1. Resident Center Culture & Management
Relationship

2. Resident & Management Relationship
University
Local
Extension
Community
Assessing Programs
Relationship
Emotional
Wellbeing
Resident & Staff
Connectivity
Physical
Wellbeing
Independent Living Assisted Living
Social
Connectivity Building
Sustainable Senior
Academics Spiritual
Wellbeing
Engaged
Communities
Community
Vocational Living Skilled Living
Connectivity
Intellectual
Wellbeing
Village
World Connectivity
Engagement
Vocational
Mentoring

3. RESIDENT ENGAGED RESIDENT CARE COMMUNITY
COMMUNITY
 Village Connectivity  Emotional Wellbeing
 Vocational Connectivity  Physical Wellbeing
 Social Connectivity  Spiritual Wellbeing
 Resident/Staff  Intellectual Wellbeing
Connectivity

4. POST ACUTE CARE CHANGES WHAT IS BEING DONE?
 Quality of care in  New Resident Care
nursing homes must be Models
addressed from all  Pioneer Network
angles:
 HatCH Model
 regulatory,
 Eden Alternative
 legal,
 advocacy, and  Evergreen Model
 within the nursing home itself.
 To name a few models

5. Each person can and does make a difference :
• Relationship is the fundamental building block of a transformed culture
• Respond to spirit, as well as mind and body
• Risk taking is a normal part of life
• Put the person before the task
• All elders are entitled to self-determination, wherever they live

6. • Establish resident direction in goal setting and care;
• Re-organize and empower staff, focusing on responsibility,
accountability and strong support to direct care workers (resident
assistants);
• Enable resident choice in aspects of daily life significant to the
resident, such as time getting up and going to bed; eating; naps; times
out-of-doors; favorite pastimes; times and methods of bathing; content
of meals and the ways meals are served;
• Emphasize the relationship between the resident and resident
assistant as central to quality of life for both;
• Create opportunities for relationships between hands-on caregivers
and residents by using consistent assignment of staff

7.  The Commonwealth  Culture change or a
Fund 2007 National resident-centered
Survey of Nursing approach to care
Homes  Holistic Model of Care

8. Categories of Nursing Homes, by Extent of Culture Change Adoption
Culture change definition*
completely or for the most part
describes nursing home
Culture Change
Adopters
31%
Culture change definition*
describes nursing home
only in a few respects or not Traditional
at all, and leadership is not 43% Culture change definition*
very committed to adopting Culture Change describes nursing home only in
culture change Strivers a few respects or not at all, but
25% leadership is extremely or very
committed to adopting culture
change
* Culture change or a resident-centered approach means an organization that has home and work environments in which: care and all resident-
related activities are decided by the resident; living environment is designed to be a home rather than institution; close relationships exist between
residents, family members, staff, and community; work is organized to support and allow all staff to respond to residents' needs and desires;
management allows collaborative and group decision making; and processes/measures are used for continuous quality improvement.
Source: The Commonwealth Fund 2007 National Survey of Nursing Homes.

9.  We are striving for …age-friendly communities,
policies, services, settings and structures support and
enable people to age actively by:
 respecting their decisions and lifestyle choices;
 protecting those who are most vulnerable; and
 promoting their inclusion in and contribution to all
areas of community life.

10.  Loneliness
 Isolation
 Depression

11. Figure 2. Resident-Directed Culture Change Principles
Currently Under Way
Percent indicating that they are currently implementing the following initiatives:
Enable residents to Actively involve Fully implement Currently
determine residents in decisions “Bathing Without a implementing
their own daily regarding their household/ Battle” techniques ALL THREE
schedules neighborhood/unit^ resident-directed
initiatives
^ Neighborhoods: Areas in which traditional nursing unit is broken down into smaller functional units,
in which ancillary services are shared with other neighborhoods; Households: Self-contained areas
with a full kitchen, living room and dining room, with a relatively small number of residents per household.
Source: The Commonwealth Fund 2007 National Survey of Nursing Homes.

12. Guiding Principles of Eden
Alternative
 The three plagues of loneliness, helplessness and
boredom account for the bulk of suffering among
our Elders – FFC, Loneliness, Isolation & Depression
 An Elder-centered community commits to creating a
Human Habitat where life revolves around close and
continuing contact with plants, animals and children. It is
these relationships that provide the young and old alike
with a pathway to a life worth living.
 Loving companionship is the antidote to loneliness.
Elders deserve easy access to human and animal
companionship.

13.  Meaningless activity
corrodes the human
spirit. The opportunity
to do things that we
find meaningful is
essential to human
health.
 Medical treatment
should be the servant
of genuine human
caring, never its
master.

14. Figure 4. Culture Change Adopters Report Residents
Are More Involved in Decisions About Their Home
Percent indicating that decisions are usually made by residents and staff jointly for the following:
Creating Planning Decorating Creating Planning Developing
schedule for menus communal calendar for social events resident’s
meals areas social events care plan
Culture Change Adopters = culture change definition completely or for most part describes nursing home. Culture Change Strivers = culture
change definition describes nursing home only in a few respects or not at all but leadership is very/extremely committed to the adoption of
culture change. Traditional = culture change definition describes nursing home only in a few respects or not at all AND leadership is less than
very/extremely committed to the adoption of culture change.
Source: The Commonwealth Fund 2007 National Survey of Nursing Homes.

