Vision without action is merely a dream. Action without vision just passes the time. Vision with action can change the world. -- Joel Barker
GEORGIA
Culture Change Connection
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By: Kim McRae
Aging Services of
Georgia, along with other groups, organizations and individuals throughout the
state, has supported an effort to appropriate “Civil Monetary
Penalty” funds (CMPs) to programs supporting Culture Change. By federal
law these CMP dollars, which were collected as fines on nursing homes, must be
spent to benefit residents of nursing homes. Due to the
“hole” in the FY ’10 budget, legislators are reluctant to
fund any new programs, and the Senate version of the budget appropriates all of
the CMP funds (an amount of more than $10 million) in an attempt to adhere to
federal law yet still be used to address the budget deficit. The House version
appropriates $1 million to the long term care ombudsman program and $600,000 to
Adult Protective Services. The differences will have to be worked out by
a conference committee when the General Assembly re-convenes on March 8.
Background:
In
1986, Congress passed the Nursing Home Reform Act (OBRA) which allowed the
government to issue sanctions against nursing homes that failed to comply with
federal Medicare and Medicaid quality of care requirements. Civil money
penalties (CMPs) are one type of sanction. The federal Centers for Medicare and
Medicaid Services (CMS) contracts with the Georgia Department of Community
Health (DCH) to inspect nursing homes on a regular basis and to issue CMPs for
failure to comply with federal statute.
CMP funds
collected are held in an account (for violations of state statute and
regulations) to be used for various initiatives allowed by CMS. CMS issued guidance to states encouraging
the use of federal CMP funds for innovative projects that improve the quality
of care and quality of life for nursing home residents. Specifically, CMS
stated, “Because CMP funds collected by a state are state funds, the
state may use the money for any project that directly benefits facility
residents.”
Civil Monetary
Penalties: An
Many
states are using the fines collected as a result of nursing home violations to
fund projects to improve the quality of life and quality of care of nursing
home residents. In those states, nursing home advisory committees provide
consultation to state regulatory agencies on the expenditure of Civil Money
Penalty (CMP) funds and make recommendations for funding of innovative
projects. In addition to efforts to improve the quality of clinical care (such
as the reduction of pressure ulcers and the use of restraints), states are also
encouraging person directed care, promoting consumer and resident advocacy,
developing family and community involvement, and supporting culture change initiatives.
Alternative
models of care have emerged in response to the growing realization that there
is a better way to provide care for our nation’s elders in nursing homes.
Sometimes referred to as “person centered care,” “resident
directed care” or “culture change;” the focus is on
empowering residents to direct their own care and caregivers to act creatively
in responding to the needs of residents. CMP
funds are
a potentially powerful source for supporting innovation that improves
conditions for everyone who resides or works in a nursing home.
See the
August 8, 2002 memo from CMS: Use of Civil Monetary (CMP) Funds by States Memorandum,
which discusses
"Appropriate CMP Fund Use" including culture change efforts. See the June 19, 2009 memo from CMS: Use of Civil Money Penalty (CMP)
Funds by States and Reporting of CMP Funds Returned to the State, clarifying
how CMPs may be directed and used by States, and sharing suggestions of
innovative projects and activities that have already been undertaken with CMP
funds in some States.
In the 2009
memo, CMS reiterated that “statutory
intent is clear that they (CMP funds) should be used for activities that will
benefit facility residents.” The 2009 memo stated that inappropriate
uses of funds are (anything) that is “not related to improving the
quality of life and care of nursing home residents.” Culture Change
initiatives are one of the examples of accepted ways to use the funds.
“Culture
Change”
is the name of the national movement to transform the way care and services are
provided to older adults, mostly in nursing home settings.
