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CW 91: Jane Rohde

Jane Rohde of JSR Associates discusses the humanistic approach to how we improve workforce development and how a person-centered care model is the best way to operate.

What if we believe in something better for elders? What if we look and took on reinventing the industry? What if we recognize what’s important to you? What do you believe?

 

Welcome to Bridge the Gap of Contributor Wednesday. My name is Jane Rohde from JSR Associates and Live Together today. We’re going to talk a little bit about intergenerational communities and workforce development. When we talk about the opportunity to do intergenerational approaches to inclusive design and inclusive living, we have a little bit of what ifs, right? So if we start thinking about what if we started with the premise to provide person-centered care everywhere? What a few minute interaction was the basis for all design? What if multi-generational approaches solved housing crisis and socialization needs? What if the 90% not served could be sustainably cared for? What if your care model supported workforce development? We never really think about our communities and evaluating our communities as a resource for the workforce development component. And then overall, what if people could look at aging as proactive adventure. So that was what we would like workforce to actually evaluate. And when they look at things to look at a career path, as aging can be a career path. And are we really looking at that as an opportunity?

 

So if we start with the premise, that person-centered care as a given, what if we believe in something better for elders? What if we look and took on reinventing the industry? What if we recognize what’s important to you? What do you believe? How do you believe it can be better and different? So when we start to evaluate this and looking at overcoming barriers, we can start thinking through how do we encourage younger people to understand that there’s a career path in the field of aging? When I was talking with a gentleman from Barito Institute, we were talking about how do we generate the interest? And he told me that it really wasn’t high school. It was really middle school, where if you want health and sciences to be part of someone’s career path or a discussion or an opportunity for young people to consider that you had to start at a really young age. So most images, when you say, Hmm, would you like to work with older people? That’s really not a very good image that we portray. Most people think of it as an old nursing home, the double lited corridors, the bad lighting, the bad nurse call the overhead paging, all those things that are associated with our existing system.

 

But what if it was different than that? What if we could provide demonstration projects that actually allowed people to think about a career, but also see that there are places that other people may want to live. We’re doing a presentation not very long ago. And a young person said, wow, it was a student at Clemson. If that’s what it looks like to work and live in senior living, I’m ready to move in now. That’s the great reaction you want. 

 

Another colleague of I and I were talking one day and I said, why do suppose we’re not at a person-centered care tipping point? Do you think part of it is the workforce training or the lack thereof? And he said, providers come to me all the time asking for that, because we’re not set up as a research institution. We’re not set up as a training institution. We don’t know really how to make that happen because we weren’t set up to be that. People can watch our staff. They can talk to us, they can evaluate and shadow people. But what if we intentionally set out for that to be part of a concept? 

 

When we first developed the Live Together idea, it really came out of wanting better. It came out of understanding operations and the function just as much as understanding the needs of each individual resident. And how do we put that at the center of our not only design, but how do we put that at the center of the operation of a community?

 

So in talking through that and working through that, we realized that part of it was the training wasn’t being done that way. People weren’t being a value waited in the same way. You give somebody for a personal care aid, maybe two weeks of training. CNA, maybe eight to 12 weeks of training. And then you go, here you go. This is what you’re gonna have to do, go. So I know that that sounds a little harsh. It’s not always the case. Many communities work very hard to train their staff, but we also have to look at what else the staff needs.

 

If we’re not providing and understanding their needs. And it is about the, how much we pay per hour in a living wage. But it’s also is housing available. We have a lovely community, lovely people, care focused. They have difficulties with staff retention. Their location is part of it, beautiful community, beautiful campus, a lot of outdoor space, but that particular county does not have affordable housing for anyone who makes between a $10 an hour, a $17 an hour or even a $25 an hour job. So if you can’t live close by and there’s no transportation that supports that, and in another setting talked with a gentleman, he goes, if we’re gonna do something creative, we have to include childcare. He goes, most of my staff are single parents. So how do we look at that as well? So in looking at the different community needs and the community base needs, and then evaluating what the training wants to be for person-centered care, then how can we take that one step further and utilize our communities as places for workforce development that can show hands on how it can be different, because until we can show people that we care about them and we can evaluate what their needs are, address those needs and support those needs, then I don’t think we’re gonna get there.

6:03 – So when we look at that from the supportive side, it’s support for everybody who lives in the building. And so what if it’s intergenerational and you have more people that are also caregivers that are living there? There’s a new community that’s being built in Green Mount area of Baltimore called Care House. This is an example of that exactly doing that. Caregivers live in the same, same home or same area as the same building as other residents that need care. So there’s a lot of different ways to look at this and evaluate it. What if we start looking at multi-family buildings and residential assisted living is part of that building and that the staffing that can live there also can work there and be participatory in a community that creates different ages as part of it? As an intentional community as its own intervention in a positive way, and really evaluating the quality of life for everyone who’s involved.

