For 35 years, gahsa has represented the key providers of housing and community-based services for older Georgians.  Our members include nursing homes, retirement housing, assisted living communities, continuing care retirement communities, and community service providers.  These not-for-profit and other mission-driven, resident-focused organizations serve over 127,000 older Georgians each year.  Historically, we have been the leaders in innovation and setting the standards of care. 

For the last several years, gahsa has been gearing up to organize a group of dedicated supporters and stakeholders, working as partners, to promote and foster “culture change” to improve the quality of life for older Georgians in all settings where aging services are delivered.  Many of us have been working toward person-centered care for a long time in many different ways, but we have not had a focused effort around that goal. 
Now is the time…

The Culture Change Network of Georgia is spearheaded by the Georgia Association of Homes & Services for the Aging (gahsa) and the Georgia Institute on Aging.  We will be working to:  define culture change;  increase awareness;  educate;  share ideas;  and highlight programs and promising practices that can be replicated in the field of aging services throughout the state.

As the clearinghouse of organizations and providers working on person-centered, long-term care in multiple care settings, we will build common knowledge, support, commitment and relationships among those represented, and coordinate with other existing groups that have similar goals and interests.

The official “kick off” of the Culture Change Network of Georgia was at the gahsa annual conference April 14-16.  The guest speaker, Francis Battisti, encouraging the development of strong leaders, referred to “change” and “culture” throughout all of his presentations to the group at large.  He also mentioned transformational leadership as the key to success.  There was also a culture change workshop presented by Kim McRae, which was a huge success.

As a part of the American Association of Homes and Services for the Aging's national Quality First program, we are committed to promoting excellence in aging services, as well as building public trust in our field.  Changing the culture of how care is provided not only in nursing home environments, but throughout the continuum of aging services, will help us accomplish these goals.  We are dedicated to providing quality housing and services that seniors need, when they need them, in the place they call home. 

Initial priorities and goals of the Culture Change Network of Georgia include convening a group of advisory partners to assist in providing high level leadership for the CCNG.  Additionally, a web site, www.culturechangega.org is already on-line and will be under development the next few months.  See more information regarding content on the web site and how you can be involved later in this newsletter.

Transformations, our culture change e-newsletter, is designed to be a vehicle to provide educational information, increase awareness, and highlight programs and promising practices that can be replicated in the field of aging services throughout Georgia.  We are committed to providing this information so that person-centered care will become a primary focus throughout the continuum of aging services. 

Kim McRae is working with gahsa to facilitate the development and implementation of the Culture Change Network of Georgia. You will meet her later in this newsletter.  In this and future newsletters, Michelle Holleran will provide articles explaining not only why transformational leadership is needed to engage others in culture change, but how transformation works in successful organizations.

GAHSA is proud to be involved in creating the Culture Change Network of Georgia.  We hope that you and your organization will be able to participate and integrate transformations into the lives of the seniors you serve and your organizations.

For me, the essence of an organization that has fundamentally transformed its culture is that it is a place where relationships matter and are valued above all else.  This shows up in ways large and small on a day-to-day basis, from the way staff at all levels interact, to the way staff, elders and families relate to one another.  When all of those relationships are built on a foundation of mutual respect, openness, equality and genuine caring, there is no telling what else is possible!

~ Ruta Kadonoff, Deputy Directory, THE GREEN HOUSE® Project

---

Kim's Column

Welcome to the inaugural issue of Transformations, the e-newsletter of the Culture Change Network of Georgia!

So, what is this “thing” called culture change?

Culture Change is…

A transformation anchored in values and beliefs that return control to elders and those who work closest
with them.  Its ultimate vision is to create a culture
of aging that is ‘life-affirming, satisfying, humane,
and meaningful.’

Culture change can transform a ‘facility’ into a ‘home,’ a ‘resident’ into a ‘person,’ and a ‘schedule’ into a ‘choice.’

…The Pioneer Network

Culture change started as a national grassroots movement to improve nursing homes in the 1980s.  With the formation of the Pioneer Network in 1997, the national non-profit organization dedicated to culture change, the movement has continued to grow and expand.  Now there are culture change coalitions throughout the United States, and the concepts are spreading internationally.

All across the country, culture change has become “the” buzz word in aging services.  It is the common name given to the national movement for the transformation of older adult services, based on person-directed and person-centered values and practices, where the voices of elders and those working with them are honored and respected.

