by Warm Valley Lodge | Health Tips, Person Centered Care, Senior Care Facilities, Wyoming Assisted Living
Realizing a loved one needs more care than can be provided at home can be extremely emotional and stressful for families. Frequent falls, injury and mobility challenges and difficulties with activities of daily living can indicate that it is no longer safe for an individual to live alone. Starting a conversation with a loved one about moving into an assisted living community is rarely an easy one for families. With some planning, research, and sensitivity towards the process the conversation can become easier. Families might need to have the conversation more than once.
Don’t procrastinate: Having the tough conversation will allow you time to do the research on which assisted living community would be the best fit for your loved one.
Stay positive: Assisted living communities are full of happy active and social individuals who love the benefit of living in a low maintenance, stress free and safe environment with many activities and opportunities to meet and socialize with peers.
Show empathy: Respect your loved one’s feelings and listen to them. Hear their concerns and understand they may be upset, scared or even angry. Reiterate that an assisted living community will help them maintain their independence, not lose it.
by Warm Valley Lodge | Cost of Living, Health Tips, Person Centered Care, Senior Care Facilities, Wyoming Assisted Living
“Where did you eat breakfast?” Derean Thornley asked. “Did you get a Bloody Mary while you were at it? I hear their Bloody Marys are really great.”
This wasn’t a conversation between two young adults on a lazy Sunday afternoon. It took place at Warm Valley Lodge, the assisted living community in Dubois, where Derean was working her shift as a certified nurse assistant (CNA). Her friend had just returned from breakfast in town with some visitors, and they were chatting in his apartment. While there, she took his blood pressure.
Some nurses would “just go in and out,” she observed later. “They do what they have to do and then leave.” But for Derean, hanging out and conversing is one of the best parts of the job.
There is a name for this kind of nursing practice: Person-centered care (PCC).
The Center for Excellence in Assisted Living describes PCC as a pivot away from the traditional mentality of the health-care industry, which is focused on the providers’ tasks and efficiency, and toward a custom based on the dignity and self-determination of the individuals in the community. The emphasis is on the individual residents’ preferences and needs–not those of the staff or the organization.
It’s not just a set of rules or a practice standard. For some senior living communities, it’s culture shift, a change of paradigm.
For some others, like Warm Valley Lodge, this philosophy has been embedded in the community from the outset. The term person-centered care was new to Warm Valley Lodge staff members last spring, when they heard about it at a conference–but not the concept. Talking afterwards, Marcy Leseberg and Melissa Miller agreed, “we already do that.”
What does PCC mean in practical terms?
- There’s usually no need to invade another resident’s personal space, for instance, just to collect a sample for urinalysis. A CNA can simply hand a resident a sterile plastic cup with a lid, and pick up the urine sample later. Most people at Warm Valley Lodge are perfectly able to complete that small task for themselves.
- An aging man wants to take care of his own clean laundry, but that’s too cumbersome with his walker, and all that moving about would tire him out. To make him feel less needy, the nurses ask him to tell them where everything goes, and they chat while putting his clothes away.
- To refill a prescription for medication, staff members never drive to the pharmacy for the man who needs it. He has his own car, and he picks it up for himself. The object is not efficiency for the staff; it’s one of many ways to reinforce his autonomy.
- A woman with early-onset Alzheimer’s disease was constantly fretting about the disorder in her apartment (far too many clothing choices and “books flung from hell to breakfast,” as Darean put it). So after asking permission, the staff worked to help the woman organize her belongings. The task isn’t ordinarily in a CNA’s job description, but they knew she no longer had the resources to de-clutter for herself. The result was reduced distress and an increased ability to care for herself.
This kind of effort can have a significant benefit for dementia patients, according to an analysis published in the journal “Clinical Interventions in Aging,” which combined the results of 17 studies. PCC reduces the prevalence of depression particularly for individuals in the early stages of dementia, the authors wrote, probably because they are fully aware of their situation and are grateful to be given choices and opportunities that affirm their individuality.
How can you recognize a senior living community that embraces these practices?
There’s no official checklist, but research shows the features of assisted living that are most important to residents’ quality of life: their level of control, how much they feel themselves to be at home, what they do all day, and their relationships with staff and other residents.
To optimize these, a residence must offer as much privacy and autonomy as possible, learn what each resident enjoys doing and provide those opportunities, and do everything possible to enable close friendships.
An assisted living residence may fulfill all of the regulatory requirements, ensuring proper hygiene, nutrition, and housekeeping, while missing out on opportunities for person-centered care. However clean, bright, and inviting the physical facility may look, the daily routines and schedules that go on behind the scenes could be revealing.
