The History of Aging and Care Early in the 20 th Century

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Lawrence Lawson
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aortigara@phinational.org 708.609.1739 PHI 2016. All Rights Reserved. Arial Regular 12 pt. Presentation Title Date Your Name Where you work? What is one thing people probably do not know about you?

care. We are driven by the desire to create fundamentally new systems of care that honor that principle.

1 Welcome! Getting to Know You BUILDING A CUSTOMER DRIVEN CULTURE The First Steps to Empowered Staff to Support Person-Directed Living Anna Ortigara RN, MS, FAAN PHI, Organization Change Consultant aortigara@phinational.org PHI All Rights Reserved. Arial Regular 12 pt. Presentation Title Date Your Name Where you work? What is one thing people probably do not know about you? Number of years in Aging Services and Supports Quality Care Through Quality Jobs Caring, committed relationships between direct care workers and the people they care for are at the heart of quality care. We are driven by the desire to create fundamentally new systems of care that honor that principle. Work with employers, policymakers, and other stakeholders across the care continuum to support direct care workers to deliver person-centered care. 25 years, 360-degree perspective #60CaregiverIssues Today s Agenda Elements of a Person Directed Culture Creating a Coaching Culture Role of Relationships Blocks to Listening Relational Skills at the Core of Person Directedness Active Listening Paraphrase Open Questions Impact/Outcomes PHI All Rights Reserved. PHI All Rights Reserved. The History of Aging and Care in the U.S. Early in the 20 th Century Elders aged in place with extended families Or moved into homes with children 1

Early Residential Care Poor Farms/ Psychiatric Hospitals 1934 Social Security

keep moving to cities Families living far from elders Creation of the Nursing

Time to move beyond institutions to Real Homes and Person Centered Living

Living Home and Community Based Services Introducing Dorothy At the Heart of

What was the biggest challenge for Dorothy in the hospital?

2 Early Residential Care Poor Farms/ Psychiatric Hospitals 1934 Social Security Signed into law 1940 s Society is Changing Women enter the workforce People keep moving to cities Families living far from elders Creation of the Nursing Home Growing numbers of elders needing care and support 2000 s Time to Change! Time to move beyond institutions to Real Homes and Person Centered Living Pioneer Network Medicare and Medicaid The Growth of Nursing Homes Assisted Living Home and Community Based Services Introducing Dorothy At the Heart of Culture Change What is important to Dorothy? What was the biggest challenge for Dorothy in the hospital? Institutional/ Provider directed Staff Centered Person Centered Person Directed What got in the way of Dorothy getting her needs met? 12 2

Beliefs, Customs, Behaviors and Language BELIEFS Something that is held with confidence to be true. So Why Change? What are you taking away from this discussion?

beliefs, customs, behaviors and language?

comfortable, healthy, successful and happy Core Psychological Needs of Human Beings The Elements and Essence of Person Directed Living Relationship

Meaning/Purpose Autonomy Meaningful Life and Engagement WELL BEING Being Well Known Choice and Control Honoring Choice, Control, and Power Tomorrow you wake up and are

3 Beliefs, Customs, Behaviors and Language BELIEFS Something that is held with confidence to be true. So Why Change? What are you taking away from this discussion? CUSTOMS A way of doing things that most people in a culture accept as tradition and beyond question What is the impact for elders living in care settings with these beliefs, customs, behaviors and language? BEHAVIORS the way we act in everyday life and the way we communicate with each other What happens if these old customs, believes, language and behaviors are demonstrated in our work? LANGUAGE the words we use to communicate to others what we believe and what we think is truly important Individual Well Being A state or condition of being content, comfortable, healthy, successful and happy Core Psychological Needs of Human Beings The Elements and Essence of Person Directed Living Relationship Relationships/Connectedness/Attachment/ Inclusion/Love Engagement/Connectedness Occupation/Accomplishment Growth Security/Comfort Joy/Positive Emotions Identity Meaning/Purpose Autonomy Meaningful Life and Engagement WELL BEING Being Well Known Choice and Control Honoring Choice, Control, and Power Tomorrow you wake up and are living in a care setting. Look deeply into the eyes of the person next to you. They will be your Care Partner What would be the most important thing for you to control in your life in a care setting to support your well being? What would be intolerable for you to lose control over? What do Elders tell us they need To know those who care for them And be known in return To feel respected To like them and feel they are liked. It is about Relationships! PHI All Rights Reserved. 3

Knowing a Person Our Life Story What are the ways you currently get to know a new elders? Have you ever read an obituary of an elder after they died? Were there any surprises?

