8. LUANA IDEAS
Loneliness, Helplessness and
Boredom are plagues of the
human spirit, not the human body.
Medical treatment offers no
medicine to ease the suffering
from these plagues.
18. CARE BALANCE SHEET
GIVING RECEIVING
•Helping your •You share with
child with their your companion
homework about a special
•Listening to your event in your life
best friend’s bad •Someone makes
day you your favorite
meal
23. EDEN RESULTS
Drug Cost per Resident per Day
Medications are $6
• too often used $5
thoughtlessly
$4
• too often toxic
• too expensive $3
• an inadequate substitute $2
for genuine care $1
$0
Careful Reductions Q1 Q3 Q5 Q7 Q9
• save money Eden Control
• improve quality of life
24. PRINCIPLE EIGHT
We’ve relied too heavily upon top‐down
bureaucratic authority...
A resident‐centered community honors its
residents by de‐emphasizing top‐down
bureaucratic authority and seeking instead to
place the maximum possible decision‐making
authority into the hands of the residents or into
the hands of those closest to them.
27. LUANA IDEAS
Department Approach Team Approach
• Numerous layers of • Few layers of
management management
• Managers make most • Residents & front‐line
decisions staff make most
• Organization directed decisions
focus • Resident‐directed focus
• Encourages conformity • Encourages innovation
with established and pride
routines
Introduce yourself. Ask your audience to write it down: If something happened to you today and you needed to come to Hale Makua, would you want to come? If you said no, what are 3 things you would miss if you came to Hale Makua? Ask students to share what they wrote. These types of things you shared is what we would like to be able to provide to our residents. Explain that the name “Luana” means “Live in Comfort”. Luana is the name for our journey. It is a journey Hale Makua start on several years ago. We have already made a lot of progress. Explain that the “Eden Alternative” is both a non-profit group that helps nursing homes to change and the philosophy of the change . You may see or hear Luana and Eden used interchangeably. The reason for today’s training session is to educate all employees of Hale Makua about Luana in order to make the lives of our residents even better than it is today. We’re planning to also provide similar training to families, physicians and the community.
We’re going to start off briefly discussing why Luana is important. Then most of our time today will be spent learning about the 10 Eden Principles. Finally, we’ll spend time talking about what “Your Luana Role” is.
Why is Luana important? It’s the RIGHT thing to do. It’s the way you or I want to live. More homelike surroundings, more choices, resident-centered care. First off, the fact that we’re talking about this Luana journey doesn’t mean we’re doing anything wrong or that staff are not already trying their best. Rather, the changes we’re going to talk about today are proven to help residents and staff feel more satisfied. There are other reasons why we as an organization feel that Luana is important. New nursing home regulations are requiring more resident choice and homelike environments. Luana has been and continues to be the vision of Hale Makua Health Services. Luana helps to set Hale Makua out on a journey to the future of long term care. If we don’t lead the way or at least keep up, another company could start here on Maui and residents may choose to go there instead.
Now we are going to talk about the 10 Eden principles. Here’s principle #1, which states the problem. Ask a student to read the principle aloud. What’s a plague? – An Illness that is widespread. If there’s anything you remember from today’s presentation, we want it to be the 3 Plagues and the ways to cure them. Elders – Why is this term used? The term Elders is used in a respected sense for those who reside here at Hale Makua. Some of our residents are younger and wouldn’t be considered ‘older’ but we can refer to them as Elders.
The first plague is loneliness. Read slide aloud. Later on in the presentation we’ll discuss how residents can have companionship. Do you agree that residents can feel lonely even though they are surrounded by others?
Helplessness is the second of the 3 plagues. Read slide aloud. Wouldn’t you feel helpless if you only received help or care everyday but you couldn’t give any help or care to anyone?
The last of the 3 plagues is boredom. Read slide aloud. What’s variety? Variety in your diet, variety on your i-Pod, variety in the jokes you tell. What’s spontaneity? Things done without planning. Unexpected.
By human spirit we mean the life force or the will to live. As you know, sometimes even antidepressants don’t take away people’s suffering.
