By Lisa Milliken / Posted on March 27th, 2018
Reposted from The Pioneer Network Newsletter
Lisa Milliken serves as the Director of Education for Select Rehab, where she researches evidence based practices and develops continuing education courses on current hot topics for therapeutic intervention in the post-acute setting. Her goal is to assist this field in the prevention of unnecessary re-hospitalizations and to help therapists deliver the highest level of rehab practices for the most optimal clinical outcomes.
“If my therapist asks me to do something that makes sense to help me achieve I want to do, then I would be motivated to do it. It would make sense to me. But how is this bicycle thing going to help me work in my garden or wash my clothes? That doesn’t make sense, so why should I have to do them?”
These are often the thoughts of residents in a community’s rehab department who are there to regain a prior function. I’m reminded of a story shared by a colleague about one man (Tom) who was in short-term rehab following his stroke. His goal was to regain function of his left arm and leg to go home and resume work on his farm. Initially Tom did not like doing the same old exercises, which were assigned to him by the physical therapist to improve his leg strength. And he surely didn’t enjoy the tabletop pegboard and exercise putty his occupational therapist gave him to work on. His comment to all of this was, “This is ridiculous, why I am doing this?” So they stopped and asked “What would you like to be able to do again?” To this he responded, “Well, I want to go home and get on my tractor and get back to work!” So the therapist called Tom’s son and they arranged for the tractor to be brought to Tom’s senior rehab community and parked it in the parking lot. Every therapy task from that point included goals to get on and operate the tractor. This meaningful therapy had a purpose and Tom’s progress then increased dramatically.
Each elder’s rehab goal is different. We should not assume that everyone wants to walk 100 feet and improve standing balance to 15 minutes. There may be no meaning or purpose to such goals. But if we ask them, they will often tell us exactly what they want. It may be that they want to sweep their own floors, go get their mail or walk to the living room to visit with other elders by themselves. Or maybe it’s to independently work in the kitchen because they’re a chef and frequently volunteer at a local shelter to help with meals.
A successful meaningful therapy task includes the following components:
• Person-centered and individualized
o Based on preferences
o Meaningful versus rote
o Graded to abilities
• Volume and content are appropriate to skill level
• Therapy and nursing team members’ attitudes are supportive of the elder’s goals
According to a study by Port and others in 2011, we can effectively solicit an elder’s preferences through a series of steps, including the systematic narrative history of activities enjoyed prior to admission and a direct interview of the elder about activity preferences and available choices. We can then identify health-related or contextual obstacles and develop novel interventions to re-engage each elder in their preferred task. Historically, traditional therapy would focus on impairment-based treatment approaches. And components of such approaches may still be necessary and beneficial at specific points of treatment, such as to collect baseline data for range of motion, strength and activity tolerance.
But functional-based treatment approaches should also be included in the elder’s skilled plan of care. Each elder needs to be challenged and tested in functional skills that will be required of him/her in the following skilled rehab, whether that be within a community setting such as a nursing home or assisted living, , or in their own home. This approach prepares the client for the specific activities and skill sets which they will need to attain their optimal level of functioning in any setting, and where possible, to successfully transition and remain in their home without the potential risks.
The recently updated Rules of Participation for Long-Term Care now cites the resident’s preferences as a requirement in many of the codes of federal regulations. For instance, the Resident’s rights section includes this statement:
“A facility must provide a person-appropriate program of activities that should match the skills, abilities, needs and preferences of each resident with the demands of the activity and the characteristics of the physical, social and cultural environments.”
Furthermore, payer sources such as Medicare and various managed care and insurance companies stress the importance of quality outcomes in a timely manner. So it should be of no surprise that our detailed graphs and charts of outcome data per client shows better and faster improvements as a result of the functional based therapy where we focused on the residents’ personal goals.
Such regulatory and outcome requirements further support our priority to first seek the resident’s input regarding their preference and then help them to achieve their unique goals. Whether we’re working to get Tom back on his tractor, helping Louise to return to her kitchen, or supporting the best quality of life possible as defined by each resident in a community, we can cater each therapy session to their unique goals and the result is a win-win for us all.
