Category: Business Strategies
Posted by Dr. El - January 12, 2010 - Business Strategies, Communication
Last month I had the opportunity to speak with Mark Kissinger, the New York State Deputy Commissioner of Long Term Care, and Jacqueline Pappalardi, Director of the Division of Residential Services in the New York State Office of Long Term Care. They answered some of my burning questions about the present and future of nursing homes.
I understand with the long term care restructuring going on in New York State, there’s a movement from nursing homes toward assisted living, but there will continue to be a need for nursing homes. How would you suggest nursing homes prepare for the future?
People will try to stay at home and at lower levels of care. The more client-centered nursing homes can be, the more helpful it will be to them. We’d suggest they diversify into rehabilitation care. More short-term rehab will help from a financial standpoint.
Are there efforts by the Department of Health to provide guidance for nursing homes? For example, is there anyone at the State Department of Health that nursing home staff can turn to for guidance if they want to start creative new programs?
Jackie meets regularly across the state to talk with the providers and with regional program directors. Regional staff are invited to these meetings and to the central office (in the Albany area). The staff at the Division of Residential Services, which includes nursing homes, assisted living, and intermediate care, can be reached via email. Every other week there are telephone calls with the Health Department about H1N1, for example. We also put out “Dear Administrator” letters to give guidance.
I see some residents and families afraid to say things to the staff, the line staff afraid of the administration, and the administration afraid of the DOH. Is the DOH afraid of the feds? If so, why?
No, we’re not afraid of the feds at all. We speak weekly with Annette Tucker-Osborne (Branch Chief at the Centers for Medicare and Medicaid Services). We work collaboratively with the federal government. The issue of people being afraid to talk to us is definitely out there, but we try to let them know they can call to talk. We have over 9000 calls on an annual basis.
Nursing home staff sometimes comment that State inspections appear to focus on arbitrary criteria. Staff are often puzzled about why certain issues are noted by the State, while others they expected to be problems aren’t seen as such. What’s your perspective on this?
Our staff are trained on state and federal guidelines. It’s not arbitrary, it’s a very set agenda. The nursing staff are very aware of what the guidelines are, and most administrators are very aware of what will be looked at. On a quarterly basis, we discuss the top five deficiencies surveyors find. While it might seem arbitrary to a staff member within one nursing home, things might be seen by surveyors as a systems problem after looking at several nursing homes.
How do you think nursing homes can be improved in general?
Through better management at the administrator level and better communication between certified nursing assistants, nurses, and administration. Examine systems and listen more to residents and staff. Constant quality assurance should be infused into the nursing home practice. The resident really should be at the center, and include their families. We encourage nursing homes to talk about best practices with each other. To facilitate best practices, for example, a chef could come in and talk to staff about meals. A spa-like environment could be created in the bathroom.
Posted by Dr. El - November 11, 2009 - Business Strategies, Communication, Customer service, Engaging with families, Resident/Family councils
In Part One of the Family Council posts, Karlin Mbah of FRIA discusses the role of the Family Council in improving the nursing home environment. In today’s follow-up post, she addresses ways in which to organize families to create a Family Council. In addition to her suggestions, some of the tips I provided in my posts on Resident Council Meetings can be adapted for connecting with potentially interested families.
Overcoming Challenges to Family Council Organizing
The most frequent question asked by Family Councils is: how do we get more members?
Recruiting and maintaining members seems to be one of the biggest challenges to Family Council organization. First and foremost, it is important for Family Councils to realize that you do not need mass numbers to be successful! A Family Council of 4-5 can often make a big difference. Additionally, arranging Family Council meetings at a time families can easily attend and conducting well-run, focused meetings often helps increase numbers.
Family Councils often spring up when a major issue occurs and then die down when the concern is resolved. Finding positive projects to keep Family Councils running when no major concerns are present will help keep the momentum going and show the nursing home that the Council is dedicated to a positive growing relationship. Some Family Councils achieve this by conducting educational forums on long term care; others have activities such as picnics and entertainment.
