Always Coming of Age

After a long absence from my beloved blog -- I’m back!  Still eager to talk about what life is and can be in our later years, about healthy aging, about expectations of aging --- about how those of us who serve elders can translate our knowledge and positive beliefs about age and aging into environments and organizational operations that reflect these beliefs to the benefits of those we serve.

Have you seen news about Sally Fields’ new movie, “Hello, My Name is Doris”? Sally plays a 60-something who returns to the workplace after the death of her mother and becomes infatuated with a new guy in the office who is in his 30s. 

Fields, who is just a few months shy of her 70^th birthday, was interviewed in the weekly “GO!” magazine published by the St. Louis Post-Dispatch. In the interview Fields describes this new film as “a coming-of-age story about a person of age.”  Then she goes on to say – and this is what I love, and believe --: "Our challenge in life, as human beings, is that we are always coming of age. It's always about transitioning into the next stage. And are you willing to make that change? Are you brave enough to step out of what feels comfortable?

Change – another word for transition -- is the most ever-present aspect of life!  Growth and development is what happens through the process of change.  These changes are transitions.  We are always, in every stage of our life, in transition!!

Some transitions are more noticeable than others:

            Becoming married;

            Becoming pregnant;

            Becoming a graduate student.

            Becoming a mother-in-law;

            Becoming gray-haired;

            Becoming a resident in a different place, a new address

            Becoming an elected official;

            Leaving elected leadership after one’s term is complete.

Note that some of these examples reflect physical changes; some imply profound emotional changes; all reflect relationship changes. It affirms the profound and sacred reality that relationships are at the heart of life.

Transitions take place throughout life.  They are not stages of life that just happen we “retire” or “leave active ministry”. To be in transition is not a sign that one is in later life; it is a sign of change – of the potential for growth and development. Are we willing to be our true, beautiful and more whole selves in our later years or do we too easily succumb to what society tells us “old people” are?

We have potential for growth and development up to and including our last breath.  Think about that long and hard and contrast it with what everything and everybody in our broader society and in the media tells us! May we keep coming of age!  May we keep transitioning in positive, wise, beautiful ways - the way of growth, the way of aging! May we provide that prophetic witness of a merciful God Who loves us with abandon, Who shaped these stages of our life, Who  can create only good!

When I Grow Up I Want to Be an Old Woman -- revisited

© Imelda Maurer, cdp February 19, 2009

I’m sitting here this evening in front of the TV answering some e-mail. I just saw the Kaiser Permanente Health Management ad – once again.  It's a delightful one-minute commercial.  Click on the link above to see this now before you even think about reading the rest of this post.

The words are sung: “When I grow up I want to be an old woman , an old, old woman.” I like that image in itself. I mean, after all, when do we ever hear anyone saying or even intimating that they want to ‘be an old woman.”

The accompanying visuals show old women – heavier than they were thirty years earlier -- but vital, happy, purposeful – looking in the mirror, keeping time to some music, laughing with friends, playing tennis, enjoying life –

It’s such a refreshing image. “I want to be an old woman.” The alternative is an early death. How often I think of my sister, three years my elder, who died at age 49, that she did not get to grow old along with me so that we could each grow, together, to be “an old woman, an old, old woman”

Kaiser has another ad in which the audio is short and simple: Kaiser: Thrive!

“Thrive” is a medical, nursing term. An inexplicable nursing condition is “failure to thrive” which can lead to death. But we all know that term, thrive, as holding so much more. What images does it bring to your mind’s eye? One thrives in a nurturing environment, in an environment which honors our uniqueness, our abilities, our life story. Above all, one thrives in the circle of loving relationships.

Kaiser has done a great favor in showing these ads because they shed a little light on the adventure and the sacredness of the latter years of one’s life.

A Lovely Piece of Mail!

© Imelda Maurer, cdp October 14, 2015
    ilmcdp@yahoo.com

Yesterday’s mail included a card from Sister Antona, a Sister I know whose Congregational mother house and administrative offices are here in the St. Louis area. Its message was “Come visit me at my new home!"  This elder Sister, whom I have visited before when she was living in an apartment complex, has now moved to a retirement center where she is receiving the supportive services she needs.

