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Indiana FSSA Division of Aging Issues Updates to e450B Process
'Why' I Originally Chose to Work in Long-Term Care
ISDH Publishes Update to Advance Directives Brochure
CMS QAPI Material Rollout for Nursing Homes
National Nursing Home Week - Team*Care - 10 Simple Ways to Work as a Team


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'Why' I Originally Chose to Work in Long-Term Care

A few days ago, Denise B. Scott, published a blog post entitled "Do You Remember Why You Do What You Do?".  If you haven't read it, I would encourage you to do so.  And while you're there, subscribe to her 'Ideas to Inspire'.  I look forward to her posts every few weeks and they certainly help keep me inspired.  

'Why' I Originally Chose to Work in Long-Term Care - Simmons Healthcare Consulting, LLC - www.simmonshc.comMy “why” – For those of you that know me, you have most likely heard me tell my ‘why’ story.  The short answer is because of my grandmother and originally, location.  For those who haven’t heard it, here’s the long but meaningful reason I do what I do. 

Growing up on the farm, we shared a double-house with my grandmother.  I saw her every single day.  On weekends as a child, Grandma would say to me (and please don’t take offense, but these were her words), “It’s time to go visit the old ladies at the home”.  And off we would go to the local nursing home.  Until I went away to college, I went with her to the small 60-bed facility.  We typically would spend the afternoon, visiting with her friends and family members that resided there.  When I was younger, I recall running up and down the hall, most likely causing havoc and irritating the nurses.  As I got older, I began visiting with other residents while Grandma would still be in her friends’ rooms.  They would share stories that fascinated me (and still do).  I would see rooms absolutely packed with all of their belongings.  A lifetime of mementos crammed into such a tiny space, each item so valuable to them.  They would tell me the history behind the items and why the particular piece meant so much to them.  They would tell me tales about the people in their photos, usually family members who had often been influential in their lives.  The men would share favorite and not-so-favorite memories of their former jobs and military experience.  The ladies would share their favorite meals to cook, humorous stories of their children, and how they would make the grocery budget last all week.  I remember thinking that those residents seemed to be just aching for someone to listen.  They had an identity and still wanted others to realize who they were.  This was the 1970s and early 1980s; that wasn’t a prevailing concept during that time.  The medical model was all staff knew.

Fast forward to the late 1980s and early 1990s - Grandma got Alzheimer’s disease. For many years, she’d still visit the ‘old ladies’, but would need someone to drive her.  When I was home, that was my duty. I tended to not always stay the whole time, but would go in for at least a while.  I’d see the same residents each time, sitting in the front lobby by the aquarium, lined up at the nurses’ station, or sitting somewhat lifelessly in the hallway staring out into space.  The same rooms with belongings practically spilling into the hallway.  Bingo being conducted in the dining room. For some reason, as I became a teenager, what was fun to do as a child now seemed to be rather depressing.  As we’d get into the car after each visit, Grandma would always say the same thing to me – “Don’t ever let them put me in here”. 

My parents cared for Grandma at home for many years - hiring caregivers, rearranging their lives to keep Grandma safe and comfortable.  On one occasion, they needed to go out of town and arranged for Grandma to have a respite stay at the nursing home. Upon my parents’ arrival home from their trip on that Sunday afternoon, they discovered my grandmother sitting on her back patio. She was, of course, supposed to still be on her respite stay at the nursing home.  No one in the family had any phone calls from the nursing home.  No notice stating that Grandma was missing.  So we didn’t call them either.  Mom simply went into the nursing home and told them she was there to discharge Grandma.  The nurse very obviously thought Grandma was still there and went to get her.  After the staff began to realize that Grandma was missing, Mom confided that she was already at home.  We were able to discover that a family friend had been visiting a loved one at the facility, saw Grandma, assumed she was doing her weekly visits, thought he’d save someone a trip into town to get her, and offered to take her home.  Of course, Grandma said yes.  

When the time finally came that Grandma’s disease had progressed in such a way that my parents simply could no longer care for her safely at home, they emotionally moved her into a small private family home with 3 other older ladies.  The owner of the home and her family members cared for Grandma until her death in February 1995.  It wasn’t necessarily the prettiest environment; it most likely would never have passed a nursing facility’s ISDH/CMS inspection; and definitely the home would not have gotten through OSHA.  But Grandma was comfortable there, my parents honored her wishes, and the owner/family obviously cared about her and kept her safe. 