The culture change movement is dedicated to transforming the old institutional, hospital-like environments and models of care into organizations, communities, and environments that focus on “person-centered,” “resident-directed,” or “patient-directed” care ~ where the person comes first.  The goal is to de-institutionalize long-term care and transform the environments into “home.”  Regardless of the setting or the services provided, it is a focus on quality care that provides quality of life.

There are many models of care and approaches under the culture change umbrella:  Eden Alternative, Wellspring, Green House Project, Pioneer Network, Planetree, Households, The Live Oak Institute and Neighborhoods.  They all focus on building relationships, and joining together to create communities where elders want to live and employees choose to work.  They all emphasize the individual and put the person first.

GAHSA endorses culture change, and believes that it should become the norm throughout the continuum of care – wherever aging services are delivered.  GAHSA is dedicated to providing quality housing and services that seniors need, when they need them, in the place they call home.  We support the transformational leadership that is necessary to encourage, empower and train staff to become active partners on the journey of change.

Together, through Transformations and the Culture Change Network of Georgia, we are going to learn about culture change, how to get started, how to lead change, recommended reading and resources, and upcoming events.  We are also going to celebrate transformational changes in Georgia.  In each issue of the newsletter, we will feature at least one story about what YOU are doing to create change in your organization.  I will be asking you to submit your stories for future issues and the website.  This is also meant to be a tool to share with others.  We are a “Network” and we all have to work together to spread the word about culture change, so please forward this information to your colleagues and friends.

I come to culture change as a result of ten years as a family caregiver and consumer of aging services.  I have experienced first-hand the system as it is, and found myself wanting better for my mother, who has Alzheimer’s disease and Lewy Body dementia.  I have been studying dementia care and long-term care in depth for 7 years.  Together with a degree in journalism; a background in consumer marketing, PR and advertising; and a deep desire to help others, I have become a Culture Change Advocate. I am also serving on the Marketing & Communications Committee of the national Pioneer Network. 

I am so honored to be working with gahsa on this wonderful initiative.  I am very proud of the leadership role that Walter Coffey and gahsa are taking, and their vision and foresight to expand culture change into all settings where aging services are delivered.  I look forward to getting to know you and working with you as we undertake this journey together.

All the best,
      Kim  

---

Culture change is a journey, not a destination.

---

Culture of organizations is the highest responsibility of leaders. Culture health is as important to monitor and foster as the air we breathe and the water we drink. The people that live and work in our organizations deserve the healthiest environments we can give them. Therefore the pursuit of culture transformation becomes our top priority of helping members improve their performance and increase the public’s confidence in our missions.

~ Larry Minnix, President & CEO, AAHSA

---

 

Celebrating Local Change

Calvary Baptist Church’s ministry to seniors grew out of an aging population within our fellowship.  In 1974, the median age of the congregation of Calvary Baptist Church, located in Columbus, Georgia, was 62 years old.  In 1989, Calvary Community opened our first 50 units of affordable housing to those who were 62 or older, or mobility impaired.  This was accomplished by receiving HUD Section 8 202 financing.  In 1992, 58 additional units were added.  This complex has had 100% occupancy since it opened, and has touched hundreds of lives over the years.

As we ministered to and loved the residents, the aging in place process of their needs was ever increasing.  The Gardens at Calvary became the answer to this need.  The complex was opened in October 2000.  The Gardens is an assisted living facility licensed by the State of Georgia for 100 residents.  It has 77 units with six apartment options. 

As we cared for these residents, we saw an ever increasing need to care for those diagnosed with dementia and early stages of Alzheimer’s.  In April 2007, we opened a revolutionary style of assisted living housing for memory care – The Green House® at Calvary.  The Green House® grew out of the Eden Alternative founded by Dr. Bill Thomas.  He recognized that the current system of care for the elderly was a medical model, and by its very nature could not provide a home-like environment.  As a result of his research an entirely new approach to elder care was developed called The Green House Project. ®

The Green House® is a HOME for 10 residents.  Each resident has a private bedroom and bathroom.  There is a common living area, kitchen and dining room.  Every effort is made to insure no “medical model” or “institutional style” of care creeps into this house.  Each employee is a universal worker who provides all the care for the residents.  They are a self-directed team led by a guide – or director.  There is always a one-to-five ratio in the house -- two Caritas (or caregivers) -- for 10 residents.  Residents are encouraged to participate as they are able to meet the needs of the Home.  This could mean being involved in meal planning and preparation, or folding clothes.  The Caritas, rather than being at the bottom of the organizational ladder, are elevated to a position of dignity and professionalism.  Each Carita has over 120 hours of specialized training to equip them in the Green House® philosophy.