Remember principle #1? What are the 3 plagues? (Loneliness, helplessness and boredom) Principle #1 stated the problem. Principle #2 gives the solution. Ask a student to read the principle aloud. There is a lot of information in this principle so we’ll be going into more detail in the following slides.
What’s a Habitat? Anybody watch Animal Channel? A habitat is an environment where animals (including people) live. Hale Makua was originally built in the 1960s and was based on a hospital-like institutional model. The Eden philosophy says that human beings were not created to live in cold, sterile “institutions”. People Who Live in Institutions... Convicted Criminals The Chronically Mentally Ill Nuns Juvenile Delinquents Military Recruits Our Frail Elders A true human habitat is a garden…
Read slide aloud. This is the physical environment that Luana promotes.
Remember we talked about loneliness as being 1 of the 3 plagues? What are the 2 other plagues that principle #1 talks about? (Helplessness and boredom) Principle #3 is one of the antidote principles. Ask a student to read the principle aloud. What’s an antidote? It’s like a cure. So the cure to loneliness is loving companionship. Let’s talk about what loving companionship means to you. Raise your hand if you have a pet at home. Does your pet provide you with loving companionship? How many of you have young children, aunties, uncles, or other extended family that live with you in your home? Do they provide you with loving companionship?
Close and Continuing Contact – Think of your relationship with the closest companions in your life. Do you talk to them every day? Do they know about what’s going on in your life? Your ups and downs? Animal Companionship is an Ancient and Universal cure for loneliness - Anybody have a pet or grew up with a pet? Did that pet provide you companionship? Did that animal greet you or join you for walks? For Human Companionship to blossom, people must share each others’ stories. It’s about making a deeper connection with someone rather than a simple “hello” or “hi”.
These are some ways that other Eden homes have brought children into their everyday lives.
In many successful Eden homes, residents keep pets. For example, a resident might request to bring in their pet from home to live with him/her at Hale Makua. The things we will need to think about when receiving these types of requests is to make sure that we still follow the required guidelines.
We’ve talked about the first plague of loneliness and its antidote of loving companionship. Principle #4 is the antidote to helplessness. Ask a student to read the principle aloud.
[You may want to illustrate the care balance concept by using “balancing scale” gestures.] Discuss how one side represents a resident’s ability to receive care and the other side represents the resident’s ability to give care to other residents or staff. The idea is to balance the two as much as possible. Example: Denise, our Marketing Manager and Tony’s Assistant, was struggling to carry some bulky items down to Aloha Café. Mr. Wong from East Unit stopped her and asked if he could help her. Mr. Wong, who uses a wheelchair, said put the bags in my lap and let’s go. Together they got the items down to Aloha Café and Mr. Wong was able to give care to another. Are there small things you do each day that a resident could help you with? Are there ways residents can provide care to other residents?
Sometimes it’s hard to really understand what principle #4 is saying. This care balance sheet helps to further illustrate with some typical, everyday examples. Review table above. Discussion: Ask audience to share examples in which residents may give as well as receive care.
We’ve talked about the antidotes for loneliness and helplessness. Do you remember their antidotes? (The antidote for loneliness is loving companionship. The antidote for helplessness is the opportunity to give as well as receive care.) Principle #5 is the antidote to boredom. Ask a student to read the principle aloud. Example: Back in the 90s Maui woke up one morning to find that there was snow on the top of Haleakala. Teresa Lopes and staff quickly rummaged through unclaimed, unmatched warm clothing in the laundry department and took a bunch of residents to Haleakala on a whim. They created variety and spontaneity for both the residents and staff. But variety and spontaneity doesn’t always have to be so big. What’s an unexpected thing that happened to you this morning?
Read the slide aloud. Before we move on to principle #6, let’s take a look at some of the things that you wrote down when I/we asked the question, “What would have to be different in order for you to want to live at Hale Makua?” Do you have anything written down that relates to one of the principles that we talked about so far? Example: I would like to be able to bring my pet dog to live with me at Hale Makua. I could say that this would most closely relate to principle #4 which is loving companionship, the antidote to loneliness.
