Senior Advocacy

The Unmet Need of Geropsychology in Long-Term Care

2011-12-20T10:28:00.000-06:00

For anyone interested in the field of Psychology and specifically Geropsychology, it is important to understand the woeful lack of resources to meet the emotional needs of our elderly. According to Erlene Rosowsky, Psy.D of Needham Psychotherapy Associates, LLC in Massachusetts “Geropsychologists and Psychologists who treat the elderly are a dying breed and by 2030 older adults will comprise about 20 percent of the U.S. population according to the Department of Health and Human Services. The Institute of Aging in a study a few years ago said that an estimated 5,000 doctoral Geropsychologists will be needed by 2020, that's 4,300 more than currently are trained” (qtd. in Esposito*). The need obviously is great, and this need will only grow as the elderly population grows.

For the college student interested in the field of Geriatrics it comes as no surprise that according to the American Psychology Association Department of Aging, older adults have the highest rates of suicide of any age group in the U.S., and depression is its foremost risk factor. In addition, stressors common in late life such as loss of loved ones, relocation, health conditions, and care giving demands, change in employment status, and poverty significantly affect the health and independence of older adults.

In the long-term care setting it has been estimated that 33% of residents have chronic mental illness, other than dementia and upwards of 50% of residents in nursing homes have or will be diagnosed with dementia. Depression among older adults is very treatable, yet symptoms of depression in the elderly are often overlooked because they are wrongly assumed to be part of the aging process, or may coincide with medical illness. This in my opinion further serves to impress upon students, even those with a cursory interest in Geriatrics the great need and opportunities that exist.

I have been all too familiar with the unmet need of psychological services in the long-term care setting. Another aspect to consider is we live in a time when a facilities census mix is comprised of younger residents. Very often the younger residents will have Medicaid as their only payer source, which greatly limits their access to these services as well.

To my fellow students pursuing a career in geriatrics and Geropsychology I would simply offer this; always keep in mind that what tools, policies and regulations we may have a voice in now likely will be those tools, policies and regulations that directly affect our lives as a senior. To those who are employed in the field of eldercare, very likely you have residents who would benefit from the services of a Psychologist trained in Geriatrics who would visit in-house.

* Esposito, Jennifer. “Demand Grows for Geropsychologist.” Nepsy.com.

New England Psychologist December 2005. Web. 14 September 2011.

Taking comfort from the good things in our Nursing Homes.

2011-08-16T14:12:00.000-05:00

Good things such as…

When a family member recognizes and compliments your work ethic and dedication caring for their loved one..

A dining room where employees, residents and family members are smiling, laughing and interacting as if in their own homes.

When a resident asks for a hug as you are assisting them to bed

The Resident smiles you observe when a cat or dog is making their rounds

The Administrator and Director of Nursing knowing employee names, and taking an interest in their lives

When Residents comfort one another in times of grief and tragedy

When an employee comes to the realization that the State Surveyor’s genuinely care for the Elders as much as they do

The family member at the end of a visit leaving with the assurance their loved one is in caring hands.

The public begins hearing about the good things happening at their local Nursing Home

An Alzheimer’s Resident, calls your name and says “I love you!”

When the employee testifies that their work in Long-Term Care goes beyond a career, rather it’s a “calling.”

Yes there are issues to be addressed in Long-Term Care, and yes there are also memorable occasions and a New Culture of Care and Life happening now and to be found and discovered.

From my cold, dead hands will you take Staff-Centered Care

2011-07-22T12:31:00.000-05:00

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As I entered the facility, navigating my way through a cloud of cigarette smoke I glanced at my watch.
It read 8:31 AM

These two department heads, on the clock for thirty-one minutes already out on break. Had this been an isolated incident fine, yet this was the routine. And the more I observed the more I found this to be the norm not the exception. From my cold dead hands….

Several residents are awoke from a deep sleep between 4:30 to 5:00 AM so the night shift can “help the day shift” by getting residents up and dressed. Of course these residents sleep through most of their breakfast. From my cold dead hands…

Spoke with the spouse of a Resident last week and was told not once in previous two months had she observed the Administrator walking the Alzheimer’s unit. And this family member spends multiple hours at the facility not less than five days a week. From my cold dead hands…

Meals? One choice. How would you like visiting your favorite restaurant only to find out that they now feature ONE CHOICE!! And if you don’t like the choice? Perhaps the kitchen can whip up a sandwich. From my cold dead hands…

The new resident, Mr. Smith was admitted today to Room 20 bed A. Upon his arrival he was placed on the CNA’s bathing assignment sheet. Lucky Mr. Smith, he will receive a bath on Wednesday and Friday afternoons at 2:00 PM. That Mr. Smith is accustomed to showers every evening before bed is not considered. From my cold dead hands…

I’m freezing… the resident remarks. Q: “Why have all the control knobs been removed from the ac/heating units?” A: tired of the residents “messing with the temperature in their room.” From my cold dead hands…

See the need for something to change in America’s Nursing Homes? I know this is written very frankly, perhaps a little uncomfortable to read. Yet do you want someone to tell you NO you can’t take a shower? Want someone to tell you there is ONE CHOICE for dinner, take it or leave it? Want to sit in your home and freeze in the winter and sweat in the summer because you must wait for someone to change the temp? As an adult you want someone waking you up at 5:00 AM daily when you prefer to get up at 8:00?

In truth, the majority of employees in Long-Term Care don’t like the routine they are required to impose on the Residents. These employees largely feel powerless. Great people, warm hearts but stuck in a broken system. It doesn't need to remain this way.

Employee, family member, volunteer, vendor, it’s TIME to make some changes in your old-model facility. Start the discussion; call the culture-change meetings to order. Many already have. And many more must.

CNA- don’t wait for the LPN to begin the needed discussion

LPN- you need not wait for the RN, YOU start thinking about what and why

RN-call a culture-change meeting to order, preferably with the Administrator’s leadership. But make that step today.

Administrator- you want your Supervisor on board with the needed changes in your facility. A change of attitude is a great place to begin. No expenditure of capital with that. Your physical plant indeed may need updated yet a new way of thinking, start there.

Tony Sexton
senioradvocacy@yahoo.com

No Senior Parishioners Left Behind

2011-07-08T10:23:00.002-05:00

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Gray hair is a mark of distinction, the award for a God-loyal life.
–Proverb of King Solomon

I have seen estimates that in the United States alone there are some 400,000 Churches and for the past 75 years, each and every year Gallop pollsters have been asking Americans if in the past week they had attended a Church or a synagogue. And since 1939 approximately 40% of those polled said yes. That would represent nearly 120 million Americans who this past week attended a religious service of some kind. Even if that figure were half, say 60 million Americans, the point being there are large numbers of citizens attending services each and every week in the United States alone.

What becomes of those elderly parishioners who no longer are able to contribute financially nor with their attendance at the local religious congregation?

Parishioners who in many cases built the local religious structure through their contributions of time, effort and monetarily. Now the years have slipped by with Pastors having come and gone, new generations are now in leadership and very often these elderly parishioners have slipped through the cracks. At times, perhaps when looking through an old directory you will hear someone ask “whatever happened to Sister…, whatever happened to Brother…” The answer comes back “I think they are in a Nursing Home Now.” And in response another parishioner states “we need to find out where they are at and go visit.” Yet far too often this is as far as it goes, with just a suggestion of what “should” be done.

Pioneers in the faith who blazed the trail so that future generations might enjoy the fruits of their labor, forgotten. With this article I wish to encourage those of you who attend a local congregation to investigate what safeguards are in place to reduce the occurrences of your pioneers from being left behind. What Ministry efforts are currently being employed to reach your shut-in members?

It’s not simply a matter of your elderly parishioner’s inability to physically be a part of services, there are a myriad of emotional trials that your members are enduring. An increased dependence on others for activities of daily life because of a deterioration of health, loneliness, decrease in mobility, grief as many friends may have died, loss of community and contact with friends and depression to name a few. Once vibrant members of our religious communities now confined to home or a nursing home. Members who will never again darken the door of our buildings, and so perhaps it’s far past time to take our services to them.

I read of a six-week program at St. Vincent de Paul Catholic Church which trains its lay members to participate in the Residential and Long-Term Care outreach Ministry. Topics covered in the training include: The Theological Background for Lay Ministry," "Understanding the Aging Process," " Creating a Climate of Openness and Trust," "Prayer and Scripture," "Active Listening," and "Confidentiality." Students also are trained as Extraordinary Ministers of Holy Communion and are commissioned as such.

I am well familiar with the difficulty recruiting Church Members to participate and support Long-term Care outreach. And there are a myriad of reasons. We live busy lives, and for many an already full schedule. Yet I am convinced there are many who have thought about these elder shut-in members, and simply don’t know how to get started. Do something; visit your leaders at your local congregation. Visit with some of your elder members who are still able to attend services. Ask questions of these elder members, you quickly will learn of those shut-in members who would greatly benefit from contact with the Congregation they may believe has forgotten them.

Start today!

Tony Sexton
senioradvocacy@yahoo.com

Thank You, CNA's

2011-06-20T18:54:00.000-05:00

Let’s celebrate National Nursing Assistants Week EVERY WEEK!! The Certified Nursing Assistant. Largely a thankless job. There is nothing pleasant about changing an adult brief. There is nothing pleasant about changing an adults bedding, perhaps for the third time before lunch. There is nothing pleasant about feeding an adult all the while being spit and hit upon.

There is nothing pleasant about all the aforementioned, and then multiply that times fifteen or more Long Term Care Residents the CNA is responsible for. And if that were not enough, throw into that mix the trend in Long Term Care, of the forty and fifty year old Residents some of who (and hopefully very few) thrive on and love nothing more than to make the CNA’s life a living hell and you can quickly see how it can all be overwhelming.

The CNA attempts to satisfy the Residents, the family, the Nursing Supervisors, the Administrator, and the Surveyors. And for all intents and purposes, an entry-level position with an entry level salary. Yet the success, failure and reputation of the facility largely falls on the shoulders of the CNA.

But wait, there is more. What if you have supervisors who only want you to show up and do only what you were trained for at school and go home. Your ideas, your observations, your comments not needed or encouraged. Or what if you work at a facility where you really have no recourse? Meaning you have no real confidence you can go to any decision maker for resolve.

Is this an isolated scenario? A rarity? Sadly I don’t believe it is.

Culture change to be effective and sustainable in my opinion is only successful as it is spearheaded by the CNA team. And make no mistake, those facilities which hold to a strict chain-of-command and strict job title/description standard, are in the greatest need of culture change and will exhibit the greatest resistance to that change.

Next time you have the opportunity, thank that CNA. Tell them how much you appreciate their dedication to caring for our Long-Term-Care population!

Senioradvocacy@yahoo.com
Tony Sexton

Culture Change missed by 18 inches.

2011-06-07T12:44:00.000-05:00

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It is said that 18 inches is the average distance between an individuals head, and their heart.

Nobody has to point out to a Resident’s family the difference between an employee called and sent, and one who just went. How many times have I heard families, volunteers and community members make statements such as “there is just something different about them,” speaking of an employee.

Let me ask a question, are we treating our employees like heroes? How many of our direct-care givers come from less than ideal, dysfunctional homes? How many of our employees are working two jobs as a care-giver to make ends meet? How many care givers live a real rat-race off the clock and certainly don’t need another rat-race on the clock!

How are we celebrating the lives and service of our care-givers, whether in long-term care, hospice and home-care? Merriam-Webster defines celebrate in the following ways: 1) to honor (as a holiday) especially by a solemn assembly or refraining from ordinary business. 2) to mark (as an anniversary) by festivities or deviation from routine 3) to hold up or play up for public notice

Fostering an environment in our facilities whereby employees look forward to clocking in, creating a work-place culture whereby even when our employees look forward to days off, they also look forward to getting back to their “other” family as well!!

If culture change is primarily about: whether a bib or a clothing protector…we may be missing it by about 18 inches

If culture change is primarily about: whether elder or resident… we may be missing it by about 18 inches

If culture change is primarily about: whether carpet or tile… we may be missing it by about 18 inches.

