Today represents not only a national holiday but a turning point in my life. I am officially 40 years old today. I am still thinking about where my life has been, and how quickly the time has gone by. Wow..I really understand what my residents speak of when they talk about how quickly their lives were spent.. On that note; I have taken much of their saged wisdom to heart and am living my life with a purpose and intent instead of simply living. (thank you to my two female elder mentors!) I am so ever thankful for the elders who have crossed into my path on this journey of living.
With that said today represents so very many things to people. Many spend it with family, many spend it at home watching football and resting. Others get out and do things like run a 5K in the snow, (Detroit today has 6 inches of snow on the ground, and it is freezing drizzle/snowing still. Not exactly great running weather!) There are also people who get out and do for others today; working at homeless shelters, handing out meals to shut ins and those in need.
The people I am most thankful for are the employees and care providers who right now across America, are working to take care of our frail, forgotten, and neediest of Americans. Yes they are getting paid to do this..However, on any Holiday they are there working to assure that these individuals are cared for and remembered. In my facility like all across America, a big Thanksgiving meal is being prepared for noon. The dietary staff in any given facility is prepping for that meal as we speak.
I am sure in most buildings, the staff and residents spend this day enjoying the day together. Holidays in a nursing home are chaotic for staff; yet rewarding. Families come into visit in large numbers; many have not been in all year and they will have questions and concerns about how their loved one is. The staff will take the time to respond to every one. Many elders will have a sad day; as their families fail to visit or worse; they have no one to visit and observing the many visitors it reminds them of their all alone in the world status. Again, the staff will recognize this; and offer comfort and empathy; in return the elder will smile, say thank you or give a great hug and both may shed some tears in silent understanding of the emotional connection that occurs.
It is this spontaneous nurturing and giving that occurs that I am so ever thankful for. Outsiders - those who have no inkling of what really happens in care facilities; do not know of the symbiotic relationship that exists between elder and staff. It is a giving/receiving/giving cycle that occurs when true care exists.
As I have focused my life; it is this very element of care that I strive to teach, role model and educate others on. We can create beautiful structures; we can give outstanding clinical care; but without the humanness of giving selflessly; we fail as care givers. It is perhaps the most difficult element to teach, and grasp; it is not visual, nor tangible; it must be felt. Yet, once understood and recognized, it becomes an intrinsic part of the heart and soul of every great caregiver. It is this giving that outsiders "feel" when they come into homes that practice this.
Happy Thanksgiving to each of you. May you recognize the gifts you have given, and those that you receive. Continue to share and allow others to share with you. Be thankful for the simple things..they matter the most in the end..
Thursday, November 22, 2007
Wednesday, November 21, 2007
Life Lessons Can Not Be Risk Managed...
I received a great article yesterday from a colleague regarding children's authors in England being "censored" for writing about risky behaviors. According to this article, authors are being told to re-write scenarios in their books that may encourage children to engage in behaviors that could lead to harm. The scenarios? Simple things that we did as children...like climbing trees... Yes you read that correctly, according to this article these types of books could lead to children engaging in behaviors that could lead to harm..
I guess this puzzles me. As a child, we did all sorts of stupid things that could have lead to our impending doom; yet by the grace of God we survived with minimal damage; and great stories for our children. None of the incidents were premeditated or directed by something we read. In fact they were usually spontaneous actions brought about from three creative female imaginations deciding that some activity would be fun. The three female minds were myself and accomplices of at least two of my three sisters. One would come up with an idea, and the others would follow or add additional embellishment to the original thought. For example the time we had a significant snow fall; and the drifts were so high that we could climb to the top of the wood piled against our garage and then slide down the roof of the garage, over the wood pile and get significant distance into the yard...Needless to say the neighbor ruined our fun by calling attention to our mother that we were on the roof...Lesson learned? Mom indicated we could break our neck from falling off the roof, or worse at least a limb; and that the neighbor was in on her anxiety.
So why do we feel the need to "protect" our children from all risks? There are inherent lessons to be learned from taking on risk. Stifling a creative story will not stifle risk. Giving parents false hope that by eliminating any "idea stimulator" will decrease the risk to their children is wrong. We are human beings; and like any animal we learn from attempting behaviors; and our minds work so that ideas and decisions can be made spontaneously.