A second major challenge to overcome is resistance on the part of the nursing home administration.
Family Councils can address administrative resistance in several ways. From the beginning, in talking with the administration, emphasize the supportive, constructive role Councils can play. Look for concrete ways to be helpful and connect personally with staff. Effective Family Councils walk a fine line between sometimes cooperating with administration, and taking a strong, independent stand at other times.
Where to Get Help
FRIA and many other citizens’ advocacy groups help Family Councils organize in nursing homes in their respective states. FRIA also has published a Family Council Manual and Tool Kit: A Guide to Creating and Sustaining Effective Nursing Home Family Councils.
For information on Citizen Advocacy Groups in your State go to the
NCCNHR website. (NCCNHR, formerly the National Citizens’ Coalition for Nursing Home Reform, is the national umbrella group of all long term care citizens’ advocacy groups).
Additionally, your local ombudsman can assist with Family Council formation. (The Ombudsman is the federally mandated nursing home advocate. Your nursing home is responsible for posting the name and number of your ombudsman in the nursing home).
Finally, you can seek out help by asking other well-established councils to mentor your group or getting assistance for a community organizing group such as a union or a non-profit.
Posted by Dr. El - October 20, 2009 - Boomers, Business Strategies, Communication, Customer service, Resident care, Resident education/Support groups, Technology
A recent study by the Phoenix Center looked at adults 55 and over, but not employed or in nursing homes, and found that Internet use decreased their level of depression by 20%. I’m not at all surprised by this, and I believe a similar decrease in depression levels would be observed in nursing home residents as well.
While residents are living together rather than isolated in their own homes, and therefore have more opportunities for socialization, there are still many people who don’t partake of the recreational activities offered for their enjoyment. Some residents never leave their rooms due to physical or psychological barriers, and some don’t like crowds. Other residents feel uncomfortable socializing because of the physical changes of illness, wish to pursue activities other than those available in the nursing home, or miss connecting with those outside the home. The Internet offers the opportunity for nursing home residents to transcend their physical illnesses, leave the boundaries of the facility, and connect with the world.
In an earlier post, I shared ways in which I use the Internet for therapeutic purposes, and I believe they’re worth repeating here:
1. Psychoeducation Regarding Illness:
Often residents are given diagnoses, but little information about them, leaving them confused or upset, which can result in noncompliance with medication and care. I search for a resident’s illness with them on the computer, and discuss the symptoms and treatment, which enhances cooperation with medical staff. Some residents are more receptive to information coming from a “neutral” source than from their own caregivers, and most residents appreciate a print-out of information they can refer to over time. Posting a list of illnesses and the Web addresses of important sites near the computer would facilitate this process (eg; The American Diabetes Association, the Amputee Coalition of America, etc).
2. Support Regarding Illness:
Most of the residents deal with their illnesses in isolation, when there are many avenues of support available to them on the Internet. Having the opportunity to “discuss” their concerns anonymously with peers can often be more effective than trying to generate a conversation between two or more residents at the nursing home, due to discomfort at revealing personal information. At strokenetwork.org, for example, stroke survivors can “meet” other survivors on-line and get information and emotional support, as can their caregivers. To find the appropriate support groups, enter the name of a particular illness and “support” into the browser window and look around from there. Another option: Look for a Yahoo group about the illness and sign up the resident after establishing a free email account through resources such as Yahoo or Google.
3. Connection with Family and Friends:
Why should residents have to limit themselves to family visits or phone calls when most of the rest of the country is communicating via email, Twitter, or a social networking site such as Facebook or MySpace? I’ve established email accounts for octogenarians to help them keep up with the grands, and a free Facebook page would accomplish the same thing with a bit more zing.
