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Trinity Association of Southwest Kansas
| Changing the Culture of Nursing Homes | The Eden Alternative | Intergenerational Program |
CHANGING THE CULTURE OF NURSING HOMES
With a rising number of older adults needing assistance, how can good employees be motivated to stay working in long-term care facilities?
We know that by the year 2030, the population age 65 and older is expected to double in the United States. The fastest growing age group over 65 is those persons 85 and older. The number will increase five times …. from 3.2 million in 1990 to more than 15 million in 2030. Moreover the number of older adults needing long-term care is expected to expand from seven million to 14 million. At the same time this trend is happening, the number of persons under 50, the potential caregivers to older adults, will increase by only one percent. With these statistics, how can long-term care facilities be staffed in the future when they are already plagued with high turnover rates?
These statistics show that long-term care facilities offer great opportunities for caregivers to perform meaningful, caring work with great job security. Nursing assistants make up less than 50% of the nursing home’s personnel, yet provide 90% of the care for residents. The nursing assistants’ job is respected, has a lot of responsibility, while work is in a safe and clean environment. While the work requires only minimal training, many life skills are used in motivating residents to do as much as they can for themselves, in comforting those in the dying process and in working with those residents with memory loss.
Today the average long-term care environment is based on a "medical model" - taken from the hospital. Professional staff provides "treatment" for "dependent" residents. Life in this kind of model revolves around routines dictating when residents get up, eat, bathe, etc. Decisions involving resident’s care are often made by someone in authority rather than by those giving care to the resident. Adding to the long-term care environment's problems are an over abundance of regulations and lack of adequate funding to pay workers well.
Around the country, long-term care facilities are looking at ways to change their environment – their work cultures – to make life for residents more homelike and life for employees more satisfying. While regulations and funding sources have not changed, the models most often chosen focus on those of a “social” origin. This model values “resident-centered” life and “whole-person” care. When Connie Hubbell, Kansas Secretary of Aging Services, visited our community on September 13, 2002, she commented on the impact workplace cultural changes can have on enriching the lives of residents, employees and the community. This type environment turns the typical long-term care system upside down causing major restructuring.
We believe that we can integrate the principles and practices similar to the Eden-Alternative, one well know program, into the living environment. There is an enormous and growing body of work that validates the fact that close and continuing contact with plants, animals and children promotes quality of life among the elderly. Smaller community oriented options are replacing larger institutional organizations. We propose to maximize quality of life for people in our "neighborhoods" by paying particular attention to giving staff special training in dementia and also providing advanced education in the areas of end of life care and palliative care. This model also supports companionship through animals, plants and children. These three elements provide the older adult with opportunities to care for other living things, variety and spontaneity that marks a "home-like" lifestyle verses the sterile "hospital-like" institution.
Creating this type of environment often involves several common components. These include:
Changing of empowerment of the staff giving resident care—to do the care on the resident’s timetable.
Assigning permanent staff to small groups of residents on a permanent basis.
Having caregivers along with residents and family involved in the care and planning processes.
Making a wish come true for each resident each day.
Having animals, plants and children as a routine part of the environment.
Having small groups of staff involved in problem-solving issues.
Having staff make decisions affecting their work within parameters set by administration.
Allowing staff to schedule their work assignments.
This type of work environment creates feelings of self-worth, respect, pleasure, creativity, satisfaction, trust and hominess in the caregiver. Attaining control and positive outcomes often lead the worker to develop loyalty both to the institution and to the residents and families they care for.
Children, plants and animals add a lot to combat loneliness, helplessness and boredom. There are facilities in the United States that have totally integrated child care services into nursing home care 7 days/week for 16 hours a day. A more frequent childcare model is having a childcare center located near or within a facility with some activities shared by the various generations. When this resource is near to the long-term care center older adults benefit from the spontaneity of children, children benefit with special relationships with older adult and staff benefits from knowing that their children are well cared for.
Having living things surrounding older adults in their environment not only allows for a more home-like atmosphere but also allows for the older adult to continue to care for and nourish—give back to – someone else or something else. This allows the older adult to continue to grow. As a child cannot be raised without a community of caring, neither can an older adult continue to grow and reap the benefits of their lifetime without the community. Imagine for a moment that the long-term care center brings together the community where families gather for outside barbeques, games, graduations and weddings. It is happening in our nation. We believe, with your help, it can happen in our community.
The Eden AlternativeTM is a powerful tool for improving the quality of life for people who live in long-term care facilities. Because it is a new way of thinking about long-term care, it has the potential of remaking nursing homes all over the country. This concept is now an important part of Trinity Manor.
The core concept of The Eden AlternativeTM is simple .... to see long-term care facilities as habitants for human beings and not institutions for the frail and elderly .... by eliminating the three plagues of long-term care facilities: loneliness, helplessness and boredom. It shows how companion animals, the opportunity to care for other living things, and the variety and spontaneity that mark an enlivened environment can succeed where pills and therapies fail. Our goal is to weave together the philosophy of The Eden AlternativeTM with practical applications and make it work in the real world of long-term care.
The Ten Principles of The Eden AlternativeTM
The Three Plagues of loneliness, helplessness and boredom account for the bulk of suffering among elders.
Life in an Elder-centered community, which resolves around close and continuing contact with children plants and animals. These relationships provide young and old alike with a pathway to a life worth living.
Companionship is the antidote to loneliness. An Elder-centered community provides easy access to human and animal companionship.
A healthy Elder-centered community seeks to balance the care that is being given with the care that is being received. Elders need opportunities to give care and caregivers need opportunities to receive care.
Variety and Spontaneity are the antidotes to boredom. The Elder-centered community is rich in opportunities to sample these ancient pleasures.
An Elder-center community understands that passive entertainment cannot fill a human life.
The Elder-centered community takes medical treatment down from its pedestal and places it into the service of genuine human caring.
Decisions in an Elder-centered community should be made by the Elders of those as close to the Elders as possible.
An Elder-centered community understands that human growth cannot be separated from human life.
Wise leadership is the lifeblood of any struggle against the Three Plagues. For it, there can be no substitute.
For more information on The Eden AlternativeTM, visit their website at www.edenalt.com.
April 2004 - Many of Trinity’s residents are involved in an “Intergenerational Program” with the Joy Child Development Center at the First United Methodist Church, Dodge City, Kansas. The goal of the Intergenerational Program is to bring generations together for that special one to one interaction, being “present” with one another, and setting aside modern technology that isolates one to himself/herself to spend time learning social and people skills.
These residents recently attended a special session at Trinity Manor, along with Trinity’s Activity Staff and a group of residents from Manor of the Plains. Angela Hays, Kansas State University Path Grant Foundation, led the training session. The focus was on the importance of being “present” with another person and, in this case, of a different generation separated by decades. A main point of interest was the difference in person-to-person interactions of children five, six and seven generations ago compared to the children of today.
Consider this: small children fifty and sixty years ago did not have television, computers, electronic games, bowling alleys, fun centers, shopping malls or DVD players. Even going to a movie theater was a rare treat.
Most of Trinity’s residents are in their 80’s but we also have some in their 60’s, 70’s and 90’s. During their childhood, play and leisure time was spent with siblings, if they had any, or friends if they lived close by. They enjoyed marbles, jacks, jump rope, kick the can, hide and seek, checkers, chess and other board and card games. They played store by cutting paper money from old newspapers and made telephones from tin cans and string.
Their activities were creative and interactive with others. Little girls spent time with their mothers learning home making skills: cooking, sewing and cleaning. Little boys were busy beside their fathers working with scaled down projects of wood, mechanics, gardens or working with livestock.
