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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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Have You Nominated Someone for an Age of Excellence Award?

                                                                                                                                                       


Nominations for the Age of Excellence awards are now open through REAL Services.  As stated on their site - "Our purpose is to recognize those individuals who quietly support their loved ones and their communities through daily acts of kindness, compassion and selflessness. They remind us in the most fundamental way, what is most meaningful in life. They remind us that we are truly serving a higher purpose when we serve our fellow man."  

Eligibility - Each award category is different and each has its own guidelines for eligibility. Nominees must work or live in Elkhart, Kosciusko, LaPorte, Marshall or St. Joseph Counties, or provide care to persons residing in those counties. (Indiana)

Deadline for nominations - April 11, 2013 at 4pm.  The awards presentation will take place on May 16, 2013 in South Bend, Indiana.  The keynote speaker is scheduled to be singer and songwriter, Amy Grant.

Nominations can be made online here or by mail via this form (opens as a PDF).  

Nomination Categories - 

  • Business of the Year:  A care giving agency or business that displays a commitment to the elderly.
  • Caregiver of the Year for an Older Adult (60+):  An individual who unselfishly provides unpaid care to someone who is 60 years of age or older.
  • Caregiver of the Year for the Disabled (0-59):  An individual who unselfishly provides unpaid care to someone who is less than 60 years of age.
  • Education Award:  A student, classroom (Kindergarten through College), teacher or school administrator that has displayed an understanding of the value of older adults.
  • Hoosier Lifetime Award (over 60):  An individual, 60 years of age or older, who has demonstrated a lifetime of service to his or her community (paid or unpaid).
  • Professional of the Year:  An individual who, throughout their career, has provided dedicated service to older adults. (ex: nurse, police officer, home health aide, doctor, etc.)
  • Kimble Volunteer of the Year:  An individual, 60 years of age or older, who has displayed a commitment to volunteerism in service to the elderly.
  • Volunteer of the Year (under 60):  An individual, under 60 years of age, who has displayed a commitment to volunteerism in service to the elderly.
  • Volunteer Group of the Year:  A group of volunteers, who has displayed a commitment to volunteerism in service to the elderly.

Contact information for REAL Services can be found at the above links if you have any questions.
As always, contact Simmons Healthcare Consulting, LLC, with any questions, concerns, or needs related to your Quality of Life (Social Service, Activities, QMRP) departments.  

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Helping Your New Residents / Families Cope at the End of the Year

A suggested project for nursing facilities this coming week, particularly Social Service and Activities staff, but every department can help –   


  • Make a quick list of current residents who are ‘new’ to your facility in 2012.  
  • Meet with those residents to discuss remaining holiday activities (include New Year’s) and any special meals that are planned.  
  • Observe their mood state and psychosocial adjustment.  
  • Listen to any feelings that they are expressing verbally.      



  • Touch-base with those same residents’ families to inquire about any holiday plans that might include the resident.  
  • Offer ideas of how the family can ‘include’ the resident, either at home, in the facility, or via phone. 
  • Remind the families of any remaining special events at the facility and any community rooms you might have that are available for family gatherings.  
  • Explain the LOA process and the procedure for purchasing guest meals or bringing in outside food.  
  • Give a reminder of the importance of adding any ‘gifts’ to the resident’s inventory list. 
  • If your facility has Skype abilities (and kudos if you do!), offer the option to help coordinate scheduling a Skype ‘visit’.      
  • If a family member will be transporting a resident for the first time, have they had training in order to do so safely?


Although this coming week or two tends to be extremely busy, taking the time to proactively help those who are attempting to cope for the first time with either residing or having a loved one in a facility over Christmas, can be crucial.  If the entire management team gets involved, it’ll be much quicker ;-)   

Could your Social Service or Activity department benefit from a review of their needs?  Indiana facilities, are you in compliance with your QMRP visits?  Contact Simmons Healthcare Consulting, LLC, and we’ll schedule a visit to help your facility continue improving Quality of Life services for your residents.   

A quick 'Must-Read' re: Dignity via @ADVANCEforLTC

Administrators and long-term care staff - please take a moment and read "The View from the Other Side of the Bed" by Tony DeWitt on advanceweb.com.  Think about the statements regarding dignity and even communication when you enter your facility tomorrow.  And from a risk management perspective, to quote the author, "people do not sue people they like".  

It's a Tech Savvy World, Are Your Residents on Board?

Over the past few years many nursing facilities have added computer stations for resident use.  But are they being used or are the computers just sitting there collecting dust?  So many residents can potentially benefit from the computer use - email, playing games, typing letters, viewing family pictures - the list is virtually endless.  

  • Do the residents and families know about the availability of the computer?  
  • Is the computer easily accessible to residents in wheelchairs?  
  • Is there adequate lighting?  

Too often when I ask LTC staff why the computer stations aren't being utilized I get this response, 'the residents don't know how to use it'.  But when I question the staff about whether there are residents who could enjoy various aspects of computer use, they can always give a name of someone.  So my challenge to long-term care communities today is to choose one resident at a time and help get the resident using the computer.

Ways to start - 

  • Remind families of the location of the computer stations (and of course any 'rules')
  • Encourage family members to use the computers to show their resident pictures of family
  • Does the resident have a teenage or 20-something grandchild who would like to visit more but doesn't know what to do during the visit?  Suggest that the grandchild show the resident the humorous side of YouTube, Facebook, etc.
  • Pair a volunteer with a resident to 'teach' them how to play solitaire, type a letter, jot down their favorite recipes into a 'cookbook' to give to family
  • Start a 'genealogy campaign' and encourage families to involve their resident with contributing to their ancestry.com family tree.  
  • Invite the local high school / college tech group to give a presentation and ask for volunteers to assist with one-to-one training
  • Ask a tech-savvy rehab resident to speak with residents about accessibility options, entertaining programs, important points-to-know in order to get started

The facility has made an investment, now, put it to good use.  Have the activities department start a small group where residents can either share information that they've learned or things that they would like to learn.  Encourage resident-to-resident conversations during meals about what they've discovered.  Remind the staff to help foster giving your residents a purpose and a project.  

Need assistance jump-starting your activity and psychosocial programs, Social Service department? Contact Simmons Healthcare Consulting, LLC, and we'll schedule a visit to help your facility continue improving Quality of Life services for your residents.

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