4. Reminiscence:
I once worked with a terminally ill 88-year old man who’d left Barbados in his thirties and had never realized his dream of seeing his country again. Imagine his expression as I entered “Barbados” into Google Images and up popped photos of the country he thought he’d never be able to see again. This intervention generated a flood of memories and a profound sense of relief and closure. Reminiscence could also be conducted in a group format, with connection to a large screen, so that residents should share with others information about their home countries or hometowns.
5. People Search:
One of my favorite things to do with residents on-line is to find their long-lost friends and relatives. For example, through the Internet white pages, I helped one extremely lonely and depressed resident find a friend with whom he lost touch sixty years ago. They are now enjoying an exchange of letters and photos, and my patient has something else upon which to focus besides his poor health and lack of visitors.
6. Fun & Miscellany:
Acting under the theory that doing something enjoyable will begin the upward spiral out of depression, I’ve occasionally brought a resident to the computer to listen to their kind of music (try shoutcast.com), to check out the latest fashions, or to see photos of famous movie stars (Google Images). Once a 97-year old Panamanian resident told me she’d felt unattractive all her life because she thought her lips were too big. “Oh, no,” I told her, “your lips are considered beautiful and the height of fashion.” She believed me after I clicked on Google Image photos of Angelina Jolie.
Do you have more therapeutic uses of the Internet? Please add them to the Comments section.
Posted by Dr. El - September 1, 2009 - Business Strategies, Common Nursing Home Problems and How Psychologists Can Solve Them, Motivating staff
Taking a page from my industrial/organizational psychology colleagues, I’ve been thinking about easy, inexpensive ways to improve efficiency in nursing homes. I recently read an article about the Starbucks company asking managers to put together a Mr. Potato Head doll as quickly as possible and then apply the experience to their work behind the coffee counter. This resulted in moving the supplies around for ease and faster turnaround of customers. I think about this when it takes me 15 minutes to photocopy a face sheet from a chart because the copy machine is located five floors away. Then I multiply that by the number of staff members needing to make a copy or two, and the outcome is this blog post.
Here are some simple ideas for improving efficiency (and reducing staff frustration) in nursing homes. I’m sure there are many more; please add your suggestions to the Comments section.
- Have a fax machine at each nursing station for faxing and small copy jobs.
- Set up all the file drawers the same way on each floor so there is no guessing where one might find an interim order sheet and other important forms.
- Put frequently used forms in an easily accessible location. Move less frequently used forms to a secondary file drawer.
- Color code the doctor’s communication books so that if Dr. Lewis is Lemon Yellow on the first floor, she’s Lemon Yellow on all the floors.
- Color code the weight books, CNA logs, etc, or at least have them all be the same type of book on each floor.
- Post important telephone numbers and procedural information in the same places at each nursing station.
- Standardize the location of the charts, logbooks, etc.
- Standardize the organization for the medication rooms, supply rooms, and linen closets.
- Be sure to include the staff members in deciding how to organize each aspect of the facility. For example, the decisions about the linen closet should be made by a small committee including representatives of the CNAs, the people who deliver the linens, the Director of Housekeeping, any other departments involved with the linen room, and someone able to guide the discussion of the committee. It’s important for every department to be represented because moving certain items might make it easier for one group but harder for another. Having all the information will make for better organization, improved job satisfaction, and greater buy-in from the staff.
Posted by Dr. El - August 20, 2009 - Business Strategies, Customer service, Tips for gifts, visits
I saw this great idea posted on McKnights this morning. My suggestion is, if needed, the residents address it in their Resident Council Meetings to see if they want to raise the funds themselves.
http://www.mcknights.com/Turning-on-the-lights-for-nursing-home-residents/article/146809/
Turning on the lights for nursing home residents
Eric Smith August 19, 2009
In 2004 I accepted a position at a skilled nursing facility (SNF) as a maintenance assistant. I was excited to have this new job as I felt the experience of being in an environment among senior citizens would be very rewarding. I had previously assisted the elderly and I remembered how enjoyable it was. The job however, was challenging, but I loved the work and it was a great job.
