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Culture Change Througout Aging Services


Culture Change News

Culture change and person-directed care have received national attention in US News & World Report and on MSN online! The first article is in US News & World Report and is titled “These Nursing Homes Care About Their Elderly Charges: At new-culture facilities, the emphasis is on respect for residents and a homelike setting.”  The article also has links to US News & World Report’s list of what they describe as the best nursing homes in each state. The list uses the 5-Star rankings, survey results, staffing levels, and quality members to create their list.

The second article is titled "America's Best Nursing Homes." and is currently on MSN online. These articles represent an enormous opportunity to share the real possibilities of culture change and person-directed care as we work to educate consumers and caregivers.  Please take a moment to read both articles, and make sure to pass them on to your friends and colleagues, so that we can continue to share the good news that culture change is gaining momentum!


MARCH 2010


Background Paper Available Now

Prepared by Carmen Bowman, MHS under contract with the Centers for Medicare & Medicaid Services (CMS), The Food and Dining Side of the Culture Change Movement: Identifying Barriers and Potential Solutions to Furthering Innovation in Nursing Homes is intended to provide the history of the culture change movement as it pertains to food and dining, including current research regarding food and dining issues and innovations.
"The issues surrounding new and innovative ways of serving food in the nursing home as you weave in and out of regulatory requirements. Thus, both the issues as well as the regulations are presented here together intertwined with what is missing. Carmen offers recommendations for what might be helpful on your journey to Culture Change." --Carmen Bowman, Author
Click here to download the background paper.




CMS Official Honored For Work With Nursing Homes

(Source: McKnight’s)

Karen Schoeneman, deputy director of the Division of Nursing Homes at the Centers for Medicare & Medicaid Services, has received the 2010 Picker Institute Award for Excellence. Schoeneman was recognized for her continuing efforts to bring the culture change movement to nursing homes in the United States. She has worked for CMS for 20 years, and helped launch the culture change movement in 1997, according to a CMS statement. Schoeneman also helped found the Pioneer Network, which advocates for culture change in long-term care.

The Picker Institute award recognizes individuals who have spent their lives improving the lives of people in long-term care. The nonprofit institute sponsors research into improving the quality of life for people in institutions.  More

Culture Change Goes Mainstream

(Source: Provider Magazine)

Bill Thomas, MD, would like to clear up a misconception about his position on nursing facilities: He doesn’t want to eradicate them; he wants to eliminate the traditional,

institutional model of care that was adopted by nursing facilities nearly 50 years ago. “I want to abolish the practice of institutionalizing frail, older people,” he says.


“The old model of the nursing homes needs to go away and be replaced with new models.”


Although he understands that doing away with institutionalization may take the rest of his career—maybe even the rest of his life—Thomas is certain that it will happen…


He emphasizes that his plan is not “some kind of silly turn-off-all-the-lights-and-walk-away idea.” No, he says, “that’s not what I want—I want us to deliberately plan to outgrow the nursing homes. Let’s go beyond something that was handed to us half a century ago; let’s embrace and develop and implement new models of care.” …


Awareness and adoption of some components of culture change have gained considerable momentum in the past two decades and made even greater strides in the past several years.

A Commonwealth Fund survey of health care opinion leaders in 2008 found that 66 percent of respondents were familiar with the culture change movement, a dramatic shift from a

2005 survey in which 73 percent of respondents were unfamiliar with the term.


In a recent article in the journal Health Affairs, Commonwealth Fund President Mary Jane Koren credits the Centers for Medicare & Medicaid Services’ (CMS’) Eighth Scope of Work contract with the nation’s quality improvement organizations as one reason why providers have become more aware of culture change. However, the battle is not entirely won, Koren notes.


The fund’s “2007 National Survey of Nursing Homes” found that only 5 percent of directors of nursing said that their facilities completely met the description of a nursing facility transformed through culture change, and only 10 percent reported that they had initiated at least seven or more culture change practices. “All told, about one-third reported adoption of some culture change practices,” Koren writes, “and another third said that they were planning to follow suit. But the rest of the respondents said that they were neither practicing nor planning to commence culture change.”


The difficulties of “operationalizing and maintaining culture change remain daunting” but are not insurmountable, she says. Speculation about why more providers have not adopted culture change on a wider scale typically centers on cost, access to capital, and perceived barriers to implementation, such as regulations that conflict with the person-centered approach that is so central to the movement.


Nonetheless, culture change has become a part of the long term care lexicon. The basic tenets of the movement—person-centered care, individualized treatment plans, and resident choice and autonomy—have become the standard by which quality care is measured.


‘It would be a mistake for any company right now not to go down the path of culture change.’



Pioneer Network Completes Year-Long Project Designed To Increase Consumer Knowledge About Long-Term Care And Culture Change: Consumers Want To Know What Culture Change "Looks Like"

(Source: Pioneer Network)

ROCHESTER, NY – Pioneer Network is pleased to announce the completion of a year-long project dedicated to increasing consumer interest in long-term care and culture change. In 2009, Pioneer Network received a grant from The Picker Institute to develop the project, Changing the Culture of Aging: Taking a First Step to Creating Knowledgeable Consumers. During the year-long project discussion groups were hosted in private homes to discover the most effective means of sharing information about culture change, and determine consumer interest in learning more about person-centered care.

Findings from the project were telling. The pilot study confirmed what we intuitively know—that consumers' knowledge of long-term care comes from reactive circumstances. That is, it is related to their personal experiences or a sudden and immediate need.

In all, 502 consumers—over half of them Baby Boomers—attended small-group discussion meetings in Florida, Georgia, Massachusetts and Oregon during the pilot. Although their experience with long-term care varied, most had visited a nursing home or assisted living community. For those participants who were currently caregivers, just over a third had family members or friends currently residing in a long-term care community.  All indicators showed that consumers who participated did indeed gain knowledge about culture change, as well as learn about the difference between a traditional nursing home and one that practices person-centered care.

Most important, a majority (78%) of consumers who participated wanted to learn more about culture change. In particular, they wanted to know what it "looks like" and how it would be affordable.  The outcomes of the pilot study reinforce the understanding Pioneer Network shares with The Picker Institute—that this is the time to rally around the consumer and fully engage the broader community in the culture change movement. 

"The Picker Consumer Project represents a major undertaking by our organization to begin focusing on increasing consumer awareness and demand for culture change." says Bonnie Kantor, Pioneer Network Executive Director. "This project, directed by Joanne Rader, is also notable because it was one of the first times that six major organizations came together to gauge consumer awareness." These organizations and individuals included:

  • Natasha Bryant, American Association of Homes & Services for the Aging 
  • Marianna Kern Grachek, American College of Health Care Administrators
  • Chris Condeelis, American Health Care Association
  • Lorraine Tarnove, American Medical Directors Association
  • Sarah Greene Burger, The Coalition of Geriatric Nursing Organizations
  • Jessica Brill and Sarah Wells, National Consumer Voice for Quality Long-Term Care

A significant outcome from the project is that Caring for the Ages, the American Medical Directors Association monthly publication is now publishing a series of tear-outs designed specifically for consumers and providing education about culture change. The first of these columns, "Person-Centered Care: What It Means to You and Your Family" can be accessed here.

Pioneer Network hopes to pursue a Phase 2 of the project later this year, by reaching out to consumers, educating them about culture change, and how they can advocate for change.  More

Richard Taylor, PhD Promotes “Donate a Dollar to Dementia” Campaign For Pioneer Network’s 2010 Carter Williams Legacy Fund

(Source: www.RichardTaylorPhD.com) 


My name is Richard Taylor and for the past several years I have been living with the symptoms and diagnosis of dementia, probably of the Alzheimer’s type. Recently, I was honored to be selected as the recipient of the 2009 Carter Williams Legacy Award for the new purpose I have created for my life - bringing a voice to people who are living with Alzheimer’s and dementia, and helping others see persons with dementia as people – first. We are not just a “disease” that needs a cure. We are whole human beings who just happen to have that diagnosis. People with dementia are whole people and should be treated as whole people.  

The award I received is given annually by Pioneer Network. With this personal award I want to take the opportunity to shape the focus of the 2010 Carter Williams Legacy Fund. This is a fund created and administered by Pioneer Network to financially support opportunities for personal growth in those individuals who are quite literally pioneers in the new frontier of aging, who are working every day to change the culture of elder care and aging across America.  

I have asked that the 2010 awards be granted to individuals who are directly engaged in research and support of folks who have been diagnosed with some form of dementia and the wonderful caregivers who care for them. I believe there is a grossly disproportionate emphasis on supporting research efforts into finding a “cure” for dementia (primarily of the Alzheimer’s type), at the expense of focusing on finding “cures” (or at least promising or best practices) to deal with the real life, every day problems created by being forced to live with the various symptoms of dementia. Unfortunately there is very little focus on how to help those who are LIVING with dementia and the angels currently caring for them…  MORE... 

The Golden Rule Is Only Half-Right

(Source: The Path to Home)

Blasphemy, right?  Sure, the Golden Rule has served for a long time as the go-to guidepost for how we should interact with others.  However, when it comes to Person-Centered Thinking, it’s only the beginning and not something we should point to as a simple, straightforward philosophy for achieving “person-centeredness”.

