The secret to LTC success? A focus on well-being

Dr. Eleanor Barbera
Dr. Eleanor Barbera

Despite the diversity of the events I attended during my brief visit to the LeadingAge convention in Boston last week, a theme clearly emerged. The thread that ran through the varied offerings was well-being.

Retaining staff

In researcher and consultant Joanne L. Smikle, PhD's talk on staff retention, rather than focusing on why employees are leaving, she looked instead at why they stay.

Based on her studies of long-term care organizations, she found that “if the leadership of the organization lacks passion, you will have trouble with retention and commitment.”

In healthy organizations, staff members “from the top of the house to the bottom of the house” stay because they can say, “I felt I mattered.” Experiences that contribute to that feeling: Recognizing staff in formal and informal ways, an open dialogue with staff rather than top-down communication, and a focus on the human elements enabling employees to make connections with each other, the residents and the families.

Dementia care

G. Allen Power, MD, FACP titled his presentation, “Enhancing well-being for people living with dementia,” so it wasn't surprising that this was a central point in his talk.

He asserted that antipsychotics don't work and don't treat the true causes of the behaviors associated with dementia. Instead, he recommends focusing on the seven primary domains of well-being, which are part of the Eden Alternative model of care: identity, growth, autonomy, security, connectedness, meaning and joy.

In one instance, a resident who became agitated when he was prevented from leaving the building was allowed outside. The man looked at the cows in a nearby field and returned to spend the rest of the day calmly. The team, who subsequently learned that the resident had been a farmer whose daily routine included an early morning check on his animals, had given him not only autonomy, but had also affirmed his identity and added meaning and joy to his life. His agitation disappeared.

Keynote address

Atul Gawande, MD delivered a Monday morning keynote address. Author of the book “Being Mortal,” Dr. Gawande discussed ways in which to improve end of life treatment. He advocated for care that takes into account the desires of the patient and noted that there is more to living than extending the amount of time we live.

He gave the example of a man who said he'd be satisfied if he could watch football and eat chocolate ice cream despite his illness. Others, he noted, would not find that at all satisfactory. Gawande suggests having conversations with patients to find out what matters to them at the end of their lives.

“Well-being is bigger than your health and abilities,” he emphasized.

Leonard Florence Center for Living

My final stop at LeadingAge was a tour of the Leonard Florence Center for Living, an urban Green House.

I wrote about the Green House Project once before (I finally visit a Green House (and it blows my mind!) and I was eager to see the special unit for residents with Amyotrophic Lateral Sclerosis (ALS).

The young residents of the ALS unit have electric wheelchairs and pretty much electric everything. Architect and resident Steve Saling gave us a tour of his home using eye movements to signal his computer to speak on his behalf. He electronically opened the doors to the residence and to the window shade in his room.

Chelsea Jewish Foundation CEO Barry Berman enthused about the residents' trip to Disney and showed us a video of their tandem skydiving jumps. It's the mission of the organization, he said, to meet the needs and desires of these residents who have a “horrible” illness.

I've spent the last few days trying to reconcile the intense and deficit-producing efforts toward the well-being of the 10 residents of the ALS unit with my impression of the amount of person-centered energy exerted for the benefit of the vast majority of other residents I've come across over the last 20 years.

I wish they could all leap from planes if they wanted to, or at least be able to order some clothes online with a debit card linked to their account in the business office. Until then, the Leonard Florence Center gives us a model of person-centered zeal worth thinking about.

Conclusion

It was clear from the LeadingAge events I attended that the residents' well-being should be a priority from their entry into our long-term care organizations until the day they die. In addition, attending to the well-being of our staff members allows us to attract and retain employees who share our passion and our mission to work on behalf of the residents. For a truly thriving community, I suggest we also attend to the well-being of the families. (For more on that, see 7 powerful ways to deliver family-centered care.)

Eleanor Feldman Barbera, PhD, author of The Savvy Resident's Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.

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