Emphasis on Person-Centered Care Citations is Underway

Person-centered care is a well-established philosophy of care incorporating the needs and desires of each person.  Providing person-centered care is dependent upon “knowing the person” as a unique, one-of-a-kind individual.  This philosophy is not new and should not be a foreign concept for anyone working in healthcare, particularly long-term care.  Elements were addressed as far back as 1987 in OBRA ’87 and in the work of Tom Kitwood who introduced the term in 1988.

Person-centered care is now a focus of the new regulations and those yet to come in 2019.

After decades of promoting and advancing person-centered care versus traditional care with a medical focus, organizations are now experiencing increased person-centered care survey citations.  Nationally, experts and consultants report person-centered care citations are on the rise and in a Provider Magazinearticle shares the citations are occurring under numerous tags

While there are many thoughts, beliefs and definitions, person-centered care is far more than resident choice.  Person-centered care is more than simply offering select dining or sleep schedules.  The ultimate goal is to know the person – the human being and unique life story of each person for whom we care – in order to determine and provide for each individual that which makes life full and worth living.

So, what needs to be done to avoid citations and more importantly, provide the person-centered care our residents want and deserve?

Person-centered care does not happen by chance. It takes an organizational commitment, especially on the part of leadership, and an integrated approach.   It is planned, strategic and purposeful.  It requires a systematic approach to education and training, gathering personal information, a process for dissemination, ongoing communication, evaluation and the inclusion of all stakeholders – residents, families and staff.

While the monetary penalties are delayed for the time being, it will not stay that way.   Can true person-centered care be provided? Yes, our experience and that of many organizations who have implemented systems and processes reap the benefits in resident, family and staff satisfaction, decreased challenging behaviors and use of antipsychotics, enhanced quality of care and life, and increased staff retention.

Our experience in assisting organizations has proven that staff want to provide person-centered care and that this philosophy enhances relationships with residents, families and employees, organization-wide.

Actions speak louder than words and while promoting person-centered care for decades, CMS and surveyors are now acting on it with increasing citations, indicating that they are serious.

You should be, too.

Delightful or Dreadful? Holidays for Long-Term Care Leadership

I’ve said it before, and believe it is worth repeating.  Holidays can present a unique challenge for long-term care leadership teams.

As the Fourth of July holiday is approaching, the country prepares for celebrations, picnics, cookouts, and fun with family and friends.  As a long-term care leader, are you exited for the celebration, or are you overwhelmed with anxiety bracing for staff call-offs on another holiday?

Typically, I see two scenarios lead me to believe that your attitude, actions and culture determine your ability to enjoy or dread holidays in long-term care.

The first scenario involved attending a leadership team meeting, where the leaders and managers were complaining about the number of staff who would probably call off for the holiday weekend.  Dreading the weekend, they were already mad at some of the staff with a history of such behavior – even though it was two weeks week before the holiday with no call-offs yet!

Members of the leadership team were discussing their own family plans and trying to sort out who on among them would be responsible for covering for employees who called off, and preparing a schedule of coverage for the entire long weekend.  It was not a particularly happy experience.

The second scenario was a leadership team who were planning a variety of fun events for the upcoming long holiday weekend.   Managers were volunteering to be responsible for various activities and food as well as times that they would be at the facility for the holiday – simply for fun – not as a requirement for staffing.   They showed no concern that the staff would call off.  The leadership and management team believed that the staff would be at work as scheduled to care for the residents, because they were dedicated to their colleagues and facility.  This team was laughing, happy and honestly trying to outdo one another in offering ideas of events to create the most fun events for both staff and residents.

Holidays can be enjoyable occasions for the residents and staff.  Plan a party, a cookout, get all staff engaged in decorating and determining what special foods should be prepared and offered.  Facility leadership, as well as managers need to be present at some point on holidays to encourage a “we are all in this together” attitude.  Lead by example.  Consider – as a staff member – if the leader and all of the management staff are always off on a holiday, what would be your level of commitment?  Why should the staff be the only ones to work holidays and why should it always be a burden to only the direct service staff?

