Creature Comforts

We talk so much about how it is the daily pleasures, creature comforts, if you will, that really make the care in nursing homes person-centered care – customizing care and services to each individual’s preference. Perhaps you’ve seen the new TV show, “Creature Comforts,” that features the voices of “fellow Americans” giving their personalities to claymation (animation of clay figures) animals. The June 18th episode, Winter Wonderland or Wasteland included a segment titled “The Zoo.” The “fellow Americans,” one would guess from their voices and comments, include a woman who works at a zoo portrayed as a monkey and children portrayed as slugs obviously talking about the zoo. There are some other voices that seem to be those of folks living in nursing homes talking about their experiences there. However, their comments could very well be those of animals living in a zoo. I’m worried now that this is all coming off badly and maybe you just have to see it for yourself(which is really the point of this blog anyway, to see this show online). “The Zoo” is part 3 of the episode titled “Winter Wonderland or Wasteland” though the first two parts are fun too.

In general, the show is quite charming (if occasionally a little naughty...afterall, the voices are from candid, unscripted interviews with average Janes and Joes). I’m sharing it with you because I think by hearing some of the things these people have to say in a safe and entertaining way, we may be better ready to hear them. There is a particular piece that features a little bird sitting on the back of a rhino. The rhino talks about how when he first came to “this place” he was lonely and miserable but after he met the bird they became close and now everything was just fine. The bird is so touched she says she’ll cry.

In another piece, the interviewer is talking to another animal (maybe it is some sort of worthog). He asks, “How is the food?” Because of his accent and the animal's apparent hearing problem, there is a struggle between them for theanimal to understand the word “food.” After a bit of back and forth (Food. Fuse? Food. Fooze? Food.) The question finally gets through and the answer is “Well, let’s just say I’m hungry.”

It all reminded me a bit of David Greenberger’s interviews with folks in nursing homes that he publishes in the magazine Duplex Planet. We don’t necessarily need to ask elders for the meaning of life to understand them as people or gain a little wisdom. And frankly, everyday conversations with our “fellow Americans” seem more fulfilling for all involved.

Group Decision Making

While self-led teams working together to make decisions that will shape elders’ lives is sort of a revolutionary notion, as a society, we’ve been using a similar format to decide the fate of people’s lives for hundreds of years. In our judicial system, a jury of twelve people listens to all sides of the story, weighs the evidence and testimony, discusses between themselves and comes up with a verdict.

I spent a part of last week serving on the jury of a murder trial. It was a very interesting and emotional experience. The jury members were chosen just after lunch on Monday and we had a verdict by 4 p.m. Wednesday. Talk about swift justice! When it came time for us to deliberate, I was all ready to pull out my group meeting and decision making tools from culture change. But, besides having to get us back on track a few times and helping to maintain balance between the shy and the talkative, the process went very smoothly. The twelve of us brought a variety of background and experience and together we made a very important decision – one that would affect the rest of a man’s life and a family grieving for their 13-year old little girl. That’s a lot hanging in the balance. And yet, 12 strangers with no qualification other than a driver’s license were trusted with that decision. We had no “training” and no help. We didn’t know the man who was on trial or any of the witnesses.

So, can someone tell me why a group of people, including elders and those that care for them (both family members and staff), can’t or shouldn’t decide what to have for dinner tomorrow night, alternatives to scheduled lift and dunk baths, an individual’s morning routine or any of the other thousands of things in an elder’s everyday life?

We assume that adults have some sort of good judgment (though of course, there are those who don’t)...but generally, we drive cars, vote, hold jobs, raise families and at times even take calculated risks. It is only institution that makes us believe there are only a gifted few who can be trusted to make decisions or know “what is best.”

Remember at the end of “The Wizard of Oz” when Glinda the good witch tells Dorothy that she’s had the power to get herself back to Kansas all along? Administrators and DONs are not the only ones wearing ruby slippers, friends.

Weighted Voting

If you have ever tried to decide with a group of friends or family where to go or what to have for dinner, you know it is rarely a “yay/nay” decision. It is usually the case with any group decision when there are multiple outcome options. When an organization makes the move from top-down decisions to a team process, it may be tempting to go back to the hierarchical way as it seems quicker and easier. But this doesn’t mean you’ll end up with the best outcome for the organization – an outcome that will best serve elders and can best be carried out by those closest to them. So, here’s a little tool to help teams make decisions.

The process is called “weighted voting” and it takes into account that people may have preferences that vary more than “like” and “dislike.” Let’s use the simple decision of wallpaper borders in a bathroom make over for an example. There are three to choose from: flowers, checked and ocean themed. Each option is written on a piece of paper and posted where all who are involved in the decision can see. Each person (in this case, you would certainly be involving elders) gets five sticker dots (available at office supply stores). Now, someone may like the ocean scene best but also doesn’t mind the flowers. So, that person may put three stickers on the ocean scene paper and two on the flowers. Maybe somebody really likes the checked one and puts all five of her stickers there. The idea is that each person gets to distribute her five votes however she would like to best express her preferences within the options.

Three options of wallpaper is pretty cut and dry, but this system works well for more complex decisions that come about in the organization as well. If there are more options, you may want to give voters more votes to use. Also, weighted voting is a way to narrow down options for further discussion as well. But the bottom line is that everyone’s opinions hold the same “weight.”

I’d love to hear and share stories of how this process has worked in your organization.