Prior to Grandma’s death, in 1994 I graduated from college.  With the feelings that most early 20-year-olds have, I was ready to conquer the world, but had no real idea what was ahead.  A high school friend was working in medical records at the ‘new’ nursing home in town and said that there was an opening.  It was about a mile from my house and within 3 blocks of my child-care provider and nursery school.  I took it as a sign.  I became the Director of Social Service/Admissions/Marketing in 1994.  I was determined to never forget my childhood memories of visiting the “old ladies in the home”.  Never to forget that Grandma obviously hated what she witnessed each week so much that she made sure we all knew she didn’t want to live there herself.  Never to forget the feeling of seeing residents staring out into space, their cramped rooms, their need to have an identity and tell their stories.  Never to believe that the prettiest facility is the best, that caring and compassion are much more important.  And never to forget how mentally hard the decision was for my parents to move my grandmother off the farm. 

Except for the family farm, nursing homes continue to be my favorite place to be.  I think of Grandma with every visit.  And I believe that taking me with her was the greatest gift I ever received.  Making visiting our elders a normal act is a priceless gift we should all give our children.  After 19 years in the industry, we have come a long way from what I witnessed in the 1970s.  I look forward to the day when the regulators realize that enabling/encouraging staff to take time to listen to stories and being able to know the residents’ identities is much more important to their quality of life than some of the regulations and would ultimately improve quality of care.  Most families would rather have someone listen to them for 5 minutes than spend that time posting the required staffing sheet that virtually no one reads.  I still feel that we can continue to improve care for our elders – one day, one person, one change at a time. 

What is your “why”? I look forward to hearing why you do what you do!

Does your Social Service department need general assistance, help 'keeping up' with MDS 3.0 assessments, or require monthly consultations to meet the requirements of F251?  Contact us at Simmons Healthcare Consulting, LLC, and we'll be glad to help your nursing facility maintain or achieve regulatory compliance.

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A Bond Between Marketing and Activities in LTC, Strange Concept or Smart Decision?

I came across this blog post and am quite interested in your thoughts - "A Different Kind of Activity Program" by Steve Moran on Senior Housing Forum (@SeniorForum).  The post is part two of a 2-part series, the first was "Let Us Entertain You to Death".  Administrators, long-term care Marketers, and Activity Directors, if you happen to find a free 5-minute break during this busy weekend, take a moment to read both of these blog posts.

  • What are we doing right with our LTC activity programs?
  • Is Bingo your facility's most attended activity?  Was Bingo the resident's most attended activity prior to admission?  If it wasn't, then why is it now?
  • Where are there areas of opportunity for improvement?
  • Is your activity department adequately staffed?  Really?  
  • Do corporations and boards of directors understand the potential benefits of the department?
  • As we begin the next 5-10 years and expect to see an even bigger increase in baby boomers, will the current structure of activities be tolerated?
  • Have you recently changed your programming?  And if so, are you seeing positive results?
  • How often are we asking for feedback from our residents and families?  Not simply the standard activity assessment, but open-ended questions about how they would like to spend their day now.
  • Activity Directors - if you had an unlimited budget (lol), how would you change your programming?  
  • Are there ways to think outside-the-box and still implement your wishlist of programming without bankrupting the facility?
  • What is the relationship between your activity program and admissions? (Possibly one of the most overlooked aspects of marketing by many facilities.)

As for the educational requirements of an Activity Director - Although I understand the author's rationale, I would strongly caution the industry not to hastily jump on board.  I know that there are many in long-term care that would disagree with me on this (including NASW), but I have witnessed what happened when arbitrary educational requirements were placed on Social Service staff.  The industry lost outstanding, caring, dedicated people.  There are ways to 'raise-the-bar' without alienating current activities staff (i.e. grandfather clauses). 

Your thoughts on activity programming, educational requirements, the referred to blog post?  Feel free to comment, I am truly interested in feedback.

Need assistance with your Quality of Life (Social Service, Activities, QMRP) services?  Contact SHC and we'll schedule a visit to help your nursing facility continue improving care.  Have a fabulous weekend!

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Are You Truly 'Looking' at Your Facility?

Occasionally, I will come across an article that simply makes me stop and say 'Wow'.  A recent guest blog on McKnight's page (found here) did just that.   Ken Tack offers some thoughts and observations that I believe we are sometimes hesitant to acknowledge.  I've pondered for about 24 hours trying to decide what I'd like to say about his 'discoveries'.  I've decided to not say much right now, however, I will leave you with this...On this Friday before a holiday week begins, read the article more than once.  Think about what he has written.  Have you really looked at your facility, organization, and staff from a different perspective?  Really?  Don't use it as a critical analysis.  Those of us in long-term care receive enough criticism.  Use your thoughts and positive observations as a way to capitalize and expand on the great aspects of your facility.  As for the negative observations, use those also - to implement needed change.  Thank your staff, communicate with your residents and families, and have a great weekend!