Serving Counties:
Bond,Clinton,Madison,
Monroe, Randolph, St.Clair
and Washington
Stories
- Cocoa Comes Home
- No Place Like Home
- Local Director of Nursing Receives National Award
- The Story of Judy
- Bibs in the Dining Room
- Bread Machines on the Halls
- Executive Director of Hitz Home Receives Special Award for Exemplary Leadership
Cocoa Come Home
Mimi Neff and Kay Strasky first met several years ago as volunteers at St. Joseph's Hospital in Breese. Mimi later took a job there and worked for nine years as secretary to the Director of Volunteers. Mimi and Kay remained friends through the years and were reunited as residents of Countryside Manor in Aviston.
Kay was one of two residents who were able to have their own pet as a roommate. Cocoa, Kay's longhaired Chihuahua, went everywhere with her, Mimi said. "He would ride on her lap in her wheelchair," Mimi said. "He even went to therapy with her. Everybody here knows who he is."
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Kay passed away on Feb. 1. Initially, her family took Cocoa and planned to make a home for him, but Cocoa already had his own family, the residents and staff at Countryside Manor. "The family took him home and two days later they brought him back," Mimi said. "They just didn't have anyone who could stay with him and spend the amount of time with him that Kay did."
That's when staff members turned to Mimi for help. "They brought him in to me and said, 'We think you need a companion,'" Mimi said. "I'm okay with that, but I can't use my left hand. I just wish I was able to do more for him." In spite of her disability, Mimi said Cocoa is starting to warm up to her. "He was so close to Kay, but he sleeps with me at night and follows me around. When I go into the bathroom, he follows right behind," she said.
Mimi is now one of two residents to have pets at Countryside Manor. Lila Link had owned her dog, Molly, for nine years when she moved to the nursing home. At first, administrator Leslie Pedtke was against the idea of letting residents keep their pets. She later reconsidered. "I figured as long as she could take care of him herself it would be fine. Lila had been with her dog for nine years, I couldn't make her leave him behind," she said.
This story is proof, kindness can be contagious. Judith Moore, whose mother had been a longtime friend of Kay, was so touched by the nursing home's responsiveness to Cocoa that she has volunteered to pay for all of the dog's care and veterinary expenses. "She knew how much Kay really enjoyed it here, and she was touched by the fact that Kay was able to continue to care for Cocoa here," Pedtke said. "She said that we just don't hear about enough good things happening in this world, so she offered to help out by paying for Cocoa's needs. "It's really worked out wonderfully."
No Place Like Home
By VICKY ALBERS
Breese Journal Editor
There's no place like home. And, you don't have to be Dorothy Gale to realize it.
In fact, that simple statement is the premise behind a movement called "culture change" aimed at promoting household living environments in today's nursing homes and assisted living facilities.
Countryside Manor in Aviston is one of five local facilities to be involved in a "culture change" collaborative with the Area Agency on Aging. Countryside Manor Administrator Leslie Pedtke explained, "It's an initiative to get facilities to be more resident oriented - to make the facility more homelike, less medically centered and more resident centered." It was the informal meetings of a small group of providers and researchers, who were brought together by their interest in changing the culture of nursing home care, which led to the creation of a national movement within less than 10 years. The result was an organization called Pioneer Network which represents a coalition of nursing homes committed to improving the quality of their institutions and practices.
Last week, Nancy L. Paul, a social worker who serves as an independent culture consultant and trainer for the Southwestern Illinois Pioneer Coalition held training sessions with employees at Aviston's Countryside Manor to introduce the practice of person- directed care. Paul said the movement is about promoting household living environments where elders and direct care workers are able to express choice in meaningful ways. She offered a list of 13 "pioneer values and principles" to use as the foundation for change. Pioneers commit to these values, she said:
. Know each person;
. Each person can and does make a difference;
. Relationship is the fundamental building block of a transformed culture;
. Respond to spirit, as well as mind and body;
. Risk taking is a normal part of life;
. Put person before task;
. All elders are entitled to self-determination wherever they live;
. Community is the antidote to institutionalization;
. Do unto others as you would have them do unto you - yes, the Golden Rule;
. Promote the growth and development of all;
. Shape and use the potential of the environment in all its aspects (physical, organizational, psychological/social/spiritual);
. Practice self-examination, searching for new creativity and opportunities for doing better;
. Recognize that culture change and transformation are not destinations but a journey, always a work in progress.
