Culture Change in Practice

Technojoy for Elders

2008-03-12T14:41:00.004-05:00

Isolation is obviously a huge issue for elders living in nursing homes. Of course, there are mobility issues in getting from one room to another in the facility, but even residing in a nursing home keeps elders from the rest of the community. Many residents don’t have phones in their rooms and therefore don’t have the opportunity to pick up the phone to say hi to someone whenever they want. Then there are cognitive impairments that further isolate them by breaking the bridge of communication and understanding with others.

The thing that has made all of our lives easier may be just the tool to address all these isolation issues: the computer. I’ll first say that the gender gap in technology has, itself, caused some isolation for elders in the same way I feel out of the loop with text-messaging teens. It is quite possible that someone living in a nursing home had not even used a computer earlier in life. However, for starters, email makes communication with friends and family more frequent and common than visits, especially from those who live far away. Checking email has become part of daily life for many of us. It can be part of elders’ daily lives too.

Obviously computer skills and access can be the hurtle for elders but HP makes a “printing mailbox” that along with service by Presto, allows people to receive email and photos without a computer and with very little technical knowledge. The system only receives (you can’t reply or send from it) messages from approved email addresses, which means no spam. Imagine one on every hallway, neighborhood or household. If you ever lived away from your loved ones for a period of time, you know how much “mail” can make your day. It is such a simple, and inexpensive, way to bring joy to elders.

Taking elders and computers to the next step is It’s Never 2 Late, a company started by Jack York in ‘99. Using adaptive hardware including touch screens and modified keyboards, the software is designed specifically for nursing homes. It offers engaging activities for elders from puzzles and games to a flight simulator. But, it also has many applications for perpetuating person-centered care. Staff can create power point type presentations to profile each resident in a “get to know me” fashion. One facility made a short video to show other staff members a way to transfer an elder from wheel chair to bed in a way that did not agitate the particular resident. The content can be personalized to meet the needs of individuals and community. Computers have enhanced our lives in many ways and it is exciting to see the possibilities they can offer in nursing homes as well. Contact glenn@actionpact.com for more info on It's Never 2 Late.

Meet me on the Web

2008-02-14T18:28:00.001-06:00

Social networking on the Web is not just for kids anymore. For elders, a virtual community is suited to best serve the real need for social interaction. In the late stages of life, and of course when one is living in a nursing home, there’s a good chance that family and friends are scattered geographically. Limited mobility leaves elders dependent on others for initiating visits. With email, suddenly no one is so far away.

While it’s great to be in touch with loved ones, it’s also nice to meet new people and the Web can help there as well. Inspired by the idea of MySpace – meeting new people around the world with whom you share interests – but finding it quite youth slanted, Marian Van Eyk McCain started ElderwomanSpace for social networking for women of the “third age.” It’s an offshoot of her Elderwoman site Just like other online social networks, there are discussion groups, photo sharing, blogs and comment boards. It’s easy to lose track of time this way and while it is still a screen and not a face you are facing, humanity and discovery still comes through. The women on ElderwomanSpace talk about everything from gardens to their families to the issues facing elderwomen.

So, how can we get folks in nursing homes on the Web? Do elders have access to computers at your facility? Any ideas about getting folks interested activities on the net? The Web is really the most immediate tool we have for combating the isolation elders face in nursing homes and it is right in front of our faces, literally. How can we put it to good use?

Elder Storytelling on the Web

2008-02-04T17:54:00.000-06:00

It is easy for us to get to hear the stories of the famous people and events in history, but I think the combined stories of ordinary folks are the ones that can best paint a story of our past and our humanity. I’m not alone in this. Anyone ever heard of Ken Burns?

Can you imagine what a nursing home would look like if we could see the stories of our elders projected on the walls and floating around in the air? Such a wealth! Taping into elders’ wealth of stories can make the day more enjoyable and rewarding for everyone. Elders have an opportunity to give of themselves and staff get to know them better giving all involved a greater sense of meaning and purpose.

