Green House Blog

Learning From David Pearce

Eleven years ago, I came to work at the Gardens. At that time David Pearce had already been here 17 years. I knew from my first interview with him that he would make a great boss. During the interview he suddenly remembered something and with my permission, he called the Grounds Dept. to alert them to some leaves that needed removing outside a resident’s window. I was astonished. Here was the Administrator who knew of a particular concern of a resident, cared enough to call about it and reported it using the resident’s name. He knew these residents.

Within a week or so of my first day on the job, David was leaving for a 3 week vacation. When I asked him what he wanted me to focus on while he was away, he said: “I think you should just take time to get to know the residents.” I secretly thought, great, what will I do in the remaining 2 and ½ weeks once I’ve done that? After my arrogance wore off I did exactly as he suggested and it turned out to be a great directive that helped me learn about life at the Gardens and see many things I would’ve missed had I been given a long task list.

Shortly after the return from his vacation, David and I met to talk more about the Wellness Program and he confessed to me that he had a reputation as a micromanager but that he was aware of it and was reforming his ways. Furthermore, he told me I was welcome any time to tell him if he was interfering too much with my work. It was a great equalizing gesture that he repeated many times over the years by giving me permission to disagree with and correct him. He has taken this to the nines when we began working on Green House development and it became clear that his role is to make sure we satisfy regulations that often reinforce institutional practices and my role is to make sure we are true to the model, which often challenges those practices. Instead of letting this create conflict he routinely calls upon the Green House metaphor of the Dragon (institutional practices that put task before person) and, with no ego and much humor, has invited me to be a bold Dragon slayer. Since David announced his retirement I have been reflecting on these and many other interactions with him. The following are highlights of what I have learned from David Pearce:

  • Be Proactive. David is almost famous for this phrase. He encourages staff to call people when answers are needed instead of stewing over the next step.
  • Updating and informing people helps things run smoothly.
  • Build relationships – whether it’s state regulators, residents or fellow staff, taking the time for relationships is always a wise investment.
  • Take Vacation when you can – don’t stockpile it, it’s meant to refresh you.
  • Invite the opinions of others. I used to call David often about Wellness Program development and his almost inevitable response? Why don’t you call this resident or that staff member and see what they can tell you about this. Eventually I cut out the middle man and went directly to the sources.
  • Model what you expect.
  • Invite people to partner with you in your self-improvement – It’s easier to refine yourself if you have helpers.
  • Tell people you trust them David said. He trusted me so often when I didn’t trust myself that I actually started trusting myself.

It has been my privilege to report to such a fine leader. He has reflected back my strengths when I had self-doubt, given wise council judiciously, and challenged me to grow by reminding me over and over again that mistakes are part of the journey.

Thank you David, I will miss you.

The Green House Project would like to thank David Pearce for being a champion of bringing this model of Long Term Care to California, and wishes him luck in his retirement.  We are looking forward to seeing “what’s next”! 

The Pioneer Network Conference: Hear the Voice, Honor the Choice

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

-Anna Ortigara

Resource Director, The Green House Project

President of the Board, Pioneer Network

Empowered Staff Video: Celebrating 10 years of The Green House Project

In The Green House model, the core value that contributes most significantly to a deep and sustainable transformation is “Empowered Staff”. The hierarchy of the organization is flattened to bring power into the home, with the elders and those working closest to them. This group of direct care staff, who have a base education as  Certified Nursing Assistants and then receive 128 hours of additional training, become Shahbazim, an honored and valued group who work in self managed work teams to protect, sustain and nurture the elders. The self managed work team reports to a Guide, and partners with a Clinical Support Team to provide individualized and holistic care with the elders. The Green House Project provides over 200 hours of education across the organization to develop coaching leaders in an environment where Elder’s Rule!

Check out this video to highlight how the Core Value of Empowered Staff!