As a parent I always hoped that I had done my best to teach my child how to way decisions and make responsible choices. Yet, he has had some significant learning from taking on risks and then dealing with the consequences. I believe he will be a better adult and person because of it. As a parent it hurts to see them suffer from their consequences. It is natural to want to protect and eliminate; but the learning is lost in overzealous protection. Ironically, the lesson takes longer to then learn.
Why was this story sent to someone who works with elders? Because, it is the same thought process that care providers deal with every single day. We are to manage/control risk for our elders; and in some cases their rights be damned. The regulations are conflicting in this case. Yes you have rights; but I also am required to protect you from all harm. Even that harm which you could cause to yourself from (gasp!) being human and having an inquisitive determined mind. For example, walking. If we (your care provider) feel you are not safe to ambulate by yourself, we must do everything possible from allowing you to ambulate unassisted. Imagine sitting in your room; and seeing your roommate drop her Kleenex box on the floor. Your mind and spontaneous thoughts tell you to "get up and hand it to her". Wrong! your thoughts are no longer allowed to govern your own behavior... Welcome to a new life lesson....
I guess this puzzles me. As a child, we did all sorts of stupid things that could have lead to our impending doom; yet by the grace of God we survived with minimal damage; and great stories for our children. None of the incidents were premeditated or directed by something we read. In fact they were usually spontaneous actions brought about from three creative female imaginations deciding that some activity would be fun. The three female minds were myself and accomplices of at least two of my three sisters. One would come up with an idea, and the others would follow or add additional embellishment to the original thought. For example the time we had a significant snow fall; and the drifts were so high that we could climb to the top of the wood piled against our garage and then slide down the roof of the garage, over the wood pile and get significant distance into the yard...Needless to say the neighbor ruined our fun by calling attention to our mother that we were on the roof...Lesson learned? Mom indicated we could break our neck from falling off the roof, or worse at least a limb; and that the neighbor was in on her anxiety.
So why do we feel the need to "protect" our children from all risks? There are inherent lessons to be learned from taking on risk. Stifling a creative story will not stifle risk. Giving parents false hope that by eliminating any "idea stimulator" will decrease the risk to their children is wrong. We are human beings; and like any animal we learn from attempting behaviors; and our minds work so that ideas and decisions can be made spontaneously.
As a parent I always hoped that I had done my best to teach my child how to way decisions and make responsible choices. Yet, he has had some significant learning from taking on risks and then dealing with the consequences. I believe he will be a better adult and person because of it. As a parent it hurts to see them suffer from their consequences. It is natural to want to protect and eliminate; but the learning is lost in overzealous protection. Ironically, the lesson takes longer to then learn.
Why was this story sent to someone who works with elders? Because, it is the same thought process that care providers deal with every single day. We are to manage/control risk for our elders; and in some cases their rights be damned. The regulations are conflicting in this case. Yes you have rights; but I also am required to protect you from all harm. Even that harm which you could cause to yourself from (gasp!) being human and having an inquisitive determined mind. For example, walking. If we (your care provider) feel you are not safe to ambulate by yourself, we must do everything possible from allowing you to ambulate unassisted. Imagine sitting in your room; and seeing your roommate drop her Kleenex box on the floor. Your mind and spontaneous thoughts tell you to "get up and hand it to her". Wrong! your thoughts are no longer allowed to govern your own behavior... Welcome to a new life lesson....
Sunday, November 11, 2007
Social Responsibility...
Does a company, or it's leaders have a moral/ethical responsiblity to educate, develop or offer personal growth for their employees?
This was the topic of discussion last week in my organizational leadership class. The further discussion centered on where are the leaders of the future going to come from, and are we facing a critical shortage of great leadership in America? One answer that resonated with me from a class peer was the perspective of social responsibiity of corporations and business to create and grow their own next generation of leaders.
As we shared our own personal journey's into leadership roles; it was evident that some companies are getting this idea better then others. I have thought about this topic all week as I face a "change" in my own leadership role and take on a new challenge. I have thought about how we/I as a leader, view development of future leaders.
I also have researched and looked for information regarding developing good leadership programs for future administrators and nursing managers. What I find is very good resources; with limited applications throughout our industry. A sad testament to what we view as important.
Yet, we espouse conversations about quality, we talk about driving down costs, increasing productivity while maintaining high staff satisfaction rates. None of this can be accomplished without some very basic leadership skill and development.
