Marilyn Oelkfke had been the Director of Nursing at Perham Memorial Home (PMH) for a long time. The facility was well respected and had stellar surveys. Marilyn and her staff were justifiably proud of the quality of care they provided to residents. That is, until her mother moved into the facility. Then Marilyn realized that her mother’s life-long routines could not be maintained in their system of care. No longer was she able to have a shower at night or was she able to sleep in in the morning. The change in routine was hard on her mother, and she began to have “resistive behaviors.” However, Marilyn felt she couldn’t expect the staff to extend special treatment or accommodations for her mother. After her mother’s death, Marilyn began asking her staff if they would want to live at Perham Memorial Home and the resounding answer was no. No longer satisfied with the way they had been doing things, the staff began a journey, now 10 years old, to change the way they thought about and provided care and support to residents.
On May 26, Marilyn Oelkfke shared the story of PMH with a MOVE audience in Woodburn. She offered many practical and concrete suggestions for others on the journey. Some of the key points included:

• Involve everyone – residents, staff, family, community, board, and management
• Develop teams, seek high involvement of EVERYONE
• Relationships are key
• Always ask “why?” – balance quality of care and quality of life
• Move to a household model of care that emphasizes in real and meaningful ways resident-directed living, self-led teams, shared leadership, cross trained staff with permanent assignments, in the setting of “home.”
• Cross train staff so that all can meet resident needs as they arise.
• Home means eating what you want, when you want; getting up and going to bed based on a resident’s schedule, promoting sleep, primary staff assignments to a household, bathing upon requests, multiple opportunities for life (both planned and spontaneous activities), and incorporating resident choice in everything we do.
Although PMH’s culture change involved significant remodeling, Marilyn stressed that implementation of culture change preceded any change in the physical environment. Changing the ways staff think about providing care, truly becoming resident centered, and making deep practice changes are critical – it is not possible to make culture change only by changing the physical layout of the facility.
Outcomes and lessons learned from the PMH experience include:
• Although there are initial costs (e.g., time for training and planning), this new model of care does not have to cost more
• Having choice and closer relationships with caregivers results in reduction of resistive behaviors, and fewer psychotropic and anti anxiety medications are needed
• Eating foods they like results in healthy weight gain, reduction in nutritional supplements, and less food waste
• Well rested residents(who get up when they are ready) require less assistance with eating, reduced risk of choking, and fewer mechanically altered diets.
• Lights are answered more quickly with everyone trained to help; one benefit is reduced urinary incontinence.
• Residents have more opportunities to give to others, giving purpose and meaning to life.

Those attending the workshop were inspired by the talk. The following comments reflect the experience of many:

Very practical, down-to-earth presentation makes all seem possible. Wonderful speaker – very engaging and positive. A very worthwhile day!

Great speaker – knows her stuff.

I really enjoyed this seminar because it opened my eyes to what we could be doing to improve quality of life for our residents as well as being the solution to staff burnout.

Thank you for sharing your journey with us! What an inspiration! Can’t wait to get started on making our own changes and taking those first steps.

This was a great program. The Learning Circle approach got people talking, collaborating and connecting. Excellent interactive day!

M.O.V.E. members were energized at the recent quarterly meeting, Honoring Personhood: The Art of Enhancing Well-being in Elders, led by Megan Hannan of Action Pact, www.culturechangenow.com. The excitement was palpable and continued to grow throughout the day as participants learned from Megan and each other, identifying new ways to honor personhood in their organizations.

Time constraints often hinder our ability to honor personhood. For example, care plans need to be developed within days or hours at a time residents when may be coping with difficult life changing transitions. Information gathered at this time is often inaccurate or incomplete and may not even be used by staff. Megan encouraged the group to think about “befriending” residents, building a relationship based on equality, rather than “bestowing,” where the relationship is mostly one way and residents have little opportunity to reciprocate. Some ways to help develop relationships and improve our knowledge about personhood that emerged from discussion included:

• Recognize it takes time to get to know people and create opportunities to foster relationships. For example, wonderful things can happen when staff share meals with residents, engaging them in normal day-to-day conversations about family, food, pets, work, and other life experiences.
• Engage residents in creating a “welcome wagon” to greet new residents and help them feel welcomed.
• Match a resident and a staff person who has some assigned activities, including working with the resident to develop a portfolio of important aspects of their lives. This could be turned into a story board and posted outside of their door.
• Develop an organizational project to reach a common community goal. An example was one facility that participates in the American Heart Association Walk (Roll & Stroll). Last year they walked around the world twice, this year they are aiming for the moon.

We also explored concepts of organizational climate and recognized that organizational structures need to move from a climate where negative interactions predominate to one based on positive relationships and experiences. We explored the concept of homelessness and how so many residents feel homeless, even with a safe place to sleep and eat. We discussed understanding the concept of “home” for residents and considered ways to help them obtain privacy, connectedness, power and autonomy, and other experiences of home.

