All posts by Julie Boggess

Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute and provides education and training to private and professional caregivers through her company Enlighten Eldercare. She lives in the Chicago Northwest Suburbs of Mount Prospect, IL.
Dementia Live, Family Caregiver, Hospital Professionals, Senior Care Professionals, The Family Caregiver

Wisdom from a Friend with Dementia

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Seek the wisdom that can be lost under the weight of memory loss in persons living with dementia.

Dementia hit close to home for me recently. It had probably been six or so years since I had last seen a friend and former co-worker. He had fallen out of sight, and now I know why. I learned of his whereabouts and paid him a visit. It started with mild cognitive impairment that has advanced to late-mid stage dementia.

I was so glad that he recognized me. We had a wonderful conversation and reminisced about people we knew and past work projects. But, as time went on, he became lost in the conversation. He was evaluating proposals, preparing to consult, and critiquing management.

Always contemplating, analyzing, envisioning, planning. That is what this man did. The beautiful thing, he still is.  The wisdom is there when entering his reality.

Wisdom

My friend said some pretty amazing things. The first was when we were talking about purpose in life. “We all need to germinate something wonderful and wise,” he said. My friend is eager to share his wisdom, and being surrounded by people who will listen provides him purpose and quality of life.

Referring to the people who work where he lives, he said that it is just as important for him to know them as it is for them to know him. It pleases him when people call him by name. It is important to him that they know who he is, and he delights when introducing his caregivers by name.

The importance of relationships between care partners is something my friend taught others back in the day. In fact, he introduced me to David Troxel’s philosophy, “Best Friends Approach to Dementia Care.” I saw before my eyes how incredibly important that is for my friend.

It is comforting to know that my friend’s personhood, the things that make him special, are still there.  Dementia does not define him. He has long-term memories with attached feelings. He continues to teach others about dementia- both how to live with it and what it takes to provide good care with quality of life.

I asked if I could share his wisdom in a blog. He said he had to think about it and then asked what the distribution and market reach would be. Yep- always thinking.

May we always seek to know the person living with dementia, and let them know us too.  Seek their wisdom, you will learn much.

Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare,  Julie provides training and educational programs on elder caregiving for family and professional caregivers.  She is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.

Senior Care Professionals

Vocabulary: A Case to Drop “Home-like”

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Human needs for safety, respect, happiness and love are feelings associated with home.

The word “home-like” has bothered me for a long time. It describes the type of environment that long term care communities must create for their residents.

The federal government mandates a home-like environment for skilled nursing participation in Medicare and Medicaid. A deficiency can occur under F-584 for lack of a safe/clean/comfortable/home-like environment.  As a result, this violation also carries the distinction of sub-standard quality of care.

Homelike

As defined in the SNF State Operations Manual:

A “homelike environment” is one that de-emphasizes the institutional character of the setting, to the extent possible, and allows the resident to use those personal belongings that support a homelike environment.  A determination of “home-like” should include the resident’s opinion of the living environment.

Clear as mud, and easy to objectively measure, right?  To that end, allowing residents to bring their personal belongings qualifies.  How generous of us.

I dislike the term “home-like” because it sounds like a cop-out.  We can aim for something “similar but not exactly.”    It’s as if we give ourselves a pass for falling short.  We can set the bar low and still be in compliance.

Home

A definition of home has been penned by fifth-grader Wynn, the winner of Habitat for Humanity essay on the meaning of home.  He writes, “Home means an enjoyable, happy place where you can live, laugh and learn. Home is where one is loved, respected, and cared for.”

Perhaps CMS could adopt this definition and base compliance on objective resident, family, and employee feedback?  But, this is a  subject for another day.

Research on factors influencing a sense of home in nursing homes reveals that psychological and social aspects are just as important as the physical space.  Is this easy to do?  Certainly not.  Is it the ideal to strive towards, I believe so.

If you accept 5th grader Wynn’s definition, then to create home means that we must provide a place that is happy rather than sort-of-happy.  Above all, home means that we respect residents rather than something short of respected.

I submit that we want no less for ourselves.   It may be near impossible to replicate the physical space of home.  Nevertheless,  stressing the importance of the emotional aspects of home puts us a step closer to having communities that are home vs. home-like.

In conclusion,  consider a new perspective.  People living in  our community are:

    •  treated with respect and love
    •  having fun
    •  safe and cared about
    •  given opportunities that promote meaning and purpose in   their lives

Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare,  Julie provides training and educational programs on elder caregiving for family and professional caregivers.  She is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.

