Tag Archives: eldercare

Vocabulary: A Case to Drop “Home-like”

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.

Creating a Sustainable Culture of Compassion

I have to be direct in asking – isn’t this every elder care community’s goal?  After all, we should be in the compassion business, and sustainability is the hot topic today.  Creating a sustainable culture of compassion – makes sense right?

As I write this I can see my readers head shaking.  “It would be ideal, however…….”.  And the list starts adding up quickly of all the barriers to creating a sustainable culture of compassion.

Let’s break this down a bit, starting with Creating.  To create is to bring into existence;  to bring about a course of action or behavior;  to produce through imaginative skill.   Creating should be a blend of many and in elder care, that means everyone from our residents, dining staff, front-line caregivers, housekeeping, clinical staff, administrators and right “up the line” to the CEO.  It’s not a top-down mechanical procedure.  We create things and ideas by listening to each other, churning ideas and then embracing it all with passion.

Sustainability if the ability to be maintained;  In elder care, maintaining a high level of care for each resident is critically important.  High levels of satisfaction from residents, families, and staff are benchmarks upon which our business either succeeds or not.  Sustainability takes a strong commitment from leadership and perseverance to maintain standards even when the going gets tough.

 Now we look at a Culture of Compassion.  Wow, now we’re getting to the real meat here.  Compassion is simply empathy and concern for others.  Culture is the characteristics and knowledge of a group of people.  It’s a collective whole that creates a certain environment.
Aren’t we in the compassion business?  
Most certainly we are in the compassion business and I believe most of us found our way to senior or elder care because somewhere in our life experiences we found that this caring business is pretty dog-gone important to others and ourselves.
Why, then do we struggle with creating a sustainable culture of compassion?  Are we not looking at the vision we must create as leaders?  Are we not listening enough to those who are really doing the work that makes our business?  And, goodness knows, are we forgetting to listen to the very people who live in our communities?
I believe that creating a sustainable culture of compassion is not only doable but essential.  So many good things will happen when compassion cultures are created and maintained.  It is a domino effect of great leadership, teambuilding, happy residents, staff and families.  It’s getting down to the basics of why we do what we do every single day.
To coin a phrase, Just Do It!
Pam Brandon is President/Founder of AGE-u-cate Training Institute and a passionate advocate for older adults and those who serve them.  She led the development of the Compassionate Touch® program.  She may be contacted at pam@AGEucate.com.

Communicating with Terms of Endearment – A Big NO NO

Dear, Honey, Hun, Sweetie, Buddy, Chief, That’s a good boy, Let’s go potty now.  No, I am not talking to my 18-month-old, I am repeating terms of endearment and phrases I hear in memory care and assisted living every day. There is so much research behind the use of this type of language researchers refer to it as elderspeak. I know I am guilty of using terms like these and I know you are too but explore the impact it may be having on our residents.

Although our intentions are generally well-meaning, communicating in such a way with a resident conveys a message of vulnerability, frailty, and inferiority. In fact, communicating with terms of endearment can be viewed as a caregiver trying to control or take charge of the situation rather than providing help and support to their resident.   You may be thinking “this doesn’t matter to me, my resident has dementia, they won’t remember anyway”. And while it is true that your resident may have little to no short-term memory, they are capable of associating feelings with interactions. They will pick up on the tone of your voice and the inflections that you are using.

I feel it’s important to mention that not all residents will respond negatively to the use of elderspeak, but to keep things consistent for all our residents we should stop using terms of endearment, they can be viewed as belittling, condescending and can trigger negative behaviors.  Did you know that using terms of endearment with a resident could lead to a state citation?

Let’s talk about some negative and positive examples:

When helping Ann, a pleasantly confused woman, after lunch the caregiver says “Sweetie” let’s go change your shirt, you spilled juice all over it, and then we will go potty, OK Annie?” The caregiver reaches out her hand to guide Ann to her room and says, “that’s a good girl, come this way” While the caregiver only means to help Ann and show that she cares for her the impact of her words could have a negative effect on how Ann will respond to the care she is about to receive. She may pull away from the caregiver and the caregiver will think that Annie is just being resistive when really Ann is feeling disrespected or confused.

The caregiver’s tone and language may remind Ann of a time when she was young, and her mother would call her Annie when she was caring for her, it could help to create feelings of a safe environment for “Annie”. OR depending on where Ann is at in her current reality it may trigger negative feelings. She could be reminded of a time after she was physically abused by her spouse when he would use terms of endearment to control or belittle her, maybe he only called her Annie after a nasty fight. OR consider this Ann was a high school principal and the use of a term like this offends her! She demanded that her students and staff respect her and the education she worked hard to achieve, and they called her Mrs. Brown, never Ann and most certainly never Annie!

