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Updates from Pioneer Network

March 2014



March 2014 Articles
Greetings from Pioneer Network
Pioneer Network welcomes new Board members
On the Road with Pioneer Network
Free Toolkit Available from Pioneer Network
Phase Two of the National Learning Collaborative: Harvest and Spread
Dining Practice Standards Toolkit to be Made Available this spring
Pioneer Network hosts a FREE online version of the Artifacts of Culture Change
New Resources have been added to Pioneer Network Web Store
Goodbye to our friend and colleague David Green
Goin' to Kansas City
Attention Surveyors and State Survey Agencies



We at Pioneer Network have been busy over the last months moving our office from Chicago, IL to Rochester, NY. Rochester was the original home to Pioneer Network and therefore it is quite fitting that we are here again. In fact we've enjoyed reminiscing through our long held tradition of having a special quilt made for each annual conference, as many of the quilts from conferences through the years hang on the walls of Lifespan of Greater Rochester where our office is located. As we walked into our new office, we were greeted with the warm familiarity of coming home.

Though the landscape of health care is changing across the country, Pioneer Network's goal of transformation in eldercare models to more strongly include self direction and individualization in care and supports, remains solid. We continue advocating transformation, conversation, partnership and change in long-term nursing home care, short-term transitional care and community-based care as well as home care to create supports and services that are person-directed. Progress has been made, yet the fact is that much more is needed. I'd like to share with you what an 80 year old friend of mine recently wrote about his identity in a long term care setting:

"I'm One Zero Eight. It's my room number. That's how I'm referred to around here. 'Here' is one of the seven Assisted Living Facilities in my community. The acronym is ALFs.

"I have a non-numerical identity. My name is Dick. That's what my friends in the 'real' world, and some people here, call me. But Richard is the preferred use in the ALF.

"When my name is used by the caregivers, med-aides, nurses – staff people – talking to one another, it, like the names of every resident, becomes their room number. I think of the number tattooed on the arms of concentration camp prisoners – that's way over the top, I know, but that's my thought."

 
Dick's experience isn't unique. He calls it "the thin edge of dignity." He happens to live in an ALF but we hear similar stories from those living in nursing homes and other settings. Even as we celebrate the progress and growth and many successes, clearly our work is not over.

Pioneer Network offers strong education and training opportunities through webinars, one-day conferences, the annual conference, and tools available on our website and through our online store. We convene and work in partnership with consumers, the 39 culture change coalitions that currently exist across the country, providers, advocates, professional groups, academia, and state and federal governments in a focused effort to make culture change the norm in this country. We are committed and we are grateful to our partners.

My best,

Lynda Crandall, Executive Director

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Pioneer Network Board welcomes new Board members

President Anna Ortigara and the members of the Pioneer Network Board of Directors offer a warm welcome to four new Directors.
 
  
Ruta Kadonoff, MHS, MA Vice President of Quality and Regulatory Affairs at the American Health Care Association (AHCA).  KaraLe Causey, CPA, MA, NHA Owner/Administrator/CFO of Haven Nursing Center in Columbia, LAMary Fuentes, Vice President of Financial Services, VIVAGE Quality Health Partners Denver, ColoradoChris Perna, BS CEO of The Eden Alternative, Inc.


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On the Road with Pioneer Network sessions are one-day, deep dive experiences to support person-centered care and culture change adoption. The sessions being offered are among the most highly rated intensives from the Annual Pioneer Network Conference which draws 1200 attendees, and the sessions are presented by speakers who are experts in their field. State culture change coalitions or local organizations partner with us to make the On the Road Intensives as successful as they can be. We will work with you to offer the program that works best for your area and for your audience. The programs being offered at this time include: Getting Started (or Re-Started) on Your Culture Change Journey, Hearing the Voice of Persons With Dementia, and Key Practices for QAPI Success.

For more information, contact Cathy Lieblich at cathy.lieblich@pioneernetwork.net or 321-277-7309.

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Free Toolkit Available from Pioneer Network to Kick-Start Your Quality Improvement Using Four Key Organizational Practices

"We achieved more in this past year
than we had in the previous 15."


Quality improvement efforts depend on how well your team communicates, problem-solves, and works together. Forty-nine nursing homes accelerated their improvement by using four key organizational practices – consistent assignment, shift huddles, involving CNAs in care planning, and QI closest to the resident. The homes were part of a National Learning Collaborative convened by the Pioneer Network with funding from The Retirement Research Foundation. They incubated B&F Consulting's method for Engaging Staff in Individualizing Care for Better Outcomes.