Friends and family know each other’s stories. It’s one of the reasons we find story telling essential for creating home in long-term care. We get to know each other this way. We can also help facilitate relationships when we recognize a common bond between residents and staff members.

Person-centered care focuses on the individual, but a lot can also be gained from understanding the shared history of elders and the years that shaped their lives. Since history often repeats itself, you may be struck by similarities to current events to those events that have shaped our elders’ lives and world earlier in time. This is a great way to start a conversation with an elder about something you both have experienced. It is a way to recognize shared humanity.

There are some great websites dedicated to elder story telling. You could get lost for days in them, reading snapshots of people’s lives. I hope they will give you understanding and inspiration. These sites also have ways for readers to contribute stories. Pull yourself and an elder up to a computer and share a story with the rest of us! You could also use a story from one of these sites as an ice breaker or learning circle to get folks to share their own stories.

I, Witness to History was founded in 1996 by the residents and staff of Larksfield Place retirement community. They had their eye on the means as well as the end: “The process of writing one’s story, promotes personal insight, provides an added sense of self-worth, restores a measure of self-control in one’s life, and provides much-needed social interaction.”

The site is a huge library of stories that you can search by author or topic or just browse. There’s some great tips and info about collecting stories and creating a program like I, Witness to History. You’ll also find info on their inter-generaltional program.

I also love Time Goes By: What It’s Really Like Getting Older blog/site by Ronni Bennett. Time Goes By features great elder issue pages like Elder Video (links for clips featuring elders on YouTube). Ronni’s blog is fantastic and there are links to about a gazillion blogs by folks 50 and older and even a page of photos if the actual rooms where related bloggers do their blogging. There’s also info on setting up your own blog. It’s not for everyone, but I bet you could find a resident or two or four who would like to do their own blog. Not ready to commit to a blog? The Elder Storytelling Place –an offshoot of Time Goes By – is a great place to read and submit one-off stories by elders.

Know of other great places on the Web for elders to share their stories? Let us know in a comment.

The Future of Culture Change

2008-02-04T17:52:00.000-06:00

There’s no denying it, the future, and frankly the present, of almost everything is on the Web. “Oh, certainly not elders and nursing homes,” you may say. But, yes! And here’s why: A)The Internet is a fast, effective and cheap way to spread information on things like, say, culture change. B) The Internet is a fast, effective and cheap way for people, like elders in nursing homes, who are separated from their families and the world in general because of limited mobility, to participate in community.

Over the next few weeks I’ll be blogging about the web and elders. Presenting elder centered websites, ways to be involved in the culture change movement on the web and ways and reasons to get elders in front of a computer. Plus, Action Pact has some great online tools coming down the pipe because the capabilities of the Web offer great learning opportunities.

I’d like to start things by saying while I am a member of Generation X, my computer skills are a bit of an embarrassment and even though the virtual dictionary is a click away, I usually find myself reaching for the bound Websters on my desk. I can think of five Baby-Boomer-and-beyond friends off the top of my head who spend more time on the net and are more comfortable with it than I am. I’m telling you this so you know we will be learning together. Because, let’s face it, our culture has changed the way it sends and receives information. Let’s hope the way we give and receive care in homes instead of institutions will catch on as quickly and well.

politics of change

2008-01-11T16:38:00.000-06:00

I bet I'm not the only one whose ears have been perking up a lot lately because the word "change" has been popping up so much because of the presidential primaries. There's a great story about it from the Associated Press by Erin McClam titled 'Change' in the air, once again.

From it, a quote:"We're obsessed with it. We can't let it go, can we?" says Marian Salzman, chief marketing officer for advertising titan J. Walter Thompson. "It's the word of the day, minute and hour, and I don't even know what it means."

Ah, but we do! Doesn't it feel nice to be ahead of the curve? The culture of our country has a lot to do with the way we treat our elderly.The culture of the 60s and 70s that valued youth, productivity and efficiency is the culture that created an maintained institutional living for our frail elders. I'm hoping that our current culture that seems to value change and progress will support us in our need to find true home for elders. As a country and as the world of long-term care, can we really back up the talk of change with action? Are we as ready for it as we say we are?