I love that this Congregation has shared this “new address” information with Sister Antona’s friends. That action reflects the recognition of the primacy of relationships at every stage of life.  It says in its own way, ‘hey, I’ve moved.  I have a new address.  But what was important to me in the past –keeping in touch with friends, maintaining relationships – is still important, so I want to continue to stay in touch!’

The letter also indirectly says that life is more than ‘good care.’  That phrase is often the stock response of a person evaluating a nursing home where a friend or family member lives:  “They get good care there.”  I wrote about that in an earlier post on this blog.

The card also reminded me of the goal of true, transformational culture change in communities that provide aging services:  We want the biggest change that an elder experiences when s/he moves to an aging services community to be just that:  a change of address. We want to still be at home ---- home which is a place where privacy, respect, security, choice, continuing one’s chosen daily routines, autonomy spontaneity and grace are part of every day. I hope that’s true for you, Sister Antona!  I’ll be over to visit very soon!

Falls among Older Adults

When an older adult (65 years and better) falls, it can be a major and traumatic health event, often leading to death within a year.  There are many Fall Prevention Programs for older adults living in the community (as opposed to an assisted living or nursing home setting).

The National Council on Aging offers information about various programs as well as handouts, videos and tips about fall prevention at their website . 

Senior Centers often offer such courses at a minimal fee. I found a “Matter of Balance” program (8 classes) in St. Louis for only $3.25 for the entire program.

Interestingly, a major risk for falling among older adults is the very fear of falling. This fear translates into physical changes in one’s patterns of moving about.  Classes that enhance balance, strength and more physical exercise provide a physical and psychological base confidence, reducing fear of falling.

Michele Obama has popularized the phrase “Let’s keep moving”.  It’s good advice throughout the entire lifespan!

A Revolution of Mercy

© Imelda Maurer, cdp September 22, 2015
    ilmcdp@yahoo.com

The following are words of Pope Francis to the people of Cuba, calling them (and all of us) to a revolution of mercy!

"Our revolution comes about through tenderness, through the joy which always becomes closeness and compassion, and leads us to get involved in and to serve the life of others."

If this culture of Mercy became the dominant culture in nursing homes and any other community, licensed or not, where supportive services are offered to older adults, what a revolution we would see!

Imagine –if mercy, tenderness and compassion carried the day –

What care planning meetings would look like!

What dining services would become!

What the daily ‘schedule’ would become! 

What the morale of staff would be!

What leadership, growth and development would burst forth among the staff!

What positive outcomes residents would experience physically, emotionally and psychosocially.

Hmmm---  That last phrase, for those readers who work in licensed homes, will be recognized as coming directly from Federal regulations: 

Sec. 483.25          Quality of care.

“Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being”

That same mandate is noted four more times under the responsibilities of these disciplinary areas/departments:

                Medically-related Social Services

                Resident Assessment

                Nursing Services

                Administration

The terms ‘accommodate’ and ‘accommodation’ are also used about five times in the federal regulations, always in the context of resident needs, preferences and choice.

I continue to find it awesome and profoundly true, that there is a close parallel between Faith values (and Sisters’ Congregational documents, mission and values) and the spirit and letter of the “Minimum Standards of Care”, the Federal Regulations. If any reader can cite an example of when the regulations do not allow mercy, tenderness or compassion, please share that information .

Imagine if we had a Revolution of Mercy in nursing homes across our country!

Some Smart Persons Who Agree with Me!

© Imelda Maurer, cdp September 8, 2015
ilmcdp@yahoo.com

There has been much written over the last several years about the promising role of technology in improving the quality of life in our later years.

The mad dash began some ten years ago or less with software companies touting brain health and brain fitness for elders through the use of their computer games.  I never really believed in the effectiveness of this approach, though I did observe elders in a retirement center some years back eagerly going through the progression of computer-based exercises and clearly feeling a sense of accomplishment.

Now we know the following:  A Special Health Report from Harvard Medical School Special Report concludes that “people who play these games might get better at the tasks they practice while playing, but the games don’t seem to improve users’ overall brain skills, such as attention, memory, use of language, and ability to navigate.”

What is a more effective way to maintain brain fitness? Gene Cohen in his book “The Mature Mind” points to research from the National Institute on Aging showing that the following are the most successful ways to maintain normal memory and overall brain fitness:  engaging in new activities and hobbies, reading, maintaining social relationships, and engaging in healthy physical exercise – that 30-minute walk several times a week.

