HouseWorks - Our 12-Month Subscription Suite
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Culture Change is QAPI
Flipbook version of Culture Change is QAPI presentation
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Household Model Characteristics
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PersonFirst® is a proven train-the-trainer process for creating and sustaining a community-based culture of person-centered support for all, including people living with memory loss or dementia. Our approach will energize your organization and enable everyone in it to learn PersonFirst® skills. Imagine the impact of dining, housekeeping, maintenance, administrative and nursing staff, family members and residents all perpetuating the PersonFirst® way of life throughout your care home.
… time is short: limit that far-reaching hope. The envious moment is flying now, now, while we’re speaking: Seize the day (carpe diem), place in the hours that come as little faith as you can.
-- Odes: Carpe Diem, by Horace (Quintus Horatius Flaccus)
Dear Friends in Dementia Caregiving,
Horace’s ode, Carpe Diem (translation: Seize the Day), reminds us that we have only the current moment to squeeze out every drop of life’s nectar and lay the foundation for our future. As care providers, we must seize the day to secure the reality we want for our elders and staff – one that enables even the frailest to experience “the envious moment” to the greatest depth possible.
Action Pact’s PersonFirst® train-the-trainer program enables your care home to do exactly that. We bring together staff, residents with dementia, and residents’ families to cooperatively form a culture that puts the wants and needs of the individual above those of the institution.
In the new PersonFirst® culture, we value residents with dementia as unique individuals who still have a purpose; who still bring meaning to our own lives and society. As we learn to recognize and nurture the identity of the person hidden behind the fog of dementia, the rigid barriers separating them from their caregivers and families begin to crumble.
A new vitality takes hold within the organization as those with cognitive loss come out of the shadows and join the care home’s circle of community and sharing.
Through intensive, on-site training, our team of PersonFirst® consultants will endow 25 members of your organization with exceptional expertise in putting people first. Those 25 members are then certified to train everyone in your care home. Your organization will be certified to use our PersonFirst® materials and continue educating long after our consultants’ initial training is completed.
CLICK HERE to request more information about the process and expectations for PersonFirst® training. Carpe diem; seize the day for all of your residents, with special attention to those living with dementia.
Creator of PersonFirst®
Compare a typical day in an institutional setting
versus a PersonFirst® environment.
This morning a strange man was in my bedroom when I woke up. I told him to go away but he said it was time to get up. The light was so bright and he was in such a hurry. He asked what I wanted to wear but before I could answer he took a sweater out of my closet. I said I didn’t want to wear a sweater. He just said we had to hurry and get to breakfast. Why were we having breakfast at 6 o’clock at night when it is dark out? I started to cry. Finally he stopped and looked at me. “Listen,” he said, “we have to go to breakfast now. It will be just fine.” He took me out of my room in my wheel chair, and then left. A woman came up to me and said, “What are you doing here in the hallway? Where’s John?” I said I didn’t know and couldn’t I just go back to my room. Then the man came back and he and the woman stood on either side of me and talked for a while. I think they were laughing at me. I wanted to go to sleep but there was so much noise, so many people. Then another woman came and wheeled me up to a table. I wanted to use the rest room but the woman didn’t understand. She said I just did that, but I wanted to go. Nobody listens to me. Instead she brought me some orange juice. I tried to tell her I wanted to go to the rest room but she walked away. The man next to me was shaking his head. I don’t know why he does that. I didn’t like all that movement. Someone brought me fried eggs and some cold white toast. I like my eggs scrambled but the girl just smiled at me when I said so. I just want to go back to my room and go back to bed.
A PersonFirst® Morning
I love to sleep in. Let the early bird get the worm, I say. But I’m usually awake by 9:30. It never fails: not long after I open my eyes Mary peeks her head in my bedroom door and says, “Oh, it’s a good one today!” She turns on my bedside lamp and brings me a glass of orange juice, my medicine and the funny papers.