Resolution

2008-01-02T11:31:00.000-06:00

Anytime is a great time to make changes in the culture of a nursing home. But, of course a new year and the feeling of a clean slate that comes with it can give you an extra push. One of the hardest things about making a change is the attachment we feel to the old way. Behavioral habits are hard to break, but making a change also means we must realize the way we have been doing things for so long has not been the right or best way. That can be tough to swallow. Making changes in the name of "New Year's resolutions" can give us a pass on the stigma of old habits. We can move forward by simply declaring, "Out with the old in with the new!"

I saw this paragraph in a story about resolutions that can increase our longevity (5 great ways to care for ourselves and elders):

"But don't let these bad habits of the past discourage you - it is never too late to make new choices. What you did in the past can be changed, and your body will respond in kind. What matters is what you do from this moment forward."

I love that line: "What matters is what you do from this moment forward." My resolution this year is to make that my mantra to remind myself every minute is a new opportunity to accomplish something good.

Best of luck on your journeys in this new year. May the best of 2007 be the worst of 2008.

Home for the Holidays

2007-12-11T14:33:00.000-06:00

Around Christmas, when I was a little girl, we used to turn off the lights at night, turn on the tree lights and christmas music and just watch the tree and the snow falling past the window behind it. All of us on the couch just relaxing and taking it all in. Well, our tree is up and it is snowing great big Hollywood flakes outside (stunning if you don't have to drive in it) and I can tell you what I'll be doing tonight after the shoveling. I've brought a tradition from my parents house to my house. Later in the week we'll make Sandbakkles, a Christmas tradition from my husband's Norwegian heritage taught to him by his grandmother. What will you do?

Living in the midwest, we have a culture built around winter, not just Christmas and I think the dark days and cold have us looking for Christmas joy for most of December. Honestly, I think I love all the little things leading up to Christmas at least as much as the holiday itself. December is a time for rituals and comfort. I bet your residents have all sorts of ideas as to what that means to them. Activities for the month of December can be sort of a no-brainer: Christmas concert from a local choir, putting up a tree and decorations, making cookies, religious services, etc. Most of us partake in all those things to some degree, but it is the specifics about the way we do those things that make them our personal traditions. Talk to the residents about their own personal spin on the holidays and personalize the holiday activities in your organization. And then, for Santa's sake, tell us about it! Leave a comment on how you went about getting input from residents and how you incorporated that input into your festivities. Sharing traditions is a great topic for a learning circle or breaking the ice(pun intended) to get to know someone better.

Slow But Sure

2007-11-26T11:38:00.001-06:00

I think all the makeover shows on TV have made us believe big change can happen overnight. Changing your hair or painting a wall is relatively easy to do – but even that can take some serious coaxing and time. How many of us know someone who is clinging to the hairstyle they had in the mid-70s and the avocado green and harvest gold wallpaper from the same time.

Culture change can be like that. It took 30 plus years for long-term care to become the institution it is. The transformation to home will take awhile. Action Pact consultant Megan Hannan knows only too well. In a special guest blog she talks about the role of “slow” in culture change and that speed is not as important as continuing to take the next step:

I was recently co-facilitating a session on listening and barriers to communication in a nursing home that has been working hard toward the Household Model for over a year. After the session, my co-facilitator, Kim a medical technologist at the Hillsboro Medical Center, said she was so surprised at how much people were willing to talk, share, and come up with solutions and ideas. I asked her, “Do you think things are changing?”
She said, “Well, yes. It is slow but sure.”
That phrase really stuck with me and I think it is such an important description of the way we feel change happens best – slow but sure. It is the sure part that we all want. We want people to “get it.” However, it is the slow part that many of us struggle with.

The staff member in this story is a member of the High Involvement team in her organization. Their team has been through some S...L...O...W.. times. There were times when they tried something that did not get good responses and when others in the organization were just not as excited as the members of the team. But eventually, they started to have more response, positive reactions, and spontaneous questions and suggestions.