This program was sponsored in part by Marquis Company. Mary Amick of The Vital Life Foundation presented the inspiring program, New Chapters, an initiative that has helped hundreds of residents achieve their wishes, including flying a plane, visiting San Francisco, riding in a hot air balloon, and attending Blazer games and meeting players. More information about some of the recipients can be found at www.vitallifefoundation.org

This was a great program. The Learning Circle approach got people talking, collaborating and connecting. Excellent interactive day!

M.O.V.E. members were energized at the recent quarterly meeting, Honoring Personhood: The Art of Enhancing Well-being in Elders, led by Megan Hannan of Action Pact, www.culturechangenow.com. The excitement was palpable and continued to grow throughout the day as participants learned from Megan and each other, identifying new ways to honor personhood in their organizations.

Time constraints often hinder our ability to honor personhood. For example, care plans need to be developed within days or hours at a time residents when may be coping with difficult life changing transitions. Information gathered at this time is often inaccurate or incomplete and may not even be used by staff. Megan encouraged the group to think about “befriending” residents, building a relationship based on equality, rather than “bestowing,” where the relationship is mostly one way and residents have little opportunity to reciprocate. Some ways to help develop relationships and improve our knowledge about personhood that emerged from discussion included:

• Recognize it takes time to get to know people and create opportunities to foster relationships. For example, wonderful things can happen when staff share meals with residents, engaging them in normal day-to-day conversations about family, food, pets, work, and other life experiences.
• Engage residents in creating a “welcome wagon” to greet new residents and help them feel welcomed.
• Match a resident and a staff person who has some assigned activities, including working with the resident to develop a portfolio of important aspects of their lives. This could be turned into a story board and posted outside of their door.
• Develop an organizational project to reach a common community goal. An example was one facility that participates in the American Heart Association Walk (Roll & Stroll). Last year they walked around the world twice, this year they are aiming for the moon.

We also explored concepts of organizational climate and recognized that organizational structures need to move from a climate where negative interactions predominate to one based on positive relationships and experiences. We explored the concept of homelessness and how so many residents feel homeless, even with a safe place to sleep and eat. We discussed understanding the concept of “home” for residents and considered ways to help them obtain privacy, connectedness, power and autonomy, and other experiences of home.

This program was sponsored in part by Marquis Company. Mary Amick of The Vital Life Foundation presented the inspiring program, New Chapters, an initiative that has helped hundreds of residents achieve their wishes, including flying a plane, visiting San Francisco, riding in a hot air balloon, and attending Blazer games and meeting players. More information about some of the recipients can be found at www.vitallifefoundation.org.

Each of us deserves the opportunity for a good life every day that offers meaning and support of who we are. How can we – nursing home, assisted living and residential care providers – help those we partner with continue to be who they are? How do we create environments where people thrive, no matter what frailness they live with?

Study with an experienced facilitator to grow new eyes in seeing, new thoughts in understanding what we must know, how we must interact, and ways of behaving that reinforce each individual’s sense of self. This session will grow your abilities to work in team to truly make a difference for the elders you serve every day.

Our Facilitator

Megan Hannan of Columbia, MO is a nationally recognized trainer and consultant for Action Pact. As the designer and founder of Person First, a unique and dramatic process that has changed the way organizations honor and relate to elders and staff, she has become the expert in growing a loving community of staff, families and residents.

Outreach Scholarships

M.O.V.E. is awarding up to two $500 scholarships to long-term care provider organizations as an outreach to those who work in regions where travel to our quarterly training is challenging. Call 503.684.3788 for more information or a scholarship form. Deadline: March 19

7 CEUs

Download the Scholarship Form

The Pioneer Network, a national leader in transforming aging, has received a grant from the Picker Institute to develop a consumer education program about culture change. Titled “Creating Home: An Initiative to Educate Consumers about Long-term Care and the Need for Change,” the project has three goals:

• To learn the best ways to inform and educate consumers
• To inform consumers of the differences between traditionally-run “facilities” and transformed, person- directed settings
• To get consumers involved in the culture change movement.

As providers of aging services, you will want to be prepared before these newly-informed consumers knock on your door! This instructive program holds great promise for educating your staff, residents and families about your own culture change efforts as well as for marketing your organization’s person-directed services.

Participants in this workshop will actively experience the newly-developed consumer education program, led by Oregon’s own culture change pioneer, Joanne Rader. Rader serves on the Pioneer Network national board and is Project Coordinator of the consumer education project.

You’ll have a first-hand opportunity to see what the Pioneer Network initiative will be advising consumers about their long-term care choices, and you’ll be able to assess how you can use these same materials in your educational and marketing programs.