Don’t misunderstand I believe all these are important, yet I also believe for culture change, for person-centered and directed care to be genuine, to be effective there will be an employee with a heart full of care delivering that care. To deliver change there must be a change in us first.

For many an employee it’s a matter of rediscovering what impressed you to enter the field of care-giving to begin with. Rediscovering your first-love is a great place to begin afresh. Likely you believed you could make a positive difference in the lives of those you care for. Do you still believe that?

Tony Sexton
senioradvocacy@yahoo.com

Home-like, BUT whose home?

2011-05-28T13:01:00.001-05:00

“I long, as does every human being, to be at home wherever I find myself.”
-- Maya Angelou.
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If you have ever looked at a Nursing Homes promotional/marketing material you most likely have read catch-phrases such as “home-like”, “home-atmosphere” and similar.

Some questions that often have come to mind as it concerns home are, what is home? Why is home important? Whose home? How are homes different and how do perspectives on home differ?

As for “whose home,” how can we assembly-line what WE believe home is or should be for someone else? For an elderly individual from a rural area “home” will be far different from the experiences of a younger resident from an inner-city area. And furthermore, what of the employees for whom we want to champion the culture-change, person-directed model of care? Employees who also would express varied interpretations of just what “home” is, based on what “home” they have known personally.

This reality of this was never clearer to me than one time as I was a guest in a resident’s room, and had the thought of how disgusting it was. Not because it was filthy, but because it was old, had not been updated in thirty years it appeared. Yet as I came to know this resident I found she liked the room because it reminded her of “home.” This was an interesting lesson in “home-like” for me.

I like new, I prefer “glass and brass” a chandelier and a modern feel. But certainly that is not a “home-like” feel for everyone. As I was discussing this topic with another resident once, she made a very telling statement. She said that she didn’t want to feel like she was living in a fancy Hotel; it wouldn’t feel like “home” to her.

Interesting thoughts from Wikipedia: A home is a place of residence or refuge. Sometimes, as an alternative to the definition of "home" as a physical locale ("Home is where you hang your hat"), home may be perceived to have no physical location—instead, home may relate instead to a mental or emotional state of refuge or comfort. Popular sayings along these lines are "Home is where the heart is.”

Psychological impact

Since it can be said that humans are generally creatures of habit, the state of a person's home has been known to physiologically influence their behavior, emotions, and overall mental health. Loss of a home (due to whatever reason, be it through accident or natural disaster, repossession, or in the case of children simply the decision to move on the part of the parents) can be a valid cause of grief.

I think this brief account of the psychological impact on an individual due to the loss of home precisely describes what our resident’s experience when they must leave their homes and move, whether to an assisted or skilled living facility.

What is the psychological effect of having a home? At home we have self-determination, we have self-identity, we have sanctuary, we have a sense of well-being, we have self-directed routine, we have purpose, we have privacy, we have the choice who visits, we have sole decision making abilities.

As a resident of a Nursing Home, how are these experiences similar or different? At the facility you are familiar with, how much self-determination do the residents have? What level of purpose do the residents feel? How much privacy do the residents have?

In truth, there is only one way to know exactly what home means to our employees and residents, and that is to get to know them WELL.

Tony Sexton
senioradvocacy@yahoo.com

And where I park is related to Culture Change how?

2011-05-26T08:56:00.001-05:00

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I fully believe that genuine culture change begins before the Nursing Home employee walks into their facility.

Culture Change begins as individuals have “I never thought of it like that” moments.

The “little” things matter. And it’s the so-called “little” things that do add up into a more consumer/customer driven model of care. And make no mistake; your elder/resident is NOT the only consumer of your product/service. Every person in that elder’s sphere of influence, whether family, friend, volunteer and acquaintance also BECOMES part of that consumer base.

Traditionally a good number of visitors to your facility will be from the elderly spouses of your residents as well from elderly friends. Let’s give them the “choice” parking. Why not? Your volunteers who unselfishly give of their time and talent to help improve the life of those you as the employee care for, why not give them the “choice” parking?

No, the employee parking furthest from the door it’s not a huge deal. It’s, just one of those so-called “little” things. Just one of those “I never thought of it like that” moments.

Reminds me of the owner at McDonald’s. When he was in one of his stores and hungry he would eat the sandwiches’ that were nearest expiration. He would not have an employee cook up something hot off the grill. A little thing? Perhaps, but it speaks very loudly of a Customer-driven model.

Nursing Home Employee, do what you can to help create and foster good experiences for your Residents, families, friends and volunteers. It's something you will not regret.

If you have an “I never thought of it like that” moment, THAT is the beginning of genuine Culture Change.

Tony Sexton
senioradvocacy@yahoo.com

Dressing for Success in Long-Term Care, yes really!

2011-05-19T12:06:00.000-05:00

Often with these articles I attempt to address aspects of Long-Term Care that I seldom if ever read from other sources. And in so doing there is always the present danger of offending and turning away the very readers I wish to reach. Yet when it needs to be addressed I will do so. As an employee of Long-Term Care you would prefer NOT to be treated like a hospital-reject, second-rate, couldn’t get a job at the Dr’s office warmed-over left over!
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See I’m not just a Long-Term Care commentator nor just an employee or volunteer, I ALSO am a consumer!
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The very day after posting the article “NO, Nurses in Long-Term Care are NOT second-rate Nurses!!”, as I was sitting at a Nursing Home where my Grandfather resides, in walks an employee to administer the afternoon meds. Apparently his shaver AND iron were inoperable. He looked like he had slept in yesterday’s scrubs. And then a few days later, while once again visiting, in walks someone to take my Grandfather for a shower. I say “someone” based on the fact if I had not already known this “someone” was an employee I would have been unable to distinguish the “employee” from someone off the street. The employee had no name tag, no scrub top and was wearing ratty jean shorts.
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And using the phrase “Dressing for Success” is not meant to imply exclusively the attire one wears. It also encompasses the positive attitude we wear, the compassion, the intensity, the professionalism we wear.
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C’mon Nursing Home employee… whether you work in housekeeping, laundry, dietary, maintenance, nursing or department heads, Dress for Success!! It has been said that 95% of the first impression you make on other people will be determined by your dress and grooming. And so if this is at all accurate I think it behooves us to make sure that first impression, and then the second and third impressions are consistent with the message we want to send. And that message should be we are a talented, well-trained professional here to take exceptional care of the public’s loved-ones.
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This is not more or less important than other aspects we could address, but it IS one aspect.
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Tony Sexton
senioradvocacy@yahoo.com

NO, Nurses in Long-Term Care are NOT second-rate Nurses!!

2011-05-06T10:45:00.000-05:00

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Current employment numbers show that there are 644,850 RN’s and LPN’s employed in America’s Nursing Homes, and 2.9 million Direct-Care-Workers (CNA’s and NA’s).

If you have been part of the Nursing Staff in Long-Term Care for any length of time you can relate I am sure being treated as a buffoon by EMT’s, Hospitals and Physicians at times. **And if given the opportunity I am certain EMT’s, Hospitals and Physicians could

relate the many times they HAVE encountered buffoons in the LTC setting**

But for you Nurse Professionals, whether RN’s, LPN’s or CNA’s stand tall and stand proud of your dedication, expertise and dedication to the 1.6 million Residents under your care. Know your Residents, know your facilities Nursing policies and procedures, know your state and federal regulations regarding LTC.

To you DON’s, ADON’s and Unit Coordinator’s I implore you to BE VISIBLE, BE ACCESSABLE and empower your direct-care givers through leadership. Please provide continuing education to your Charge Nurses and CNA’s whether through seminars, literature, books, in person or by the web. There are plenty of free resources available. Every State has a Health Care Association’s, Nurse Association’s, Administrator Associations that organize and provide classes and seminars that would benefit your Nursing Staff. More States now have Culture Change groups that you can take advantage of.

To you LPN’s and CNA’s, according to Geoffrey Colvin in his bestselling book “Talent Is Overrated”, he states that most people learn how to do their job in the first year, and then they just coast never to rise above average. Most will never invest any time or money in upgrading their skills with additional training unless the company they work for pays for it. FIND A WAY LPN’s and CNA’s to take continuing education courses, whether in pressure ulcers, incontinence, culture change, leadership, psycho-social well being, the list is endless.

No, you are not a second-rate Nurse!! Be the BEST in your field. Author Brian Tracy states to become the top in your field requires discipline and application. He suggests the following three steps to be the very best

1) Read sixty minutes in your field each day
2) Listen to educational audio programs in your car
3) Attend courses and seminars in your field regularly.

Thank you Nursing Staff, Happy National Nurses Week!!
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Tony Sexton
senioradvocacy@yahoo.com

Sorry...We're Closed !!

2011-04-30T10:02:00.002-05:00

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Please… would someone make an announcement…… HEALTHCARE IS NOT ONLY MONDAY-FRIDAY 9-5!!

Generally, every Department Head in Long-Term Care work nearly identical hours.

WHY?

I was somewhat taken aback once, while giving a facility tour and the family of the prospective Resident inquired of “weekends.” I knew exactly what he was asking but I played dumb and asked what he meant. He had apparently remo

ved his loved one from two previous facilities because the “weekends” in his words were so AWFUL.

He went on to explain that the weekends “had no one in charge.” I tried to move the conversation along as quickly as possible by offering that we had a weekend manager.

Yet sadly I was all too familiar with his concerns.

The following I received from an employee in a Nursing Home this week:

“Supposed weekend manager, those who come in and go straight to their office. Making the announcement that if needed they are there. But door is closed while they catch up on paper work. Play on internet or, talk on phone. The phone continues to go unanswered. Staff breaks are often longer than allowed, rooms not always cleaned. Meals are often late and cold. They may come out around lunch and ask “how’s it going”, then not really listening state “I’m going to lunch be back later.” Often the Aids assume the weekends are a free-for-all as no one here to notice. Meanwhile the resident still needs assistance with everyday cares. Family members are often in at this time which makes for an ideal time for the Week-end Manager to interact with families and walk the halls. What would happen if State was to start coming in on weekends? Would this wake management up?”

Very often, the only time a Residents family and friends will be a guest in a facility is evenings, weekends and Holidays. Make NO mistake; decisions to remove a resident from a facility largely will be made by the family and friends of your Resident based on what they observe AFTER 5p.m and on the WEEKENDS.

No, the decision makers don’t win many popularity contests when new work schedules are implemented. But the Monday-Friday 9-5 schedule is part and parcel of the OLD STAFF-DIRECTED/STAFF-CENTERED model of care. Out with it!!

Tony Sexton
senioradvocacy@yahoo.com

Tony Sexton guest on Talk Radio Show "The Unexpected Caregiver"

2011-04-20T10:45:00.004-05:00

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I enjoyed visiting with Kari Berit (http://www.kariberit.com/) on her Talk Radio Show “The Unexpected Caregiver” last week heard weekly on 1080 KYMN (http://kymnradio.net/local-programs/unexpected-caregiver-kari-berit/) out of Minnesota. The show airs live every Thursday 11-11:30 Central Standard Time in the United States.

The link to the show which aired on 4/14/2011 can be found at: http://kymnradio.net/2011/04/14/the-unexpected-caregiver-who-helps-your-loved-ones-getting-to-know-the-aids-with-tony-sexton/

Take a few minutes at browse Kari’s website, many great resources are available.

Her book “The Unexpected Caregiver” would be a great resource for anyone who finds themselves providing care to an aging parent and is available on her website at: (http://www.kariberit.com/)

Thank you Kari for your dedication both to the caregiver and those whom they are caring for!!

Tony Sexton
senioradvocacy@yahoo.com

Alzheimer’s and Taco Bell…. WHAT?

2011-04-07T09:02:00.005-05:00

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True story… happened just this week.

There I stood in line at Taco Bell; I should have known something was askew when the elderly lady immediately in front of me had a knit winter stocking cap on with one of those silly crocheted balls attached to the very top. Askew because it was nearly eighty degrees that day.