Pedtke understands that changing the nursing home environment will be a long-term process. She said the facility has already begun taking "baby steps." The facility encourages families to bring in the residents' own furnishings, and two of the residents even have pets. At breakfast, residents are given a menu so that they can choose their own meal. The idea is to change the concept of nursing homes from a place to end your life to a place to continue living which Pedtke said is fitting with the motto at Aviston Countryside Manor: "Continuing a Life of Quality." Paul said the culture change process can seem a bit overwhelming. After all, you're changing the whole culture of long-term care - from the way the administrator leads to the institutional dishes food is served on. She told staff members that situations which they won't even think of until they arrive will need new approaches. Paul suggested using "Bump's Law" - four questions developed by Linda Bump, a leader in the culture change movement - as a tool for addressing situations as they arrive. "Begin to question everything in the nursing home," Paul said. "Ask yourself the following:
. What does the resident want?
. How did the resident do it at home?
. How do you do it at home?
. How should we do it here?"
Paul explained that the four questions put the focus on the humanity of a situation. When you use Bump's Law, she said, you are pushing aside "the way things are done" and letting choice rule. Once you have asked the first three questions, connecting with the resident and his or her preferences and realizing that "the way things are done" is certainly not the way you'd have things done in your house, you can't help but let those answers influence the answer to the fourth question. For example, she said, if cooking with a daughter was a favorite activity of a resident when they resided in their own home, why couldn't the daughter and the resident continue cooking together when the resident's daughter comes to visit her in the nursing home? She suggested creating a working kitchen where a resident could actually cook with her daughter if she wanted to. Naturally, Paul said, there would be come safety concerns, but she stressed that almost anything is possible. "You may come up with a million and one reasons why you can't do something, but usually you can overcome those reasons," Paul said. "It's a continuous process of asking questions. You have to figure out as a team how to do it." In some cases, Paul said, the inside of a nursing home may literally have to be gutted to get rid of the hospital-like atmosphere, including nurses' stations, she said. "Along with the medical model of nursing homes, we have all been ingrained with the idea that we all have specific duties. In a culture change home, a dietary worker may not be the only one that cooks," Paul said. We're looking at much more of a universal approach, much more of a family approach to care."
Paul stressed that implementing culture change doesn't happen overnight. "It's a continuous learning process," she said. In most cases, she said residents will need to be educated as well as staff members and administration. "Residents can be just as ingrained as we are," she said. "They believe they have to give up everything when they become to live in a nursing home, and that's just not true." Pedtke and her staff are excited to be involved in the culture change phenomena. Paul said culture change does not occur and will not, be a success if the administration is not committed to change.
She believes the movement offers a vital source of hope for millions of elderly individuals who may feel they are trapped by the old system. She stressed, "It's about giving residents choices. It's not something you can learn. It's an attitudinal change where you see elderly citizens and their environment through a different set of glasses."
Nancy L. Paul, a social worker and an independent consultant and trainer, has been conducting training sessions with employees of Countryside Manor in Aviston, which is one of five local nursing homes implementing "culture change" in its facility.
Local Director of Nursing Receives National Award
Cheryl Smith RN, Director of Nursing at Clinton Manor Living Center in New Baden, recently attended the annual National Association Directors of Nursing Administration Long Term Care Conference at Caesar's Palace in Las Vegas. Cheryl accepted an award in recognition of Excellence in Service in Long Term Care. This award was presented by Sherrie Dornberger, Presidnet of NADONALTC. This award recognizes nursing homes that receive zero deficiencies during their annual Department of Public Health survey. Michael Brave has been Administrator of Clinton Manor since 1988. Cheryl Smith has been DON at Clinton Manor for 7 years, along with Darla Loomis RN as her assistant. During the past 7 years Clinton Manor has received 4 deficiency free surveys from the Department of Public Health. Cheryl credits these excellent surveys to staff getting to know each person that moves into Clinton Manor and providing services that allows each person to live as they choose with integrity, dignity and quality of life. We pride ourselves on being a culture change home, and work very hard at developing relationships with our residents and their families. We focus on treating the whole person while providing quality health care services. We want everyone that moves into Clinton Manor to continue living their life as they choose in a safe, happy, and homelike environment, and receive the services that meet their needs.
The Story of Judy
Judy came to live at Hitz Home in Alhambra, Ill. few years ago. She was a determined soul; out spoken; and always challenging us to think outside the box. When we began our culture change journey we knew she was the right person to be part of the team, but little did we realize the energy she would contribute to this journey.
Judy managed restaurants all her life. Soon after she moved in, you would find her busy in the small activity kitchen, but she wanted to do things on a bigger scale. In order for her to join the dietary staff in the home’s regular kitchen, she agreed to attend the required sanitation class. Soon she was able to enter the kitchen and planned and prepared (with the help of the kitchen staff, of course), a special supper for all of the residents. And what a meal it was! We had paprika chicken on rice, fried cabbage, green beans, cottage cheese with pears, homemade rolls and tapioca pudding. After we had eaten, Judy proceeded to critique the kitchen staff and shared ideas to make the kitchen more efficient.