It’s creative. It takes time. It takes energy to try to figure out the different components, but I think we need to broaden the base if we’re gonna get there in terms of improving our overall industry. So when we look at different models, in addition to the training, we’ve also been looking at the coordination of wraparound service. So if you look at the pace model, which many of you are familiar with the a program for all-inclusive care of the elderly, if you’re evaluating the pace program and you know that there’s a wraparound potential for service colocation of a pace program with a multi-family or independent living building can be a very good way to provide a continuum of care for various income levels and economic levels. So being more creative with thinking about the community at large solving some of their needs, and then evaluating accordingly.

Some providers that we have talked to said, we’d be happy to continue to train our frontline staff. It’s really a barrier. If we don’t have the lodging covered, it’s not so much about the cost for the services to actually do the training it’s at actually the hands on part of having lodging being affordable enough. So what if that was accommodated in a different way. And so that accommodation was made for students that wanted to be trained and come through a program and actually spend time within a demonstration project. Is that an opportunity for the Airbnb be of elders. So that extra apartment becomes that extra bedroom within an apartment becomes the location for our students to stay? American field service was very big when I was growing up and we did exchange programs all the time, both in the US and in Europe and in other countries and in Asia and people would go and stay for a month or sometimes an entire year on an exchange program that could actually work very well for some of the staffing that we’re trying to accommodate if we just talk through it and, and realize that this is an opportunity, instead of it, looking at it as something that’s difficult.

Looking to someone else to always provide your staffing, isn’t always the way to evaluate it. It really needs to be looked at on our grassroots level. So a another point of training, that was a good example for us was we opened a nursing home in China, and it was the first nursing home that was person-centered focused. It had small households, it had very high staff ratios of one to four, and we created scenarios. And as we were trying to get the building built with all these different complications of building in China and building in a different country, we evaluated all these different pieces and parts, but we had hired staff and started are doing the training for the staff. Most came out of the acute care setting so most of the care side of the nursing programs were already something that they were familiar with, but this idea of person-centered care was not something that was familiar. So as we evaluated it, we set up scenarios. The scenarios would basically be grandma, and in my case, grandpa Mark and grandma, other people that work there and, and different people that we would create the scenario. And so we all had a profile and in that profile we would be working through who was who and what are your needs and what are the different pieces and parts. Part of that was I wrote down that I was allergic to soy because we had to have some different things that were on the informational sheet.

  • What are our problems?
  • What are activities?
  • What are our things that we love to do?
  • What are our favorite foods?
  • How do we like to get up in the morning?
  • When do we like to get up in the morning?
  • What do we like to have what our breakfast might be?

And so in evaluating that I had developed the scenario I had been gone for about three months from the community. And I came back three months later and I was having lunch at the table and we were working through some scenarios. And all of a sudden, I had one of the, the young women came running over and she’s like, no soy, she imagined that. And according to my profile that I should not be eating soy sauce. And so to me, that was totally person-centered care. It came across the language barrier. It came across the activities around dining about her being observant about her understanding what the needs were of an individual.

And she was right on it. And it made me feel so good. And the scenario training really works when you start to evaluate what are the day to day activities that you’ll be doing and how would they be more person centered?

 

So we evaluated all of those. We did scenarios for every different kind of activity you can imagine that would happen. Everything from dining to care, to showering, to evaluating the spa tubs and utilizing the spots of doing activities of various types, what would be good for activities? What would be not as good for activities? What would impact people? What would work for cognitive ability? What would not? They saw it firsthand and they got to experience it firsthand. So instead of being undertrained, if you will, or under experienced, they had another sense of what it was like. And preparing a meal, having residents assist with preparing a meal, coming together and having that meal together.

12:07 – So there’s all those different pieces and parts of the person-centered world that we really expose the staff to. Yet we expect them to just know how, and I think that that is part of the workforce development that we need to evaluate. So as we continue to work through the workforce development and what workforce development can be for people, I also think that creating a pathway. So if I am a certified nursing assistant and I then can do my medical passing of medications certificate, and then I can see a pathway for LPN, I can see a pathway for RN. I could see a pathway for social work. I could see a pathway for PT, OT. Seeking out pathways, and then encouraging that pathway and allowing people to know that these can be very rewarding careers, and they can be very instrumental in their own personal development, as well as financially rewarding, as well as caring for residents from a person-centered perspective.