AARP Foundation Invests in Green House homes

Contact:

Hillary John

(202) 434-2560 | media@aarp.org | @AARPMedia

AARP Foundation Invests $2.5 Million in Innovative Housing Strategies to Help Vulnerable 50+ Population

Washington, D.C. – AARP Foundation is pleased to announce $2.5 million in investments to fund three housing organizations that serve the vulnerable, 50+ population. The Foundation’s new impact investment instrument will serve as a valuable funding source for these organizations while at the same time spark housing solutions for low-income people age 50 and older. Each investment will create or preserve homes for residents who are measurably low-income and over 50 years of age.  The investments will leverage market-rate financing to multiply impact.

AARP Foundation’s Program Related Investment (PRI) aims to create new models of housing that are scalable and replicable; that result in an increase in affordable and adequate housing to fill the gap in surrounding rural housing and rental housing; and finally, to increase the number of affordable and/or adequate units of housing.

“As people age, their need for safe and affordable housing grows more critical.  For vulnerable older Americans housing upkeep is a challenge to maintain, particularly in these tough economic times,” said AARP Foundation President Jo Ann Jenkins. “By utilizing this ‘new’ instrument of impact investment, AARP Foundation will be a catalyst for organizations to leverage these funds and make sure more families can find a way back to stability.”

At least 13 million people who live in low-income, 50+ households struggle with unaffordable and/or inadequate housing.  The Housing Impact Area of AARP Foundation seeks to win back opportunity for the struggling 50 and older population by helping to preserve adequacy and affordability within current homes; increasing the supply of adequate and affordable housing; raising awareness of housing needs of the low-income 50+ population; and building thought leadership ideas on the subject through various research techniques.

The national organizations that were selected by AARP Foundation include the following:

·   NCB Capital Impact will use the investment from AARP Foundation to bring to scale The Green House Project’s innovative nursing care model, which offers an alternative approach to the traditional nursing home. Elements of Green House homes including their small scale, unique staffing model, and home-like layout, restore the dignity and sense of wellbeing to elders in need of nursing care.  This model is very exciting because of the potential for broad-scale market adoption across a variety of geographic and demographic markets, as well as a wide range of income levels. The AARP Foundation funds will bolster support to The Green House Project, also generously supported by the Robert Wood Johnson Foundation and the Weinberg Foundation.

·      An investment with Enterprise Community Loan Fund, Inc., to help fill the financing gap in the creation of affordable rental housing, rural housing and livable communities with a focus on low-income seniors. In addition to housing, Enterprise also invests in federally qualified health centers to provide and expand community-based health services for low- and moderate-income individuals.

·      The third organization, ROC USA®, will use the AARP Foundation investment to empower owners of manufactured homes, a vulnerable and aging group, to cooperatively purchase the land on which their homes are located.  This serves a unique but growing niche in that manufactured housing is the largest source of unsubsidized affordable housing in the country.  www.rocusa.org

“All of these projects aim to build, retrofit or purchase safe and affordable housing that not only helps older residents avoid high housing cost burdens, but also addresses their need for community either by helping them age in place or create a new community based a non-institutional model,” added Jenkins.

 About AARP Foundation

AARP Foundation is working to win back opportunity for struggling Americans 50+ by being a force for change on the most serious issues they face today: housing, hunger, income and isolation. By coordinating responses to these issues on all four fronts at once, and supporting them with vigorous legal advocacy, the Foundation serves the unique needs of those 50+ while working with local organizations nationwide to reach more people, strengthen communities, work more efficiently and make resources go further. AARP Foundation is AARP’s affiliated charity. Learn more at www.aarpfoundation.org.

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THRIVE: The Research Initiative Valuing Eldercare

 

 

 

The Green House Project has partnered with the Robert Wood Johnson Foundation’s THRIVE (The Research Initiative Valuing Eldercare) collaborative to learn more about the Green House model as well as other models of care. Supported by the Robert Wood Johnson Foundation, the THRIVE team is conducting a series of interrelated research projects that together will comprise the largest research effort undertaken to date in Green House homes. Each month, a member of the THRIVE team will contribute a blog post to the Green House Project website.