For the first 18 months I worked under a maintenance director whose favorite answer to almost all issues was “fix it,” and he would further go on to add, “I don’t care how long you take just fix it.” Well, one of those issues happened to be me constantly replacing the over-the-bed light switches. The problem was that the residents would tie the string that activated the light switch to their bed rails, electrical cords, bed sheets, stuffed animals or to anything they could reach easily due to their limited dexterity. Whenever these items were moved by the staff or sometimes by the residents themselves, they would inadvertently rip the string from the light switch damaging the switch, making it inoperable. Now the maintenance director had a problem with not just me spending the time to replace the switch but also incurring the cost to replace the damaged switches.
I did not like his solution to the problem. My boss had made a decision that all strings that were tied to bed rails, etc., be cut loose immediately. Unfortunately for me, I was instructed to carry out this unpleasant task. To this day, it remains among one of the most difficult things I have had to do. Residents begged and pleaded to me, used vulgarity, cursed me and even tried to bribe me not to cut their strings loose.
Then the company promoted me and moved me to another facility. I was now the maintenance director and the “string problem” existed here too. The strings were tied to call cords, bed rails, stuffed animals and even towels. I have further come to recognize that not only do the residents have limited physical dexterity; they also have a problem gripping the very thin strings that come with these light fittings. This is a common problem I have seen it in every SNF I have visited. Some buildings were new and the residents had those silly strings tied to anything they could reach.
I had an idea and a friend of mine and I fabricated a bracket. We installed the bracket to the reading light in the nursing home and it WORKED!!!!. We then had a tooling company build 10 of the brackets and I installed some of them in my building. The residents loved them. The first resident that got a bracket for her light was Mrs. Pittman. I asked Mrs. Pittman to tell me in her own words what she thinks about the bracket. These are her words:
The new overhead light switch is great. It is easy to reach from my bed and to locate. The chain is a whole lot better than the string as it is clean and doesn’t wrap around anything. Just pull the chain and the light is there. Sure looks nice the way it is put up. Thanks so much.
Frances Pittman
I installed five more brackets after that and everyone thought they were great. When a resident would move to another room that didn’t have a bracket they would ask me to move the bracket to the new room. Family members would ask me if I could put one in their loved ones room. I even had a resident that intentionally kept breaking her light string in the hopes of us putting a bracket in her room. Unfortunately, my resources were limited. We only had 10 units. The residents that had a bracket in their room told me there is no way they could reach their light string without it. I’ve also been told by the residents how nice and clean they are.
I have since talked to nursing home owners, CEOs, administrators, designers, architects, builders and even the Department of Aging and Disability. Everyone thinks it is a great idea, but nobody wants to do anything about it. In the four years I have worked in SNFs, I have come to understand how things work or how the “game is played.” Things change only if the guidelines, rules or the code dictates it. The phrase, “we will wait for the state to write it up then we will fix it,” is commonplace in our business. In other words, we’re not going to spend any money until we have too. I think that is exactly the same mindset I’m seeing with this problem. Nobody wants to spend the money to address the problem until they have to. In the meantime the residents are the ones that are doing without.
The Texas Administrative Code, Title 40 Part 1 Ch. 19 Subch D Rule 19.334(a)(6) states:
Each room must have general lighting, bed reading light, and night light. …. A durable nonglare (opaque front panel) reading light securely ancored to the wall, integtrally wired, must be provided for each resident bed. The switch must be within reach of the resident in the bed.
I would venture to say that more than 80% of SNF residents cannot reach their switch from their bed.
Eric E. Smith is director of maintenance at the Winters Park Assisted Living and Memory Care in Garland, TX. Smith can be reached at Eric2960@gmail.com.