If someone needs help with a shower, for instance, does the schedule require staff to assist in the morning when the resident prefers to have a shower at bedtime? Does housekeeping staff routinely vacuum at night when there’s no traffic in the corridor, although that may disturb someone’s sleep? Is there only one set of options at meals, because that’s simpler for the kitchen staff
The nature and environment of the facility may also be a factor, judging from experience with nursing homes (not assisted living facilities) in Ohio. After that state began to mandate steps toward providing PCC in skilled-nursing facilities in 2015, studies showed that the ones most likely to fulfill the requirements were those located either in large cities or in rural areas, not in mid-sized cities.
Contrary to previous research, they were also more likely to be for-profit entities, rather than nonprofit. The researchers speculated that the for-profit facilities in the study had more resources and a greater ability to change practices quickly in the face of a government mandate. Perhaps nonprofit facilities, being more “mission-oriented,” have been doing this all along, they wrote, and were simply less motivated to spend time documenting their results.
“Most large businesses do not want to run a place like this because it’s too small. There’s not enough profit margin in it,” said Warm Valley Lodge resident Dick Hodge, “But I think it ends up with some very positive aspects because of the personalized relationships between the people that work here and the residents.
“It’s a very powerful thing,” he went on. “You’ve got to talk to each resident and find out what each resident is like,-wise, health-wise, all of the different aspects of a human being, and try to adjust to that. You can watch the people working here and they will treat people differently. But that’s what they need.”
So CNA Chandra Baughn measures vital signs, serves meals, and helps people change clothes if they need it, but she said most of her job is “just to sit and listen to their concerns. A lot of these people don’t have family nearby, so I feel like I’m their family.”
Ultimately that kind of person-centered care works in more than one direction. “The residents embrace each other,” she went on. “They’re concerned for each other. It’s just a big family.”
by Warm Valley Lodge | Cost of Living, Person Centered Care, Senior Care Facilities, Wyoming Assisted Living
How do you find a good motel? You check reviews on TripAdvisor. How would you check out whether a rental cabin is really a dream or just a dump? You’d look it up on VRBO, of course, and learn the facts from people who stayed there.
What if you’re thinking of a long-term care residence for yourself or a family member? You might read some reviews online – although how many people take the trouble to write reviews if a place is just OK, but not wonderful? Many places don’t get lots of reviews, and how many residents would know how or where to post a review anyway?
In Wyoming, high-quality information of this kind actually is available. Searchable information about complaints and inspection reports for Wyoming facilities for the aging are available online here.
The state also requires all long-term care facilities to carry out annual satisfaction surveys of residents and their families, and to keep this data on file for review. The Wyoming Department of Health doesn’t tell facilities which questions to ask on these satisfaction surveys, doesn’t post the results online, and doesn’t require these residences to share them with the public, prospective residents, or their relatives.
But the survey results do exist and are worth requesting–if only for the opportunity to judge how a long-term care facility responds when it receives the request.
Administrator Margaret Chantry says anyone is welcome to look at the results of the 34-question survey distributed every year to residents of Warm Valley Lodge, the assisted living facility in Dubois, and their relatives. The answers exist even for residents who find it too daunting to complete the survey themselves.
Most often when high school volunteer Mia Chandler stops by, she spends her time playing cribbage with one resident. (“He always wins,” she said.) But one day last fall, the staff asked her to help with the survey, rephrasing questions and recording the responses for four others who were unable to complete the task.
Sometimes she had to speak more loudly than usual, Mia said, which was a challenge because she’s a “bit of an introvert” and “not a loud person.” But recording the responses was fun.
On the scale of 1 to 4, she said, “most people were all in the 4s. There was nothing below a 3. They really love Warm Valley Lodge. Nobody wanted to change anything.”
That’s not entirely true: There was the snack problem. One question, about the availability of snacks, scored a very low mean of 2.2. Chantry explained the issue with a chuckle: Snacks began to disappear when they were left out on the food-service counter, and housekeeping staff later discovered that a few residents had been hoarding them.
Now the nurses distribute them every afternoon when they refill the water jugs. (In any case, residents are able to buy their own snacks on regular trips to the center of town in the Lodge’s van.)
The state requires long-term care facilities to maintain several other kinds of quality-assurance procedures, in addition to the surveys. Beyond fire drills and specified kinds of staff meetings, it mandates calendars of activities and regular resident council meetings where people can raise concerns.
Facilities are required to keep notes from regular residents’ meetings, which also might be useful reading for someone considering a residence. Besides reminders to be kind to each other and the staff, and compliments about the menu, people at Warm Valley Lodge have had issues to raise. In January 2022, they had cabin fever and wanted to visit a virtual museum or play shuffleboard. Two months later, someone complained that the dining room was noisy. Last September, someone said that the shrubbery beds could be landscaped better.
Visitors are welcome to attend resident council meetings in person, said Administrator Chantry, as long as they just listen and don’t speak. “It really is their meeting,” she explained.
by Warm Valley Lodge | Health Tips, Latest News, Person Centered Care, Senior Care Facilities, Wyoming Assisted Living
They were probably the wittiest couple in town back then, and they loved giving dinner parties. She usually planned them around a theme, like Mexican or Asian, with place settings to match. Gregarious and wry, she was a terrific hostess.