It is as if we "assume" that persons in leadership roles have a skill basket filled with the necessary ingredients to create the recipe for success. The reality, is that most leaders in health care are in these positions perhaps based on some in born ability or talent and personal drive. They may/may not have actually recieved good hands on training and knowledge of the nuances of leadership it takes to reach the level of excellence we are seeking.
I again am fortunate to work for someone who recognizes this as an area of growth to be developed on an individual basis. Yet as I start to think of our industry on a global realm; I realize how truly lucrative it could be for me/my building and my company if we develop a phenomonal talent pool of future leaders. It is something our competition has not even begun to address or focus time and resources on.
Growing our own leaders comes at a cost. In fact, the cost may be losing some of those that you develop. I sit in my office at work today; cleaning out my desk. On my desk is the list of the upcoming nursing graduates that we will sponsor an event for. I have two of my own employees on this list. Both are part of our tuition reimbursment program. Both will make phenomenal nurses and have bothpersonal drive for quality and a passion for customer service. As a leader to have had a hand in developing these two young women and watching their personal growth is a reward unmatched. Yet, the dilemma is where are we going to place them? I have no nursing positions in my building. Discussion with sister facilities will have to take place to find a place for them to continue their journey. Perhaps they will even leave our company.
So is it worth growing future leaders if you have no place for them once ready? My answer to this question is a resounding yes. I feel as a care provider it is my social obligation to create excellence for all care givers. If this means over development of potential leaders then so be it. Imagine the possibilities if all companies felt this responsibility. We would not be facing a leadership drought, and health care would be so much better for it...
This was the topic of discussion last week in my organizational leadership class. The further discussion centered on where are the leaders of the future going to come from, and are we facing a critical shortage of great leadership in America? One answer that resonated with me from a class peer was the perspective of social responsibiity of corporations and business to create and grow their own next generation of leaders.
As we shared our own personal journey's into leadership roles; it was evident that some companies are getting this idea better then others. I have thought about this topic all week as I face a "change" in my own leadership role and take on a new challenge. I have thought about how we/I as a leader, view development of future leaders.
I also have researched and looked for information regarding developing good leadership programs for future administrators and nursing managers. What I find is very good resources; with limited applications throughout our industry. A sad testament to what we view as important.
Yet, we espouse conversations about quality, we talk about driving down costs, increasing productivity while maintaining high staff satisfaction rates. None of this can be accomplished without some very basic leadership skill and development.
It is as if we "assume" that persons in leadership roles have a skill basket filled with the necessary ingredients to create the recipe for success. The reality, is that most leaders in health care are in these positions perhaps based on some in born ability or talent and personal drive. They may/may not have actually recieved good hands on training and knowledge of the nuances of leadership it takes to reach the level of excellence we are seeking.
I again am fortunate to work for someone who recognizes this as an area of growth to be developed on an individual basis. Yet as I start to think of our industry on a global realm; I realize how truly lucrative it could be for me/my building and my company if we develop a phenomonal talent pool of future leaders. It is something our competition has not even begun to address or focus time and resources on.
Growing our own leaders comes at a cost. In fact, the cost may be losing some of those that you develop. I sit in my office at work today; cleaning out my desk. On my desk is the list of the upcoming nursing graduates that we will sponsor an event for. I have two of my own employees on this list. Both are part of our tuition reimbursment program. Both will make phenomenal nurses and have bothpersonal drive for quality and a passion for customer service. As a leader to have had a hand in developing these two young women and watching their personal growth is a reward unmatched. Yet, the dilemma is where are we going to place them? I have no nursing positions in my building. Discussion with sister facilities will have to take place to find a place for them to continue their journey. Perhaps they will even leave our company.
So is it worth growing future leaders if you have no place for them once ready? My answer to this question is a resounding yes. I feel as a care provider it is my social obligation to create excellence for all care givers. If this means over development of potential leaders then so be it. Imagine the possibilities if all companies felt this responsibility. We would not be facing a leadership drought, and health care would be so much better for it...
Sunday, November 4, 2007
Hello and Goodbye...
Ok, so i can talk about embracing change, and my need for constant flux in my life..But when it hits you out of the blue are we ever really ready for it? For those of you newly reading; welcome to my blog. For my current readers, a little update. I am leaving my nest, the comfort of home and the known that I have retreated back to from time/time in my life. I have been offerred, and accepted a position in another building, located 100 miles from my home.
