Jump to minutes: February 4, June 3, October 7
Minutes for February 4, 2010 MEMBERS PRESENT: Sophia Bunch, Lisa Drury, Laurie Gyscek (via telephone), Beth Hercher, Laurie Loughlin, Liz Pearson, Virginia Vollmer, Carol Wesson, Linda Williams, Sarah Yates
Laurie L. convened the meeting at 11:00 a.m.
The first part of the conference revolved around dining changes being implemented at participating facilities. In many surveys, food issues rank highest in factors determining resident satisfaction. Kort Nygard sent information that homes with restaurant-style menus report no increase in raw food costs because there is 50% waste in traditional “one size fits all” meals and near 0% waste when residents eat what they want; residents also eat more and experience less weight loss.
Carol reported that Tennessee Health Management (THM) facilities vary in the styles of dining that they offer which can include buffet, restaurant, set-up menu and a la carte items which can be ordered in advance. They have to follow doctors’ dietary orders, but many physicians are switching their patients back to regular diets as they tend to eat better on those than on the special diets. Some have even left standing orders for alcohol to be served for special occasions.
Virginia shared that at Alexian Brothers, slips are passed out to the residents prior to each meal so they can check their choices, which the aides then bring to the kitchen. Residents whose cognitive impairment makes it impossible for them to understand the choices are served a customary meal.
Linda declared that at Ivy Crest the staff members eat with the residents, rotating tables so they can all get to know each other. Every other week a resident’s name is drawn, and that resident gets to plan the lunch and dinner menus plus an activity for that Friday.
Sarah stated that at Tennessee State Veterans Home (TSVH) in Murfreesboro they have a buffet 3 times a week and that breakfast waffles are made right in the units so that the residents can experience the wonderful smells. Sophia added that they try to accommodate late risers and requests for special items at meals. If the kitchen does not have the ingredients for an item on hand, the resident is promised that they will obtain said ingredients and serve the item the next day. They have weekly weight meetings, and families are encouraged to bring in home-cooked meals.
Virginia, who is a volunteer, asked if the other homes with members present used volunteers as servers in the dining room as is done at Alexian Brothers because “in our society, food is love, and that is one way to make the residents feel cared about”. She informed the group that in some other states, volunteers are trained as feeding assistants because this constitutes good interaction, and that speech therapy programs have some good videos that demonstrate and explain about the swallowing process.
Carol responded that at THM, volunteers assist at meals by filling glasses, etc., but that they are not allowed to feed the residents. They primarily help out with activities. Sophia answered that at TSVH volunteers mainly help organize and orchestrate parties and outings. Linda told the group that a volunteer at Ivy Crest leads a weekly devotion and takes individual time with each of the residents, which they really appreciate.
Laurie announced that at the 5th Eden Alternative International Conference in June (see Item #5 in the “Mark Your Calendar” section below for more details) Kort Nygard and Melanie Adair will be co-presenting 2 sessions on ageism and institutionalization, one with Dr. Bill Thomas and one with Joe Adair.
Virginia opined that, because nurses and social workers are acutely aware of both the emotional and physical well-being of their residents and the regulations that govern their care, they are in an excellent position to point out to the powers that be that the Centers for Medicare and Medicaid Services (CMS) has recently been making a lot of references to long-term care culture change, and to impress upon them that adopting culture change practices will ultimately have a positive effect on the bottom line.
QSource officers Beth (Memphis) and Laurie G. (Nashville) detailed the progress of 3 projects in their Achieving Excellence Campaign. The use of physical restraints is down from 13% to 4.5%, with some participating facilities at 0. Pressure ulcers have also declined. They have administered the Patient Safety Culture Survey that has been used in hospitals for 2 years to staff at some of the nursing homes, and this revealed that lack of adequate communication is the #1 perceived threat to resident safety. These surveys are anonymous by employment category and provide a good tool for facilities to see where the breakdowns are occurring.
Re updates from facilities, Sophia revealed that the Certified Nursing Assistants (CNAs) at TSVH have a lot of passion for their work and freely come up with ideas and suggestions. Virginia interjected that Alexian Brothers is also empowering its direct care staff and that by serving on committees, they have more say. Carol was happy to report that the THM leadership is seriously embracing culture change and attending various trainings and meetings. They are implementing consistent assignment and have eliminated nurses’ stations where possible. Linda leads learning circles during staff meetings at Ivy Crest. After the recent snowstorm, they took the residents on a drive to see the ice in the trees. They have bought a scanner to make videos of the residents on their birthdays. And, in a continuous celebration of holidays, the residents have made Valentine boxes to put outside their doors and have constructed Mardi Gras floats by wrapping tissue paper around shoe boxes and decorating them.
Kort recommends a new book by Al Power entitled Dementia Beyond Drugs: Changing the Culture of Care published by Health Professions Press as an excellent analysis of polypharmacy and the effects of off-label use of antipsychotics.
Laurie L. adjourned the meeting at 12:20 p.m.
Mark Your Calendar:
- TEF BOARD OF DIRECTORS MEETING – Thursday, 03/04/10, 7:00 p.m.
