Culture Change in Nursing Homes

This year the federal Centers for Medicare & Medicaid Services are finally upholding the Olmstead Act. Below are resources and information.

The Olmstead Decision of the Supreme Court (1999) states that: ... under the Americans with Disabilities Act, it is a form of discrimination to isolate and segregate persons in institutions when they can live like other people in the community and enjoy the benefits of society.

State surveys of nursing homes will now include a “self-determination” component that will be embedded throughout the survey, addressing all levels of nursing home operations. Below are some links to key culture change websites. Check out The Pioneer Network's 40 page document about the changes to the nursing home survey.
But first, here are some of the radical inspiring results of a typical culture change program:

Results of The Tupelo Project (Tupelo, Miss.)
The Tupelo operation has been cost neutral in a 99% Medicaid funded facility

• Elders moved to the Green Houses without transfer trauma.
• Elders report very high levels of satisfaction with their quality of life
• Families report high levels of satisfaction with care.
• Dementia related behavior problems have been markedly reduced.
• A decrease in wheelchair use related to the short navigable distances.
• A decrease in urinary incontinence.
• An increase in appetite, food consumption with accompanying weigh gains.
• A decrease in the use of nutritional supplements.
• An increase in elder engagement in personal and household activities.
• A consistent care staff with a 10% turnover rate in 2 years (nat'l average 90% annually.)
• Two deficiency free state surveys.

VISIT THESE GREAT SITES to learn more! 

Pioneer Network - http://www.pioneernetwork.net/
The Pioneer Network is a clearinghouse of information and resources about culture change in nursing homes. The Pioneer Network facilitates deep system change and transformation in our culture of aging.
"We: Create communication, networking and learning opportunities; Build and support relationships and community; Identify and promote transformations in practice, services, public policy and research; Develop and provide access to resources and leadership."

Eden Alternative - http://www.edenalt.org/about/index.html
Information and tools for making life better for our Elders and those who care for them.

Greenhouse Project - http://www.ncbcapitalimpact.org/default.aspx?id=664
A revolutionary new model of care developed by Dr. Bill Thomas. The ideas and Principles of the Eden Alternative with small houses for 6-10 Elders who require skilled nursing care.

Action Pact - http://www.culturechangenow.com/
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Selftalk - Generating Your Caregiving Experience

"Life is 10% what happens to you and 90% how you react to it"
~ Charles Swindoll

We all have our dramas. You know those moments, when your mind strays into your bad neighborhood. It doesn’t just happen at four in the morning. Even in the daytime, we invent useless stories about the past or future, stories that undermine our well-being. The better you can distinguish between your made-up dramas and the more useful interpretations, the more clear cut and smooth your caregiving path will be.

It all starts with paying attention to your language. Begin to notice the words you choose in conversation, in your emails, in your head. Notice the power of your thoughts. “I look like hell today!” “That guy is such a jerk.” “This is never going to work.” Each time you tell yourself even the most casual negative phrase, you are depleting your energy and knocking down your ability to cope, notch by notch. Some say you actually are creating your reality.

Society trains us to be assessment machines, firing off judgments about the world around. Just look at the headlines and you’ll see what I mean. And we do the same to ourselves. We forecast bad news for our lives so fast we're not even aware of doing it. “THIS EXPERIENCE IS GOING TO BE HARD.” “THAT FAMILY MEMBER IS GOING TO BE A PAIN IN THE NECK.”

As surely as the negative messages in caregiving undermine you, constructive messages make you stronger. Ask yourself each step of the way, What caregiving experience am I choosing? What caregiving reality am I committed to creating? What are the words and statements that will support me in reaching my goals? Practice the skill of editing your inner caregiving editorials. Ultimately, you will be able to reinvent the story of the rest of your life.
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Musings on Balance, Imbalance and Change

You might as well fall flat on your face
as lean over too far backward.
~ Thurber, James


A few years ago, I wrote in my caregiving journal, The balance is shifting. I'm putting more of myself in the mix, yet in other ways I’m holding more of myself back, so I'm not sucked dry. Sometimes it feels like some people suck all my stuffing out of me. Gotta keep my stuffing.

One dictionary definition of balance, perhaps the most usual, is “mental steadiness or emotional stability; habit of calm behavior, judgment, etc.” However, in my life, I find it to be more complex and interesting than that. Though balance can imply steadiness with a degree of predictability, it is Not mere stability. Balance implies a degree of control while in motion. In fact, a smidgen of imbalance is necessary if one wants to stay in motion. But when one is about to lose control, one’s condition becomes a “balancing act”. And when off-balance, one is about to fall on one’s face. But wait! Is that true? Things are not always as they seem. I have actually learned a few things from being off-balance.

In ‘98, I wrote, When Mom walks she must look up to keep good balance, and when I walk I keep looking down to stay in the moment. Funny. Perhaps I'd better look up so as not to get obsessed by the moment, but to see the bigger flow that I am a part of. A bigger flow in the moment. Keeping a focus on the bigger picture was a way of grounding myself during caregiving, to stay balanced while in motion. It enabled me to notice the learnings that surrounded me every day.

During caregiving, the times when I was off-balance were, though unnerving, the more instructive times. What do I learn from allowing myself to be off-balance? That I do NOT lose control—I learn to walk differently. I learn that I have far greater resources than I believe, (or than I tell myself). This all sounds so appealing that it’s a wonder that I still fear losing control. So maybe the goal is not to be IN balance, but rather to be ENOUGH in balance to keep from falling on my face. In fact, another definition is “in the balance, with the outcome in suspense”. Maybe not comfortable, but useful. Perhaps in caregiving we can look not so much for comfort as a survival strategy, but rather look for balance that makes for the good and vital living of this life.

There are many definitions of balance. In dance, balance means “to move in rhythm to and from: to balance one's partner.” So here we are again, thinking of balance in motion... as a way of dancing with Life?

In Maslow’s hierarchy of needs, stability is near the bottom under Safety Needs, while balance is listed under Aesthetic Needs, just two levels below Transcendence. So might balance be a state of beauty rather than a state of survival?

The dictionary tells us that balance can mean, “to have equal amounts of the necessary elements such that no one predominates.” Which brings us to the matter of having a balanced life, as distinct from emotional balance (though they can be connected).

During caregiving, when I was able to achieve that delicate balance of the right elements in the right proportion to each other in my life I would find moments of great peace... and then... life, being by nature in motion, would run past me and pull my carefully constructed life out of whack again. So I'd scurry to pick up the pieces. Much as I tried to keep my ducks lined up, they kept swimming away! Maybe the real problem was that I kept thinking those ducks should line up and stay that way. So maybe change isn't a problem—maybe it’s just life. “Just keep swimming. Just keep swimming" as Nemo says in "Finding Nemo." Not bad advice during caregiving.
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