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Although at first glance it may seem like regulations are at odds with customization and accommodation of individual preferences, the truth is that rules are put into  place to provide minimum benchmarks for acceptable care practices.   These benchmarks are not a barrier to delivering care in a holistic and thoughtful manner, unless we allow ourselves to blame the regulations for our own shortcomings in providing person-centered care.

The truth is that many regulations have been promoting a person-first approach to care for a long time.  North Carolina’s standards for In Home Aide services, funded through the Home and Community Care Block Grant, is a perfect example of how regulations can  support person-centered care practices.

For two decades, these requirements have focused on the delivery of home care that takes into account everything about the individual, including the living environment, the personal and financial resources and the social network and family support available.  The regulations promote a thorough and thoughtful assessment process, with a customized and unique plan of care for the individual that will hopefully enable him or her to remain in the home for a long time to come.

All too often, however, the home care industry has focused its attention on the elements of physical care, neglecting the softer, social side of the individual’s life and lifestyle.  That short sightedness can spell trouble as those other resources, or lack thereof, are often the deciding factor in whether or not the individual can remain in the home over the long term. 

That’s why these regulatory standards have always promoted a holistic assessment process and regular contact with the care recipient, over and above the act of daily care provision, and why these regulations continue to stand the test of time.

Read NC’s In Home Aide Standards

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Across the US, there are more than 1.6 million individuals living in 16,000 nursing homes and more than 1 million in 50,000 board and care-assisted living facilities. Residents’ Rights Month comes to a close in a matter of days, but the need for all residents of long term care facilities to receive quality care, enjoy quality of life and be treated with respect does not end.  Making and keeping connections with these individuals and the greater communities in which they live is a goal worthy of our attention, each and every day.

Copied from “The Week Ahead At TJCOG: Oct 24-28″

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The recently released report, Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers, compiled by AARP, the Commonwealth Fund and the SCAN Foundation, offers a window into our nation’s readiness to deal with the long term needs of our aging boomer population. The hope is that this scorecard will help states objectively assess their ranking in key areas of long term services and supports, and open the door for them to learn from each other about how to improve their systems and move forward.

The scorecard focuses on four key dimensions of long term services and supports, and examines each of these areas in detail. The four dimensions addressed in the report are: affordability and access, choice of setting and provider, quality of life and quality of care, and support for family caregivers.

North Carolina, our home state, ranked as 24th in the nation overall for long term services and supports, and is one of only two southern states to score in the upper percentile.  However, in spite of our state’s modest achievements, our work remains cut out for us.

Where is our Achilles heel? Quality of life and quality of care was the lowest scoring dimension for our state.

We can certainly do better.  

To review the scorecard in its entirety, visit longtermscorecard.org

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Read this account of a long term care admission experience and tell me-is this “atypical”?

Nursing home stay an eye-opener for advocate for elderly

 

 

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Next week, a co-worker and I travel to Washington DC to attend the 36th annual National Area Agencies on Aging’s conference and trade show.  The highlight for us will be on Monday, when this project will be recognized with an Aging Achievement Award, presented by Kathy Greenlee, Assistant Secretary of the Administration on Aging.

We are more than thrilled to receive this honor, but it really isn’t about us.  Rather, this honor validates all the hard work and time that has been put in over the last two years by our local partners in the long term care continuum.

You know, they are the ones who really face the challenges of applying the concepts of person-centeredness and culture change to everyday situations.  Even when the alternative of “business as usual” may seem tempting, they forge on and continue to welcome us and our culture change message in to their world.

This award is for them!

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We had a conversation amongst ourselves this week about the difficulties of  helping organizations understand that changing culture is more than changing schedules or environments.  We began to ponder self-assessment tools and how these might help point organizations in the right direction.

