This year’s annual conference, entitled “Meeting at the Crossroads,” will be held in Indianapolis, Indiana, from August 8 through August 11.

The event will showcase innovative thought and best practices in the long-term care culture change movement. It will also provide an opportunity for all stakeholders interested in culture change to network and learn from other attendees’ experience.

The Pioneer Network is also offering a reduced rate called the “Culture Change Team Special” to four or more registrants who attend from the same address, a response to previous conference participants’ feedback about the value of having several team members attend. A limited number of partial and full scholarships (pdf) are also available.

Continuing Education Credits are available for an additional fee. The Pioneer Network has applied for credits for administrators, nurses, social workers, and activity professionals.

PHI’s Expertise Tapped

Several of PHI Training & Organizational Development Services staff members will be leading sessions and facilitating discussions at the conference:

• Susan Misiorski, National Director of Training & Organizational Development and Pioneer Network Board Member
  • The Role of the Nurse in a Person-Directed Culture (Lead Guide, Full Day Intensive)
  • Elder Perspectives on Quality of Life: What Matters Most! (Guide, Concurrent Session)
  • Selecting and Prioritizing High Impact Organizational Changes (Guide, Concurrent Session)
• Cean Eppelheimer, Training & Organizational Development Specialist
  • Conversations at the Crossroads: The Collective Wisdom of Coalitions (Lead Guide, Full Day Intensive)
• Renya Larson, Training & Organizational Development Specialist, and Kathleen McCollett, Organizational Culture Change Specialist
  • Coaching: A Key to Sustaining Change (Facilitators, Concurrent Session)

– by Deane Beebe

The study — which consisted of a series of discussion groups attended by consumers — found that nearly four out of five consumers wanted to learn more about culture change: what it looks like and how providers pay for it.

What the Study Found

“A major finding of this project was the need to educate consumers about options,” said Joanne Rader, the project director.

“Those who had been exposed to the traditional model were unaware that things could be different. Those who had little contact with nursing homes were surprised that there could be such a lack of choice about basics such as when you decided to get up and go to bed,” Rader said.

As a result of the study, Caring for the Ages, the monthly publication of the American Medical Directors Association, has begun publishing a series of informational tear-outs on culture change. The first installment, “Person-Centered Care: What It Means to You and Your Family,” was published in the March 2010 issue.

“I am really excited about this project,” said Susan Misiorski, PHI National Director of Training and Organizational Development. “As consumers become more knowledgeable about what is possible to expect from the support systems available to them, they will seek out only those organizations that embrace the principles and practices of the culture change movement.”

Conducting the Discussion Groups

During the course of the year-long study, the Pioneer Network brought consumers together to conduct small-group discussion meetings.

In all, approximately 500 consumers attended the meetings, which were held in private homes in Florida, Georgia, Massachusetts, and Oregon.

The research project “represents a major undertaking by our organization to begin focusing on increasing consumer awareness and demand for culture change,” said Bonnie Kantor, the Pioneer Network’s executive director.

The Pioneer Network hopes to begin the second phase of the project later this year. The second phase will focus on educating consumers about culture change and how they can advocate for it.

The research project, entitled “Changing the Culture of Aging: Taking a First Step to Creating Knowledgeable Consumers,” was funded by the Picker Institute, a foundation that sponsors research pertaining to patient-centered care.

For more information on culture change in nursing homes, visit PHI’s website.

– by Matthew Ozga

The web-based evaluation tool allows long-term care providers to measure how successfully they have implemented culture change in their facilities.

The tool helps providers determine whether they have introduced culture change in a sustainable way, as well as how far along they have already progressed in their culture-change journey.

“The artifacts tool is not only a wonderful way to measure change progress, it also offers ideas about opportunities for change an organization may not have been aware of,” said Susan Misiorski, PHI National Director of Training and Organizational Development.

Scoring Points for Culture Change

The web-based tool measures a facility’s culture-change progress in six categories:

• Care Practice Artifacts — What are the facility’s policies on person-directed dining, bathing practices, etc.?
• Environment Artifacts — Do residents have ample space and privacy? Does the facility include amenities such as Internet access and outdoor areas? Does it reflect “home”?
• Family and Community Artifacts — What is the facility’s visiting policy? How are families involved and welcomed?
• Leadership Artifacts — Are residents given the opportunity to voice their opinions to staff members?
• Workplace Practice Artifacts — Are CNAs allowed to set their own schedules and work consistently with the same residents? Are they given the opportunity for advancement via a career ladder?
• Staffing Outcomes and Occupancy — How long do workers remain with the facility? What is the staff turnover rate over the last 12 months?

At the end of the evaluation, facilities are awarded a point total based on their responses, with a maximum score of 580 points.

Providers can use the evaluation tool as often as they want, free of charge. The Pioneer Network recommends quarterly “tune-ups,” but stresses, “It’s your choice.”

