Kansas State University March 2008Center on AgingPEAK Project Newsletter Websites of Interest National Long-Term Care Ombudsman Resource Center - Culture Change News http://www.ltcombudsman.org/ombpublic/251_1339_13017.cfm National Citizens' Coalition for Nursing Home Reform http://www.nccnhr.org/public/50_541_1952.cfm Issue Brief: Changing Nursing Home Culture http://www.allhealth.org/publications/Long-term_care/Changing_the_Nursing_Home_Culture_79.pdf Culture Change in a For-Profit Nursing Home Chain: An Evaluation http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=668880 The thing that lies at the foundation of positive change, the way I see it, is service to a fellow human being. ~ Lech Walesa ~ RESOURCE REVIEW The Virtual Dementia Tour by Second Wind Dreams, Inc. Caring for another human being requires a special kind of person. A person who is empathetic, patient and kind. But how can a person who cares for our elders be empathetic when they have never experienced old age in it's fragile state? The experiences of our elder population are the only ones that caregivers have never lived through. But nursing homes make decisions for and about our elders as though we know what they are coping with. We all know that we help others better when we can identify with them or maybe even have had a similar experience. Most caregivers have never personally experienced the physical limitations of aging, dementia or life in an elder care community. The Virtual Dementia Tour (VDT) Kit helps sensitize staff to the issues of residents which results in better care. This powerful training tool is the offspring of a study conducted in elder care communities. The findings were so incredible that a kit was designed to assist in replicating a heightened level of sensitivity in a facility. The VDT simulates Dementia as well as some of the physical problems associated with aging. The kit includes the results of the complete VDT study, a manual to guide you through the VDT training, all of the forms needed to administer the VDT, all the forms needed to tabulate results, goggles, confusion tape, and a guide to the in-service that follows the VDT. This kit can be used as a training tool for new employees as well as a sensitivity training tool for all staff. For more information please visit http://www.secondwind.org/virtualdimentiatour.html. The Journey Toward Culture Change Continues Advisory Group Resources Schowalter Villa, Hesston Before Implementation The name of Joyce Bedsworth, a former manager at Schowalter Villa in Hesston, is still present in the current management's memory. Joyce is remembered as an excellent leader with a dynamic vision for the home. She introduced the concept of consistent assignment at Schowalter Villa at a time when the notion was not even considered in the long- term care industry (about 15 years ago). Identified by this history of person-centered care, more recent changes at Schowalter Villa have included the introduction of buffet dining in 2002 and the creation of cluster leaders. Prior to these dramatic changes, a group of all-level staff members toured a Missouri home, (then under the leadership of Eric Hader), that was one of the first homes nation-wide with advanced culture change. Meadowlark Hills in Manhattan was the other home that served as a starting point for staff's numerous discussions regarding the appropriate changes suitable for their home. Touring these homes helped staff "put themselves in that bed." Transformation A genuine transformation of staff attitudes occurred with the implementation of buffet dining. Residents started voicing their food preferences and began exercising choice related to when they get up, eat and go to sleep. It was a huge change effecting how food was served, how dietary staff had to work, and how activities were organized, as most activities were held in the dining room. Every single department was impacted by the buffet introduction. Two dietary aides left, as they could not deal with the changes, but the staff members who stayed worked really hard on increasing their skills to reinforce culture change at Schowalter Villa. The implementation of this step soon started the process of incorporating other elements of person-centered care. The home provided training on mentoring new leaders, conflict resolution, decision making and other aspects critical to the success of culture change. Their Mission The principles of person-centered care strongly coincide with Schowalter Villa's mission, which is focused on consistent improvement of their residents' quality of life and care. Staff members who promote values of the new model of care to their co-workers by modeling the philosophy through their daily conduct and following the home's mission are rewarded financially. Creating a home through positive attitude of staff and constant encouragement is what drives the change. Staff are rewarded with a percentage of the profits to encourage their assistance in creating ideas that increase productivity and enable resources. This incentive allows the home to do the extra things that benefit residents and staff. New hires are extensively trained on culture change principles where the residents are the center of attention. Their unique needs dictate how staff work and the work schedule reflects the residents' lifestyles. Staff Empowerment Staff empowerment is a fundamental element of the new model of care. One of the factors enforcing this element at the Villa is allotment of funds in each