Funding for Innovation: A Review of
State Practices with Civil Monetary Penalties, is a report funded
by The Commonwealth Fund. In it you will
find The Long Term Care
Community Coalition's summary of findings from a 2006 study of states' use of
CMP funds with recommendations for state and federal governments and strategies
for stakeholders. It recommends
the use of federal CMP funds for innovation, and strongly advocates for public
disclosure of the use of these funds. The report also provides examples of
special projects funded in other states:
* Support for the Long Term Care Ombudsman
Program
* Culture change initiatives
* Initiatives that support recruitment and
retention of nursing assistants
* Promotion of resident and family councils
and other types of consumer advocacy
* Alzheimer’s and dementia care
training
* Research to identify the extent of mental
illness among residents and to make recommendations regarding staff training
* Training workshops for facilities on
restraints, pain and pressure ulcers
* Also included will be training tied to
the goals of the national Advancing Excellence in Nursing Homes campaign
including consistent assignment, reducing
turnover, resident/family satisfaction and employee satisfaction.
In
terms of what is going to happen here in Georgia, We Will See…
Georgia
is Participating in Pioneer Network Pilot Project to Reach Consumers
A
Good Age: Making Nursing Homes More Like Home
The Pioneer Network, an umbrella group in
This includes respecting the residents’ wishes on schedules for getting
up in the morning, having meals, showering, and going to bed at night. More
Front Line Staff Could Benefit from Affordable Homeownership through the Habitat for Humanity program
You can be the link by connecting your staff members with the Habitat for Humanity affiliate in your area and providing valuable information. The benefits to your organization could be many…better staff retention when employees are homeowners, thus adding value to their job, a more financially stable staff, and staff possibly living closer to work, cutting commute time and cost. You provide the mentoring contact for your staff. They will know that you care about the quality of their housing, too.
By the way, there are more than 70 Habitat for Humanity affiliates across
All
Georgia
The Culture Change Network of Georgia received a grant from Healthcare
Research, Inc. to provide this significant resource to every nursing home in
Webinar Series NOW Available
Click here for Culture Change Webinars held recently entitled Setting the Stage for Culture Change: Preparing for our Aging Population
CULTURE CHANGE NEWS & EVENTS
Early
Bird Registration
Pioneer Network's 10th National
Conference
Meeting at the Crossroads -
August 9-11 in Indianapolis ,
Indiana
Pioneer Network's highly anticipated national conference is the nation's
largest and most successful conference of its kind. The three-day conference is
a showcase for innovative thought and transformative practices in the long-term
care culture change movement — as well as an opportunity to facilitate
communication among people interested in propelling this important work.
Pioneer Network hosts the only national conference devoted solely to culture
change and features pre-conference intensives, inspirational plenary speakers,
50+ group sessions and special events. Now preparing for its tenth year, the
Pioneer Network conference has been attended by more than ten thousand culture
change advocates from around the nation,
Georgia
(INT-1) Getting Started: Mapping the Course of Culture Change
(INT-5) How Can We Radically Transform Activities in Long Term Care?
(INT-7) Beyond Care: Exploring the Glorious Adventure of the Spirit
(INT-10) Get On The Bus For Change: Culture Change Within Adult Day
Services
(INT-8) The Role of the Nurse in a Person-Directed Culture
(INT-12) Eliminating Restraints including Alarms by Engaging the Whole
(INT-13) The Long-Term Care Improvement Guide: Practical Guidance for Culture
Change Through the Eyes of Residents, Staff and Leaders
MORE
Scholarships
A limited number of partial & full scholarships are available. Download the application.
The Food and Dining Side of the Culture Change Movement February Dining Symposium Canceled: Online Programming and Plan B Announced
As many of you know, the much-anticipated Creating
Home in the Nursing Home II: A National Symposium on Culture Change and the
Food and Dining Requirements, sponsored by Centers for Medicare
& Medicaid Services (CMS) and Pioneer Network, was canceled due to
devastating snow storms that hit the Mid-Atlantic region on February 11 and 12.
