Neighborhoods

We’ve heard some great news from Town & Country Health and Rehab in Minden, LA. Their National Night Out celebration won a first place award from Minden’s City Council. Each of Town & Country’s five neighborhoods had its own celebration. Their participation in National Night Out is a reminder that even if you live in a nursing home, having a sense of community both within the nursing home and in the greater community is essential for identity, meaning, purpose, relationships and, yes, fun.

It has me thinking about neighborhoods. Truth is, for many nursing homes, the Neighborhood Model is the way they go. The Neighborhood Model focuses on community, relationships and a sort of graceful living that comes when the stage is set for spontaneous gatherings and activities. People know each other and look out for each other. (In fact, those operating in the Household Model should not ignore the neighborly relationships between households and with the greater community outside the facility.)

The Neighborhood Model is more than just calling a hallway a “neighborhood.” A neighborhood pools its resources to make positive things happen. John McKnight and John Kretzmann of Northwestern University and the Asset Based Community Development Institute have developed a system for neighborhoods to get the most out of what they have. From the website: The ABCD Institute spreads its findings on capacity-building community development in two ways: (1) through extensive and substantial interactions with community builders, and (2) by producing practical resources and tools for community builders to identify, nurture, and mobilize neighborhood assets.

Once all the resources are out on the table, interdependent relationships can start to take form. This means that everyone – staff, elders, family – both give and receive care and friendship. The Pioneer Network’s Declaration of Interdependence says this: “As human beings, we live by and through cooperation with others- it is out destiny. In spite of the emphasis placed on being independent, in reality we are all interdependent. The nature of our cooperation withy and relationships to others changes as we grow, mature and age. These relationships form the basis of all true communities. Therefore, we seek to understand and possess the skills necessary to be interdependent in healthy, productive ways.”

I would also humbly recommend the information and activities in the Good Neighbors Action Pact workbook . I wrote it because I happen to live in a thriving neighborhood, Washington Heights, on Milwaukee’s west side. I have come to depend on and treasure the people in my neighborhood even though we are acquainted just because we happen to live in close proximity. Some of those people are now my dearest friends. If it is possible here, where people leave the neighborhood for hours or even days at a time and can hole up in their own houses for similar periods of time, it can certainly happen in a nursing home.

Here are just a few facilities operating in the Neighborhood Model:

Levindale and Jewish Convalescent Baltimore, MD

Elizabeth Seaton Pediatric Center New York, NY

Provena St Joseph Freeport, IL

Provena Sacred HeartAvilla, IN

Kateri Residence New York, NY


I really encourage you to make community or neighborliness a priority and corner stone in your culture change. It’s one of the easiest things you can do to change your culture because it is already there, you just need recognize it and put it to good use. Start with the elders, they’ll show you how it’s done.

Project Looking Glass

There are two new residents at Garden Spot Village in New Holland Pa. – at least for a few weeks. Bob Fell and Lori Aulenbach are researchers from Varsity, a full-service marketing communications agency specializing in reaching out to the growing 55-plus population. They have moved into Garden Spot retirement community for 30 days to, in the words of Varsity’s David Shoffner, gain first-hand knowledge of the real issues surrounding the life of seniors in order to help companies develop better products/services for seniors and to market them more effectively.

While Bob and Lori are there they are blogging about their experiences and what they are learning. They've been telling of the wealth of joy, wisdom and love elders have to offer as well as the challenges faced by those in the community. I love their message that there isn't really such a thing as a "typical" elder which goes a long way toward person-centered care. It is a good sign that people are looking at ways the world (and yes, manufacturers) can better cater to elders instead of writing them off. In this spirit, you can even increase font size of the blog for easier reading. Bob and Lori are doing a great job of looking at, and showing readers, what elders are not what they are not.

The other interesting thing about reading the blog is to watch the personal transformation of Bob and Lori as their eyes are opened to individual issues of aging. (You know how we love transformation stories at Action Pact.) Perhaps you will recognize aha moments from your own journey. I have. So, have a read of the Project Looking Glass blog for yourself and be sure to leave comments as you are moved. They are doing research, so I’m sure the more info they can gather the better.

Speaking of Faith

This week the NPR show, Speaking of Faith, featured the L’Arche movement. Founded in 1964 by Jean Vanier, the movement establishes communities for people with mental handicaps. The episode of SOF focused on The Arch home in Clinton, IA. At its heart are the same general principles of the Household Model – respecting each other as human beings, generosity of spirit, the need for individuals both to give and receive care, building relationships, community, home and days filled with the natural rhythm of life as we know it. The movement is so person-centered that those who live in L’Arche homes are called “core members” because as one assistant says in the story, “They are the center of what we live. Our life revolves around them.” I especially like the way, in all aspects of their lives, the focus is on what people living at The Arch can do and are and not what they can’t and are not.

You can listen to the story online as well as read more about the movement.

Debriefing

If your facility is going through culture change chances are you are doing a lot of training and trying new things. By taking a few extra minutes to debrief after using a new system you can better assure changes will stick.

Say you are implementing a new meeting model, or have a learning circle with residents to plan a special activity, or do conflict resolution training or have your first week of letting residents wake up when they want instead of having a wake-up schedule. Afterwards you’ll want to talk with those involved to get feedback. This will help tweak the new process or training. You’ll find out if more resources are needed, what went well and what was shaky, what was really helpful and maybe even some ideas of how to make things better.

Also, feedback lets everybody have a voice in the process and see others’ points of view. Traditionally, formal leaders dictate change. Front line staff implement the changes and elders live with the consequences. Of course, it is the front line staff that will know if the change works and the elders that know if the change makes their lives better. So, instead of just dictating, it is important to get staff and elder input from the beginning and then check in to see how things have worked out.

The easiest way to do this is with a learning circle (read a how-to here). Here are some examples of questions that will solicit feedback and give folks a chance to really absorb the outcomes, growth and awareness of change and learning.

How did it feel to deal with “x” in this way?
What worked well about “x” and what can we do better next time?
What did you learn from “x”?
How do you plan to use this new knowledge/system in the future?
How does this work better for the elders?

Doing this in a group is great because it is an opportunity to share different insights and points of view, but debriefing can and should be used in smaller situations such as conflict mediation and behavior coaching. When folks are working through a challenge, it is important to underline and process preferred behaviors to hopefully prevent falling back into the “old way” of doing things. Bottom line in debriefing is follow through.