The “do unto others as you would have them do unto you” way of thinking does set a certain tone for developing empathy.  That’s a good start towards determining how we relate to others.  Without empathy, we can’t develop connections and relationships with other people.  Empathy is what helps us seek out commonalities and to find common ground.  Without we can’t get far outside of ourselves.

However, to believe that others want to be treated as we would want to be treated leads to a critical error in thinking, or a cognitive bias.  Social sciences have a name for this kind of error; it’s called a Projection Bias.  In making such an error, we are guilty of thinking that others share our same beliefs, our culture, our values and so forth and we project our own way of thinking onto others.  In other words, we mistakenly believe that others are just like us.

The Golden Rule philosophy plays right into this mistaken idea-that of believing others want to be treated the same as us.  The problem is that they aren’t us!

Although we may all have some common need for safety and security, for example, our views on what constitutes “safe and secure” may be vastly different.  For me, safety might mean keeping my feet firmly planted on the ground; for the parachutist, safety might mean checking one’s pack twice before taking the big leap.  There’s a vast difference between what each of us considers important.

To attain true Person-Centered Thinking, we have to be cognizant of our differences and understand how to assess the needs and desires of others, without clouding the picture with our own beliefs and values.  The Golden Rule approach doesn’t take us far enough to do that and could lead to unintentional conflict and misunderstanding, rather than to our intended target.

We are guilty of shortchanging the process, if we instruct our employees to adopt such an approach to person-centeredness and we will fall short of attaining our goal.  Rather, we must encourage our employees to view Person-Centered Thinking from the mindset of an investigator.  That means learning how to listen and to pay attention and how to develop critical thinking skills.  These are the tools that will bring us the evidence that tells us how others want to be treated.    More

What The Long-Term Care World Needs Now

(Source: McKnights)

The Centers for Medicare & Medicaid Services' shift to a prospective payment system in 1998 sent shock waves through the industry and claimed the financial lives of many prominent long-term care companies.  The current combination of recession, Medicare cuts, RUGS IV, MDS 3.0, state budget crises, QIS, RAC, and the unknowable final shape of healthcare reform have today's leaders feeling déjà vu.  What do long-term care companies need in order to avoid last decade's casualties? Here are a few very important things:


An organization's culture—its structure and values—is the single most important factor for overcoming acute challenges and for transforming the industry one facility at a time. 

Centralization vs. decentralization, Values and Creating new cultures

Empowering the field and eliminating bloated bureaucracy is for many an impossible pill to swallow. Yet, if you were to ask the dozens of beaten companies from the late 1990s if they would try that medicine if given the chance, I bet they would.

Read entire article here… 

Colorado Culture Change Coalition VIDEO

(Source: YouTube)


Click here for video

(Source: Mature market Experts)

‘Participation’ vs. ‘Engagement’

Companies which provide services to seniors will need to look beyond traditional approaches to aging, Colin notes. “There is a difference between participation and engagement,” he explains, pointing out that ‘engagement’ will become more important in the years ahead. “The example I always use is my school career. While I was a participant, I was not engaged and my grades suffered. Similarly, it’s not enough for seniors to be enrolled in a health plan’s fitness plan or be just living at a retirement community. People are looking to be fully engaged because they understand that engagement is a key component to being healthy.

“Technology has already changed how we are aging and we are just seeing the tip of the iceberg,” Colin continues. “I think one of the most exciting possibilities rests in 3D Holographic projection. Just like we used to see in the old Star Trek adventures, soon your fitness instructor will be projected into your home to work out with you. The technology is not that far off. Don’t believe me, just check out what Musion Systems Ltd. is doing!”

Effect On Companies

Colin believes that companies which don’t adjust to the new expectations of people entering their retirement years are likely to struggle. “Today’s mature market has very different expectations for how they expect to age,” he says. “The dinosaurs of the last generation — like outdated senior centers and retirement communities — are a complete turnoff. In fact, just string the phase ‘senior center’ in front of most boomers and you’ll see a clear reaction. For example, retirement communities and golf destinations are being replaced by urban, multi-generational settings with proximity to restaurants, shops, gyms and theaters. Simply put, outdated products with obsolete names and terminology must change … or face extinction.”  More


JUNE 2010



CMS Official Honored For Work with Nursing Homes

Kudos To Karen Schoeneman ~ THANK YOU For All That You Do!!!


Karen Schoeneman, deputy director of the Division of Nursing Homes at the Centers for Medicare & Medicaid Services, has received the 2010 Picker Institute Award for Excellence.  Schoeneman was recognized for her continuing efforts to bring the culture change movement to nursing homes in the United States. She has worked for CMS for 20 years, and helped launch the culture change movement in 1997, according to a CMS statement. Schoeneman also helped found the Pioneer Network, which advocates for culture change in long-term care.  The Picker Institute award recognizes individuals who have spent their lives improving the lives of people in long term care. The nonprofit institute sponsors research into improving the quality of life for people in institutions.


Ground-breaking "Nurse Competencies for Nursing Home Culture Change" Released
Hartford Institute for Geriatric Nursing in Collaboration with the Coalition of Geriatric Nursing Organizations and Pioneer Network Finalize Competencies Completed in a Two-Year Initiative of Historic Proportion


Pioneer Network Executive Director Bonnie Kantor announced that a two-year initiative designed to develop nursing competencies specific to nursing home culture change that brought together nursing and geriatric experts from across the country is now complete. The resulting document, "Nursing Competencies for Nursing Home Culture Change," offers ten competencies deemed most relevant and critical for creating and sustaining person-directed care. The initiative was supported by the Commonwealth Fund.

In 2008 Hartford Institute for Geriatric Nursing (HIGN) collaborated with Coalition of Geriatric Nursing Organizations (CGNO) and Pioneer Network to convene a panel of 31 nursing and other experts to explore opportunities and barriers for nursing and culture change. The panel worked to answer the question, "what is the role for nurses in achieving and sustaining this change?"

"I'm excited by these competencies because they are the first step in defining the role nurses must play in this civil rights movement we call Culture Change," notes Diane Carter, CEO of the American Association of Nurse Assessment Coordinators (AANAC).  It is just simply the right thing to do."  READ MORE


Pioneer Network Completes Year-Long Project Designed to Increase Consumer Knowledge about Long Term Care and Culture Change (Georgia Participated in Pilot)

Consumers Want to Know What Culture Change "Looks Like"


Pioneer Network is pleased to announce the completion of a year-long project dedicated to increasing consumer interest in long term care and culture change. In 2009, Pioneer Network received a grant from The Picker Institute to develop the project, Changing the Culture of Aging: Taking a First Step to Creating Knowledgeable Consumers. During the year-long project discussion groups were hosted in private homes to discover the most effective means of sharing information about culture change, and determine consumer interest in learning more about person-centered care.


Findings from the project were telling. The pilot study confirmed what we intuitively know—that consumers' knowledge of long-term care comes from reactive circumstances. That is, it is related to their personal experiences or a sudden and immediate need.


In all, 502 consumers—over half of them Baby Boomers—attended small-group discussion meetings in Florida, Georgia, Massachusetts and Oregon during the pilot. Although their experience with long-term care varied, most had visited a nursing home or assisted living community. For those participants who were currently caregivers, just over a third had family members or friends currently residing in a long-term care community.  All indicators showed that consumers who participated did indeed gain knowledge about culture change, as well as learn about the difference between a traditional nursing home and one that practices person-centered care.


Most important, a majority (78%) of consumers who participated wanted to learn more about culture change. In particular, they wanted to know what it "looks like" and how it would be affordable.  The outcomes of the pilot study reinforce the understanding Pioneer Network shares with The Picker Institute—that this is the time to rally around the consumer and fully engage the broader community in the culture change movement.  MORE


Culture Change Close to Home

(Source: Provider Magazine)


Providers in most states can find educational resources and training opportunities on culture change in their own backyards.  The Pioneer Network, a nonprofit organization whose mission is to facilitate deep system change in long term care, shares information and resources with national stakeholder organizations and 30 state culture change coalitions to promote culture change and person-centered care.


The primary purpose of the coalitions is to advance culture change in their respective states through a variety of activities, such as presenting educational programs and networking meetings for providers; developing communication vehicles, including newsletters and Web sites; and educating policy makers and regulators about culture change.


The table below contains information about state-level culture change initiatives that are coordinated by state survey agencies (SSAs) and/or state culture change coalitions. Among the initiatives are a number of opportunities for providers to obtain technical assistance, training, and even grant funds.  Click here for Provider Extra News Online article, "Culture Change Close to Home

Dr. Richard Taylor Launches “Donate a Dollar to Dementia” Campaign

Funds Raised Will Support Awardees of the 2010 Carter Williams Legacy Fund


The Carter Williams Legacy Fund is a grant program to support the personal growth of individuals involved in creating a new culture of elder care and aging. Last year the Carter Williams Legacy Fund Honoree was Dr. Richard Taylor, a speaker, author, blogger and retired psychologist.  Dr. Taylor has launched a new fund raising campaign, "Donate a Dollar to Dementia," which will provide support for the 2010 Carter Williams Legacy Fund.


