senior living success starts here

Ray Miller, Direct Supply 10/11/2016

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Senior Living success starts here.

1

Holistic Approach to Transformational Change™

Keeping the CARE and CARING Connected

90 m

in f

or

NE

HC

A

4

Holistic Approach to Transformational Change™

Keeping the CARE and the CARING Connected

… but (MY hands are) stretched still … Isaiah 9:12

Strengthening Resident Choice & Culture of Safety Using FLS Engagement

5 Copyright 2015-2016 Direct Supply, Inc. All rights reserved

Nate Sproat, UW Eau Claire

Health Care Administration

President - ACHCA Student Chapter

[email protected] (920) 883-9183

“This is the young boy I noticed across

the street with the sores on his feet”

The Journey of Culture

mailto:[email protected]


414 405 0492 2

6

Th

is w

as a

t a

na

tura

l wa

ter

sp

rin

g

ne

arb

y th

e v

illa

ge

of K

ilo 1

6.

“This was a makeshift kitchen

at Francisco’s old house.

The Journey of Culture

Copyright 2015-2016 Direct Supply, Inc. All rights reserved

7

Pastors of the local church decided which families received new homes. This is the inside of the house that a single mother and 4 small

children lived in. This is the house that we built for them.


8


The bed legs were sawed down,

you can still see some rust.

“This is the gentleman

tied to the wall ...”

The Journey of Culture – “Institutionalized”

“These are the pictures from the nursing home.”


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Today’s Agenda

1. Introductions: Me + You + Things That You Do For Your Residents

2. HATChTM: The Six Domains + The Key Responsibilities

3. Culture + Clinical Practices + Contractures + A Smile

4. Workplace Practices + Leadership + Empowerment

5. Community + Family + Technology

6. Nuns, Alzheimer's and Aging

7. “Risk Enablement”

11

The HATChTM Model Holistic Approach to Transformational Change

On December 9, 2014, Kara Butler of Healthcentric Advisors granted Direct Supply permission to use the HATChTM Model.

Copyright 2013 Healthcentric Advisors and Turnswing, Inc. Produced by Turnswing Studios

Helping YOU Build and Sustain

Quality of Life and Quality of Quality Care

for You and Your Residents –

YOU are LEADERS and

YOU MAKE THE DIFFERENCE

Ray Miller

Direct Supply

Educator,

Story Teller,

& Grandpa

Healthcentric Advisors

is a nationally-recognized

non-profit health care quality improvement agency providing

consulting, research and educational

services to the health care community.

Healthcentric Advisors (QIO) 235 Promenade Street, Suite 500, Box 18 Providence, RI 02908

401-528-3221 or

[email protected]. http://www.healthcentricadvisors.org

http://vimeo.com/57899184

12

“When I think of my Grandparents, I

think about how THEY would like to

be cared for.

“So I care for my Residents like they

were my Grandparents.”

Good Samaritan Caregiver Kissimmee, FL

April 2015

mailto:[email protected]

http://www.healthcentricadvisors.org/



http://vimeo.com/57899184


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13 Copyright 2015-2016 Direct Supply, Inc. All rights reserved 13

When thou wast young,

Thou girdedst thyself,

And walkedst whither thou wouldest:

BUT

When thou shalt be OLD,

Thou shalt stretch forth thy hands,

And another shall gird thee,

And carry thee whither thou couldest not.

An “Old Thought” About Aging In Place

John 21:18 Copyright 2015-2016 Direct Supply, Inc. All rights reserved 14

15

What do Caregivers do for their Residents?