I did not expect this quite so quickly, I have come to learn to be careful what you wish for; in my life it seems to be if I speak it, write it, or even think about change, it happens.. With that said I am thrilled by the opportunity, sad for what I am leaving unfinished, and remorseful about leaving my elders.
For my new building, staff and elders we are about to embark on a new path. I am so very excited to be working with a great team. Your reputation for great care and outstanding compliance precedes you all. You should be very proud of what you have accomplished, and I am honored to be able to work with you as we take this building to a level of remarkability that will be a model of care, customer service and what aging should and will look like in the future. Given your expert abilities at care, we are going to transition well to the next level. As your leader on this journey I am committed to giving my heart and soul to working with you as we create the new vision of care.
For my current staff, friends, peers and elders; I am sad that our journey this time around was only a year. But what a journey, and look at what you have accomplished! The communication levels, the team work, the focus on customer satisfaction and community involvment are all off the chart successes you should be very proud of! You are all responsible for taking a facility and making it part of the community. A place that everyone recognizes for not only great care, but greatness period. When people in our area talk about our building, they talk about the environment, culture and feeling that you have all worked very hard to create for the elders whom you serve. I hope you realize how very special each of you are; and that every individual has played a role in this achievement. I am honored to have played a small role in your success, and cannot wait to see what you accomplish next. I am forever grateful for the opportunities, support and lessons I have learned working with you over the past 14 years.
As I told someone last week, no I will not be back, unless it is to live in about 35 years... and yes I would be proud to allow you to care for not only me, but any of my family. That in itself should speak volumes to the level of trust and respect that you have earned.
What a crazy week this has been...I return from a great training where ironically the focus was on the implications of change. Only to come back to a phone call first thing on Monday with a change being offered. The implications of this change? Huge for all involved.. I have spent the last 48 hours thinking about it all..planning for the future, getting a little organized and adjusting my mind to the past memories; and future possibiities..
Hello to the unknown future, and Good Bye to the comfort and known of my past... All at the eve of my 40th birthday...I apparently enjoy the drama of it all..
I did not expect this quite so quickly, I have come to learn to be careful what you wish for; in my life it seems to be if I speak it, write it, or even think about change, it happens.. With that said I am thrilled by the opportunity, sad for what I am leaving unfinished, and remorseful about leaving my elders.
For my new building, staff and elders we are about to embark on a new path. I am so very excited to be working with a great team. Your reputation for great care and outstanding compliance precedes you all. You should be very proud of what you have accomplished, and I am honored to be able to work with you as we take this building to a level of remarkability that will be a model of care, customer service and what aging should and will look like in the future. Given your expert abilities at care, we are going to transition well to the next level. As your leader on this journey I am committed to giving my heart and soul to working with you as we create the new vision of care.
For my current staff, friends, peers and elders; I am sad that our journey this time around was only a year. But what a journey, and look at what you have accomplished! The communication levels, the team work, the focus on customer satisfaction and community involvment are all off the chart successes you should be very proud of! You are all responsible for taking a facility and making it part of the community. A place that everyone recognizes for not only great care, but greatness period. When people in our area talk about our building, they talk about the environment, culture and feeling that you have all worked very hard to create for the elders whom you serve. I hope you realize how very special each of you are; and that every individual has played a role in this achievement. I am honored to have played a small role in your success, and cannot wait to see what you accomplish next. I am forever grateful for the opportunities, support and lessons I have learned working with you over the past 14 years.
As I told someone last week, no I will not be back, unless it is to live in about 35 years... and yes I would be proud to allow you to care for not only me, but any of my family. That in itself should speak volumes to the level of trust and respect that you have earned.
What a crazy week this has been...I return from a great training where ironically the focus was on the implications of change. Only to come back to a phone call first thing on Monday with a change being offered. The implications of this change? Huge for all involved.. I have spent the last 48 hours thinking about it all..planning for the future, getting a little organized and adjusting my mind to the past memories; and future possibiities..
Hello to the unknown future, and Good Bye to the comfort and known of my past... All at the eve of my 40th birthday...I apparently enjoy the drama of it all..
Sunday, October 21, 2007
Goal Realized...