"We are not just a 'disease' that needs a cure," says Dr. Taylor. "We are whole human beings who just happen to have that diagnosis.  People with dementia are whole people and should be treated as whole people!" The focus of this year's Carter Williams Legacy Fund awards will be on individuals who are directly engaged in research and support of folks who have been diagnosed with dementia-related illness and the caregivers who support them.  MORE


More Retirees Find Facilities Speaking Their Language

Senior Centers, Nursing Homes Respond to Increased Diversity

(Source: The Washington Post)


About 10 percent of Americans over age 65 are foreign born, according to the Pew Research Center. AAHSA President and CEO Larry Minnix recently told The Washington Post that as that number increases to 20 percent by 2050, more retirement communities will be looking for ways to attract foreign-born residents and make them feel at home. Some AAHSA members have gotten a head start in that effort.


"Everyone is going to have to learn more about various ethnic and cultural sensitivities, because the marketplace of aging is getting more diverse," said Larry Minnix, president and chief executive of the American Association of Homes and Services for the Aging. "I think, over the next five to 10 years, you're going to see a lot of attention paid to this."  MORE  


Creating Home in the Nursing Home II: A National Online Symposium on Culture Change and the Food and Dining Requirements STILL AVAILABLE!


Pioneer Network and the Centers for Medicare & Medicaid Services (CMS) are collaborating to offer this special online symposium to focus specifically on culture change and dining. (This is the Symposium that was snowed out earlier this year...)  Innovations in dining including liberalized diets, buffet-style service and reductions in bib and supplement use have been welcomed by providers, but they often struggle integrating new approaches with the regulatory guidelines. The sessions offered below will address dining initiatives and explore potential and perceived regulatory barriers so that both innovators and regulators can come to a common understanding of responses congruent with OBRA '87. (NOTE: Be sure to check out all of the background papers!) More


It’s Never 2 Late/Pioneer Network Person-Centered Care 3 Minute Video Contest


Enter to Win $500 and a Chance to Showcase your Organization's Initiative at the Pioneer Network’s National Conference! Are you doing things in your community that would blow away the rest of the country if they could only see it? It's Never 2 Late and Pioneer Network have teamed up to sponsor a video contest! First prize winners will receive $500 and will be highlighted during the closing luncheon at the Annual Conference in August!


We know that there are amazing initiatives are happening in your organizations with technology and with dining. Can you capture person-centered care in your community while the residents are using technology? Or show how your dining program is person-centered? Submit a short video, no more than three minutes in length in either the technology or dining category. READ MORE


JULY 2010


Robert Butler, Aging Expert, Is Dead at 83

(Source: DOUGLAS MARTIN, www.nytimes.com)

Dr. Robert N. Butler, a psychiatrist whose painful youthful realization that death is inevitable prompted him to challenge and ultimately reform the treatment of the elderly through research, public policy and a Pulitzer Prize-winning book, died Sunday in Manhattan. He was 83 and had worked until three days before his death… Dr. Butler’s influence was apparent in the widely used word he coined to describe discrimination against the elderly: “ageism.” He defended as healthy the way many old people slip into old memories — even giving it a name, “life review.”

In speech after speech, he pounded home the message that longevity in the United States had increased by 30 years in the 20th century — greater than the gain during the preceding 5,000 years of human history — and that this had led to profound changes in every aspect of society, employment and politics among them.

Dr. Christine Cassel, president of the American Board of Internal Medicine, said in an interview that Dr. Butler had in effect “created an entire field of medicine.” She said he had helped change attitudes so that aging could be perceived “a positive thing.”

Dr. Butler was the founding director of the National Institute on Aging at the National Institutes of Health and advocated for the aging before Congress and the United Nations. He helped start and led the American Association for Geriatric Psychiatry, the Alzheimer’s Disease Association and the International Longevity Center. President Bill Clinton named him chairman of the 1995 White House Conference on Aging. “He really put geriatrics on the map,” Dr. David B. Reuben, chief of the division of geriatrics at the University of California, Los Angeles, said in an interview.

Dr. Butler challenged long-held conceptions about aging, calling it “the neglected stepchild of the human life cycle.” He helped establish, for example, that senility is not inevitable with aging. When the Heinz Family Foundation presented him with an award in 2003, it called him “a prophetic visionary.” The most noted exposition of his vision was the 1975 book that earned him his Pulitzer, “Why Survive? Being Old in America.” It went from a bleak explication of the elderly’s condition to prescriptions to improve it.

“Human beings need the freedom to live with change, to invent and reinvent themselves a number of times through their lives,” Dr. Butler wrote. MORE

We Want Real Care Now

(Source: Dr. Bill Thomas, changingaging.org)

I am excited to announce the launch of the Real Care Now social networking campaign to advance person-centered approaches to long term care at www.ChangingAging.org/RealCareNow. Real Care Now is a partnership between my blog, www.ChangingAging.org, and the Picker Institute, the leading foundation advancing person-centered health care, and the Erickson School of Aging Studies at UMBC, a first of its kind professional program integrating aging, management and policy.

Using social media tools such as blogging, Facebook and YouTube, we will introduce and popularize concepts of person-centered care. It's a simple message -- People want Real Care Now that responds to the needs of the individual, not to the needs of the health care system -- and we hope you will join us in spreading this message.

I've been working to reform nursing homes and long term care for over 20 years by promoting and creating new person-centered models of care. These include The Eden Alternative and The Green House Project, revolutionary alternatives to institutional nursing home care designed to provide person-centered care to older people.

We see person-centeredness as a social movement, and we’re fortunate to be doing this work when it's never been easier to communicate and coordinate using social media. These social networking tools help us connect with other people who share our vision of what high quality care should look like. Building off ChangingAging.org’s existing social media networks on Facebook, Twitter, YouTube and LinkedIn, we will post videos, social commentary and news updates related to person-centered health reforms.

The goal is to build support for transformational change in how the health care system takes care of older adults. Our healthcare system was designed to serve the need of younger people with acute conditions. But America faces a future where most of our healthcare resources will go to older populations with chronic health conditions.

We need Real Care Now.

Please join us,
Dr. Bill Thomas

Connect with ChangingAging on:

Eden Alternative Appoints New CEO

(Source: www.ltlmagazine.com)

The Eden Alternative, an international not-for-profit organization dedicated to long-term care culture change, has appointed Christopher D. Perna as its CEO. The CEO position was recently created by the board of directors to help the Eden Alternative organization’s growth.

“Chris brings his passion for serving elders along with his outstanding leadership and business skills to this new role,” said Eden Alternative founder Bill Thomas. “We are excited to have him join the Eden team as we prepare for our fifth International Conference and the launch of The Path to Mastery later this month.”

“I met Bill Thomas several years ago and have watched the Eden Alternative grow as a driving force in the long-term care culture change movement,” Perna added. “It is an honor to be selected to lead an organization doing such important work and touching so many lives.”

Perna spent 25 years in the insurance industry, most recently in long-term care insurance as president of MedAmerica Insurance Company. His tenure at MedAmerica was marked by the introduction of a new line of long-term care insurance products. Perna has also distinguished himself through his service to elders in the community of Rochester, New York, as a multi-year board member for Lifespan and Family Service of Rochester—two organizations serving the needs of elders. He currently serves as board chair for both organizations.  More

National Movement Focuses on Choice, Independence for Elderly

(Source: Diana Nelson Jones, Pittsburgh Post-Gazette, www.post-gazette.com)

At a recent training session for elder-care workers, Patricia Hillebrand asked the class of 15, all but one of them women, to imagine the anxiety of a person with Alzheimer's disease. "Remember the first time you were going to call a guy and ask him out?" Around the room of the Holiday Inn Express in Robinson, smiles acknowledged the fluttering fear and anxiety. "Imagine what it would be like to feel that way all the time," she said. Then she initiated a role-playing session designed to inspire trainees to walk in their clients' shoes.

Ms. Hillebrand is a training specialist for Paraprofessional Healthcare Institute, a national organization that advocates a shift away from traditional institutionalized elder care. PHI recently received state grants totaling $500,000 to run a pilot program that Joe Angelelli, PHI director for Pennsylvania, describes as "training the trainer toward culture change."

Culture change is the term for a national movement that calls for a reversal of the traditional nursing home model -- re-education of care workers and a break-down of institutional housing. Increasingly, care is being taken to people where they live or in newly built enclaves designed to foster independence.

Foundations are spending millions to advance the idea. The Robert Wood Johnson Foundation has granted about $13 million. Ann Christiano, a spokeswoman for the foundation, said most of the money has been in support of the "Green House" model -- housing enclaves in which people who choose to be together can live individually but with communal spaces and support staff on site.

"People don't want to be in nursing homes," Mr. Angelelli said. "It's where they get sent. And the care they get is done by people who don't get the pay or support they need."

The grants from the Pennsylvania Department on Aging and the Department of Labor and Industry started a statewide re-education process for workers. It is heavy on role playing, such as walking across a room with eyes covered to give a worker an idea of the challenges blind people face. Most of the trainees are employers of people who do lifting, feeding, bathing and other elder-care support services. The state grants pay for their training and for the training that they take back to their employees.

Tiffany Richter, a master's student in social work at the University of Pittsburgh, said that when she saw the role playing, "I got excited. I have never seen role play like this."

