CARF Accreditation: Striving for Excellence

Kayda Johnson, COO, Senior Resource Group (SRG)

Accreditation by an independent non-profit organization such as CARF (Commission on Accreditation of Rehabilitation Facilities) is a sign of quality and should be an important consideration of seniors and their families in making a decision about a retirement community. More than operational prudence, CARF accreditation demonstrates heightened care, comfort and peace of mind for residents and families.  What’s more, it signifies a provider’s dedication to offer a range of activities; emphasize resident choice; and a provider’s willingness to solicit resident feedback. Continue reading

CARF’s over 1,000 rigorous standards and dedication to person-centered care are reflected in provider facilities such as Senior Resource Group’s nine locations (SRG). Through SRG’s Genuine Hospitality program, service is delivered by a dedicated group of people who truly believe residents’ well-being and quality of life is their personal responsibility. The goal is not just to meet resident needs but to enrich and enhance their lives in the process.

Just as striving for excellence is an on-going endeavor, so is accreditation. SRG is committed to continuous improvement and enhanced performance in serving its residents, future residents, and their families.  As such, in addition to maintaining their current three year accreditation status at nine communities, SRG is seeking accreditation for all of the company’s assisted living communities when they become eligible this year.

“While no easy feat, CARF accreditation is a worthwhile venture for any senior living provider who seeks to improve the quality of their services or demonstrate true value, care and consideration of their residents,” said Johnson.

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Doing the Right Thing; It Can Come Naturally

by David Sprowl: Executive Director at Lutheran Towers, Atlanta; Director CCAL.

A recent and very personal experience put the concept of person-centered care in the forefront of my mind.  Last month, my 90-year old grandmother, Mama Dora, fell and broke her hip.  Until that time, she had lived independently in her own home and until her car was wrecked by her great-grandson, she was still driving.  Being the dutiful grandson, I immediately took the one and a half hour car trip to be by her side.  Continue reading

In less than a two week span, she underwent successful hip surgery, a short hospital stay, rehab in another city, and was suddenly returned to the hospital with renal failure before peacefully dying.  As someone who is particularly sensitive to how individuals treat Elders, I was struck at how well the hospital staff interacted with Mama Dora.

From the aids to the nurses, to the doctors, everyone without exception focused on her.  They did not exclude my family in their  interactions, but it was clear that my grandmother held their primary interest.  They spoke directly to her, asked her personal questions about her family, about how she was feeling, etc.  Now, I must acknowledge that Mama Dora has never met a stranger, so she exerted her own personality in the exchange.

I suspected that each staff member providing care was not especially trained to be sensitive to the needs of Elders, but it was simply a natural part of who they were.  Upon asking one of the nurses, I  learned that they had not received any special training related to  eldercare.  It turns out that she and the others had only received basic patient care training delivered via educational videos.  She had never heard of culture change, patient-directed care, or person-centered care.

Often, we only hear the horror stories, but we have to acknowledge that there are those who are doing the right things for the right reasons, but lack the awareness and formal training that provides them a common language from which to speak and a platform for working at a higher level.

Although what I observed seemed to happen naturally, how much more meaningful would the experience have been if the individuals providing the care were given tools to enable them to create a culture of caring that would last beyond the current group of employees?

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Person-Centered Care: Is It Actually Happening

by: Karen Love, Founder CCAL

Recent experiences have me wondering if our country does a
better job caring for and about people when they are dying in a hospice program than when they are living.  My mother passed away earlier this  year in a hospice.  The last several months of her life included numerous hospitalizations, several ambulance trips to the Emergency Department, a 10-day stay at a nursing home for rehab services, and many doctor and therapy appointments. Continue reading

During this time she received care from the spectrum of health care settings including primary, ambulatory, acute, rehabilitation, sub-acute, nursing home, and hospice.  The clinical care she experienced in all of the settings – except the nursing home – was excellent.  Yet it was only in the hospice setting that she and our family experienced humane care.

While my mother was only in the hospice for five days, the staff and volunteers all took the time to get to know us, made us feel welcome and at home, were attentive to our comfort needs, went out of their way to answer questions, and even made sure we knew when food was set out.  Everyone we encountered at the hospice was kind, caring, sensitive, and thoughtful.  They were as focused on my mother’s clinical needs as her human needs.  As a result, the sad and difficult experience of dying for my mom and losing a parent -grandparent for our family was special and memorable.

In contrast, my mother’s 10-day stay at the nursing home was barely humane and mostly unpleasant.  Not one staff member took time to get to know anything about her other than her medications. Despite the fact that she was very ill and scared, the staff bathed and toileted her as if she was an object.  The environment was noisy and intrusive at night making sleep difficult.