We both like Family Circus. She says the little boy reminds her of her son and he reminds me of my son, too. She goes to my closet and asks if it is a red day or a green day to help me decide what color shirt to wear. I like to dress myself. Mary is patient with me and is right there if I need help. I like the way she hums while I’m getting ready. My brother always hummed. Sometimes I hum along. Then she turns to me and says “Ready?” and I say, “Ready.” She opens my drapes and takes me to the windowsill to water my plants. Last week one of them bloomed and she asked me if she could bring one of the other girls in to see it. She did and I was so proud. Now that same girl sometimes stops by in the afternoon to say hi and tell me about her garden.
Mary takes me to the dining room. Since I am a late riser, the dining room is not too busy. Mary asks if I’d like cereal or scrambled eggs. When I choose eggs, she always remembers to bring me ketchup. Then Mary says she has other people to help, but she’ll be around if I need her. I finish my breakfast and Mary says, “Ready?” and sometimes I say, “Ready,” and want to go back to my room. But sometimes I just want to sit at the table for a while. Mary might pour a little more coffee for me and some for herself. She’s a good friend.
Now read what people are saying about the power of this program.
PersonFirst® at Pacifica
Recently 23 Pacifica staff, residents and relatives attended the first round of PersonFirst® training and WOW -- what a couple of days we had! I have had a number of staff come to me since to thank me for the opportunity to attend, and I've also had other staff asking when the next session is being held so they too can attend. Obviously the 'vibe' from the training is permeating our home. I have already scheduled our next session and have a list of staff, residents and relatives who wish to attend.
There are so many aspects of this training that will help us improve our residents’ quality of life and involvement in their home, but there was a resounding affirmation of the benefits for all participants of the Community Circles. Community Circles are being conducted in all four of our households now. The Memory Support Unit, through great leadership and participation, have been holding Community Circles daily -- and on some occasions twice daily. The topics discussed have included birthplace, food, hobbies, likes, dislikes, time spent in the services, fashion and many more. Two of our residents in Memory Support realised they had lived near each other for many years when they were children. Staff are getting to know the residents better and residents are getting to know the staff. It is truly a 'win-win' situation.
Ihave also enjoyed some sing-alongs in two households that join together following their community circle because they enjoyed the sing-along at the beginning and the end of the Community Circle so much. Oh my gosh -- such a lovely sight to see residents and staff alike getting involved, smiling and laughing.
Just goes to show how this training has inspired the staff that attended and how this has flowed into what they are doing in only one day. I am so looking forward to keeping this momentum going.
What a great time to be working in Residential Care. So exciting.
From Jo Butler, of UnitingCare in Australia
PersonFirst® at Virginia United Methodist Homes
Recently Hermitage on the Eastern Shore has had two great examples of Person Centered success.
The first resident, Mrs. E, at 90 years old, wanted to be able to go shopping for her personal items with a team member rather than have the shopping done for her by the Activity Team members. After holding a learning circle with the Activity Team, a Transportation Team member and Mrs. E, we created a plan. At the beginning of the month, the transportation team member would meet with Mrs. E and the two would decide on a date for the shopping trip. The trip took place this week, and she felt empowered by the chance to make a decision with our support. We worked together to make it happen. A side note: before we began our more person-centered focus at Hermitage on the Eastern Shore, we would have rejected the idea with many reasons why we could not do this, i.e. "you can't do it for all so you can't do it for one," or "we don't have the resources for this."
In the second example, Mrs. G, who lives in a private room, loves to order clothing and other items. While this was satisfying to her, storage in her room was becoming an issue. Time after time, staff tried to help her decide what she wanted to "weed out" or "send home with her son." She always refused as she wanted her items here with her. After having a learning circle with her companion, C.N.A.s, Nursing Team members and Mrs. G, we offered her a storage space that has routinely been offered only to IL residents. Mrs. G. felt like she had a reasonable option for her extra clothing and that team members support her in what brings her pleasure.
From Kristie Annis, Hermitage on the Eastern Shore
Hear The Voice of Households
Listen to voices from a variety of household communities, reflecting on household life and sharing stories.
