diem to carpe.” ― Flint Lockwood in “Cloudy with a Chance of Meatballs”

The big myth about nursing homes is that Bingo is the only activity. Bingo is important to many of our residents, but most homes have varied and creative activities.
In some homes there’s often a few residents who want Bingo seven days a week. This often poses a problem for activity directors. Several activity directors have solved this by having Bingo on the activity calendar on certain days and, on other days, the residents have bingo parties. Bingo parties or resident-directed-bingo is a way to have Bingo any day of the week. Residents have access to Bingo equipment and a Bingo room at any time.

Resident-guided activities are important and generally popular with most residents. Not only do they provide more activity opportunities, residents become involved in daily life. These activities use their leadership skills, decision-making and diplomatic skills to enhance residents’ independence, self-confidence and acceptance of this stage in their lives.

What about seizing the day? What about activities that make you catch your breath, make you laugh until you cry, or make you remember you are still alive? We are seizing the day in Arkansas nursing homes with these creative activities.
A balloon ride was part of a “bucket list” request from a resident living at Southern Trace Rehabilitation and Care Center in Bryant. It was something she had always wanted to do. What a wonderful experience.

“The wheels on the bus go ‘round and ‘round,” is an enhancement of the nursing home’s weekly ride. The residents get to map out the journey and set the destinations. It may be a ride to all the old home places or a trip to a casino. We’ve been to the horse races, the movies, gone swimming and horseback riding.

Laughter IS the best medicine and laughter was flowing at the Annual Snowball Fight at Craighead Nursing Center in Jonesboro. Who knew that throwing large marshmallows, as Christmas carols played in the background, could be such fun.
Residents laughed, staff laughed and the marshmallows flew.  A resident told me, “I’ve laughed until I’ve about died.” Then she hit her friend with a huge marshmallow, as she peeped out from behind a wall. Somehow I got stuck in the crossfire and my shoe got covered. The memory is stuck on my shoe–I mean,… mind.

Kathy Caskey from Woodruff County Nursing makes everyone glad to be having another birthday. Kathy knows all about seizing the day but she’s not the activity director. Kathy is the dietary manager and is also known as the “hat lady.” Kathy started wearing crazy hats on Fridays, just because residents’ loved it. From there it has grown to a birthday hat day that has the residents excited about having another birthday. On their birthday, every resident gets a visit from Kathy with her singing birthday hat and a cake.
Even providers have gotten into the act. The home’s food supplier brought her a chef’s hat to wear. The dietary staff joined in the fun by adding an apron. Now Kathy is a life-size version of the Pillsbury Dough “girl.” Residents rush to the dining room to see what hat will be on Kathy’s head! hathat1

Enhancing our resident’s lives, as Kathy has shown, is not just the activity director’s job.

Come on Arkansas, we have a day to seize.
For our residents who are “walking with forgetfulness,” this link includes ideas to help them seize the day too.

Posted in Uncategorized | 1 Comment

“Everything has beauty, but not everyone sees it” Confucius

This gallery contains 12 photos.

“A nursing home is a place for people who don’t need to be in a hospital but can’t be cared for at home. Most nursing homes have nursing aides and skilled nurses on hand 24 hours a day. Some nursing … Continue reading

Gallery | 1 Comment

“Good management is the art of making problems so interesting and their solutions so constructive that everyone wants to get to work and deal with them. “ — Paul Hawken

A nursing home is a place resident’s  call “home.” It is also a place where residents at times receive complex medical care. It can be hard for caregivers to blend these two ideas. We have difficulty speaking the language of home and the language of medicine in the same conversation.
Some of this language is slowly changing through education, team mentoring and new workers coming into the long-term care environment. We welcome these changes and we welcome new ideas to help with some of the problems we face in long-term care.

For example, compare the medical model of language and the natural culture change model for these terms:
Medical model language                       Natural language
Wing, unit                                                       Household,street, neighborhood,lane
Allow                                                                Encourage,welcome
Patient                                                              Resident, individual, elder
A feeder/the feeders, feeder table              Person who needs assistance \dining

One of our best change ideas is to use teamwork to find solutions to safety issues, falls and quality of life questions. Many of our change homes are actively seeking out employees at health fairs, schools and community events. They are developing ideas and encouraging employees to help invest in the home. They are doing this by providing direct care staff with access to education and by encouraging the trained staff to be the educators for new programs and ideas. Change teams, behavior teams and quality teams are formed with all levels of staff participating in finding solutions for their home.

At our next training, we will be discussing teamwork, leadership and how to make it exciting to find solutions to problems in our homes.

Join us at : National Park Community College in Hot Springs on Tuesday, Nov. 12 for a culture change workshop.   http://aipp.afmc.org/

We will have several leaders, including Melinda Davis, who was in our first-year project and serves as a mentor for our new project homes. She is an Eden Educator and has recently participated in a training project with Dr. Al Power, author of Dementia Beyond Drugs.