As promised, we are providing you with an update on how we plan to proceed
given this unavoidable turn of events. We hope you will agree that "Plan
B" provides a very timely and accessible alternative. While the dates that
the information and web program will be available cannot yet be confirmed, we
want to share the details we have so far and the approach that has been
developed. Learn More
Background Paper Available Now
Prepared by Carmen Bowman, MHS under contract with the Centers for Medicare
& Medicaid Services (CMS), The
Food and Dining Side of the Culture Change Movement: Identifying Barriers and
Potential Solutions to Furthering Innovation in Nursing Homes is
intended to provide the history of the culture change movement as it pertains
to food and dining, including current research regarding food and dining issues
and innovations.
"The issues surrounding new and innovative ways of serving food in the
nursing home as you weave in and out of regulatory requirements. Thus, both the
issues as well as the regulations are presented here together intertwined with
what is missing. Carmen offers recommendations for what might be helpful on
your journey to Culture Change." --Carmen Bowman, Author
Click
here to download the background paper.
Creating Home--Access to Nature Webinar Series
Did You Miss the First Two Webinars? Register
for the Final Webinar Two!
Pioneer Network is proud to offer a three-part webinar series that investigates
outdoor environmental design and green spaces to benefit older adults. The webinars
will take place on three Tuesdays in March -- the 2nd, 9th and 16th from 1:00pm
to 2:00 p.m. EST.
CULTURE CHANGE THROUGHOUT THE CONTINUUM OF LIFE-LONG LIVING & LONG-TERM CARE
Developing Partnerships, Collaborations, and Networks to Advance Culture Change in Long-term Care
(Source: Pioneer Network)
Pioneer Network is a national resource to the field of aging and long-term
care, a clearinghouse for ideas, and a facilitator of partnerships focusing on issues
of culture change and person-centered transformations throughout the continuum
of care. Pioneer Network began in 1997 when a small panel of prominent
professionals came together to advocate for person-centered care. Since that
time, Pioneer Network has continued to serve as the umbrella organization and
communication conduit to collect and share adaptable practices and procedures
that put person before task and create communication, networking and learning
opportunities. As the center for thought leaders and innovators in the field of
aging, Pioneer Network is a catalyst and diffuser of person-centered innovation
with a strong focus on developing evidence-based and
adaptable approaches that are cost effective.
After a decade of persistent determination and grassroots advocacy, the movement for person-centered care is taking hold. At this juncture, Pioneer Network is collaborating and networking with stakeholders at all levels of the long-term care community including policymakers, consumers, researchers, educators, providers, and partner organizations By sharing our knowledge, we accelerate adoption, diffusion and dissemination of person-centered concepts and help to create a more cost effective and responsive long-term care system that addresses societal, fiscal and market concerns.
“Culture change” is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them. Its ultimate vision is to create a culture of aging that is inclusive, life-affirming, satisfying, humane, and meaningful. In the culture change journey, person-centered care most resembles the kind of care and caring most consumers desire. Long-term care environments become places where elders can continue to live and, most importantly, make their own choices and have control over their daily lives. The transformation accompanying culture change requires changes in organizationpractices, physical environments, workplace practices, and relationships. While many specific approaches have been developed, the core values that unite them are choice, dignity, respect, and self-determination. These values are reflected in key aspects of the care setting as well as in the philosophy and practices of leaders and caregivers. More
Focus Is On Individuals and Quality of Life
(Source: AARP Bulletin)
They aren't diseases, but the word that is used to describe them -- plagues
-- is certainly morose. Those in the long-term care business say boredom,
helplessness and loneliness are the three plagues that account for most of the
suffering among the elderly.
There has been a national movement that has been going on for about 20 years
that's goal is to try to deinstitutionalize medical settings and promote
patient-centered care. The name given to the movement is "culture
change."
"It is all about the patient and their needs," said Gwynn Powell,
director of home health services for Palms Home Care in Sebring. "We are
the provider for the customer; they are the customer. "It's a whole
different realm of thinking," she added… More
Leaders Need to be Visible
(Source: Long-Term Living)
Effective leaders never ask someone to do something that they are unwilling to do themselves.