By Rachel Scher McLean / Posted on July 27th, 2017
Next week, visionary leaders will come together at the 2017 Pioneer Network Conference. The theme, ‘Be The Future’, is a powerful charge to change the way society views aging, and create a better world for elders and those who work closest to them. The goal of this conference is to showcase innovative thought and best practices in the long-term care culture change movement. The Green House model is featured throughout the conference, and the national initiative is leading two sessions, one on the value of short term rehabilitation with a Green House home, and one on Best Life for elders living with dementia.
Short term rehabilitation presents an opportunity to position an organization for the future. The small house model provides a consumer-driven experience that leads to positive outcomes. During the education session, The Green House Project will highlight The Woodlands of John Knox Village, an organization who has captured their market by utilizing The Green House model for short term rehabilitation. They will share how they achieve positive outcomes using functional rehabilitation in the home, establish credibility with key stakeholders, and positively impact their bottom line.
As the population of the United States ages, the prevalence of Alzheimer’s and related dementia is growing. Dementia was estimated to cost the United States more than $236 billion in 2016. To address this challenge, The Green House Project has developed Best Life, an initiative that aims to connect elders with life and community through the philosophical, architectural, and organizational elements of The Green House model. It requires dedicated teams, extensive knowledge of the types of dementia, and a fervent belief in the unique ability of every individual to enjoy a meaningful life.
The Green House Project is a proud leader of what is possible in long term care. This conference is a time to connect with like-minded visionaries. As the paradigm shifts to view elders as creative, resourceful and whole, their potential is unlocked, and we all benefit.
By Mary Hopfner-Thomas / Posted on May 12th, 2016
A recent Department of Justice investigation takes the state of South Dakota to task under the Americans with Disabilities Act for high utilization of nursing homes to serve people – old and young – living with disabilities. I found the story disturbing, but not for the reasons you might think.
This wasn’t the news we have come to periodically expect when something sensational happens. What really hit me was that the places described did not sound like bad apples. As far as was evident, there was nothing egregious. In fact, one might say the picture painted by the DOJ is that of a pretty typical, garden-variety nursing home.
By Rachel Scher McLean / Posted on February 10th, 2016
We are thrilled to congratulate, Ruta Kadonoff, former Green House Project team member, on her new role as Executive Director of The Pioneer Network. The Pioneer Network is an organization that was formed to support, advocate and enhance the work of individuals, organizations, regulators and policymakers who are creating a life-affirming, satisfying and meaningful culture of aging and long-term care.
“I am honored and excited by this opportunity to serve the Pioneer Network and advance its critically important work,” Kadonoff says in a press release. “I am passionate about seeing our vision and values fully realized and look forward to working hand in hand with innovators and individuals across the country who share this passion, who have come together in this unique gathering place for those of us unwilling to settle for the status quo.”
We look forward to opportunities to collaborate with Ruta and advance our shared vision and passion.
Thought Leaders in Aging Gather at the 2014 Pioneer Network Conference: THE GREEN HOUSE® Project Leadership Among Those Presenting
By Mary Hopfner-Thomas / Posted on September 4th, 2014
“Journey to the Heartland” was the theme for the 2014 Pioneer Network Conference held last month, and many indeed made the journey! Over 1,200 people made the trip to Kansas City for a chance to network and learn with others who are deeply committed to the cultural transformation of long term care. The Green House Project is a true trailblazer in this movement and we are strong supporters of the conference. Green House team members, David Farrell and Susan Frazier were presenters at two different sessions during this national event.
Nurses have a critical role to play in supporting deep transformation within aging services.
“Nurses Building Relationships for Organizational Transformation” was a session co-led by Susan and former Green House team member, Anna Ortigara who is now with PHI. Both Susan and Anna are nurses and can speak first-hand about nurses engaged in culture change. The session discussed the need to build effective communication strategies that will engage both the Elders and direct care staff members. The discussion also explored how nurses as leaders, partners, gerontological specialists and teachers are faced with many more opportunities to enhance quality of life and quality of care. The Green House model is designed to support Clinical Support Team Members, which includes nurses, in developing partnerships with individuals and self-managed work teams.
“THE GREEN HOUSE Model –Delivering Quality of Life and Bottom Line Results” was the special research session delivered by David to attendees. He confronted the myth that The Green House model is not viable—with over 150 Green House homes operating in 25 states, the innovators who adopted the model are happy with their consumer satisfaction and their bottom lines. David shared data from operating Green House homes that demonstrates an excellent return on their investment, and their decision to build even more Green House homes. He told the group that Green House homes are delivering the results that Accountable Care Organizations (ACOs) in health care reform are looking for today.