Why is the Minimum Data Set so Important for Research?
The Minimum Data Set (MDS) – nothing very “minimum” about it! – was developed to monitor and improve the quality of care in nursing homes. Nursing home staff use it to develop resident care plans, and the information is used more widely to develop quality measures and resource utilization group case-mix reports. Indeed, the MDS is the source of the quality information on the Federal Nursing Home Compare website (www.medicare.gov/nhcompare).

What many nursing home staff don’t realize is that MDS information is tremendously useful for research. After all, it’s not often that a mandate exists to report on the status of over 400 data elements for roughly 1.5 million people across 16,000 settings on a regular basis, is it? Beyond purposes of oversight, this information provides a tremendously rich data set to understand the needs of older adults who receive nursing home care, as well as how their needs change over time, and differences in the care they receive across different homes and regions of the country.

Of course, some information in the MDS is more useful for research than other information. A number of items create “standardized” scales, such as those that compose the Brief Interview for Mental Status (BIMS), or the depression scale from the Patient Health Questionnaire (PHQ-9). Before being included in the MDS, these scales were tested to assure they are of research quality in terms of how reliably and validly they actually document mental status and depression. Other scales have since been created from the MDS items, such as one summarizing resident function, and tested for research-quality.

Hundreds of research studies have been conducted with MDS information; in fact, a literature search found almost 800 such studies! The focus of recent research relates to differences in incontinence by race, the relationship of fracture risk to antipsychotic medication use, and the relationship between resident pain and behaviors; clearly, research such as this and others is helpful to inform practice and policy.

The THRIVE team will be using MDS information in multiple ways. It will be used to inform the quality of care for residents, how it varies across participating sites, and how it changes over time. This information also will allow us to “control” for resident differences so we can better understand similarities and differences in care provision that are not related to differences in the resident population. In this way, the MDS is a powerful tool to help us all understand and predict the care needs of the people served in nursing homes.
Questions about THRIVE can be directed to Lauren Cohen (lauren_cohen@unc.edu or 919-843-8874).

Jewish Senior Services Tikkun Olam: Repair the World, Celebrate World Elder Abuse Awareness Day, June 15

The Green House Project is honored to highlight a blog from Jewish Senior Services in Fairfield, CT.  This organization’s innovative work to support and protect the most vulnerable elders, has already made an impact on the local and national stage. 

June 15th is the eighth annual World Elder Abuse Awareness Day ; a day we have observed at Jewish Senior Services for the past six years after opening the first long-term care based shelter in Connecticut. As we work every day to provide dignity and independence in a caring environment, a mission The Green House Project shares, we have also witnessed humbling examples of the barriers seniors face to receiving adequate care in other settings.  Through these experiences, we have learned how an aging service provider can play a crucial role in reducing those barriers.

At Jewish Senior Services, Tikkun Olam, which means “repair the world”, has always been a guiding core value of our mission. Our skilled nursing facility has served victims of elder abuse throughout our 40 year history, but prior to establishing our Center for Elder Abuse Prevention, we never formally recognized our role in that care.  Because we are often the primary or sole source of support for our country’s older adults, I firmly believe that all senior service agencies have an obligation and unique opportunity to practice Tikkun Olam.

Marta’s Story

The adult day center that Marta attended had been worried for over a year about the appearance of occasional bruises. Despite suspicions and inquiries, staff walked a delicate balance of attributing the marks to accidents and suspecting Marta’s niece, the caregiver, of abusing her elderly aunt. When Marta arrived one morning with a bloody broken nose and a painful-looking bruise on the back of her head, staff suspicions were confirmed. Due to advanced dementia, Marta was unable to remember how the injury had occurred. Social workers, doctors, police and emergency room personnel knew they could not send Marta home until an investigation had been conducted and her safety could be ensured. Our Center, the only specialized resource in the state, stepped in to secure emergency, confidential shelter and appropriate services to Marta in her time of need.