As I sit here; my feet, legs and back are screaming in agony...But it is a good agony. Yours truly finished her first half marathon(13.1 miles!) today at the age of 39.11 months...Yes it is a goal realized.
No I did not run it, I walked it with the encouragement/companionship of a peer/coworker who has completed several of these as a walker. When I say walk, do not picture a leisurely stroll..No it is a timed event, and we averaged a 16.38 mile. It does not seem like much, but to me, it is a goal that I never thought would be met..
As I reflect on the past 10 years of change and growth in my life, exercise and getting healthy were not high on the list until the past two/three years. As I have lost weight, and started exercising, the thought about doing something like this was in the back of my mind, but it took someone to be persistently annoying and encouraging to first adopt it as a goal, and then to continue encouraging me to seek and desire it for myself.
Now I have not only pain, but I also have the medal proving "I did it" and knowledge that I completed an idea from start to finish and can cross this goal off my list of things to get done in my lifetime. The other interesting thought that comes from this; is that I don't think it will be my last...I think the experience is something I will seek out/train for harder next time. The other irony of goals realized..."So I did this now how can I do it better?"
I think these personal principles apply so aptly to what I am desiring as a leader for my staff, peers and elders. It is time for some personal pain, sweat and tears to get the goals we have, achieved.
Another analogy to use as a talking point for my managers and staff. What goals do they have, personal/professional that they would like me or someone to be persistently annoying and encouraging about for them? Personal goals will remain a secret personal goal until you share it with others..The cool thing about sharing is that now you are held to level of accountability to see your goal come to fruition. The downside is that you are now held to a level of accountability to see your goal come to fruition. There is a risk in the sharing...the paradox of sharing as I call it.
Is it worth the risk to share? Yes, it makes us human, and it makes us stronger achievers...If I had just listened to this specific peer talk about her walking, instead of saying, "you know,I think I would like to try that" one time; my Sunday would have been spent not in pain! But isn't the emotional pain of having goals and ideas that you don't share, more difficult then the physical pain of seeing your goal/idea realized?
Think about that..I am now off to pack for a week of training in Texas. Another goal that I have wanted for two years...I am sure it will make great discussion for my next blog.
No I did not run it, I walked it with the encouragement/companionship of a peer/coworker who has completed several of these as a walker. When I say walk, do not picture a leisurely stroll..No it is a timed event, and we averaged a 16.38 mile. It does not seem like much, but to me, it is a goal that I never thought would be met..
As I reflect on the past 10 years of change and growth in my life, exercise and getting healthy were not high on the list until the past two/three years. As I have lost weight, and started exercising, the thought about doing something like this was in the back of my mind, but it took someone to be persistently annoying and encouraging to first adopt it as a goal, and then to continue encouraging me to seek and desire it for myself.
Now I have not only pain, but I also have the medal proving "I did it" and knowledge that I completed an idea from start to finish and can cross this goal off my list of things to get done in my lifetime. The other interesting thought that comes from this; is that I don't think it will be my last...I think the experience is something I will seek out/train for harder next time. The other irony of goals realized..."So I did this now how can I do it better?"
I think these personal principles apply so aptly to what I am desiring as a leader for my staff, peers and elders. It is time for some personal pain, sweat and tears to get the goals we have, achieved.
Another analogy to use as a talking point for my managers and staff. What goals do they have, personal/professional that they would like me or someone to be persistently annoying and encouraging about for them? Personal goals will remain a secret personal goal until you share it with others..The cool thing about sharing is that now you are held to level of accountability to see your goal come to fruition. The downside is that you are now held to a level of accountability to see your goal come to fruition. There is a risk in the sharing...the paradox of sharing as I call it.
Is it worth the risk to share? Yes, it makes us human, and it makes us stronger achievers...If I had just listened to this specific peer talk about her walking, instead of saying, "you know,I think I would like to try that" one time; my Sunday would have been spent not in pain! But isn't the emotional pain of having goals and ideas that you don't share, more difficult then the physical pain of seeing your goal/idea realized?
Think about that..I am now off to pack for a week of training in Texas. Another goal that I have wanted for two years...I am sure it will make great discussion for my next blog.
Tuesday, October 16, 2007
The Gift of Potential.. A Thank You on Bosses Day..!
