Kansas State UniversitySeptember 2004Galichia Center on AgingPEAK Project Newsletter PEAK 2004 Award Winners Advisory Group Resources Anthony Community Care Center, Anthony Meadowlark Hills, Manhattan Medicalodge Post-Acute and Rehab Center, Arkansas City Memorial Home, Inc., Moundridge Pleasant View Home, Inc., Inman St. Joseph Village, Manhattan Congratulations to all who applied. We'll include information on the 2004 Award winners in our next several newsletters. Interesting Quote ...I also wonder what would happen if we dropped our feigned hope that we can indefinitely forestall the inevitable. What if instead we really concentrated on honoring the lives entrusted in us, making them as comfortable and respected as possible? What if we thought of this place as a gathering of life patterns and outcomes, a showcase for honesty and repression, a foster home for the inner child within us to the very end? Thoughts from "Nobody's Home: Candid Reflections of a Nursing Home Aide, by Thomas Edward Gass New Advisory Group Member Vera Vanbruggen is a new member of the PEAK-Ed advisory group. She replaces Pat Maben who has retired from KDOA. Vera is the Director of the Long Term Care Division of the Licensure, Certification, and Evaluation Commission of the Kansas Department of Aging. The Division of Long Term Care assures quality of care and quality of life of residents in adult care homes through several efforts. These initiatives include the development of policies, regulations, and educational offerings, as well as developing and maintaining effective liaison with officials in CMS, other state agencies, professional organizations, and the public. The division provides assistance to long term care providers through consultation on nursing, administration, environment, and data issues. Pioneer Network Conference Many members of the PEAK-Ed advisory group attended the Pioneer Network Conference, "There's No Place Like Home" in Overland Park, Kansas on August 4-7. A special highlight was the "Taste of Kansas" reception on Wednesday evening where Pamela Johnson-Betts, Secretary on Aging, expressed her excitement about the future of long term care and recognized the 2004 PEAK winners. Interesting Quote The constant unrelenting ache of loneliness in this place certainly illustrates how much families really mean to us. What if a proud and peaceful death here was a crowning achievement rather than a failure of medicine? We hide death as if we are ashamed of it.... Thoughts from "Nobody's Home: Candid Reflections of a Nursing Home Aide, by Thomas Edward Gass Several members of the advisory group played key roles in the conference: Bill McDaniel, Letty Siedl, Steve Schields, Monte Coffman, and Gayle Doll served on a planning committee Letty worked hard to get all participants registered and spent countless hours at the registration desk Several group members facilitated learning circles Bill McDaniel, Steve Shields, Monte Coffman, and Gayle Doll were presenters Meadowlark Hills was featured the last day of the conference. Participants could register to take a bus trip to Manhattan to tour the home. Sound Off The August 6 issue of the Older Americans report contains an article about nursing home residents in Washington state filing a class action suit to halt the use of feeding assistants. These residents claim that their health and even their lives are at risk if assistants who are required to have only eight hours of training are used. Thirteen states have already approved the use of feeding assistants with four more planning to approve soon. Governor Sebelius signed the House Substitute for Senate Bill 272 which includes the provision for paid nutrition assistants. The next step is to adopt the regulations in Kansas. Do you believe that this program can be an asset or a deterrent in a culture change home? One of the concessions that has been made is to call the program "the Dietary Aide Program" because residents were offended by the term "feeding assistant" because it made them feel like cattle. What other concessions might be made to enhance the program or should other solutions to understaffing problems be generated? Have you implemented solutions in your own home? Please report to us by sending an email to linda@ksu.edu. We'll print your responses in our next newsletter. (For a copy of the full article from Older Americans Report, please email Pam Evans at pevans@ksu.edu.) Book ReviewsNobody's Home: Candid Reflections of a Nursing Home Aide by Thomas Edward Gass. Thomas Gass returned to the Midwest to care for his dying mother after traveling abroad for many years. When she passed away he determined that he wanted to do something to give back to the community so he took training as a certified nurse aide and worked in a nursing home for three years. He paints a very candid and personal portrait of the people he meets there. While Gass appears to be unfamiliar with the concept of culture change, his insights and the solutions he suggests at the end of the book are fundamentally at the heart of the movement. I read this book in an afternoon (couldn't put it down). This is a must read! A Framework for Understanding Poverty by Ruby Payne This book was developed with classroom instructors in mind but has tremendous applicability in long term care settings. Payne proposes that all organizations operate from middle class values and rules. Many of the people within the organization as well as those who interact with it, like family members, are not of the middle class. Quite frequently front-line staff may come from generational poverty. Different social classes have different unspoken rules and values that they bring to work with them. Payne is careful to distinguish that none of the rules associated with social class are better than each other, just different. Understanding these differences may lead to more harmony and improved work conditions for all. Teaching the rules and values of the "middle class" organization insures that staff can be successful in the work environment. Montessori in Long-Term Care: Spotlight on Cameron Camp Throughout 2003/2004, the Aging Research Institute has had the opportunity to bring Cameron Camp to Kansas for several educational opportunities. Dr. Camp is a noted psychologist specializing in applied research in gerontology. He gives workshops