The four foundational practices are interrelated, and mutually reinforcing. With consistent assignment, staff are able to be dedicated to the residents they serve and know them well. As staff come to know residents well, huddles allow them to do on-the-spot problem solving to catch problems early and prevent declines. CNAs then contribute pivotal information to the care planning process and QI. Incubator home staff were able to make individual adjustments in care delivery to align with residents' customary routines in a systematic manner. In QI huddles, staff can share observations and engage in problem solving and care planning. Through QI huddles and CNA involvement in care planning, staff from all departments worked together to follow residents' rhythms of life in waking, sleeping, eating, bathing, and daily activity.

The improvements the incubator homes saw include: increased mobility for residents; fewer falls; reduced use of bed and chair alarms and antipsychotic medications; stronger relationships between staff and residents, and among staff within and across shifts and departments, as well as between management and staff; and most importantly, improved quality of life for those in their care.

The Pioneer Network's free Starter Toolkit for Engaging Staff in Individualizing Care, produced by B&F Consulting, builds on the incubator homes' experiences. The Toolkit contains tip sheets and media clips providing how-to information, and starter exercises to get the change conversation going in your home.
  • Step One covers the four organizational practices – consistent assignment, huddles, involving CNAs in care planning, and QI closest to the residents.
  • Step Two provides help to apply these practices to key clinical areas – promoting mobility while reducing falls and alarms, reducing off-label use of antipsychotic medications, and providing a good welcome in the first 24 hours of a new resident's stay.
  • Step Three addresses ways of expanding individualized mornings, dining, and night-time routines.
Click here to access this free toolkit.

 The complete set of 12 webinars used in the
National Learning Collaborative
"Engaging Staff in Individualizing Care"
including all handouts, tools, and trainer facilitator guides may be purchased on the Pioneer Network website store.

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Phase Two of the National Learning Collaborative:
Harvest and Spread


Thanks to the generous support of The Retirement Research Foundation in funding the Incubator Phase of the National Learning Collaborative on Using MDS 3.0 as the Engine for High Quality Individualized Care, 49 nursing homes in nine states learned how to operationalize systems to support staff closest to the resident in individualizing care. The homes successfully 'incubated' four key organizational practices – consistent assignment, huddles, CNA involvement in care planning, and Quality Improvement (QI) closest to the resident. The 49 participating incubator nursing homes engaged in Learning Sessions that fostered collaborative how-to sharing among participants as they implemented the practices and applied them to clinical areas such as reducing avoidable hospitalizations and inappropriate use of antipsychotic medications or alarms (see article below from one of the participating homes). Our Starter Toolkit for Engaging Staff in Individualizing Care, is based on the incubator homes' experience.

In October 2013, The Retirement Research Foundation awarded a grant to Pioneer Network for a 12 month project entitled "Phase Two of the National Learning Collaborative: Harvest and Spread." This project will involve an in-depth analysis and case studies on exactly how the incubator homes implemented the organizational practices and the role that doing so has played in shaping positive outcomes for residents, staff, and the organization. A How-to Handbook on Engaging Staff in Individualizing Care will be produced as an outcome of this project.



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Dining Practice Standards Toolkit to be made available this spring

Thanks to the generous support of the Hulda B. and Maurice L. Rothschild Foundation, Pioneer Network's Dining Practice Standards Toolkit will be available in the Spring. The Toolkit is a comprehensive package which operationalizes the Dining Practice Standards for every day use. It will include: model policies and procedures, brochures for residents and family members, "how to" tip sheets and sample forms for staff, and an extensive list of resources to help nursing homes and other long-term care communities implement the new Dining Practice Standards agreed to by 12 national clinical standard setting organizations.



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Pioneer Network hosts a FREE online version of the Artifacts of Culture Change to support provider efforts

The Artifacts of Culture Change is a tool for providers to assess readiness, implementation and sustainability of person-directed care. Pioneer Network is host to a FREE, web-based version of this tool for providers to input, score and track their efforts online. Currently over 1,500 registered users from more than 1,000 organizations in nearly every state have submitted 2,766 surveys through the online Artifacts. It is our hope that this user-friendly, informative version of the Artifacts can assist in culture change implementation and ongoing sustainability efforts across the country.

Over the years, providers have noted the value of the tool as both education and inspiration for implementation efforts. According to Julie Ballard, member of the Missouri Coalition Celebrating Care Continuum Change (MC5) and Director of Culture Change at Health Systems Inc., "I can say from personal experience that our homes that use the Artifacts tool have also been educated by it along the way. The tool has helped their teams identify areas that they are weak in and have room for improvement. The tool has been a good starting point for many homes and a good way to measure their progress along the way, not as a report card, but to see where they have made progress."