By Meaghan McMahon / Posted on August 28th, 2014
The theme of the 7th Annual Green House Meeting and Celebration this November in Memphis is Leading with Heart and Soul. We are excited to have both Dr. Bill Thomas and freelance journalist and author Beth Baker as our opening and closing plenary speakers, respectively. We caught up with Bill and Beth at The Pioneer Network’s 14th Annual Conference in Kansas City, Missouri to hear more about what Leading with Heart and Soul means to them.
“It means bringing passion into what you do, believing in it…” Dr. Thomas began, going on to say that we all have a moral imperative to help people find new ways to live in the community, including those living with frailty and dementia.
Beth agreed and added that leading with heart and soul is honoring a person’s desire for independence and autonomy as well as their need to balance this with strong relationships and connection to a greater community. For Beth this is what interdependence is all about and will be a key theme of her closing plenary.
“In Green House homes it is interdependence that defines the relationship between Shahbazim and Elders,” Dr. Thomas concluded. “People in each group need each other. Being a part of a community means that we need each other.”
Visit our Facebook page to see a video from this discussion and hear more from Bill and Beth at our Annual Meeting this November at The Peabody Memphis in TN. Green House adopters can register here: https://greenhouseproject.wufoo.com/forms/7th-annual-green-house-meeting-and-celebration/
By Meaghan McMahon / Posted on May 14th, 2014
We’re not surprised…but we are very pleased to hear that our colleague and friend Anna Ortigara is one of the four people selected this year to receive Long-Term Living Magazine’s 2014 Long-Term Living Leaders of Tomorrow award.
The award honors individuals who are “…making a difference in their towns and states while serving as exemplar model for others across the country” as leaders in the long-term and post-acute care field.
For the past six years Anna was the Resource Director for The Green House Project. She was a passionate and driven team member who played an integral role in developing our educational program including countless tools and resources.
Earlier this month, Long-Term Living Magazine published a profile of Anna and the incredible work that she has done over the years, including her work before Green House and the role she holds now as an organizational change consultant with the Paraprofessional Healthcare Institute (PHI). In the article, Anna talks about the importance of educating others about communication and team-based problem-solving skills and says, “I’ve come to really believe that using a coaching approach to leading change as the model or framework creates the capacity, the possibility of all the rest of the transformation for the organization.”
By Tara Cugelman-McMahon / Posted on November 15th, 2013
On December 5th, Carmen Bowman will be presenting a webinar on Tools to Operationalize the New Dining Practice Standards. The New Dining Practice Standards were released in August 2011 and thanks to the generous support from the Hilda B. and Maurice L. Rothschild Foundation, Pioneer Network convened a Task Force to develop the Dining Standards Toolkit. To register for this webinar, click here.
This webinar will: 1) summarize the new dining practice standards and how they support residents to eat the food they want to eat, 2) explain how the standards are backed by research, and 3) describe the tools that will be available to help operationalize the new standards.
Carmen Bowmen is the owner of Edu-Catering: Catering Education for Compliance and Culture Change. For 9 years, Carmen was a Colorado surveyor and a policy analyst with CMS Central Office where she taught the national Basic Surveyor Course. Carmen also co-developed the Artifacts of Culture Change tool and facilitated both CMS/Pioneer Network Creating Home national symposium, Culture Change and the Physical Environment Requirements and Culture Change and the Food and Dining Requirements, among many other accomplishments.
By Meaghan McMahon / Posted on September 9th, 2013
Last month, at the Pioneer Network 2013 Conference, a session entitled “Networking Elders to Provide Them with a Greater Voice,” engaged audience members by inviting Elders themselves to talk about their peer networking and advocacy work. These Elders were introduced as members of an organization called “Seniors Aid New Hampshire” (SANH). They are a community of Elders that live in Nursing Homes, Assisted Living and Independent living settings throughout their state. With the help of a conference call line, they have joined together each month over the past seven years to host senators, state representatives and members of government agencies in addition to advancing their own community organizing and advocacy agenda. As a result of their organizing, these Elders even provided video testimony in a Senate Committee hearing regarding medication administration.