As I took my place in line she immediately turned around and started staring. Strange, having worked with seniors my entire adult life and didn’t immediately recognize the situation yet here we were. About tenth in line with a trainee at the register, not a clean table in the dining room and here I have this lady to deal with. And not a “stare glance”, no. This lady had completely turned around and was staring me down. After what seemed like an hour the line started advancing and the lady left her husband’s side; or I presume it was her husband.

She meandered out to the dining room; hands clasped behind her back and would stop at each occupied table and stare at the customers.

Ok, now I got it.

And so now I was watching the husband more than the lady. His reactions, his facial expressions are what now I wanted to observe. He just watched her. The customers I could tell were taken aback as I was but just rolled with it. Finally the husband sat her down at the table, pushed her very close I presume so it would be difficult for her to get up and I didn’t pay any more attention.

As I was concluding my meal a car pulling out of the parking lot caught my eye. It was the husband leaving. But no lady. Did this all really happen? Was there really a lady? She must have been laying down in the back seat of the car, I guess.

Yes confusing, yet not as confusing as the life of the one stricken with Alzheimer’s.

tony sexton
senioradvocacy@yahoo.com

A New Generation to Lead our Nursing Homes.

2011-03-29T11:02:00.009-05:00

Very good article by Success Magazine Publisher Darren Hardy in the April issue on Leadership. He says that there are only a few certainties in life and one of them being “change.” One interesting factor that is impacting such rapid change is knowledge. Hardy states that by the year 1900, it had taken 150 years to double all human knowledge. Today it takes only one or two years, and by 2020, knowledge will double every 72 days, according to estimates.

Another factor impacting such change Hardy develops is the changing demographics. The Millennial generation (those born in the 1980’s and 1990’s) are the largest to enter the workforce since the baby boomer generation. This generation was nurtured through a different era and a different value system and will play a key role in the changing nature of workplace dynamics.

Hardy states that leadership over the previous 50 years has been based on the premise that the organization is purely an economic entity. The priority was to develop structures, set controls which were accomplished through pyramids of hierarchies performing rigidly narrow tasks within clear guidelines.

BUT today, the speed of change is demanding a far different leader. One who can rapidly adapt to change.

Hardy states “The New Leader will need to be an expert in human capital, not just financial capital; the new Leader will be able to master emotional intelligence, not just economic competence; will know how to collaborate not just control. The New Leader will lead through networks not hierarchies and will know how to align people through meaning and purpose not structures and spreadsheets. Leadership will reply more on emotional and relational aptitude rather than technical or financial expertise.”

This alone should be required reading of every Skilled Facility Supervisor, Owner, Administrator and DON!!

Long-Term Care as we have known it is rapidly changing. This new workforce, the millennial generation is not going to be a part of the “us four and no more” leadership model. A model that places the power in a few hands, hands that are desperately trying to cling to their comfortable job descriptions.

Our CNA’s, CMT’s, Dietary Staff, LPN’s in this millennial generation are not so much interested in just being an “obedient” follower!!! This powerful work-force want, and are going to be experts themselves in self-confidence, self-management, time-management, communication and networking and are very capable of leading themselves.

It’s all about exceptional care for our Nursing Home Resident, taking care of those who care for our Residents is the future. AND THE FUTURE IS NOW.

tony sexton

senioradvocacy@yahoo.com

Taking Ownership in your Nursing Home

2011-03-22T10:22:00.005-05:00

Taking ownership….

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I presume this would have various meanings and connotations depending with whom one would speak to. I remember some time back I visited with the Administrator of a Skilled Facility regarding the daily morning department head meeting. Not knowing the salaries of each member of the team I came up with an estimate and then came up with a dollar figure over the course of a month that it was costing the facility for these daily meetings.
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Why would I bother? Wasn’t coming out of my pocket. BUT in a real sense if these morning meetings were not productive, if they had degenerated into gripe sessions or too much time was spent on personal matters those funds were coming out of the pocket of direct-care staff (CNA’s, CMT’s, LPN’s) BEFORE it even reached their pockets, in that those funds could be better spent on raises ect..
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More recently I had a similar conversation with a Nurse in Long-Term Care related to medication counts that must be performed by the outgoing and oncoming Nurse at each shift change. Conversation was similar in that we looked at how much roughly this was costing the facility over the course of a month in salary. At the facility in question I estimated it was costing in gross salary alone sixteen-hundred dollars each and every month. For most that would go a long way in making a monthly payment on a pretty nice home. In other words, is the facility receiving their money’s worth? Are the counts accurate and completed in a timely fashion?
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Point being…we must think beyond our own world if we would desire to grow because everything counts, and everything matters. I am reminded of T.Harv Eker and his book “Secrets of the Millionaire Mind.” He makes what I believe are some valid points regarding the different mindset oftentimes between those who have achieved financial success and those who have and may not. In the book the author states that poor people often look at other people’s success with resentment, jealousy, and envy. He goes on to say “It’s amazing to witness the resentment and even outright anger that many poor people have toward the rich. As if they believe that rich people make them poor. Yup, that’s right, rich people took all the money so there’s none left for me. Of course, this is perfect victim talk.”
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Taking ownership in your facility, the place where you will spend a great amount of your life means to think and act in ways that you would want your employees to act and think if you were the owner!! If you are a CNA you work in a fashion you would want your staff to work should you be the Charge Nurse. Unnecessarily criticizing Administrators, Supervisor’s, Owners and your Corporate Offices on “outward” appearances will only serve to sabotage your own life and efforts. As an example, it’s not too difficult to criticize the supervisor who pulls up to your facility in a shiny new Jag when you may have to take the bus to make it to your facility. What you may not be privy to is the monthly student loan payments they make, the sacrifices made to now be able to enjoy a different lifestyle.
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Taking ownership will result without fail, in better care for our Resident’s.

Tony Sexton

senioradvocacy@yahoo.com

What Happens in Nursing Stays in Nursing.

2011-03-11T09:55:00.001-06:00

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An INSANE model !! Yet the Director of Nursing at a Long-Term Care facility stood before the Nursing Staff; Lpn’s, Rn’s, CMT’s and “in-serviced” the staff on this foolishness.
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Every department, every employee of every department, every action by every employee of every department affects and impacts every other department.
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The term “interdisciplinary team” is used in Long-term care, meaning that every department in a facility is working as a team towards one common cause and that is to meet and hopefully exceed the need of every Resident.
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In fact, in Author Brian Tracy’s series titled “Customer’s for Life”, he states that the minimum requirement to just survive, to stay in business is to “meet” the customers’ expectations. Moreover, if you fail to meet their expectations, perhaps only one time, they will leave and find someone else who will. He then goes on to say that exceeding your customers expectations is to surprise your customer, going above what is expected gives you an edge over your competitor and can in some measure build customer loyalty. But there is more than meeting and exceeding your resident’s expectations, there is a level where they are delighted with your service. The resident, the resident’s family are touched on an emotional level, and at this level it will be very difficult for your competitor to pry your customers away. Tracy says that at this level you are well on the way to building a highly effective and profitable business.
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And finally… “Amazing your customer.” And I will add, to truly operate at this level consistently, your facility is dominated by Amazing Employees. At this level your facility, your business, your corporation is on its way to dominating the marketplace. Your facility is “the” place to go, the place to go for care, and the place to go to for employment.
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“Research suggests that good interdisciplinary communication leads to improved patient and family outcomes (i.e. high levels of patient and family satisfaction, symptom control, reductions in length of stay and hospital costs)” by Hearn J, Higginson IJ: in a research article titled "Do specialist palliative care teams improve outcomes for cancer patients? A systematic literature review."
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There is a research article related to Interdisciplinary teams titled “An interdisciplinary team communication framework and its application to healthcare 'e-teams' systems design” available online at: http://www.biomedcentral.com/1472-6947/9/43 that is worth a read.
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It is not my intent to pick on Nursing, not at all. I have written enough regarding my appreciation for Nursing in Long-Term care that makes my position clear.
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I also want to be clear that any idea that a department works independently of another renders an “interdisciplinary team” void and of little effect. Simply, the needs of the residents will not be met. Every member of a team, any team whether Sports or in business brings to the table strengths and weaknesses.
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Recently I made the following comments related to an article on hiring staff in Long-Term Care. “Perhaps most don’t think of it in this fashion yet those with whom we work in a real sense become ...a second family based on the number of hours we spend with them. We had no choice is choosing our first family, but we do get to choose in some respects our second family. And just as important as the ideas of relationships are between employee and customer (resident) so are the relationships among employees. Anyone who has been employed as a caregiver understands how critical good communication and teamwork is to providing exception care!”
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To all Administrators, to all Corporate Nursing Supervisors, to all field Supervisors, don’t linger long in unloading those from your staff who are not entirely dedicated to meeting, exceeding, to delighting and to amazing your customers’ (residents) expectations. To delay is to further poison the well of cohesion and morale in your facilities. Any department that sees no need to be accountable to another needs new leadership.

tony sexton
senioradvocacy@yahoo.com

The Organizational Pillars of Change in Long-Term Care (guest article)

2011-02-24T09:00:00.003-06:00

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I am pleased to include the following guest article related to Culture Change here on the Midwest Senior Advocacy site. The author Ben Adkins is the Media Relations Manager for Signature Healthcare. In my correspondence with him it is apparent he has a passion not only for our Long-Term Care residents and employees, but also is excited what his company is doing to change the Culture of care in their facilities. I have included his contact information; take a moment today to drop him a note.

tony
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Ben Adkins
Media Relations Manager
Signature Consulting Services, LLC
12201 Bluegrass Parkway
Louisville, KY 40299
(502) 568-7746 Desk
(502) 396-1409 Cell
badkins@signaturehealthcarellc.com

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Gandhi had it about right: “Be the change you want to see in the world.” And if there’s room for one thing in nursing homes, it’s change. Considering the demographics, devising new methods of caring for our elderly is pretty much an imperative – and it’s a global issue.
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So, how do we change nursing homes? Key word: collaboration. This means greater collaboration between all parties involved in delivering long term care, as well as deeper partnerships between the public and private sectors. We think it’s time to set aside biases and come together to contribute to the conversation.
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We also should be looking toward new innovations to improve long term care and elder care. We can’t rely on the same staid practices and tools of yesterday. It will be interesting to see how telemedicine, personalized medicine and other yet-to-be-seen concepts will figure into health care and long term care models of the future. In addition, people have more access to information than ever, so increased consumer transparency will create demands that force providers to change.
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Another vital aspect of culture change in long-term care is treating residents holistically and tending to their spiritual needs. Residents in LTC facilities have rich experiences, personalities and interests, and those don’t cease to exist when they move into an LTC facility. To that end, vibrant Spirituality and Quality of Life programming is a must to try and meet their needs and desires as individuals.
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Obviously, volumes could be written on the topic of changing long term care, but at Signature HealthCARE, we’re attempting to do so through the culture and philosophies we’ve adopted – and it’s a multi-tiered approach, to say the least.
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Three organizational pillars serve as the guideposts for our actions: Learning, Spirituality and Intra-preneurship. Marketing speak? Hollow corporate sloganeering? Hardly. These are actual divisions of the company, developing actual programs to serve residents as well as employees (which, in turn, serves the residents.)
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Learning – We invest in our employees through internal educational programs and teaching skills that relate not only to their current job functions, but other more generalized 21st century job competencies. We also support employees in the pursuit of additional schooling. And that isn’t limited to any particular group – members of our executive team recently completed CNA training to better understand the challenges faced daily by CNAs, and to look for areas to improve.
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Spirituality – Our Spirituality pillar is open to all faiths and designed to meet individuals at their own point of need. Each of our buildings have full-time chaplains that vary in terms of experience and religious background. Employees have the option to engage in various educational and philanthropic activities, and we’ve found that our Spirituality program aids in employee retention.
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Intra-preneurship – This is basically the notion of our own employees creating companies to serve the long-term care space. Great ideas can come from anywhere within an organization – not just the top. And who better to develop solutions to the challenges in long-term care than people who are entrenched in it on a daily basis?
In addition, we partnered with the University of Louisville to launch the International Center for Long Term Care Innovation, a business accelerator designed to advance new products and services that target long term care. The Center also will serve as a data repository for best practices in long term care.
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Like any type of change, there are challenges – resources are finite, people are sometimes resistant and there are plenty of unknown variables to contend with. But the demographics, combined with what we know about the attitudes and desires of the individuals who will populate the nursing homes of the future, certainly justify the efforts.
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And, once we change nursing homes, we can turn the tide of negative sentiment surrounding them.