YOU

Staff Member

Miracle Max

Care Giver

Leader

Friend

Staff Members of:

Willowcrest, Milwaukee, WI

Guardian Care, Orlando, FL

BRIA Health, Geneva, IL

Kissimmee HCC, FL

Keystone Rehab, FL

Plus MANY Attendees At

State & National Shows

1. Help

2. TIME

3. LOVE

4. CARE

5. Honor

6. Safety

7. COOK

8. SMILE

9. Dignity

10. TEACH

11. Support

12. LISTEN

13. Respect

14. Advocate

15. Heal them

16. Fix Things

17. Encourage

18. PURPOSE

19. Greet them

20. Daily needs

21. Conversation

22. Be a FRIEND

23. Guide / advise

24. Jokes / humor

25. Rub their back

26. Sing and dance

27. COMFORT THEM

28. Adjust the temperature

29. Provide SPECIAL Events

30. Make them feel IMPORTANT


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17

Today’s Agenda








18

Key

Responsibilities

R

19

Key

Responsibilities

1. Body

2. Mind

3. Spirit

4. Emotions

Clinical Practice

R


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20

Key

Responsibilities

1. Do

2. Hire

3. Train

4. Mentor

5. Retain

Workplace Practices

R

+ + + =

21

R

Key

Responsibilities

1. Five Senses

2. Safety

3. Comfort

4. Cleanliness

5. Compassion

Environment

Shanti B., CNA (NS):

For 12 years I’ve

been on the night

shift. ... I have

learned to tap into

“individual

considerations”.

I have learned to

LISTEN.

WAIT

22

Key

Responsibilities

1. Team

2. Vision

3. Culture*

4. Finance

5. Education

6. Processes

7. Development

8. Physical Plant

9. Human Resources

Leadership

R 1. Trust

2. Quality

3. Patience

4. Empathy*

5. Sanctuary

6. Fulfillment

7. Friendship

8. Compassion

9. Engagement

CULTURE

S.A.

Esteem

Love & Belonging

Safety & Security

Physiological


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27

Key

Responsibilities

1. HOME

2. Society

3. Connection

4. Engagement (RSF)

5. -

6. -

Community and

Family

R

30

Key

Responsibilities

1. Knowledge

2. Awareness

3. Experience

4. Preparation

5. Consistency

Compliance

R

31

The HATChTM Model

Holistic Approach to

Transformational

ChangeTM


R


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32

Which Matters the Most?

1. Knowledge

2. Awareness

3. Experience

4. Preparation

5. Consistency

Compliance

1. HOME

2. Society

3. Connection

4. Engagement (RSF)

5. -

6. -

Community and Family

1. Trust

2. Quality

3. Patience

4. Sanctuary

5. Fulfillment

6. Friendship

7. Engagement

8. Compassion

Culture

1. Team

2. Vision

3. Culture*

4. Finance

5. Processes

6. Education

7. Development

8. Human Resources

9. Physical Plant

Leadership

1. Five Senses

2. Safety

3. Comfort

4. Cleanliness

5. Compassion

Environment

1. Do

2. Hire

3. Train

4. Mentor

5. Retain

Work Place Practices

1. Body

2. Mind

3. Spirit

4. Emotions

Clinical Practice

Let’s take a look at

several examples

33

Today’s Agenda








34

Culture Contractures +

+

Actually Using a HOLISTIC Approach


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37

Fishing

Pole

Analogy

USED WITH PERMISSION: by Karen L Bonn, President, Restorative Medical, Inc.; 270-422-5454; 800-793-5544; www.restorativemedical.com . Copyrighted

copyrighted by RMI

So how does it work?

Prolonged, low-load, passive stretch

over a predictable period of time

The steady pressure will cause the

fish to reach the point of “Muscle

Iinhibition” (Relaxation)

Orthopedic: Rehab (quick + surgery + painful therapy)

Restorative: disease process, CNS injury, neurological

38

Golgi Tendon Organ

Proprioceptive sensory

receptor organ

They are located at the insertion of

skeletal muscle fibers into the tendons

of skeletal muscle.

41

Ms. Bessie

USED WITH PERMISSION: by Karen L Bonn, President, Restorative Medical, Inc.; 270-422-5454; 800-793-5544; www.restorativemedical.com .

