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The Green House Project Blog

White House Conference on Aging Launches Regional Forums- We Need Your Voice!

In a blog post earlier this month, Executive Director Nora Super began to outline the goals and events that will occur as a part of the 2015 White House Conference on Aging (WHCOA). The WHCOA happens only once every decade, so you don’t want to miss this opportunity to have your voice heard! The regional forums, announced this month, will provide a venue for the public to discuss issues in the aging field that are most important to them including: retirement security, healthy aging, long-term services and supports, Elder abuse and supporting caregivers.

More specific details of the forums are to follow but the locations and dates are the following:

Tampa, Florida (February 19th)

Phoenix, Arizona (March 31st)

Seattle, Washington (April 9th)

Cleveland, Ohio (April 27th)

Boston, Massachusetts (May 28th)

According to the WHCOA website, “The regional forums are co-sponsored by AARP and being planned in coordination with the Leadership Council of Aging Organizations, a coalition of more than 70 of the nation’s leading organizations serving older Americans.  While participation is by invitation, all of the events will be live webcast to engage as many people as possible.”

We encourage all Green House adopters and culture change advocates to engage in the regional forums by watching the webcast and using social media during that day and the weeks leading up to the event.  Stay tuned for details and ideas to assist you with that process!  In addition, consider having an event at your Green House homes or in your community during the same time that a regional forum is occurring and invite local legislators and press to attend. The more Green House buzz near each regional forum, the more national attention we will receive as others recognize that now is the time to push for radical changes in aging and long-term care!

 

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“Expect the Best!”

My work often brings to mind my good friend and mentor, Nancy Fox. Nancy is Chief Life Enhancement Officer for Vivage in Colorado, was the first Executive Director of The Eden Alternative™, and has many years’ experience as an administrator and an educator. The lessons she has taught me pop into my head on many occasions.

In 2007, Nancy wrote a book called Journey of a Lifetime: Leadership Pathways to Culture Change in Long-Term Care (available at www.edenalt.org or online booksellers). The book lists ten important principles for enlightened leadership, illustrated by stories of good and not-so-good experiences she has had, and lessons learned. One of these is called “Expect the Best,” a principle that is ignored with alarming regularity in long-term care, on both the provider and the regulator sides.

Here is an example of each:

First, a recent McKnight’s article described a study in the upcoming issue of Geriatric Nursing that can only be described as what my friend Jane Verity would call “a blinding flash of the obvious.” This study of nursing homes in the US and Germany showed that CNAs had a much better work experience if they were notified of the deaths of their elders before discovering it for themselves (such as walking into a room to provide care and finding an empty bed). The study recommended “more mindful” approaches to such transitions for those who have formed close, caring relationships.

Wow. What’s sad about this study—even the need to conduct such a study!—is that it reveals how often we give lip service to honoring our hands-on care partners, but choose actions that say the opposite. Then we are quick to blame those same people for lack of a “work ethic.”

Look at your employee handbook and ask yourself, does this document expect the best of our employees? Does it treat them as responsible adults or as children (or worse yet, as potential criminals)? Then look at the actions and interactions of leaders and managers throughout the day. Are our care partners included in decision-making discussions? Do we ever ask for their opinions or advice?

Expecting the best creates two complementary results—it improves people’s abilities and their accountability. Nancy frequently says that “empowerment is not something you try; it is something you do.” When we approach those who support our elders with an expectation that they are capable of great wisdom and growth, we create an environment where growth can occur and wisdom will blossom. And by treating people as equals, we create an environment where people care about each other and about the consequences of their actions, and accountability thrives.

Such discussions raise the inevitable objection that there are people who will take advantage of your good intentions and try to game the system. Welcome to the planet Earth. The problem not that such people exist; the problem is that we write our policies and choose our actions based on the worst person we can imagine and punish everyone else with our low expectations, rather than addressing (or removing) the individual in question. Nancy would likely say, “Expect the best, (and individually address the worst).”

The second example was raised by Karen Schoeneman, formerly of CMS, in a recent culture change discussion that highlights this issue on the regulatory side. She was upset to hear that surveyors in her home state were not permitting elders to have refrigerators in their rooms because of the concern that a resident with diabetes could potentially enter the room and take something that would not be good for his/her diet.

There is so much wrong with that citation that I could devote an entire post to it. But let’s stick with “Expect the Best,” as it applies to surveyors. The fundamental flaw in our regulatory system, I believe, is that surveyors inhabit a primary identity as enforcers, rather than educators. Therefore, they come into the nursing home expecting the worst and constantly imagining “What could possibly go wrong?”