Danielle Brunson, CNA, from the Davis Community in Wilmington, NC
Sherry Lynn Lyttle, Homemaker II (Dietary) at The Davis Community in Wilmington, NC
Action Pact in the News
Find out more about us. On this page you will find links to Action Pact in the news, press releases, articles and events featuring Action Pact.
► Transformative Leadership: Reinventing How We Age | Steve Shields | TEDxFHSU
► Putting the 'Home' in Nursing Home, Atlantic, July 10, 2014
See also Kaiser Health News July 10, 2014
► A design overhaul from Action Pact puts the ‘home’ back in the nursing home model, MEDCITY News, July 10, 2014
► Wisconsin Nursing Homes are Becoming More Home Than Nursing, Milwaukee Journal Sentinel, April 21, 2014
Nurses Guide workbook
Workshops by location
Look for your state -- or one nearby,
and find workshops to attend!
FOR DETAILS ON ANY OF THE LISTED WORKSHOPS,
PLEASE CLICK ON THIS LINK TO OUR CALENDAR.
None presently scheduled
None presently scheduled
None presently scheduled
Check back for 2019 dates and topics.
Design and Development
From the very first steps of project scoping, to design assistance, financial modeling and operational expertise, Action Pact Development offers a truly comprehensive suite of services for organizations with a vision of transformed elder care.
Additional services include strategic planning, board development, design and build. Whether building from the ground up or retrofitting an existing campus, organizations can now partner with Action Pact throughout the entire process.
For more information, call Steve Shields, CEO of Action Pact, at 785.313.4059
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’s expertise and scope of service include: pre-feasibility analysis (integrated financial, design and programming); full design and development; and consultation and training to transform the organization’s culture, structure, and household operations. The result: Aging and frail seniors enjoy all that home offers, direct their own lives, experience daily pleasures and continue to live with meaning and purpose. Read more...
New Dining Practice Standards
From remodeling to new construction, Action Pact Design offers architectural design services to organizations with a vision of transformed elder care.
The architects of Action Pact Design have Household Model specific experience with an understanding of how good design can influence the life and behavior of those who live and work in care environments.
The architects’ previous and ongoing involvement with Action Pact Development in the project scoping and financial modeling process gives them unique perspective and skills for the particulars of long-term care transformation.
• Master Planning: Site Selection, Facility Evaluation, Master Planning, Functional and Space Programming, Short stay environments, Equipment Planning, Technology Planning, Cost Analysis, Project Budgeting
• Architecture: Retirement living and health care campuses including households for skilled nursing, memory care, assisted living, short term rehab, home plus
• Interior design: Interiors Master Planning, Concept Design, Image Development, Space Planning, Interiors Evaluations, Art Consultation, Finishings and Interiors, way-finding
Action Pact Design’s portfolio includes:
- Kansas Masonic Home, Wichita, KS
- Kansas Masonic Rehabilitation Household, Wichita, KS
- Meadowlark Hills, Manhattan, KS: Library Remodel - Massage Therapy Remodel - Physical Therapy Remodel - Wayfinding Masterplan - Maintenance Facility - Lyle House Remodel - Community Center Bathrooms - Exterior Tower Remodel - Doctor's Office
- Care Cottages, Lawrence KS
- Inglis House, Philadelphia, PA
- Rosedale Green, Covington, KY
- Fellowship Village, Basking Ridge, NJ
- Midland Care, Topeka, KS
- Leonardville Nursing Home, Leonardville, KS
- Fair Haven, Birmingham, AL
- Wesley Manor, Dothan, AL
- Asbury Place, Maryville, TN
- Crown Point Health Suites, Lubbock, TX
- Autumn Hills, Riley, KS
- The Davis Community, Wilmington, NC
Tales of Transformation
On this page you will find motivating stories from communities who have embraced Culture Change, promote Wellness, and are working to create Vibrant Living. The stories will change regularly and provide ideas and insights, share struggles, and make you smile -- perhaps even laugh out loud!