4 Knowing a Person Our Life Story What are the ways you currently get to know a new elders? Have you ever read an obituary of an elder after they died? Were there any surprises? With a partner: Share one childhood memory that stands out for you, a story you like to tell. Knowing a Person: Debrief What impact did learning your partner s story have on your relationship? How might knowing their stories influence your future relationship? Meaningful Life and Engagement We crave meaning in our lives. Why get out of bed in the morning without it? Values are a person's principles or standards of behavior; one's judgment of what is important and priorities in life. Values that make life meaningful Dorothy How did Dorothy attempt to assert her choice and control? What happened? What seem to be Dorothy s values? Where was the power held in the relationship between the nurses and Dorothy? How did this effect Dorothy s experience of control? What could have helped the nurses to get to know Dorothy better, and to understand her values? 22 Communication Norms INSTITUTIONAL Talk about Elder Conversations focus on illness Tell Elder what s/he can and can t do Role of Elder is to listen to health care professional and comply PERSON CENTERED/DIRECTED Talk with Elder Conversations focus on what s important to Elder Ask Elder what s/he would like to do Role of staff is to listen to Elder and follow through Relationships Matter! Dietary Social Work Rehab Housekeeping Physicians Elder Nursing Maintenance Activities Administration Chaplain

25 26 Traditional vs. Coaching Supervision PHI Coaching Approach A relational approach to managing and supporting direct-care workers and teams that helps them to own problem-solving skills.

the ability to think critically, prioritize and communicate effectively Traditional Identify the issue to be addressed Explain the rules clearly Explain consequences of breaking rules Offer

5 How are You Doing? How would you describe relationships: Between supervisors and employees Between shifts Between departments Between staff and elders Between staff and families Communication Gone Bad! Traditional vs. Coaching Supervision PHI Coaching Approach A relational approach to managing and supporting direct-care workers and teams that helps them to own problem-solving skills.. i.e. the ability to think critically, prioritize and communicate effectively Traditional Identify the issue to be addressed Explain the rules clearly Explain consequences of breaking rules Offer possible solutions Request compliance PHI All Rights Reserved. Coaching Establish relationship with the worker Clearly present the problem Gather information on the worker s perspective Engage worker in problem solving Help the worker commit to action steps The PHI Coaching Skills Active Listening Self Awareness/Self Management Feedback, Without Blame or Judgment When Listening is Blocked We can t fully take in what the other person is saying Our attention is focused at least in part on ourselves and meeting our own need in that moment

Blocks in Action How did you hear the nurse advising? What was the impact of this conversation on Dorothy?

Before people get to what s really troubling them, you jump in with suggestions for how to solve the problem.

What does it feel like? What s the impact on the person? Judging What judgments is this nurse making?

33 Placating You are pleasant and supportive without really taking in what the other person is saying.

6 Blocks in Action How did you hear the nurse advising? What was the impact of this conversation on Dorothy? Who had control in this conversation? Why is this a block to listening? Advising. Before people get to what s really troubling them, you jump in with suggestions for how to solve the problem. Before they are finished talking, you are thinking about what to do. 31 Blocks in Action What does it sound like? What does it feel like? What s the impact on the person? Judging What judgments is this nurse making? Why is this a block to listening? How do judgments influence how we treat patients? 33 Placating You are pleasant and supportive without really taking in what the other person is saying. In this mode, you may also be patronizing. This listening block is often used with children and older people. What s happening for Dorothy? How did you hear the nurse placating? What was the impact of this conversation on Dorothy? Who had control in this conversation? Why is this a block to listening? 36 6

Self Awareness is the Key Notice when your listening is blocked! Put your attention back on the other person Stay open to hearing their perspective!

clear up misunderstandings on the spot Lets the other person know you are listening Helps the other person think through their ideas 38 Types of Paraphrasing Skills Practice CONTENT I m hearing that

7 Self Awareness is the Key Notice when your listening is blocked! Put your attention back on the other person Stay open to hearing their perspective! Paraphrase Paraphrasing Putting into your own words what you think someone else just said Keeps you focused on what the other person is saying Provides an opportunity to check your understanding and clear up misunderstandings on the spot Lets the other person know you are listening Helps the other person think through their ideas 38 Types of Paraphrasing Skills Practice CONTENT I m hearing that being in the hospital has disrupted your bowel routine. FEELING It sounds like you re really concerned about this. Open Questions Closed Questions Open questions help you learn the other person s perspective, they lead to discussion and keep a conversation going. Can you tell me more about your home? Closed Questions can be answered with a simple yes or no or other one word answer. Do you prefer a bath or shower? Would you like to have your hair washed today? 7

questions? Where was the power/control in this conversation?

Residents who give up tend to disengage and withdraw Staff is creating an Us/Them climate Staff may think the resident is difficult Staff may feel caught in the middle between facility

8 Skills Practice Why Ask Questions? Learn what s important to the elder Learn their simple pleasures Develop relationship Understand their perspective 44 Knowing a Person How did you hear us using paraphrase and open questions? Where was the power/control in this conversation? When We Don t Listen Elders are distanced and are not seen as equals Elders may become upset, anxious, or agitated Elders may give up on trying to assert their own control. Residents who give up tend to disengage and withdraw Staff is creating an Us/Them climate Staff may think the resident is difficult Staff may feel caught in the middle between facility expectations and resident preferences Why Teach Communication Skills Improved satisfaction Improved Employee Retention Time saved managing complaints Improved relationships Improved critical thinking and problem solving skills Improved teamwork Improved clinical outcomes PERSON CENTERED/PERSON DIRECTION! There are few presumptions in human relationships more dangerous than the idea that one knows what another human being needs better than they do themselves

9 Questions? Anna Ortigara RN, MS, FAAN Organization Change Consultant, PHI, East Fordham Road, 11th Floor Bronx, New York PHI 2017 Pioneer Network 9

What are ADLs and IADLs?

What are ADLs and IADLs? Introduction: In this module you will learn about ways you can help a consumer with everyday activities while supporting his/her independence and helping the consumer keep a sense