Leaders at all levels of an organization need to be available, approachable, and visible. If leaders spend all of their time in their offices, how can they know what the employees need or the quality of care they provide? Effective leaders make time and actually schedule time to walk throughout the facility, engaging with staff, residents, and families. It is not about the need to “check on employees,” but rather a genuine desire to interact with the staff and residents in order to determine that both are receiving the care and attention that they deserve. More
The Washington
(Source: Aging In Action)
The Village model for community-dwelling older adults has become quite
popular in
The Village model is less of a cookie-cutter approach to aging-in-place than it
is a shared spirit of empowerment for older adults to live independently in the
community late into life. Each village is very different, with tailored
services and programming structures.
For
more information,
NURSING HOMES
Young Nursing Home Residents:
Person-Centered Culture Change Must Include Them 
As quiet
as it’s kept, young residents are often found in nursing homes. They are
a growing population that many overlook when they think of nursing homes as
“old people’s homes.” In many ways, traditional nursing
homes are not designed with needs of young residents in mind.
The first young resident I came to know while I was hospice volunteering was
a young woman named Velma… But there was a sadness about these
young people and some others I have seen in nursing homes…
More
Grants Offered for Nursing Homes in Colorado
(Source: The Colorado Springs
Fines collected from
LGBT
Nursing Home to Open in Massachusetts
(Source: 365gay.com)
The Elsie Frank House at the
ASSISTED LIVING
(Source: ChangingAging.org by Dr. Bill Thomas)
The popular misconception is that the only “problems” within aging services are related to nursing homes. This falsehood reminds me of the ancient royal concept of the “whipping boy.” It is as all of the sins and defects of the system can be loaded onto nursing home so that all other parts of the system can be exonerated. Here is a rare commercial television of report on problems with quality in Assisted Living facilities. More
ADULT DAY
Institute on Aging Study: Adult Day Health Care Improves Senior Participants’ Quality of Life
(Source: cts.businsesswire.com)
A recent study by
HCBS (HOME & COMMUNITY BASED SERVICES)
Factors That Ensure Successful Aging-in-Place Services
(Source: Aging In Action)
Home and Community Based Services (HCBS) offer support to older adults who
wish to grow old in their own homes, and previous research has shown they can
help prevent nursing home usage; however, very little is known about what mechanisms
make the programs succeed or fail.
After comparing the impact of HCBS services on the older adults’ ability
to stay in the home, the researchers found that participating in paid services
for instrumental activities of daily living (IADL) and having a high awareness
of what the typical unmet needs are for older adults helped research
participants stay in their homes longer than others. More
END-OF-LIFE & HOSPICE
Marking Our Journey: The Importance of Ceremony During Life Stages and Beyond
(Source: Carol Bradley Bursack in ouralzheimer’s.com)
Birth, graduations, marriage, anniversaries, death - important moments in
our lives are often celebrated by some type of ceremony. In our middle to
late years, we are often encouraged to plan the type of funeral we'd like,
even pre-paying so our loved ones won't have to juggle business and
grief. Everyone has different ideas about when a ceremony is appropriate,
however I've learned about a new ceremony that I find very appealing. It's the "Walking You Home" program
and it offers a dignified touch and family support immediately after the
death of a loved one…
"Walking You Home" is a way for staff, residents and family to show
their respect for the deceased by accompanying the deceased's body from their
room to a waiting funeral coach. There's a touching dignity about this program
that I think I would have found comforting.
When people live in a care center for a long time, residents get to know one
another. When someone dies, they - well, they just disappear. As a friend said,
they seem to kind of slip away in the middle of the night. Or, as I often
witnessed, residents who noticed the funeral home's cart being rolled up to
the elevator will mumble, "well, someone is dying again," and
look away. More
THE ELDERS (The People With & For Whom We're Doing) & THE STAFF (The People Doing the Doint)
Women's Friendship Reaches Beyond Barriers
(Source: Fayetteville
Contributed photo Gladys Ingram, left, and Grace Pillsbury became friends when Ingram worked at an assisted-living care facility where Pillsbury lived.