We talked about the problem, the solution and the antidotes. Principles #6, 7 and 8 are some challenges that the nursing home industry faces. Ask a student to read the principle aloud. Examples: * Asking residents to fold napkins from a basket. Then throwing napkins in a pile and asking the resident to start over again. * An activity is only as good as it relates to the person. Knowing the needs and interests of each resident. * Sweeping up leaves, gardening, setting the tables. The Eden philosophy speaks to de-emphasizing programmed activities. The nursing home regulations tell us to have a formal, structured activities programs which is great. But what we need to remember is that planned activities are not for everyone and we must continue to think about what is meaningful to someone. The key to principle #6 is “meaningful” activity. Meaningful activity is one that fulfills a genuine purpose. When we talk about “activities” we aren’t talking about the Activities department to provide meaningful activity, we’re talking about this being the responsibility of the entire organization.
Ask a student to read the principle aloud. Encourage student participation. Have them share examples. Some questions to ask: Are there times when residents ask for medical assistance, a medication for example, when they are probably bored, lonely, or feeling helpless? Or was there a time when no matter what medical assistance you provide, they do not feel better? According to the Eden principles we have made more treatment mean the same thing as care. We have to look beyond medications as a way to provide care.
According to Eden Alternative’s research, they found that when residents were no longer suffering as much from the 3 plagues, the use of certain medications actually went down.
Ask a student to read the principle aloud. Basically, it would be better for the residents and staff if people at the top didn’t tell you what to do. Bureaucratic is defined as administration, rules & regulations.
Read slide aloud. Are there times when management tells you how to do your job and you know how to do it better another way? What’s lost when this happens? * Your sense of control * Your self-worth, self-esteem What happens in these types of situations? * You may feel anger, frustration, resentment * You may give up Do you think our residents are any different? How would you feel if someone told you what to do all day? “Time to eat.” “Time for your shower.” “Time to play games.”
The Eden philosophy says to move from a “department approach” to a “self-directed team approach”. Hale Makua Health Services currently falls under the department approach but if you look at the team approach, this is where we want to be. Luana/Eden introduces the idea that staff teams can and should be given authority to make decisions that affect them.
Our Luana Journey has no end point. It is a way of approaching our work and providing care. Ask a student to read the principle aloud.
Our last principle #10. Ask a student to read the principle aloud. By “Leadership” – we don’t necessarily mean managers. Instead we mean people who have the ability to influence others to make positive change. Think about those people you work with everyday that you go to for advice or help that are not managers. These are the people who will help make and help you to make the difference in our residents’ lives. There is a “Core Luana Team” that is here to support you. We as an Eden-certified company have access to information, best practices and lessons learned from other Eden homes.
Ask the students: Why are we doing this? * It’s the Right Thing to Do * Required by Nursing Home Regulations * Hale Makua Health Services’ Vision * We want to be everyone’s first choice. Ask the students: What are the 3 Plagues? * Loneliness * Helplessness * Boredom Ask the students: What are the Antidotes to each of the 3 Plagues? * Companionship (pets, children, friends) * Opportunity to give as well as receive care (assisting in day-to-day activities) * Variety and spontaneity (unexpected and unpredictable)
What we want you to think about and ask yourself is, “is it Luana?”. By this we mean: Read the 3 steps. Illustrate how to use this process by using an example: What if you’re talking with co-workers about adding plants to the courtyard garden? What if you’re talking with co-workers about plans about for an upcoming holiday party in your neighborhood?
These important changes cannot happen without your help. The company needs your help and our residents need your help. Read bullet points on slide. What we are asking you to do is to identify any challenges that prevent you from creating antidotes for the 3 plagues. We are not asking you to research policies or regulations. Managers and the Luana Core Team are here to help with any questions or concerns. We want you to create open dialogue within your teams and with others about ways to meet the needs and wants of residents and their families. Instructor’s Note: If staff are saying that they have ideas but don’t know how to share them, encourage them to let their supervisor or manager know. They can help them or bring it further to the Luana Core Team.
