Care Planning for Resident Choice

The assessment of risk in long-term care is often an unbalanced exercise.  In order to optimize opportunities for resident choice; to attain each resident’s highest practicable level of well-being; and to mitigate risk, the Rothschild Foundation has created a task force.  This group is charged with developing a care planning process to plan for each resident’s choice when that choice carries potential risk.  Please see the documents below for the process.

Artifact of Culture Change 2.0 - SNF/Assisted Living

Originally developed by Pioneer Network in collaboration with CMS, The Artifacts of Culture Change was revised in 2020. Artifacts of Culture Change 2.0 (ACC) is an internal implementation, inspiration, and self-assessment tool available for both SNF and AL and is a great tool to help re-ignite your person-centered journey. You can access all documents through the Pioneer Network Website (Be sure to check out the drop-down menu on the left side of the page for more information, resources and On-Demand Videos).

Dining Standard Toolkit from the Pioneer Network

Medical evidence from recent research studies has demonstrated that restrictive diets for older individuals in long term care are of little benefit, and in fact can be detrimental.

Selfie Tips

Tip # 1:  "Where's the Focus?"
Just as a "selfie" is all about YOUR SELF, Person-Centered Care is all about the PERSON!  So why are we looking at Person-Centered Care?

Tip # 2:  "My Life! My Choice!!"
As we take a "selfie" and examine ourselves, we see the things that are important and unique to us.  We have a favorite color, a hairstyle we prefer, and favorite foods we love to eat.  We make many choices each day that make us satisfied or happy.

Tip # 3:  "Care Conferences:  Developing a portrait of the person"
Care Conferences are the ultimate "selfie!"  The conference is an opportunity to really examine the person and their preferences and needs.

Tip # 4:  "Consistent Staffing"
Think of yourself in a new and unfamiliar situation, surrounded by unfamiliar faces.  Imagine this happens almost every day.  It feels like starting out in a new high school over and over again.  Who are all these other people?  How will I remember their names?  There are so many strangers-what do they really know about me?  Now, imagine you also have dementia.

Tip # 5:  "The Power of Huddles:  Making sure we all see the same picture"
As in football, a caregiver huddle gathers to briefly exchange information, share observations and develop strategy.  Use huddles to pass insights about what really helps each resident feel comfortable and understood, so that all caregivers are equipped to provide the best person centered care.

Tip # 6:  "Me in My New Home"
Just as a “selfie” is about YOU, Person-Centered Care is all about the PERSON!  Think of yourself in an unfamiliar situation.  Finding the bathrooms and where to get a cup of coffee or a bite to eat is likely a top priority.  And by the way…who are all these people and how will I remember their names?

Tip # 7:  "Don't Call Me 'Honey!'"
Have you listened to yourself and the words you use?  Not only the words, but the way you say them may be condescending to people.  Using person-centered language is one of the essentials in changing our culture.

Tip # 8:  "Please Pass the Hot Sauce"
Food preferences along with the way meals are favored (and sometimes flavored) depend on the individual.  Dining should be about more than nutrition.

Tip # 9:  "The Power of Meaningful Activities"
We all need to have a purpose: to be needed, to make a difference, to be a part of something.  It is no different for those living in long-term care.  Helping residents find meaning and purpose in their daily life is not just the Activity Director’s job.  Find out what makes an activity meaningful, according to what each resident values.

Tip # 10:  "Simple Pleasures: Preferences and Choices"
Learn how to honor each person’s “Simple Pleasures.”  Personal preference is essential in almost every piece of our lives.  Honoring a resident’s choice and discovering their likings can make a big difference in their lives.

Tip # 11:  "Communicate Caring When Words Fail"
Do I communicate what I mean? A person may ignore my words, yet react to how they view my attitude. Communication involves sending and receiving both verbal and non-verbal messages. As memory loss progresses, words may become confusing, and word-finding is often frustrating. A person with memory loss will often mirror the non-verbal messages of the caregiver, and search for prompts to tell them how to respond. With such communication challenges, how can we acknowledge and support the person’s feelings, when words may not make sense?

Tip # 12:  "Person-Centered Care and QAPI"Person-Centered Care is one of nine Advancing Excellence goals -- aligned with QAPI - which provide tracking charts and trend graphs to help your home monitor progress on your chosen goals.  While Advancing Excellence supports the QAPI approach, participation does not automatically mean you are implementing QAPI.