**The EasyReach Bracket is available for sale. For ordering information and sample requests, contact Niven Padachy at (800) 641-2345. Check out the Web site at http://txerich.com/
Posted by Dr. El - August 11, 2009 - Boomers, Business Strategies, Customer service
As Father Bart pointed out in his July 28, 2009 blog interview, one of the greatest challenges facing the residents of nursing homes is their dependence upon others to meet their needs. I often work with them on coming to terms with this unavoidable fact of life, and to find ways in which they can retain control over their situation. After numerous discussions about the frustrations of relying on busy staff or family members to purchase items for them, I began to consider the merits of an Independence Cart.
An Independence Cart is a roving store on wheels. Imagine if twice a week the residents could buy stationery, pens, stamps, phone cards, eyeglass repair kits, personal care items, or order a birthday present for a grandchild. It would give them some means of accessing the goods available in the outside world, and free up time that good-hearted staff and family members spend on burnout-inducing errands.
I once worked in a nursing home with a candy and soda cart that traveled from floor to floor. Items purchased in bulk were sold at discounted prices, and the money from the venture funded resident activities. Residents helped the recreation department leaders stock and staff the cart. It was a dietary disaster, but a practical and financial success. I believe that this concept, taken in the right direction, could be successful in every way.
Posted by Dr. El - July 14, 2009 - Business Strategies, Common Nursing Home Problems and How Psychologists Can Solve Them, Communication, Depression/Mental illness/Substance Abuse, Resident care, Role of psychologists
The July 2009 report, Trends in Mental Health Admissions to Nursing Homes, 1999 – 2005 notes that “the proportion of nursing home residents with mental illness, in particular depression, has overtaken the proportion of those with dementia”. According to a July 1, 2009 article by Liza Berger in McKnights.com, “younger mentally ill people now account for nearly 10% of the nation’s nearly 1.4 million nursing home residents”. While there is discussion of more preferable housing options for these residents, here are some suggestions to help those currently in long term care. As always, if there’s something I’ve missed, please add it to the Comments section.
1. Collect as much information as possible prior to admission about the psychiatric history and the medications which stabilize the individual.
2. Upon admission, refer the resident to the psychiatrist to assess mental status, review medications, and to establish a relationship. Mentally ill residents need to feel there are people in the nursing home looking after their mental health care as well as their physical care.
3. Upon admission, refer the resident to the psychologist, who can offer additional mental health support and monitoring. It’s better to refer someone before problems arise than to wait until negative behaviors and conflicts have been established. For more on this, see my earlier post, The Critical Period in Nursing Home Placement.
4. The social worker, as the most consistently available member of the mental health part of the treatment team, can act as the liaison between the psychiatrist, psychologist, resident, family, and the rest of the nursing home team, helping to share information.
5. Train the staff, especially the CNAs and nurses, to be familiar with the signs and symptoms of mental health problems.
6. Add the element of “behavioral rounds” to the change of shift report, noting any changes in behavior. In the psychiatric hospital, we did it very quickly, running down the names of the patients on the unit, speaking up if any unusual behavior occurred. For example, when the CNA-equivalent on the psychiatric team reported she’d seen a man with Bipolar Disorder laughing by himself in the hallway, the psychiatrist immediately increased his meds, recognizing the early signs of a manic episode. Early detection is particularly important because the lag time between referral for and completion of a psychiatric consult can be substantial.
7. Refer unstable or aggressive residents out to the psychiatric hospital as soon as possible. Doing so sends the message to other residents, staff, and visitors that their emotional and physical health are important, and relieves them of the anxiety of living or working with a resident who might be dangerous to themselves or someone else. It also provides the limit-setting such a resident requires for their own well-being.
8. Establish a relationship with a psychiatric hospital that’s familiar with the needs of older adults and provides adequate stabilization. For example, one nursing home changed the psych hospital they used after a paranoid schizophrenic resident in her 80s returned from a hospitalization still actively psychotic, with a baby doll, reflecting the hospital’s view of the elderly.
9. If possible, use the resident and family as resources. Knowledgeable residents and family members will be able to tell the team what medications have been successful in the past, and what proved troublesome.