- TEAC MEMBERSHIP MEETING – Thursday, 04/01/10, 11:00 a.m. – 1:30 p.m., in Nashville; see “TEAC MEMBERSHIP MEETING SCHEDULE 2010” for details.
- TEF BOARD OF DIRECTORS MEETING – Thursday, 05/06/10, at 7:00 p.m.
- TEAC VIDEOCONFERENCE – Thursday, 06/03/10, 11:00 A.M. – 1:00 P.M.
- 5th EDEN ALTERNATIVE INTERNATIONAL CONFERENCE – Sunday 06/13 – Tuesday, 06/15/10 at the Westin Tabor Center, Denver, Colorado
- TEF BOARD OF DIRECTORS MEETING – Thursday, 07/01/10, 7:00 p.m.
- TEAC MEMBERSHIP MEETING – Thursday, 08/05/10, 11:00 A.M. – 1:30 P.M.
- TEF BOARD OF DIRECTORS MEETING – Thursday, 09/02/10, 7:00 p.m.
- TEAC VIDEOCONFERENCE – Thursday, 10/07/10, 11:00 a.m. – 1:00 p.m.
- TEF BOARD OF DIRECTORS MEETING – Thursday, 11/04/10, 7:00 p.m.
- TEAC MEMBERSHIP MEETING – Thursday, 12/02/10, 11:00 a.m. – 1:30 p.m.
Submitted by Laurie Loughlin
Minutes for June 3, 2010
MEMBERS PRESENT: Conita Grigsby, Beth Hercher, Laurie Loughlin
GUEST – Carol Mace – State Government Liaison
TEAC requested the State Government Liaison’s presence at this meeting because discussion topics included the State of Tennessee.
Laurie convened the meeting at 11:10 a.m.
Carol announced that the TEF Grant Review Committee has awarded this year’s 10 Eden grants to the following facilities, in alphabetical order by city:
Byrdstown Pickett Care and Rehabilitation Center
Covington Covington Care Nursing & Rehabilitation Center
Kingsport The Village at Allandale
Knoxville Continuum Courtyards – Inskip Drive
Continuum Courtyards – West Parkway
McKenzie Oak Manor Health Care Center
Memphis St. Peter Villa
Nashville Bordeaux Long Term Care
Knowles Home Assisted Living & Adult Day Service
Pulaski Ivy Crest ACLFTEAC congratulates them and encourages all who did not secure a grant this year to try again next year.
Laurie relayed that an item has been added to the grant proposal TEF will be submitting to the state for use of federal CMP (Civil Monetary Penalty) funds, which would be money to have a day-long reunion/refresher for Tennessee’s CEAs (Certified Eden Associates) to keep everyone in touch and aware of long-term care developments across our state. Debbie Meredith is polishing the proposal.
TEAC chair Kort Nygard, who was not present due to being in Colorado pre-5th Eden Alternative International Conference, had wanted to get the group’s take on the desirability and feasibility of holding TEAC webinars in place of our videoconferences. Laurie stated that while the videoconferences had been substituted for half of the actual TEAC Membership Meetings in hopes of drawing more attendees, they actually draw fewer members, as was the case with the teleconferences tried a couple of years ago. Carol said that the state does have webinar capability, but that it would have to be used in conjunction with training, not just a meeting. Beth concurred because during a webinar participants see documents on their computers, not the other people involved, and communication is limited to topical questions and answers submitted via keyboards. Also, QSource does not have webinar capability. Conita interjected that webinars are actually a very good way to do training, because you can print the materials off the computer and give a copy to everyone attending the webinar at your site. So, it was decided that webinars will not be held in place of TEAC Meetings or Videoconferences, but the Board of Directors will take up the possibility of using them for training at its July meeting.
Carol, who is the Chair of the 2010 Annual Meeting of AHFSA (Association of Health Facilities Survey Agencies), advised that this year’s event will be held in Nashville from 9/20-22/10. Long-term care providers are welcome and should find it beneficial. Half a day will be dedicated to CMS (Centers for Medicare and Medicaid Services) updates for next year, and other agenda items include an NFPA (National Fire Protection Agency) update re code changes and a session on new nursing home MDSO requirements. For more details, see Item # 7 in the “Mark Your Calendar” section below.
Conita is a credentialed Culture Change Nurse Coordinator through an independent study course offered by the Health Education Network, which gives 18 hours of contact credit to RNs and LPNs that go through the program and includes information on many different approaches to culture change. She highly recommends it, and members who are interested can contact her at conita.grigsby@villa.cdom.org.
It being a year since CMS issued new guidelines for state surveyors instructing them to take into account how well a facility responds to the needs and requests of residents, Laurie inquired whether those present had noticed any shifts in regulatory emphasis during their inspections since 6/17/09. Beth answered that she has not heard much from the facilities in the QSource studies about those new quality of life tags and that their inspections focused heavily on safety and infection control. Conita concurred, adding that medication passes and the administration of eye drops were very closely watched.