SANH began in the summer of 2006, when Elders living at different Nursing Homes and Assisted-Living communities in New Hampshire determined that it was “unacceptable for people to go to bed hungry.” The group was assisted by the New Hampshire Health Care Association in creating a forum for fund-raising and communication to occur. In the early years this group called themselves “Seniors Feed New Hampshire” and in the first year alone raised $42K to assist the New Hampshire Food Bank. In later years the group gained momentum, changed their name and began to focus on other areas of interest that provide opportunities for meaningful resident work and creating communication between Elders living in different long-term care residences across the state.
The session at the Pioneer Network Conference was facilitated by Darlene Cray, a Long-Term Care Ombudsman and Statewide Volunteer Coordinator in New Hampshire and Mark Latham, Administrator of Pleasant View Center, a Nursing Home in Concord, New Hampshire. In addition to the panel of SANH members, Kathleen Otte from the Administration for Community Living also joined by phone, as well as Jennifer Hilliard, Public Policy Attorney from Leading Age and representatives from Senator Larsen’s office. During the session, Darlene Cray reminded attendees that “When we focus on the ability of the individual, we see Elders.”
The American Healthcare Association and National Center for Assisted Living (AHCA/NCAL) named Seniors Aid New Hampshire as their 2012 National Group Volunteer of the Year.
By Rachel Scher McLean / Posted on July 23rd, 2013
The Pioneer Network is a group, formed in 1997, with the charge to convene person-centered advocates, providers and consumers to create change in long term care, “We believe that the quality of life and living for America’s elders is rooted in a supportive community and cemented by relationships that respect each of us as individuals regardless of age, medical condition or limitations. ”
On August 11-14, in Bellvue, Washington, the 13th Annual Pioneer Network Conference will be held, with the theme, “Hear the Voice, Honor the Choice”. The Green House Project has long been a leader in this movement, and very involved in this organization. Team members, David Farrell and Anna Ortigara serve on the board, and The Green House Project is a regular sponsor and speaker at the conference.
This year, our presentation, “Meaningful Lives, Empowered Staff, Strategies for Real Transformation: THE GREEN HOUSE® Project“, will delve into workforce transformation, and how the comprehensive changes of the model, create powerful outcomes for elders, staff and the organization. We will be joined by Jaime’s Place, a Green House project located in Winthrop, Washington. There is nothing like hearing stories and experiences directly from the people who are living and working in the model everyday.
The Pioneer Network conference brings people together to deepen this social movement of culture change in long term care. Together we will change the way that the world views aging by “working towards a culture of aging that supports the care of elders in settings where individual voices are heard and individual choices are respected”.
By Anna Ortigara / Posted on June 24th, 2013
The Pioneer Network once again is calling. The annual conference held each August has become tradition for many who are deeply committed to cultural transformation, and also serves as a big brother/sister for those just starting the journey. It’s a place of kindred souls, of networking, of listening and of sharing about person-directed living and transformation. Old and new friends gather to build roots into the transforming world. The aura of the conference is almost legendary— beyond all the learning opportunities folks report a magical renewed resolve, merely by being present and absorbing the energy and passion found there. So come join the transformation as we explore this year’s theme, Hear the Voice, Honor the Choice. We’ll be meeting in the beautiful northwest this year—August 11-14 in Bellevue, WA. www.pioneernetwork.net
Resource Director, The Green House Project
President of the Board, Pioneer Network
By hmarshall / Posted on August 29th, 2012
It is hard to believe there is a group of older adults who are less likely to use health services, visit their local senior center and be open about their lifestyle when living in a nursing home or assisted living facility. However, this is the reality for most older adults who are Lesbian, Gay, Bisexual and Transgender (LGBT).
Kate Waldo, Project Guide at THE GREEN HOUSE ® Project discussed this issue at The Pioneer Network 12th National Conference in Jacksonville, Florida. She talked about ways aging providers can improve services and support for LGBT older adults. To say support for this population is inadequate would be an understatement. So why is this happening? There has been a long history of discrimination, stigmatization and persecution of this population. The LGBT older adults we are currently serving have lived through heinous treatment, from electric shock therapy as the standard “treatment for homosexuality” to losing their jobs and children for being gay. It is no wonder many individuals have waited until late life to come out or continue to hide it.
As health care providers, we cannot be satisfied with services that are not meeting the needs of one of the most vulnerable populations. To learn more, contact the National Resource Center on LGBT Aging.