A second way in which technology is presented is in the context of improving care for older adults.  There are so many types of monitors on the market, for example, that promise this ‘better life.’ After critiquing a few popular high-tech approaches to elder health care, Dr. Ken Covinsky, UCSF School of Medicine says this in today’s post at geripal.org: “My advice to entrepreneurs and venture capitalists:  Think high touch before high tech.  What kinds of innovations will actually improve the quality of life of older people and make them feel better and promote social engagement?  Think about this question before even thinking about technology.  Then and only then, think about how your technology can promote high touch.  Technology that promotes high touch is where the real innovation may lie-and your chance to prove us skeptics wrong."

High touch over high tech any day!

Singing the music that is in the Heart of God

© Imelda Maurer, cdp August 19, 2015
ilmcdp@yahoo.com

The Pioneer Network, on its Facebook Page, posted an article this morning from McKnight’s online publication. The article is entitled “Spirituality in long-term care” by Eleanor Feldman Barbera, Ph.D. Pioneer Network asked if there were any comments. Oh, yes, I have a comment!

 

Dr. El, as this PhD. psychologist refers to herself, gleaned from Kushner’s book, “When Bad Things Happen to Good People” the message that the question of the negative events of our life should be not “Why me?” but “Why not me?”  Dr. El uses this insight to “help people come to terms with their experiences.” “Come to terms” ----hmmm --- Does that mean I should accept my situation without any positive expectations? I’ve seen this attitude of ‘coming to terms’ addressed by priests and other ministers who advise elders in nursing homes to practice patience when they have to wait endlessly for their call bell to be answered, for example, or when the food arrives cold and unpalatable.

"Come to terms" in this context, then, is the "offer it up" message those of us in the Catholic tradition used to hear so often years ago:  Just “offer it up.”

 

Another “spiritual aspect of long-term care” according to Dr. El is “the need to cope with the rules and regulations of an institutional environment.” The task, she says, is to “stay serene in the face of these challenges.”  Another example of ‘just offer it up.’  The prior question, however, must be asked: WHY are elders forced to live in an institutional environment rather than HOME in the nursing home?

 

Many years ago, I gained an insight about this “offer it up” message. I heard a zealous Jesuit priest in New Orleans say that as religious with a vow of Poverty, we should live like poor people.  That included, he said, using the services of Charity Hospital when medical services are required, just like poor people, who are forced to do by necessity. I took the words seriously and when a minor incident prompted my need for emergency care not long thereafter, I went to Charity Hospital Emergency Room in Lafayette.

 

It was late afternoon on a Saturday. The only details I remember are seeing the large number of people coming in with all sorts of emergencies. I remember waiting for hours in the large waiting room with so many obviously poor and overwrought families. I left Charity Hospital with a new insight:  my role is not to endure Charity Hospital services, but to work to change the system so that no one has to endure those conditions. I must work for the presence of conditions that honor my and every other person’s dignity and rights. After all, this is what God wants for each of us. This is what we work for, the presence and lived experience of all that God wants for each of us – the Kingdom of God with us.

 

Sister Carol Zinn, in her Presidential Address to the Leadership Conference of Women Religious in 2014, spoke of precisely these kinds of issues and conditions using a stirring metaphor: God's wish for all that is good for us as the music that is in God’s Heart. Carol noted many ‘lamentations’ in today’s world: war, poverty, hunger, persecution. And she repeatedly asked at naming one lamentation after another: “Are we standing in the lamentations singing the music that is in the Heart of God?”

 

The lamentations of our elders who live institutionalized in institutions are so obvious:  task and schedule taking priority over person-centered living; resultant boredom, depression, withdrawal, loss of self. Many of these losses are due to the effects of ageism throughout our society. Ageism which is so deep and so pervasive that we – even many of us dedicated to aging services – succumb to its lethal consequences to our elders and our staff.  We wear blinders so close to our eyes that we fail to imagine there may be another way to serve our elders. 

 

Our task is not to tell our staff and elders, in effect, “offer it up.”  We are impelled to change the system, to bring forth the Kingdom of God among us.  More beautifully stated by Sister Carol Zinn, we are called to stand in these lamentations and sing the music that is in God’s Heart.

 

Let us sing! With loud, determined and persistent voice, with courageous and compassionate hearts!