Expanding the Scope

As we serve more clients and learn more, our scope of services has expanded. We have staff expertise across our organization that contributes to these services. We’ve grown from a safe haven to providing education and advocacy throughout the state and across the country. Ultimately, the Center seeks to empower older Americans and their allies through education, outreach and services. Since our inception in 2007, the Center has provided:

  • 290 consulations to victims, professionals, friends and family members
  • 848 hours of service to 72 care management clients
  • 19 geriatric assessments, primarily for probate and criminal court proceedings
  • Shelter to 14 clients, who stayed in safe haven a total of 1,258 days
  • Training to 2,604 health, justice and human service professionals
  • Education and outreach to 714 seniors and other community members
  • Lectures at National Association of Area Agencies on Aging conferences across the country, as well as testimony before the Connecticut General Assembly and
  • Local, state and national leadership on the issue of elder abuse and elder rights.

 We are all on a shared journey to deliver a higher level of care and quality of life for adults as they age. Toward this end, I ask you to consider honoring World Elder Abuse Awareness Day. What can you do as an organization to recognize the day and help prevent elder abuse? Together we can work to reduce needless suffering and death among some of our nation’s most vulnerable citizens.

 

 

To learn more about WEAAD, visit the Administration on Aging website for resources and links: http://www.aoa.gov/AoA_programs/Elder_Rights/EA_Prevention/weaad.aspx.

To join the network of elder safe haven providers and learn more, visit the newly formed SPRiNG Alliance website at: http://www.spring-alliance.org/.

 

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Contact: Laura Snow

203-365-6403

 

The Center for Elder Abuse Prevention is a grant-funded program of Jewish Senior Services (the new name of the Jewish Home in Fairfield) that opened in September 2007 to assist victims and reduce the prevalence of elder abuse. Serving seniors across Fairfield County, the Center provides clients with an array of services, including safe, confidential emergency housing. Its work is supported by matching grant from the Robert Wood Johnson Foundation, as well as, the Near & Far Aid Association, The Southwestern Connecticut Area Agency on Aging, the Town of Fairfield, and private donors.  For more information on elder abuse, contact the Center at 203-396-1097.

 

Raising Awareness about Elder Abuse

June 15th was  World Elder Abuse Awareness Day.  Elder abuse is described by the Administration on Aging as any knowing, intentional or negligent act by a caregiver or any other person that causes harm or serious risk of harm to a vulnerable adult.  This can take the form of physical abuse, emotional abuse, sexual abuse, neglect or exploitation.

In a recent studies, 7.6%-10% of elders reported abuse in the prior year.  Only about 1 in 14 cases actually reaching the attention of authorities.  This means that the number of known elder abuse incidents is just the tip of the iceberg.  Abuse can also affect elders living in nursing homes.  In a study that interviewed 2,000 nursing home residents 44% said they had been abused and 95% said they had been neglected or seen another resident neglected.

Elder abuse can affect any elder, so it is up to everyone to raise awareness about elder abuse and reach out to elders who may be abused.  You can be a part of the solution.  Learn more about how to identify abuse here and how to report suspected abuse here.

In my experience as an Elder Abuse Caseworker, I saw first-hand how difficult it can be for an elder to leave an abusive situation and regain control of their life.  Elders are most commonly abused by those closest to them, their family and caregivers at home or in long-term care.  When an elder feels isolated, this can be even more difficult.  Often, the abuser is the only social support in an elder’s life.  The Green House model creates deep knowing relationships among elders, shahbazim and staff.  For many elders, the promise of a real home without abuse could be the first step away from abuse.

Reflections from the Director: Changing Times / Changing Measures / Changing Behavior

Changing performance metrics can catalyze a dramatic improvement. I recall the story of Walgreens in the book “Good to Great” by Jim Collins. Collins and his research team describe Walgreens as nothing more than a sleepy retail pharmacy chain that limped along for years before a dramatic rise to great results that lasted for over 15 years. The researchers examined what triggered the change and discovered that Walgreens had deviated from the industry norm of measuring their performance. All retail pharmacies, including Walgreens before their rise to greatness, had used one key performance metric to measure their performance – revenue per square foot per store. When Walgreens began measuring their own performance with a new measure – revenue per customer visit – their dramatic acceleration began. Gradually, all other retail pharmacies followed suit and began to use this new performance metric and it changed the retail pharmacy industry forever. The change in this one performance metric led to new systems, improved staffing and re-designed stores. In fact, when Walgreens reset their measure they set a new goal. The goal was $40 per customer visit. My wife consistently exceeds that goal.