It was painful to go through the slow times. In some organizations the philosophy might be get it or get out. However, this process of personal transformation, which is necessary for organizational transformation, takes time and lots of opportunities for people to see, here, feel and discuss what the change might be. This High Involvement team didn’t give up – painful as it could be – and found other ways, asked different questions, created new opportunities and kept at it. Their tenacity puts the “sure” in “slow but sure.”

Poetry at Home

2007-10-29T12:56:00.000-05:00

Frankly, I can’t believe I didn’t come up with this blog sooner. I’m smackin’ myself on the forehead. I’m always begging folks to share their stories with me so I can in turn share them with the readers of this blog and our newsletter (and because I personally really like reading them). Well, I just got a great story from Perham Memorial Hospital and Home in Perham, MN about a household that got together with their Household Coordinator, who writes poetry, to write a poem about home. What a great idea, I thought, and what a great poem! So, I decided I’d share the poem here and ask for others to send in their poems and stories about home collected from residents. Suddenly, my brain got a little tickle, you know like when you know you’ve forgotten something but don’t know what? As I was trying to figure out how to format the poem in HTML it dawned on me! There is already a site publishing short stories and poems about home – none other than the NPR radio show, Prairie Home Companion. For those of you not familiar with it, well, just put on your public radio station on Saturday evenings. I’m betting your residents will really enjoy it. It’s charming and nostalgic and completely relevant.

Anyway, on their website, PHC has a feature called First Person (not to be confused with our own, PersonFirst) where you can submit your stories and poems and read those other folks have sent in (including one from yours truly ). I think this is a great and entertaining way to underline the value of home in our nursing homes and to share the fruits of culture change movement outside of the “industry.”

Before and After

2007-10-09T09:57:00.000-05:00

Our friends at Huntersville Oaks in Charlotte, NC have recently crossed that line into the "after" - that is after culture change, after institution and after lots of hard work. Their move into new households has drawn local media attention. I'm pointing out these two articles from Charlotte Medical News and Charlotte Observer because they do a really nice job of showing the difference between before and after and highlight some great improvements in person-centered care. Make sure to click on the "slide show" on the photo from the Observer to see the drastic differences in the old building and the new. Congrats to residents and staff at Huntersville Oaks!

Do Not Go Gently

2007-09-28T12:19:00.000-05:00

Have you heard about a new documentary called Do Not Go Gently: The Power of Imagination in Aging? It’s out on DVD and in showings around the country. It shares stories of some creative people who just happen to be in their 80s, 90s and one is even 109. Now, most of these people have been pretty amazing all their lives – a woman from the Gees Bend quilting community, a famous composer, a career ballet dancer – but of course we find them more so for continuing to do it in their late years. For them, it is just continuing to do what they’ve always done – what they have dedicated their life – their whole life to.

However, the backbone of this movie is the importance of creativity in later years, even if it means shaking a tambourine for the first time in your life while you’re living in a nursing home. We know how important it is for elders to be able to contribute to their community – to have meaning and purpose – and the thing is, being creative is one thing, even on the smallest cognitive or physical level, that every elder can do. They can put something out into the world that wasn’t there before, even if it is just a smile.

One of the folks from Arts for the Aging, a group out of Washington D.C., says about a poetry group for people with early Alzheimer’s in the movie, “They don’t have to remember, they can imagine something in this moment.” Others in the film mention how aging seems to give a person more liberty to be creative. Elders are more in tune with themselves and tend to care less about what people think of their creative expressions.

So, I’m recommending the movie. Here’s the site. It is interesting because of the stories of the artists involved, but I think it is most helpful, or inspirational in the way that it reminds us of how important creativity is in our communities and our lives, no matter what age.

"I'm 86, not 8"

2007-09-24T10:08:00.000-05:00

I saw this little story on the web today - "Seniors balk at ban on free doughnuts." You'll see that there are many factors contributing to the refusal of baked goods donated to senior centers. However, the thing that really stuck out to me is the tone through which the new policy expressed. It sounds like they are talking about children, not adults. Choice is taken away from elders even before they move to a nursing home. Why do we do this?! Ideally, they would have healthier snacks donated too, but instead of offering more choice they are eliminating the choice all together.