Monday morning report

© Imelda Maurer, cdp August 3,2015
ilmcdp@yahoo.com

It’s like homecoming week here at the Pioneer Network Conference.  You know the experience of seeing old friends once again.  And the friends I connect with here at this conference are a source of a special delight because they all have in common their efforts in and their commitment to the journey to Culture Change.

Last evening I had a long visit with Karen Schoenemann.  Karen retired recently from the Center for Medicaid and Medicare Services where she directed that part of the agency that wrote nursing home regulations. Karen is also a founder of The Pioneer Network. She tells the story of that meeting, summarizing it by saying that when she joined this circle of Pioneers (truly pioneers for life-giving change for our elders) she was so delighted and uplifted: “I finally found my tribe!” I identify with that too each year as the changing-yet-stable group gathers once again in pursuit of such noble goals.

 Yesterday’s workshop with LaVrene Norton and Megan Hannan was very rich.  Just one thought this morning.  It comes from the book, “Breakpoint and Beyond: Mastering the Future Today by George Land and Beth Jarman which LaVrene pointed to several times.  “The springs don’t push the river. Gravity pulls the river to its future.”

The implication of this the authors tell us is that “when enough people in an organization are prompted by a powerful purpose to commit to a shared vision, they are drawn to it like water to gravity.”

Busy Doing Nothing?

© Imelda Maurer, cdp  August 1, 2015
ilmcdp@yahoo.com

"Are your residents busy doing nothing? Are they actively engaged? Evidence shows elders prefer continued engagement in meaningful and purposeful activities/occupations. Those who are occupationally active show positive therapeutic benefits; need less help with self-care; report positive mood; and describe greater quality of life.

“Despite positive outcomes of meaningful engagement, studies suggest elder residents are inactive most of the time, are engaged in passive activities, and do not experience significant verbal interaction with caregivers. This session offers real-time strategies to increase engagement for residents living in post-acute settings, and to focus on continued quality improvement plans.”

The above is a description of one of the sessions at the current Pioneer Network Conference. The title is an apt description of how too many elders spend their days in “Activities.” As Carter Williams, renowned geriatric social worker has told us, “Life is not ‘activities’. Life is about engagement.  And it is about relationships  These are the standards against which to measure what’s going on in terms of  how our elders spend their days. Applying these standards calls for us to really know each person we serve. To really know his/her interests, life-long habits and preferences, the passions throughout his/her life history, about the presence of significant relationships that make life richer -----.  Those suggestions are just for starters.  Applying them, I believe, would mean we would see fewer groups engaged in passive events or in ‘activities’ that hold no meaning or purpose for the individual.  It is a challenge!  It’s a worthy challenge!

                        

Remember the Sears Christmas Catalog?

© Imelda Maurer, cdp  July 31, 2015
ilmcdp@yahoo.com

One of the anticipated excitements of my early childhood was the Sears Christmas Catalog that the mail carrier delivered faithfully.  Oh, the excitement of looking through all the pages of toys -- again and again!  Years later when I rediscovered the joys of gardening, I had that same experience when the Burpee Catalog arrived, as it always did, in the dead of winter. Oh, the snow peas! The summer squash! The broccoli for the fall garden!  Now, in my very mature years, that same sense of excitement is anticipated and experienced when the educational sessions of the Pioneer Network Conference are posted on their website!  Oh, the agony of having to select one over the other at times!

For several years I have actively encouraged participation in the annual conference of the Pioneer Network.  I do so because for anyone engaged in any way in the noble work of serving others through aging services, this conference is just absolutely the best!  It is the only national conference that focuses entirely on changing the culture of aging and aging services.  Think about that mission for a minute!

I’m leaving on Saturday, August 1st for this year’s conference in Chicago which opens with a marvelous full-day pre-conference workshop led by staff of Action Pact. LaVrene Norton and Megan Hannan are the guides.  As is standard within the Action Pact team, these presenters are superb in understanding how adults learn and in their utilizing the most effective techniques. The results include not only new knowledge, but experiences that deepen and extend the cognitive issues presented. There is always a sense of community that arises from their work.  Sunday will be a wonderful day!

For those of you who cannot be there in person, the Pioneer Network is offering some of their wonderful conference sessions free to the public via live streaming.  You can go to this website to see the specific sessions that will be streamed. There is also a brief description there of each streamed website and the names of the presenters.

