PART 1, By Susan Misiorski

Susan Misioriski

Recently, I had the chance to visit several nursing homes in New Hampshire to interview elders about a topic I think about often: What matters most to the people living in nursing homes? The reason this question seems so provocative to me is simple—I have yet to meet an elder living in the community who actually wants to live in a nursing home! The truth of this has far reaching implications for the business side of the nursing home spanning all the way from the mission and vision to the bottom line. So, who better to turn to than the individuals who live there to help us understand how to change this?

When I asked the elders I interviewed what mattered most to their quality of life, several themes began to emerge. They can be grouped into the following categories:

• Competent staff who meet their individual care needs
• Freedom to make personal choices
• Relationships in which each person is able to both give and receive
• Opportunities for meaningful activity

In this first of a four-part series on what matters most to elders living in nursing homes, we’ll focus on competent staff who successfully provide individualized care.

In speaking with Hilda Thompson, an elder living at the Edgewood Centre in Portsmouth, NH, I asked what was meant by “competent staff” and she explained the connection, for her, to trust. A competent staff member is someone who “knows what they are doing, is consistent and reliable, and I trust them.”

Hilda Thompson

The specific use of the terms “competent” and “trust” caused me to step back and consider what she meant. A competency is defined as “a measurable, occupationally relevant and behaviorally based characteristic or capability of a person.” It is the combination of knowledge, skills and attitudes that are necessary to perform one’s job successfully.

Understanding this, it is important to consider how we are supporting staff to ensure their continued professional development and competence. What are the core competencies to support individualized care needs? Over and again, staff in all positions tell me what they need are skills to communicate effectively with elders, families and one another. It is the combination of personal integrity, good interpersonal communication, and task competency that builds that trusting relationship.

It was clear to me that the types of competencies the elders were referring to were interpersonal communication skills, not the usual skills listed on new orientation checklists! Competencies required for individualized care include such skills as active listening, clear communication without blame and judgment, and collaborative problem solving–the skills that are the core of The PHI Coaching Approach^SM. Staff need training and practice in growing these skills, and these competencies need to be carried through into job descriptions, performance evaluations, new employee orientation, and ongoing staff in-services.

For more information on the impact training in these skills has on organizational culture, read about Partners in Care, a New York City based home health agency that has offered widespread training to improve relationships.

In the April issue, we’ll discuss freedom to make personal choices and identify some practices that achieve that goal.