Nancy Mercer, a home companion service worker for From the Heart in Trafford, said an aspect of the training she appreciated was "practicing how to feed someone and encouraging nutrition, not just slapping a meal in front of them and walking out of the room."

Mr. Angelelli said the goal of the training is to build a more stable workforce and help workers bond with their clients so that the work will be more rewarding. Much of the industry's cost is in turnover. The rate ranges from 25 percent to 75 percent, he said. The lost time and retraining cost of losing a worker averages about $3,000, he said.

Language in the new federal health-care bill supports PHI's training model and is based on recommendations from an Institute of Medicine report that PHI helped shape, Mr. Angelelli said. The Institute of Medicine is the health arm of the National Academy of Sciences and is an independent, nonprofit organization.

The culture change movement came out of the Omnibus Budget Reconciliation Act of 1987, which was in part a reaction to abuse scandals that rocked the nursing home industry, said Susan Feeney, a vice president of the American Health Care Association. She said the mission now goes beyond "person-centered" and seeks to have the elderly shape their own care.

Last year, amid massive budget cuts, one expansion of funding went to Medical Assistance to serve 2,000 people at home in the PDA Waiver program. These clients would have been eligible for government-funded nursing-home care, but similar care in their own homes cost the state less. The waiver program now serves more than 15,000 clients.

"Even institutions are starting to realize that this is what people want, and from the market standpoint, it will all come down to this: What do people want to pay for?" Mr. Angelelli said. "In Pittsburgh, we have a great opportunity because so many of our elderly population are already in neighborhoods where they could organize their own" villages.

"I don't know of anyone who has balked at culture change," said Ms. Feeney, adding that nursing care for a more independent client has to balance the client's lifestyle desires with his medical needs.

Culture change adherents acknowledge that "there will always be a need for nursing homes," said Mr. Angelelli, but the movement can reshape how they are managed and run.  MORE

NASUA (National Association of State Units on Aging) Changes Name to National Association of States United for Aging and Disabilities (NASUAD)

(Source: www.NASUA.org)

In keeping with its mission to design, improve, and sustain state systems delivering home and community based services and supports for the elderly and individuals with disabilities, the NASUA membership voted overwhelmingly in support of a proposal to change the name of the association to the National Association of States United for Aging and Disabilities, NASUAD.

The change was made, in part, to accurately reflect the evolving role of state aging agencies in the delivery and administration of long term services and supports, and to streamline the coordination and provision of these services across the continuum of care. Current NASUA President, and Commissioner of the Alabama Department of Senior Services, Irene Collins, applauds the members’ decision, “Through this meaningful step forward, the association welcomes the opportunity to build relationships and enhance the capacity of the state agencies to provide long-term services and supports to both older Americans and individuals with disabilities.”

When first established through the Older Americans Act (OAA), state units on aging were primarily responsible for the administration of OAA services within the aging network. Recently, federal legislation, increased reliance on additional funding sources, and the economic downturn have dramatically impacted and increased the scope of services states are called upon to provide, and their ability to do so. As the need for long-term services has expanded, so has the role of the state aging agency, with nearly 65 percent of the states serving both seniors and individuals with disabilities as of October, 2009. James Toews, NASUA Vice President and Assistant Director of the Oregon Department of Human Services, Seniors and People with Physical Disabilities, recognizes the significance of the name change, saying, “This is a pivotal time in our nation’s history. As an organization, we are looking forward to working with members of the aging and disability communities to emphasize the importance of a comprehensive long-term care system.” NASUA’s Executive Director, Martha Roherty, echoes these sentiments, “We welcome collaboration with our partners in the aging and disability communities as we work to further strengthen relationships at the national, state and local levels.”  

This transition will be phased-in over the coming months. In the interim, please visit www.nasua.org for additional information.

National Association of State Units on Aging, founded in 1964, represents the nation’s 56 officially designated state and territorial agencies on aging. The Association’s principal mission is to support visionary state leadership, advance state systems innovation and articulate a national policy on home and community based services for older adults and individuals with disabilities. More

AAHSA Board Approves New Name: LeadingAge

(Source: www.mcknights.com)

The American Association of Homes and Services for the Aging's board has signed off on a new name for the organization: LeadingAge.

The organization for nonprofit eldercare providers has begun sending out e-mails to its 5,400 members. Each recipient has until July 30 to accept or reject the new moniker. But the vote is likely to be little more than a formality.

AAHSA originally planned to announce the new title at its November meeting in Los Angeles. But members were anxious to find out sooner, noted Lauren Shaham, vice president of communications. LeadingAge tested well with members early, and "really stood out as a strong candidate," she said.

The organization's new mission statement is also being changed, to "Expanding the world of possibilities for aging." A short video explaining the shift can be seen at www.youtube.com/aahsa.

The new name better reflects AAHSA's role and internal vibrancy, said Sharon Sullivan, the organization's vice president of marketing and conference services. Minneapolis-based Brand Tool Box was brought in to help with the rebranding effort.  More

NCCNHR (The National Citizens’ Coalition for Nursing Home Reform) Changes Name to The National Consumer Voice for Quality Long-Term Care: The “Consumer Voice” For Short

(Source: Deane Beebe, PHI)

The National Citizens’ Coalition for Nursing Home Reform (NCCNHR) has changed its name, reorganized, and expanded its national advocacy priorities. NCCNHR is now The National Consumer Voice for Quality Long-Term Care — a modification of its tagline — or the “Consumer Voice” for short. The Consumer Voice has broadened its federal advocacy efforts to include addressing policy issues regarding at-home care and assisted living. The organization has been a force for improving the standard of care in nursing homes since its inception in 1975 as the National Citizens’ Coalition for Nursing Home Reform.

Among the ways that the Consumer Voice says it will carry out its revised mission — to represent the consumer voice at the national level as an advocate for quality long-term care, services, and supports — is to “promote the critical role of direct-care workers and best practices in quality-care delivery.”

The Critical Role of the Direct-Care Workforce

Recognizing the value of direct-care workers to the care team and how these workers impact quality of care is not new to the organization. “No matter what laws and regulations are in place, no matter who or where the care is provided — the experience of the consumer is determined by his or her interactions with the direct-care worker,” said Consumer Voice Executive Director Sarah F. Wells. “I am confident that consumers and workers partnering together can advance quality in all care settings,” she continued. “This is an exciting time for The National Consumer Voice for Quality Long-Term Care and the people we represent.”

New Policy Agenda

The organization’s new policy agenda includes:

  • the reauthorization of the Older Americans Act;
  • implementation of long-term care provisions in the health care reform law, including nursing-home transparency, elder justice, and criminal background checks on workers;
  • development of policy on non-nursing-home settings, including assisted living;
  • promoting a high-quality and effective long-term care workforce;
  • strengthening oversight and enforcement; and
  • promoting long-term care quality initiatives.

The Consumer Voice’s expansion of priorities was the outcome of a seven-month strategic planning process (pdf) that was funded by The Atlantic Philanthropies and announced on June 14. The process brought together consumers, members, past and current leaders, donors, grant makers, long-term care experts, staff, and other stakeholders.  More




Pioneer Network Spearheads Culture Change Community Comments to CMS Regarding Use of Civil Money Penalty Funds (CMPs)

The Centers for Medicare & Medicaid Services (CMS) sought comments for proposed rules regarding the use of civil money penalty funds for nursing homes.  The deadline for comments was Wednesday, August 11th.  The Culture Change Community rallied, under the leadership of Pioneer Network, to respond in force.  Thanks to grant funding from Rothschild Foundation, Pioneer Network created an electronic toolkit -- including model language with easy “cut and paste” format, to simplify the process of responding and providing comments and consensus.  This issue is critical to the culture change movement.  To learn more, visit the site:

One Way to Judge a Nursing Home: Talk to the Nurses’ Aides

(Source: By DALE RUSSAKOFF, newoldage.blogs.nytimes.com)

Photo: Chang W. Lee/The New York Times

A certified nursing assistant helping an Alzheimer’s patient at a nursing home in New York.

While looking at nursing homes for my mother, I always asked the tour guides if I could talk to the nurses’ aides. This seemed to me a logical request. After all, these were the women — and they were all women — who would spend the most time with my mother, who would notice small changes that raised big questions, who would make her feel cared for. Or not.  “They don’t do that,” I was told almost everywhere I visited.

I soon realized why. In casual conversations in hallways and dining rooms at more than a dozen facilities, I found only one nurses’ aide who had been on the job more than six months. I was witnessing in real life one of the most dismal statistics in long-term care: More than 70 percent of nurses’ aides, or certified nursing assistants, change jobs in a given year.

Then came the tour guide who didn’t say no. “No one has ever asked that before, but why not?” the marketing director of a New Jersey nursing home said in response to my request. He said he would ask three aides then on break if they wanted to talk to me. They said yes.  I asked how long they had worked there. One said 12 years; another, 8. The third answered: “I’m the baby. I’ve been here four years.”