Working some part of a holiday weekend is an opportunity for facility leadership – to be with residents and families in a festive environment, and as a chance to further relationships with residents, families and staff in a relaxed, fun atmosphere.   It demonstrates that the organization exists as one whole – equally supportive and responsible.  Believe me, employees will notice, and they will be grateful, for gestures such as this promote staff satisfaction and retention.

Happy Fourth of July to the leaders and to all staff in long-term care, no matter where you are.

Ongoing Education, Communication a Must for Long-Term Care

Establishing a routine, ongoing mechanism for learning and communication serves many purposes in all long-term care environments, including assisted living.  Such a program addresses many of the desires employees have indicated are important in the workplace for decades, and at the same time ensures regulatory compliance.

Value, Respect and Appreciation

Employees indicate a desire for more respect and appreciation, and to be valued as a member of the organization.  Routine meetings, whether educational in nature or a time to simply communicate, demonstrates that they are valued participants.  Providing opportunities for education and involvement provides a more stimulating and motivating environment in which to work, and research demonstrates that it enhances satisfaction and retention.

Ensure Employees are Equipped and Competent

Ongoing sessions provide an opportunity to ensure that staff is not only equipped initially, but enables staff to continue to learn and grow.  New diagnoses, medications, and behavioral strategies continue to challenge staff and this creates an opportunity to continue to learn skills, discuss issues, evaluate processes or procedures and create more effective plans. Sessions offer a chance to learn, communicate, update, and share information.  Providing a forum where employees can share information they may know about a resident with other staff benefits everyone.

Relationship Building In and Among Departments

Listening, sharing and learning from one another is rewarding to all who participate.  It cements staff relationships and encourages teamwork.  Employees get to know one another and will understand the role and difficulties of colleagues in other departments as they share their own experiences and perspectives.  Gathering all staff together encourages interdepartmental collaboration, as they “walk in one another’s shoes” when they seek to solve problems and plan new initiatives together. 

Increased Ownership and Organizational Participation

Staff want to be heard, to have a voice in the organization and be involved in discussions about the people they care for and ways in which they conduct their work.  Participating in organizational plans and decisions is important to them.  They want to know the “what” and they want to know “why,” all of which enable them to do their job better.  They want to feel part of an organization.  Educated and empowered employees can be more decisive as they know the overall organizational vision and have been taught expectations for performance.  Once prepared, they can act confidently to bring about the best care and provide for individual resident needs given the ability to make decisions in a particular situation.


Routine, ongoing education and communication sessions open to all staff employed in an organization enhance the ability to meet the needs of residents and families, and elevates their contributions as a colleague and team member.  It facilitates a sense of “we are all in this together” to serve, no matter what it takes.  The expectation is that we all join together to meet the organizational goals and realize the vision.

Staff Education and Training – More than Compliance

A recent conversation among long-term care leaders illuminated current beliefs about staff training and education in Alzheimer’s disease and dementia.  While one participant asked how many hours of training is necessary for staff to be competent in providing quality memory care, the conversation turned to a discussion about compliance versus education for competent staff.

Often leaders are only concerned with compliance in regard to staff training and education, yet it would be wise instead to focus on the bigger picture.   If facilities, and memory care providers in particular, are to provide true quality person-centered care, we need to view education and training as more than compliance.

Any and every effort to educate is to be applauded.  Employees will not learn everything they need to know in one session or the same twelve hours of education per year.  Learning should be a continuous process as there are always new residents, a different disease or diagnoses, new treatments, and care providing strategies.  Offering ongoing educational programs not only provides information, but is an indication that the organization sees employees as important and valued.

From an organizational standpoint, training in all of long-term care settings should include all staff, all departments, and all shifts.  Every employee in the community is going to come into contact with the residents regardless of the department in which they work, and should be prepared and knowledgeable.  For example, housekeepers spend considerable time in resident rooms and have information and observations that are valuable.

Ongoing training is essential for the growth and development of all employees, and research indicates this enhances retention as well.  Routinely scheduled sessions are an opportunity for employees to communicate and share with one another, understand one another’s role and responsibilities, and enhance relationships across disciplines.  And for leadership, training sessions provide the opportunity to assess morale, gather information on staff needs, tap their expertise, garner their commitment, and communicate organizational issues or changes.

In essence, ongoing, all-inclusive education and training is beneficial for all – the residents, families, staff and the organization.