If you are working in an aging services organization, take advantage of this opportunity; plan to have a live, streamed in-service with your team members. Invite Board Members to view a selected session to advance their own understanding of and commitment to transformative culture change for the elders in your organization.

I hope to have a few minutes to share more of the experiences of this conference as the days go on.

Changes are Afoot!

© Imelda Maurer, cdp  July 28, 2015
ilmcdp@yahoo.com

Years ago in undergraduate philosophy courses, at least as I remember, we studied how classical thinkers envisioned change.  Heraclitus taught that things are constantly changing. “All matter is in flux.”  This ongoing change takes place while the underlying essence is maintained. Heraclitus taught, in fact, that change was necessary for an object in order for that object to maintain its essence.  An example:  I am the same person – in essence – throughout life.  But where is my five-year-old body?

We expect change.  As knowledge, awarenesses and technology expand, related, logical changes show themselves outwardly.  Let’s look at the hotel/motel industry for example. Basically the mission of this industry has always been to provide respite and comfort for the traveler, the person away from home.  Let’s quickly surf the changes over the past 60 years.  For those of you who can remember back that far, do you remember signs outside public buildings, motels included, that exclaimed “Air Conditioning!”  Later motel marquees began to note “HBO” followed by other up and coming amenities:  free Wi-Fi, a smoke-free environment, free breakfast. Can you imagine anyone even entertaining the thought of a night in a hotel or motel without most of these amenities being taken for granted? This hospitality industry has changed greatly, and yet has remained the same because its mission is basically the same:  respite and comfort for the person who is away from home.

What about institutions that serve our elders today?  Yes, that dreaded term, nursing homes.  Is the nursing home you visit, that you have a friend or relative in, the nursing home that perhaps you know you will one day be living in --  has that nursing home pretty much remained essentially the same over the past 50 – 60 years as evidenced by scheduled meal time, enforced rising and retiring times,  baths/showers scheduled by the sole decision of the staff,  an exponential diminishment in the ability to make choices about daily life, the ever-present groups of elders sitting purposelessly and  with a aura of isolation waiting for the next meal, the next whatever.

“They get really good care there” doesn’t cut it as the final standard of validation for any elder’s life if each day is lived within the above environment. Life is more than care!  While the mission of nursing homes has not changed, our deeper and broader knowledge of aging, of geriatric medicine and of psychology call for immediate, humane changes to the present institutionalized life too many elders live in nursing homes.

The Center for Medicare and Medicaid Services (CMS) has proposed some revisions and additions to its regulatory standards for nursing homes, introduced because of these very factors.  In the introduction to the suggested changes, open for comment until September 14^th, CMS states why these changes are being suggested.  They include significant innovations in resident care, the presence of quality assessment practices that have emerged and the growing knowledge base of evidence-based clinical services.

More on some of these suggested changes will follow on this blog.  If you or those you love are living in a retirement center that is not licensed, the information is still quite applicable for two reasons.  1) These regulations are referred to as minimum standards of care.  We all certainly want to provide more than the minimum  2) A close examination of Religious Congregations’ principal documents reveal an amazing basis for implementing all of the CMS regulations in the very spirit in which they were written – to enhance the quality of life and the quality of services provided for our elders.

Traveling to Omaha Tuesday morning

© Imelda Maurer, cdp   June 29, 2015
ilmcdp@yahoo.com

The Sisters of Mercy have a very intentional and active network around issues of aging and aging services for their own Sisters.  The individual in Omaha who is the staff person responsible for the overall program for the retired Sisters for the Mercy Sisters' West Midwest Province is Kris Sullivan, MHA, BSN.

Kris told me not too long ago that they (the group in Omaha, I believe) are looking at and working on what comprehensive professional preparation and continuing education should be provided for those individuals, lay and religious, who serve their retired Sisters in unlicensed settings where there are not federal or state regulations to guide them.

I invited myself to Omaha because I’m eager to learn about the thinking and the work on this ‘curriculum’, and the programs that are part of daily life there for the Mercy Sisters in Omaha. My knowledge of Kris, gained through a few phone calls and browsing their website has revealed a woman who is well prepared academically for her position and who brings such great energy and passion to her work.

Early this evening I went to Kris’ LinkedIn page and found the following ‘comment’ written by a person who regularly visited the Sisters there at their convent.  I include it here because it reflects such positive images of what life must be like for the Sisters and the staff at that Mercy convent. Clearly the scope of the work there goes far, far beyond “good (physical, nursing) care” and embraces every aspect of daily life.  I’ll share my experiences here when I return on Wednesday.