Updating the Evaluation Tool

The new online evaluation tool is an update of the paper-based Artifacts of Culture Change, which the Pioneer Network debuted in 2006. The Web-based version incorporates interpretive guidelines issued in 2009 by the Centers for Medicare & Medicaid Services (CMS).

According to the Pioneer Network, the evaluation tool “represents the first national database of implementation activities ever collected.”

The Pioneer Network used funding from The Commonwealth Fund to build the online version of Artifacts of Culture Change.

– by Matthew Ozga

Indianapolis, Indiana

Proposals must be submitted electronically through the Pioneer Network’s online Request for Proposals form. Proposals that are already in process on the electronic form can also be completed by the new deadline.

The Pioneer Network is seeking proposals in several focus areas and is especially interested in proposals on Research and Technology.

The 10th National Conference of Culture Change is entitled “Meeting at the Crossroads” and will take place from Monday, August 9 until Wednesday, August 11 in Indianapolis, Indiana.

The annual conference showcases innovative thought and best practices in the long-term care culture change movement. It also provides an opportunity for people interested in culture change to network with and inspire each other.

The Pioneer Network is dedicated to making fundamental changes in values and practices in long-term care. Their mission is to create a culture of aging that is life-affirming, satisfying, humane, and meaningful.

The nonprofit organization advocates for culture change in various eldercare models, including long-term nursing home care, short-term transitional care, and community-based care.

For more information about submitting proposals for this year’s Pioneer Network conference — or information about the conference in general — email Christie Dobson or call her at 585.271.7570.

Dr. William Thomas

Bill Thomas calls himself “a nursing home abolitionist.”

“I want them to go away,” he says. “Our greatest adversary is the institutional mindset. That must go.”

Talk of culture change doesn’t matter as long as people retain an attitude of elders as “the helpless inmates of total institutions,” he says.

Looking back on the last decade of the culture change movement, Dr. William “Bill” Thomas, an international authority on geriatric medicine and eldercare, says it has progressed from the point of “being laughed at” to the subject of serious criticism.

An increasing number of organizations, regulatory bodies, corporations, non-profits, and unions are now seriously considering what happens when the concept of a nursing home is less of an institution and more of a real community where elders can thrive.

Now a professor at the University of Maryland’s Erickson School of Aging Studies, Thomas is a medical doctor who left the emergency room for geriatrics, surprising himself when he fell in love with elders and those who provide their care. It was then that he discovered he could make life better for them.

“I feel that’s what I was born to do,” he said, by phone from Maryland this week.

Direct Care Worker in Culture Change

When we asked him where the role of the direct-care worker fits into his vision, Thomas said, “Older people are held in low esteem in this country, so people who work with them are held in low esteem. First, we have to tackle ageism in this society in general, because it bears directly on the quality of life of those who work with elders.”

Thomas founded The Eden Alternative,  a philosophy and program that has worked to de-institutionalize nursing homes worldwide over the past 20 years. As we featured on our blog last month, he most recently developed the Green House, a radically new approach to long-term care where nursing homes are torn down and replaced with small, home-like environments where people can live a full and interactive life.

There are now 54 Green Houses around the country, either open or in development. While some are built from the ground up, others are transformed from the old model of the nursing home, receiving “bulldozer therapy,” says Thomas.

This means good things for both consumers and direct-care workers, when meaningful relationships are built on a foundation of dignity, equality, and mutual respect.

“One of the tragedies of long-term care,” says Thomas, “is you take big hearted, compassionate people and put them into itty, bitty little jobs. Culture Change holds promise to the extent that it’s willing to envision bigger jobs for the people doing this work – jobs that offer more decision-making autonomy and authority, better training and better pay. That’s what we’re fishing for out here.”

Better jobs and diversity of skills

The workforce you get is based on the jobs you have to offer, he says.

“Without attractive jobs, you can’t wake up and say we have a magnificent workforce. I oppose the idea of attracting new people into the field to take jobs that are not worthy of them. I don’t want to recruit people to work in the current authoritarian regime. I want people to be attracted to our field because we offer tremendous jobs with great fulfillment and personal growth.”

When we asked Thomas what skills workers will need in the future, he said, presuming the success of the culture change movement, those who work with elders will have the wellbeing of elders in mind. They’re going to need a wider range of skills because the focus will be on the people they care for and not on service to their department.

Workers will need to work cooperatively. With a more team-based system, they will need to carry out plans together, have greater communications skills, a wider range of technical skills, and community building skills.

“Healthy communities help those who live there and those who work there,” he says, adding, “we’ve got a big challenge to upgrade the workforce to match the philosophy of culture change. That’s going to take decades of work, actually.”

– Story by Dinah Cardin

For more information on how to ensure your workforce has the necessary skills to support culture change, contact Susan Misiorski, PHI Director of Organizational Culture Change, smisiorski@PHInational.org.