Now we see the aging in place of residents who will need the skilled care level.  It is our desire to provide this level of care in the Green House® model.  We are currently seeking authorization to do this work through one of several possibilities.  Calvary feels passionately that our elders who require skilled care should receive the best care possible.  The Green House® model is the direction that the industry will adopt for the future.  As medical model nursing homes reach the point of having to be replaced, the better option is to provide this level of care in a more compassionate environment that moves us away from simply “warehousing our aged.”

We have demonstrated in our first Green House® that it is financially feasible to provide this level of care with this approach. As the number of elders increase who need this level of care, we will be on the leading edge of providing them with the best care possible.

---

“GMCF, the Medicare Quality Improvement Organization for Georgia, is proud to work with the Culture Change Network of Georgia and hopes this new effort will inspire all healthcare settings to practice person-directed care.  At the heart of quality improvement is the right care provided to the right person at the right time.  Elders today deserve this from their healthcare providers and it requires us to work at examining processes, develop leadership skills, and inspire the passion to improve.

By working with the Culture Change Network of Georgia this information will not be just a flavor of the month, but instead it will be the way we do our work in all settings in the future.”
~ Linda Kluge, GMCF,
the Medicare Quality Improvement Organization for Georgia 

---

Website

The new Culture Change Network of Georgia website is “Live” and ready for viewing!  Please visit www.culturechangega.org to learn more about our new network.  Of course the site will be “under construction” for a while, and that is how YOU can get involved and contribute now.

First of all, we want to hear your stories about how you are changing!  We all need to work together to look for, recognize and celebrate our steps on the culture change journey.  It’s not just about “building a new building” ~ it’s about relationships and people.  Tell us your stories, your “baby steps” to change, so that we can celebrate with you, and spread the word.  Please send your stories to kim@haveagoodlife.com.

Secondly, under the “Frequently Asked Questions” section of the website, we are creating a way for you to submit your questions regarding culture change.  Together we will build a “Frequently Asked Questions” list that we can all learn from.  In the meantime, you can submit any questions that you have to me.

And we all know that the language of culture change is a confusing issue.  I invite you to visit “The Language of Culture Change” article located in the “Frequently Asked Questions” section.  One of the ways that we can all get started on our culture change journey is to start thinking about the words that we use.  Please read the article, and send any ideas and suggestions about language to me.

We can work together to make our website a useful, educational and successful tool!  

Getting Started

We have already discussed several ways that you can GET STARTED by sending in your stories, thinking about language, asking your questions, and sharing the information and resources of the Culture Change Network of Georgia with your colleagues and friends. This is your network.

Later in the issue, we recommend the book "Old Age in a New Age," by Beth Baker.  Reading this book, and discussing it with others, is a fabulous way to start on the journey.  It is written primarily about nursing homes, but the concepts are universal and  can be “translated” into all of aging services.  I really love this book, and I think it provides a wonderful history of culture change, and a great foundation for getting started.  Beth Baker gives amazing real stories of what is already being done, the successes and joys, which are improving the lives of elders, staff and families all over the country and the world.

Now I would like to feature something called BUMP’S LAW.  It’s a great way to get started just by changing your thinking and your frame of reference.  You can use this as a conversation starter with your staff just to “GET STARTED.” 

Linda Bump is a national pioneer of person-centered care.  She poses four benchmark questions to help keep organizations from sliding back into the old “medical model” of care.  This is a great tool to share with your organizations.

BUMP’S LAW

Always ask yourself:

• What does the elder want?
• How did/does the elder do it at their home?
• How do you do it at home?
• How should we do it here?

Linda Bump, MPH, RD, LD, LNHA
Action Pact, Inc.
www.culturechangenow.com

Source:  In Pursuit of the Sunbeam:  A Practical Guide to Transformation from Institution to Household, by Steve Shields and LaVrene Norton

For a Printer-Friendly version of BUMP’S LAW, please click here. 

---

When I hear the term Culture Change, I imagine a long-term care facility where residents and staff work together to create a true homeplace where residents are encouraged to direct their own care.  The residents are free to keep to their own daily schedule, rising and retiring as they chose, they may decorate and furnish their room with personal items, and if they wish they may be involved in growing and preparing their own food.  I am excited to join the Culture Change Network of Georgia!