neighborhood that staff spend on residents without having to consult about expenses with their supervisors. Each neighborhood receives $3.50 per resident monthly. This fund helps staff and residents pursue their ideas for parties, decorations, prizes or whatever they choose for their community. All-level staff members are involved in providing information for residents' care plans and multi-disciplinary brainstorming is a routine method for identifying practical solutions. Change starts when someone sees the next step. ~ William Drayton ~ Sustainability Lillian Claassen, Vice-president of Health Services, states that if she had to redo the process of culture change implementation, she would have spent more time on staff education. Schowalter Villa's goal is creating the system, so that if current leaders leave, new people will step in and move forward with the model of care where consistent improvement of residents' quality of care and life is its foundation. The PEAK award of 2007 validated the value of their hard work and its positive outcomes affecting the residents, the staff members and the home. Pleasant View Home, Inman Before the Implementation Years ago, the Pleasant View Home staff heard terms like "Culture Change" and "Green Houses" and were familiar with a few concepts associated with the new model of care. According to Jalane White, Administrator, this led to an excited group of staff members who wanted to see these new ideas in practice. They visited Meadowlark Hills in Manhattan, which was the leader in this new concept of care in the nursing home industry in Kansas. This experience also served as a good base for staff discussion. The staff considered the changes which would be necessary related to their own particular roles in the home. Seeing the culture change model in action inspired the staff to begin working on the Pleasant View Home transformation. There were already a few elements of culture change present in the home. For example, direct care staff members exercised their decision making skills by participating on many committees. Another unique feature about the home was that consistent staff assignment was in place in the existing special care unit. These two elements and enthusiastic staff support for the new model of care helped with the transition from a clinical model to a social model of care. Helpful Resources The Kansas Foundation for Medical Care (KFMC) pilot project was very instrumental in staff education. While the majority of staff members embraced the new culture change, there were a few staff members who were unsure about the process. They soon lost their resistance to the change, as they experienced more training and consequently gained a better understanding of culture change principles. The KFMC workshop helped the trainees not only to be aware of potential problems but also to be ready to respond to them. Resources such as the Peak-Ed modules, Kansas Association of Housing and Services for the Aging (KAHSA) programs, Geriatric Education Resource and Training Institute (GERTI) training and Nancy Fox/Eden Alternative workshops on leadership were other resources used for staff trainings. Transformation In order to help staff transform their mindset, as well as illustrate the focus on individualized residents' needs, a basket filled with different dolls was passed among staff members. Each person chose a doll and this visual aid reminded them that each resident has unique needs, routines and personalities and that the home's priority will be in meeting these needs. The first genuine steps in the transformation of the Pleasant View Home started with the formation of neighborhoods in 2001. Being part of a team was a transforming experience for staff. Staff empowerment has enhanced the process of decision making and has brought unexpected outcomes. Recently, maintenance workers were encouraged to join neighborhood teams. One of them quickly noticed a void in men's activities and created a weekly coffee group for them, and then he organized Bible reading in three languages: English, German and Spanish. The home has discovered hidden talents and resources among staff members who in the past would not have been expected to directly contribute to the residents' quality of life and care. Bumps in the Road and Sustainability of the Model There have been no major barriers in the implementation process. The staff recognize that "bumps in the road" can be viewed as guarding the process against a return to the old model. One of the decisions that prevents its reverse is selecting neighborhood team leaders who are not nurses. This guarantees a stronger focus on residents' non-clinical needs. Satisfaction surveys help identify problems that need improvement and all-level staff work on finding best solutions. The staff strongly believes that culture change is deeply rooted at the Pleasant View Home and everybody working there sees its sustainability as a part of their mission. Pleasant View Home's successful expansion and enforcement of culture change was acknowledged by the state in 2007 with the home's fifth PEAK award in a row. If you want to find out more about the resources mentioned in this article, please visit: GERTI http://www.gerti.info/ Eden Alternative http://www.edenalt.org/ KAHSA http://www.kahsa.org/ People can't live with change if there's not a changeless core inside them. The key to the ability to change is a changeless sense of who you are, what you are about and what you value. ~ Stephen R. Covey ~