(Of course, Nancy added her two cents to the discussion thread as only she can do, suggesting that perhaps “surveyors shouldn’t be allowed to drive, because they might hit a diabetic.” If it’s possible to laugh and cry at the same time, that’s what I did when I read her comment.)

Incidentally—to be fair to surveyors—many of them work in states where they are required to be enforcers only, because the rules say that they cannot advise providers, only tell them if what they are doing is “in compliance” or not. Apparently the concern is that surveyors might lose their objectivity if they try to mentor the homes. And apparently the rule makers have never heard of school teachers, who mentor their students every day and still give them quarterly grades. If the regulatory bosses don’t expect the best of their surveyors, then a trickle-down effect at survey time is entirely predictable.

These are two examples of why I sometimes despair that our current system of elder care will never truly create well-being for anyone. There is far too much talk about “culture change” and too little evidence of it. Nancy Fox is one person who has always walked the talk. We would all do well to read, or re-read, Nancy’s book.

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The Wall Street Journal Exposes Common Myths of Aging

A recent article in The Wall Street Journal exposes many common myths of aging. Some of these myths have become so common, they could easily be mistaken for the truth. Have you ever heard someone say, “depression is a normal part of aging” or “cognitive impairment is inevitable with age”? This article clears the air for six big myths about aging.  You can read more here.

For many people, the myths of aging may have come from observing what Dr. Thomas calls the three plagues of long-term care: loneliness, helplessness, and boredom.  Fortunately, the culture change movement is showing us what aging is really all about – another stage of growth and development for all people.

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New photos available from the first Green House Home at the Zablocki VA Medical Center

 Clement J. Zablocki VA Medical Center in Milwaukee, Wisconsin welcomed Elders into their first Green House home in November, 2014.  This is the first of three Green House homes planned for this VA medical center.

These Green House homes will serve Veterans in need of long-term skilled nursing care, including veterans living with cognitive impairment and mental illness.  The medical center looks forward to welcoming veterans into their next two Green House homes when they are completed in the spring of 2015.

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Music Can Be at the Heart of a Life Worth Living

As a geriatrician, I’ve spent much of my time in the company of elders exploring life beyond adulthood. The shortcomings of our medical system to meet the human needs of elders as they navigate this uncharted territory are too numerous to list. Particularly when it comes to the way in which it treats people living with dementia. Of the 1.5 million people who have been institutionalized for medical problems, about 80 percent have been segregated from the general population because they are living with Alzheimer’s disease or dementia.

Because our medical system treats the trials of sickness, aging and changing cognitive ability exclusively as medical concerns, these people are too often tucked away from sight and treated with powerful psychotropic drugs. The treatment is not aimed at providing relief or a cure, but at making the patient more manageable – at the cost of hundreds of millions of dollars for drugs that provide limited relief and cause significant side effects.

For more than a decade, a handful of passionate organizations and advocates like myself have argued, and proved, that it can be different. Programs like The Eden Alternative, Ecumen’s Awakenings (http://www.ecumenawakenings.org), Anne Basting’s Timeslips (http://www.timeslips.org) and Dr. Al Power’s book “Dementia Beyond Drugs” demonstrate that non-pharmacological interventions for dementia provide meaningful benefits without the cost or the dangers of psychotropic drugs.

One of the most exciting of these new techniques is also the most elegantly simple – providing personalized music to people living with dementia.

The benefits of providing music to a person who has lost access to it include better memory, improved mood, decreased pain, increased engagement and enhanced well-being. Clinical studies demonstrate that it is possible for personalized music to have a greater effect than any medication.

Anyone who has doubts about the efficacy of personalized music can watch the technique graphically demonstrated in Alive Inside, the groundbreaking documentary on music and memory that is now available on DVD and streaming on Netflix.

I was honored to participate in the filming of Alive Inside with director Michael Rossato-Bennett. Time and again, Michael’s camera captured small miracles as life re-ignites in the eyes of people who have long been unresponsive after they are exposed to familiar, beloved tunes.

This simple, elegant film opens the door to a conversation about how we think about aging in general and about what we think makes a life worth living. For too long we have put the fate of our elders – our fate – into the hands of a medical system designed to focus exclusively on the repair of health and ignore what makes life significant. We’re not going to see music in the lives of every old person until we confront our own fear of aging and our own fear of death and demand a long term care system that does more than provide for safety and protection of elders. If we do that, we can build a society where nursing home means “nurturing” home. Where people go there to grow and live and love and laugh and listen to good music.

Music can be at the heart of the conversation about what makes a life worth living.

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