Missouri Resources

LeadingAge Missouri
LeadingAge Missouri’s work is dedicated to assisting its members to be the leaders in Missouri in the delivery of innovative, quality long-term health care, housing, and services for older adults. LeadingAge Missouri's mission is to create a future where quality of life is optimized.

Missouri Association of Nursing Home Administrators (MANHA)
MANHA is distinctive because its target membership, is the nursing home administrator. Their entire mission is the commitment to providing a professional organization of and for Long term care Administrators who are dedicated to providing a quality of care for the elderly and disabled of our state. We strive to be a strong, vital and knowledgeable resource for the long-term care administrators of the state. The administrator’s support network in a climate of high-turnover, high frustration and rapid changes. The organization has modified its original founding principal for education to include the provision of “Quality/Valuable” education. Additionally the organization attempts to promote issues of pertinence to its membership and to voice members concerns to all regulatory and political agencies. A voice in an ever changing industry, that often has not been heard or heeded. Beyond, promoting the professionalism of its members the organization has added the need to foster professionalism in its membership. Promote and foster that which is good about who we are and what we do as licensed nursing home administrators and as professional dedicated to continually improving our product and services. Lastly, beyond acting as a catalyst for improvement of health care and the quality of life, the organization has recognized the need for the professional long term care administrator to advocate for quality of life for the residents in long term care facilities around the state. Who better to advocate for the clients we serve?

Missouri Department of Health & Senior Services
Check out the latest information from the Section for Long Term Care Regulation including Culture Change, Training, Events, CMS/MDS news and other important information.
SLCR BlogLTC Weekly Information Update sign up

Missouri Health Care Association (MHCA)
MHCA was founded in 1949 on the premise that its members have a moral obligation to the residents we serve. Therefore, the end result we seek in all our efforts is to improve the quality of care and life of the residents of Missouri's facilities through advocacy for full funding and fair and effective regulations.

We are a nonprofit professional trade organization of licensed, long term health care facilities, residential care facilities and assisted living facilities, as well as persons in allied professions and business and persons, firms, or corporations interested in the advancement of the aims of this organization.

MHCA provides effective representation to Missouri lawmakers and federal agencies; online discussion forums, committee involvement and access to colleagues through online membership directory; educational opportunities to help you maintain your professional certifications; and communications to keep our members updated on legislative and regulatory issues.

Missouri League for Nursing (MLN)
The Missouri League for Nursing is a not-for-profit organization established in 1953 to support the delivery of quality health care by nurses and other health care providers through education, collaboration, and information. We are the leading organization for promoting quality health care through programs designed to meet members and health care professional's continuing educational needs. We are committed to collaboration and networking with other professional organizations and coalitions across the state. The Missouri League for Nursing is one of the top constituent leagues in the nation and has been recognized several times during the past 15 years for their leadership and service-including being selected for the NLN Distinguished Service Award in 1999.

Mission statement: The MLN advances global, national, and state health by supporting the delivery of quality health care by nurses and other health care providers though education, collaboration and information.

Missouri's Long-Term Care Ombudsman Program (LTCOP)
The mission of Missouri's Long Term Care Ombudsman Program is: To improve the quality of life for residents of long term care facilities through advocacy and education.
The goals of the program are to provide ombudsman services to all residents of all long-term care facilities in Missouri, including Intermediate Care Facilities for the Mentally Retarded and Veterans Administration Nursing Homes; to advocate for residents rights; and to provide community education regarding long-term care facility issues.

This is the task set before each volunteer ombudsman. These goals will help to ensure and maintain the best quality life possible for all residents in long-term care facilities.
To achieve these goals ombudsmen make sure all residents are informed of their rights as established by law; strive to empower residents and/or help to resolve all complaints at the facility level through the involvement of all concerned parties; and work with the Regional Ombudsman Coordinator to provide suggestions for relaying non-confidential information to the community on residents needs and concerns.