We MUST Have Vibrant Activity Programs in our Nursing Homes

2011-02-15T12:07:00.008-06:00

thank you Kimberly for your great article and permission to include it here on the Senior Advocacy site. Very important to remember as the article articulates that ALL staff members are responsible for promoting "meaningful" activities! Every employee has the opportunity to help make every facility a great place to live.

Tony Sexton

senioradvocacy@yahoo.com

Department-Specific Quality of Life Strategies
By Kimberly Grandal BA, CTRS, ACC
Executive Director, Re-Creative Resources Inc.
http://www.recreativeresources.com/

Getting facility staff on board with activities and helping to provide opportunity for meaningful activities for the residents is a major concern for activity professionals. The Activity Director must get the support of the Administrator and the department heads in order to truly create an environment that promotes an interdisciplinary approach to quality of life. Even after the implementation of the revised F248 in June 2006, Activity Directors around the country continue to express that facility staff members are simply not assisting with activities. Be sure to meet with the Administrator first to discuss your concerns and ideas and inform him/her that F248 clearly states that all staff members are to promote meaningful activity, not just the activity staff.

The Activity staff, often professionally certified through NCCAP or NCTRC, are specially trained to facilitate activities that are designed to meet the needs and interests of each resident, however, facility staff can supplement the activity program in a variety of ways. The assessment, care planning and planning stages are key to successfully facilitating a program of activities, therefore the Activity staff must commit to training facility staff and communicating residents’ interests and needs.

When developing an interdisciplinary approach to quality of life program, it is important to remember the following:

* All interventions must match the needs and interests of EACH resident.
* All work-related activities must be included in the comprehensive care plan.
* Residents have the right to refuse activities.
* Residents have the right to refuse to provide work for the facility.
* The intent is not for the residents to do our work, but to feel a sense of self-worth and purpose!

The following are just a few ideas on how each department can offer meaningful activity experiences for the residents.

Nursing

* Incorporate meaningful activities into ADL’s and restorative programs.
* Schedule medications, ADL’s, and treatments around residents’ favorite activities.
* Assign CNAs to assist in the day rooms and other activity areas.
* Facilitate simple, groups, and one to one activities.
* Incorporate resident interests into the daily CNA assignment.
* Provide opportunity for residents to assist with making beds.
* Staff Educator can provide in-services to residents such as diabetes, infection control, flu

shots, dealing with residents with cognitive impairments, etc.

Food and Nutrition

* Have residents’ favorite comfort foods readily available.
* Create an ice cream cart or ice cream parlor that is always stocked with sweet, cold, treats.
* Cook or do food preparations in a common area for residents to see and smell the food.
* Host cooking programs and specialty dinners, breakfasts, etc.
* Facilitate a Menu Planning Committee.
* Provide cultural meals in accordance with resident’s tastes.
* Provided meals that meet residents’ religious needs.
* Provide opportunity for residents to set tables.
* Have residents plan a meal.
* Have residents do some food preparations.

Social Services

* Assist with utilizing residents PNA to purchase electronics, adaptive equipment,

decorations,community outings, etc.
* Play a major role in the Resident Council process.
* Purchase clothing, schedule beautician appointments, etc.
* Facilitate a new Resident Support Group, Adjustment Group, or other support groups.
* Facilitate a Life Review Program (Group or one to one).
* Provide One to One visits for reminiscing, support, and companionship.
* Encourage family to bring in personal belongings to create-homelike atmosphere.
* Have mock elections during voting seasons.
* Facilitate Resident Rights Bingo.

Housekeeping and Laundry

* Some residents may enjoy cleaning-give them a duster, cloth, broom, etc. and have them help.
* Put on residents favorite TV station, music, etc.
* Discuss what the resident is watching on TV, reading, etc.
* Discuss family photos, memorabilia, etc.
* Assist in facilitating specialty groups such as a men’s club, cultural programs, young adult

groups, etc.
* Provide opportunity for residents to fold towels and linens.

Maintenance

* To cut costs, build items that can be utilized with the residents such as: garden boxes, tactile

boards with various objects and textures, games (target toss, Wheel of Fortune Boards, etc.).

If appropriate, have a resident assist.
* Ask residents to assist with minor projects such as hanging a picture, repairs, etc.
* Assist in facilitating specialty groups such as a men’s club, cultural programs, young adult

groups, etc.
* Facilitate a wood working program (bird houses, shelves, etc.). These items can then be used

to decorate facility or personalize a resident’s room.
* Bring in videos of sporting events.

Business Office and Human Resources

* Residents may be able to assist with folding brochures, mailings, some filing, clerical work, etc.
* Have residents be part of an Employee Appreciation Program such as a resident committee

that nominates employees for “Employee of Month/Year.” Have a special recognition

program where residents can present awards.
* Have a resident greet family and visitors at the reception area.

Admissions

* Residents may be able to assist with folding brochures, mailings, some filing, clerical work, etc.
* Put up a welcome sign, provide a welcome greeting card, flower arrangements, etc.
* Follow-up to see how the resident is doing and if they like their room and roommate.

Marketing

* Encourage residents to be part of marketing strategies such as news articles, videos, etc.
* Some residents may even be able to assist in writing press releases, or interviewing other

residents about what they like about the facility. You may even bring a resident to a luncheon

or meeting and have the resident express the positive aspects of the facility. The greatest

marketing tool we have is our residents!
* Implement the “Adopt-A-Nursing Home” Project.
* Be on the lookout for community and volunteer opportunities.
* Market specialized activity programs and special events.

Therapy

* Schedule therapy sessions around resident’s favorite activities.
* Make recommendations and referrals to the Activity Department such as range of motion

activities, ADL activities, cognitively stimulating activities, etc.
* Utilize Pet-Facilitated Therapy
* Provide opportunities for co-treatment groups such as cooking, gardening, etc.
* Develop a Fitness Trail designating specific exercise that can be done standing or sitting.
* Help co-ordinate a “Walk/Wheel- A-Thon” to raise money, or a “Senior Olympics”.

Administration

* Host a monthly “Lunch with the Administrator” or “Meet the Administrator” for new

Residents.
* MC a special event
* Attend Resident Council
* Encourage Residents to be on facility committees
* If possible, involve Residents in facility renovations. Ask them about color preference, styles,

décor, themes, etc.
* Be proactive in the Culture Change Movement.
* Create an Administrative policy that supports and interdisciplinary approach to quality of life.

Although an interdisciplinary support to quality of life is prominently stated in the revised F248 Activities regulation, it is not adherence to this regulation that Activity professionals are concerned about, but rather the idea that all residents should be given an opportunity to engage in activities that are purposeful, meaningful, therapeutic and enjoyable. Truly providing a program of activities that meets the needs and interests of each resident requires support, continuity, education, commitment and a complete team approach.

About the Author
Kimberly Grandal, Founder and Executive Director of Re-Creative Resources, Inc., is a strong advocate for the field of Therapeutic Recreation and Activities, with over 18 years of experience in various management and consultant positions. She is an Activity Consultant Certified and a Certified Therapeutic Recreation Specialist. Kim founded Re-Creative Resources Inc. in 2006 and provides seminars for various local, state and national activity associations. She also offers lectures for Re-Creative Resources Inc. and provides online webinars. In addition, Kim provides consultation and support to numerous facilities in the state and nationwide and writes for numerous online sources.

Permission to Use
Permission granted to print this article for non-commercial purposes only, as long as the source of information is retained. No portion of this article may be altered. Contact Kim Grandal at kimgrandal@aol.com for questions regarding the terms of use of this article.

I don't work in sales, I work in a Nursing Home. NOT

2011-02-09T11:35:00.001-06:00

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People buy people-then they buy your product.

Nursing staff would you like to have better success with cooperation from your Residents you are caring for? Don’t underestimate the importance of your Residents “buying” in to YOU FIRST before they “buy” in to the task at hand, whether that task is taking medications, attending activities, using the restroom, the list is endless.

Tony Hsieh, CEO of Zappos in his book “Delivering Happiness, a path to profits, passions, and purpose.” States that “over the years, the number one driver of our growth at Zappos has been repeat customers and word of mouth. Our philosophy has been to take most of the money we would have spent on paid advertising and invest it into customer service and the customer experience instead, letting our customers do the marketing for us through word of mouth.”

I think it has been well said that nothing happens until a sale takes place. All the producers of goods and services, factories, offices and businesses leap into action only when someone, somewhere makes a sale to someone.

If you are a parent you most definitely are in sales. How many times have you “sold “your child on the benefits of good grades, of good friends, of a clean bedroom, of a bath?

Administrator… do you need to turn around your facility? Your facility does not have a good reputation in your community? Take another look at the idea of people buying people then they buy your product. Have you assembled a team that your community will buy into? No matter your physical plant, your building… what about your team?

Director of Nursing…your residents need to buy into your staff.

Lpn’s… your CNA’s need to buy into your compassion, your expertise, your direction, your genuineness,

CNA’s… your residents need to buy into you!!

Sales, YES Sales. Think about it.

senioradvocacy@yahoo.com
Tony Sexton

Go and Keep Going

2011-01-10T10:57:00.004-06:00

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Orison Swett Marden wrote in his book, “There are two essential requirements for success. The first is 'go-at-it-iveness' and the second is 'stick-to-it-iveness'” Referring to the quality of persistence he wrote, “There is no failure for the man who realizes his power, who never knows when he is beaten; there is no failure for the determined endeavor, the conquerable will. There is no failure for the man who gets up every time he falls, who rebounds like a rubber ball, who persists when everyone else gives up, who pushes on when everyone else turns back.”

To you who are employed in Long-Term Care, there will be no over-night changes in your facility.

I read that Ford Motor Company’s CEO has said that most people are not frightened by “change” as much as they are frightened by “uncertainty.” Meaning, how is the change being discussed going to impact me either positively or negatively. Genuine change will come one suggestion, one conversation at a time. It will happen as Charge Nurses, CNA's, Department Heads, Administrators, take every available opportunity to ask and answer such questions as “why are we doing it this way”, “are there better ways to do it”, and “do we need to be doing this at all?”

And perhaps the most question MUST be is: “how do our customers (the resident) want us to do it.”

Yes this is a FAR cry from the usual one-size-fits-all philosophy.

How many times do we not say, but say to our new customers…. “welcome to our facility, now please place all your former habits, likes, dislikes, routines into this nice little bucket and I will place this bucket in storage. It’s OUR way now.”

This fight for change in Long-Term Care is worth fighting for. And so as Orison Swett Marden wrote, if you have fallen, get back up. If you have become discouraged because your colleagues don’t seem to be “getting it”, get back up.

senioradvocacy@yahoo.com
Tony Sexton

A Day in the Life of a Nursing Home Charge Nurse

2011-01-04T10:12:00.010-06:00

I recently received this account from a Nursing Home Charge Nurse of the challenges in charging a unit. Oftentimes family members have no idea what goes on behind the scenes in the course of a typical day in Long Term Care. I have been on both sides of the counter, both as a consumer (currently I have a relative in Nursing Home) as a volunteer and as an employee. I have often said a Nursing Home is very similar to a small city. A city within a city and the challenges are great.