Copyrighted

Cervical Extension (“tone” in the spine)

Staff could not get enough nutrition into her to sustain life

Ms. Bessie Ms. Bessie was to have surgery to put in a feeding tube


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42

Ms. Bessie

USED WITH PERMISSION: by Karen L Bonn, President, Restorative Medical, Inc.; 270-422-5454; 800-793-5544;

www.restorativemedical.com . Copyrighted

Immediately after fitting 20 minutes later

SIDEBAR: Thinking of the Resident Holistically

Breathing

Caring For the

Whole Person

Circulation

Elimination

Orientation

Dignity

Self-Esteem

Hygiene

Skin Tissue

(Wound)

Nutrition



Mind and

Spirit

43

Breathing

Circulation

Elimination

Orientation

Dignity

Self-Esteem

Hygiene

Skin Tissue

(Wound)

Nutrition

SIDEBAR: Thinking of the Resident Holistically



Mind and

Spirit

Caring For the

Whole Person

44


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48

Today’s Agenda








50


1. Kodak

2. Nokia

3. Xerox

4. DEC

5. Lucent

6. Motorola

7. ICL

8. Atari

9. Marconi

10.IBM

Innovative Tech companies that “Set Up Camp”

11.Olivetti

12.Our Price

13.TVR

14.Amstrad

15.Blockbuster

16.Polaroid

17.Commodore

18.Palm

19.HP

20.Borders

ANSWER WIKI: https://www.quora.com/What-are-great-examples-of-companies-that-failed-because-they-didnt-adopt-new-communications-technology

And then began a new process – STAGNATION

They allowed strongly held beliefs and values, to outweigh critical

analysis, “new thinking” AND continuous progress on the journey.

WHY?


1. Do +

2. Hire +

3. Train +

4. Mentor =

5. Retain

Work Place

Practices

Work Place Practice –

Consistent Assignment


414 405 0492 12

http://wjn.sagepub.com/content/early/2014/02/10/0193945914521903.abstract;

http://www.mcknights.com/consistent-assignment-study-shows-need-for-careful-culture-change-implementation-eden-alternative-leader-says/article/335463/

“Although care aides initially welcomed the

restructuring, they described gradually becoming

overwhelmed by the work, confined by consistent

assignments, and isolated from colleagues and

other residents.”

22 care aides from 5 nursing homes

in a western Canadian city

55

Alone in Eden: Perceptions of Consistent Assignments


Chris Perna, CEO Eden Alternative®:

“What the researchers can conclude is that the organizations involved did

not do a very good job implementing these changes.

“The testimony from these aides underscores that simply implementing

consistent assignment is not guaranteed to improve outcomes or staff

satisfaction — it must be done properly,”

Tim Mullaney, Associate Editor Consistent assignment study shows need for careful

culture change implementation, McKnights, 25 Feb 2014

My Belief:

The better I know my RESIDENTS,

The better I can care for my RESIDENTS.

Copyright 2015-2016 Direct Supply, Inc. All rights reserved 59

The Family hangs this picture up in the Resident’s room.

Any questions come to mind?

How do you ensure that your Staff learns

about their Residents?

1. Simple Pleasures: The community speaks with Residents to learn the Residents “simple pleasures”. They then share that information with Staff, and work to include those items in the residents meals, activities, etc. LeadingAge CO Attendee

2. Story Boards: Post story boards that include highlights of the residents’ life stories helping the Staff to talk with their Residents about “things that matter”. Guardian Elder Care Team

3. Video Interviews: Video tape interviews with Residents to accurately record their life stories. Care Givers then watch these to learn more. LeadingAge CO Attendee

4. Room Signs: Add Residents names, photos, and background to the apartment room signs. (e.g. past experiences, hobbies, family info, etc.) This is then visible to every caregiver before they enter a residents’ apartment. AzurA Memory Care