~ Jeni Coyne,
Acting Georgia State Long-Term Care Ombudsman

---

National News

On April 3, 2008, the Centers for Medicare and Medicaid Services and Pioneer Network hosted a historic symposium on the impact of innovative environmental design on creating home and community for nursing home residents. Throughout the day, long-term care innovators, regulators, researchers, architects, advocates and public officials came together in an unprecedented discourse to highlight environmental innovations and to discuss regulatory challenges associated with transforming the physical environments of nursing homes into comfortable, pleasurable places for elders to call home. 

This extraordinary event assembled a powerhouse of key stakeholders to enlighten, discuss, collaborate and move forward with recommendations to advance more widespread innovation in new care environments. More

Click here for the April 3 Creating Home in the Nursing Home Symposium Presentations and Papers

The background paper set the stage for the April 3rd, 2008 Centers for Medicare & Medicaid Services (CMS) and Pioneer Network co-sponsored Creating Home in the Nursing Home: A National Symposium on Culture Change and the Environment Requirements

National Culture Change Symposium Review

I had the great fortune of being able to attend one of the most incredible conferences I have been to in a long time regarding changing culture in long-term care environments.  It just happened a few weeks ago in Washington, D.C.

I was so jazzed by what I learned and experienced that I felt it necessary to type up my notes and share the highlights with you. 
I am so pleased that gahsa is spearheading the Culture Change Network of Georgia.  We need to get going and not be the last ones on the train of change!

With a caring spirit… Nancy Kriseman

Summary of Washington, D.C. Conference on The Environmental Side of the Culture Change Movement (April 3, 2008)

The conference was historic in nature, as it gathered together many of the movers and shakers and innovators in the long-term care industry who are all about changing the culture in long-term care.   The conference was put on by the Centers for Medicare and Medicaid and the Pioneer Network.
A background paper written by Carmen S. Bowman was presented to all participants at the conference.  The Pioneer Networks website has all of the presentation papers available. 

A public forum was provided for all participants, so that we could respond to the various panel presenters.  Our comments and suggestions were recorded and will be put together in a paper presentation at the National Pioneer Network conference this August.  Recommendations from the conference will be formerly presented to CMS and state and federal law makers in the long-term care industry.

Gathered there were: 

Thomas Hamilton and Karen Schoeneman, CMS directors The Center for Medicare and Medicaid
Larry Minnix,  CEO for the American Association of Homes and Services for the Aging;
Amy Carptenter, society for the Advancement of Gerontological Environments;
Joani Latimer, National Association of State Ombudsman Programs;
Jeffery Anderzohn, American Institute of Architects;
Robert Jenkins, Director of the Greenhouse Project and
Nancy Fox, Director of the Eden Alternative,
Directors of the Greenhouse projects nationally;
Elizabeth Brawley, Author of several important books and articles on designing environments for those with dementia Light Up Your Life: The Critical and Often Unexamined Role of Lighting and Other Design Elements in Creating Quality of Life –paper presented at the 2007 National Pioneer Network conference and her most highly recommended book- Design Innovations for Aging and Alzheimer’s : Creating Caring Environments 2006  John Wiley and sons.  (she has recently done a very important study that was published on the importance of lighting in communities which I will share bullet points on);
Janet Wells, National Citizens Coalition for Nursing Home Reform;
Cathy Lieblich, Pioneer Network State Coalition Liason;
Robert Solomon, Assistant VP of National Fire Protection Association; Rosalie Kane PhD, Gerontological Researcher- for Long-term care communities;
Chris Mallet, American Health Care Association, plus many, many other culture change professionals!

Summary of Important Informational Points Gathered by Nancy L. Kriseman, L.C.S.W.

Pioneers are never lost, just occasionally bewildered.
               ...Daniel Boone

Opening Remarks of Interest:

• We need to SHOWCASE INNOVATORS!  We do not need to reinvent the wheel!  The Pioneer Network is trying to identify those who are truly innovating and changing culture!
• Environment communicates what we expect of care and has to be matched with how we support care
• Healthy cultures = very hard team work, partnering with residents, families, staff, community and state and federal regulators
• Quality of life was defined as helping people to live in fullness
• Well meaning regulations can be at odds with resident quality of care and quality of life
• Too many of our older nursing homes and assisted living communities were built more with the medical model in mind, much like how our hospital environments were built
• We need to move from compliance to quality improvement and that takes RISK AND A WILLINGNESS TO CHANGE.  WE NEED TO BE WILLING TO THINK OUT OF THE BOX!!!
• Are our elders living “homeless” lives?  Do our communities communicate a sense of home, not just “homelike” but “feel like home” –different concepts…
• We have to move away from the TRADITIONAL WAYS WE HAVE DELIVERED CARE AND BUILT OUR LONG-TERM CARE FACILITIES  - -  TO PERSON-CENTERED, RESIDENT CENTERED, OR WHAT I HAVE NAMED- RELATIONSHIP CENTERED CARE.  I truly believe that in order to create a culture that cares, you must create environments that support all who live and work in them.  When you think about that, coupled with creating care that supports the “relationship between the resident/family and careprovider you have true caring!  Studies have demonstrated that if the staff in communities are not cared about, appreciated, and valued, their dissatisfaction results in BAD CARE!!!
• We don’t have to make BIG CHANGES, but SMALL CHANGES that provide quality of life for residents and staff
• We need to give our regulators at the state level more FLEXIBILITY

11 Domains in the Environment (all these need to be considered)

• Autonomy
• Dignity  
• Privacy 
• Meaningful activity
• Enjoyment
• Relationships
• Comfort
• Security
• Functional competence
• Spiritual well-Being
• Individuality
• We need to get rid of Institutional Icons- i.e.  overhead announcements; big calendar board on walls; nursing stations; nursing carts; food carts; hours for dining need to be changed; privacy curtains; having three to four residents in a room (the presenters suggested more private rooms -  in the long run studies demonstrate elders have a better quality of life than in shared rooms); institutional bathrooms; rigid shift staffing; activities that just involve the activity directors and not the rest of the staff; turning lights on to check on residents at night (we need lights with dimmers, so that residents and their roommates don’t get awakened unless absolutely necessary)
• We are asking our elders to live in “unnatural” environments!
  The physical environment is the container for the social and spiritual environment
• Outdoor spaces in the environment are just as important as the indoor spaces
• Important to create spaces that provide easy access to the outside for staff and residents

Recommendations from Studies done on Lighting by Elizabeth Brawley

NOT ENOUGH LIGHT- BOTTOM LINE

• We need “task lighting” over toilets, in closets, in the kitchen, where the residents spend quality time and could be in danger of falls, etc.
• We need more natural light and combinations of light
• We need to get the residents out more in natural light and use more skylights in our communities
• Daylight exposure promotes:
  • Better sleep.  75% of long-term care environments have residents that have sleep problems, especially those with dementia
  • Vitamin D
  • Prevents depression, as it increases serotonin
  • Reduces agitation (very important for those with dementia)
  • Regulates our circadian rhythms
  • Consider hiring a “lighting designer”
  • More dimmers
  • Solar timing shades

Other Physical Recommendations:

• European Showers
• Wide Grab Bars, not the rounded type which are hard for those with arthritis to grab
• Outdoor spaces that promote activities; provide shade when it’s hot; are interesting  and promote activities; are relaxing for staff and residents; make porches deeper; tint walking paths
  

Websites to check out and things to google:

• www.pioneernetwork.net
• Dr. Bill Thomas
• The Greenhouse Project
• Bathing Without a Battle: Creating a better bathing experience for persons with Alzheimer's disease and related disorders

Books and Articles:

1. Environments for Late-Stage Dementia, Alzheimer’s Care Quarterly Vol 6, #1  2005, pp.71-75  Calkins, Margaret
2. The Nursing Home of the Future: Are you ready?  www.ideasinstitute.org/future.asp  Calkins, Margaret

   ---

   Nancy Kriseman is a licensed social worker with over 21 years of experience working in the eldercare field.  She is president and founder of Geriatric Consulting Services, Inc., where she provides  in-service training for long-term care environments.

   ---

---

Culture change improves the quality of life for consumers and their families, and the quality of work life for staff at all levels. Culture change requires substantial organizational transformation and cannot be achieved through any one intervention. Culture change activities focus on one or more of three strategic objectives:  expanding person-centered care;  promoting workforce development;  and building nursing home capacity to engage in continuous quality improvement.  IFAS congratulates gahsa for developing this network in Georgia.

~ Natasha S. Bryant, Institute for the Future of Aging Services (IFAS)

---

Culture change in aging services has focused on person-centered care – the idea that residents should be fed and bathed according to their liking, not the convenience of the facility staff.  Yet, culture change is so much more than this.  Change happens in a wide variety of ways, and should not be defined in a limited fashion.  Embracing change is about changing our mindsets, our worldviews, our assumptions and our attitudes.  It starts from within each of us, and manifests itself organizationally in teamwork, innovation, systems thinking and new leadership practices.