In the Skilled Nursing profession, for over 45 years, we have all measured our performance by, generally, a single measure – our annual department of health inspection results. Recently, my Dad shared with me a newspaper article that described 5-Star nursing home closing its’ doors in Massachusetts and the article kind of shook me up. After all, the whole intent of the 5-Star rating system is to drive consumers to the best performing SNFs. So…why do 5-Star homes close and 1-Star homes remain full? Perhaps the 1-star home is actually a better performer than the 5-star home. The answer lies outside of our one key performance measure.

The metrics of SNFs are shifting – and this bodes well for the profession as a whole. Two performance measures are taking hold that will surely help to separate the star performers from the rest of the pack. The two we are speaking of have been hammered away at the nursing home professionals nationwide – reduce or eliminate the off-label use of antipsychotics and reduce the avoidable re-hospitalizations. Just like Walgreens, the improvements in these two measures will require improving the systems of care, enhanced staff composition and competence, and changing the physical environment of SNFs.

Reducing or eliminating the off-label use of anti-psychotics triggers providers to get serious about delivering person-centered care. Organizations will need to reduce their C.N.A. to resident ratios and de-institutionalize their physical environments (and we are not talking about simply new wallpaper). Enhancing the competence of the entire staff through a significant increase in education hours that are focused on caring for those living with dementia will be foundational to their success.

Reducing re-hospitalization rates leads SNF leader’s to raise the bar on increasing clinical competence and adding talented and compassionate RNs to their staff. Also, this new measure forces leaders’ to re-examine their turnover rates and absenteeism because staff instability does not allow for consistent assignment and diminishes communication. Clearly, the health of the relationships among the staff of each SNF is reflected in their re-hospitalization rate. Therefore, better systems of communication and new job descriptions are needed to strengthen staff relationships. Today, many providers can see that their current physical environment – an average of 85 elders living together in tight quarters, shared rooms, shared bathrooms, shared shower rooms – is perfectly designed to spread infections among the elders and staff. Private rooms with private baths and showers for each elder will become the new norm. A smaller and better designed environment is critical to both clinical outcomes and a dignified quality of life.

Of course, a SNF’s performance on their annual department of health inspections is important and always will be. It has to remain a key measure with the other 5-Star metrics. Examined next to a SNF’s performance on these two measures will provide consumers, operators, surveyors and policy makers a way to more clearly identify where elders should flock to for their care.

Media Coverage of The First California Green House project

There was such a buzz created by the dedication and celebration of Mt. San Antonio Gardens, the first Green House project in California. It seemed fitting to share the list news outlets that covered this event, with many more who reposted and amplified the message.

Coverage

Leading Age California

March 2013

Green House Comes to California

Inland Valley Daily Bulletin

June 3, 2013

California’s First Green House homes Open, Ushering in New Kind of Nursing Care

Grantmakers in Aging

June 1, 2013

Evergreen Villas in Claremont offers new model of senior living (Cross-posted on Contra Costa Times, SGV Tribune and InsideBayArea.com)

Claremont Courier

June 1, 2013

Larry Wilson: A restful rest home? You’re talking ’bout my generation (Cross-posted on Pasadena Star and SGV Tribune)

May 29, 2013

A New Type of Green House

McKnight’s Long Term Care News

May 29, 2013

First Green House homes in California

Inland Valley News

May 23, 2013

California’s First Green House® Homes Open, New Era of Nursing Home Care

Pending (interviews completed)

California Healthline, Stephanie Stephens

Leaving to Go Back: Al Power and the St. John’s Home Green House Project

When Al Power was in med school and specializing in geriatrics, he would visit his grandmother in a nursing home. During one these visits, he noticed the nameplate on her door; the last name, “Power” had an “s” at the end of it.