C.W. Miller will begin our day with new teamwork ideas and activities. Mr. Miller has been creating high performance teams in a variety of industries for more than 25 years. He has lectured to executives nationwide on such topics as quality assurance, cost containment, time management and customer satisfaction. Mr. Miller understands that our people in long-term care are Arkansas true diamonds.

“From the backroom to the boardroom, one principle prevails. People are our most important asset and success is dependent on the human interaction skills of those people. Therein lies our opportunity and our challenge.” — C.W. Miller

Posted in Uncategorized | Leave a comment

“Everything that can be counted does not necessarily count; everything that counts cannot necessarily be counted.” — Albert Einstein

Nursing home quality measures have four intended purposes, according to the Centers for Medicare & Medicaid Services (CMS):
1. To give you information about the quality of care at nursing homes in order to help you choose a nursing home for yourself or others
2. To give you information about the care at nursing homes where you or family members already live
3. To give you information to facilitate your discussions with the nursing home staff regarding the quality of care
4. To give data to the nursing home to help them in their quality improvement efforts
And according to CMS, these ”measures assess the resident’s physical and clinical conditions and abilities, as well as preferences and life care wishes. This assessment data has been converted to develop quality measures that give consumers another source of information that shows how well nursing homes are caring for their residents’ physical and clinical needs.”
The current quality measures are listed at http://www.cms.gov/Medpicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIQualityMeasures.html.
Where are the measures for preferences and life care wishes?
The nursing home quality measures come from resident assessment data that nursing homes routinely collect on the residents at specified intervals during their stay. CMS also says, “The current quality measures have been chosen because they can be measured and don’t require nursing homes to prepare additional reports. They are valid and reliable. However, they are not benchmarks, thresholds, guidelines, or standards of care. The quality measures are based on care provided to the population of residents in a facility, not to any individual resident, and are not appropriate for use in a litigation action.”
This assessment data is from the MDS 3.0 (Minimum Data Set), which has been recently updated to allow more resident involvement in the assessment. Sounds like a good idea when the quality measures want to reflect preferences and life care wishes.

But what do consumers really want to know about a nursing home? Glad you asked!
According to surveys done by some leading organizations and advocacy groups in long-term care, the people they survey want very simple things in a nursing home.
1. They want the staff and the residents to be happy. They feel that if the staff is happy the residents will be happy.
2. They want an active lifestyle to continue in the nursing home.
They want books and computers available for resident use, and where the home stands in culture change areas.
3. They want the kitchen to prepare food the residents want and like to eat.
4. They want the wheelchairs and mobility products to fit the individual.

Sounds like they want quality meaures for living.

That is just what many of our Arkansas homes are offering: quality measures for living. If you look back over the earlier blogs entries on this site, you will see homes making changes to promote individualized care. You will hear of many positive changes made by staff and residents in Arkansas — changes like…
Westwood Health and Rehabilitation provides empowerment and education of staff through special programs. Staff is paid for a voluntary four-hour “resident experience,” a program in which staff members are given a diagnosis and a list of limitations. They then live out that life for four hours. The CNAs also self-schedule. Education on changes coming to long-term care — we bring them by the busload. Staff members come from St. Johns Place to hear Richard Taylor and Dr. Power speak on changing the way we look at dementia. (We won’t mention the parking garage incident.)(We will laugh and be happy.) Springcreek Health provides special education for memory enhancement of residents with the Spark of Life program. The direct care staff leads the training and helps grow other staff with education.
The CMS Hand in Hand educational series is off to a great start in Arkansas, in part due to the team approach for training modules. Many of our homes have the involvement of all staff in training. Leadership teams to promote involvement of staff in developing motivation systems in the nursing home — what measure is this under?

