Wednesday, January 7, 2009

Changing Nursing Homes and culture of care, one person at a time

December is a very busy month in my office. Many administrators of nursing homes and assisted living communities have a December 31 deadline for renewing their licenses. Many of those get to the end of the year only to find that they're lacking just a few continuing education courses they need for license renewal.

And we get really, really busy meeting those last-minute needs for training.

It's a fun time for us, as we get to talk to one person after another, calling us for help in solving their urgent need. Most of the conversations start off something like this,

"This is really embarrassing, but I need to take an online course that I can finish within the next 2 days. Can you help me?"

The typical caller goes on to explain why he or she left it to the last minute, and why the rush is on to finish so they can keep their license.

This December, I got to personally field more of these calls than usual. An extraordinary amount of snow virtually shut down all traffic to our office. Fortunately, I live close enough so that I could put on 6 layers of ski clothes, boots, hat and goggles, grab my ski poles and walk in to work.

That meant that I also answered the phones.

Here's what I heard:

"Thank you so much for helping me. I was afraid that I wouldn't be able to renew my license this year. It's been such a rough year - my husband died, completely unexpectedly, just 3 weeks ago. My job - my residents and staff - are the only things that keeps me going right now."

This caller and I ended up talking for nearly 20 minutes about life's challenges, and how she was handling them with grace and courage. I was humbled by her story, and proud to be able to help.

Then Sherry called:

"I had never been a nursing home administrator before this year. I have no nursing background either, and even though I had worked in a drug store pharmacy and had been involved in placing several families members in nursing homes, the staff didn't think I knew anything about the job. That was hard."

Sherry went on to share some of the changes she had made in the past year in her job:

"Staff were feeding residents in the living room. They had put sheets over all the chairs and had turned the chairs away from the windows. After a meal, staff were busy helping residents and food didn't get cleaned up quickly enough, resulting in flies and ants on the floor. In general, it was horrible, but it was 'the way things were done.'"

Sherry instructed staff to take all the sheets off the chairs, deep-clean the living room and turn the chairs to the windows. No residents were allowed to be fed in the living room; they had to be fed in their rooms or in the dining room only. After a little resistance, but careful monitoring on Sherry's part, here's what happened:

"Staff say that is is easier to feed residents in the dining area. Extra food is available, clean up is faster and the residents have begun to eat more.

"Residents are using the living room more as a living room, too. Families visit longer; residents are calmer and happier."

Sherry makes me proud to be a part of training administrators to manage person-centered care environments. But she also makes me aware of how much farther we still need to go.

"It's an uphill battle working in a nursing home trying to care for residents on the minimal amount of money available."

Sherry's right about that. As we head into a new year and a new economic reality the money is not going to flow any more freely.

But we'll have one person here and another person there, working their hardest to ensure that care is provided to our nation's most vulnerable citizens in a way that is caring, compassionate and dignified.

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