10. When the right combination of medications is found, post this prominently in the chart and educate the resident and family so they have the information for future use.
11. If there are a group of residents with a psychiatric history who are functioning relatively well physically, it can be beneficial to provide them with a well-monitored space for group activities such as dominoes and card games which they can initiate without staff intervention. Training the staff monitors to work with groups of mentally ill residents will make such programs more successful.
12. Consider providing access to support groups such as Alcoholics Anonymous, either on-campus or in the community. Many mentally ill residents have a comorbid substance abuse history due to attempts at self-medicating. Such groups will provide emotional support and skills for living.
13. The social worker and psychologist can prepare appropriate residents for living in the community in a less restrictive, but still supportive, environment such as an adult home.
Posted by Dr. El - May 16, 2009 - Business Strategies, Customer service, Motivating staff
The best nursing home staff dining room I’ve ever seen was a large bright room with a wall of windows and plenty of welcoming seating. Staff members purchased discounted food, which was tasty enough to entice those outside the nursing home community to come in and pay full fare. A salad and sandwich bar was offered, as well as a choice of three hot entrees. On pigeon pea soup day, there were lines down the hall and folks buying extras to bring home for dinner.
Unfortunately, most nursing home staff dining rooms are cramped, windowless, basement spaces, renovated some time during the Reagan administration. With peeling wallpaper, inadequate seating, and unappealing food, these dining rooms offer no refuge from the busy units on which the staff work.
It is essential for the line staff to have a place where they can be nurtured and replenished so they can return to their units to nurture others. Those working on the floors spend their days dealing with often unattractive aspects of life: toileting, wound care, agitation, etc. Providing a clean, cheerful, well-maintained dining area can go a long way toward creating a psychologically healthy work space. Upgrading the staff dining room is an instant morale booster, affects the greatest number of people, and lasts longer than a staff party.
One nursing home I know made a vast improvement in their basement dining room with a very low budget. A fresh coat of paint, some artwork by the staff, and matching secondhand tables and chairs completely changed the atmosphere, and the attitude of the diners.
Posted by Dr. El - April 24, 2009 - Boomers, Business Strategies, Customer service, Tips for gifts, visits
Dale Carter, of Transition Aging Parents, sent me the following question after reading my last post about caregiving for family members in nursing homes.
“Eleanor, when I went to check in to volunteer today at our local nursing home, I was chatting with a lady and she said the thing she missed most was not being able to get outside in the beautiful springtime. She was in a wheelchair. How do you respond when you hear that? Any suggestions on something the nursing home or a volunteer could do?”
As someone who plans to spend the spring, summer, and fall of my nursing home years out on the patio, it saddens me to see how difficult it is for many nursing home residents to get outside. Sometimes people tell me they haven’t been out for months, and occasionally years, or only for clinic appointments. I have several suggestions to help nursing home residents get some fresh air.
- If getting outside is important to you, pick a nursing home with accessible outdoor space. Be aware that some nursing homes limit the times of year the patio can be used.
- Try to get a room on the ground floor of the building, so it’s easier to get outside.
- Attend activities such as barbecues and outdoor games provided by the recreation department.
- If you’re unable to wheel your own chair, encourage family members to go with you to the patio, or off-campus, if there’s no patio, even if it’s just wheeling around the block.
- Enlist a volunteer to bring you outside, either through the volunteer directly, the volunteer coordinator, the social worker, or another advocate.
- Recruit staff members to take you out. If you’re able to stay outside by yourself, or with another resident, ask one staff member to bring you out, and another to pick you up at a certain time, such as before lunch. Try to make it convenient for their work schedule.
- If you can’t wheel your chair, but have private funds, and the nursing home permits it, buy an electric wheelchair and get out there on your own.
- If there are nursing home-wide difficulties accessing outdoor space, this can be addressed in Resident Council Meetings or with the nursing home administration.