I decided this was the place for my mother. These women used the word “we” when talking about the nursing home, making clear that they felt a sense of ownership. And it seemed significant that the marketing director asked their permission before allowing me to impose on their break time. Moreover, he trusted them enough to leave me alone with them in the break room…

Culture change initiatives are under way in nursing homes around the country to make aides’ jobs more fulfilling — not so much through better pay, but by offering better training, more responsibility and more respect from superiors. The aides at my mother’s nursing home had all this, plus health and pension benefits…  MORE  


Chicago Nursing Home Joins Flexibility Revolution

(Source: Barbara Brotman, Chicago Tribune)

The revolution at the Bethesda Home and Retirement Center began with sleeping in. Letting people sleep late may not sound subversive. But in the traditional world of nursing homes, which for decades have been run like highly regimented mini-hospitals, it is a radical change. And when Bethesda made that change two years ago, it was taking its first step to join a movement that hopes to transform the nation's nursing homes.

The "culture change" movement seeks to get these facilities to alter their physical layout and their caregiving practices to create homelike environments where residents are seen not as passive recipients of care but as individuals with control over their lives. Nursing homes that embrace the new philosophy are letting residents decide when to bathe, eat and sleep; allowing them to organize their own activities; and redesigning nursing units into small "households."

Advocates say residents in such homes are happier and healthier; the employees have more job satisfaction; and giving care this way even costs less. And baby boomers who need long-term care will expect no less, said Julie Boggess, chief executive officer at the Bethesda Home, on the Northwest Side. "I became an adult in the late '60s; I'm real accustomed to doing things my way, and I'm not very apologetic about it," she said.

She doesn't even like to speak of "allowing" residents to sleep late. "It's not for us to give them that freedom," she said. "They should have it." But until Bethesda began adopting culture change two years ago, they didn't. And at many nursing homes, they still don't.

The idea is not new. The Pioneer Network, a national umbrella group of nursing home providers and consumer advocates, has been promoting it since it was formed in 1997. Yet only 25 percent of the nation's nursing homes say they have "for the most part" embraced culture change, according to a 2007 survey by the Commonwealth Fund, and only 5 percent say they have done so "completely."  MORE

'Villages' Let Elderly Grow Old At Home

(Source: By Haya El Nasser, USA TODAY)

Photo: By Doug Kapustin for USA TODAY

Volunteer Margaret Missiaen tends a garden in the yard of Maurine Phinisee, 90, left, who is back in her Washington, D.C., home with the help of Capitol Hill Village.

The explosive growth of the USA's older population is fueling a grass-roots "village" movement in neighborhoods across the country to help people age in their own homes. More than 50 villages in a neighbor-helping-neighbor system have sprouted in the past decade from California and Colorado to Nebraska and Massachusetts. They are run largely by volunteers and funded by grants and membership fees to provide services from transportation and grocery delivery to home repairs and dog walking.

Most villages have opened in the past couple of years, an indication that the momentum is growing in the face of a demographic tsunami: The number of Americans 65 and older is expected to more than double to 89 million by 2050, according to the Census Bureau. The oldest of 79 million Baby Boomers turn 65 next year, a turning point that will begin to put pressure on social services, retirement homes and assisted-living facilities.

The "village" concept is taking off in small and big cities and suburbs across the country as the percentage of elderly rises while the share of the working-age population that supports them declines. The percentage of people 65 and older is projected to climb from 13% today to 19% by 2050, while the share of adults age 20 to 64 is expected to drop from 60% to 55%, the Census Bureau says.

"We will hit a really pivotal point," says Julie Maggioncalda, a University of Pennsylvania geriatric social work student who is interning at the Capitol Hill Village in Washington, D.C. Nursing homes won't be able to handle all the elderly, she says. "We simply don't have enough space, and if we don't have a village, that burden will fall on families," Maggioncalda says.

AARP research shows that 90% of people want to grow old in their home and community. "Villages are one way people can lead the life they want to live," says Mimi Castaldi, AARP vice president for volunteer engagement. "They've caught the imagination of people." 

CLICK HERE for full article and chart of Existing and Planned Villages

Sowing the Seeds of Culture Change and Person Centered Thinking:  Chicken or Egg?

(Source: Posted by: srdaystay | July 22, 2010, The Path to Home)

Scientists recently announced that they now have proof of which came first, the chicken or the egg. Surprisingly, they say it was the chicken. I doubt, however, that this age-old debate will stop just because of this new finding. However, it got me thinking that sometimes, sorting out “culture change” and “person-centered thinking” can be a little like the chicken and egg conversation. Which exists before the other? Which is most important?

Recently an associate expressed confusion over the relationship between “person-centered thinking” and “culture change”, and asked for my guidance in thinking it through. What she wanted to sort out was which of these terms encompasses the other and is of greater importance.  MORE

Assisted Living Facility Benefits from Community Culture Change Activity

(Source:  The Gazette, July 2010)

On May 16, Eden Springs Living Center, an assisted living facility in Durham, North Carolina, received numerous improvements from members of the Christ The King Moravian Church of Durham. About 75 church members landscaped, painted, hung art pictures and made small repairs at the facility. Additionally, residents at the facility spent the morning at the church with approximately 35 church members. Each resident received a new sheet set and bath towel set, donated by church members.


Many community vendors, including Dillard’s BBQ, Sears, Witherspoon Rose Nursery, Sherwin-Williams, Taylor’s Nursery, Lowes and Home Depot contributed food, paint, garden plants and more to help transform the facility.  The idea for this project stemmed from the Sowing the Seeds of Culture Change initiative. A Durham County Community Advisory Committee volunteer Martha Simpson spearheaded the project by gaining support from her church.  “The much needed help has drastically transformed our environment. Thank you all,” stated Eden Springs Administrator Jackson Odondi.


For pictures of the event, visit www.tjaaa.org, or contact Carmelita Karhoff, regional long-term care ombudsman for Durham County at 919-558-2714 or e-mail.     CLICK HERE for entire article

A "Culture Change" Permeates Island Nursing Home As Plans Emerge:  Deer Isle, Maine

(Source:  by Faith DeAmbrose, Island Ad-Vantages, July 29, 2010)

Work on developing a long-range plan for the Island Nursing Home is well on its way to creating and implementing sustainable changes in daily operations there. Volunteer planners have been meeting for a year and expect to continue the process for another year. The long range planning process took another step forward June 26, as approximately 40 volunteer participants (comprising 10 working committees) met to discuss their progress and talk about next steps in what is being called a 20/20 visioning process that looks ahead to the year 2020.

Recognized widely as a community asset, INH is home to 70 residents (long- and short-term), is the primary source of revenue for up to 100 employees, and maintains a waiting list at least 10 deep at any given time. Over the last few years improvements at the facility, including a redesigned courtyard, have been made with the aim of implementing what INH Administrator Marc Plourde calls a “culture change.”

This culture change is being taken another step further as INH makes resident relations its number one priority. Plourde explained that a number of improvements identified in the working committees are in the process of being implemented ahead of final committee reports. He said some of the changes also came about when the results of two surveys were calculated. One measured the satisfaction of employees and the other measured the satisfaction of residents’ families.  MORE

Residents Organize Employee Morale Committee

(Source: Pascack Valley Community Life, Thursday, July 22, 2010)

Residents at the Jewish Home Assisted Living in River Vale "want to do a little extra for the employees," said resident Mel Robertz. In order to do this, residents have organized an Employee Morale Committee, chaired by Robertz. The committee will raise funds and decide on ways to show their appreciation. "For instance, if an employee gets sick, we can send flowers. We've also asked the employees for a wish list. If it's realistic we'd consider it," said Robertz. In addition, the group sends cards to each employee on their birthday and they're looking for other ways to show that the residents value the employees' work, added committee member Jerry Zucker.

The residents recently held their first fundraising effort — a raffle which was won by resident Carrie Hain. They are now working on pulling together a gift basket that they can raffle off.  MORE

Photo: Courtesy of Jewish Home Assisted Living

An Employee Morale Committee was recently organized by residents of the Jewish Home Assisted Living (JHAL) in River Vale.  Pictured from left: resident Shirley Malick; social worker Nancy Ames; resident Joe Leeds; member of JHAL's dietary staff Judi Biondi; and resident Jerry Zucker pick a raffle ticket. The raffle was a fund-raiser for an employee appreciation program at the Jewish Home Assisted Living.

ElderspeakNew Program to Improve Communication with Elders Now Available

(Source: Pioneer Network)

Language, and our choice of language has a very powerful effect on those around us.  Elderspeak was developed by Daniel Baer, MD, to heighten awareness regarding the impact of communication tone and content with elders. LEARN MORE




(Source: PHI)

Download Chapter 5 of Getting Started: A Pioneering Approach to Culture Change in Long-Term Care Organizations for free.

 Joanne Rader

 Susan Misiorski

Four years ago, PHI’s National Director of Training and Organizational Development Susan Misiorski authored Getting Started, a handbook on implementing culture change, published by the Pioneer Network. The handbook has been a great success, but many Pioneers have asked for more direction regarding which changes to tackle when.

In response, Misiorski has teamed up with independent consultant and culture change expert Joanne Rader to author a new chapter titled, “Selecting and Prioritizing Changes.”

Both Misiorski and Rader have been supporting elder care and disability services providers to implement person-directed culture change for over 20 years.

Read an interview with them about the new chapter HERE

What additional information is in the Getting Started Handbook and how do I get it?