Hey, and remember the blog about Salem’s Place, the pool table and book club? The community involvement, the man cave… What about the wedding at St. Andrews? Fishing and cooking at River Ridge in the backyard by the gardens.
Computer labs and wireless internet are in many of our homes.
And what about that food! We have many homes now with restaurant style dining; you get what you want, sometimes all day. Chefs like those at St. Andrews and Whitehall cook to order. Greenhurst tells you on its web page about the dining there.
What about those cafes in our nursing homes? The Rusty Bucket at Ozark Health, the Bistro Café at Broadway Health, Café 720 at The Crossing at Malvern — they all provide special areas for food and socialization. Many cafes like the one at Brookridge Cove are on the memory unit, decorated in a style for special memory appeal. Apple Ridge has family-style dining on its memory unit. Many of our memory units cook and bake on the neighborhood. Many of these cafes are named by the residents and decorated according to resident choices. Many have internet and fresh baked items. Some have different coffees available like Starbuck’s.
Many of our homes are taking out the central nursing station and placing a living area in the middle of the units, excuse me, neighborhoods.
Oh and what about that — neighborhood, street name, home address, lane? What’s in a name? Where would you rather live, on Unit 3 or Hummingbird Lane? We even will help you make the change. At Katherine’s Place, you can get a book written by staff on how to develop a neighborhood.
What about the big changes, such as Greenbrier changing medication times to promote resident satisfaction. Wake up at noon, sleep in (don’t wake me at night) or stay up late. Our homes reflect the changing mindset, not to just maintain the resident, but encourage the resident to continue to grow. To not just have the right wheelchair, but provide learning programs and adaptive equipment. Hillcrest Home has the Never2Late to Learn series along with adaptive equipment. Many of our homes have this program. With the changes occurring in the nursing home population, the adaptive equipment must be ever changing. Therapy departments are jumping in with the nursing home team to provide holistic plans of care.
Teamwork — what a concept! What a measure!
Increasing involvement of teams, like at Arkansas Health, Ozark Health and Eaglecrest, are growing in Arkansas —teams made up of all departments to promote reduction of falls, reduction of restraints and reduction of alarms. These teams use measures like learning circles, huddles and communication connections. Measurement tools like the Home Thermostat Tool are being developed in Arkansas. This tool, developed by our state ombudsman and available on our website, measures, “What is our home like to our residents”?
Now that’s a quality measurement! All I can say is, Way to go Arkansas!

Posted in Uncategorized | 4 Comments

“How you treat the one reveals how you regard the many, because everyone is ultimately a one.” ― Stephen R. Covey

Changing the way we care for people in the long-term care setting, or changing the “culture” in long-term care, has been a hot topic in the recent news. The Pioneer Network , the Eden Alternative Program and the Arkansas Innovative Performance Program are just a few of the organizations that provide resources for those who want to change the way we provide care to our residents in long-term care. The goal is to move our mindset as a nation to a person-centered approach to health care. One of the first big changes in long-term care is the need to look at things in a positive way. We need to document the positive things we are doing, we need to involve the community in our homes, and we need to gather teams that work for positive changes. We need to provide the positive to the media — film our own stories. We are doing incredible things in long-term care.

Let’s look at some of the negative thoughts we hear in team meetings about change.
What we hear: “We’ve always done it this way.” “It ain’t broken — why fix it?” Or the all-important, “We have always done it this way and no one has complained…not got a tag.” “What if?”
What they are really saying: We know it works and we are afraid of a new routine. What if the survey team does not understand the changes we are making? Why should we get a tag? We hear the same complaints from the same people; they do not understand how it works in long-term care.

Ideas and technology change and so does the delivery of health care, thus changing regulatory guidance. So just because it works now under the same regulation does not mean it will be the standard of practice forever. Our population in nursing homes is changing, just like the population in the world around us is changing. We can bring about positive change if we keep up with education, technology and resident surveys, and if we document the positive results of our change process, not just the negative issues of our investigations. We can look at all the what-ifs and determine if a problem is really a problem.

What we hear: “We cannot, because the money is not there … our company won’t give … our staff is strained…”
What they are really saying: My staff will not want to do extra. (Have they been asked to do something fun?) We are a medical organization, not a social organization. (New studies suggest that quality is not just skin care.) Money is tight and we do not get reimbursed for social programs.

For some programs to begin and continue, money must be spent at the beginning for things like educational training, environmental changes, activity expense, staff expense, etc. Many owners and managers looking at cost vs. return on investment ask, “If a change occurs and the environment is improved, is the reimbursement better?” Usually, the answer is no. Will it change in the future? Maybe, as our mindset changes as a nation. Will it help bring new residents to our home? Many of our homes are marketing their changes. Quality of life — does it have a price tag?

Many free educational opportunities are available to our staff members. Just look at the events calendar at http://www.afmc.org. Many homes have tapped into community help, grants and volunteers to start projects of enhanced activity, childcare for staff, and individualized therapy plans for residents. Try using employees creatively. Bring different disciplines together to solve problems. Involve residents’ families in projects. We need to look at what we can do to make people want to work in long-term care. What do we as health care providers offer to our workers? Is it a negative image or one of flexibility, creativity and engagement? We spend a lot of money on staff turnover — money that could be spent on enhanced activities for our residents.