Providers have also expressed the benefits of using the tool for collaborative involvement. "Much of the value you will get out of the tool comes from how you complete it. Done by the administrators in their office is likely not to give you the true picture. It's when done collaboratively by members of the team from all disciplines and all shifts that you will really get an understanding of where you are on the journey. Like so much of culture change, how you do it is as important as what you do!" shares Joan Devine, a member of MC5 and Director of Performance Improvement at Lutheran Senior Services.
Julie Ballard observes, "We love the online tool, as it makes it easy to enter the data and also go back and review previous entries and compare progress." This ease of use of the online version also assists providers that want to store and track information longitudinally for strategic purposes. For example, homes that consistently use the online tool have shown improvements to scores overtime including outcomes based scores (e.g., turnover, occupancy), which can be used to estimate return on investment.

Click here to learn more about this free and confidential tool!

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New Resources have been added to Pioneer Network Web Store


Please visit our Store and read the descriptions of the books, toolkits, and DVDs that include tips for optimizing the use of each resource. Note the big price reduction on "Household Matters: A Good Life 'Round the Clock"

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Goodbye to our friend and colleague David Green

As we say goodbye to David we thank him for the contributions he made to the early forming of Pioneer Network and for all he did for elders throughout his career.

David Green (1938 - 2014)

David Arthur Green died Monday, March 3, 2014 in his home surrounded by his family and friends. David was born on July 12, 1938 in Fort Madison, Iowa to Florence and Clifton Green.

David's education included a Bachelor's Degree in Architectural Engineering and Business. After working for Proctor and Gamble in Cincinnati, Ohio as their lighting and acoustical expert, he changed directions and began to pursue a Master's Degree in Studies in Aging in the first class from North Texas State University in Denton, Texas. One of his joys was to be a part of new innovative thinking in the field of aging and to work with the pioneers in his field.

His work experience included working at Otterbein Home in Lebanon, Ohio, Lake Park in Oakland, California, The American Hospital Association in Chicago, Illinois, Bensenville Home in Bensenville, Illinois, and lastly at Evergreen Retirement Community in Oshkosh. After 29 years of service at Evergreen he retired in 2005.

David received a number of honors through the years including Administrator of the Year in Older Adult Ministries of the United Methodist Association of Health and Welfare Ministries in 2003; Award of Honor, AAHSA's highest award in 2005; Doctor of Humane Letters, honoris causa, in 2006 from the University of Wisconsin-Oshkosh; UM Association of Health and Welfare Ministries' Conference Related Unit Leader of the Year in 2010; and Long Term Care's 10 Most Influential People according to Long Term Living in 2011.

David was one of the founders of the Society for the Advancement of Gerontological Environments (SAGE), a founding member of Wellspring Innovation Solutions, and a leader in many other aging organizations, including Pioneer Network.

His retirement years were spent developing Worth-Driven Policy Governance, the Life Model to benefit residents in long term care, and working as Director of Conceptual Development with China Senior Care to develop, the first household model nursing home of its kind in China.

The family has set up the David A. Green Memorial Fund, with the Wisconsin Conference United Methodist Church Foundation.

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Goin' to Kansas City!

Mark your calendars and register today for the most amazing culture change meeting of the year. Join us the first week of August for the Pioneer Network annual conference. 100 formal learning opportunities will be offered, including 84 concurrent 90 min sessions, 12 intensive workshops, a site visit, sage conversations, think tanks and plenaries. Additionally we've created lots of networking opportunities, introductions to resources and tools to aid your transformational journey. This is the only national conference dedicated solely to culture change transformation, self-directed care and supports for elders. We are committed to excellence in learning and experiences and we look forward to serving you and walking with you on the journey.

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Attention Surveyors and State Survey Agencies:
A full-day surveyor workshop at the annual conference

"Getting Individualized Care Right: The Surveyor Perspective"

This session is by, for, and about surveyors. Individualized care practices are clearly established by nursing home law and regulations, but that doesn't mean it's easy to implement or evaluate them. This interactive session will identify and discuss current challenges and determine what additional resources may be useful to support the important work of the survey process in ensuring residents have individualized care that respects their preferences and assures their highest practicable physical, mental and psycho-social well-being. Download the handout.

Thanks to the generous support of the Hulda B. and Maurice L. Rothschild Foundation, the cost for surveyors to attend this one-day program AND the rest of the conference is just $99 per person.


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