Place Matters

 

“The first duty of love is to listen.” ~Paul Tillich

 

 

 

Several weeks ago (March 7^th), I wrote about my mother’s move to a new home in an independent living apartment. What a difference it has made in her attitude toward all things!! She is thrilled with her new home, new friends, and all the options afforded her in this special community. It is such a reassuring, up close and personal reminder that the places we create do matter and impact the health and well-being of all those we serve.

Again, Mom reached this decision on her own and I do not want to undervalue the huge impact that makes in the process, but there were a few other points I think added to the success of her transition:

• All three children were in complete agreement and had one unified voice. Even when it came to dealing with those small details that we weren’t “in sync” on, we remained unified.

• Mom and I talked almost every day about options for the interior, what things to take, etc. By doing this, we built up the sense of anticipation and excitement.

• We let her make all the decisions in her own time. (This was tough, but as my sweet granddaughter says, I was “a zipper” . . . what the family calls keeping our mouths shut!)

• We bought a few new things to compliment her existing pieces.

• We found places for every salt and pepper set she had ever collected.

• We let her take it easy on moving day; we handled the logistics, so she didn’t get overly tired out.

• We installed all the items (shower chair, handheld shower, extra night-lights) that would help keep her safe right from the beginning so they were all part of the “new” and not given particular emphasis as items for the elder.

So to all my colleagues and professional partners: be assured that in this crazy, rushing world, the place called Home matters!

Kudos to the Alzheimer’s Associaton!

“I think one of the best words in the English language is compassion.  I think it holds everything.   It holds love, it holds care…and if everybody just did something.  We all make a difference.  ~Michael Crawford

 

 

 

I was honored to be the guest of a dear client Thursday morning at the Greater Richmond Chapter’s fourth annual “Reasons to Hope” breakfast. The event was attended by more than 600 caring and compassionate folks. The presentations were heartfelt and sincere.

Consider:

• Alzheimer’s is the 6th leading cause of death in the U.S.

• 1 in 8 older Americans has Alzheimer’s.

• In 2012 the direct cost of caring for those with Alzheimer’s or other forms of dementia is an estimated 200 billion dollars.

The staggering statics go on and can all be found in the 2012 Alzheimer’s Disease Facts and Figures annual report (http://www.alz.org/downloads/Facts_Figures_2012.pdf).  And that is why we all need to be called upon to have Reason to Hope.  Our local chapter and their sister organizations give us great reasons to hope.

They lead the way in research, provide awareness to the community, and create opportunities for care givers to learn and support one another.  Their work is monumental, and they “continue to provide a multitude of services to families and professional caregivers in our area.”

There were but a few who did not stand up that morning as someone who was personally touched by this growing epidemic. I would invite you to share in the hope and support the Alzheimer’s Association today.  As one of the young men in the video we watched put it: “Those with Alzheimer’s won’t remember they have the disease—we have to!!”

www.ALZ.org/grva

The Bulletin Board Challenge

 

“All life is an experiment.  The more experiments you make the better. ~Ralph Waldo Emerson

 

 

Many years ago (and I mean many), one of my tasks in the fifth grade was to do our grade’s bulletin board in the school hallway. That year in March I did the traditional lion and lamb theme—you remember: “In like a lion, out like a lamb”—complete with the lion, the lamb, and puffy white clouds made from cotton balls. This memory came rushing back last week when I was doing a competitor site visit. There hung a bulletin board, nearly identical to my fifth grade design! A bit too cute for this lovely, sophisticated Assisted Living residence. I have long had a pet peeve about the bulletin boards being created for our elders. We need to remember that these are wise seniors who have seen just about everything; they aren’t in elementary school any more.

A bulletin board’s purpose is to communicate! It is certainly necessary to have an activity calendar of events, in order to stimulate excitement and encourage participation and community interaction. Menus should be posted, so that everyone knows what’s for dinner. Bulletin boards are a great point of interest on tours of families and prospective residents—they can provide insight into the life of the community. But the design and style need to reflect the dignity of our elders.

A few suggestions:

• A 4’ x 6’ horizontal format will give you space for a legible calendar and extra bits of info. A handsome frame will outline the information and convey that it is important and needs attention.

• The location should be near the front entry but not be the first thing you see.

• The board should be well lit. An art lamp mounted at the top will illuminate from the top and reduce shadows. If the fixture is not mounted behind the board, pay attention to the cord—wire molding painted the wall cover can help conceal it.

• The background should be just that: the background. A neutral fabric will allow the information to stand out.

• For high contrast and easy reading, the letters should be upper and lower case in dark print on a light background. Vary the text, the font, and the line quality. Keep it simple: no cursive or fancy letters. Remember the average American reads left to right, top to bottom.

• Keep the decorations to a minimum. Let the events and activities be the focal point. And if you do use seasonal details keep them current.

