Five Stars and a Blog

So, how about the five-star nursing home rating system, huh? My first thought was that eating at a five-star restaurant doesn’t guaranty a good dining experience and that during one of my favorite dining experiences ever at a diner in New Orleans I saw one dead roach on the floor. I’m not saying that pest issues should be ignored or that a five-star rating doesn’t indicate some level of excellence, but that there are a lot of factors that effect a person’s experience that rating systems, such as the one recently released by Centers for Medicare and Medicaid Services, ignore.

I am, of course, not the only one who feels this way as the point is mentioned in the first few paragraphs of the many articles I have read on it. (Here’s one for example).

Interestingly, another sort of “quality indicator” recently showed up on the Web as well. The goal of Bob’s “Nursing Home Ninja Blog” is “to comment on conditions, care, and circumstances in Nursing Homes & Extended care facilities.” Bob is a resident in a long-term care facility and will be providing an “inside view” of the situation at his nursing home. Somewhere between these two new websites, and some personal investigation, perhaps people will find some aid in choosing a nursing home for themselves or a loved one. I think Bob will be able to bring up some good issues to think about and ask about that may not come to mind unless you’ve actually lived in a nursing home – some of those things that the five-star system doesn’t cover.

I encourage you to comment here on what you consider important indicators of quality of care so that with many view points we can all get a really good big picture of what quality life in a nursing home should be.

Power Struggle

I had an interesting dream last night - I was in a large group being taught different movements that were meant to represent animals. The teacher asked us to break up into groups of three and put several movements that we learned together to make a routine. So, I went off with the other two in my group, a woman and a man both in their 50s, and we got started. The woman said, “I thought we could start with the crab” and demonstrated. I said “Wow! I was thinking the same thing! But I was thinking we could modify the movement at the end so that we could more smoothly move on to the next movement” and there the woman cut me off and said. “No, I think we should do it my way” and I said “But you haven’t even heard or seen my suggestion.” “It doesn’t matter, “ she said, “I want to do it my way.” “Well, I could just as easily say ‘I want to do it my way’ that’s not a convincing reason.” (The man, bless his soul, was keeping out of it.) She then said people my age (30s) thought they could just come in and tell people who had been doing their jobs for years how things should be done and she wasn’t going for that. I pointed out that in fact, we usually did what the more senior people in the organization wanted to do often only because they were the more senior people. At this point, I think my mind figured out what was going on and I woke up, mad and frustrated. I mean, she didn’t even want to hear my idea.

There are two things you should know: 1) the dream took place in the gym of my grade school which is never a pleasant place for the subconscious to visit, making everything that happened feel a little more hostile and 2) I’m working on some stuff on steering teams. I think this dream was telling me that I have to make sure to pay proper attention to the power struggles that happen as an organization moves toward self-led teams.

Obviously there are power issues linked to position and that is technically changed as the organization is restructured. But just because positions change doesn’t mean behaviors or feelings change. We have some pretty well ingrained feelings about whose say has weight…As in my dream, age can be a factor. (Though in a nursing home, power can be denied to someone who is “too old” as well as “too young.”) Part of the age factor has to do with experience, but there is also experience in the particular organization – that is those who have worked there for years having more power than those who have only been there for a few months regardless of overall experience. While those with seniority may know the ins and outs of the organization well, a fresh perspective can be equally valuable.

And then there is the issue of personality types within subgroups. There are those like the woman in my dream and me who are comfortable taking the lead but there are also those like the man in my dream who wait to see which way the wind will blow, uncomfortable with the responsibility that comes with power.
These power struggles are part of our general culture, not just nursing home culture, making them a little harder to overcome because they are reinforced outside of work. Please share with us what you have done in your organizations to level the playing field. I’d really like to share the power of this blog platform.