60

http://wjn.sagepub.com/content/early/2014/02/10/0193945914521903.abstract

































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62

Empowerment =

“Making” Them Leaders

1. Trust

2. Quality

3. Patience

4. Empathy

5. Sanctuary

6. Friendship

7. Fulfillment

8. Engagement

9. Compassion

CULTURE

+ 1. Vision

2. Team

3. Culture*

4. Finance

5. Processes

6. Education

7. Development

8. Human Resources

9. Physical Plant

Leadership

Leadership + Culture

64

You asked me 4 questions about my job: *

On December 9, 2014, Kara Butler of Healthcentric Advisors granted Direct Supply permission to use the HATChTM Model.

Copyright 2013 Healthcentric Advisors and Turnswing, Inc. Produced by Turnswing Studios

Shelly B. RA Woodbury Senior Living,

Tealwood Inc, MN

BEST

HARDEST

MOST

IMPORTANT

MOST

FRUSTRATING

A Resident said, “I knew I’d be

OK because YOU are here.”

1 - We need to stay out of the

“factory care” approach.

2 - Transitions between shifts.

RELATIONSHIPS

When I KNOW something needs

to change but no one listens ...

65

(Your) Pivotal Role – Creating Positive Outcomes

The Pivotal Role Of The Nursing Home Administrator, Provider Magazine, August 2014


“I think our role is shifting from being traditionally autocratic to

being facilitators and coaches.” Erica Cona, NHA, Opis Mngmnt, Ormond Beach FL

Building Engagement Through Commitment

“Lasting Staff Commitment is the most powerful tool

available for stemming the tide of rampant turnover.”

WHO “… to the Residents … to the Staff … to the company …

to their own profession of caring …”

WHY “… dedication and emotional attachment between …

Residents … Staff … the Mission …”

HOW “… create opportunities for employees to be involved beyond

just the day-to-day job functions …”


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68

Staff Dynamics

Authority vs. Familiarity

http://www.apbs.org/conference/denver/files/A18-Bird.ppt#369,13,Federal Regulations: Potential areas of citations


Level of Authority Degree of Familiarity

Administrator

RNs / LVNs

Therapies

CNAs, Activity &

Hospitality Aides*

Seeking

Permissions

CNAs, Activity &

Hospitality Aides

Therapies

RNs / LVNs

Administrator

Seeking

Knowledge

IF You Empower Staff THEN You Achieve Quality and Culture

SHELLY: “When I KNOW something

needs to change but no one listens.”

+

* Nicole Krause and other Life Enrichment directors of Montana

New Section: Comprehensive P-CC Planning (§483.21)

CNAs, Dietary and SS will have members on the

interdisciplinary care plan team

77

HARDEST: “Transitions between shifts”

“Every Good Boy Does Fine”

+ “FACE”

“ROYGBIV”

Handoff Mnemonics

78

1. AIDET

2. ANTICipate

3. ASHICE

4. CUBAN

5. DeMIST

6. GRRRR

7. HANDOFFS

8. I PASS the BATON

9. Just Go NUTS

10. MIST13

11. PACE

12. PEDIATRIC

13. SBAR

14. I-SBAR

15. SBARR

16. SBAR-T

17. SHARED

18. SHARQ

19. SIGNOUT

20. SOAP

21. STICC

22. 4 P’s

23. 5P’s

The Pivotal Role Of The Nursing Home Administrator, Provider Magazine, August 2014

The Quality of Care in Nursing Homes -- The University of Scranton – A Jesuit University