“The thing that lies at the foundation of positive change, the way I see it, is service to a fellow human being. “ — Lee Iacocca

Posted in Uncategorized | Leave a comment

“People protect what they love.” Jacques Yves Cousteau

At the end of 2007, the Bureau of Labor Statistics at the U.S. Department of Labor released data projections for the years 2006–16. Their analysis of the data suggested that the direct-care workforce demand over the next decade would continue to outpace supply dramatically. The bureau suggested that policy makers and employers work together to make these jobs competitively attractive compared to other occupations. The fastest employment growth for direct care workers was expected to occur in …drum roll please… services for the elderly and persons with disabilities. That is not a surprise to anyone working in the field of long-term care. So how have we made the field attractive to new workers?
One way is to continue to provide education on building relationships and team building. We encourage our direct care workers to continue growing in their field with new information.
(See our website at http://events.afmc.org)

The Heartbeat of Care:
Arkansas’ CNAs
♥ July 23: Fort Smith
Mercy Hospital (formerly St. Edwards)
♥ July 25: Paragould
Paragould Community Center

Another way is to encourage nursing homes to try new ideas and share their successes with other nursing homes.
Many of our Arkansas nursing homes are working on employee turnover, motivation and empowerment. A number of studies indicate that using a process to encourage staff involvement in identifying issues and solutions can improve the practice of resident care and employee turnover. Providing information and learning opportunities for staff is a basic principle of culture change. Many of our culture change nursing homes include staff in decision-making policy, use group learning circles for clinical areas, and provide career mobility specialty areas inside their homes.

Ozark Health Nursing Center in Clinton is trying out learning circles in an attempt to improve some of its clinical areas. This allows all employees to participate in quality improvement, not just the administrative team. Westwood Health and Rehabilitation in Springdale has its CNAs self-schedule, encouraging a sense of empowerment and responsibility among direct care staff. Spring Creek Health & Rehabilitation in Cabot provides staff with specialty training in dementia. Many of the educational modules are presented by CNAs.

In September we hope to have some of our leaders in the field speak to us on topics such as principles of change and history of change and have some of our homes give us ideas on how to continue to improve the lives of our staff and our residents. More information will be coming soon.

In Arkansas, we have a long history of protecting what we love and trying new ideas!

Image | Posted on by | Leave a comment

“Technology is nothing. What’s important is that you have a faith in people, that they’re basically good and smart, and if you give them tools, they’ll do wonderful things with them. “ — Steve Jobs

phone2Using new technologies can be challenging in an industry entrenched in using the same telephone, fax, and pager systems for decades. Many problems in health care stem from the industry clinging to outdated methods of communication.

But in Arkansas nursing homes, we are embracing new technologies. We have homes that are using new technology to improve the quality of care and the quality of life for their residents.

Can you imagine talking into your phone in one language and hearing a translated voice in another language? What a wonderful way to allow communication between residents and staff. No longer are we tied to a communication board and the stilted language of gestures.

Lakewood Nursing and Rehabilitation Center recently purchased a Lenovo tablet computer and an application called Lyngo that allows CNAs to provide care for a lady who speaks only Mandarin Chinese.

The lady did not come to the home when they thought she would, but the staff used the technology to communicate with another resident who spoke another language.

The administrator, Sandra Mancell, demonstrated the application and how easy it is to use for bedside care. Just speak into the tablet and the app produces the translation in the language you choose. The program and computer were not costly. It could be kept at bedside and could be used by all staff and visitors. What a wonderful learning experience for staff and residents. The social director, Nan Kelley, talked about how it would be useful for different residents, because of the many languages in the application. Imagine hearing “How can I help you?” in your own language, being able to respond without having to wait for family or others to translate your needs. Real-time care!

In Arkansas we are using many other new technology tools as well. Our homes are embracing the possibilities of patients communicating with their physicians via the Internet. The resident can see the physician, and the physician can both see the resident and hear lung sounds, heart, etc.

What about our culture change homes? Call lights and buzzers often create an overwhelming amount of noise in our homes. What a glaring way to transmit that you have a need. The flashers or beepers are going off because they’re required by regulation, but in some homes the call lights are wired into a silent system that goes to personal pagers, and overhead paging systems are turned off or used only in case of emergency. Messages get to the right people via phone speaker systems, walkie-talkies and pagers. Staff members at homes where overhead paging is turned off say it is nice, quiet, like home, and peaceful. Visitors notice that it is not a loud scary place, but somewhere you can hear laughter and singing from down the hall.

Many of our Arkansas homes are using computer labs, video programs and Skype. We know that some nursing home residents are lonely and feel disconnected from the outside world. Some studies have found that nursing home residents who communicate with friends and family via computers or video experience a better quality of life. For residents whose family members are out of town, a short video chat can help to combat feelings of not being connected to family. Some residents talk with their home-bound spouses through personal area labs.

Computers with programs like It’s Never 2 Late to Learn are being used for residents to keep their minds sharp. All these technologies help make residents feel like a part of the world community.

In Arkansas nursing homes we are using new technologies to make person-directed care a reality.

Posted in Uncategorized | 3 Comments

“I alone cannot change the world, but I can cast a stone across the waters to create many ripples.” ― Mother Teresa

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!

Posted in Uncategorized | Leave a comment