~ Michele Holleran, Holleran Consulting, Leadership AAHSA

---

Leading Change

The very word “transformation” conjures up images of leaders who have revolutionized our history, our society or the world at large. Ghandi, Martin Luther King, John F. Kennedy, Susan B. Anthony, Mother Theresa. You no doubt can think of someone who revolutionized your world and life—a parent, a mentor, a supervisor at work or some other inspirational person who saw something in you that you failed to see in yourself.

It is these types of people—the transformational leaders of our time—that motivate us to be our best and to perform at our highest levels. Now, more than ever, we need these individuals to craft a vision for our field and our organizations. We need these individuals to expand our horizons, help us to think out of the box in creative ways and mobilize followers around a cause they believe in. We need these individuals to help us find our way, make sense out of our job roles and show us how these roles connect to the organizational vision.

These are the transformational leaders who are called to make culture change happen in the field of aging services. People like Dr. Bill Thomas who brought the concept of Greenhouses to us.
People like Jenny Chin Hansen who put the first PACE program in place. And Nancy King of Ohio Presbyterian Homes and Services who figured out a way to make home and community based services a reality many years ago.

Culture change is about change. Human beings by nature do not like change—they want things to stay the same. We humans like routine, consistency and non-confrontational environments. Most of us do, at least. Transformational leaders love change—that’s what makes them tick and how they change other people’s perspective about change. A transformational leader craves change and inspires others to embrace it too.

Change typically happens in organizations slowly. In fact, some say it takes 7-10 years for a culture to truly change. That is because culture change is more than a new program, a new physical structure or a new way of delivering services. Culture change is about attitude. About taking risks, making mistakes, experimenting and finding new solutions to old problems. So, a transformational leader has to get into the hearts and souls of people before they are willing to change their attitudes. Not an easy job.

How does a transformational leader get people to welcome change instead of run away from it?

First, the leader demonstrates a willingness to change him/herself. By role modeling the behaviors he or she wishes to see in others, the transformational leader builds trust and sets the tone for the culture change. For example, the leader might wish to start asking thoughtful questions instead of having all the answers all the time. He or she might place the responsibility for coming up with solutions on the followers instead of taking it on her own shoulders. This is a behavior co-workers will notice. By spreading out the decision making, seeking constant feedback and alternative opinions, the leader demonstrates a commitment to shared power. This sends a clear message to others that the leader does not intend to own the responsibility for success or failure; that the team is in this all together.

Transformation efforts often fail, and that is because leaders fail to capitalize on the momentum initially created. Sometimes they revert back to old habits, cannot coalesce a shared vision, or fail to motivate followers to implement the strategies to achieve the vision. And yet, these are the very things which must happen for successful culture change.

A second critical step in the culture change process is to band together a group of core supporters who are able to influence others to go along with the culture change. A non-profit multi-site nursing home organization in Minneapolis successfully changed its culture when it converted many of the homes to CCRCs (continuing care retirement communities), created mobile assisted living units, and developed a plethora of home and community based service offerings. At first, many of the employees bulked at this transition. However, well-respected influential supervisors at the middle of the organization began to see why the new vision made sense, got on board with the CEO and her executive team, and won over the hearts and souls of the rest of the employees.

Part of the reason for the successful culture change at the Minneapolis organization happened because of the repetitive nature of the messages coming from both the top and the middle of the organization. Importantly, leaders reinforced the fact that this culture change would allow employees more flexibility and variety in their jobs, a chance to grow into new skill areas, and ensure the long-term stability of the organization so that jobs would be plentiful and secure for many decades to come.  By aligning the personal goals of the workers with the professional vision of the organization, leaders were successful in allowing culture change to take root and flourish.

Culture change often results in some employees dropping out of the organization. This happens because they feel too uncomfortable or insecure with the change to hang in during the sometimes turbulent transition. Learning new skills, adopting new attitudes and changing the way things are done are not comfortable for most people. Therefore, the leaders must pave the way, and create a safe “holding environment” for followers.  The heat is turned up during culture change, yet it must be turned up at a pace that is tolerable for the majority of people.  And that is the job of the transformational leader. The transformational leader realizes that culture change is “adaptive” work—meaning it is gradual, messy and uncomfortable. He or she must have the skill to be reassuring, while at the same time, challenging people to be and do more.