The original handbook is available for $99.00 at the Pioneer Network’s bookstore. The handbook includes:

  • A reproducible chapter explaining what culture change is. Share this with staff, elders and families.
  • A process for developing and/or revising mission, vision, and values with high involvement of elders, families and staff.
  • An organizational assessment ensuring measurements are built into the change process.

Multiple staff inservice modules. There are 4 inservices included for each of the 13 Pioneer Network Values (pdf)

(Source:  By Kathy McCollett, PHI)

Kathy McCollett is an Organizational Culture Change Specialist with PHI’s Training and Organizational Development team.

The Pioneer Network’s 10th National Conference “Meeting at the Crossroads” was convened in Indianapolis August 9-11, 2010. The Pioneer Network “advocates and facilitates deep system change and transformation in our culture of aging.” In record attendance, people from all over the country and around the world participated in the nearly one hundred sessions offered for those interested in advancing the culture change movement.

Bonnie Kantor
, executive director of the Pioneer Network, presented valuable new tools and information that have been developed this year by the Pioneer Network–all of which are now available at pioneernetwork.net.

Carter Catlett Williams
opened the conference. She acknowledged that we are at the crossroads of a nation, of an industry, and as individuals. The beauty of meeting at these crossroads, she said, is that it allows us to share information with each other about where we have been, what we have learned, our visions and our dreams, and where we are going.

Assistant Secretary for Aging Kathy Greenlee said that she “has a heart for people.” She believes that there is a great need for more home- and community-based services and sees culture change as a national priority. Acknowledging that the attendees at the conference are “revolutionizing aging,” she said, “I want to be a partner with you in every single way,” and, “I want this to be about ‘long term independence’ rather than ‘long-term care.’”

In recognition of her contribution to “deep system change,” Karen Schoeneman, the deputy director of the Division of Nursing Homes for CMS, was presented the 2010 Picker Institute Award for Excellence in the Advancement of Patient-Centered Care in the Long-Term Care Setting. She has worked tirelessly for many years toward deepening culture change values in the long-term care survey process.

Many of the presenters reflected the thought that changing the culture of aging is about developing and maintaining relationships. Dorothy Seman of the Alzheimer’s Family Care Center in Chicago said, “What we do isn’t rocket science, it’s much harder than that! We are about people and relationships. With each encounter, you either deepen or diminish the relationship.”  MORE 

(Source: Steve Gurney, www.retirement-living.com)

“The only thing that should change when someone moves to a nursing home is their address”  This was a quote that someone shared with me at the Pioneer Network Annual Conference last week. Although it may seem like a lofty and unacheivable goal - after attending this event and meeting so many caring, creative and committed people - I am confident that we will see dramatic sweeping changes in senior living in the near future!

I was a speaker and it was my first time attending one of their conferences. I am kicking myself for not attending sooner!  The Pioneer Network was founded with a focus on radical change in the culture of aging often referred to as the "Culture Change" movement in Nursing Homes and Long-Term Care Settings.  Click here for a definition of Culture Change.

I guess I thought that concepts of Culture Change relied primary on changes to the physical structure of a community or nursing center.  After attending the conference I realize how wrong my interpretation was!  Through conversations with attendees and going to several seminars it’s clear that this movement is centered on the people living in these homes.  As Holly Whiteside Author of "The Caregiver’s Compass" states, “The architectural or administrative changes only support and facilitate people shifting their focus to human connection.”

It gave me hope that there are so many caring people motivated to think creatively and try new ideas to improve these environments.  I also liked the fact that there was so much healthy debate and challenging of ideas and thoughts.  I liked how everyone seemed to challenge each other from the viewpoint of “is that going to be what the resident wants?”

There were many topics and resources that I discovered at the conference, I hope to explore many of these in future postings on the blog and in articles in Guide to Retirement Living SourceBook.  :

If you are working with seniors and their families you need to try to attend a Pioneer Network event.  Trust me, there is nothing you will read that will convey the benefits of attending this event with your eyes wide open and a willingness to meet and talk to others. The programming and organization are great – but it’s the people that you will meet that will make you feel confident that we will have better care for our elders.  LINK


Since the issuance on June 12, 2009 of the revisions to the CMS Interpretive Guidelines, providers have indicated interest in tools and resources for nursing homes to operationalize the guidelines which are all about resident Quality of Life, Person-Centered Care and a Home Environment. Pioneer Network heard this need, and is proud to introduce Promising Practices.
Promising Practices in Dining is our first topic, with Promising Practices in Home and the Environment expected next. We have incorporated and highlighted promising practices from a broad range of nursing homes and care settings to create this easy-to-use resource to enhance the quality of life for our nation's elders and those who care for and about them. LEARN MORE

Artifacts of Culture Change

The CMS Artifacts of Culture Change is a tool for providers to assess readiness, implementation and sustainability of person-directed care. The Artifacts of Culture Change tool fills the purpose of collecting the major concrete changes homes have made to care and workplace practices, policies and schedules, increased resident autonomy, and improved environment. It results from study of what providers and researchers have deemed significant things that are changed and are different in culture changing homes compared to other homes. The tool was developed by Carmen S. Bowman, the owner of the culture change consulting business, Edu-Catering: Catering Education for Compliance and Culture Change in LTC (click here for details) and Karen Schoeneman, Deputy Director of the CMS Division of Nursing Homes.

The Artifacts is one of several tools available to assess culture change transformations. The Development of the Artifacts of Culture Change Tool (click here to download) lists other assessment methods (pg. 5), describes the development of the Artifacts, and provides additional helpful information to support the use of the tool. The full Artifacts tool is available in Appendix A of the Development document or click here to download the tool separately.

Civil Rights vs. Right to Choose Under Review

(Source: www.alfa.org)

Provider companies and caregivers nationwide have been closely watching the case of an Indiana nursing home resident who did not receive care after a fall because she had issued specific instructions about the race of her caregivers.  Certified nursing assistant Brenda Chaney found a resident lying on the floor of an Indiana nursing home but couldn’t help her as the resident did not want to be treated by black CNAs. Chaney is black. This incident led a July court ruling which upheld that honoring privacy laws to that extent is taking them too far.

The Nursing Home Reform Law of 1987 gave individuals more rights and some occasionally request not to be treated by staffers of a certain race. And nursing home staff will often honor an individual’s preferences.  "When people write laws, they don't think about these types of things very much," said Dennis Frick, an attorney with the Indiana Legal Services' Senior Law Project, to the Associated Press.

Under federal law, those who reside in nursing homes have the right to choose their own doctors. And nursing homes are also under legal obligation to reasonably accommodate their residents’ “individual needs and preferences.”  Although patients can refuse to be seen by doctors of the opposite sex due to privacy concerns, the 7th U.S. Circuit Court of Appeals ruled in Chaney’s case in July that race cannot be applied to that law.  "The privacy interest that is offended when one undresses in front of a doctor or nurse of the opposite sex does not apply to race," the ruling said.

In addition to battling privacy issues, nursing homes throughout the nation must also deal with potential legal disputes when it comes to staffing. A California jury recently awarded a group of class action plaintiffs one of the highest awards ever in a suit against a nursing home alleging inadequate staffing. 

Read the Associated Press story, “Huge Verdict Shakes up Nursing Home Industry.”

Read the Associated Press article, “Ind. Ruling Halts Caregiver Choices Based on Race.”  

Link to ALFA article

Ask the care expert: deli gloves vs. home-like environment

(Source: Sherrie Dornberger, McKnights)

In order to observe a homelike environment and resident dignity, we are not supposed to assist wearing gloves. But if we are one-on-one with a resident and bread needs to be buttered, should we wear gloves?

This question is one that everyone seems to be struggling with. You need to put on deli gloves, use food handling paper—like those used in bakeries to pick up individual donuts or cookies—or use the “knife/fork it” method, where you use a knife and fork to pick up food items to hand it to the resident if they can't pick items up alone.

This method is the personal favorite of some infection control nurses when it comes to feeding residents. It is tricky to get used to but works well and cuts down on the number of gloves needed while assisting in the dining rooms. After all, we don't wear gloves in our own homes.

Food code regulations require that gloves be worn when preparing and handling food unless the food can be handled with utensils. The staff working in the kitchen and tray line must always wear gloves when handling food, and hands should be washed each time gloves are removed.

When assisting with feeding an individual resident, the caregiver's hands should be washed first and care should be taken not to touch food while feeding. If bread must be buttered, it is best to use a hands-free approach (very tricky!), or apply gloves, prepare the food, and remove gloves. In this case, there would not be a need to wash hands again, unless the facility policy requires that.

But, with all of this said, let's not forget cleaning the resident's hands also. If you hand food to them and their hands are not clean, then all of your hygiene efforts—cleaning your own hands or using the knife/fork method, for example—will not matter.  LINK to ARTICLE

American Association of Homes and Services to be no more

(Source:  McKnights)

It's official: The American Association of Homes and Services for the Aging will become LeadingAge, the group announced Monday.

Approximately 40% of members voted recently in an election to approve the name change, said AAHSA President and CEO Larry Minnix. The final tally was 85% for the name and 15% against the name in voting that closed in mid-August. The new name will take effect in early 2011—the 50th anniversary year for the agency. Legal paperwork and transitioning steps have already begun.