• Use visual cues to break up the text . . . a picture is worth a thousand words!

We all share the responsibility to show respect and dignity to our elders; the visual details of a community speak volumes.

Culture Change is happening – look closely

“Sometimes it’s the smallest decisions that can change your life forever.”  ~Keri Russell

 

 

The Virginia Culture Change Coalition will celebrate its 10^th anniversary this December. The coalition is comprised of a growing and very devoted group of individuals from all spectrums of those serving our elders, and most recently of several elders themselves.

The vision of the VCCC is “a culture of aging that is life-affirming, satisfying, humane, and meaningful.”

The mission: “The VCCC advocates and facilitates deep system change and transformation in our culture of aging. To achieve this, we:

          Create communication, networking and learning opportunities;

          Build and support relationships and community in aging services;

         Identify and promote transformations in practice, services, public policy, and research; and

         Develop and provide access to resources and leadership.”

 

The work over the last ten years has been slow but steady in Virginia. Change of this magnitude will come in small steps. As one of our elders reminded the group yesterday, the “change in culture needs to start with the culture of how we see aging; we still don’t want to talk openly about growing old.” (I just love seniors; they tell it how they see it—so refreshing and most often so very wise!)

The coalition remains dedicated to supporting those who serve. The programs and monthly meetings are well attended as everyone seeks to increase their understanding, but more importantly share their best practices for the advancement in the quality of life of seniors living in the Commonwealth.

The group at times shares frustration at the slow pace of this movement but there are always many examples of change shared that are encouraging. One of my favorite stories (and I paraphrase) was of a new resident moving to a community in the valley. She was from England and enjoyed her afternoon tea. She commented one day that the tea just wasn’t quite the same if not drunk from a china tea cup. The remark was noted and the next day she was served her tea in a beautiful bone china tea cup with the proper tea pot and best of all, the company of the compassionate person who listened and knew that the small details are what matter most. The two still share tea together and have built a new friendship. I know from my visits across Virginia with many of our communities that this kind of caring compassion happens as the norm. So I would urge us all to look for the small changes that are occurring and know that each one matters most to the one we serve.

From the other side

 

“There’s no place like home.” ~ Dorothy, The Wizard of Oz

 

 

Last week, my mother moved into a lovely, simple, modest senior apartment home.

Like most seniors making this transition, she had just over six weeks to make the final decision to move (she had been on a waiting list since last May); list the condo; complete the paperwork; downsize over seven decades worth of possessions and memories—all the symbols of a full life; and plan the details of the move. My sister, brother, and I quickly discovered that she was ready to make the change (we were blessed that she had reached this conclusion on her own). What she was dreading was the move itself—the practical steps and details involved in creating a new home. I discovered many things last week and one is that during this emotionally tough transition it is best for everyone to focus on the present and the future, but to give the past the respect it deserves . . . and maintain a sense of humor.

First came the discussions of what to keep, what each of us children might want (trust me: our ideas did not align with her plan), and how to discard the rest. Being respectful of her independence, we encouraged her to downsize, but if she wasn’t sure about letting something go, we would move it and see if it worked in the new space. Not the most efficient plan for this designer, but it was a compromise for family peace. Seniors value their independence and having the flexibility to manage their personal belongings is very important. Granting them the independence to do so is key to the fulfillment of their new life.

The plan was working until it came to the dining room table. She really wanted to move a table that seats eight into a one-bedroom apartment. We showed her floor plans. We outlined the size of the table with tape on the floor. Nothing could convince her that the table was simply too big. Finally I called one night and said I had a new idea: we would put her mattress on top of the table and it could double as her bed. Just the thought made her laugh and then we talked about a young family who was just starting out and who could use the table to create their own memories. To me it was just a dining room table . . . to her, it was years of holiday meals, homework, and family debates. It could tell our story. (In the end she moved the small table for the kitchen.)

All the agreed-upon items (and a few other things) made their way across town to the new place. The art was hung, the new window treatments installed, everything established in its new spot. Mom has settled in to her new home, secure and comfortable.

A Change for Culture Change

  “Creativity flourishes not in certainty but in questions.” —Sue Monk Kidd

 

 

Today’s quote captures all the time, energy, and creativity that have been invested by so many people during the last years to bring about change in the way we care for Elders. I was fortunate to attend the Creating Home in the Nursing Home: A National Symposium on Culture Change in Washington, D.C., in 2008 and well remember the collaborative spirit that was present. Change is difficult, but with the right questions, perseverance, and tenacity it is possible! I would like to thank the many dedicated people who recognized a need, began this movement, and who have brought these changes to fruition.