As a leader, I think the best gift I have ever been given is having someone who leads me; recognize my potential. Not only was the potential recognized, it was developed through opportunities, education, and some well deserved kicks in the seat of my pants when needed. Now, as I reflect on my relationship with my own "boss" whom I view as a mentor and role model, I find myself thinking about what she could possibly have recognized in me close to 8 years ago when I was first given the opportunity to become a leader.
It is an interesting self retrospective; I have undergone dramatic personal growth during the past 8 years; most who know me view the change as occurring in the past 18 months. The reality is that once I understood that it was okay to have ideas; and then to try implementing those ideas, I found confidence in both the success and the failures. A recognition of self potential was the gift she gave me and I now recognize this for what a true gift it is.
So on bosses day, I give a sincere thank you to my boss, mentor and leader; for recognizing my potential and then giving me the tools and opportunity to recognize it for myself to develop new skills and confidence.
I only hope that as I develop my own leadership style and see ideas come to fruition; that I too can help develop the potential of those I lead. There is no greater gift to be given; or perhaps receive as a leader....
It is an interesting self retrospective; I have undergone dramatic personal growth during the past 8 years; most who know me view the change as occurring in the past 18 months. The reality is that once I understood that it was okay to have ideas; and then to try implementing those ideas, I found confidence in both the success and the failures. A recognition of self potential was the gift she gave me and I now recognize this for what a true gift it is.
So on bosses day, I give a sincere thank you to my boss, mentor and leader; for recognizing my potential and then giving me the tools and opportunity to recognize it for myself to develop new skills and confidence.
I only hope that as I develop my own leadership style and see ideas come to fruition; that I too can help develop the potential of those I lead. There is no greater gift to be given; or perhaps receive as a leader....
Wednesday, October 10, 2007
Vigilante Regulators...
Wow...Who wants to duck and run from long term care in Michigan today after yesterdays frightening "joint provider" training?
For those of you who are not fortunate enough to work in long term care, let me share with you that yesterday we (providers from all over Michigan) and our survey agency staff, affectionately called the "state" by providers sat thru the most vigilante/out to get you with a vengeance seminar/training that I have ever experienced. "The underlying theme I felt was that we, (providers) cause harm, have the potential to cause harm, and that we are going to be "caught" irregardless of what we do for our elders.. When I define caught, I am referring to the use of the surveyors new weapon against nursing facilities; the Immediate Jeopardy tag that strikes fear in the heart of every Nursing Home Owner, Administrator and staff care giver.... Read on for the highlights of yesterdays events.
The original purpose of these training seminars was to bring providers and the oversight agency from the State of Michigan together for training on best practices, new regulations and to create an environment that focused on collaborative visionary care thinking... Well the training continues but what originally was started as a collaborative "good will" event has quickly become a "here are the new rules and best practices as we see them; and by the way; tough about what you think is really important/priority for your elders"... Common sense and practical thinking about what elders really need and want be damned....
Maybe I am biased, maybe I am way off base, but when I sat and listened to the surveyors from the CMS regional office share "great stories" about facilities that have been closed, or suffered from an IJ tag with such relished enthusiasm I felt an illness in my stomach. Where is the elder in their enthusiasm? Where is the resident opinion and right in the citations that they quoted so joyously? As an advocate for elders I fear that our regulators are jumping to judgement without considering the resident point of view and their rights are being forgotten..
Let me share the story that made me the most ill and frightened for my elders..During a presentation about how an immediate jeopardy citation can be cited for the potential to cause harm, the CMS regulator spoke with great enthusiasm about a small facility in rural Wisconsin that had received four perfect, zero citation surveys during the past four years; only to get an IJ on the last day of survey for delivering a resident a birthday cupcake with a lit candle on it. The surveyor even described the scene, "the dining room was full of staff, families and residents; all there to celebrate this residents birthday and they were singing to her and it was her special day".
The problem? the resident had a nasal cannula in her nose with oxygen to it. NO she did not blow up, no fire, no injury no harm. Yet, they(the surveyors) ruin the excitement for this elder/staff and give them(the facility) an immediate jeopardy for the potential for a fire due to oxygen in her nose, and the small lit birthday candle....Could she have been hurt, possibly. Should they have known better, probably. Did the facility deserve to be fined, nearly closed, lose it's ability to admit residents, get placed on a "bad facility listing" and lose it's nurse aide training because of it? Not to mention the "label" and Internet label of poor performer; hardly.