An excellent resource for those who wish to learn more about culture change is John Kotter’s book entitled “Our Iceberg is Melting” which is a fable about a penguin colony in Antarctica.
Other resources on leadership and culture change are available on my website: www.dearmentconsulting.com under the resources section.

Michele Holleran, PhD, MBA, is the founder of two firms: Holleran, specializing in customized satisfaction surveys and needs assessments and DeArment Consulting, specializing in organizational and leadership development. She currently chairs the Leadership AAHSA program. Contact Michele at 970-349-1632 or via e-mail at mdholleran@earthlink.net.

---

As Culture Change relates to nursing home care, I have come to view the concept as including the kinds of multifaceted and transformational changes that will be necessary for us all to focus greater emphasis on improving the quality of life for nursing home residents by providing more individualized, resident-centered care, in an environment that respects individual dignity, self-determination, choices and preferences about the services they receive and the physical environment within which they live… I see this as the most important yet-to-be-realized promises of the 1987 Nursing Home Reform Act (OBRA ’87).  I look forward to participating with you and the others on this initiative.

~ David Dunbar, Director, Long-Term Care Section,
Office of Regulatory Services,
GA Department of Human Resources 

---

The Georgia Council on Aging continues to promote best practices in the delivery of services to older Georgians.  Through collaborations with community partners to sponsor forums highlighting best practices, providing input to state agencies through work group participation and public testimony, the Council promotes innovation and creative problem solving.  Although the process of culture change often seems to move more slowly than we might like, with steadfast dedication we move public policy in the direction needed to better serve older Georgians.

~ Melanie McNeil, Executive Director
Georgia Council on Aging

---

Recommended Reading and Resources

I've read about the "Green House Project." I've seen homes that proudly carry the moniker "Eden Alternative." I've witnessed tremendous progress, physically and culturally, in many of our local nursing homes. But I've never had the foundation to defend my dream of patient centered, dignified lifestyles for our elders until I read Beth Bakers "Old Age in a New Age: The Promise of Transformative Nursing Homes."

This book should be read by every nursing home employee, from certified nursing assistants to administrators, and every government regulator and Medicaid employee. I'd also love to see everyone who is considering a nursing home for an elder have a copy of this book. If more people were informed about what is possible, there would be such a demand for improved services that there would be no way the masses could be ignored.

Baker has issues with the way aging is viewed in this country. She writes, "Nursing homes are a predictable outgrowth of a U.S. culture that views old age as a disease to be prevented or conquered, rather than a life stage to be honored."

Baker's book is all about cultural change. It's about moving from the perceived "efficiency" of most nursing home models to a patient centered model. She tracks the culture change pioneers in the nursing home field and visits their facilities to see how the elders respond.

What she sees is that when an elder is given choices; when an elder is treated like an individual; when an elder is tended to lovingly by staff that is respected by peers and supervisors alike - and the same caregivers are consistently there for the elder - then the elder thrives. People who had once quit communicating or were considered to exhibit "difficult behaviors" tend to become engaged in their new, patient-centered environment and exhibit more friendly personalities. Many examples given by Baker are total transformations for people thought to be unreachable. They were "reached" simply by giving them choices and treating them as honored individuals.

Much of this progressive thought process has been spreading across the nation in the last decade. Too late for my folks, but several years ago, the nursing home where my parents spent many years went to a flexible meal plan. If my mom could have eaten the frequent light meals offered at any time of day - the plan they now offer - she likely would have been able to eat more. She would have lost less weight, stayed healthier and maybe even fallen less often.

Unfortunately, though the home was excellent, they were still stuck in the three-meals-a-day plan, with a huge heaping of meat and potatoes at noon. Mom would feel sick at the sight of the heavy meal and completely lose her appetite. I kept her supplied with fruit and vegetables she loved, and cold shrimp and sauce (she had a cooler) and other goodies. But still, I couldn't be there for every moment she wanted something light to eat. With new meal plans now being adopted by facilities today, this would have not been an issue. She could have eaten lightly several times a day, and she would have enjoyed food far a longer period of time.

Doesn't this type of food plan cost more? That's the first question people ask. The answer I've gotten, coming from Baker's book as well as administrators I've visited with, is a resounding "no." There is less waste when there is more choice, and people eat better, so fewer supplements are needed. Many homes find food costs go down.

Baker writes about ground up physical renovations such as building homes per the Green House plan, where groups of ten people, each with his or her own bedroom, live together in a modified house. They are watched over by a specially trained CNA. Baker writes about other homes in the Pioneer Network that are working under their own plans.