Carol was very excited to see that the cover story in the current issue of Provider Magazine is on culture change and makes a strong case for the financial viability of culture change practices, particularly Green Houses.
Laurie asked if the Flood of 2010 had had any impact on facilities practicing culture change, and how any physical or emotional situations had been handled. Conita replied that nearby Midsouth had been flooded and had had to quickly evacuate all its residents to other facilities. St. Peter Villa, which had a nearly full census, took in as many as it could. The new residents settled in well and the incumbent residents adjusted to having them. The one stress she noticed was that the families of the evacuated residents were most concerned about what had happened to their belongings. Beth responded that QSource had called the facilities it is working with in its Advancing Excellence studies, and none were experiencing any flood-related difficulty. However, the homes were acutely aware of the crucial importance of their disaster plans and were reviewing those.
Beth was happy to tell the group that the 2 collaboratives QSource has been working on with the Tennessee nursing homes will be wrapping up in October with a Regional Outcomes Congress for all in its study groups. There will also be learning sessions conducted at each nursing home. She elaborated that the 2 projects had vastly different processes: 1) Decreasing Pressure Ulcers required a certified wound care specialist advisor, Susan Dulaney, and the acquisition of clinical knowledge as to the etiology, treatment and prevention of these sores; 2) Restraint Reduction is achieved through a process of education and elimination.
Conita proudly declared that St. Peter Villa has 1 final step – the conference call – to complete its re-registration as an Eden Home. During Nursing Home week they held a carnival complete with a petting zoo. They have elected new mayors for each of their neighborhoods; a mayor can be a resident or an employee. They are adding mayors to each neighborhood for the evening and night and weekend shifts so that those staff members won’t feel left out and activities will be able to be scheduled for those residents who are night owls. Carol remarked that this could lead to a decrease in Sundowner Syndrome, because an increase in the opportunity for activities usually leads to a decrease in behavioral issues. Beth is curious to know if the additional options for structured activity with others present will lead to a decrease in falls in the off hours.
Conita also expressed that St. Peter Villa would very much like to have more contact with other Edenizing facilities in or near West Tennessee, as they sometimes feel isolated. So, if you are in that section of our state or in another state but close to Memphis, and you would like to share your Eden journey, please e-mail her at conita.grigsby@villa.cdom.org.Laurie adjourned the meeting at 12:25 p.m.
Mark Your Calendar:
1. 5th EDEN ALTERNATIVE INTERNATIONAL CONFERENCE – Sunday 06/13 – Tuesday, 06/15/10 at the Westin Tabor Center, Denver, Colorado
2. TEF BOARD OF DIRECTORS MEETING – Thursday, 07/08/10, 7:00 p.m. at Allium Restaurant in East Nashville
3. TNAHSA ANNUAL MEETING – Monday, 08/02 – Wednesday, 08/04/10 at Cool Springs Marriott, Franklin; for more information, contact Ashley Walker at awalker@tnahsa.org.
4. TEAC MEMBERSHIP MEETING – Thursday, 08/05/10, 11:00 A.M. – 1:30 P.M
5. PIONEER NETWORK 10TH ANNUAL CONFERENCE – Sunday, 8/8 – Wednesday, 8/11/10 at the Indianapolis Downtown Marriott; for more information, contact stephaniebuck@illinoispioneercoalition.org.
6. THCA ANNUAL MEETING – Sunday, 08/29 – Wednesday, 09/01/10, Knoxville Convention Center; for more information, contact Linda Jennings at ljennings@thca.org.
7. TEF BOARD OF DIRECTORS MEETING – Thursday, 09/02/10, 7:00 p.m.
8. AHFSA ANNUAL MEETING - Monday, 9/20 – Wednesday, 9/22/10, at the Hilton Hotel, 121 4th Avenue South, Nashville. For more information, visit www.ahfsa.org.
9. TEAC VIDEOCONFERENCE – Thursday, 10/07/10, 11:00 a.m. – 1:00 p.m.
10 TEF BOARD OF DIRECTORS MEETING – Thursday, 11/04/10, 7:00 p.m.
11. TEAC MEMBERSHIP MEETING – Thursday, 12/02/10, 11:00 a.m. – 1:30 p.m.
Submitted by Laurie Loughlin
Minutes for October 7, 2010
MEMBERS PRESENT: Laurie Loughlin, Kort Nygard, Michael SantoroGUEST – Carol Mace – State Government Liaison
TEAC requested the State Government Liaison’s presence at this meeting because discussion topics included the State of Tennessee.
Because no one else showed up at any of the available sites, by mutual decision of those present, the TEAC Videoconference was cancelled.
At their November meeting, the Board of Directors will discuss the advisability of scheduling future videoconferences, with a likely outcome that there will be no more.
Mark Your Calendar:
1. TEF BOARD OF DIRECTORS MEETING – Thursday, 11/04/10, 7:00 p.m. at Sole Mio Restaurant, 311 3rd Avenue South, Nashville.
2. TEAC MEMBERSHIP MEETING – Thursday, 12/02/10, 11:00 a.m. – 1:30 p.m.
Submitted by Laurie Loughlin