As an Administrator this type of story is not only infuriating it is devastating. This facility has to be one of the best facilities you could encounter. Knowing the type of care/resident and staff interactions that must exist for a perfect survey to occur; I know that this facility has to have real person centered care relationships and outcomes in existence. I would bet this facility has great family, community, resident and staff support and enthusiasm. How do I know this? I use my own facility as a gauge and my peers who also have had the great fortune of a "perfect survey". To attain this you have to have reached beyond the regulations to create the remarkable person center nirvana that is the pinnacle of the elder care experience.
I can only imagine how crushed/damaged the dietary aide who delivered the cupcake would be. I think of my own enthusiastic, caring young people who work in my kitchen. I see them deliver the snacks in the hallway, in fact as I type this I am hearing them singing to one of my elders a rap song...there is laughter and a real relationship occurring spontaneously.
I think of the emotional damage to the elder. In our building, the elders are outspoken about their needs and wants. This is good! To me that says, "hey, I trust you to fix this, and I know it is o.k. to say what I think because I trust you, you will not harm me, you love me and want what is best for me when you care for me." They demand real relationships and the unconditional love that is given and received in a person centered care model.
I think about some of my elders and how devastated they would be if they knew that their special day and the love from the staff resulted in devastation for the very same caregivers who love and care for them. They would feel such guilt and be emotionally harmed by the knowledge that their event caused this. (No, my staff would not share, but trust me they would know, we exist as a community and family; that is why our great buildings remain great...)
So where was the elder in this citation? Yes, I agree we must protect our elders from actual harm. But to try and prevent every "possible harm outcome" is ludicrous. Every environment, every person has the ability to be a victim of potential harm. I think about when I fill up at a gas station, and see the person next to me smoking a cigarette or filling a gas can in the back of their pick up. I think about my own bad behavior of using my cell phone while driving. I think of the countless times I have spilled hot coffee on myself in my car; or while wearing ridiculously high heels I have tripped or stumbled.
I think of my parenting and how I raised my son. If you were to look at my environment when he was young, using this model of "potential for harm" you should have taken him from me early on...He broke his collar bone three times before he was 12 years old. I was present at only one of the fracturing events. Yet, he had actual harm from his own volition, and my apparent lack of keeping him from harm. Using the surveyor model, I should have been eliminated from the mother model.
Apparently, because "we" accept money to care for elders, "we" are now held to the light that we must eliminate every "potential for harm" that could exist for the person/elder we are being reimbursed to care for. Resident choice be damned; if your care is being funded by the government I am obligated to give you lukewarm coffee, and wrap you in bubble wrap...Your right to the dignity of making poor choices such as falling from trying to ambulate as long as possible,or smoking a cigarette with poor reflexes, or eating sugar while diabetic could get me an immediate jeopardy, and can no longer be tolerated if I am to exist as a provider of care.
I wonder how many great caregivers went home yesterday and pulled out the resume...This quest for culture change and person centered care is definitely not for the faint of heart.
For those of you who are not fortunate enough to work in long term care, let me share with you that yesterday we (providers from all over Michigan) and our survey agency staff, affectionately called the "state" by providers sat thru the most vigilante/out to get you with a vengeance seminar/training that I have ever experienced. "The underlying theme I felt was that we, (providers) cause harm, have the potential to cause harm, and that we are going to be "caught" irregardless of what we do for our elders.. When I define caught, I am referring to the use of the surveyors new weapon against nursing facilities; the Immediate Jeopardy tag that strikes fear in the heart of every Nursing Home Owner, Administrator and staff care giver.... Read on for the highlights of yesterdays events.
The original purpose of these training seminars was to bring providers and the oversight agency from the State of Michigan together for training on best practices, new regulations and to create an environment that focused on collaborative visionary care thinking... Well the training continues but what originally was started as a collaborative "good will" event has quickly become a "here are the new rules and best practices as we see them; and by the way; tough about what you think is really important/priority for your elders"... Common sense and practical thinking about what elders really need and want be damned....