“Comment” on LinkedIn Page

I was a weekly visitor to retired Sisters of Mercy that I worked with when I was an elementary principal. I saw firsthand how Kristine and her staff took care of every need for these Sisters from health care and accommodations to activities and entertainment. Kristine put together a fantastic staff, provided needed training, supervised operations and did so with respect for both her staff and the sisters for whose care she was responsible. Outstanding administrator, great person.

When you see the picture of this elder, are your first thoughts "loss and diminishment?

© Imelda Maurer, cdp  June 5, 2015
ilmcdp@yahoo.com

This is Sister Adrienne Marie, a Sister in my Congregation of Sisters of Divine Providence. On Sunday she will note 75 years as a Sister of Divine Providence. This is a beautiful picture of a beautiful person -- beautiful inside and out. This 90-something-year-old woman reflects life, vitality, warmth, and a deep relational capacity in this picture. Thank you, Sister, for providing such a positive, affirming view of what aging really can be. On to Sunday's celebration in our beautiful Conventual Chapel!

“We are in the midst of re-aligning our practices with our mission... ”

© Imelda Maurer, cdp  June 3, 2015
ilmcdp@yahoo.com

“We are in the midst of re-aligning our practices with our mission... ” Thus read the first line of a letter to LeadingAge HR Listserv earlier this week.  It struck me as quite a significant statement. The writer was seeking information from her peers about a particular program in her community that clearly is valued precisely because it is aligned with her community’s mission.

“Mission-driven” is a term that has always stirred me, particularly since the beginnings of my work in aging services.  For me this term means that beyond the Mission Statement that may be framed and posted in the lobby and included in every marketing brochure, the mission is the wellspring of every practice, every policy, and every procedure in the workplace ‘where the rubber hits the road.’ Of course in licensed communities, many regulations frame policies. But the mission and values of the community should be wrapped around the technicalities of those regulations.

An exciting reality for me is that the mission of the community, its values and philosophy, in so many instances parallel the spirit and letter of the federally mandated minimum standards of care, ‘the regulations.’  If you are connected to a licensed aging services community, take a few minutes to see if you can discover those parallels, particularly in the areas of Quality of Life, Quality of Care and Residents Rights.

For Sisters and their staff who live in or serve Sisters (by election or by appointment) in a convent setting  that is not licensed, the parallel with these non-binding regulations is so evident.  We need only to read our documents and our Congregational mission statement with new eyes, the eyes that see the provision of aging services as closely aligned with justice, mercy and compassion. I invite you to read your documents again -- with new eyes.

“Best Practice”

© Imelda Maurer, cdp  June 2, 2015
ilmcdp@yahoo.com

Businessdictionary.com defines best practice as follows:  "A method or technique that has consistently shown results superior to those achieved with other means and that is used as a benchmark. Wikipedia’s definition adds this: “In addition, a ‘best’ practice can evolve to become better as improvements are discovered”

In a way the concept of transformative culture change within aging services organizations can be seen as a systemic ‘best practice’. The work of Sister Lucy, as a leader of Pennybyrn at Maryfield reflect this.  Pennybyrn is a continuing care retirement community near Greensboro, NC.  Although the “facility” had deficiency-free surveys as a matter of course, Sister Lucy felt that something just didn’t feel right. Along with some of her staff, she learned of the Household Model at an annual conference of the Pioneer Network.  Their organization was in the midst of major architectural renovations and the household model made perfect sense.  Pennybyrn moved from a good institution caring for elders to HOME!  still serving elders with the same clinical proficiency, but at HOME! not in an institution. 

The transformation at Pennybyrn was/is systemic because transformational culture change is not experienced just because certain programs or policies are part of the organizational life.  This transformation is the result of a shift of consciousness, a shift in thinking about aging and aging services, about organizational leadership and how it is exercised not just by someone or some few who hold a title, but from within the total circle of staff. A successful shift will result in a positive new way of life for staff and for residents.

Interestingly, even though transformational culture change cannot be equated with the presence of certain programs or policies, within those organizations moving toward culture change, certain “artifacts” are usually present.  Karen Schoeneman and Carmen Bowman developed the “Artifacts of Culture Change Tool” in 2006 which is available here.