The other care settings at least provided good quality clinical care, but ranked low in humanism.  Staff generally were hurried and only focused on her clinical care: taking her temperature; drawing blood; and delivering medications.  Occasionally someone would mention how cold a room was, but make no effort to do something about it or to get a blanket.  It was as if they had blinders on about the fact that they were caring for human beings with emotional, physical, mental and social needs.

In our family’s experience, all the talk about person/patient-centeredness was just that…talk.  It’s hard to understand why.  Not only was the time at hospice good for our family; it was the only setting where the staff seemed to actually enjoy being there.  Maybe person-centered and humane care is good for staff too.

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The Cost Efficiencies of Creative Thinking: Covering the Expense of Person-Centered Care

by: Claudia S. Blumenstock, NHA, Pres. & CEO Copernicus, Inc. –

During these financially challenging times, when the idea of incorporating Person-Centered care is broached, it is not uncommon to hear a provider exclaim, “how are we going to pay for it”. The thought of integrating collaborative approaches inclusive of older adults and their care givers, may be perceived as expensive and irresponsible as positive bottom lines dwindle. Continue reading

It is a misconception that change needs to be expensive. The perception that creative thinking is pricey erects barriers which can prevent or slow forward movement that initiates and sustains individualized Life-Enrichment in the lives of older people.

Ask yourself this question: What are YOUR favorite life activities? I enjoy entertaining friends. Taking pleasure in engaging conversation and laughter brings fun and meaning to my life. Thinking about the favorite experiences of someone else begins with thinking about that which brings you joy. We can relate to another person by understanding what it would be like to have or not have desired experiences in our own lives.  If “Mrs. Jones” lives in an assisted living residence and is missing her lifetime friends who don’t visit, she may be suffering emotionally, physically and spiritually by her loss. The potential health decline puts her at risk and increases the cost of her care. What if she and her caregiver create an opportunity to enjoy regular visits with friends?  Invitations can be written together, inviting them to join her for their weekly bridge game in her new home. Light snacks might be served and are inexpensive as compared to the costs of declining health. A meaningful and pleasurable atmosphere is fostered cost efficiently.

Consider this: There are several people living in a community that enjoy gardening. Residents and caregivers meet to plan a community garden. They till the soil together, creating an abundant harvest that can be shared by all. Vegetables and fruits are offered to the community’s chef and are used to make sumptuous meal offerings. Costs are minimal. The joy in the process and in the giving back is priceless.

Shift your focus and your thinking by understanding what brings meaning to you. That is the first step in embarking on the creative thinking journey and it doesn’t cost a dime.

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From Person to Condition & Back Again

by: Michele Ochsner, Ph.D., Co-director Occupational Training & Education Consortium, Rutgers Univ. –

About a dozen years ago I realized that my parents’ confusion and forgetfulness was probably the beginning of dementia. The realization was delayed by the long distance that separated us and my relatively brief visits home to the Mississippi Gulf Coast.  After a period of hiring caregivers that might allow them to stay in their home, I realized it simply wasn’t possible to keep them safe.  My still strong, independent eighty year old father would decide to pay a bill on foot—undertaking a five mile walk into town in 98 degree weather–followed by my much frailer, nearly blind mother and their small dog Minnie.  Neighbors would find this sadly comic trio walking along busy roads and with no small amount of difficulty, persuade them into their cars for the ride home. Caregivers were fired or simply unable to keep up.  Miraculously my parents survived half a dozen or more misadventures that could have led to tragedy. Continue reading

Recently divorced with two pre-adolescents and working full-time, I knew that I could not provide the care they needed. I wasn’t familiar with the term person-centered care at that point—but I knew I wanted to find a place near my home where my parents could make friends, find and offer affection and make a new home. My parents were simply the kindest people I’ve ever known—and I was sure that we would forge a new family that included caregivers who could keep my parents safe.

From 2001 – 2004, my parents lived in what was generally believed to be the best dementia care unit within a 30 mile radius of my home in Princeton NJ.  I loved the non-profit facility’s principles of dignity, autonomy, and respect—my parents were free to walk anywhere and would be gently guided back into the building.  But the facility provided little in the way of meaningful activities. Nor did the staff seem to engage with the residents.  My father used his autonomy to pack his pillowcase daily for return walk home to Mississippi—and my mother was equally determined to leave.  In numerous conversations, the unit director and nursing staff explained that my parents’ unhappiness and troubled behavior –to me the result of loneliness and a lack of engagement–was simply a symptom of their dementia.