on designing interventions for dementia across the country. He currently works as Director and Senior Research Scientist at the Myers Research Institute of the Menorah Park Center for Aging in Cleveland Ohio. In 2003, Dr Camp presented at the KAHSA Spring Convention with an overview of abilities that are relatively spared in persons with dementia. He demonstrated some of his unique Montessori based activities and a technique called spaced retrieval which electrified the audience. KAHSA brought Dr. Camp back again on June 10th and 11th, 2004 to present at the Joint Provider Seminar Summer Training for Adult Care Home Staff and KDOA surveyors. Dr. Camp presented "New Approaches to Improve Self-Worth and Quality of Life in Persons with Dementia and Spaced Retrievals. Facility staff and surveyors alike brought back knowledge and techniques that they could use on residents immediately. This fall, Dr. Camp presented workshops on Team Training on Montessori Interventions for Persons With Dementia. The four workshops included residents from each home participating in activities. The homes where the workshops were presented were: Emporia Presbyterian Manor, August 12; Johnson County Nursing Center, August 13; St. Johns of Victoria, September 15; and Catholic Care Center on September 16. In 2005, Dr. Camp will return to present two more seminars on Montessori Interventions, and 4 more seminars on Spaced Retrieval. Be sure to check on KAHSA's website education page for these dates. Contributed by Letty Seidl, KAHSA. KDOA Recognition The Journey Toward Culture Change In this issue we will conclude discussion of Kansas nursing homes that won the 2003 PEAK Award given by the Kansas Department on Aging to recognize nursing homes pursuing "nontraditional" models of care with progressive environments. Featured in this issue are Schowalter Villa, Hesston; Lyons Good Samaritan Center, Lyons; Wichita County Health Center, Leoti; Rossville Valley Manor, Rossville; Sandstone Heights Nursing Home, Little River; and Kansas Veterans Home, Winfield. Realizing that in most cases culture change is a journey or progression that takes from three to seven years or longer, KDOA decided, for the 2003 awards process to recognize homes for specific achievements in separate areas. Those areas were: resident control, staff empowerment, home environment and community involvement. Schowalter Villa and Lyons Good Samaritan Center received the award for all four areas. Homes that received a PEAK Award for three areas include Wichita County Health Center and Rossville Valley Manor. Both Sandstone Heights Nursing Home and Kansas Veterans Home received a PEAK Award for one area. Staff members at Schowalter Villa in Hesston believe that culture change can only happen when people catch a vision of the benefits and potential of change and are willing to work together to make it happen. For more than 12 years, the Villa has used the cluster model of providing consistent caregivers and a neighborhood environment for residents. It recently selected team leaders, who receive extra training in leadership, conflict resolution, activities, restorative care, and understanding non-verbal communication. To create more direct care positions, Schowalter eliminated three management positions, bringing its caregiving staff ratio up from 3.79 to 3.99. The result has been more one-on-one interactions between residents and staff and more activities for residents, especially in the evening. One gentleman resisted all the staff's attempts to engage him until it was found that he previously enjoyed painting. Staff found a space where his paints and canvas could be left undisturbed for him to use when he wanted. Since then, he has created beautiful paintings, some of which have been hung in hallways near his room for staff and other residents to enjoy. Other changes made include expanded dining hours, instituting buffet dining, giving residents more bathing choices in more pleasant surroundings, and building renovation. Since the program began, residents have gained weight, the volume of conversation during mealtime has increased, and resident and family satisfaction survey results have improved. Staff members are currently working with Hesston College faculty and students to provide opportunities for students and residents to meet and learn from one another. They have also gathered the funds to build an on-site preschool, to promote interactions between children and members of the Schowalter community. Lyons Good Samaritan Center formed a neighborhood watch team the summer of 2001 which examined ways to improve the quality of care. Their objectives were to create a home-like environment, create choice and control for residents, and create ownership and move decision making to front line staff. The team led discussions at all-staff meetings. Staff became engaged discussing the need for and ways to change the culture at Lyons Good Samaritan. After that family members and residents where brought into the discussions resulting in the home being divided into four neighborhoods with permanently assigned staff. Each staff member has "adopted" at least one resident to help ensure that they get what they want and need. This has blossomed into a community-wide "Make a Wish" program. If a resident wants something that is difficult for the home to accommodate, that desire is publicized in the newspaper or on the local public access channel. As a result of this program, one resident got an airplane ride and another rode in a Model-A car. Resident choice also extends to hiring new caregivers. When a potential staff member is being interviewed for a neighborhood, a resident from that neighborhood (who has been trained in interviewing techniques ) participates in the interview. Since instituting its focus on resident-centered care, Lyons Good Samaritan Center has experienced a host of improved outcomes. Between 2002 and 2003, turnover decreased from 77% to 48% and deficiencies fell from 11 to 3. The percentile rank for all quality indicators decreased from 54% to 44%. The home's latest resident and responsible party satisfaction survey results were also the best they'd ever experienced. Wichita County Health Center (WCHC) in Leoti, has set resident control as a priority. What makes this unique is that WCHC is a long term care unit in an acute