Posted by Dr. El - April 13, 2009 - Business Strategies, Customer service, Resident education/Support groups, Something Good About Nursing Homes, Technology
At the Center for Nursing and Rehabilitation (CNR) in Brooklyn, New York, Recreation Director Brenda Torres, has established computer stations with Internet connection in all the “neighborhoods,” as they call their units, and has several groups currently being run by the residents themselves. I believe both of these steps are essential for the emotional health of residents, but as they are all too rare in nursing homes, I asked Brenda if she’d share with us how she managed these accomplishments. She graciously agreed, and what follows is my interview with one of the most talented, dynamic, and creative people in the field. You can visit her at technohealer.com for more information about her work.
How long have you been a recreation therapist and why did you choose to work in nursing homes? I’ve been in Recreation over 19 years. I was a psych major and had been gifted in the arts and when I started working in adult day care, I was able to use my art and my psych background, as well as an exercise component. I work with both young and old folks through the intergenerational program at CNR. I don’t focus on age, I focus on abilities.
You’re a big advocate of the use of technology with the residents. What do you see as the benefits and how did you go about getting the administrative support and financial backing for this? Walking through the nursing home halls, I noticed there were a lot of bed-bound residents, and I wished there was a way to get the activities to the residents because they couldn’t get out to them. I had a vision of having a mobile computer unit, so I started Googling it. At the time, they only had a unit that was used for hospital paperwork, so I started to research adaptive devices. At about this time, you and I started talking about a particular young resident and how he would benefit from Internet access. Using your testimony about the need, and other paperwork such as photos of the computer unit and information about the cost, I put out a request for funding. Two and a half years later, the funding came through the CNR community advisory board, which had collected the money through community fundraisers. Now CNR has a mobile unit, which we call R2D2, that brings games and activities as well as Internet access to bed-bound residents, in addition to multiple computer stations throughout the nursing home.
Some of your residents run their own groups. Do you think this has been beneficial for the residents and group leaders? Currently I have a poetry group, a bible group, a collage art group, and a crochet group run by the residents. The President of the Resident Council is in charge of games. Another resident is in charge of R2D2’s “wife” Techno, whom we were able to purchase through additional funding, and other residents come to her to gain use of it. One of the main benefits of having the residents run their own groups is empowerment. It gives them self-worth, a sense of being part of a community, and it gives them purpose. Being empowered prolongs their life and makes them feel needed. Traditionally in a nursing home, people tend to feel like they don’t have a life, that they’re just there until the end, but it’s not true. These are individuals who are survivors, they planted the soil for the new leaders. If it wasn’t for them, we wouldn’t have Obama. They are the blueprints to our society.
How would you suggest a resident who wanted to start a group within their facility go about doing this? [I thought the residents were coming to Brenda to ask if they could run a group, but I learned it was Brenda who was approaching and encouraging the residents.] Before you start a group, look at the needs and skills of the residents and assess the skills of the potential leader. The challenge is how to address a possible leader. I share with them the notion that leisure should not be work, it should be a fulfillment of purpose. It can take time to nurture a potential leader. Display their gifts, show them they still have the ability, invite them to teach others. Help them to visually see the group. We have to take away the barriers, using visual guided imagery. It can be a process taking up to a year, highlighting abilities, and providing reassurance.
What kind of practical support do you offer them in terms of set-up, supplies, etc? We do help with supplies and bringing the residents to the group. A staff member stays with the group as needed, puts up fliers for recruitment, reminders of the group, etc. It can start out at 100% support and eventually over time it moves to 30% support.
Are there any changes you would like to see in long term care in general, from your perspective as a recreation therapist? Yes, many. There has to be change in all long term, because life is changing. The changes have to match our lives, like technology and aging baby boomers. We have to make society paint a picture of long term care in the future, because then it will be more acceptable to be in a nursing home and they will be ready for people like you and me. All the work I am doing is part of building my own home for the future.