This is a lengthy document, made so by the wealth of information it contains. In addition to providing the free-access tool (pages 22 – 31) it provides the rationale for including the various areas of nursing home life that make up the tool. There is also a section on topic-relevant research references and a general bibliography.

If you look at nothing else, study the tool.  It is not a government tool, or an enforcement tool. Finally, in the words of the authors, “The tool affords the opportunity for an individual home to gauge its progress and do its own benchmarking of where they are on a culture change journey.”

So there we are, back to where we began:  best practice as a benchmark and as part of a journey, an ongoing journey of transformational culture change, whose practices can evolve to become better as improvements are discovered

The Culture of a Community

© Imelda Maurer, cdp May 11, 2015
ilmcdp@yahoo.com

Yesterday I posted “Simply Caring” which included a powerful, simple picture with an accompanying commentary.  I posted that entry just hours after learning that the woman on the left, Dolores, providing a shoulder and a place of rest and comfort, had died earlier in the day.  That news came to me via an email from Jan who quoted from an email message sent to all the staff from  Allison Dolan, the Nurse Manager for the community”

Dolores passed away today at 8:40am at St. Luke’s Hospital with her brother holding her hand. She will always be remembered as Ms. Marvelous, who consistently complimented you. We will miss her dance moves and smile.

Many aging services communities have some way in which the death of a resident is noted and ritualized in a way that acknowledges and honors the deceased while remembering that person’s unique qualities and gifts to the community.  Such ritualizing also serves as comfort to staff who also, if they open their hearts to it, experience grief and loss upon the death of one whom they had served with compassion and competence.

My reading of Allison’s message was that she is a professional who has not suppressed her human emotions or vulnerability to pain.  She nurtures and deepens the sense of community in acknowledging individual and communal grief over Virginia’s death.

Simply Caring

© Imelda Maurer, cdp May 10, 2015
ilmcdp@yahoo.com

Several months ago I was invited by Jan McGillick, a social worker, gerontology professor and colleague, to facilitate an evening event at an assisted living community which serves persons living with dementia. Residents and family members who were present were invited to gather in the living room to talk about their experience of friends and friendship throughout their life. At the end of a fascinating experience, Jan escorted me through the house to the front door.  In the foyer we both saw a sight which was literally “a Kodak moment.” I took the picture which is here.

  

Hoping for permission, which was granted, to use the picture, I articulated for the family members of each of these women the tender, personal yet powerful message of the picture:

This picture reflects simply and profoundly the human capacity to care and the human capacity for mutuality and relationships at all stages of life.  Though the disease of Alzheimer’s may prevent proper verbal articulation of these capacities and needs, they can still be experienced and expressed, particularly if the physical environment and the philosophy of services facilitates and honors the movements of the human heart.

In this aging services community, the environment is intentionally focused on “home” where individuals feel secure and have a sense of belonging. The image shows that one elder is allowing another to lean her head on her shoulder. The smaller, petite woman wants to sleep, but she does not want to go to bed. The care partners know this particular preference of the resident and it is honored. In doing so, even if by happenstance, a sense of community and of caring is experienced by the second elder in the picture.

This picture is precious for more than one reason: First, in what the picture reveals, in the stirring of the human heart upon seeing it.  Secondly, it serves as a powerful model when used to reflect how principles of person-directed living can be lived out in a setting that is home and where spontaneity is a normal aspect of an elder’s day. The picture opens the imagination of those in the helping professions who only have images or experiences of an institutional, medical-model style of “health care” where task and staff convenience take precedence over the centrality of the person.

A New Look at Thickened Liquids

© Imelda Maurer, cdp May 9, 2015
ilmcdp@yahoo.com

Dr. Alex Smith is featured in a fascinating six-minute video entitled, "The Thickened Liquid Challenge."  Similar to the popular ice bucket challenge to raise awareness about Lou Gehrig's Disease, Dr. Smith, San Francisco Veterans Administration Medical Center, challenges health care providers to take 'the thickened liquid challenge,' experiencing what it is like to drink your ice tea, coffee, coke, orange juice, or water with thickener added.  The video pictures several individuals as well as groups of healthcare professionals taking the one-time challenge. Among the responses was a comment that 'it tastes like paste.'