In this New Year I will be posting articles from various disciplines within Long Term Care that have been sent to me. Look forward to connecting with new friends who work and are concerned to provide great care to our Seniors and all residents of Long Term Care.

senioradvocacy@yahoo.com

Tony Sexton

Well the day starts innocent enough, receiving report from Charge Nurse from previous shift. As I begin with accu-checks(checking blood glucose levels) and tube feeding, phone rings and on the way to answer the phone (which turns out to be one of my CNA’s running late) another of my CNA’s asks if I can come take a look at a Resident who is not acting right. While in assessing Resident bath aide asks if I can come to whirlpool room and look at what appears to be a new bruise. Upon finishing assessing resident I head out to assess resident with new bruise and am stopped by another resident at their room door asking if I can help find her TV remote. I tell resident I will be happy to if she will give me a few minutes, while at the same time I am being paged for a phone call (which turns out to be same CNA telling me she will not be in at all… leaving us one short on the hall.) On way to whirlpool room alarm on resident chair sounds (an alarm btw I soon find out that was D/c while I was off.) Take a look at the clock and find I still have eight accu-checks and nowhere close to being finished, but have to be in dining room for breakfast very soon.

Back to accu-checks and on my way to second accu-check the DON finds me and asks where are all my CNA’s, a Resident is asking her to use the restroom. Finally, on my way to the dining room when I am stopped by the Physical Therapist asking if I had charted on a Resident so they can pick them up for therapy. “No, sorry but I will right away!” I scan the hall, making sure everyone is up and room trays are being passed, as the ADON asks me where is the CNA who is supposed to be in the dining room? As I head back down the hall to find CNA I am making some mental notes as the facility Medical Director will be in shortly for rounds.

On way past the Nurses Station asked if paper work ready for a Resident who will be leaving facility for a medical appointment, “no, but I will have it ready in time.” Head to dining room, only to walk by a Resident sitting at table who obviously needs to use the restroom. As I give direction for a CNA to help Resident to restroom I am told by laundry employee that a washer is down and fresh bedding and lift pads will be delayed. Ok, Dr. here now, and he doesn’t like to wait long, he has a very heavy patient load today!

Just as I am ready to get started with rounds with the Dr. a family member of a Resident calls telling me that her mother just called and told her that the bed has not been made and she has to use restroom.

Oh boy…. And it’s only 9:15 a.m

Walking a Mile in the shoes of a Resident

2010-12-28T11:59:00.007-06:00

(this story is taken from the HCCI newsletter www.hccil.org dated 8/10. Please consider purchasing this DVD, email Leslie Pedtke and she will give you all the contact information to purchase. (leslie.pedtke@kingmgt.com)

senioradvocacy@yahoo.com

Tony Sexton

Pictured are contestants (left to right) Kat McCrory, Leah Schmit, Christopher Ranz, and Darlene Huelsman.

Imagine it: one day you're a healthy young CNA and the next you move into a nursing home suffering from congestive heart failure and have fluid accumulation in your legs that makes it difficult to walk.

It may sound improbable, but this was exactly the situation one CNA at Aviston Countryside Manor faced as part of the facility's “Through the Looking Glass” project. The project was the brainchild of Administrator Leslie Pedtke, who wanted to create an experience for her staff that would simulate the challenges nursing home residents face each day.

“In providing compassionate care, the key is empathy,” said Pedtke. “You have to place yourself in the residents' shoes.

Pedtke pitched the project to her staff as a contest to see who could live at the facility as a resident for the longest period of time. Four staff members participated in the contest: CNAs Leah Schmit, Kat McCrory and Chris Ranz (also a nursing student) and Housekeeper Darlene Huelsmann. Contestants were not allowed to leave the facility, and shared a room with a resident. In addition, contestants ate the same foods as the residents and were required to draw a random diagnosis, which was simulated in creative ways.

“The initial diagnoses ranged from congestive heart failure to stroke,” said Pedtke. “For the stroke, we simulated partial paralysis by having the staff person wear a weighted sling. To simulate fluid accumulation, the contestant wore weights on both ankles and support hose.”
As the contest continued, participating staff were presented with new complications each day. Some suffered from bowel or urinary incontinence; others were forced to drink thickened liquids because of choking. Additional challenges included wearing vision-impaired goggles during bingo, head injuries requiring neuro checks, eating pureed food, using a bed pan for extended periods of time, room reassignments and more.

CNA Kat McCrory won the contest by spending eight days as a resident. She and her fellow contestants all gained a much deeper insight into resident life and the importance of building relationships with the residents.

“This experience provided me the opportunity to truly get to know many of the residents,” McCrory said. “I hope to continue developing closer relationships with the residents as I transition back into my caregiver role.”
Pedtke is quite proud of the staff who participated in “Through the Looking Glass” and plans to hold the contest again in the future.
“I couldn't be more proud of these dedicated staff,” Pedtke said. “They have all come away from this experience with a greater dedication to the residents in their care.”

Editor's Note: Aviston Countryside Manor videotaped many parts of the contest and now has DVDs for sale for $25. If you're interested, contact Administrator Leslie Pedtke at: mailto:hleslie.pedtke@kingmgt.com.

The Corporation isn't interested in Culture Change

2010-12-28T11:23:00.002-06:00

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They are only concerned about money. They are only interested in profits. They are only interested in numbers.

I sure have heard this a lot.

For the Administrator, Supervisors, Nursing Home Staff, Board Members, CEO’S and owners…. Dignity, compassion, choices, individualized care, Culture Change IS PROFITABLE. And it is the ONLY future for Long-Term Care!!

But first I DO NOT believe the Corporation is ONLY INTERESTED in numbers! Yet I am beginning to get the distinct feeling that many have no clue.

-what do I mean?-

I have asked of Administrators if their corporate supervisor, to their knowledge has ever visited the facility on a Friday night at 8:00 p.m? Has the corporate nurse ever visited on a Sunday morning at 5:00 a.m?

To every Owner, to every CEO, to every Board Member to every Supervisor: It’s time to find out what is going on in your facilities.

senioradvocacy@yahoo.com
Tony Sexton

"The Crotchety old woman"

2010-12-22T10:44:00.007-06:00

An Old Lady's PoemSue Diaz(?)

What do you see, nurses, what do you see?

What are you thinking when you're looking at me?

A crabby old woman, not very wise,

Uncertain of habit, with faraway eyes?

Who dribbles her food and makes no reply

When you say in a loud voice, "I do wish you'd try!"

Who seems not to notice the things that you do,

And forever is losing a stocking or shoe.....

Who, resisting or not, lets you do as you will,

With bathing and feeding, the long day to fill....

Is that what you're thinking? Is that what you see?

Then open your eyes, nurse; you're not looking at me.

I'll tell you who I am as I sit here so still,

As I do at your bidding, as I eat at your will.

I'm a small child of ten ...with a father and mother,

Brothers and sisters, who love one another.

A young girl of sixteen, with wings on her feet,

Dreaming that soon now a lover she'll meet.

A bride soon at twenty-my heart gives a leap,

Remembering the vows that I promised to keep.

At twenty-five now, I have young of my own,

Who need me to guide and a secure happy home.

A woman of thirty, my young now grown fast,

Bound to each other with ties that should last.

At forty, my young sons have grown and are gone,

But my man's beside me to see I don't mourn.

At fifty once more, babies play round my knee,

Again we know children, my loved one and me.

Dark days are upon me, my husband is dead;

I look at the future, I shudder with dread.

For my young are all rearing young of their own,

And I think of the years and the love that I've known.

I'm now an old woman ...and nature is cruel;

'Tis jest to make old age look like a fool.

The body, it crumbles, grace and vigor depart,

There is now a stone where I once had a heart.

But inside this old carcass a young girl still dwells,

And now and again my battered heart swells.

I remember the joys, I remember the pain,

And I'm loving and living life over again.

I think of the years ....all too few, gone too fast,

And accept the stark fact that nothing can last.

So open your eyes, nurses, open and see,..

Not a crabby old woman; look closer ...see ME!!

Medical Mistakes, honesty

2010-12-21T09:56:00.003-06:00

Found this story from McKnights interesting coming just one day after a conversation with a Long-Term-Care Nurse on this very topic.

Click below to read the short article.

Apologies boost provider reputation, don't increase lawsuit risk, study reveals - McKnight's Long Term Care News

In my conversation related to Medical mistakes, the statement was made to me by the Nurse that the initial step of reporting mistakes was often hard. And I can understand this. Perhaps nobody knows better than a direct care giver that mistakes are made, we are not robots.

And a Nurse knows this, and at least partially there is an apprehension in that even the best, most caring Nurses can and do make mistakes. And when a Nurse does find a medical error, that nurse knows full well that a career could very well be in jeopardy.

But at the end of the day, every caregiver has a responsibility to report and provide a high standard of care, which regrettably at times includes the acknowledgement that an error was made.

senioradvocacy@yahoo.com
Tony Sexton

State is in the Building

2010-12-15T13:33:00.001-06:00

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Anytime state is in the building there is naturally some anxiety.

I don’t want it to appear I am suggesting staff walk around on eggshells yet I am and do suggest there has to be accountability, follow-up and follow-through ALL the time. NOT just when state is watching.

And why not??

There really are no surprises what the State will be looking at when they are in your building.

Walking by problems, keeping the blinders on simply is a recipe for disaster. And I well understand to take off the blinders, to walk your facility with eyes wide open will cause some unrest.

But let me say this, the one area, the one group where it will NOT cause unrest is with those paying the bills. From your customers (the resident and their families.)

If you do start taking notice, make sure you balance it, lace it with lots of praise for all the GOOD you see as well. Because there are lots of good things going on in your facility! Your team will be far more receptive when there is this balance.

Start today.

senioradvocacy@yahoo.com
Tony Sexton

Two nursing homes face closure | WIVB.com

2010-12-11T12:34:00.002-06:00

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Link below will take you to a disturbing story regarding the proposed closing of two Nursing Homes in the Buffalo New York area.

Two nursing homes face closure WIVB.com

Anyone in the LTC industry well understands the challenges of Medicaid reimbursements.

There are so many questions to be asked; How well is the clock being managed would be at the top of my list.

Look forward to your thoughts.

senioradvocacy@yahoo.com
Tony Sexton

Symptoms of Under-Earning

2010-12-09T11:23:00.003-06:00

I would invite any employee in Long-Term Care to take a look at this list, and as well visit the website: underearnersanonymous.org.
Getting "un-stuck", becoming "sick and tired of being sick and tired"... are you there? Have you thought about it? do you want to get on with your calling, your purpose, your goals and visions? Think about it.

senioradvocacy@yahoo.com
Tony Sexton

Symptoms of Under-earning

1. Time Indifference – We put off what must be done and do not use our time to support our own vision and further our own goals.

2. Idea Deflection –We compulsively reject ideas that could expand our lives or careers, and increase our profitability.

3. Compulsive Need to Prove – Although we have demonstrated competence in our jobs or business, we are driven by a need to re-prove our worth and value.

4. Clinging to Useless Possessions – We hold onto possessions that no longer serve our needs, such as threadbare clothing or broken appliances.

5. Exertion/Exhaustion – We habitually overwork, become exhausted, then under-work or cease work completely.

6. Giving Away Our Time – We compulsively volunteer for various causes, or give away our services without charge, when there is no clear benefit.

7. Undervaluing and Under-pricing – We undervalue our abilities and services and fear asking for increases in compensation or for what the market will bear.

8. Isolation – We choose to work alone when it might serve us much better to have co-workers, associates, or employees.

9. Physical Ailments – Sometimes, out of fear of being larger or exposed, we experience physical ailments.

10. Misplaced Guilt or Shame – We feel uneasy when asking for or being given what we need or what we are owed.

11. Not Following Up – We do not follow up on opportunities, leads, or jobs that could be profitable. We begin many projects and tasks but often do not complete them.

12. Stability Boredom – We create unnecessary conflict with co-workers, supervisors and clients, generating problems that result in financial distress.

The Fear factor

2010-12-08T11:40:00.004-06:00

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In the latest edition of Success magazine (Jan 2011) I found an interesting survey question and the results.

The question was asked: “What fear most impacts your success?”