Who should attend:

• Marketing staff, admissions staff, and any other staff who market your program or educate consumers about their long-term care choices
• Administrators, nurses, direct care workers, dining
  staff, social services staff and others who communicate with residents and families about your organization’s culture change efforts
• Educated consumers have the power to effectively demand changes in where and how we age. Be prepared before this tidal wave hits – join us January 27!

3 Ethics CEUs!

That question is an essential one for all aging services providers who seek to change the culture of their organizations from one that is institutional to one that is person-centered and person-directed.

The culture change movement in Oregon is gaining steam as nursing homes, assisted living and residential care facilities, and other aging services providers seek to create environments where elders experience joy, meaning and purpose in their daily lives.

Whether your organization is just beginning its culture change journey or is well on its way, we invite you and your staff to join with other culture change champions from across Oregon to examine that essential question: Where do you fall in the culture change continuum, and what steps do you need to take to make progress in your journey?

Participants in this program will view and discuss the DVD “Tales of Transformation: Four Stages Tell the Story,” a culture change training video that describes the stages of culture change transformation and offers images and stories to help organizations move from an institutional environment to one that offers all that home provides. You’ll examine how culture change impacts decision-making, staff roles, physical environment, organizational design and leadership, and identify areas in your organization where further work can be done.

That question is an essential one for all aging services providers who seek to change the culture of their organizations from one that is institutional to one that is person-centered and person-directed.

The culture change movement in Oregon is gaining steam as nursing homes, assisted living and residential care facilities, and other aging services providers seek to create environments where elders experience joy, meaning and purpose in their daily lives.

Whether your organization is just beginning its culture change journey or is well on its way, we invite you and your staff to join with other culture change champions from across Oregon to examine that essential question: Where do you fall in the culture change continuum, and what steps do you need to take to make progress in your journey?

Participants in this program will view and discuss the DVD “Tales of Transformation: Four Stages Tell the Story,” a culture change training video that describes the stages of culture change transformation and offers images and stories to help organizations move from an institutional environment to one that offers all that home provides. You’ll examine how culture change impacts decision-making, staff roles, physical environment, organizational design and leadership, and identify areas in your organization where further work can be done.

Sometimes aging services providers become so accustomed to traditional care practices, they don’t notice how “unhomelike” they are. Focusing on activities critically important to residents’ quality of life, this interactive session will discuss three common care practices:

• Providing care at night
• Helping people to the bathroom
• Giving medications

Participants will have the opportunity to explore their current practices with others and discuss what practical actions they could take to make them more resident- friendly.

Goal: To help providers see their care practices from the resident’s perspective and discover practical and creative ways to make changes.

Our program will be facilitated by Oregon’s own Joanne Rader, RN, MN, FAAN, a founding member and board member of the Pioneer Network, an organization working to change the culture of aging in America. Joanne is an independent consultant who has worked in the field of long-term care for more than 30 years. She frequently speaks and consults across the country on culture change in long-term care.

Don’t miss this opportunity to inspire and motivate all levels of your staff to take a look at your organization’s care practices with new eyes as you continue your culture change journey!

4 Ethics CEUs!

Efforts to individualize care and services within the long-term care field have evolved over many decades. Through this evolution, people working well together in shared leadership has been key to effective and sustainable change. This highly interactive session will offer a way to examine each person’s own practices and their own impact, and how to use shared leadership practices to achieve active engagement from everyone in transforming from institutional to individualized care.

This session will explore ways of increasing active participation through skills and systems that make sure people have the information they need in time to act on it, and the systems in place to support them in doing so.

About Our Presenters/Facilitators

MOVE is excited that Barbara Frank and Cathie Brady of B &F Consulting, based in Connecticut and Rhode Island, are joining us in Oregon to help us with our culture change journey! Frank and Brady are known across the country for their hands-on work consulting with long-term care organizations on the challenges of culture change. Nursing home providers may recognize them as key presenters and producers of the national CMS four-part webcast series on culture change, which was required viewing for nursing facility surveyors around the country. Don’t miss this opportunity to explore strategies for making our long-term care communities better places to live and work!

You’ll meet Lori Silverman from Portland State University’s Professional Development Center, who will present practical information on how adults learn and change, and how you can apply this information to the culture change process. You’ll have the opportunity to examine examples of books, DVDs and other tools to help educate your staff, residents and families about culture change, and to help guide you in the journey toward a transformed organizational culture. Learn how you can access culture change-related books, videos and more from the Oregon Geriatric Education Center, and meet with your neighbors who use this valuable resource. You’ll also get a sneak peek at AARP’s campaign, “Strengthening Oregon’s Long-term Care System – Independence, Choice and Dignity.”

Be one of the first to log on to M.O.V.E.’s new website and become familiar with this resource! Find out how you can get up to date information about conferences and events, news about the culture change movement, and resources and tools to support your goals. And you won’t want to miss your chance to enter our drawings for some exciting door prizes!

M.O.V.E. gratefully acknowledges the support of our sponsor for this event: AARP Oregon