“What we need is a radical reinterpretation of longevity that makes elders (and their needs) central to our collective pursuit of happiness and well-being.” – Dr. Bill Thomas

its-about-time-headerWe are so excited to have a conference coming to our state that embodies everything our culture change homes believe in for continued improvement in our nursing homes. We have many homes in Arkansas that everyday use their “out of the box” thinking to provide quality care and improve the well-being of their residents.

We have as a state embraced the idea of well-being is essential for the continued growth of staff and our residents. That we still have a journey ahead of us, is clear to all of us that work in health care.

We have joined with other organizations to provide education on individualized care. We have provided training on understanding dementia and how to decrease medication. By joining together we have found we can educate our staff on a budget…we can provide on site training….get staff to mentor other staff.

All these things, we are doing in Arkansas are in line with the need of providing a collective pursuit of improving the lives of our elders, our residents and our staff. We are trying to make the difference in the mindsets of other health care partners, that aging is a growth period, a time for change….just an important time as the periods of our youth.

Yes, we are excited in Arkansas to have a conference that speaks to the need for change……..



Eden Mission statement..To improve the well-being of Elders and their care partners by transforming the communities in which they live and work.



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“Our greatest glory is not in never falling, but in rising every time we fall.” – Confucius

Nursing home residents have a tendency to fall, and that is a big problem homes must face. The Centers for Disease Control and Prevention (CDC) says 1,800 residents die from falls each year, and those who survive have injuries that reduce their quality of life.

Fall prevention in nursing homes presents many challenges. Of all the research accumulated so far, the most effective intervention found is the use of a multidisciplinary team approach for fall prevention. This goes back to what many innovators for change have been saying for years: we are all in this together to improve quality of care.

Fall interventions that are evidence-based include:

Investigating reasons a fall occurs

Assessing residents after a fall

Educating staff about the root cause of the fall (not just what caused the fall)

Making interventions that fit the root cause, not just a care plan fill-in or one to respond to a possible state survey

Creating a true team approach for fall prevention

Many of our homes are using tools and services from our web site to help prevent falls. These tools are developed by people in the industry who have real research data to support the use of these tools. All of our tools have one thing in common: a focus on a team-based approach to decrease falls.

Many of our homes in the Culture Change project are using different team strategies to decrease falls. Team programs that feature data collection and competition encourage good results of monitoring and investigation of falls.

One of these homes is Grace Point in El Dorado. This team approach program includes sharing and investigating information about falls from shift to shift and also area to area. The falls team is managed by the activity director, and the CNAs make up the majority of the team.

The program’s title, “Don’t stand for it!” is a great reminder that we all are necessary in providing a safe haven for our residents. The results of this program have been very rewarding to residents and staff. This program provides staff a teamwork approach while allowing for some good natured competition. Management posts team results in the nursing home halls. Each team is eager to have good results and to have decreased resident falls. A reward of pizza party spices up the incentive for working as a team on each hall, shift or designated area to decrease falls.

The program uses staff closest to the resident to gather data, propose interventions and carry through with interventions, making the end result of decreased falls a true team victory.

Again, it takes a team to make our residents quality of life great. We salute those homes that continue to try innovative ways to improve our residents lives. Kudos to the homes in the culture change program for continuing to use evidence-based research to improve the life of our residents.


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“I’ve never responded well to entrenched negative thinking.” David Bowie

This year has brought many changes already, both in health care and in the world. We have already lost many of our musical lights and people who have inspired us to think in new and exciting ways. What makes many of these people special is not only their talent in their field but the ideas that they shared with us.

The Centers for Medicaid and Medicare Services (CMS) has also started sharing some new direction for health care, including new programs and innovative ideas to improve the quality of life for the aging population.

The Department of Health and Human Services has released information to improve our nation’s health care by setting clear, measurable goals and releasing a timeline to move Medicare and the health care system toward paying providers based on the quality rather than the quantity of care. This quality care is based on resident, patient and family involvement in health care decisions. It’s also based on a team approach to planning care, involving all health care workers who are providing the day-to-day care.

Does this sound familiar? Person-centered care, person-directed care and culture change … all these terms reflect the basic idea that we must change the way we provide health care. Positive changes start with encouraging staff to participate in new programs and ideas, doing away with entrenched negative thinking. It’s no longer acceptable to say, “We have always done it that way, why should we change” or “Our workers will never give us input on that program.” That kind of negative thinking prevents bright, innovative employees from shining in our homes.

As leaders, we should be inspiring our staff to make positive changes. And as one innovative person once said, “We can be heroes if just for one day.”

Encourage your staff to be heroes, even if just one day or with one project. Give them positive encouragement to change things and improve the quality of life for our residents. Above all, provide them with the guidance and tools they need to make positive changes in our health care system. Then we all will be heroes. At least for one day.




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“The only person who is educated is the one who has learned how to learn and change.” Carl Rogers

People living with various forms of dementia often exhibit emotional behaviors, such as anger, sadness, fear, frustration or anxiety. But so do people without dementia. So why do we put such a stigma on these behaviors when they are exhibited by a person living in our nursing home? One of the reasons could be that we don’t understand these emotions in relation to how they are being expressed by our residents. We often think that our residents are “acting out” or “being difficult” with caregivers. What they often lack is the ability to communicate their feelings. Dementia robs the brain of the ability to communicate and take in information, sometimes slowing down the resident’s ability to process thoughts and language.

How can we help our residents with dementia continue to have a high quality of life? One way is to continue to educate care partners on how to assist residents with everyday tasks. Our health care workers need to look at how they are providing care and change the way they think about a task. There are several programs and educational trainings going on all over Arkansas that address caring for residents with dementia.

With our culture change group, we are setting up an educational training with a certified dementia instructor to educate our caregivers on this misunderstood disease. Many of these trainings have already had success all over the state in helping nursing homes reduce the use of drugs. We are changing the way we learn and preform our tasks. That is an innovative way of thinking, and Arkansas is all about innovation.




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“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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