And the answers were:
39% fear of failure
23% fear of trading security for uncertainty or the unknown
18% fear of overextending yourself financially
15% fear of what others will think or say
5% fear that your achievements and success will alienate your peers

I would ask the same question to CNA’s, LPN’s, RN’s, Administrators, Social Service Directors, Activity Directors, to every employee in the Nursing Home. What is holding you back from making a profound impact on your facility?

What are your fears?

From experience, talking with so many employees spanning the last twenty-three years, one predominant comment I have heard is “it doesn’t matter anyway, they don’t listen.”

In this same issue of Success magazine was an interview/story from actor/producer Ron Howard. The article states that Ron has maintained a reputation for being one of the nicest guys in the business. Ron states that “As a director, I try to create an environment where people feel they can creatively flourish, where they can excel, and that creates a lot of confidence and an ongoing dialogue and a kind of creative excitement that I can, as the director, really work with and help focus.”

He goes on to say… “But nobody’s operating out of fear or anxiety as much as they are a kind of creative excitement and a belief that in a business that often throws up roadblocks, as many of those as possible are going to be cleared away.”

This could be taken right out of far too many Nursing Home playbooks. Supposed “roadblocks”, blaming ownership, management, the State and Federal regulations, The surveyors ect…

Finally Ron said, “People know I am a good listener and that I’m eager to include people’s creative ideas, I find that many are willing to accept no from me more readily because they also understand that I’m very eager to say yes and include their ideas.”

I think it safe to say that our CNA’s especially, would be far more apt to bring forth great ideas to improve care in our Nursing Facilities if they felt their input was genuinely appreciated. If their ideas were consistently solicited, if there was ongoing dialog.
How desperately our facilities need to cultivate an atmosphere where creative excitement as Ron Howard describes it was allowed to flourish!!

senioradvocacy@yahoo.com
Tony Sexton

Are you getting referrals from your vendors???

2010-12-03T09:14:00.002-06:00

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Where are your referrals coming from?

The traditional method of course are visits to discharge planners at Hospitals, and this is a given.

What about all the vendors who visit your residents(the facility) and make their rounds, often including your nursing staff? Interesting….

From these vendors often including Hospice groups are you filling beds? Your vendors want you to buy from them, are they referring potential customers to you? How are you tracking this?

Try letting your vendors know how many available beds you have, tell them you need THEIR help to fill them!!! I remember well the surprised looks I have received when I have done this very thing.

senioradvocacy@yahoo.com
Tony Sexton

Thank you for your comments

2010-11-27T10:07:00.002-06:00

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I always appreciate getting feedback from those who have read any of the articles posted on this site.

I know what it's like to read informative stories, articles, ect... and not send a short note to the author.

Yet.... it's very encouraging to hear from the readers.

I have heard from many in the industry and I always request that you please pass along the link to this site to others in the Healthcare field. We have to change this product being offered. Our Long Term Care population deserve it.

Our employees in the industry deserve it!

Again, thank you for so many of the emails I have received this past year. It only takes one kind note from you the reader to make it worth it.

Sincerely,

Tony Sexton
senioradvocacy@yahoo.com

New housing choices for mentally ill nursing home residents spark concerns - McKnight's Long Term Care News

2010-11-23T10:29:00.004-06:00

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click the link below to view this brief story:

New housing choices for mentally ill nursing home residents spark concerns - McKnight's Long Term Care News

I understand the financial impact on a facility should many of these current residents were to choose a different living invironment. That said, what is best for these residents? What is best for their quality of life, their psychosocial well being?

ok... I will also say, Were many Long-Term-Care facilities providing a quality product, one in which the psychosocial well-being of mentally ill residents were of primary concern these concerns would at the very least be minimized.

This is a growing trend that needs addressed, younger residents who need care are falling through the cracks. The options for these individuals are few. And so I am pleased when the resources are available in which "choice" is realized.

senioradvocacy@yahooo.com
Tony Sexton

They are in there with the door shut again.

2010-11-20T10:34:00.004-06:00

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“They are in there with the door shut again”

My, how many times have I heard that from CNA’s, CMT’S, LPN’S, residents and families?
Forgive me for asking, but generally speaking the residents are not holed up behind closed doors and so why are the Department Heads?

Yes I have beaten this drum before, and I will continue to do so.

WAKE UP, please Department Heads reading this. Yes, take care of what you must. I am fully aware of the necessary meetings. Been there done that.
BUT… you are unnecessarily sabotaging any culture change “talk”, if you are not recognizing how important it is to be OUT WITH THE CUSTOMERS, with the families, with the volunteers, with the nursing staff.

Your feasts behind closed doors are creating havoc. STOP IT!!

There are a few who get it, would love to hear from you soon.

senioradvocacy@yahoo.com
Tony Sexton

Depression in nursing home residents often unrecognized

2010-11-12T09:37:00.006-06:00

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I had the good occasion to sit in on a question and answer session with Dr. Todd Hill, founder of Northland Psychiatric Specialists, LLC. Dr. Hill has a passion for elder care and it was a real pleasure to hear him speak.

Dr. Hill made a comment as part of an answer to a question that he sees the great benefit of Residents who are able to have consultations with a Psychologist when dealing with depression or other issues. I made the comment and asked Dr. Hill what of the greater majority of residents whose only payor source is Medicaid and don’t have the opportunity nor can they afford to privately pay for the services of a Psychologist in the Long Term Care setting. I asked what can we as family, as volunteers and as care givers do to help improve the lives of our Residents.

Dr. Hill answered that training for the CNA’s is a huge first step. Those caregivers who spend the most time with the Nursing Home Resident are the CNA's and any level of introductory training in depression and psychological issues would be beneficial.

According to the American Geriatric Society depression affects approximately 30 to 40 percent of Nursing Home Residents yet often goes unrecognized. "Prompt diagnosis and treatment of depression is essential to improve the quality of life for nursing home residents," said Lorraine Phillips, assistant professor in the Sinclair School of Nursing.

I am not at all convinced this accurately represents the percentage of Residents with depression. I am concerned that the rate is greater, perhaps much greater. Everything one knows and holds dear for all intents and purposes is gone when one enters a Nursing Home and is reduced to an area about the size of a piece of plywood.

I agree with D. Hill, initial and continuing education is imperative. And I believe it is a win-win for not only the Resident but produces greater job satisfaction for the employee when that CNA feels they can better meet the needs of those they are providing care for.

senioradvocacy@yahoo.com
Tony Sexton

click on the following link to read more:
Depression in nursing home residents often unrecognized

It's Time to Get Back Up

2010-10-15T11:36:00.002-05:00

In her book “The Long Goodbye”, by Ronald Reagan’s daughter Patti Davis she talks about how her father would often say to her to always get back on a horse after falling off so that fear wouldn’t have a chance to set in.

If you have not read this book I would recommend it to you. I picked up a copy the other day and have greatly enjoyed it. And I think anyone who has a family member afflicted with Alzheimer’s will appreciate the journey as described by President Reagan’s daughter.

And whether getting back up after a fall from a horse or life itself, I think President Reagan has left his daughter and us with sound advice. Fear can be such a formidable enemy to peace and happiness in one’s life. And I think we can safely say that the longer one hesitates, waits after a fall to get back up the more difficult rising from the ashes can become.

It matters not if your fall was professionally, or domestically. A personal problem or a difficulty at your facility.

It’s time to get back up, life needs you.

senioradvocacy@yahoo.com
Tony Sexton

No One Is Coming To The Rescue

2010-10-14T11:11:00.009-05:00

“No one is coming to the rescue”, Author and Psychologist Nathaniel Branden in his book How To Raise Your Self-Esteem has said that in working with clients in psychotherapy he often has seen that the most radical transformation occurs after his clients realization that indeed no one is coming to the rescue.

We are not omnipotent; we certainly are not responsible for every aspect of our existence and all that happens to us. Some things we have control over, others we do not. And from experience I would suggest that determining this in our life is very important.

And so if this is correct, and I believe that it is that no one is coming to the rescue, what are we to do? Those who have found themselves in the depths of despair, in depression, perhaps tired of life itself?

Keep reading, join the discussion. Even if you have given up. Even if it doesn’t matter anymore. Even if everything is gone. Even if it seems no one cares.

The fact that others have travelled down this lonesome road really doesn’t in and of itself help, yet I am persuaded there are connections you can make with others. Others that can be a conduit to your coming out of that dense fog. And by others I mean the obvious, a new relationship yet it also can mean an author, a blog such as this, a website, don’t limit yourself.

But don’t wait for someone to rescue you. Reach up, reach out, grab onto. You were put on earth for a reason, for a purpose. Some know that purpose but have lost their way. Others truly don’t know. Time to live. Time to rescue yourself, you are so important.

Many can relate to the thought… “Life is not what I had imagined as a youngster”, “I am not what I thought I would be like at this point in my life”, “I am not in a position at this age that I thought I would be”.

And to my fellow colleagues in Long Term Care and Healthcare in general I write this specifically to you. Your residents, your patients, your team needs you!! They need you to be healthy, healthy physically, healthy emotionally, healthy spiritually. Perhaps when you started in the field you imagined by now you would have been further along in your career. Don’t give up. Don’t quit. This is for you, for us.

You may find that you have just become too comfortable in your position, time to grow now. Time to once again stroke those flames of opportunity and advancement.

Don’t leave

senioradvocacy@yahoo.com
Tony Sexton

Grieving

2010-04-26T19:38:00.003-05:00

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First there is no correct way to grieve. And never pass judgment on the way an individual process’ sadness, tragedy and stress.

The news of sickness, the death of a loved one, loss of employment, placement in a Nursing Home are all examples of events that can turn one’s world upside down.

I began this article while sitting in a hospital waiting room as an acquaintance laid a few floors above me, surrounded by family nearing eternity. It had only been a short month since sickness had struck unexpectedly, without warning. This lady, young, when faced with the word that every human fears; cancer, kept a positive “I will beat this attitude”. Yet now just a few days later was clinging to life. Her family facing issues that no family are ever ready to process.

The entire event was so surreal. Could this really be happening? Strong individuals, reduced to sobs. Questions for a spouse, children, grandchildren and family. Life was changing for this family and there was nothing that could be done. There is nothing more helpless than having no control at a time like this.

Some at a crisis moment cling the ever more tightly to their faith. And in a real sense God becomes that needed comfort in a tumultuous storm. Yet some will blame God, become angry. And whether angry or not ask “Why God?” Why did this happen? And more often than not, the best anyone can offer to these questions are to just sit and listen. Not having “all” the answers is generally the best answer. To a grieving family, just to know someone cares and is near can mean the world.

Scripture teaches that life is but a vapor, it is fleeting.

What are we spending our life on? What are we giving our time to? Will it matter much when we are given tragic news? What legacy are we leaving, how will we leave this world a better place, will anyone know we were here, will anyone miss us? Perhaps there will be no more opportune time to take inventory of our life than during those times of grief that we all have, are or will experience.

senioradvocacy@yahoo.com
Tony Sexton

I STILL HAVE A VOICE

2010-03-17T19:39:00.001-05:00

I have a voice. I may not talk but do you take the time to listen? I lay here in bed unable to move. You come into my room pulling back the covers to turn and change me while you talk to the other aide or while talking on your cell phone. I am talking to you, but you are too busy to listen, yet I wait for you to hear me, I am screaming “I am still here, I am still alive”.

You have my radio tuned to music I have never and would never listen to, doesn’t anyone care? How can all these employees come into my room and just leave that nasty music on my radio? Don’t you see the sign above my bed that reads I like Gospel music? Why is my TV tuned to music videos, when the sign clearly reads movies only!

What would you think if it were your mom, your sister, or you in this bed and your wishes were totally disregarded? Oh sure there are a few that DO care. They ask questions, they talk to the Department heads, they raise their hands at in-services I am told. But they are just told not to stress over it, what’s the use, don’t start nothing.

But there is a use… Please DO start something; I DO still have a voice. PLEASE someone listen to me!!!!