However, even with the best of tools and resource materials, it can be very hard for staff undertaking this effort to fully realize what deep level change means.  After much discussion, we decided that the process comes down to two critical things:

•    Adopting a collective organizational mindset that pays attention to and assesses EVERYTHING from a person-centered perspective, questioning the status quo over and over again without blame.

•    Building trusting and intersecting relationships at all levels of the organization and within the community, and consciously doing the things that strengthen and maintain those ties over time.

This is what it comes down to-There can not be deep and lasting change unless these two things are integrated into daily organizational life.

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On June 15^th, the date designated for the sixth  annual World Elder Abuse Day, advocates around the globe will don purple as a symbol of unity in the ongoing battle to end elder abuse and neglect.

Abuse and neglect of older persons is often hidden from the public eye, under-recognized and under-reported.  Unfortunately, no community or country in the world is immune from this costly public health and human rights crisis, and as our population ages, this threat grows ever larger.

As we continue inculcating  the values  of  “culture change” throughout our region,  it’s become clear that the adoption of person-centered  practices within our long  term  care homes  can significantly aid in the prevention of resident  abuse and  neglect.  The following points help support this belief:

• National Center on Elder Abuse has recognized that a nursing  home’s culture is  a crucial factor  in  determining  the   success  or failure  of efforts to prevent  abuse.  (Nursing Home Abuse – Risk Prevention Profile Checklist)
• Numerous studies have shown that poor staffing and institutional indifference create fertile conditions for abuse. 
• Instances of nursing home neglect have often been attributed to under-qualified and inexperienced   staff.  Staff, unprepared to handle difficult situations, may also take out their frustrations on residents. (Elder Abuse Foundation)
• Unintentional neglect resulting in bedsores, malnutrition, dehydration, and contractures/frozen joints can also happen when staff lacks knowledge, empowerment, and a sense of accountability.  These health consequences can be very difficult for a resident to overcome, and in some cases can prove fatal.

This is why the culture change journey is so necessary to undertake.   The impact can be far greater than just keeping residents happy or comfortable.  Their very lives may depend on it.   

Imagine Our World-Free from Elder Abuse

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 Recently, I came across this thought-provoking quote:

“All the flowers of all the tomorrows are in the seeds of today.”

We’re very excited to be planting more “seeds” in the upcoming weeks, as we bring our  “how of culture change”, focusing on the First 48 Hours and on Dining,  to Raleigh and  Pittsboro, NC.   (For more about these topics, see this blog post and this one.)

Wednesday, June 15, 2011 

8:30 am – 3:30 pm

Wake County Commons Building

4011 Carya Drive

Raleigh, NC 27610

 

Thursday, June 16, 2011

8:30 am – 3:30 pm

Central Carolina Community College 

764 West Street

Pittsboro, NC 27312

Registration is $35 per person and closes on June 10, 2011.  For more information or to register, call our TJAAA Program Associate at 919-558-2711.

Meanwhile, at our last meeting of the Durham LTC Culture Change Collaborative, it was inspirational  to hear how homes represented in the Collaborative have approached improvements  to their admission procedures and to dining options, following our discussions around these topics. 

Yes, all of the flowers of all the tomorrows are in the seeds that are being  sown right now.  Come start your own amazing garden, by joining us on June 15 &16!

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In discussing our culture change project, people are naturally curious as to outcomes we’ve observed, given all the time we’ve devoted.    

Finally, at the end of two years of effort, the short term outcomes are beginning to emerge and to be identifiable.  As exciting as it may be for our staff to convey the improvements we’ve noticed, it’s equally gratifying when others can point to positive changes within our long term care continuum.

Case in point is this excerpt from a report from one of our Community Advisory Committees about identifiable strengths and weaknesses within a particular county’s long term care facilities.

