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The Pioneer Network, a coalition of organizations and individuals working to change the culture of aging and long-term care of elders in the U.S., is hiring an executive director.

This position requires a visionary leader who will serve as the organization’s representative and guide its efforts in:

• strategic development;
• fundraising;
• business planning; and
• financial management.

Interested applicants should contact James Zaniello at Vetted Solutions.

Pioneer Event Postponed

The Pioneer Network has postponed Creating Home in the Nursing Home III: MDS 3.0 as the Engine for Individualized Care and Quality Improvement, which was to be held in Washington, D.C. on April 10, 2011.

The Pioneer Network will, however, hold a series of webinars — to be scheduled this spring — and additional events on this initiative throughout the year.

- by Toccara Heath, PHI Communications Intern

A new study published in the 2010 Seniors Housing & Care Journal found that nursing homes that embrace and sustain culture change have a higher occupancy rate and greater revenue than traditional nursing homes.

In Occupancy and Revenue Gains from Culture Change in Nursing Homes: A Win-Win Innovation for a New Age of Long-Term Care, Pioneer Network Policy Analyst Amy Elliot, Ph.D., the study investigator, reports that a review of the literature finds that anecdotal accounts and empirical studies show that nursing homes that have adopted culture change have improved consumer outcomes and greater consumer and staff satisfaction.

Other Gains of Culture Change

The purpose of this study, explains Elliot, is to answer a question posed by providers and policymakers when considering innovation of any kind: “Culture change at what gain?”

The study compares traditional nursing homes to those that have adopted and sustained culture change for two years or more from 2004 to 2008. It found that both types of homes had occupancy rates of 86 percent in 2004, before culture change was instituted. For the facilities that adopted culture change, the occupancy rate increased to 89 percent in 2008, but the rate remained the same for the nursing homes that did not subscribe to the culture change philosophy.

The study also found that for the homes that adopted and sustained culture change, there was an increase in revenue of $11.43 per bed per day — which amounts to a $584,073 increase in revenue per year for homes with 140 beds.

“This data is particularly important to the growth of the culture change movement because it supports the business case,” said Sue Misiorski, director of PHI Training and Organizational Development services. “Culture change is not just ‘the right thing to do’ on behalf of elders and employees — it is good business.”

Culture Change Supported by Policy

Elliot reports how culture change has gone from a grassroots movement in the early ’90s to a practice supported by national policy. She notes that the effort was led by the National Citizens Coalition for Nursing Home Reform from which the Pioneer Network developed, with support for implementing person-centered care practices from advocacy organizations like PHI and the Direct Care Alliance and organizations promoting new models of care such as the Eden Alternative and Green House.

Federal and state policies have helped to incentivize and spur nursing homes to embrace culture change further, Elliot explains. She points out that the “National Demonstration Project on Culture Change” (pdf, see page 3), a provision in the Patient Protection and Affordable Care Act of 2010, is further evidence of how culture change has taken hold.

The study on occupancy and revenue gains from culture change in nursing homes was made possible with support from The Commonwealth Fund.

– by Deane Beebe

The Pioneer Network has extended the deadline to submit proposals to be a guide and/or presenter at its 2011 National Conference, which will take place in St. Charles, Missouri, from August 1-4.

The new deadline is Friday, December 10; all proposals must be submitted electronically.

Ten tips for writing proposals to be a conference guide and/or presenter are available on the Pioneer Network’s website. Session guides/presenters represent a wide range of professions, such as nurses, architects, administrators, direct-care workers, researchers, artists, and advocates. Elders and family members are also encouraged to present.

The Pioneer Network is a leader in the culture change (pdf) movement and advocates for person-centered care. The organization boasts that it “hosts the only national conference devoted solely to culture change.”

The theme of this year’s conference is “Explore. Discover. Change.” Registration to attend the conference will be open this spring. More information about the Pioneer Network 2011 National Conference is available on the Pioneer Network’s website.

– by Deane Beebe

The Pioneer Network is requesting proposals to be a guide and/or presenter at its 2011 National Conference, which will take place in St. Charles, Missouri, from August 1-4.

The deadline to submit proposals is Tuesday, November 30; all proposals must be submitted electronically.

Ten tips for writing proposals to be a conference guide and/or presenter are available on the Pioneer Network’s website. Session guides/presenters represent a wide range of professions, such as nurses, architects, administrators, direct-care workers, researchers, artists, and advocates. Elders and family members are also encouraged to present.

The Pioneer Network is a leader in the culture change (pdf) movement and advocates for person-centered care. The organization boasts that it “hosts the only national conference devoted solely to culture change.”

The theme of this year’s conference is “Explore. Discover. Change.” Registration to attend the conference will be open this spring. More information about the Pioneer Network 2011 National Conference is available on the Pioneer Network’s website.

– by Deane Beebe

PHI joined more than 300 ombudsmen, long-term care consumers, nursing home family and resident council members, professionals, government officials, nursing home employees’ union representatives, and advocates this week at the Consumer Voice‘s 35th Annual Meeting and Conference, which kicked off in Orlando, Florida, on October 18.

PHI was one of the sponsors of this year’s conference, and helped several direct-care workers attend the event.

Person-Centered Care and Culture Change the Buzz

Many of this year’s conference sessions have focused on — or included discussion of — strategies to achieve culture change and deliver person-centered care. The role of the direct-care workforce in achieving culture change was highlighted throughout these workshops.

PHI, which is currently partnering with SAGE on the National Technical Assistance Resource Center for LGBT Elders, was pleased to see a workshop addressing the challenges of supporting LGBT elders.