National Long-term Care Life Safety Task ForceSummary of Proposals Approved by NFPA  A Rothschild Regulatory Task ForcePioneer Network is pleased to announce that all of the proposals that its National Long-term Care Life Safety Task Force: A Rothschild Regulatory Task Force submitted to the National Fire Protection Association (NFPA) have been approved and will be incorporated into the 2012 edition of NFPA 101® Life Safety Code®. The new edition of the Code can be ordered from NFPA.We are proud to report that the description of the publication on the NFPAwebsite indicates that there are: “Revisions in health care occupancy rules to foster a more comfortable, home-like environment.” This is due to the work of the Task Force which was made possible by support from the Hulda B. and Maurice L. Rothschild Foundation.The four proposals cover the following areas that will help to “create home in the nursing home.” Kitchens Kitchens will be permitted to be open to other spaces, and the corridor, as long as they meet all of the following criteria: May use either residential or commercial stoves or cooktops The kitchen cannot serve more than 30 residents The kitchen must be within a smoke compartment and must only serve residents in that smoke compartment. However, if you have a building that has multiple smoke compartments, each one may have an open kitchen. The smoke compartment where the kitchen is located, whether new or existing building, must be fully sprinkled. A range hood must be provided with a fire suppression system, grease clean-out capability and a 500 cfm fan. You can get all of this in a hood manufactured by “Cooksafe,” or combine a higher end residential hood with a UL 300a fire suppression system. Hoods may be vented to the exterior or re-circulating but do not need to meet full commercial hood requirements. Local smoke alarms that are not tied into the fire alarm system may be provided in the area of the open kitchen. Seating in corridors: Furniture may be provided in corridors when they meet all of the following criteria: Furniture must be attached to the wall or floor to prevent it from migrating into the required hallway clearance or moving from its intended location. This can be achieved with a simple metal bracket that is screwed to the legs of the chair and to the floor. The bracket could be easily removed for cleaning and maintenance purposes. Furniture in the corridor may not reduce the clear width of the corridor to less than 6 feet. That means if you have an 8ft corridor, you can have a maximum chair depth of 2 ft. If you have a 12 ft corridor, you could have up to 6 ft of furniture depth. Furniture must be located only on one side of the corridor. This will allow residents to navigate the hallway continuously without having to weave back and forth across the hallway to get around seating areas. This also helps emergency responders. There are limits to how long a seating area can be and how far apart they must be spaced but these are all very generous. The building must be sprinkled and must have smoke detectors in the corridors. Decorations: Combustible decorations will be permitted in resident rooms, corridors, on doors, and in common space. There are limitations on the percentage of coverage depending on whether the building is sprinklered and where located. Fireplaces: This proposal will allow gas or electric fireplaces to be used in smoke compartments that contain sleeping rooms, but not within individual sleeping rooms. Some of the restrictions are that the controls must be locked and a sealed glass front must be provided to prevent anyone from throwing object into the flames. Next steps include advocating for the adoption of the 2012 edition of the Life Safety Code by the Centers for Medicare and Medicaid Services (CMS) and subsequent adoption by states across the country. Download Summary of Proposals as approved by NFPA (PDF)

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A Touch of Yellow

 

 ”How wonderful yellow is.  It stands for the sun. ~Vincent Van Gosh

 

 

Here’s an easy idea that will provide a big impact for minimal cost.

In Richmond on Friday, temperatures reached the mid-80s. By yesterday morning (Sunday), they had dropped to the mid-20s! As I wrote my grandchildren yesterday, only God could make a summer day in the middle of winter. But it led me to think about how to bring a bit of that summer feeling inside during these last weeks of winter. Spring fever is starting early!!

The Danish have a word, hygge, which means design that just feels good, that’s comfortable to live with. So to the effort of just feeling good I say . . . Yellow!

Yellow is the first color the eye sees. It reminds us of the sun, it is one of the three primary colors, and it is warm. The easiest, least expensive way to bring yellow into a room is with flowers. What says spring better than daffodils or tulips in bright, happy saffron? You will need just a few simple things: a large glass container (clear is best) filled partway with clear, sparkly gems or marbles; an assortment of sticks or a branch cut from the woods; and a couple bunches of tulips or daffodils. Keep it simple and don’t overthink it—you don’t have to be a professional to create a stunning arrangement. Place your arrangement in the location that gets the biggest visual impact—near the front door!

Residents, staff, and family will all see it and smile. If you place the arrangement on the center table of the foyer or the sideboard, keep it proportional—if it needs volume, add more sticks or a few green leaves. Try this . . . I promise it will work!

Happy almost-Spring!!

The words we don’t say…

  “What you do speaks so loud that I cannot hear what you say.” ~ Ralph Waldo Emerson

 

 

I have had a lot to say about words in the last two blogs but please pay attention to body language and non-verbal cues as well. We inadvertently transmit a lot of information and attitude with a yawn or glare. Part of an overall attitude of respect includes unspoken communication and behavior. Be aware of actions that can seem like impatience, anger, or mocking. Instead, try for soft, gentle gestures, an open attitude or a comforting touch.