hospital. Residents go to bed and get up when they want. A short order breakfast of the resident's choice is served at any time in the morning. Other choices such as bath day and time, menu choices for dining, and how their rooms are decorated are just a part of "residents living their life to their liking." Staff members know they will be supported in their decisions to provide choices and encourage residents to make their requests known. This includes residents going out into the community if they desire. The attitude at WCHC is "the resident chooses to live here so we can assist them in being able to enjoy their time to its fullest by being socially and emotionally stimulated, medically healthier and safer." Care plans are reviewed with the resident, family, and staff in the resident's room where the resident and family feel at ease in familiar surroundings. Care plans are developed to be simple and understandable to the resident, their family, and the staff. The belief is this creates understanding, trust, and compliance among everyone involved. Rossville Valley Manor (RVM) began their culture change journey with staff education and visits to see other facilities engaged in culture change. They began to define their vision of neighborhoods, with consistent staffing that would insure continuity of care and better meet residents' psychological, functional, and social needs. Above all they wanted to make living and working at Rossville Valley Manor more fun for the residents and staff. To reach the vision they realized they needed permanent staff so in late 2002 they stopped using agency staffing (they now have a waiting list of applications). To make life fun for the residents, they realized that residents needed more control over their lives. In addition to expanded meal times, cooked to order breakfasts and a myriad of choices from the lunch and dinner buffets, more activity choices were added to each neighborhood. Expanded activities were accomplished by each shift in every neighborhood adding an activity everyday. In the early stages of neighborhood formation activities included planning neighborhood names and d‚cor and residents deciding on their own room d‚cor. Then it progressed to a "make a wish program" where life-long hobbies, long ago desires and special wishes can be accomplished. One resident was able to receive permission, tickets were obtained, and the van readied so that he could see his granddaughter presented as a football queen candidate! Staff has been empowered all along the journey, from helping form the community vision to setting their own personal and neighborhood goals. Learning more about regulations and budgeting and planning processes have led to further empowerment. One CMA, who envisioned a patio for the Alzheimer's neighborhood, took it upon herself to make it a reality by planning fund raisers, seeking donations and contacting numerous concrete companies. Besides taking residents out into the Rossville community individually and as a group to area festivals, parades and other events, RVM invites Rossville and the surrounding communities into their home. Along with events like Halloween games and treats, Easter egg hunts, fire works, kite flying and school programs they have started a summer intergenerational program. When the home participated in the Christmas Tour of Homes it was so well received that RVMs maintenance supervisor plans to enter their fish pond (which the administrative assistant/office manager renovated) for the Topeka Annual Pond Tour. Sandstone Heights Nursing Home in Little River applied for the PEAK award in the area of home environment. When they started their journey toward culture change they had white halls, shiny floors, loud hallways, and staff who dressed alike in separate colors for each department. They began by studying the Eden Alternative philosophy and integrating these principals into the facility, resulting in a more homey environment for residents. They have added pets, a day care center for community and staff use, indoor and outdoor gardens, and color in the form of artwork, wall coverings, carpet and paint. Leadership wants the home to bring joy, laughter and companionship to the elders who live there. Because Sandstone Heights is a governmental nursing home they cannot borrow money for improvements, so their changes are accomplished in increments. Currently a committee is working with a small budget to add some contrast and warmth in the shower and whirlpool rooms. Sandstone Heights' leadership believes that residents feel more at home now. They say that, "residents are happier, quieter, and need less interventions for behavioral episodes. Employees wear bright colorful clothes and smile, and all decisions from the board room to the break room are made with the resident and their needs considered." Kansas Veterans Home (KVH) in Winfield opened in May of 2000 and since then has become a fixture in the Winfield community through resident and employee participation in community events, volunteer participation at the home and KVH hosting community events at the facility. Residents participate as a group and individually in community events such as KANZA Days, parades, and holiday ceremonies. Individual residents have entered prize-winning vegetables and crafts in the Cowley County Fair every year since the home opened. KVH served as the drop off point for items to be sent to troops in Afghanistan in 2002. Semi-annual dances, Easter egg hunts and a car show are a few events that bring guests of all ages to the home for entertainment and socialization. Volunteers help in a variety of ways such as preparing donated clothing for the "store" at KVH where residents can shop for free. KVH's volunteer program has grown each year since they opened. In their first year they celebrated 35 volunteers. This past year they honored over 160 individuals and groups who volunteered 4700 hours of service. Congratulations to all of the PEAK 2003 winners. We hope that by telling their stories you will learn that it makes no difference what first step is taken in the journey as long as the nursing home recognizes that culture change must be based on a philosophical change in how care should be delivered. The care should be thought of in a holistic manner to improve quality of life for all within the organization.