WHERE MY RUBBER MEETS THE ROAD IN THE NURSING HOME

Greetings!

For those of you who have periodically enjoyed my MindfulCaregiving articles about Being and Doing in caregiving, I beg your indulgence as I digress a bit today from my usual style. I have entered a new and (to me) important phase in my mission to grow person-centered care. It is time for me to share my journey thus far with you, but if your taste buds are primed for a meaty article to sink your teeth into first, click here to see the one I just posted on Senior Health Weekly, 
 Doctor, I am So Lonely" The Power of Human Connection 

For those of you still with me, the last nine months have been an educational ride at a large county nursing home where I've been working for close to three years. We are now on the brink of a radically new phase of our person-centered initiative.

A little background: In 2009, when I learned about The Eden Alternative and their revolutionary approach to building community in nursing homes, I became certified as an Eden Alternative Associate, but what then? I didn't work in a nursing home as did my classmates, so I joined the flegling NH Culture Change Coalition to keep learning, and to look for a way in, to be DOING culture change rather than just talking about it. Culture change is an experience, not just an idea. When I first heard of the Office of the Longterm Care Ombudsman, I thought, Aha! A way to do meaningful work in a nursing home! I trained and became the Ombudsman for a large local county nursing home with over 200 residents. That was where my rubber met the road. I began to learn, ALOT! 

Over a period of two years, I walked the fine line between the needs of the residents and the limitations of the medical nursing home model, seeing the frustrations of both sides. I also found myself up against the stereotype of the Ombudsman as a policing force (not my style at all) but I supported a number of residents, learned what I needed to learn, and developed a groundwork of trust with many of the residents, staff, and administration. 

My belief that  What you look for, you get  grew. As a possibility-oriented person rather than problem-oriented person, my position eventually began to feel restrictive. When I admitted that it was time for a change, I offered myself to the administrator as a volunteer to begin fostering person-centered programming through the Activities Department.

Why the Activities Department? I see it as the not-always-acknowledged heart of the nursing home. The staff are trusted by residents. Starting by doing programming through Activities seemed to be a lower-risk point of entry than trying to jump right into Person-centered Care working with the nursing staff. I wanted first to give the residents the experience of being listened to and offered real choices based on who they were as unique individuals.

As a long-time student of change—my own, that of others, and of organizations—I have a sense of the complexity, breadth, and subtlety of true culture change, as well the many misconceptions about it. I also know that change is an organic process that usually takes time. When taken too fast and in a left-brained forceful way it can do damage. When taken slowly, it can evolve, as a garden grows.  

In my diary eight months ago I wrote:

It is perfect that I write this in early March, just as the weather warms and the tiny shoots begin to peek their head out of the garden—our first programming steps feel like warming the soil. A month ago, just about the time of Imbolc (the Feb. third celebration of the seeds beginning to move in the ground in preparation for spring) I began planting seeds with the residents of my nursing home, sitting one-on-one and feeling for their receptivity. A month later I met with a group of 15 residents and as I spoke, I saw the lights begin to come on, one by one. They said Yes to being considered The Resident Advisory Group for Personalized Activities Programming. It is also perfect that, as I write this, I am scared. One doesn’t begin this sort of heartful endeavor without trepidation. Tending to the environment of living beings is a humbling thing. I believe that one of the many prerequisites for participating in real culture change is personal vulnerability.

The next five months were a rocky road of unpredictable successes and setbacks. When the Activities Director quit unexpectedly, we forged ahead for almost three months with hardly any departmental support, though the staff did bail us out a couple of times, giving me a 3-minute crash course in nursing home protocol. The residents experienced participating in the blow by blow planning and execution of their ideas, and enjoyed seeing the results. By that time, the group had not unexpectedly dwindled and I took some time off to recuperate, but two residents who had caught the spark joined Seniors Aid New Hampshire, a coalition of over 30 New Hampshire nursing home residents committed to improving life for people in the state. They started a statewide petition letting residents raise their voices to change federal legislation that has allowed some residents to be denied their pain medication. (Click Here and scroll down to learn more.)

The new Director of Activities is Eden Alternative certified, as I am. Understandably, she is focusing on slowly building her program and her team. We have a shared vision but it quickly became clear that it was yet again time for me to reinvent my approach. The administrator and the Director of Nursing agreed that I could work with them to begin a small pilot program on one of the smaller units of the nursing home, this time explicitly fostering Person-centered Care. Stay tuned as we unroll yet another phase in this story of reinvention.