Neighborhoods

2007-08-29T13:10:00.000-05:00

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

2007-08-15T15:26:00.000-05:00

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

2007-08-09T13:52:00.000-05:00

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

2007-08-03T12:25:00.000-05:00

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.

"Natural" Leadership

2007-07-27T11:22:00.000-05:00

Here’s a little profile of a “natural” leader:
“...alpha male Lody models compassion and leadership skills for the troop. When his good friend Kidogo was dying of heart disease, Lody carried him around, served him the tastiest morsels of food and was visibly depressed when he died.
“Lody has adopted orphans, cradling and nurturing them for weeks, and regularly assisted a blind, elderly bonobo by leading her around the enclosure. When Milwaukee acquired Brian, a troubled young bonobo who’d been abused by his father, Lody mentored him. Other troop members were disturbed by Brian’s behavior and picked on him. But through Lody’s intervention, Brian was accepted into the group, and it appears that he – not Lomako, the son of dominant matriarch Maringa – may end up being Lody’s successor.”

These paragraphs are from an article on the Milwaukee Zoo in Milwaukee Magazine. It just made me smile thinking about how helping others to do the right thing, that is, transformational leadership, is really easy enough and natural enough that monkeys do it! It seems that modeling leadership is actually a part of preserving the species...what it takes to survive in the wild.

The view from Sri Lanka

2007-07-16T12:49:00.000-05:00

Emi Kiyota, who spent a month living in a nursing home to discover how to best design environments for elders in Culture Change Now Vol 3, is taking on a new challenge. She and her colleagues have just returned fromSri Lanka where they were looking at the current and future states of eldercare.

As you will see in her blog Sri Lankans value community and a happiness based on that community and relationships, not material things. Because these things are so valued in society in general, they find it from the start of value for their elders. We are lucky to have Emi sharing her insight. I can’t say enough about how inspirational I found her blog and the amazing things happening in Sri Lanka. So, I’ll stop writing and you just go see for yourself.

Creature Comforts

2007-06-26T11:17:00.000-05:00

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

2007-06-18T10:54:00.001-05:00

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

2007-06-08T14:38:00.000-05:00

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.

An "Older American" Activist

2007-05-23T14:17:00.000-05:00

Our friend Imy Higbie, an elder (or “older American” as she prefers to be called) who has lent the story of her experience in a nursing home to In Pursuit of the Sunbeam, continues to work as an activist for reform of long-term care. She spoke at a recent Pioneer conference and can even be seen on YouTube sharing her wisdom. She has written an interesting paper on her reflection on deep system change in eldercare in our country. I can’t say much more because Imy speaks so well for herself so I’ll just invite you to download her paper here for your own contemplation and for sharing.

I’d like to use this blog to give other elders a platform to give their perspective on the long-term care system and aging in general. If you are (or know someone who is) an elder who wants to share your story, leave a comment and I will be in touch.

The virtual community

2007-05-15T13:10:00.000-05:00

We talk a lot about how important community is for elders and while they don’t replace personal contact, the Internet and email have opened many doors, some of them surprising, for elders to connect with others and have their voice heard.

Because computers have become one of society’s main sources of communication, information and entertainment, I would like to encourage nursing homes to find a way to offer computer access and simple training to residents so they are not left out of this very large part of our culture and community. In fact, a staff person could help a resident set up a blog as an individual activity. A blog is a great opportunity for an elder to document their history, tell stories and lend perspective to friends and family far away as well as the folks in their nursing home. If you are in the process of a deep and long-term culture change, get an elder to blog on your own website to give updates and comments on the change from a resident’s point of view. Who’s going to be the first to do that?

So, I thought I’d point out a couple of gem web pages that feature elders making it clear they won’t be left in technology’s wake.