Long-Term Care Workforce Issues: Practice Principles for Quality Dementia Care

I was honored to lead the development of the best practice recommendations for creating a person-centered dementia capable long-term care workforce for the new 2018 Dementia Care Practice Recommendations.

The National Alzheimer’s Association 2018 Dementia Care Practice Recommendations outline recommendations for quality care practices based on a comprehensive review of current evidence, best practice and expert opinion.

The recommendations were developed to better define quality care across all care settings and throughout the disease course. They are intended for professional care providers who work with individuals living with dementia and their families in residential and community based care settings.

The National Alzheimer’s Association 2018 Dementia Care Practice Recommendations are comprised of ten topics. The articles are published in the Supplemental Issue of The Gerontologist; each article provides more detail about the specific recommendations, as well as the evidence and expert opinion supporting them.  For an overview of all 56 recommendations in the articles, click HERE.

Click HERE for the 2018 Dementia Care Practice Recommendations.

Capitol Hill Event for 2018 Dementia Care Practice Recommendations

Susan Gilster was recently a speaker on Capitol Hill as she joined the National Alzheimer’s Association and the nation’s top researchers, interested organizations and members of Congress to discuss ways to improve quality of care and quality of life for those living with dementia.

Dr. Gilster was one of 27 experts invited by the National Alzheimer’s Association to update and develop the 2018 Dementia Care Practice Recommendations, presented to policymakers and the dementia care community formally during the Capitol Hill event in February. Dr. Gilster led the development of the best practice recommendations for creating a person-centered dementia capable long-term care workforce.

The recommendations have been posted online and were published as a supplement to the February issue of The Gerontologist.

Free Alzheimer’s Foundation of America Conference June 7th!

I am looking forward to presenting at the Alzheimer’s Foundation of America Concepts in Care Conference on Wednesday, June 7th in Franklin, Tennessee.  The conference will be held at The Franklin Theater.

In celebration of its 15th anniversary, Alzheimer’s Foundation of America is hosting the AFA National Educating America Tour.”  AFA’s Concepts in Care Educational Conferences will provide individuals throughout the nation the opportunity to hear experts on topics to include: access to healthcare, transitioning from home to residential care setting, safeguarding your space, long-term care, perceptions of aging, and clinical trials and research.

The free program includes an exhibit hall, memory screenings, AFA Quilt to Remember display and Virtual Dementia Tour™.  For more information and to register, call 866.232.8484 or visit www.alzfnd.org.


Alzheimer’s Disease: Caregiver Shares Regrets To Benefit Others

When I see an interesting title for an article posted on the Alzheimer’s Reading Room or the Huffington Post, I always look further and all too often it is written by Dr. Marie Marley.

One such title and article is by Dr. Marley, where she shares with us things she learned as a caregiver of a person she loved with Alzheimer’s disease.  The article is on the Huffington Post site and entitled, “My Greatest Regrets as an Alzheimer’s Caregiver.

Memory loss, regardless of the reason or diagnosis, is difficult to explain to those who have not had person experience.  There doesn’t seem to be anything in our daily lives that can compare or help us understand what it is like to go through the disease process, as an individual or as a caregiver.  But those who have hold a tremendous amount of knowledge that is valuable to all of us.  While every experience is unique, years of personal caregiving is valuable to anyone who is a family member or professional.

Marie shares her perspective on the concerns, dangers, and social isolation of a person with memory loss living alone.  Safety of course is of concern, as we have all heard too many stories of burnt pans, leaving a house and not being able to get back in, or their inability to reach out to someone if in need – people with memory impairment simply can’t remember how to do so.  While Marie, like others, struggled to secure her beloved Ed’s cooperation to move from home, it is often not a decision the person with memory loss is capable of making – an inability to comprehend the dangers, and simply fear of the unknown.

With experience over 25 years of experience working in this field, I like Marie found that people with memory loss like being with other people and enjoy attention, human care and touch.  It is as though they feel a sense of comfort and safety having other people around them.    Some of the most isolated people we worked with became our greatest “social butterflies” as though they had come back to life being around others, they had been so lonely at home.