Our interpretation of body language, notably the eyes, facial expressions, and hand gestures are instinctive, and many say make up 50–80 percent of what we are communicating. It goes both ways: it reveals what you are meaning and feeling and it reveals what the other person is meaning and feeling. So understanding body language and becoming aware of our own can give us a significant advantage in dealing with others. It happens on both a conscious and unconscious level, so guard your thoughts as well!

Body language should take into consideration the type of person and the situation involved. Two significant factors would be gender and age. Keep in mind that non-verbal signals don’t occur one at a time, but are clustered together—facial expressions, hands, and general posture all work together to convey attitude.

Two of my favorite body languages to practice:

 Direct eye contact when speaking communicates honesty and focused interest and in return reveals active listening.

A smile is a friendly “ice breaker” in any language, conveying warmth, good will, and openness.

And a few to be aware of:

A clutched purse held in front of someone is a signal of nervousness and a form of self-protection.

The rolled eye . . . no need to explain that one!

A clenched fist indicates resistance, aggravation.

Crossed arms are often a sign of defensiveness or discomfort (though it could possibly just indicate that the person is cold).

Crossed arms and legs are likely a sign of defensiveness.

An excellent way to put someone at ease is to practice mirroring. Mirroring another’s body language, pace, and level of speech creates a mutual feeling of empathy, trust, and understanding.

I say it often: Mom was right—please, thank you, a warm smile, and a genuine handshake speak volumes.

Culture Change continues to talk nicely….

“Treat others as you want them to treat you because what comes around goes around.”

No matter the age, sex, or economic status of your everyday conversational partners, talking nicely can be tricky in the workplace, at home, or in social situations. Just think about what your spouse had to say about how those new pants fit or that snarky remark your sister made about your recipe for cranberry sauce, and you have experienced an obstacle to sweet talking.

In my research, I was struck by the observations of families and caregivers about how essential it is to personalize your approach to language. Everyone is an individual with a different comfort level. Try to listen carefully and understand the context of comments that on the surface seem belligerent. Think about it from the resident’s point of view. It is very embarrassing to have to admit that certain activities are just too hard to perform anymore. “Say what you mean and mean what you say” just isn’t an option for some long-term care residents. At the same time, consider your own word choices and the underlying implication (often unintentional, but there nonetheless) an elder or family member might hear.

Karen Schoeneman, a senior policy analyst in the Division of Nursing Homes in the Centers for Medicare and Medicaid, has published an excellent list of outdated or potentially offensive terms used when conversing with elders. Here are just a few examples (www.pioneernetwork.net/CultureChange/Language/):

Old Word/Phrase	Suggestion
“victim of . . .” or “suffering from . . .”	“has . . .” or “with . . .”
wing, unit	household, street, neighborhood, avenue
allow	encourage, welcome
diaper	pad, brief, disposable brief, brand names, incontinence garment
the elderly	elders; older adults, people, or individuals
patient	resident (some think this is passé), individual, elder
a feeder/the feeders, feeder table	person who needs / people who need assistance with dining, dining table
a diabetic, a quad, a CVA	a person who has (whatever condition)
nurse aide, CNA, nursing assistant, front line staff (sounds like war)	resident assistant, certified resident assistant
admit, place	move in
discharge	move out
lobby, common area	living room, parlor, foyer
nurses’ station	work area, desk
facility, institution, nursing home	home, life center, living center
100-bed facility	100 people live in this home/center
housekeeping, housekeepers	environmental services, homemakers
long-term care industry	long-term care profession or field
eloped, escaped, elopement	left the building, unescorted exiting
dietary services, food service	dining services
problem residents, behavior problems	person with behavioral symptoms
agitated	active, communicating distress
ambulation, wandering	walking

Old habits are hard to break, but now is the time for change.

Culture Change starts with our words…

“Respect is what we owe, love, what we give.” ~Philip James Bailey

 

 

 

I passionately believe in the cultural change that offers dignity to older adults who reside in community care centers and other long-term living arrangements.  At the heart of this nationwide change in attitude and professional practice is effective, respectful communication.  We all have an obligation to spread the good word on the benefits of talking nicely to our elders.

Speaking respectfully is always a good business practice in any occupation.  Why should we care about speaking courteously?

• Because we are professional, dedicated individuals with a passion for serving seniors.
• Because we genuinely care about the people we are responsible for and respect them regardless of their physical or mental status.
• Because it is good business practice.
• But most of all, because in doing so, we become part of a cultural change that respects and honors older adults.

Talking nicely can brighten someone’s day.  It empowers persons with little control over their circumstances to make informed decisions for themselves.  It increases cooperation.  It will make our clients “honored friends.”