The new name will “reinforce the kind of leadership and innovation that our members have been involved in for a long time,” Minnix said.  AAHSA leaders have been involved in a process to rework the brand for 18 months, according to Minnix. The board approved the new name before it was pitched to members. With the new name also comes a new mission statement: “Expanding the world of possibilities for aging.”  Link to Article  




Pioneer Network Develops Promising Practices, Web-Based Resource for Providers Who Are Navigating the Revisions to the CMS Interpretive Guidelines

Promising Practices in Dining, the First Topic, Illustrates How Providers Can Honor Resident Dignity and Choice

(Source:  Pioneer Network)

ROCHESTER, NY – Pioneer Network Executive Director Bonnie Kantor announced today the launch of Promising Practices, a web-based resource for providers who are navigating the revisions to the CMS Interpretive Guidelines. Providers have indicated interest in tools and resources for nursing homes to operationalize the guidelines which are all about resident Quality of Life, Person-Centered Care and a Home Environment. Promising Practices serves to meet that need.


Promising Practices in Dining is the first topic, with Promising Practices in Home and the Environment expected next. The release of the June 12 2009 CMS Interpretive Guidelines reinforces the need for nursing homes to re-evaluate resident quality of life, including the methods by which providers honor resident dignity and choice in dining.  Pioneer Network has incorporated and highlighted promising practices in dining from a broad range of nursing homes and care settings to create this easy-to-use resource. This resource was created in response to providers asking for a concrete resource during February’s Creating Home in the Nursing Home II ‐‐ A National Symposium on Culture Change and the Food and Dining Requirements.


“Providers throughout the country have asked us to develop a ‘one stop shopping site’ so they can more easily create responsive and cost effective systems and practices that exceed their residents’ expectations,” says Bonnie Kantor. “Thanks to the generosity of the Commonwealth Fund and our many partners we were able to launch Promising Practices to address that need.”    To visit the Promising Practices in Dining resource, CLICK HERE   

(Source:  Dr. Bill Thomas, www.changingaging.org)

In the movement to make elderhood a rich and productive time of life — not just a leftover — the voices of those who are living through and grappling with this transition must be heard.  Social media and blogging have provided a platform for millions and millions of unheard voices to speak out, and that’s why ChangingAging.org is partnering with the Picker Institute to launch a new blog — the Picker Report on Aging in America at www.PickerReport.org — dedicated to promoting person-centered care by building a social network of elders, their advocates, care givers and families.


Using streaming video and Skype, we want to talk directly to YOU.  Join the conversation by watching our welcome message below and subscribing to our new YouTube Channel and Twitter account @PickerReport. By subscribing you’ll get instant updates with our latest conversations. You can send us messages by commenting on our videos, messaging us through YouTube, Twitter or emailing us directly at PickerReport@Gmail.com.


The Picker Institute is the nation’s leading foundation advancing person-centered care. They’ve been transforming the way patients and doctors approach health care by funding research, education and awarding outstanding advances in person-centeredness.  LINK HERE  

Congratulations to the Illiana VA, the First Federal VA Green House Project to Break Ground

(Source:  THE GREEN HOUSE® Project)

Congratulations to the Illiana VA, the first Federal VA Green House Project to break-ground. October 12,2010 was a great day for the Danville VA. More than 250 attended the Groundbreaking with lots of media coverage. See Project Guide, Bill Keane, describe the new home and experience that is being created to honor and serve those who have served our country.   WATCH HERE  

Peddling a Product Few Want, Nursing Homes Innovate, Broaden Offerings to Turn a Profit

(Source:  Associated Press)

Seniors amble the nursing home's halls, while children from around the world visit for biofeedback treatments. One floor down from the hospice, middle-aged workers fill its pain management clinic. A rehabilitation center attracts people of all ages.  For decades, the mission at Miami Jewish Home and Hospital was simple: To care for the old. But like nursing homes around the country, the facility is changing how it does business because of consumer demands and the economic realities of selling a service nearly no one wants.

"This is a place of life. This isn't a place of impending death," said Blaise Mercadante, chief marketing officer at Miami Jewish. "And that's fundamentally the mindset change."

Other companies whose core business has been housing the elderly are also coming up with new ways to make money, but Miami Jewish has taken the innovation further than most. While similar providers have expanded senior-related offerings like in-home care or assisted living, the South Florida home took a gamble in recent years by hiring specialists in fields that attract younger patients.  The moves are paying off: Miami Jewish expects to break even in 2011 after several years of losses.

"Nursing homes are waking up more and more to the reality that their old model of doing business is not going to hold up in the 21st century," said Elinor Ginzler, an expert on long-term care at AARP.

Another provider that's changed its mix of services is Ecumen, which operates 70 senior communities in Minnesota, Wisconsin, Iowa, North Dakota and Idaho.  In 2004, Ecumen derived more than 80 percent of its $99 million in revenues from traditional nursing homes. Five years later, revenues climbed to $126 million while nursing homes' share fell to less than 60 percent, as Ecumen markedly expanded assisted living complexes that allow seniors to be more independent. A $2.5 million loss in 2005 became a $937,000 profit last year.

"We were heavily invested and reliant on a product that wasn't very popular," said Mick Finn, one of the company's a vice presidents. "That's a no-win proposition for any business."

Meanwhile, managers of its facilities were challenged to find new ways to make money off their existing services.  One began offering meals from its cafeteria pickup service to community members. Another started an online business selling incontinence products. A third opened its fitness classes to nonresidents.  "It was either diversify or die," said Eric Schubert, another Ecumen vice president.

Even as the number of older Americans surges with the aging of the massive baby boom generation, demand for nursing homes is decreasing. The Centers for Disease Control and Prevention estimate that the number of nursing home residents fell from 1.63 million in 1999 to 1.49 million in 2004, the last year for which data is available. Meanwhile, the number of nursing homes decreased by nearly 16 percent over the two decades ending in 2004.

Demand for services like assisted living, in-home care and adult day care, meanwhile, is booming. Nursing homes have expanded their offerings to cope with shortfalls after finding that in many cases they are unable to provide care for less than the amount they are reimbursed under Medicaid, the main governmental provider of long-term care.

Brian Williamson, an analyst for Standard & Poor's who follows nursing homes, said facilities have been branching out to deal with lower occupancy rates. "Where before you may have been able to keep your facility 97 percent full, now maybe it's 92 percent," he said. "You have to figure out how do I compensate for that lost percentage of beds."

While some facilities have shuttered, observers say there will always be a need for nursing homes. Neil Kurtz, CEO of Golden Living, one of the largest nursing home operators in the U.S., said the emphasis has shifted from providing a place where seniors can grow old and die, to a place where seniors can recover from illness or surgery before moving back home or elsewhere.

"The concept where we're just warehousing patients and this is where they go to die is just the furthest from the truth," Kurtz said.  READ MORE HERE

October is Patient-Centered Care Awareness Month

(Source:  www.planetree.org)

Patient-Centered Care Awareness Month is an international awareness-building campaign that occurs every October to commemorate the progress that has been made toward making patient-centered care a reality and to build momentum for further progress through education and collaboration.  Hospitals and health care organizations around the world are encouraged to celebrate by empowering patients, strengthening their patient-centered practices, and publicly proclaiming to their patients and communities their commitment to patient-centered care.  

For the past three years, health care organizations around the United States, Canada and the Netherlands have celebrated Patient-Centered Care Awareness Month.  In addition, several state governors commemorated the month signing proclamations officially recognizing the importance of patient-centered care to their states’ citizens.

What is “Patient-Centered Care?”

Although the phrase “patient-centered care” is defined and used in a variety of ways, the essential theme is the importance of delivering healthcare in a manner that works best for patients.  In a patient-centered approach to health care, providers partner with patients and their family members to identify and satisfy the full range of patient needs and preferences.  Organizations practicing patient-centered care recognize that:

          A patient is an individual to be cared for, not a medical condition to be treated.

  • §  Each patient is a unique person, with diverse needs.
  • §  Patients are partners and have knowledge and expertise that is essential to their care.
  • §  Patients’ family and friends are also partners.
  • §  Access to understandable health information is essential to empower patients to participate in their care and patient-centered organizations take responsibility for providing access to that information.
  • §  The opportunity to make decisions is essential to the well-being of patients and patient-centered organizations take responsibility for maximizing patients’ opportunities for choices and for respecting those choices. 
  • §  Each staff member is a caregiver, whose role is to meet the needs of each patient, and staff members can meet those needs more effectively if the organization supports staff members in achieving their highest professional aspirations, as well as their personal goals.
  • §  Patient-centered care is the core of a high quality health care system and a necessary foundation for safe, effective, efficient, timely, and equitable care.  MORE

‘VIVE’: Interviewing Frail Elders

(Source:  Picker Institute)

The systematic inclusion of the resident’s voice in her or his own assessments represents an enormous advance in the new Minimum Data Set 3.0 (MDS 3.0). The Video on Interviewing Vulnerable Elders (VIVE) demonstrates best-practice approaches for implementing the new MDS interviews for cognition, mood, preferences and pain. Specific video sections explain why interviews have been added; review techniques to improve communication with older, frail populations; and demonstrate each interview being conducted. Using real-life nurses interacting in scenarios based on actual situations, VIVE helps to build understanding and ease implementation of MDS 3.0 for nursing home staff members. The goal of VIVE,funded by Picker Institute and developed by the UCLA/Jewish Home Borun Center, is to help staff members build the confidence and skills they need to interview their residents both for MDS 3.0 and for other clinical evaluations.  The “VIVE” video is available at no cost from CMS. Click here to order.  SEE MORE

2010 State of Senior Living and Senior Living Capital Markets

(Source:  Prepared by Jeffrey Girardi, Research Specialist, Ziegler, Hat Tip to Colleen Bloom)

The Ziegler Senior Living Finance + Strategy (SLF+S) Conference at the Coconut Point Hyatt Regency Resort & Spa in Bonita Springs, FL this week provided a literal and figurative calm after the storm. The literal storm (Tropical Storm Nicole) passed quickly through South Florida just before the conference began, leaving blue skies in its wake for conference attendees to enjoy; the figurative economic “storm” of 2008 and 2009 has left a few remnants of ‘foul weather’ in its midst, though senior living providers seem to be riding several positive trends in its wake. 