I am not sure that the “transition” of moving from home to a facility is as challenging or agonizing as most think it will be.  Perhaps of greater significance is the philosophy and practice of the facility.  If the facility is equipped with trained, supported and caring staff and a person-centered approach with staff who desire to serve others, the outcomes can be life enhancing.

We all need physical contact and others who care about us, regardless of the length of time one can remember an encounter.  A sense of happiness and knowing that they are loved and cared for lingers in the spirit of those with memory loss, even when they can’t articulate that feeling.

It is such a gift to all of us that Marie willingly shares what she has learned, as well as what she regrets.  If you haven’t already read much of her work please , find her “shared learning” in these two books, “Come Back Early Today,” and her latest book with Daniel Potts, “Finding Joy in Alzheimer’s: New Hope for Caregivers.”

New and Unique Nursing Program Provides Valuable Post-Acute Experience

It is no secret that the number of healthcare professionals needed for the tsunami of baby boomers is far from adequate.  The recently released Facts and Figures from the Alzheimer’s Association states that there are currently less than 1% of registered nurses, physician assistants, and pharmacists who confirm that they specialize in geriatrics.  Geriatricians already operate at a ratio of 1 for every 2,500 Americans, and that is expected to double to 1 for every 5,000 in a little over a decade.

A new and innovative nursing residency program at Rutgers, believed to be the first of its kind, will encourage nursing students to work in non-hospital settings such as skilled nursing facilities, rehabilitation centers, home care and other geriatric settings.   This provides a very valuable clinical education for nurses, many who will likely end up working with older adults regardless of the healthcare settings they choose.

The changes in demographics and healthcare delivery initiatives demand more geriatric education and expertise along the continuum as well as transitional care.  Historically, nursing education and clinical experiences have been in acute, hospital based care organizations.  However, as more and more care is provided outside of the walls of the acute care institutions, nursing students need to understand and experience the unique needs of other health service providers and settings.

There is a great need for enthusiastic, competent, compassionate nurses for these non-hospital settings and to understand it is a “different world.”  Goals, care, priorities, support systems and expectations for nursing are different in every setting.  This unique initiative is an opportunity for faculty to prepare nurses for what they will experience and the skills required.  Hopefully the experience will raise the level of interest in working in these non-hospital sites as most nursing jobs in the future will be in these in the community.

The clinical, hands-on involvement of this program is significant and will enable nurses to be far more comfortable and successful in these alternative settings.   They will have a greater sense of the work, scope of practice and performance expectations.  Congratulations to Rutgers, whose insight is inspiring and hopefully will prove the impetus to more community-focused nursing education.

Memory Care Forum Provides Shared Learning

Shared learning is a model with many benefits, one of which is the ability to gain knowledge through other’s experience within a group setting, sharing what works and what doesn’t.  It is a beneficial method of enhancing knowledge and accelerating advances in a particular area.  Memory care is one in which shared learning can quickly improve care, programs, systems and outcomes.

Recently I was honored to participate in the Memory Care Forum in Philadelphia, a shared learning opportunity where numerous experts in memory care shared their personal learnings, experiences and perspectives.  I marveled at the level of commitment of my fellow experts, helping others to create exceptional memory care programs by sharing “hands-on” strategies and programs.  Most speakers came with 20 or more years of experience, willing to “share their learning” and offer their expertise to “raise the bar” in memory care, an area of great need.

If your organization wants to develop or enhance a memory care program on your own, consider that it took these experts 20 years or more to gain this knowledge and expertise.  My question then is, why not learn from others who have already done so, instead of struggling on your own?  Forums and conferences offer us a chance to advance rapidly toward the goal of creating authentic memory care programs.

A secondary benefit of such learning environments is the opportunity to meet other like-minded people who become resources for information and support in the future.  Many of the experts willingly offer advice, services and opportunities for further collaboration.

As described above, the Memory Care Forum is sponsored by the American Medical Director Association’s Society of Post-Acute and Long Term Care Medicine and the Institute of the Advancement of Senior Care, which is dedicated to promoting continuous innovation, best practice, research, resources and educational programs.  The next Memory Care Forum is scheduled for September in San Diego.   I would recommend that if you are in the area or can travel to the San Diego, do so to seize the opportunity to participate in a unique “shared learning” experience, have some fun, and garner some new friends.