At “Gay and Gray or Heading That Way,” presenter Debi Lee, lead regional ombudsman, Centralina [North Carolina] Area Agency on Aging, discussed her organization’s project on bridging the gap between direct-care workers and lesbian, gay, bisexual, and transgender (LGBT) elders through relationship building, training, mutual support, and advocacy.

Lee noted that, in order for the project’s second phase to be more successful at bridging that gap, its events will take place in nursing facilities and while direct-care workers are on the clock, rather than on their own unpaid time.

Models for Quality Improvement

At “Innovative Collaborations to Improve Nursing Home Life for Residents, Family, and Staff,” two innovative models were presented.

Direct-care workers from Virginia’s Trinity Mission Health and Rehabilitation (pictured below) discussed how their facility used Civil Monetary Penalty funding for its quality improvement project to reduce certified nursing assistant turnover by 25 percent. To achieve their goal the facility works to:

• empower CNAs
• provide CNAs with more support
• enhance CNA awards and recognition opportunities
• enhance CNA skills and training
• create a CNA mentorship program for new staff
• involve CNAs in care plan meetings

“The CNAs are key members of the team; they know and work closely with the residents,” said Claire Curry, legal director of the Virginia-based Legal Aid Justice Center, which initiated the Community Partnership for Improved Long-Term Care, Trinity Mission’s project partner.

Presenters (L-R): Sheila Faulkner, Brittany Burgess, Melva Proctor, Latisha Ayres, Phyllis Crenshaw, and Zelda McGruder

“It is preposterous when the CNAs are not a part of the care planning meetings…. [Their input] is essential to delivering person-centered care,” Curry said.

During this session, Karlin Mbah, family council coordinator and policy advocate for FRIA: The Voice and Resource for Quality Long-Term Care, discussed a project the organization is launching in 2011 with family councils and the 1199 SEIU Labor Management Project.

In this collaboration, family caregivers and direct-care workers are strengthening their relationships by looking at the meaning of the word “dignity” as it applies to workers, family members, and residents.

“Family and friend caregivers believe that working together from the bottom-up — formal and informal caregivers — can bring person-centered care to nursing homes,” Mbah said.

OAA Reauthorization Act and the Direct-Care Workforce

PHI National Policy Analyst Gail MacIness was a panelist for the plenary session entitled “Older Americans Reauthorization Act — Listening Session,” where she discussed PHI’s recommendations (pdf) on:

• improving training and empowerment for the direct-care workforce;
• building infrastructure for self-directed services; and
• incorporating workforce planning and assessment into the aging services network.

Official listeners from the U.S. Senate Special Committee on Aging and the Administration on Aging participated in the panel presentation.

Preventing Elder Abuse

A presentation on stopping elder abuse included information on how professionals can help.

During the Q and A, PHI staff had the opportunity to highlight the role of direct-care workers in preventing abuse, as well as PHI’s free curriculum, Adult Abuse & Neglect Prevention Training.

– by Deane Beebe

The 2010 Annual Quality Report (pdf) published on September 21 by the American Health Care Association (AHCA) and Alliance for Quality Nursing Home Care found that there has been a positive trend toward quality improvement in nursing and rehabilitation facilities.

The gains are not universal, however, note the authors. They write that the report highlights the need for ongoing efforts that focus on ensuring enhanced quality and increased consumer and employee satisfaction.

The organizations’ second annual report includes analysis and data from experts in the long-term care field, data from the Centers for Medicare and Medicaid Services, and consumer and workforce satisfaction scores from an independent research company.

Culture Change Improves Quality

In a chapter entitled “Improving Performance through Person-Centered Care,” which is an analysis of the impact of culture change on nursing home quality, Leslie A. Grant, Ph.D., states that “culture change innovations are diffusing more broadly into the mainstream as more stakeholder groups…recognize the value of person-centered care practices in long term care.”

Grant concludes that person-centered care is associated with:

• higher levels of resident and staff satisfaction
• better workforce performance
• higher occupancy rates, and
• improved organizational performance.

“One of the significant culture change practices that has impacted the workforce is consistent assignments,” said PHI Director of Training and Organizational Development Services Susan Misiorski. “With consistent assignment, direct-care workers support the same individuals about 80 percent of their time or more.”

“The implementation of consistent assignment has resulted in better care outcomes and improved resident and staff satisfaction. We are also seeing significant strides in the amount of empowerment/problem solving/decision making authority direct-care staff and elders are able to make as a result of culture change,” Misiorski said.

Satisfied Workers, Satisfied Families

In “Quality: By the Numbers,” AHCA and the Alliance analyze the relationship between consumer and workforce satisfaction, and conclude that they correlate positively — facilities with higher workforce satisfaction also have higher family satisfaction.

The authors of the chapter write that an “effective strategy for quality improvement must include an intense and sustained focus on the skills, commitment, and satisfaction of the workforce, particularly those staff who directly care for residents and communicate with family members.”

CNAs on the Team

In a case study on the “Pain Collaborative,” Stefan Gravenstein, M.D., Ph.D, and Richard Besdine, M.D, report on both the success of the collaborative in reducing moderate- to-severe pain among “long-stay” residents, and the benefits of forming quality improvement teams that include certified nursing assistants (CNAs) as well as nurses and their directors.

While the primary goal of the Pain Collaborative is to improve pain management, the “secondary goal is to break down barriers between stakeholders and better understand the challenges to moving toward a new, team-driven approach,” the authors report.

– by Deane Beebe