Maybe I am biased, maybe I am way off base, but when I sat and listened to the surveyors from the CMS regional office share "great stories" about facilities that have been closed, or suffered from an IJ tag with such relished enthusiasm I felt an illness in my stomach. Where is the elder in their enthusiasm? Where is the resident opinion and right in the citations that they quoted so joyously? As an advocate for elders I fear that our regulators are jumping to judgement without considering the resident point of view and their rights are being forgotten..
Let me share the story that made me the most ill and frightened for my elders..During a presentation about how an immediate jeopardy citation can be cited for the potential to cause harm, the CMS regulator spoke with great enthusiasm about a small facility in rural Wisconsin that had received four perfect, zero citation surveys during the past four years; only to get an IJ on the last day of survey for delivering a resident a birthday cupcake with a lit candle on it. The surveyor even described the scene, "the dining room was full of staff, families and residents; all there to celebrate this residents birthday and they were singing to her and it was her special day".
The problem? the resident had a nasal cannula in her nose with oxygen to it. NO she did not blow up, no fire, no injury no harm. Yet, they(the surveyors) ruin the excitement for this elder/staff and give them(the facility) an immediate jeopardy for the potential for a fire due to oxygen in her nose, and the small lit birthday candle....Could she have been hurt, possibly. Should they have known better, probably. Did the facility deserve to be fined, nearly closed, lose it's ability to admit residents, get placed on a "bad facility listing" and lose it's nurse aide training because of it? Not to mention the "label" and Internet label of poor performer; hardly.
As an Administrator this type of story is not only infuriating it is devastating. This facility has to be one of the best facilities you could encounter. Knowing the type of care/resident and staff interactions that must exist for a perfect survey to occur; I know that this facility has to have real person centered care relationships and outcomes in existence. I would bet this facility has great family, community, resident and staff support and enthusiasm. How do I know this? I use my own facility as a gauge and my peers who also have had the great fortune of a "perfect survey". To attain this you have to have reached beyond the regulations to create the remarkable person center nirvana that is the pinnacle of the elder care experience.
I can only imagine how crushed/damaged the dietary aide who delivered the cupcake would be. I think of my own enthusiastic, caring young people who work in my kitchen. I see them deliver the snacks in the hallway, in fact as I type this I am hearing them singing to one of my elders a rap song...there is laughter and a real relationship occurring spontaneously.
I think of the emotional damage to the elder. In our building, the elders are outspoken about their needs and wants. This is good! To me that says, "hey, I trust you to fix this, and I know it is o.k. to say what I think because I trust you, you will not harm me, you love me and want what is best for me when you care for me." They demand real relationships and the unconditional love that is given and received in a person centered care model.
I think about some of my elders and how devastated they would be if they knew that their special day and the love from the staff resulted in devastation for the very same caregivers who love and care for them. They would feel such guilt and be emotionally harmed by the knowledge that their event caused this. (No, my staff would not share, but trust me they would know, we exist as a community and family; that is why our great buildings remain great...)
So where was the elder in this citation? Yes, I agree we must protect our elders from actual harm. But to try and prevent every "possible harm outcome" is ludicrous. Every environment, every person has the ability to be a victim of potential harm. I think about when I fill up at a gas station, and see the person next to me smoking a cigarette or filling a gas can in the back of their pick up. I think about my own bad behavior of using my cell phone while driving. I think of the countless times I have spilled hot coffee on myself in my car; or while wearing ridiculously high heels I have tripped or stumbled.
I think of my parenting and how I raised my son. If you were to look at my environment when he was young, using this model of "potential for harm" you should have taken him from me early on...He broke his collar bone three times before he was 12 years old. I was present at only one of the fracturing events. Yet, he had actual harm from his own volition, and my apparent lack of keeping him from harm. Using the surveyor model, I should have been eliminated from the mother model.
Apparently, because "we" accept money to care for elders, "we" are now held to the light that we must eliminate every "potential for harm" that could exist for the person/elder we are being reimbursed to care for. Resident choice be damned; if your care is being funded by the government I am obligated to give you lukewarm coffee, and wrap you in bubble wrap...Your right to the dignity of making poor choices such as falling from trying to ambulate as long as possible,or smoking a cigarette with poor reflexes, or eating sugar while diabetic could get me an immediate jeopardy, and can no longer be tolerated if I am to exist as a provider of care.
I wonder how many great caregivers went home yesterday and pulled out the resume...This quest for culture change and person centered care is definitely not for the faint of heart.
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