Gladys Ingram, with a full-time job as a correction officer and a funeral
service to attend at her church, was facing a busy day Thursday. But she
seated herself on the edge of one of the twin beds in the last room on the left
at Willow Place Assisted Living Facility and settled in for some
conversation. Sitting next to her, in a warm robe and a wheelchair, was
her good friend Grace Pillsbury. No matter how busy life gets, Ingram
always makes time to visit Pillsbury.
"At least three or four times a week,'' Ingram said.
Theirs is an unusual relationship.
Gladys Ingram is a middle-aged black woman.
Grace Pillsbury, who makes no bones about her age, is white.
"I'm 85,'' she said. "I'll be 86 in June.'' More
Profile of a Person at the Center of Person-Centered Care
(Source: Action Pact Newsletter, Culture Change Now)
Opportunities to give, be helpful and be responsible give meaning to the
lives of elders living in long-term care. They are also essential for helping
people feel part of the community and have ownership in their home. Action Pact
consultant Bev Cowdrick recently talked with a resident at Masonic Home of
Shelbyville, KY, and shares his story of purposeful daily life here. More
John Clinton has lived at the Masonic Home of Shelbyville for three years. I
met with him recently in the newly constructed living room of his neighborhood,
North Terrace. John embodies what is best about what happens when
residents get involved as true partners in creating home in a nursing home. More
Working
in Households "Like Coming Home" for 67 Year Old Pearl
(Source: Action Pact Newsletter, Culture Change Now)
At age 67, Pearl Barnes doesn't need to hold a job. But she still gets up
before dawn to work the early shift as a full-time homemaker in McEwen
Household, the memory support unit at Pennybyrn at Maryfield Retirement Community
in
LIVING LIFE & ACTIVITIES
The Hope of Music's Healing Powers
(Source: Los Ageles Times)
Yes, yes, it hath charms to soothe a savage breast (or beast, if you prefer to repeat a common mistake). But researchers are finding that music may be an effective balm for many other afflictions: the isolation of conditions such as autism and Alzheimer's disease, the disability that results from stroke, the physical stress of entering the world too early. More.
DEMENTIA
Campaign Warns of Dementia Stigma: One in Three People are Uncomfortable Around People with Dementia, a Government Survey has Found
(Source: BBC NEWS)
Launching a campaign to raise awareness of living with dementia, care
services minister Phil Hope said people with the condition were often
stigmatised.
As part of the project, people with dementia will be educating the public about
how they can best help people with the condition.
The survey of almost 1,700 adults found that 53% of people said they do not
know enough about dementia to help someone who has it. More
Creative Activities for Persons with Dementia
(Source: Eden
Emilie was once a vibrant woman, capable wife and nurturing mother of 11 children. Her days were full – managing a large family farm house, bandaging little knees and singing with her musically talented family. When she was a schoolgirl, Emilie developed a strong sense of competition as a gymnast. Now she struggles with the effects of advanced-stage memory loss. Caregivers who work with Emilie tap into her family experiences and competitive nature to guide the administration of her care.
Some researchers believe consistent mental stimulation helps combat the loss
of brain power by creating new pathways to compensate for damaged ones. Care
that incorporates an individual’s interests, abilities and needs into
daily activities has advantages over a strict medical model. Caregivers can
more successfully engage individuals in activities that reflect their past hobbies
and careers.
More
Check
out these films entered into the 2010 Neuro Film Festival from the
TECHNOLOGY
Two Vincentian Nursing Homes Experiment with Robotic Pets for Alzheimer's Patients
(Source: Pittsburgh
Lake Fong/Post-Gazette
Millie Lesek, 89, pats Paro, a $6,000 furry robot at Vincentian Home in
McCandless. At right is Eileen Oldaker, her daughter.