Submitted to Midwest Senior Advocacy Blog by LTC Nurse

CNA from New York nursing home dies in Haiti earthquake - McKnight's Long Term Care News

2010-03-05T09:56:00.001-06:00

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Please click on link below, God bless this CNA

CNA from New York nursing home dies in Haiti earthquake - McKnight's Long Term Care News

When Grandpa doesn't remember my name.

2010-02-27T13:15:00.006-06:00

This is a story told many times over, each and every day around the world. The Alzheimer’s association estimates there are 5.3 million people living in the United States afflicted with the disease. Every 70 seconds someone develops the disease, think of those figures.

I believe it was our President, Ronald Reagan’s letter to the American public, disclosing he had been diagnosed with Alzheimer’s that brought much needed attention to this devastating illness.

Following is the text of former President Reagan's letter to America announcing that he has been diagnosed with Alzheimer's disease:

My Fellow Americans,

I have recently been told that I am one of the millions of Americans who will be afflicted with Alzheimer's disease. Upon learning this news, Nancy and I had to decide whether as private citizens we would keep this a private matter or whether we would make this news known in a public way.

In the past Nancy suffered from breast cancer and I had my cancer surgeries. We found through our open disclosures we were able to raise public awareness. We are happy that as a result many more people underwent testing. They were treated in early stages and able to return to normal, healthy lives.

So now, we feel it is important to share it with you. In opening our hearts, we hope this might promote greater awareness of this condition. Perhaps it will encourage a clearer understanding of the individuals and families who are affected by it.

At the moment I feel just fine. I intend to live the remainder of the years God gives me on this earth doing the things I have always done. I will continue to share life's journey with my beloved Nancy and my family. I plan to enjoy the great outdoors and stay in touch with my friends and supporters.

Unfortunately, as Alzheimer's disease progresses, the family often bears a heavy burden. I only wish there was some way I could spare Nancy from this painful experience. When the time comes I am confident that with your help she will face it with faith and courage.

In closing let me thank you, the American people, for giving me the great honor of allowing me to serve as your President. When the Lord calls me home, whenever that may be, I will leave with the greatest love for this country of ours and eternal optimism for its future.

I now begin the journey that will lead me into the sunset of my life. I know that for America there will always be a bright new dawn ahead.

Thank you, my friends. May God always bless you.

Sincerely,
Ronald Reagan

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senioradvocacy@yahoo.com

Tony Sexton

Great U.S. News & World Report Article

2010-02-23T00:22:00.007-06:00

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Worthwhile U.S News and World Report story highlighting quality care being provided in facilities implementing culture-change practices. Click on link below:

http://health.usnews.com/articles/health/best-nursing-homes/2010/01/14/these-nursing-homes-care-about-their-elderly-charges.html

senioradvocacy@yahoo.com
Tony Sexton

THE 4-QUESTION TEST

2010-02-21T21:28:00.003-06:00

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What does the Resident want?

How did the Resident do it at home?

How do I (the employee) do it at home?

How should WE do it here at our facility?

I know for those not involved in Long-Term Care, these questions will sort of be a no-brainer. "You mean this isn't the way it ALREADY is in the Nursing Home???

These four questions, more than anything it is hoped will simply be a "I never thought of it like that" moment in the hearts and minds of facility staff.

With these simple four questions, ANY employee can begin today on the path to changing the environment in which they work. There are no loser's, and there are only positive outcomes when these questions can be asked and honestly answered.

Don't wait another day to start asking and answering.

senioradvocacy@yahoo.com
Tony Sexton

LOVE WORKS

2010-02-20T16:43:00.006-06:00

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I recently began reading the book “The Love Dare” which corresponds to last year’s hit movie “Fireproof”.

While it primarily, if not fully is a book written to strengthen and save a marital relationship, its truths will also strengthen any relationship, personally or professionally. For our purposes of Changing the Culture in Nursing Homes, its truths if followed is I think the only genuine method of true change.

The first chapter, first paragraph reads as follows: “Love works. It is life’s most powerful motivator and has far greater depth and meaning than most people realize. It always does what is best for others and can empower us to face the greatest of problems. We are born with a lifelong thirst for love. Our hearts desperately need it like our lungs need oxygen. Love changes our motivation for living. Relationships become meaningful with it; no relationship is successful without it.”

The author goes on to say: “Love is built on two pillars that best define what it is. Those pillars are patience and kindness. All other characteristics of love are extensions of these two attributes.”

Much has been written on the topic of motivation. The number of Motivational speakers abound, most with good information that can inspire. Yet I think what this author has written surely is true. Love is life’s most powerful motivator.

While I agree the dining experience must change, the bathing experience is woefully lacking, and the environment indeed is far too often cold and institutional, none of these if changed will really make for a home if love is not the foundation. Employees, residents, families, the community recognize it. The word “love” may not be used necessarily, but people know “something is different” when the Nursing Home Employee has genuine love and compassion for those they are caring for. When there is an environment of patience and kindness, no matter how old the physical structure is, no matter if the meal is served on trays or plates, there will be real culture change.

Because indeed, Love works!!

senioradvocacy@yahoo.com
Tony Sexton

87 years and counting video

2010-02-12T10:08:00.001-06:00

87 Years and counting, wanted to share this touching video with our Senior Advocacy readers

KEY TO SUCCESS

2010-02-12T00:35:00.004-06:00

Believe while others are doubting

Plan while others are playing

Study while others are sleeping

Decide while others are delaying

Prepare while others are daydreaming

Begin while others are procrastinating

Work while others are wishing

Save while others are wasting

Listen while others are talking

Smile while others are frowning

Commend while others are criticizing

Persist while others are quitting.

--William A. Ward

senioradvocacy@yahoo.com

Tony Sexton

There are good things happening in America's Nursing Homes

2010-02-10T21:52:00.006-06:00

Wow, I read over previous blog entries today. And the temptation is to go back and do some radical editing. Sweeten things up a bit. Try and put a positive spin on an otherwise negative situation.

And with this entry I AM going to shine the light on some positive aspects in the Long-Term Care industry. But I am not going to go back and sugar-coat previous posts. Simply because what has been written is all too very accurate, albeit regrettably.

There are thankfully many very dedicated individuals working in Long-Term Care. There are many who clock in with the sole purpose of being a positive impact on some dear elderly person’s life. There are many wonderful volunteers who take great satisfaction in befriending a Nursing Home resident. There are vendors who will take a moment to plant good seed while in a facility. There are many community leaders who stand squarely behind local facilities, and are vocal in their support of their neighborhood facilities. There are still owners who have never lost sight of excellence in caring for those trusted to their care.

There are churches, whose members still practice the golden rule and see that local Nursing Home as a mission field that cannot be ignored. There are local schools, where teachers, parents and administrators recognize the importance of exposing children to the wisdom and experience of those residents living in America’s Nursing Homes.

There are employees who are starting to “get it”, whose eyes are being opened to the fact that business as usual will no longer work. There are those who are greatly embarrassed that it has taken this long to get it, but they are wasting no time in implementing new policies and procedures to care for America’s most vulnerable. They care not they are in the minority, they have peace that what they are doing is right. They feel a sense of calling to the profession now. They go home at night, yet they take their nursing home family with them in their thoughts and prayers. They may take their children in to visit in the evening or weekend. They volunteer to help at activities; they may stop at Qt in the morning to bring a donut to a resident. They may pick up a blouse, or a pair of pants while at a garage sale for one of their residents.

Yes, there are rays of light that often go unnoticed. There are positive things happening in America’s Nursing Homes.

Don’t miss the opportunity to plant some good seed, for you surely will harvest a good crop!!

senioradvocacy@yahoo.com
Tony Sexton

What part does the Nursing Home Volunteer play in Culture Change?

2010-02-10T02:17:00.005-06:00

Far more than most realize.

A thought occurred to me this evening as I contemplated this entry. In those facilities where you find few volunteers (non-employees) you seldom will find a real interest in providing a home-like atmosphere. Rather, far too often what you find is a “my way or the highway” facility. You will find little accountability, little follow-up and follow-through, and you will find a nursing staff fearful to speak up and expose problems because of a chain-of-command style of management.

You will find greater potential for resident abuse in a facility where you have few volunteers.

Beyond the obvious benefits to the Resident of companionship, additional activities ect… The volunteer is an extra set of eyes and ears. The volunteer is a method the community has of knowing what is really going on inside a facility. The volunteer in a very real sense becomes, or should become an advocate for the resident.

And let me offer a word of caution to the potential volunteer at such a facility. You will sadly face some resistance. And if you are the type that is easily offended, and gives up easy. Well, I hope you are serious at making a difference. In a facility that has few volunteers you will be viewed as a “bother”. And it will take real effort to make changes, but it can be done. It has to be done!

And this is not to say that you will not find some staff that will welcome and appreciate your efforts, because you will. You will find staff; you will find facilities that will see the relationship of volunteer and Nursing home as a needed partnership.

And in truth, a facility and staff that has any common sense will know that their volunteers can be their greatest marketing tool. If the facility has a quality product, you will not be able to stop your volunteers from marketing your facility. But also know the volunteer is going to also advertise a bad product as well.

The Nursing Home needs volunteers, the residents need a voice. And the public, the community needs to embrace the Nursing Home.

senioradvocacy@yahoo.com
Tony Sexton

Culture Change STARTS with ME, continued...

2010-02-07T21:33:00.007-06:00

What do we want out of life? This isn’t dress rehearsal for our upcoming life, this is it!!

We will spend more time with one person more than any other in our life; we will talk to one person more than any other; ourselves. What is our opinion of ourselves? How do we view ourselves? How do we like ourselves? How do we talk to ourselves?

Why bother with such prattle?

Because just “what if” our opinion of ourselves will determine the quality of our relationships with our fellow employees, with the Residents, with the Resident’s families, and with the community as we represent our facility?

Ever look at yourself in a crazy mirror, one that you might find at an amusement park or an arcade? When the vision of ourselves comes mainly from the opinions and perceptions of the people around us our view is about the same as the reflection in a crazy mirror.

We would not argue that our past conditioning has not greatly influenced us, yet we contend that our future is not and need not be determined by it. We do not believe we have no control over that early childhood, adolescence influence.

In describing the nature of man two different models or paths emerge. One path is labeled proactive, and the other path reactive. On the proactive road we do not blame circumstances, conditions or conditioning for our behavior. We recognize our behavior is a function of our decisions, and our conscience choices based on our values.

The second path called reactive empowers our childhood conditioning to control us; we become ruled by feelings whether founded on fact or fiction. On this path a person builds their emotional lives around the behavior of others. On this path a person empowers the weakness of other people to control them. On this path environment and circumstances rule supremely and are easily to blame for all “bad luck” a person experiences.

Just what “if” we could come to a place whereby we can admit that what we are today is a result of the choices and decisions made yesterday? The answer to that question is we could then start making new choices today. We could determine what our values really are. We could choose to surround ourselves with people who believe the best for us, people who will be our cheerleaders. We could then determine and choose to forgive the past. This in itself is an entirely separate body of work to be developed later, but to hold onto unforgiveness is to keep only ourselves in an emotional prison.

Yes, real Culture Change happens on the way to our facility, not once we get there. Because Culture Change is something that begins within us.

senioradvocacy@yahoo.com
Tony Sexton

Culture Change STARTS with ME

2010-02-05T12:08:00.005-06:00

Culture Change in the Long-Term care setting must first start with changes within the Long-Term care employee, and future employee.

What kind of changes?

It is my contention that our Nursing Family must be healthy physically, emotionally, and spiritually in order to provide exceptional care.

J. Paul Getty, philanthropist and founder of the Getty Oil Company said “The individual who wants to reach the top in business and life in general must appreciate the might and force of habit. He must be quick to break those habits that can break him-and hasten to adopt those practices that will become the habits that help him achieve the success he desires.”

But perhaps the most appropriate way to begin is by stating that FAILURE IS NOT FINAL!! Meaning, no matter what sort of pit we found ourselves in yesterday we need not stay in that pit!! Put another way, if we have been digging a hole for ourselves, if we find ourselves in the bottom of that hole, sound advice is to stop digging.