The immediate impact of Elderspeak may not always be apparent and we must never assume that using a term of endearment is appropriate. Always call a resident by their proper name and if they have a title like Dr. or Professor until you have gained permission to call them by another name. If they have a nickname that they prefer to be called it must be documented in their ISP. For example, John has been called Bub his entire adult life, this is ok! If fact Bub might respond negatively to be calling John.

Research has shown there are 3 main factors on a caregiver use of Elderspeak.

  1. Familiarity with the resident- The more comfortable we are with the resident the more likely we are to use elderspeak.
  2. Whether the resident has dementia- the level of dementia plays a huge role in our use of elderspeak, the further progressed the dementia is the more likely we are to use a term of endearment. Maybe we view the resident as helpless or frail and in our effort to show or convey caring we may use elderspeak.
  3. If the resident is alone with the caregiver or if there are others present during the interaction. In the presence of family, other residents, or other caregivers we are less likely to use elderspeak, maybe because deep down we know it is disrespectful and we are more aware of what others would think if we used endearing terms.

So, have you ever caught yourself addressing a resident with Elderspeak? I know I have. And the only way we can change this behavior is to be aware of it then stop it.

My challenge to you is to be more aware of not only your communication methods but of those around you.  Maybe you need to remind a co-worker, in private that they shouldn’t use endearing terms. Or you may need to be reminded yourself on occasion.  After you catch yourself using elderspeak you may need to apologize to your resident when you call her Sweetie and correct your actions by using her preferred name. I challenge each of you to focus on the strengths of your residents and not their inabilities or weaknesses. Remember that everyone has value and should be treated in a respectful way.

Emmy Kaczmarksi, RN is a Master Trainer for AGE-u-cate® Training Institute, Dementia Educator, Behavioral Specialist, and works at White Pine Senior Living in Hudson, WI.  

http://www.AGEucate.com

When Disaster Strikes – Are you Prepared to Care for Your Loved One?

The devastation we are witnessing in the wake of Hurricane Harvey is a reminder that we must all be prepared to care for a loved one, elderly or  disabled neighbor or friend when disaster strikes. Here is a list of 6 basic yet vital precautions that everyone should have in place, especially in the event of a natural or manmade disaster:

Communications Plan

How will you communicate with immediate and extended family members in the event of an emergency?  These discussions should include how to get in touch with neighbors, friends, a loved one’s church or other support systems that are in place.

If your loved one lives in a community setting,  discuss what response and evacuation plans they have in place, including their designated emergency shelters.

Prepare a comprehensive Healthcare and Medication Record that includes but is not limited to:

A healthcare record lists chronic illness, allergies, immunizations, disabilities, doctors and hospitals and emergency contact information (names, relationship and cell phone numbers of family members and/or primary caregivers).

Families can maintain this list on a spreadsheet and share electronically with family members, but also know that a hard copy should be accessible to first responders in  the elderly person’s home.  Placing a decal on the refrigerator door is advisable with all information kept in a baggie or vial inside the refrigerator.  Vialoflife.com is an excellent project and their website has valuable forms, tips and resources.

Have an emergency/escape plan in place

Talk with your loved one about what to do in case of emergency.  Write out simple, clear instructions where it is can easily be read.  If your loved one has any level of cognitive impairment and lives independently, a disaster can cause immediate confusion and anxiety.  In this case,  plans should immediately include receiving aid from someone else.

Emergency supply kits

Three days of food and non perishable food items are advisable to include in case of disaster.  Other items recommended include but are not limited to portable, battery powered radio, flashlight, sanitation and hygiene items, clothing, blankets, cell phone and charger, whistle and photocopies of identification, emergency contacts and healthcare/medication records.   If your loved one has any level of cognitive impairment, make sure food items are easy to open, kits are well marked and simple instructions included.

Plan for pets

Find out what veterinarians and pet services are available to shelter animals in emergencies.  Include in personal information phone and contact information of pet services in the area.

Learn CPR and train on using an automated external defibrillator (AED).  These classes are free and can save someone’s life.  Go to www.redcross.org for training information.

Pam Brandon is President/Founder of AGE-u-cate® Training Institute and a passionate advocate for older adults and those that serve them.  

www.AGEucate.com