15.  An Elder-centered community creates
opportunity to give as well as receive
care. This is the antidote to helplessness.
 An Elder-centered community integrates daily
life with variety and spontaneity by creating
an environment in which unexpected
and unpredictable interactions and happenings
can take place. This is the antidote to
boredom.

16.  An Elder-centered community honors its Elders by
de-emphasizing top-down bureaucratic authority,
seeking instead to place the maximum possible
decision-making authority into the hands of the
Elders or into the hands of those closest to them.
 Creating an Elder-centered community is a never-
ending process. Human growth must never be
separated from human life.
 Wise leadership is the lifeblood of any struggle
against the three plagues. For it, there can be no
substitute.

17. Figure 6. Staff-Related Culture Change Principles Currently Under Way
Percent indicating that they are currently implementing the following initiatives:
Consistent Staff Include direct Include Create Currently
assignment of leadership care workers andcertified nursing self-managed implementing
certified nursing training residents assistants in work teams ALL FIVE
assistants to opportunities on senior resident-centered staff initiatives
residents management care planning
team sessions^
^ For instance, utilizing the “I Care” or “First Person” approach.
Source: The Commonwealth Fund 2007 National Survey of Nursing Homes.

18. Guiding Principles of Eden
Alternative
 Modifications
 Housing is modified to meet senior needs
 Modifications are Affordable
 Equipment for Modification is Accessible
 Financial Assistance is Available
 Competent Assistance provided

19. Guiding Principles of Eden Alternative
 Aging In Place
◦ Housing is located close to
services
◦ Services are Affordable and
support senior to remain at
Home
◦ Seniors are well informed of
services to help them age in
place
◦ Home-Care services are
provided to support
independence
◦ Respite care is provided on
a “Care Sharing Model”

20.  Active ageing depends on a variety of
influences or determinants that surround
individuals, families and nations
 They include material conditions as well as social
factors that affect individual types of behavior and
feelings
 The interaction between these factors play an
important role in affecting how well individuals age.

21. Gender
Culture

22.  Chart Rehab Adult Life Older Age
Early Life Maintaining Maintaining
Growth & highest independence
Development possible level of and preventing
function disability
Range of
Function
Disability Threshold
Rehabilitation and
ensuring the quality
of life

23.  Village Connectivity Emotional Wellbeing
 Vocational Connectivity Physical Wellbeing
 Social Connectivity Spiritual Wellbeing
 Resident/Staff Intellectual Wellbeing
Connectivity

24.  Clothing Room
 Donation Room
 Community Care
 An Artist and …
 ….his Cat “Rocky”
 Spiritual Connectivity & Expression
 Gardening for the Community
 Caring Connections – re-cycled cards
 Dough-Nations, social responsibility
 Music Man delivers Holistic Therapy

25.  Expand Clothing Closet (Activity has been operational
since January, 2010)
 Sponsor and oversee a clothing donation and
 distribution program to provide appropriate
 clothing for residents in need.
 In addition to clothing – residents can use, radios,
 tape and CD players that you no longer need.

26. If the Walls of Ackert Park could Talk-!
History if music reverberates
through the walls

27. Lou & Rocky
Friends for over 15 years
…best plan for Lou’s
Rehabilitation
Rocky moves in with Lou-!

28. Families need a friend
Birthdays…or just a kind note, Dorothy is
there

29. Ackert Park sites along an old Trolley path
called Ackert Way. It serves as our Walking
Rehab Trail, connection to Community Gardens
and a place to shared nature with our
neighbors-!

30. Guiding Principles of Eden
Alternative
 Community Integration
◦ Housing design facilitates
continued Integration of
seniors into the Fabric of
the Community
◦ Transportation services
supportive to Greater
Community
◦ Employment, Enterprise,
and Volunteerism is
supported throughout the
Community

31. Guiding Principles of Eden
Alternative
 Living Environment
◦ Housing not Overcrowded
◦ Older people Comfortable
◦ Housing not in areas
Prone to Natural
Disasters
◦ Older people feel Safe!
◦ Financial Assistance for
Housing Security
measures

32. Guiding Principles of Eden
Alternative
 Living Environment in
Veteran Administration
◦ Overcrowded SNF’s
◦ 1700+ in MO
◦ Older Vets in SNF’s
◦ SNF’s filled with MEN
◦ 11% of current Military are
Women
◦ 36% more likely to use
Rehab
◦ Greenhouse Model in
Convent

33. Guiding Principles of Eden
Alternative
 Living Environment in
Prisons
◦ Housing Overcrowded
◦ Older inmates @ risk
◦ Housing not an option
◦ Focus on their skills and
natural abilities!
◦ Financial Assistance for
Housing Security &
Employment

34. Culture Change in Prison
 Educational and
Offender Change Work and Vocational
programs: Programs
 Adult Basic Education  Building Maintenance
 General Education Diploma  Roofing
(GED)
 Siding
 Getting it Right Job Readiness
 Drywall Installation
 Stress and Anger Management
 Information Technology
 Intensive Out Patient Chemical
Dependency  Department of Natural
 Cognitive Behavioral Resources Forestry
Treatment Workers
 Moral Recognation Therapy  Community Work Crews
(MRT)  Institutional Support Jobs
 Dog Training and Adoption
 Sustainability Jobs
Program

35. Kendall Brune, PhD, MBA,
FACHCA
kbrune2339@gmail.com
314-757-0131