Quality Improvement Program for Missouri (QIPMO)
QIPMO will send gerontologic nurse specialists to Missouri nursing facilities. They will provide information and assistance related to clinical issues of interest to long-term care staff. QIPMO is a cooperative program between the MU Sinclair School of Nursing and the Missouri Department of Health and Senior Services (DHSS) with funding by DHSS using the Missouri Quality of Care fund (senate bill 556). QIPMO nurses are not surveyors from the Department of Health and Senior Services.  The site visits are treated confidential.

Books and DVDs

Word of the Week: Building a Culture Change Dictionary
A collection of reproducible flyers for your journey to home is now on sale! Culture Change advocate Joan Devine (also President of MC5) has collected a year’s worth of wisdom to help you reconsider the language your community uses to talk about itself, its residents, and its staff. Made to share with coworkers, these weekly flyers point out the clinical language that continues to ‘stick’ in our daily vocabulary and suggests replacements. You’ll never look at your community’s language the same way again!

Alive Inside:  A Story of Music & Memory
The award winning documentary film about Music & Memory is now available.

Resources and Links

Long-Term Care Improvement Guide
Long-Term Care Improvement Guide was created to propel long-term care communities in their improvement efforts by presenting a collection of concrete strategies for actualizing a resident-directed, relationship-centered philosophy. Ultimately, the aim of this Guide is to encourage communities to take action.

Action Pact, Inc.  Changing Communities.  Changing Lives.
Action Pact is a unique culture change company.  Recognized for developing and promoting the Household Model, Action Pact provides full services that enable residential senior environments including institutional nursing homes and assisted living communities to transform into warm and pleasant households.
Action Pact works directly with organizations committed to this profound change, often beginning work with them at the visioning stage and aiding them throughout the difficult work of environmental and organizational design, change of culture, operational changes of systems processes, and development of new skills – including technical, self-led team, people and process skills.

Activity Professionals National Credentialing Center

APNCC offers an all-encompassing certification to assure an individual is well rounded and prepared to work in any long term care, adult day program, assisted living, in-home program, senior centers or retirement community.

Advancing Excellence in America’s Nursing Homes
The Advancing Excellence in America’s Nursing Homes Campaign was founded in 2006 by an unprecedented coalition of 28 organizations representing groups ranging from nursing home providers to quality improvement experts to government agencies.  The Campaign now includes more than 62% of the nation’s nursing homes and we have Local Area Networks for Excellence (LANEs) in every state and DC.  The Campaign helps nursing homes improve the quality of care and quality of life for the more than 1.5 million residents of America’s nursing homes by establishing and supporting the infrastructure of LANEs, strengthening the workforce, and improving clinical and organizational outcomes.

Alzheimer's Association
The Alzheimer’s Association works on a global, national and local level to enhance care and support for all those affected by Alzheimer’s and other dementias.  As the largest non-profit funder of Alzheimer's research, the Association is committed to accelerating progress of new treatments, prevention and ultimately, a cure.  Through our partnerships and funded projects, we have been part of every major research advancement over the past 30 years.
Our Vision: A world without Alzheimer's disease.
Our Mission: To eliminate Alzheimer's disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health.

American Health Care Association (AHCA)
As the nation’s largest association of long term and post-acute care providers, AHCA advocates for quality care and services for frail, elderly, and disabled Americans.  Our members provide essential care to approximately one million individuals in 12,000 not-for-profit and proprietary member facilities. AHCA is committed to developing necessary and reasonable public policies which balance economic and regulatory principles to support quality care and quality of life. AHCA's Mission: Improving Lives by Delivering Solutions for Quality Care.

B & F Consulting
Change can be overwhelming and may feel chaotic during a transition.
B & F Consulting Inc., founded in 2004, helps providers with the “how” of change by walking people through how to bring staff together, examine daily operations, and systematically re-frame and re-organize the day-to-day of nursing home life.  B & F customizes services to meet provider needs, whether it be stabilizing staffing, initiating or re-energizing culture change, or building systems to support quality improvement.

The Eden Alternative
The Eden Alternative® is an international, non-profit 501(c)3 organization dedicated to creating quality of life for Elders and their care partners, wherever they may live.  Building on this new paradigm, it affirms that care is not a one-way street, but rather a collaborative partnership.  All caregivers and care receivers are described as “care partners,” each an active participant in the balance of giving and receiving.  Together, care partner teams strive to enhance well-being by eliminating the three plagues of loneliness, helplessness, and boredom.