“It was a note to me,” he said. “Of how anonymous she was.”

To Al, such anonymity wasn’t an issue unique to that particular nursing home — it was in the corners of every traditional nursing home. It is evident whenever elders are pushed into an institutional setting and away from their families. Away from the libraries. Away from neighbors. Away from the coffee shops. And away from the streets they know.

In other words, away from the community.

Al Power and The Green House Project are bringing elders back to a space where they know the greater community and the community knows them. It is a space that allows for growth, both for the people who serve elders and the elders themselves.

Eventually, Al left geriatric medicine, but he didn’t leave behind his passion for serving elders — not by a long shot. Even before he had left his practice he had already started working with St. John’s Home in Rochester, New York, and had learned about a new movement to revolutionize elder care embodied and supported by The Green House Project.

The Green House vision was the perfect marriage of the physical and operational change along with the philosophical change we really needed to move elder care forward,” explained Al.

“We talk about trying to create independence,” he continued. “But so many of our systems create dependence, make people shut down and feel incapable. I realized how a normalized environment can really liberate those people.”

Now Al Power and the team at St. Johns are focused on normalization. His goal is to maintain the same kind of life for elders in nursing homes as the one they had before they arrived. To do that, St. John’s took the real home concept of the Green House model one step further.

While many Green House adopters had built smaller, person-centric homes to replace the larger institutional-type buildings on their campuses, Al and his team wanted to build their new homes in existing residential neighborhoods. They wanted to bring elders out of isolation, back into multi-generational communities, where they could go to the local gym and the library and walk down the same sidewalk as other people.

Many nursing home executives try to save costs by having a central campus as a base of operations. St. John’s, in effect, wanted the exact opposite; they wanted to decentralize.

Although individual licensing of resident Green House homes proved to be an obstacle with the Centers for Medicare and Medicaid Services, the Green House Project helped resolve conflicts, brought everyone together, and helped St. John’s succeed in desegregating elders from the rest of the community.

In 2012, St. John’s became the first Green House adopter in the nation to locate individual Green House homes in the community. They built two houses, eleven miles away from their campus, in multi-generational, diverse neighborhoods. And it worked.

“When we saw the results,” said Al. “We were even more convinced that it was the way forward.”

________________

Al Power and everyone on the planning team knew that the St. John’s Home Green House Project would have success stories; they just didn’t know the stories would already be written before the homes even opened.

In preparation for opening day, the St. John’s staff invited family members, elders, and

people from the community to come have lunch. At one table, there was an elder, who Al recognized, sitting with his family. Al also knew that the man needed help from people to lift him up from one chair to another at his traditional nursing home.

Al ended up joining the man for lunch. When they finished their meal, the staff brought over the elder’s wheelchair. But before they could assist him, the man got up and got into the chair — by himself.

When one of the staff asked him how he did it, he said. “I don’t know, I guess over there I’m supposed to be sick.”

Al and the entire team at St. John’s have learned to expect more of the elders they serve. And by raising the bar for long-term services and supports in the community, they are inspiring providers everywhere to expect more of themselves.

Advances in Person-Centered Dementia Care

In 2001, the Institute on Medicine released a seminal report titled “Crossing the Quality Chasm” that called for a redesign of the nation’s healthcare system and described healthcare in America as impersonal and fragmented (IOM, 2001). The report noted that a critical element needed in redesigning the healthcare system was a shift to person-centered practices. These practices are rooted in humanistic psychology and the work of Carl Rogers and Abraham Maslow among others. Unfortunately, little progress has been made in the past dozen years to transform systems and practices to support person-centered outcomes. Recently, a group of concerned national dementia care experts decided to focus on advancing person-centered values and practices for dementia care.