When Millie Lesek called his name, the white furry creature looked over at her. Then Paro cooed and blinked, his long lashes sweeping past his large dark eyes.
"I love you, too," she told the lifelike "therapeutic robot." "You must be eating too much," the 89-year-old grandmother joked. "You look a little fat." As she petted him, Paro responded with a variety of sounds, ranging from a purr to a yelp…
"When the staff brings Paro to my mom and she takes him in her arms, it
seems like all her fears go away," Mrs. Oldaker said.
Read
more
ATTITUDES ABOUT AGING
International Views on Aging Well
(Source: Aging In Action)
Considerable research has been done that describes how older adults perceive
successful aging; however, the diverse views of older adults worldwide have
never been put together in a comparative framework. Researchers from South
America, the Caribbean, and Europe published results of a survey that outline
the diverse views that older adults have about successful aging worldwide in
seven countries in Latin America and
The findings suggest that European and Latin American older adults have similar
conceptions of what it means to age well. Regardless of age, country, or world
region, respondents believe remaining in good health until death, being able to
take care of oneself, having family and friends there for them, and feeling
good about oneself are the most important aspects of successful aging.
Interestingly, the least important factors in aging was living a very long time
and being able to work after retirement. More
Suicide Among Seniors Citizens Increasing
(Source: The Korea
Three elderly women threw themselves to their deaths in the southern city of
"Elderly people think of their present problems as larger and more serious
as they have less hope of getting better as time goes by, compared to the
younger generation," an official of the
How are We Feeling Today, Dearie?
(Source: Time Goes By)
There comes a time for everyone when, in the eyes of the people around us, we have passed an invisible barrier into old age. If we have not yet realized this transition ourselves, there are plenty of younger people willing to set us straight.
A nurse may address us in the infantile plural: “And how are we today?
If shopping with a young person, the sales clerk may speak to him or her, rather than you: “Does she want the red or the blue?”
Or as happened to me during one of my final job searches before retiring, a 20-something interviewer says, “Tell me about your life goals, dearie…
More (Be sure to read the comments section in this one!)
Elderly Seen as 'Burden on Society'
(Source: ABC TV, Australia
Some Australians still view older people as a burden on society. (ABC TV)
New
research has found some Australians still see older people as a burden on
society.
The university's Associate Professor David Mellor says young people and baby boomers perceived older people as unproductive.
"While older people are seen as friendly and pleasant, ultimately, they're seen to be unproductive," he said.
"Now, that ties in with baby boomers talking about older people as having no ambition, or as being fragile and being a burden on society."
Professor Mellor says the research revealed a number of reasons why older people are not treated with respect.
"Things like the smaller family size, broken families, the pressure of time that affects people who are working, and the rise of technology," he said.
"All of those kind of factors were seen to be barriers to younger people giving respect or expressing respect to older people."
FROM CAREGIVERS & CONSUMERS
Caregivers Corner: Nursing Home Staff Needs a Lesson in Caring
(Source: The Capital)
DEAR MARY: I just lost my dear husband of 65 years to Alzheimer's disease. Mary, you would hardly believe the many times I thought about you during his stay in the hospital and nursing home. I am so glad we had the experiences of the wealth of knowledge you shared through the many workshops and seminars we attended together.
During this difficult period there were many times I thought how much the staff would benefit from your depth and detail of knowledge of dementia care. I was horrified by how they handled him; like he was a piece of meat. One time two aides were moving him up in the bed and slammed his head into the headboard. No one talked to him like he had any sense at all. Even the doctor dismissed him as if he should just die.
He was capable of following directions if they took the time to tell him what to do. Instead, they just did things without warning, which frightened him. I think they could learn a lot by being in bed for a day and having someone tend to all their needs. They would discover how humiliating and degrading an experience it is.
My husband was a person and the love of my life, and I would do anything to
have him with me today - even in his Alzheimer's state. He was a gentle, loving
soul who would never hurt anyone. I am heartbroken over this experience.
More