Grow with Evergreen Resources for Transforming Innovations (GERTI)
GERTI is the educational arm of Evergreen Community.  The mission of Evergreen Community of Johnson County is to provide the best possible long-term care services to the individuals we serve, including residents with limited assets.

GERTI believes that education is the key to transforming long-term care and the lives of residents.  We offer educational programs that emphasize culture change and person-centered care.  Through these programs we encourage employees to take pride in their work and improve the quality of life for residents.

GERTI's mission is to improve the quality of care throughout the field of aging by providing education, training and development.

The Golden Experience – Kareen King
Registered Drama Therapist, Kareen King is inspired by the amazing stories and thoughts that are often expressed when someone makes the effort to truly acknowledge those who reside and/or work in long-term care communities.  She is intrigued with the idea that as long as there is breath, there is a mission to be accomplished and new horizons to explore. Through original song and story, she has captured golden moments stemming from her work as an Activities Supervisor at a skilled nursing facility and beyond.  Her mission is to focus on the enrichment needs of lives in long-term care, placing on center stage the value of both human connection and personal growth.  She believes in the potential of every situation and human being as a golden experience.

The Green House Project
A house… and a whole lot more.
Green House homes are a way of life for the elders thriving in them, the teams working in them, and the healthcare providers who believe in them.
The Green House Vision:  We envision homes in every community where elders and others enjoy excellent quality of life and quality of care; where they, their families, and the staff engage in meaningful relationships built on equality, empowerment, and mutual respect; where people want to live and work; and where all are protected, sustained, and nurtured without regard to the ability to pay.

The Green House Mission: We partner with organizations, advocates, and communities to lead the transformation of institutional long-term care by creating viable homes that spread THE GREEN HOUSE® Project vision – demonstrating more powerful, meaningful, and satisfying lives, work, and relationships.

IDEAS Institute
The mission of IDEAS Institute is to provide solutions that improve the lives of older adults through the conduct of rigorous applied research.  Our highly respected staff examine the therapeutic potential of the environment-physical, social and organizational-as it relates to frail and impaired older adults.  Serving older persons, their caregivers, and the community, the IDEAS Institute seeks to be a premier resource of information and environment - behavioral research centered on improving care and quality of life for people with chronic forms of physical and cognitive decline, including, but not limited to, Alzheimer’s disease.  Our areas of expertise lie in dementia care, long term care, environmental design and modifications for older adults and those with dementia, caregiver /staff education and research.  Ingenuity, innovative solutions, and integrity are core values of the organization.

LeadingAge
The mission of LeadingAge is to expand the world of possibilities for aging.  Our membership includes 6,000 not-for-profit organizations representing the entire field of aging services, 39 state partners, and hundreds of businesses, consumer groups, foundations, and research partners.  Together, our members touch 4 million lives every day.

Mather Lifeways
Mather LifeWays is a unique, nondenominational not-for-profit organization that enhances the lives of older adults by creating Ways to Age WellSM.  The Institute on Aging was created in 1999 as a way to expand the impact of Mather LifeWays by evaluating programs for senior living and community-residing older adults through applied research.

Mather LifeWays Institute on Aging is dedicated to creating Ways to Age Well for older adults by conducting applied research and developing award-winning, evidence-based education programs for professionals who serve older adults.  The Institute teaches a holistic, person-centered approach to care.  This emphasizes caring for more than just health issues by getting to know individuals and connecting on personal levels.

My Inner View
National Research implements surveys and performs analyses that recognize a provider’s strengths and problem areas, and then uses the data to design specific, measurable improvement strategies.  The company’s products and solutions build on the “Eight Dimensions of Patient-Centered Care,” a philosophy developed by noted patient advocate Harvey Picker, who believes patients’ experiences are integral to quality healthcare.  National Research goes a step further, extending this philosophy to include families, caregivers, senior housing residents, and other stakeholders - empowering customer-centric healthcare across the continuum.

The Institute for Caregiver Education (IfCE)
IfCE is a not-for-profit 501 © (3) organization that provides continuing education and professional development opportunities for healthcare professionals, including a variety of literacy, language, and life skills training for entry level staff across all disciplines.