Several significant events occurred in 2011 that catalyzed the gathering of this group of diverse dementia care experts representing the practice, policy, and research sectors to form consensus on a definition and conceptual framework for person-centered dementia care. This initiative is known as the Dementia Initiative. In early 2011, President Obama signed the National Alzheimer’s Project Act (NAPA) into law. Part of the law mandated the formation of an advisory council to make recommendations to the Secretary of the Department of Health and Human Services on actions to expand and coordinate programs to improve the health outcomes of people who have dementia. NAPA was viewed by many dementia care experts as an opportunity to spotlight and advance the implementation of person-centered dementia care practices. Sadly, NAPA’s primary focus has been on the ‘cure’ aspects of Alzheimer’s disease. The little focus given to dementia ‘care’ has been silent on person-centeredness.

In late 2011, the U.S. Senate Subcommittee on Aging held a hearing focused on the overutilization of antipsychotic medications for nursing home residents with dementia and the need for alternative care strategies other than automatically giving antipsychotic medications for what are perceived as behavioral challenges exhibited by people who have dementia. These behaviors are often expressions of unmet needs such as pain, hunger, thirst, boredom, loneliness, or an underlying medical condition that a person who has dementia is challenged to verbally communicate to a care partner or to address him or herself. Person-centered practices, considered the gold standard by the IOM and the World Health Organization (WHO, 2012), are oriented to the person and thus understanding and addressing the cause of the behavior being expressed.

A person-centered model of care reorients the medical-disease model of care that can be experienced as impersonal and fragmented to one oriented to holistic well-being that encompasses all four human dimensions – bio-psycho-social-spiritual. Person-centered care recognizes this multi-dimensionality dynamic and reorients practices to be delivered in a manner that is positively experienced which, in turn, helps promote holistic well-being.

A recently published article in Health Affairs describes person-centered care from one individual’s experience. While the example describes the experience of someone with a mental illness and not dementia, if a person who has dementia could publish an article in a national publication, they would likely echo this person’s sentiment. Ashley Clayton, a Yale University researcher, suffered for many years in her teens with mental illness. In the article, she describes the care she experienced when hospitalized and how receiving care in a person-centered manner helped her immeasurably. “The nurses got to know me and could support me in ways that were personally meaningful…These might sound like little things – a soda, an art project, a few minutes spent talking…Nothing they did cost extra money or required intensive training, but the fact that they saw me as a person – and treated me like one – helped restore my dignity and sense of personhood” (Clayton, 2013).

The diverse Dementia Initiative experts gathered for a one-day meeting in Washington, DC in June 2012 to form consensus about the definition and conceptual framework of person-centered dementia care. Discussions and email exchanges continued over the course of the next six months. In January 2013 a white paper titled “Dementia Care: The Quality Chasm” that provides the consensus definition and framework for person-centered dementia care was published. The white paper can be accessed online at http://www.ccal.org/national-dementia-initiative/white-paper.

There is no better time for our nation to “cross the quality chasm” for dementia care as NAPA and other national dementia initiatives provide timely pathways to spotlight and transform systems and practices of care to person-centered ones. Successfully evolving to person-centered dementia care practices will require the efforts of all stakeholders including individuals living with early stage dementia, family members and other care partners, healthcare practitioners, long-term care service and support providers, consumer advocates, policy-makers, researchers, funders, regulators, academicians, and scholars among others. The Dementia Initiative white paper provides the blueprint to transform dementia care values, systems and practices in this country to person-centered ones. With 5.4 million Americans living with dementia today and the number projected to increase three-fold by 2050, there is not a moment to lose.

Karen Love is a former speech therapist and long-term care administrator with more than 25 years of experience operationalizing and advancing person-centered practices in all long-term service and support settings. Ms. Love has been co-investigator of numerous research projects to study the effects of and advance knowledge and evidence about person-centered values and practices. Karenlove4@verizon.net

References
Clayton, A. (2013). How ‘person-centered’ care helped guide me toward recovery from mental illness. Health Affairs, 32(2): 622-626.

Institute on Medicine. (2001). Crossing the quality chasm. Washington, DC: Institute on Medicine.

World Health Organization & Alzheimer’s Disease International. (2012). Dementia: A public health priority. United Kingdom: World Health Organization.