So I think that the workforce development component, it’s something that we can all work toward. So with the Live Together group that we’ve created, we created a non-profit so that we could evaluate what does an institute look like? And then in the same time, working on person-centered care opportunities and models in different communities. So as we’re looking at those, we also want those demonstration projects to become the hands on component. So in working with the non-profit side of creating the institute, we’ve assembled a group so that we have nursing, social work, PT, OT, measurement, and evidence, research, and looking at what happens when we evaluate that all those different areas, including environmental services from a person-centered care perspective. So can we actually evaluate that information, put it together and actually start by virtually training people to at least understand the concept, because if we’re not exposing frontline staff to the concept, then they’re going to come into an institution and treat as an institution and not a home.

14:18 – So I think that there’s an opportunity with intergenerational living to allow people to also have the exposure two older adults. I think a lot of times grandparents don’t live near grandchildren anymore, or we find that they are not as close for different reasons. We’re not in a village concept anymore from all generations living in one place, but we can create that intentionally if we evaluate community design in community and solving some of those issues and some of those items. And I think the consistency of staff, one of my favorite examples is I was working one day with an administrator. And I said, so I see your different residents are here, 16 residents living in your household. So what do those residents do; tell me about your residents. And she basically listed off their diagnoses, like, well, four, are higher stages of dementia.

You know, this guy has higher level of issues with diabetes and we have trouble controlling his insulin intake. It was about chronic disease and it was about issues that were completely diagnosis based. And I paused and I said, so what about like, what’s their favorite color? What do they like to get up in the morning? What’s her favorite food? And she looked and paused and looked at me and she goes, I didn’t get the question did I? I was like, no, not really. And she goes, those are all really good questions. And I should know the answers and I don’t. So it was also someone coming from a clinical side, not really thinking about the 90% that’s the person and the 10% that’s the diagnosis. So once that’s better understood and can be more consistent with the same staff, then staff will know that and they’ll be able to evaluate how that works and the consistency of what you can have in terms of that.

In the same little community, I was working in there one day and another woman came out and she was a beautiful woman and an older woman and, and the nursing assistant asked her, would you like an outfit? I have an outfit. It’s a traditional African outfit. And I think you would like it very much based on what I know about what you like and the culture that you respect and like, and talk about. And I’d like to bring that to you. And she goes, and I think it’s the perfect colors for you. I think it would look very nice on you and that warmed me because that frontline worker, she totally got it. She totally got the understanding and the possibility and making somebody’s day in terms of understanding who she was and recognized her, saw her, made her not feel invisible at all, but very visible. And so that was a staff person that I know really got it.

We have another advisory council member for Live Together. She works in the physical therapy in the OT side, predominantly an occupational therapist. And she said, I think people miss how important this is in terms of the interaction. And she used to work in a community and when a resident would get really upset or could not be calmed, they would all say, you need to go get Tanisha, because she can help this. She can help this person because she had a way with folks. She had a way with understanding and knowing that what they needed to calm down because she knew each one personally. So I think that there’s something to be said for the care and the outcomes. And also the understanding of how important that is. I was working in one community doing focus groups and we were doing the operational frontline staff, always my favorite group and residents with dementia, because they’re fascinating because they tell you exactly how it is and the group, if we were working with the frontline staff, I said, so what, what has been the problems?

 

And we find that when you do focus groups with frontline staff and you really wanna know the real answers and what’s really going on, you have to do it anonymously. They cannot be in the presence of other administrative staff. We’ve had administrative staff come in and no one will say anything in front of someone who they view as, as a boss, or even a threat sometimes. And when no one was in there and, and it was just us and the group and she said, I’m really, really upset with the facility manager. I was like, well, why are you upset with that? They changed the laundry detergent that I used to wash the clothes for the residents. I have a lovely woman who’s just come into memory care. She’s been confused. She doesn’t understand why she’s there. She has lovely clothing and it’s something she takes pride in and I’ve been trying to help her feel more at home.

19:02 – And when I wash her glasses, she has lots of white clothes. I like to get them nice and white. And so she looks just as fine as she can in what she feels comfortable in and that new laundry soap, it does not do the job. And I thought to myself: now that’s person-centered care. She wanted to make sure that lady was as comfortable as possible as she transitioned from living in assisted living and having to transition into memory care. That’s person centered. I think we don’t and reward nor do we recognize those that are a part of the person-centered care movement. And the frontline staff is where it’s at. So overall I would like to convince, maybe encourage, start looking at workforce development as an opportunity within your community and finding out what the local community needs are starting to fulfill some of those may lead to some relationships that then actually fulfill your workforce needs.

We need to do something better. We need to have more staff retention. We need to be able to have people who can rely on us as much as we can rely on them. And I think that that is an intentional intergenerational opportunity, but I also think that that’s a humanistic approach to how we work on our workforce development. So I want thank you for listening to this week’s BTG Contributor Wednesday, please connect with me at btgvoice.com.

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CW 91: Jane Rohde