The Institute’s mission is to foster the highest quality of life for elders through professional development and continuing education for caregivers.  Working with organizations across the continuum of care, the Institute seeks to identify and address unmet provider and community needs with services that are accessible, affordable, and relevant to those with greatest need.

The Consumer Voice
The Consumer Voice is the leading national voice representing consumers in issues related to long-term care, helping to ensure that consumers are empowered to advocate for themselves.  We are a primary source of information and tools for consumers, families, caregivers, advocates and ombudsmen to help ensure quality care for the individual.

The Consumer Voice envisions a world in which all consumers of long-term care, services and supports are treated with respect and dignity and have a wide range of affordable, quality options across all settings.  These options will make it possible for individuals to receive care and services in the location and manner of their choice and to attain a high quality of life.

Paraprofessional Healthcare Institute (PHI)
PHI is a national nonprofit that works to improve the lives of people who need home and residential care-and the lives of the workers who provide that care. PHI’s goal is to ensure caring, stable relationships between consumers and workers, so that both may live with dignity, respect, and independence.

Pioneer Network
We recognize our need to create ways of living and working together different from the traditional models. The Pioneer Network supports models where elders live in open, diverse, caring communities.  Pioneers are working for deep system change by both evolutionary and revolutionary means, using Pioneer values and principles as the foundations for change.  In-depth change in systems requires change in governmental policy and regulation; change in the individual's and society's attitudes toward aging and elders; change in elders' attitudes towards themselves and their aging; and change in the attitudes and behavior of caregivers toward those for whom they care.  We refer to this work as culture change.  Our aim is nothing less than transforming the culture of aging in America.

The Pioneer Network advocates and facilitates deep system change and transformation in our culture of aging.  To achieve this, we create communication, networking and learning opportunities; build and support relationships and community; identify and promote transformations in practice, services, public policy and research; and develop and provide access to resources and leadership.

Planetree
Planetree, Inc. is a mission based not-for-profit organization that partners with healthcare organizations around the world and across the care continuum to transform how care is delivered.  Powered by over 50,000 focus groups with patients, families, and staff, and over 35 years of experience working with healthcare organizations, Planetree is uniquely positioned to represent the patient voice and advance how professional caregivers engage with patients and families. Guided by a foundation in 10 components of patient centered care, Planetree informs policy at a national level, aligns strategies at a system level, guides implementation of care delivery practices at an organizational level, and facilitates compassionate human interactions at a deeply personal level. Our philosophical conviction that patient centered care is the “right thing to do” is supported by a structured process that enables sustainable change.
Planetree’s Vision:  As a global catalyst and leader, Planetree promotes the development and implementation of innovative models of healthcare that focus on healing and nurturing body, mind and spirit

Second Wind Dreams (SWD)
Second Wind Dreams® is a 501(c)(3) nonprofit corporation that has become involved in more than 400 eldercare communities, weaving thousands of dreams from the simple to the sublime, since 1997.  Financial support for SWD comes from individual contributions, memberships, corporations and eldercare industry associations.  Additional revenue is generated as a result of their educational program, the Virtual Dementia Tour®.  The Virtual Dementia Tour is a scientifically proven method designed to increase sensitivity toward those with dementia.

The mission of SWD is simple - to change the perception of aging through the fulfillment of dreams and the offering of innovative educational opportunities to caregivers and communities.

National Council of Certified Dementia Practitioners
The National Council of Certified Dementia Practitioners®, LLC was formed in 2001 by a group of professionals with varying work and personal experiences in the field of dementia care.  Their backgrounds include Nurses, Regional Managers, Nursing Assistants, Consultants, Geriatric Care Managers, Psychiatry, Dementia Unit Managers, Alzheimer's Disease and related Dementia Care Specialist, Alzheimer's Disease Educators, Dementia Educators, Activity Professionals, Therapeutic Recreation Specialist, Licensed/Certified Social Workers, Occupational Therapists, Physical Therapists, Speech Therapists, Dietitians, Pharmacists, Long Term Care Administration, Support Group Leaders, Owners, Elder Law Attorneys and Home Care Administration.  The Council was formed to promote standards of excellence in dementia and Alzheimer's disease education training to professionals and other caregivers who provide services to those with dementia.