Hospital Professionals, Senior Care Professionals

Retention Culture: Antidote to C.N.A Turnover in LTC

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Shaping organizational culture and respect for Certified Nursing Assistants can impact retention.

Kathy Dreyer penned a terrific post last week about Long Term Care Certified Nursing Assistants and turnover. This issue has been identified as a crisis. I submit that it is also a tragedy, because, we have ignored the problem with the lack of a national strategy.

Certified Nursing Assistants are the backbone of care in long term care. They provide care for those that nobody else can, or will.

Our nation’s 1.3 million nursing home residents depend on C.N.As  365 days of the year for personal care of all types and levels. This is not an easy job. But those that continue to do this work know that it is also soul-filling and rewarding. But, what else makes some stick with it?

Retention Through Culture and Respect

A 2009 study found that an organizational culture that respects and invests in their workers inspires retention. To that end, I submit that Certified Nursing Assistants in Long Term Care do not receive the recognition they deserve.

Nationally, nothing has been done to advance the vocation. Additionally, at the state level, dismal Medicaid reimbursement has a disastrous effect on wages. Consequently, all we can directly control is our organizational culture.

If we truly value our seniors, we should vigorously value the people who are taking care of them, day in and day out.  An article in Provider Magazine speaks to the importance of respecting certified nursing assistants as individuals to retention.

Concrete Steps

  • Invest in training and education. Help C.N.As grow,  and acquire new skills (refer to previous blog for more ideas).
  • Tell their wonderful stories. Profile C.N.As who live the values of your organization and contribute to a high quality of life and care.
  • Lift them to your residents, family members, and the larger community.
  • Arrange for regular scheduled time off the floor with coverage to participate in QAPI initiatives.
  • Ask for their opinions, ideas, and find ways they can contribute to decision making.
  • Intentionally incorporate into their schedule time for relationship building. In addition, allow them to spend time with elders outside of their job as a caregiver- as a human being that enriches life.
  • Find ways that your C.N.As can share their gifts and talents with co-workers, residents and family members.

Ponder whether your organizational culture truly respects not just the work, but the personhood of your Certified Nursing Assistants. In doing so, you may realize improved retention, the antidote to turnover.

Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare,  Julie provides training and educational programs on elder caregiving for family and professional caregivers.  She is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.

Dementia Live, Hospital Professionals, Senior Care Professionals

Education First in Dementia Care

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Foundational Education is critical for inexperienced caregivers of persons with Dementia. Don’t rely on understanding through experience alone.

Working in senior care for over 30 years, it takes digging deep to recall my early experiences interacting with the elderly and those with dementia.  I was a volunteer and an intern during college when my first encounters occurred.

My experiences were mostly pleasant and fun. The people were just older versions of my grandparents. I enjoyed visiting with the independent seniors. They showed me around their cute apartments and told me stories.  However, encountering people with dementia was another story.

It puzzled me when one lady repeatedly said, “I want to go home,” when she was at home. I didn’t know what to say. One lady forgot that I was picking her up for a concert, even though I reminded her the day before. I thought maybe she didn’t want to go after all.

Little did I know that these people had Alzheimer’s Disease.  Learning that their memory was impaired, I assumed they had NO memory.  Therefore, I thought it was my job to remind them of everything.  I thought their brains could be fixed. I was wrong about a lot of things, albeit well-intentioned.

Learning Through Education and Experience

Over-time, I “got it” and became more comfortable being around people with dementia.  My confidence grew as time went on.  I learned that the things they said and their behaviors didn’t define their personhood. Consequently, I came to enjoy being with them.

Looking back, I can see how extraordinarily helpful training like Dementia Live would have been. I genuinely think it would have propelled my understanding and improved my interactions ten-fold.  Webinars and lectures barely scratch the surface to learn what it takes to promote quality of life for persons with dementia.

Time and experience alone should not be our only path to understanding.  The valuable lessons that the  Dementia Live experience teaches learners include:

  • persons with dementia experience feelings, even with impaired memory
  • their behaviors are a form of communication
  • the environment makes a big difference in their ability to connect
  • purpose in life is still essential for their well-being
  • our communication approaches can make or break an interaction

Learning does comes with time and experience.  However, I submit that ground zero isn’t the best place to start.  People with dementia deserve better than to be surrounded by uninformed, clueless people, such as I was years ago.

 

Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare,  Julie provides training and educational programs on elder caregiving for family and professional caregivers.  She is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.