“Hand-off” Mnemonics


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81

I-SBAR

> Introduce

> Situation

> Background

> Assessment

> Recommendation

SBAR

> Situation

> Background

> Assessment

> Recommendation

SBAR-T

> Situation

> Background

> Assessment

> Recommendation

> Thank the Residents

SBAR-D

> Situation

> Background

> Assessment

> Recommendation

> Documentation

“Hand-off” Mnemonics

“Hand-off” Mnemonics S-BAR Iterations

82 https://www.ted.com/talks/atul_gawande_how_do_we_heal_medicine?language=en

1. Complexity of Care: 1970 = 2.2 FTEs. 2000 = 15 specialists

2. To succeed, we must create “Systems” in medical care

3. Positive Deviants: getting the best results at the lowest cost

4. Checklists -- help experts become better by not forgetting

5. “Systems” can results in both individual and group success

6. Many times these systems require a “pit crew” approach

7. Many times we ALL need to be “pit crews”

Atul Gawande

Surgeon by day and public

health journalist by night. He

explores how doctors can

dramatically improve their

practice using something as

simple as a checklist.


86

Insert Ferrari

Pit Crew

Video

* Copyright 2015-2016 Direct Supply, Inc. All rights reserved 86

https://www.ted.com/talks/atul_gawande_how_do_we_heal_medicine?language=en

https://www.ted.com/speakers/atul_gawande_1





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87

Today’s Agenda








95

1. HOME

2. Society

3. Connection

4. Engagement (RSF)

5. -

6. -

Community and Family

Preventing

Social Isolation

97

Community and Family: Technology Can

Improve the Quality of Residents’ Lives*

LeadingAge Magazine July / August 2014: Fighting Isolation With Technology

by Linda Barbarotta; http://www.leadingage.org/Fighting_Isolation_With_Technology_V4N4.aspx

Technology-based Solutions For Social Isolation

Shirley: "I look at the calendar

before I go to sleep to see what

programs are on the next day.”

“This program has enriched my life.

I have friends I can talk with every

day."


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98

Insert Resident

Technology

Adoption

Video


101

Today’s Agenda








114 http://www.nytimes.com/2001/05/07/us/nuns-offer-clues-to-alzheimer-s-and-aging.html?pagewanted=all ; HTTP://WWW.ONBEING.ORG/BLOG/WISDOM-

ALZHEIMERS-DISEASE-GAINED-NUNS/2566; https://en.wikipedia.org/wiki/David_Snowdon

Nuns Offer Clues and Wisdom*

to Alzheimer's and Aging (photo: Lorna Benson/MPR News)

Dr. Snowdon's book on the Nun study,

Aging with Grace: What the Nun Study Teaches Us About

Leading Longer, Healthier and More Meaningful Lives,

won a Christopher Award in 2002.

Reality Check

Dr. David Snowdon is quick to agree with other experts --

his conclusions need to be corroborated by other studies.


http://www.nytimes.com/2001/05/07/us/nuns-offer-clues-to-alzheimer-s-and-aging.html?pagewanted=all
















http://www.onbeing.org/blog/wisdom-alzheimers-disease-gained-nuns/2566










https://en.wikipedia.org/wiki/David_Snowdon

http://minnesota.publicradio.org/display/web/2009/03/24/nuns_alzheimers_study/


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115

Today’s Agenda








Peter Ashley, Person With Dementia

‘Nothing Ventured, Nothing Gained’: Risk Guidance For People With Dementia

“Don’t get me wrong, (care givers) are the most

important people in the world but you can have ‘care

givers’ and you can have ‘keepers’.

“The keepers try and assume total responsibility for

your life, prematurely ...”

“Everything you do for me you take from me.”.

Maria Montesori

Dr. Cameron Camp,

Center for Applied

Research in Dementia

12



414 405 0492 19


The LSC, 2012 edition provides allowances for FIXED

FURNITURE in corridors (NFPA 101, 2012 ed. §18/19.2.3.4)

Two Pictures

Your Heroes MAKES THE DIFFERENCE

Loneliness, Fear, Isolation LIFE, ENGAGED, FRIENDS


5

129

Keeping the CARE and the CARING Connected

… but (MY hands are) stretched still … Isaiah 9:12



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