“Most nursing homes are actively engaging in Culture Change activities.  Some of the changes that are a direct result of Culture Change education collaborative are: 

a.  Waffle Wednesdays – where residents have waffle breakfast during the morning.  The residents are not required to dress and have choice related to time of this meal.

b.  Cookbook Creation - Residents are creating a cookbook of favorite recipes.  Before a recipe goes into the book, it is tested by the residents, who both prepare and taste test the recipe. 

c.  One facility re-designed its dining room.  Meals will be served by wait staff, hoping to create the feel of restaurant dining experience.  This facility also implemented an Ambassador Program to ease a resident’s transition into the facility.

d.  Collaborative between select committee members, Ombudsman and facility staff is working to improve first 24 hours of resident’s stay in a home.

e.  One facility stands out in the way it keeps residents independent by lessening dependence on wheelchairs.

f.  Many facilities have established coffee bars or bistros giving residents increased choice related to snacks.

g.  All have implemented consistent assignments for health care staff.”

It’s just one little paragraph, but it speaks volumes about the hard work by all those  involved with this project, especially those in the facilities who’ve had the courage and desire to make these changes.  Equally impressive is the enthusiasm of our Community Advisory Committee volunteers for acknowledging and incorporating quality of life improvements into their routine visits and reports. 

Let’s hope this is just the beginning of bigger and better things to come!

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Wow!  The Durham Learning Collaborative Pilot Project was recently voted in the top ten of NCSU’s Institute for Emerging Issues’ promising practices in healthcare innovation.  Using an online voting process, the public selected these innovative projects from a field of 70 nominees.

This puts the Durham Learning Collaborative on the agenda for this year’s Emerging Issues Forum, a summit bringing together leading thinkers, practitioners and decision makers to ponder NC’s grassroots innovations in healthcare practice,  and what might be generated  in terms of potential public policy changes or possible replication on a grander scale.

Obviously, we are proud of this achievement and of all those who’ve made the Learning Collaborative special, but now we need to articulate what is innovative about the Collaborative and how it differs from the traditional learning that most long-term care staff members experience.

One of the key differences is that the Collaborative is based on the development of relationships, at many levels.   The forming of relationships helps establish a sense of trust and understanding (rather than blame or criticism) that has made the Collaborative possible.  Just getting competitors together to explore areas of mutual interest, along with Nursing Home Ombudsmen and Community Advisory Committee members, is something of an accomplishment in and of itself.  This didn’t happen without lots of preparation (we like to refer to this as “tilling the soil”) to develop the readiness, open-mindedness and atmosphere were people could be comfortable sharing their ideas with one another. 

Another key difference is peer-based learning and applied knowledge. The underlying model for the Collaborative is called a “Learning Circle”, defined as a group with a common interest that approaches learning in a self-defined and flexible way.  The idea is that everyone in the group has something to share and something to learn, and the end goal is to move from sharing knowledge to implementing action.  The diversity amongst group members is an asset to the learning process, as it brings forth unique perspectives, rather than focusing only on what a teacher brings to the learning experience.  You can find out more about the use of learning circles at http://www.pioneernetwork.net/Data/Documents/LearningCircleKeane.PDF

Finally, this is a grass-roots effort to achieve improvements in” long term living”.  The curriculum evolves based on the interests of its group members and it is not prescriptive.  It is not a top-down requirement, but is instead, a voluntary undertaking by those participating in the group.

Participation in the Collaborative reflects belief in the value of our collective knowledge, and that each of us can positively impact our organizations through our own intentional actions, at whatever level of an organization we find ourselves.

 How change manifests itself, as a result of the learning experience may vary, but the issues that are tackled are of universal interest to the group members.  Take the topic of the “the first twenty-four hours” after admission, for example.  Facility A and staff member A  may approach change in this area very differently from Facility B and staff member B, but all can make small improvements  in the way residents are first introduced to their new homes.  Those involved figure out what those improvements need to be and how they need to be implemented. 

 If rules or policies need to be changed, they can be adjusted to support the changes under taken at the grass-roots level.  This is not to discount the importance of formal leadership, but to affirm that everyone has a role to play in creating a more person-first environment.