Dr. Smith said  very few of the health care professionals who were challenged to drink only thickened liquids for twelve hours succeeded in doing so. Smith weighed this reality against the fact that some persons, especially those living with dementia, are often prescribed 'thickened liquids only' for years!

Evidence from video swallow studies shows that thickened liquids prevent fluid from being aspirated into the lungs, rather than going into the stomach. Beyond that there is "no evidence in real life that putting someone on thickened liquids is more beneficial than harmful." There are some harms associated with thickened liquids, one of which is dehydration!

The final decision, Smith says, should be a very individualized one.

I highly recommend viewing this informative, well-done video here.






http://makingsenseofalzheimers.org/stories/thickended-liquid-challenge/

Words

There was a letter to the editor in the April 6th issue of the New York Times from a physician, a geriatrician.  Dr. Barry Farkas’ letter refers to an earlier NYT feature article on adolescents facing death and having a say in how they want to live those last weeks and months. Dr. Farkas makes this point: “Language is so powerful that it not only reflects what and how we think of things, but it also directs what and how we think of things.”  

I've written before in this blog about the power of language and the conviction that if we change our words we can change the culture.  One obvious example of how the broader culture profoundly acknowledges the double function of words (to both reflect and to construct our concepts) is in the totally unacceptable use of the “n word” under any circumstances. Well and good.

In our society where ageism is so deeply embedded in the culture that we don’t recognize it, it behooves us to examine the words we use about aging, older adults, and aging services. Let’s look at a few terms that are still too prevalent in aging services communities:

If you need supportive services, do you want to move in to a community that provides those series, or do you want to be admitted? Clearly, one is admitted into an institution: a hospital, a university, the legal profession (‘admitted to the bar’).  If we want our nursing home to be HOME, do we admit new residents or help them move in?

In many nursing homes, meals are prepared by the dietary department.  What if we said food services instead? The food already tastes better, and the meal time seems more like the social act that dining really should be.

If a person in a nursing home needs assistance with meals, is that person’s dignity better recognized by describing her as a feeder or as Sharon, who needs assistance with her meals?

Nursing homes sprang up in our country from two pre-existing institutions:  the county almshouses and hospitals.  Gawande addresses this historical reality well in his book, BEING MORTAL.  It’s time to move our thinking from nursing home as institution to nursing home as HOME.  One way to initiate that move is to consciously choose our words because “Language is so powerful that it not only reflects what and how we think of things, but it also directs what and how we think of things.”  

Which Side Are You On?

There’s a new book out entitled “The Age of Dignity” in which the author makes the point that America had better get ready for the “elder boom”, referring to the 10,000 “baby boomers” who are turning 65 every day in the United States. The book addresses the reality that by 2050, 27 million Americans will need varying degrees of supportive aging services. 

In a recent National Public Radio interview, Ai-jen-Poo, author, says the following: “The way that we approach aging and dying in this country is from a place of scarcity and fear.  And what this book is saying is that getting older is actually a blessing and an opportunity.  Living longer is about loving longer, learning longer, teaching longer, and connecting longer, if we figure out the supports and infrastructure to make all of that possible.”

So Ai-jen-Poo says we Americans approach aging and dying from “a place of scarcity and fear.”  Doesn't the term diminishment fit here?

After articulating the positive aspects of aging, the author says that all this is possible if we ‘figure out’ the necessary supports.  Doesn't the term Culture Change fit here?

What do you believe about aging?  Do the concepts of diminishment and decline so totally encompass your view of aging that you see it as a time defined by depression and loss?

Do you see your future in a traditional long-hall nursing home

n  That is run like a mini-hospital,

n  Where one’s days are determined by staff-imposed schedule and staff convenience,

n  Where a common sight is slumpers in wheelchairs -- those are residents who have totally withdrawn within themselves because the external environment is unbearable,

n  Where meal time is spent in interminable waiting at assigned tables, where waiting time and meal time are spent in silence,

n  Where “Activities” have replaced what really gives life: Engagement?

If you see aging and/or aging services in the ways described above, then you are among the multitude of Americans who view aging from scarcity and fear.

What are you willing to do to change the culture of aging and aging services in our society? If one is not changing the culture, s/he is sustaining it.

Come on, Prophets, let’s “sing to the lamentations the music that is in the Heart of God.”  (Carol Zinn, CSJ, Presidential Address, LCWR Assembly, August, 2014)