Our friend Imy Higbie talking about culture change

A group of Brittish elders “talking about my generation” and a member of the group talking about the musical project.

The Young at Heart Singers having some fun. Their renditions of rock songs lend a whole new perspective.

What to call “old people.” I vote for “classics.”

And then, the Internet being what it is, there is always room for the quirky.

Disclaimer: Now, of course, as you investigate some of these sites you will see some ridiculous stuff from idiots (I don’t use this term lightly) in response to the posts from elders. Those people love the Internet and seem to have a vocabulary consisting of only four-letter words. I can only suggest brushing them aside like little bugs as responding only eggs them on.

Battle on the Home Front

2007-05-07T14:35:00.000-05:00

Today's Wall Street Journal features an article about Laguna Honda nursing home in San Francisco. They will be tearing down the huge, old institutional building to replace it with a new institution. The article paints a detailed picture of all the many agencies and organizations and their opinions on the project and how those who have the most at stake, the residents of course, barely have a voice at all. Have a read for yourself: San Francisco's Massive New Nursing Facility Draws a Fight as Institutions Lose Favor

The "culture" in culture change

2007-04-06T11:27:00.000-05:00

Some folks are not fond of the “culture change” title for this movement of person-centered care and home for elders. I’ve heard that people have a problem with it because it seems everyone will have to change their personal “culture” which indeed is a big part of our individualism. More nursing home centered language is sometimes favored to point out where the focus really is. However, the behaviors and practices we’d like to change are born in the greater climate of American culture. In our daily lives, these things may not seem to be a problem or at worst, an annoyance or something that can be quickly dismissed with a “Oh, that’s too bad.” But in the microcosm of a nursing home, their effects are amplified.

Take, for instance, one practice that is on the rise in our broader culture that is symbolic of the one-size-fits-all mentality that we are trying to abolish in nursing homes: the forwarded friendship email. Now, of course the people who send them mean well – the way we’ve always “meant well” in caring for our elders in nursing homes. But, there are some people who are so “busy” they maintain their relationships with these generic emails that at the end demand that if you are a true friend you will send it to 10 people or you’ll have bad luck. I understand that these are somewhat like the “old fashioned” greeting card, a way to say “I’m thinking of you” to someone. (Stick with me, this is not just a rant, I have a point.) But, when this sort of email (that is also sent to several other people at the same time) replaces a phone call or a lunch date to actually build and maintain a relationship, well the relationship dwindles to consist only of the “sent” and “delete” buttons – completion of task. You know it is in trouble when a file of cute cat photos gets sent to someone who doesn’t even like cats. This is just one example of efficiency trumping relationships. Substitute “care” for “email” and you’ll see what I mean.

When the world outside the nursing home walls reinforces bad habits, they are more difficult to break. So, call the movement whatever you’d like, but try out this activity to help people be more aware of how our culture effects what goes on in a nursing home.

Ask the group to brainstorm some examples of how culture at large influences the culture in nursing homes. You may mention the example above to get things rolling. Other examples may be multitasking, always being busy, liking things to move quickly (how many places and times do you think, “c’mon, C’MON!”), fast food, no use for elders, not respecting or honoring our elders, the ever striving to be “young and hip” and “fight signs of aging.” Let the group come up with what they can before you add any of these. List them on a board as you go. Now, have a discussion about each one, addressing these questions:
What does fast food (for example) look like in our culture and why do we do it and/or like it?
What are the disadvantages?
How do those things about fast food carry over into the nursing home?
How can we alter these practices to better honor people (staff, residents and families)?

This is obviously an exercise to get people thinking, but it can also be a great first step in making an action plan for creating person-centered culture in your nursing home and perhaps even in other areas of life.

Of course, this stuff could make for some very interesting learning circles with elders. (see learning circle directions) Since theirs is a generation that certainly honored their elders, ask them about it. What do they think of fast food? Why is everybody always in a hurry? What’s a good way to make someone feel special?

For more discussion-generating material related to this topic, try Dr Bill Thomas' book What Are Old People For? and the related article Maturing With Soul from our free resources page.