Not every facility can completely rebuild their physical plant, but changes can be made to make even older facilities less institution-like. Most changes are attitude changes. Cultural changes. As always, it's the people that count. And that means the people who work at the facility, starting with the most important employees - the lower paid and often less respected CNAs. A true culture change puts all employees into the mindset that they work together for the good of the elder and they each respect the other for the job they do. The staff is happier, therefore there is less staff turnover, and once again, the homes save money.

The key to a good employee is how he or she views the elders they care for. Do they look at them as individuals that, if understood and worked with can still have a satisfying life, or as just another resident to warehouse until he or she dies? This is where the most fundamental change must occur. Giving choices - truly believing that elders are in another life phase, as opposed to just sending them out to pasture - this is where the culture change must start.

Floor plans, food plans, costs and regulations are all addressed in "Old Age in a New Age." What Baker leaves me with is a sense of excitement. She helps me have faith that nursing homes can and will be totally transformed. She leaves me with the hope that the sheer numbers of boomers, rather than being a frightening thing, may push change so that our elders (and older boomers) are able to experience a quality life, even when their bodies and minds make it impossible to live an independent life.

Baker gives examples of changes made that save money while providing better care; changes that stay within the Medicaid budget, so it's not just more of the same - the people with money get good care, and those without get ignored (or worse). These changes would take place in such a manner that every elder gets the kind of care and living conditions he or she deserves, no matter what financial circumstances they come from.

I pray that Beth Baker's "Old Age in a New Age" has as lasting effect on our culture as the hospice movement has had. Our elder years are part of our life cycle and people in that part of the life cycle deserve humane care that includes making choices in their everyday life.
Old Age in a New Age, by Beth Baker is published by Vanderbilt University Press (2007).

For more information about Carol click here or click here.

This is not yet available in book stores. 
It can be ordered on the Pioneer Network website or on the ActionPact website or through Amazon

---

As a part of the Wesley Woods Center on Aging and Emory University, The Fuqua Center for Late-Life Depression is dedicated to improving public awareness and understanding of depression in older adults in order to de-stigmatize and eliminate discrimination associated with mental illness.  We believe that promoting a culture change regarding overall mental health will improve the quality of life for our seniors for years to come. We are thrilled to be part of the Culture Change Network of Georgia, and feel that now is a great time to organize, develop and improve partnerships in aging services communities in order to facilitate this exciting movement.

~ Nancie Vito, The Fuqua Center for Late-Life Depression

---

In 1962 when I entered nursing school in Houston, Texas I was surprised to learn that my education did not include care of persons with developmental disabilities. As the sibling of a developmentally-disabled brother, I was shocked by this dismissal of a unique population with special needs. Children were cared for by pediatricians, and older persons were just the other end of the age spectrum. There was no field of gerontology or geriatrics. We learned about illness and disease and caring, but we did not learn about difference and diversity and self-direction. Care plans were laboriously created for the patients we served, but never did we ask the patient what they would like to see happen. Everything was done for them, to them, and sometimes for their families, but certainly not “with them.

Today, that has all changed in our culture! No stronger statement of culture change comes to my mind than the massive changes in society and in human and health services that those!  It is for these reasons that I wish to participate in the Culture Change Network of Georgia,  and work with others in our state to consider the culture change around care of persons for the long term.

~ Norma Lundy, Atlanta Regional Commission

---

Events Calendar

June

June 3 – 6

Eden Alternative International Conference
Columbus, Ohio
           

June 9 – 12

Myers Third Annual Spring Conference
Myers Research Institute
Columbus, Ohio
The Myers Research Institute offers in-depth training in Montessori-based Dementia Programming® and Spaced Retrieval.   

July

July 23 – 25

Eden Associate Training
Nashville, TN

July 29       

SAVE THIS DATE
Tale of Transformation
Culture Change event in Atlanta
Watch the website for more information and updates!

           
August

August 20-22

Pioneer Network 8th National Conference
A Call to Action
Washington, DC

August 24-27

Alzheimer’s Association Dementia Care Conference
Garden Grove, CA 

September

 

September 4

SAVE THIS DATE
Culture Change Symposium in Atlanta
Presented by gahsa and the Culture Change Network of Georgia
Watch the website for more information and updates!

September 14-16

The Georgia Gerontology Society
53rd Annual Meeting & Conference
The Art of Aging
Columbus, Georgia

October

October 19 – 22

Planetree
2008 Annual Conference
Chicago, IL