In 2004 a continuing care retirement community with a dementia unit opened a few miles from my house, and my parents were among the first to move in—for a few weeks at least the staff may have outnumbered the residents.  The staff were excited about the new facility and unit and determined to create a good environment for the residents. For the first time since I had moved my parents from their own home, my parents became Doris and Bob, people with dementia—but more importantly, people, who could be enjoyed and known.  My dad rediscovered his sense of humor—words were beginning to fail him—but a wink, a military salute or a quick hug connected him to the aides and nurses.  The staff loved my mom’s southern accent and the mixture of affection, irony  and pride she exhibited toward her husband of more than 50 years.  My parents were no longer able to tell their own stories, so I told the stories of my parents’ lives —and helped build the web of connections among nurses and caregivers.  When I eventually remarried, the ceremony was held in the dementia unit decorated for the occasion with white satin bows and flowers—among new family and friends. In the face of many losses—we had all found new connections, hope and humor.

My dad was lucky to make this small, caring place his home for four years.  A little more than a year after the move, my mom fell and broke her hip.  Facility policy required that she move upstairs to the nursing home.  But until she was very frail—she would come down to sit in the common room near my dad.  At this point she had to share him with nearly half a dozen nurses and aides and activities staff who he loved, helped, and sometimes tried to protect when a frustrated resident became aggressive.  And he developed relationships with other residents—with whom he sometimes strolled the halls hand-in-hand—having conversations whose words were hard to interpret but whose affection was unmistakable.

Given the freedom to be themselves, many of the residents seemed to decline slowly here.  Problems arose on a fairly regular basis—residents became frustrated, families shared annoyances, staff were often spread too thin and not all staff engaged with residents; formal activities were sometimes uninspired…but there was still a sense of community forged by shared jokes, arguments, and small victories.

My mother had a series of strokes that left her paralyzed on one side–but upstairs in the nursing home she developed a close relationship with an aide who cared for her tenderly.  Downstairs, my father continued to heal—leaving his room in the morning with arms outspread to embrace the aides who had become like daughters.

In the face of recurrent bacterial pneumonia due to a weakened swallowing reflex, my father who had struggled so hard against a loss of control, relaxed even in the strange environs of the hospital, lighting up when I visited and taking me in his arms to croon a melody.  He was discharged from the hospital and spent his final 72 hours at home in his unit—eventually unaware of the procession of aides and nurses who entered his room to touch him lightly and say good bye and who comforted me and my husband.

My parents are gone now, and I know that we were lucky to find a place in which people with dementia are seen as more than their illness and that has managed to recruit and retain such caring staff.  My family’s experiences taught me a great deal about the human capacity for growth and healing in the face of illness. I believe that environments in which staff have the time, training and desire to see and engage with the person—not just the illness—are a crucial foundation for person-centered care and a source of life and hope even in the midst of loss and decline.  “Customer service,” a term I hear batted around in nursing homes and assisted living these days, is a pallid shadow of the kind of engagement and connection I sought for my parents and if I live long enough, may someday seek for myself.

I hope that many of us will take up the challenge to create and strengthen environments in which life can unfold.

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Person-centered Care: Living the Commitment

by: Elsie S. Norton,SVP Quality Care, ACTS Retirement-Life Communities –

As a resources specialist at CARF I have the great honor to work with professionals  from  the United States and Canada.  These professionals bring so much to our field of Aging and to Person Centered Care.   As the only accreditor for Person Centered Long-term Care Community providers, many stories and examples are shared with us.   I had asked one of the providers to share with me what she thought Person Centered  care meant to her.  Here is what she shared. Continue reading

“Regarding Person Centered Care, to me, it means we focus our care and service on meeting the needs, desires, and routine of the individual resident.  It means our staff members from all disciplines really know each resident and work together to honor the individuality and special gifts each resident brings with him/her into our environment, providing opportunities for choice in all aspects of life.  What it means to a consumer is that his/her loved one is in an atmosphere where people genuinely care about the uniqueness of each individual and work as a team to carefully integrate each person into the residence respecting his/her individual needs, but also working to provide his/her daily pleasures.  It takes a great deal of communication, sharing of information, and flexibility on all parts to make person-centered care more than just a philosophy.  If disciplinary silos can be replaced by learning circles and open care coordination discussions, then ideas to enhance autonomy and healthy aging can be shared and creative means implemented to achieve the goals of each resident.  True person-centered care and service can take place in any environment as long as there is a commitment on the part of the resident, staff, and family to work together to find every way possible to meet the needs, desires, and routine of each resident within the limitations of a communal living and highly regulated environment.  Quite a commitment, but it can be done!”

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