Lowdown at the Loo
The job of the High Involvement Action Team is to get everyone in the organization involved in the transformation process; to get them informed and excited about the changes happening in their community.
The High Involvement Team at Manor Park Retirement Community in Midland, TX (came up with a creative way to spread the word about culture change throughout their campus. They call it, “Lowdown at the Loo.” Now, in each of the 50+ bathrooms on campus, you’ll find a plastic sleeve in the stall or in front of the paper towel dispenser where the latest issue of “Lowdown at the Loo” is posted. As Manor Park begins to form neighborhoods from their four halls, it is a critical time to get folks excited and involved.
Sherice Barndt, a member of the High Involvement Team explains, “The team decided that if we covered all the bathrooms on the campus we could reach a variety of people - staff, residents and family. The team agreed we should limit the information so that it wasn’t more than could be read in a typical bathroom visit. We chose three topics to address: Highlighting Action Teams, Good News from around the campus, and What’s in a Name defining a term from the new culture change language.” The first issue defined “loo,” a British slang term for toilet.
A new issue has come out monthly for the last eight months and the team believes there has been a positive response from everyone involved. “It has generated interest and inspired questions for the Steering Team staff to address. Residents from Independent Living have become more curious and involved after reading the different issues of the ‘Loo’,” Sherice says.
From our February 2012 newsletter
A Nice Warm Bath
The Steering Team at St. Margaret’s in New Orleans, LA didn’t want to wait for their new building to make their environment more comfortable for the residents. After holding learning circles about what they could do in the current building that wouldn’t be cost prohibitive but would make residents feel more at home, they decided the bathroom would be a great place to start because it is used every day and by everybody.
The Steering Team set up two Action Teams, one for each floor, to get input from residents about what they would like in their bathing rooms. (Each floor has two, one with a whirlpool and shower and one with just a shower.) Each team went about getting resident input in its own way. One team asked four residents to be on the Action Team while the other team surveyed all the residents on the floor about their preferences.
Each floor decided on a theme for their bathroom; one a New Orleans/French Quarter theme and the other went for a beach design. Staff brought in paint swatches to help residents decide on paint colors and got their input on towels, shower curtains and décor. Charlie Vaugn, St Margaret’s maintenance man, also an artist, painted murals in each of the whirlpool rooms. While residents are in the tub, they now look upon a scene of French doors, open to a balcony draped in plants and the French Quarter below. The residents on the other floor have a beach scene to help them relax.
The residents were very excited about the changes. It created quite a buzz and they were always anxious for the next bit of the decor to be added. On a roll with the bathrooms, the CNAs decided to do away with the bathing schedule and asked each resident when he or she would like her bath or shower. They also decided that everyone would give baths instead of having one CNA as a bathing aide. The video “Bathing Without a Battle” helped them with new techniques, allowing residents who once fought bathing to be more relaxed. Even family members have noticed and appreciated the changes.
St Margaret’s proves once again, when you get lots of folks involved you can make a big impact with small changes and budget.
From our August 2012 newsletter
Compassionate Healing at The Cottages at Brushy Creek
Religious services have long been a staple in nursing homes. But, a new approach to nursing homes
requires a new approach to the spiritual and communal needs of those living and working there.
Rev. Ralph May, the chaplain at The Cottages at Brushy Creek in Greer, SC, has been cultivating culture change in worship services of this new community and in his own approach to spiritual service.
In addition to the usual weekly worship services, once a month around 130 elders, staff, family
members and volunteers gather for a non-denominational Christian service lead by the elders. A
potluck with dishes brought from the 12 cottage kitchens follows. “Our elders both offer and receive
compassionate healing,” said Rev. May. “There is the participation that comes from being in an
audience and participation that comes from speaking before a group and leading. The second kind
of participation brings with it the exciting anticipation of performance and the associated sense of
personal accomplishment. From beginning to end, Cottage elders lead our worship: starting with an
invocation, including the homily, on through the extemporaneous prayer of the people, and ending
with a benediction. We, the audience, benefit from their wisdom. They, the leaders, find purpose
and meaning in their continued participation in the community. Through it all, elders, family and
staff, are transformed through our service to one another. “
Many elders and staff participate in the choir, which practices weekly, and some elders take roles
leading parts of the service. Rev. May finds volunteers during his pastoral care visits and the weekly
services. “I’ll ask elders if they would like to help lead worship. I often have more volunteers than
parts,” he said. “We provide them with as much or as little support as the individual elder requires.