Author Brian Tracy often writes about what he terms “zero based thinking” a question asked everyday and can be applied to every business and personal activity. The question: “Is there anything in my life that, knowing what I now know, I would not start up again today, if I had to do it over?”

Zero based thinking requires that we look over all of our business and personal activities and be willing to discontinue or eliminate any activity that we would not start up again today if we had to do it over again with our current state of knowledge and experience.

senioradvocacy@yahoo.com
Tony Sexton

Choosing a Nursing Home

2009-12-17T10:54:00.008-06:00

This little fact is really disgusting, but it has been my experience individuals put more effort into picking out a vacuum sweeper than in choosing a Nursing Home for their loved one.

WHAT???

Yes, not once did I ever have a family ask if they could just sit and observe. Oh sure they wanted to see “the room”, see the “shower room”, perhaps glance at the activities calendar, but to just sit and watch, just sit and observe, just sit and get a feel of the facility. Nope.

Average time spent in facility by family pre-admission maybe thirty minutes. Average time their loved one will be stuck in that facility, rest of their life.

Is it just me, or is something terribly wrong with this picture?

To be fair, there are rare occasions that a decision must be made on short notice for placement. But even in these rare instances, that decision need not and should not be final.

Oh sure, kids, grandkids are more computer savvy and go online to search for information. More good questions are being asked. But nothing takes the place of observation, watching.

What is it like after 5p.m? What is it like after 5p.m Friday until 9a.m Monday morning? For some unexplained reason, 9-5, Monday-Friday is the most important time period, in a Nursing Home. The Administrator, the Director of Nursing the Social Services Director and for that matter all the Department Heads need to make their presence known in the evening and weekends.

Ask the Administrator what is so extraordinary about 9-5 Monday through Friday. Please email me the response you get. You might find some few exceptions, but they will be very few, (and if you do find one of these exceptions, chances are good it may be a facility safe to place your loved one in.) Usually the answer will be something along the lines of “we can’t be here 24/7”. You might think about responding with “too bad my loved one has to be”. And I am very aware there is a multitude of work to be done by all department heads, but this 9-5 thing is a problem and it largely is NOT being addressed.

Too confrontational? Afraid to cause waves? Afraid of what they will think should you ask such questions?

That’s interesting… I have observed these same people throw a fit if Burger King puts a pickle on their burger when they ordered it without. Afraid to “step on toes” concerning grandma’s care, but will demand to see the manager and nearly call for the firing of that 17 year old should the sandwich not be prepared correctly.

senioradvocacy@yahoo.com
Tony Sexton

A day in the life of a Resident

2009-12-16T17:40:00.006-06:00

I mentioned to a nurse some time ago, if every Nursing Home employee were required for one day to wear a brief (what, you may call a diaper) there would be a far better understanding what a resident’s life is all about. And it’s not pleasant.

Imagine for a moment, those things that come natural to you and I now presents itself as a request for the resident. Grabbing for the remote to change the channel comes natural, yet what of the resident who must either press a call light or yell for help? And how far in advance must the call for help begin in order to catch a favorite show? Grabbing for that can of pop for a drink we don’t think twice about, yet what of the resident who can no longer just grab for a pop but must wait for help? We don’t think twice about wiping breakfast from our face and brushing our teethe before leaving the house, yet what of the resident who must wait, must hope, must ask for this? I could go on, but these are not just idle words to embellish a point, this IS the life of an individual in a nursing home.

And this does not take into account the emotional and psychological turmoil one experiences being separated from a home, personal effects, pets, neighbors, and an automobile. An entire lifetime collection of “things” gone, maybe divided among family members, yet for that resident gone. An entire lifetime now reduced to perhaps a 4x8 area, the size of a piece of plywood. A nightstand, a bedside table, a dresser, and if lucky one chair.

Yes, this is depressing. It wears on ones soul, just to consider its truth. This is why I beat the drum called CHANGE! This is why I call for the observation of what is going on in our facilities, and why. Why are we doing it this way, can we do it better or perhaps we don’t need to do some things at all. Questions, he who asks the questions has the control and can facilitate change. We need more employees to start asking questions.

senioradvocacy@yahoo.com
Tony Sexton

McDonald's "the owner is here." part 2

2009-12-15T14:18:00.006-06:00

“The owner is here”, and that same McDonald’s employee who only a few days earlier would not have thought twice about wasting time on the clock was now very aware that the owner at any time could and would pop up any time, any place.

I can hear it now, the slackers saying they would not work in an environment where they have to walk on eggshells. Yet those employees who truly take ownership and pride in their exceptional work never feel this way. Sure I would rather that slacker work from a position of pride and a strong work ethic, self motivated. But if not, there better be a healthy dose of fear that at any moment “the owner” is around the corner and watching! And so when the self-motivation runs thin, the fear had better kick in. The customer is counting on it.

In truth, policing ourselves and holding ourselves accountable is the point. Long Term Care is highly regulated and is accountable to the State and the Federal Government. Far better to identify and correct the deficiency in-house before it reaches that level. But this can be accomplished only when “the owners” are in, are working as a team, and when the customer is the focus!

senioradvocacy@yahoo.com
Tony Sexton

McDonald's, "the owner is here" part 1

2009-11-17T11:51:00.006-06:00

“You can’t run the nursing home like McDonald’s” that unfortunate comment allegedly came from a Department Head, and if true, a sadly misinformed one.

And so with this entry let me build the case why the Nursing Home BETTER be ran like a successful McDonald’s. Incidentally, I spent most of my young adult life managing, working alongside the owner of a McDonald’s and am well acquainted with what does and does not work.

First and foremost, when you find a successfully ran McDonald’s the foundation of that success will be the understanding that there is nothing more important than the customer walking through the door. Wow, consider that statement for just a moment. NOTHING is more important than the customer. (and theory has it, if you will take great care of your employee, they in turn will take great care of the customer.) It is hard to imagine someone not agreeing with that statement, yet in practice that foundational principal somehow far too often gets lost.

But allow me to lay the groundwork; I remember well my first re-visit to the McDonald’s I had spent so many hundreds of hours working at as a teen, now under new ownership. I was home from college for the weekend and on that Friday night as was my custom I would drive up to see and chat with so many of my friends. This visit would stand in such stark contrast to previous visits. Whereby in times past, employees would not think twice about standing outside wasting time on the clock, this night was far different. I noticed a nervous concern, it was said, “the owner is here”.

The owner is here, what a marked difference that will make in any profession, at any business, in any setting. And I do not necessarily speak of the CEO/owner but I speak primarily of those employees who are taking ownership in their Nursing Facility. I can tell you the greatest compliment that can be given are for Resident family members, and community members who are under the impression the care giver has ownership in the Nursing Home they are employed at. But it will come at a price. It will come with persecution.

senioradvocacy@yahoo.com
Tony Sexton

The worth of every employee

2009-11-17T00:26:00.003-06:00

Every person, every employee no matter the profession has strengths, redeeming qualities that can be built upon, must be built upon.

Sure, I would prefer every individual who enters the Long-Term-Care field to do so with a sense of “calling”. Yet this is not realistic, rather why not allow one another to grow into that calling? And I mean by that creating and fostering an environment whereby employees feel appreciated, needed, and wanted. An environment where we have each other’s back, not covering up mistakes but by picking up the slack for one another. I remember well my restaurant days as a teen. The manager spent the last quarter of all shifts attempting to “turn over” to the next crew a clean, stocked and staffed shift. What could we be doing at 2 pm so the next crew at 4 pm could hit the ground running was the goal. I have not necessarily seen this proactive type attitude in the Long-Term-Care setting. In other words, a real sense of team spirit. And as a team working together for one purpose, and that is for the best care of the resident.

Sure there are times when the employer/employee relationship must be severed. Author Brian Tracy says of employers, be slow to hire and quick to fire. There is I think some truth in that, yet we all have been given chances when most likely we didn’t deserve it. Even many undeserved chances. I am reminded of a scripture that says love covers a multitude of sins. There is a delicate balance that must be struck, I understand. Rather than lowering the standard, why not lift our team up to the standard?

At the end of the day, how much of our lives will we invest in others? I believe what motivational speaker Zig Ziglar has so famously said, you can get everything you want in life if you will help enough people get what they want.

senioradvocacy@yahoo.com
Tony Sexton

Change

2009-11-08T21:31:00.003-06:00

Change you can believe in. We perhaps in America heard this ad nausea this past Presidential election cycle. But as it concerns the very future of Long Term Care, and aging in this world, there will be change. There must be. Our seniors, and anyone for that matter we care for deserve it!

We speak of creating a more home-like atmosphere, and anyone even loosely associated with Long Term Care has used similar language. Yet, whose home are we to model after? What if the very employee you want to buy into change comes from a home where all they have known is turmoil, all they have known is disrespect and dysfunction?

The idea that the Long Term Care Resident is the customer, and the employee is the guest in their home is nearly and sadly a foreign idea.

The conduct at times of employees in a Long Term Care setting has been alarming. In that, we would never dream of going into someone’s home, into their living room and acting a fool. Acting a fool in our language, our conversation, acting a fool in our tone, in our volume.

And then when the Resident “acts out” in this environment, we label it as behaviors and the Psychiatrist is called and new meds are ordered.

And should an employee start asking such questions, they will be accused of not being part of the “team”, a troublemaker, causing waves. Well it’s my contention there needs to be someone(s) that will lift their voice, as one in the wilderness and proclaim that all is not well. Someone(s) that will with a proper attitude not be afraid to cause waves when and if it will better serve the Resident, the customer.

All of this is predicated on taking care of the direct-care-giver. There is no more important role in a Nursing Home than the CNA. How are we taking care of that CNA, are they a part of the decision making process? Is their voice encouraged? Are their opinions important? Who is listening to them?

Hard to imagine there would be any other employee in a facility that works harder in an eight-hour shift than the CNA.

Someone better wake up. It’s truly change that we need, change that our customer can count on.

The CNA, this will be the next entry. Don’t miss it.
Tony Sexton

The Resident as the Customer

2009-11-06T20:38:00.002-06:00

“Where are your people and what are they doing. Are they doing what you want them to do, or are they doing what they want to do” ? Fare warning… start-asking questions like this and you don’t have a “license” on the wall, watch out!!! And perhaps even worse, God forbid you ask such a question and not be a part of nursing. To do so will ultimately mean the only friends you will have are the customers, those paying your salary. And thank God, those who share your vision for not doing care as usual. Incidentally, that is the only “click” you need to concern yourself with, the customer. And the customer is that resident in the Long Term Care Facility.

And so this blog begins.

Long Term Care, is in big trouble. Don’t fool yourself into believing otherwise. I have said on numerous occasions I would rather thrust myself headlong from the Paseo bridge into the mighty MO below rather than spend even one hour as a resident in a nursing home. How’s that for a little honesty. Away with your stupid bingo, your off-key $25 entertainers, and your inappropriate talking out in the hall about whom was with who last night!! Not interested in your product. And increasingly neither is the public. How could I make such a comment, am I not shooting myself in the foot? No, I am preparing for the future in Long Term Care. And only the fittest will survive in the industry. My generation, called generation x and the baby boomers simply are not going to settle for the current product being offered. And so I make no apologies for my assertions.

February 1987, Maranatha Village Springfield, Missouri. My first real foray into Long-Term Care. And that after as a toddler God placing a call on my very life to Long-Term Care as I would tell my grandmother that when I was old, I would have a big house (nursing home) and take care of her. Twenty-two years associated with Long Term Care, thought for the most part it was fine. Oh sure it would bother me slightly to observe Department Heads behind closed doors so often. Rarely to see Dept Heads interacting with Residents. Yes the endless lunches in the “conference” rooms between the Department Heads. I would sometimes wonder what is so extraordinary about 9 am to 5 pm, I guess after five and weekends the facility is closed? And mostly I would wonder “why are the dept heads so important”, what about the Nursing Staff, they are the ones with direct customer contact constantly.

Yes, all this over the span of twenty-two years had me scratching my head a bit.

Look forward to our next entry,
Tony Sexton