But then she needed surgery, and afterwards it all got to be too much to take on.
These days the couple eats out sometimes. But mostly they enjoy the dinner entrees and side dishes of their choice, prepared by a chef who had a lifetime of experience in Jackson, and delivered directly to their dining table.
“Oh, no. Now I will have to think again,” joked the husband, when he heard that as residents of Warm Valley Lodge, the assisted living residence in Dubois, he and his wife would begin making their own choices from regularly changing menus.
But later he remarked: “We’re not eating out as much as we used to. It really makes a difference.”
One of the founding principles of assisted living is to encourage autonomy and independence among people as they age. The basic idea is to provide a real home where residents can follow a normal life, while escaping the most burdensome obligations of household activities as they grow older, including cooking, which may be a considerable sacrifice in its own way.
“The ability to make decisions intentionally and independently is a basic human right, yet people living in residential aged care facilities often give up a certain amount of their right to choose what to eat or drink,” wrote the authors of a study published three years ago in the “Journal of Clinical Nursing,” adding that “the loss of autonomy to make food choices is of particular concern, as a lack of choice decreases motivation to eat, placing residents at risk of malnutrition and reducing their quality of life.”
Several recent studies have found that when diners at residences for the elderly are given meal choices, they tend to eat sensibly and tend not to lose weight (which is a major contributor to frailty). Yet anyone who moves into a “residential care facility” may still face daily fare that is “three slabs of whatever – one green, one orange and then one maybe looks like mashed potato or something with gravy” (as one RN described it).
The report in the nursing journal stated that staff in two Australian facilities were more concerned about the nutritional status of meals than about how they were prepared. “They don’t know how to cook anything,” said one 73-year-old resident. “They walk around with the tops like chefs…but they’re just glorified cooks.”
Allen Sphatt probably didn’t know about any of this research when he answered the ad from Warm Valley Lodge for a new head cook. What he did know was that he had grown very tired of driving back and forth over one mountain pass or another. After losing his lease in Driggs and being priced out of Jackson, he had settled in Dubois. So he answered the ad.
What he also knew was that the customary way of doing things was going to be “ridiculously boring.”
As former head of the commissary at Fine Dining Group, which owns breweries and restaurants in Jackson including the Bistro and Bin 22, Sphatt absolutely deserves to wear the chef’s hat. Before that, he was dinner sous chef at Snow King and executive chef at Spring Creek Ranch.
Warm Valley Lodge had been using a menu service to determine the daily meals. “They outline the meal every day,” he explained. “You pull the menu from the computer, make it, serve it, you’re done.”
Soon after being hired as Dietary Manager, Sphatt suggested a different approach to Margaret Chantry, the administrator of the Lodge, and she let him change the system. Himself a Certified Food Manager, he still relies on the menu service and the contracted registered dietician to determine portion control and dietary needs. But he uses his own recipes.
If an entrée is meatloaf, for example, he starts with the menu-service basics and adds seasonings like Worcestershire sauce and thyme, knowing from experience that they enhance the flavor of the beef. His new clientele gets to choose main meal and breakfast options from menus that change every two weeks.
“Al introduces many new menu items that most of us have never experienced, things that he would make in the past or learned from his family,” remarked Chantry. “Based on comments from our monthly resident council meetings, the residents unanimously favor this new system. Also, the staff enjoys the food just as much as the residents, and we choose it over our own.”
Preparing a new menu at Warm Valley Lodge requires two days of intense work: putting the main items into the freezer, making the sauces ahead and replacing what is ordered. Afterward, everything is ready to grab and cooked to order—just like in a restaurant.
Studies show that kitchen staff at some residences for the aging resist the idea of departing from the institutional menus, because it would require too much extra planning and time. But “it plays into my hands,” Sphatt said.
“That’s my experience—not institutional cooking, restaurant cooking,” he said. “I’ve been doing this for 40 years. It’s not hard. It’s easy.” And it gives the diners something to think about.
The Center for Excellence in Assisted Living describes PCC as a pivot away from the traditional mentality of the health-care industry, which is focused on the providers’ tasks and efficiency, and toward a custom based on the dignity and self-determination of the individuals in the community. The emphasis is on the individual residents’ preferences and needs–not those of the staff or the organization.
Allen Sphatt probably didn’t know about any of this research when he answered the ad from Warm Valley Lodge for a new head cook. What he did know was that he had grown very tired of driving back and forth over one mountain pass or another. After losing his lease in Driggs and being priced out of Jackson, he had settled in Dubois. So he answered the ad.
“Al introduces many new menu items that most of us have never experienced, things that he would make in the past or learned from his family,” remarked Chantry. “Based on comments from our monthly resident council meetings, the residents unanimously favor this new system. Also, the staff enjoys the food just as much as the residents, and we choose it over our own.”