INTERVIEW: Anna Ortigara, PHI Organizational Change Consultant

December 19, 2013

PHI is thrilled to announce that in January, Anna Ortigara will be joining our team as an Organizational Change Consultant. Based in the Chicago suburbs, Anna has worked in the field of aging and long-term care for more than 35 years, first as a nurse and later as an expert in culture change and person-centered care. Anna most recently worked with The Green House Project, where she made many key contributions to the Green House® model, a physical and philosophical model for nursing homes that encourages person-centeredness in small residential houses. Recently, Anna spoke with PHI about her career, the idea of "values-based" care, and what she likes to do when she isn’t working to improve the lives of elders and people who care for them.

Q: How did you get involved in gerontology in general and culture change more specifically?

A: I've worked in the field of aging and long-term care for a long time. I really got started in gerontology in 1980, which is a long time ago. I got involved in culture change before it even had that name.

In the '80s I started getting very involved with people living with dementia. That was around when dementia special care units in nursing homes were beginning. It was clear to me that how we took care of people living with dementia in nursing homes didn’t work very well for them.

In the mid-80s I was part of a research grant from the University of Illinois Medical Center, and we created a special care program within a nursing home. We were able to define what this model looked like. So we emphasized the need to support people who are living with dementia to have full, active days. We emphasized educating and supporting staff to approach people living with dementia differently. And we emphasized family involvement: Family members, too, need both education and support. We also said that the physical environment of this unit needed to feel more familiar, more comfortable, less institutional. 

We didn't call it culture change, but that's what it was. And those were my first steps in really challenging and changing what we do in nursing homes -- because the way we had been doing it didn’t really support people to live real lives. And although my early work specifically focused on people living with dementia, things eventually expanded. I realized that these problems -- people living in settings where they don’t have complete control, or they don't recognize it as home -- affect elders and people with disabilities in all long-term care settings.

Q: You've written and talked about a "values-based" model of long-term care. Could you elaborate on what those values are?

A: I spent the last six years at the Green House Project, and we worked very hard at figuring out what values we were trying to convey. We had all these practices, but of course you're not just doing things for no reason: You're doing them to support certain values. At the Green House Project we said our Core Values are Meaningful Life, Real Home, and Empowered Staff. And all the practices evolved from there. Why do anything unless it's values-based?

Q: And that all dovetails with the PHI Coaching ApproachSM?

A: Yes, definitely! The reason I feel very comfortable coming to PHI is that, when I was at Green House, I worked closely with PHI to adapt PHI Coaching to fit the Green House model. The Green House Project really embraced PHI Coaching, and I personally developed a high level of respect for Coaching.

The easy connection between PHI Coaching and Green House Project's Core Values is the "Empowered Staff" piece, right? But it's really more than that. Part of staff empowerment is that staff cannot be in these deep, reciprocal relationships with elders if they themselves are not empowered. They have to be powerful in order to support the decision-making and the deep humanity of the elders they work with. So to me, the PHI Coaching model is about supporting caregivers' ability to work well with each other, and it's also about supporting caregivers' relationships with the elders. And without empowered staff, you'll never ever get to culture change, and you'll never get to the point where elders experience Meaningful Life. Because if staff are not truly valued, then how can they be asked to be in caregiving relationships where they deeply value the elder?

Q: Do you have any specific memories of moments from your career where you’ve seen these values first-hand?

A: I have some amazing memories. Some of those moments involve watching residents and elders themselves, become engaged in something. I'm thinking of one lady who grew up on a farm in Iowa, and even though she now lives in a Green House Project home in Michigan, she has direct access to a garden. She sits out there and deadheads plants all day long, and it's deeply meaningful to her. Now, you could say, "Oh come on, that doesn't sound like a big, glorious story." But I think it is. Because being out there gardening every single day holds such meaning for her. That's important.

Then the flipside of that is watching staff make decisions. One of the first times I heard a Shahbaz [the term for the direct-care worker in the Green House model] ask the elder what she wanted to do -- that was kind of miraculous. That just doesn't happen in long-term care very easily. That means that staff member was empowered to raise the question: What does this elder say that she wants? That is so far from where I entered long-term care in 1980.

Q: In your spare time, when you're not working, what are your interests? What do you like to do?

A: I love reading, I love theater, I love music, I love musicals, I love jazz piano and jazz guitar -- jazz in general, but particularly jazz piano. I love traveling and I love being with my 12 nieces and nephews. That's what I love. It's a good life.

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