Judy had respiratory problems and soon required oxygen which meant her time in the kitchen had to end. Hospice was called in to assist with Judy’s care, but she never gave up. She continued to make home made soup, cookies and other foods in the activity kitchen for special occasions with staff support. She was determined to live life to the fullest even to her last breath.
Judy served on the food committee, the welcoming committee, and the marketing committee. She understood what “culture change” meant, and was always ready to share the story with others. She and other residents met with a class from SIUE, spoke at a QIO seminar, and was featured at the first meeting of the St. Louis Pioneer Coalition. Judy was always gracious to those that came to learn more about what it meant for an elder to control their life to the very end, and how the principles of culture change provides that opportunity. She wrote the President and the Governor to encourage them to “come see “. She made sure she found the Public Health surveyors as soon as they arrived, “to set them straight about culture change”. There was no better advocate for transforming nursing home care than Judy!
While part of Hospice, she decided to put a cook book together of her favorite recipes and to redecorate her room. The room is finished and the gathering of recipes has begun, but Judy was called away by God before her work was done.
Judy lived her life helping and serving others even as she took her last breath. She has been an inspiration to all of us living and working at Hitz, knowing that if we were not on this journey, Judy may not have been able to touch as many lives as she did; fulfill her desire to continue giving through her cooking; or spread her commitment and vision for the change that to her was an obvious. How can any of us do any less for those who have chosen our home as their home? Judy was truly a gift to all of us at Hitz.
Bibs in the Dining Room
One of the first things Hits Home did when it was looking for ways to be more like home was to get rid of the bibs. After all we do not wear bibs at home. The leadership team got together and decided to buy large cloth napkins and put them in the dining room for resident use. Staff was told to encourage napkin use instead of bib use. The resident was not asked. After all it was a dignity issue.
Staff did not encourage the residents, didn’t even give them a choice. They still went around and tied a bib on every resident, except for a few who realized there was a choice, and they asked for a napkin.
After a few weeks of this, the management staff decided to take the bibs from the dining room, matter of fact we threw them away. After all we were in charge and we know best.
All heck broke out. First time I had received any complaints from the families over culture change activities. How could any one complain? WRONG, many families and residents wanted bibs for a variety of reasons. The main one was dignity. As the management staff we stuck to our guns. A few were given bibs but only when someone insisted.
It wasn’t long and an anonymous individual made around 30 bibs, very nice ones that looked like clothing on the resident, were brought in and placed in the dining room. Everyone who wished, whether it was staff or residents, picked what they wanted. By this time staff and the management team had softened up some to realize not all residents needed or wanted bibs, but there were many who did need and want a bib. Our goal was more apparent to us now – we all wanted dignity for our residents
What did we do wrong? First we as the management team made all the decisions. We didn’t ask the staff, residents or the families. We also had no plan for failure, never dreamed that would happen.
What did we learn? We realized that all people involved need to be included in discussions concerning change. We also realized that it is okay to regroup, rethink and redo. Plans, goals, and interventions need to be evaluated and revised as needed to ensure outcomes that are acceptable and workable to all involved. We all wanted the same thing – just didn’t realize it at the time until we grew and realized what culture change really is, involvement of all to meet the needs expressed. You have to be willing to listen and then discuss, plan, and evaluate together. Then real change occurs!
Bread Machines on the Halls
Hitz Home uses learning circles to learn from the staff, residents and recently we have started to invite families to participate. Last month we had two open learning circles. One to discuss where we have been and where we want to go, the other was to discuss the nurses stations and how we could change them to be more home like.
One of the suggestions brought up was to use aroma therapy in different areas of the home. One place was at the nurses stations by using bread machines. We decided this was a good idea, and made the plans to put it into place. We were careful to buy one that did not radiate heat. We chose who would be in charge of making and cleaning and serving the bread. We found a place that was acceptable to all. An added benefit to this was the score on the Artifacts of Culture Change Survey gives points for baked goods on the hall – up to 5 points and for aroma therapy 5 points.
We evaluated this over a couple of weeks. There was one concern noted, the serrated knife was a concern so we use a diner knife or tear the bread. Many staff from different departments have joined in with the making of bread. Activities, nursing and office staff are involved. It isn’t baked every day. It is several days a week. When the person who was in charge of the bread machine had to have surgery so others, not appointed, stepped up to volunteer now make the bread.
All are invited to eat the bread. Sharing of bread is spiritual and fun when you are with people who you care for, no matter if it is staff, residents, families or visitors. Our Medical Director has suggested onion soup so now we also have crock pots available on the halls.
The bread machines have provided a sense of sharing, wonderful aromas, sharing of recipes and enjoyment to all. We will need to remember as time goes on to evaluate use and need, and any problems we see to resolve.