These trends — eleven, in fact — were the highlight of this year’s traditional opening session of the SLF+S Conference (Thursday, Sept 30). Presented by Kathryn Brod, Ziegler’s Sr. Vice President and Director of Senior Living Research; Dan Hermann, Ziegler’s Senior Managing Director, Head of Senior Living Finance; Mike McDaniel, Ziegler’s Senior Managing Director, Head of Sales and Trading; Ron Mintz, Principal, Vanguard; and Jim LeBuhn, Director, Fitch Ratings, these eleven trends were woven into each of the subsequent educational sessions of the conference and were enumerated by this team of speakers as follows:…


3. Adopting Resident-Centered Service & Care Models. The models of resident-centered care are proliferating, whether in stand-alone Green House® and small house

settings or incorporated in culture change new community or repositioning initiatives.  READ MORE HERE  http://image.exct.net/lib/ff021271746401/d/1/zNews_Featured_100110.pdf?utm_medium=email&utm_campaign=Z-News+for+the+Week+of+10-01-2010&utm_content=cbloom@aahsa.org&utm_source=

The Language of Change: Finding Words to Define Culture Change in Long-Term Care 

(Source:  Author: Meldrena K. Chapin)

Chapin, M. K. (2010). The Language of Change: Finding Words to Define Culture Change in Long-Term Care. Journal of Aging, Humanities, and the Arts: Official Journal of the Gerontological Society of America, 4(3), 185-199. doi:10.1080/19325614.2010.508332

ABSTRACT:  Many senior living organizations are working to transform their institutional character into home and community. This undertaking amounts to a virtual cultural shift, known in the industry as culture change. Culture change is receiving growing popularity in the senior living industry; however the majority of organizations have yet to begin tackling this transformation. One of the contributions to this hesitancy may be that no universal explicit definition of culture change is accepted within the industry. This article, based on an extensive literature review, examines the current definitions within the culture change literature and proposes a new definition that may be helpful in understanding and undertaking this challenging holistic transformation.

Six New Villages Expand Aging in Place in California

(Source:  By Athan Bezaitis, communications specialist at The SCAN Foundation)

In the face of declining public resources and cutbacks to social programs for older adults, a grassroots movement has brought groups of local elders together to provide services and

healthcare to help people age in place. These communities call themselves “villages,” a naming derived from the aphorism, “It takes a village to raise a child.” This concept is expanded to include community engagement, support for a growing aging population and helping elders maintain their active presence as a vibrant element of a healthy society. 

Villages are membership-driven, nonprofit organizations designed to meet the needs and preferences of older adults at the neighborhood level. They provide transportation, discounted services, social activities, volunteer opportunities and a vetted list of trusted vendors for home repairs and personal care.


Currently, there are nearly 45 operational villages nationwide with hundreds of other communities seeking to start their own programs. Membership dues and fees are based on village location. The largest villages have more than 450 members, the smallest fewer than 100.  Some charge annual dues of up to $1,200 per year, others as little as $300. The hallmark of the villages is their commitment to being part of the continuum of services in their communities and to collaborating with existing organizations.  READ MORE

(Source:  By Beth Sanders, www.lifebio.blogspot.com)

I work with a lot of senior living communities, assisted living, and skilled nursing homes across the US and Canada. I have found that you can feel the difference when you walk into a community that loves and respects every person in the building.

The ripple effect of love is very powerful when the director or administrator or other leaders in the community starts the waves and keep them going with a simple kind word, a genuine compliment, or smile every day. It will surely ripple over into the lives of families and residents over time. In a professional and caring way, his/her love and respect for the staff needs to be felt equally from laundry to nursing to activity director. Listen carefully to each other's needs and concerns and creative ideas. Help people feel appreciated no matter their pay scale. Everyone is in this together!

I can also see residents in these communities starting the ripple effect themselves. When they are caring and see the workers around them doing all they can to help, it is a wonderful thing too. It means a lot when residents are thankful and loving to the people who could be helping them with dressing or bathing or physical therapy. It is a two-way street, but the ripple effect must start somewhere.

Drop the pebble of love in the water, and watch the ripple effect begin.  That is true culture change.  MORE

Aging in Place — A Graceful Living Option for Seniors

(Source: By Barbara Bedway, The Fiscal Times)

The swelling ranks of Americans 65 and older — a figure expected to more than double to 89 million by 2050 — have inspired communities and companies to find innovative ways to help older Americans work longer and age gracefully and affordably in their homes.

The small but fast-growing "village" movement — where seniors help seniors to coordinate and deliver services within their communities — is a grass-roots response to the well-documented preference of older people to remain in their homes as they age. There are many different models for this approach, but one of the most venerable is Boston’s Beacon Hill Village, which was created by a group of long-time residents in 2001. Now there are more than 50 such villages nationwide, and more than 600 in development. Experts believe some type of village model could help fill the growing need for affordable housing and services for our rapidly aging population.

It Takes a Village

"People who join Villages are planners," notes Elinor Ginzler, senior vice president for livable communities at AARP. "The notion of either delaying or avoiding institutional care is exactly why these folks joined."

Aging-in-place systems are cost-effective. Consider this: The median monthly cost for nursing home care in 2009 was $5,243 — more than five times that for seniors living at home, according a study published in the 2010 issue of Health Affairs.

With the need for long-term care expected to double between 2000 and 2040, these models can postpone the need for institutional care and cut significant costs for individuals as well as government programs like Medicare and Medicaid. 

Businesses Step Up

Businesses, too, are stepping up to confront the parallel challenge of a rapidly aging population: how to support workers juggling fulltime jobs with their duties as caretakers of elderly relatives. According to a study by the National Alliance for Caregiving and AARP, an estimated 21 percent of all U.S. households are providing care for an adult family member. Increasingly, employers see the toll that takes on their own employees’ health and productivity.   As the MetLife Study of Working Caregivers and Employer Health Care Costs reports, workers caring for an older relative are more likely to report health problems like depression, diabetes, hypertension or heart disease — costing employers $13.4 billion annually.  Here are some of the most creative and cost-effective solutions citizens and companies are developing:  READ MORE

National Aging in Place Week October 11th through the 17th

(Source:  Mary Lea Quinn, NAIP Georgia Chapter)

This year’s National Aging in Place week will be held from October 11th through the 17th.The following will be continuously updated with national events as they are planned, so keep checking back for ideas.  Aging in Place Week is in its seventh year.  Past events have, and future events should, incorporate business to business, business to consumer, and media events. The goals of these events should focus on chapter fundraising, creating local awareness among seniors, community involvement, and finding new referrals.

Some of the past and future promotion ideas presented were:  The publication of resource guides, highlighting local service providers; Official proclamations from local government; Story placement in local newspapers; Home remodeling events taking place at a senior modified home; A seminar on financial planning for seniors and boomers; Medicare seminars; A Miss Aging in Place contest; Leaflet exchanges with local theaters; A golf tournament where each hole had different sponsor; Bingo with age-in-place product and service prizes; Senior job fairs; Senior "speed dating."

In the Works -- Atlanta

This year, the Atlanta chapter has ambitious plans for an "extreme home makeover-style" contest where people write letters and send photos about their homes and why it needs aging in place updating. The chapter will choose 3 – 5 people for the public to vote on to receive free services from their member providers. "The goal is to assess the home and help provide a plan," Quinn says, "as well as to get some press on aging in place. We might redo a bathroom or provide other free services to that senior, like free hours of home care or meal delivery."




Background Paper Available Now

Prepared by Carmen Bowman, MHS under contract with the Centers for Medicare & Medicaid Services (CMS), The Food and Dining Side of the Culture Change Movement: Identifying Barriers and Potential Solutions to Furthering Innovation in Nursing Homes is intended to provide the history of the culture change movement as it pertains to food and dining, including current research regarding food and dining issues and innovations.
"The issues surrounding new and innovative ways of serving food in the nursing home as you weave in and out of regulatory requirements. Thus, both the issues as well as the regulations are presented here together intertwined with what is missing. Carmen offers recommendations for what might be helpful on your journey to Culture Change." --Carmen Bowman, Author
Click here to download the background paper.