We have a diverse community. I match the abilities and gifts of the elder with their part of the service
to optimize the participation of each individual.”
Like many culture change efforts, these services have been transformative for elders. Rev. May
thought one particular elder who had a “wonderful, clear voice” would be a great addition to the
service, but she did not want to join in. Then, at the first worship service, she saw other elders singing
and leading worship. “Then she wanted to join the choir. Shortly there after, she became a worship
leader. This is a prime example of elder healing elder,” said Rev. May.
The elders aren’t the only ones transformed by this new approach to worship service. Rev. May feels
changes too. “One of the challenges for me was, and is, giving up the sermon. I am the preacher after
all. Well, not really; I’m not the preacher, I’m the chaplain. Preachers preach and chaplains support.
Supporting this style worship transforms my belief system. Culture change is not just happening out
there. The most important culture change is happening inside me. As I grow, my personal sense of
urgency for the need for continued transformation increases,” he said.
From our November 2009 newsletter
Chaplains are invited to join "Chaplains for Culture Change," our new LInkedIn group -- a forum for discussion about spirituality and Culture Change. (Share this with your chaplain!)
Let's Play Ball! Pennybyrn Goes Major League
All over the country, the baseball season is now in full swing (pun intended), but at Pennybyrn at Maryfield in High Point, NC, it’s always baseball season. At least once a month for the past two years they’ve been clearing out everything in the town square of the facility to make room for the baseball diamond. It’s always the same match-up: The Pennybyrn Racers (residents) against The Maryfield Staffers (staff). There is plenty of cheering, base stealing and smack-talk. It’s at least as rowdy and as much fun as anything you’ll find in the major leagues. “Everyone gets involved,” said Janet Golden, Lead Activity/Life Enhancement, “People who don’t usually come out for activities bat the ball.”
All agree the baseball game is a highlight in the Pennybyrn community. But, there was one game that almost didn’t happen. The game was scheduled during the week the survey team was at Pennybyrn to conduct the annual survey and this gave Administrator Vonda Hollingsworth pause:
“On the way to work that morning, I thought to myself, ‘Jeez, I wonder what they will think?’ When we play, it is loud and crazy with everybody running this way and that, trying to steal bases, and residents being pushed in wheelchairs or running arm in arm with staff round the bases. Would the surveyors think we are putting our residents’ safety at risk? I knew the surveyors would be right in the middle of it since they were working out of a room in our town square.
Then I thought - what am I doing? Whose choice is it to take a risk? I am “taking chances” right now-driving my car. Individuals should be able to decide themselves what risk they want to take. Our residents are LIVING and living life is all about little risks everyday. If they want to play ball, my apprehension should not stop them. I thought there might be a real chance the surveyors would not like our game - but that was a risk I was willing to take. To my delight, several of the surveyors stop working to watch our game. They laughed and even cheered. It turned out they thought it was wonderful! I am so glad that I didn’t allow my hesitation to limit our residents’ ability to choose their life that day.
LaVrene Norton witnessed a game on a visit and was delighted to witness some serious living going on when she saw a resident being whizzed around the bases in her wheelchair – legs straight out in front of her with a look on her face that was wide-eyed exhilaration.
That’s how you play ball!
From our May 2010 newsletter
The Kitchen’s Always Open
￼Many night owls will tell you they get some of their best ideas in the dark hours. Community Care of Rutherford County (CCRC) in Murfreesboro, TN got one of its best ideas because of its many night owl residents. CCRC, while organized in neighborhoods, with one central kitchen and dining room, makes food available to residents 24 hours a day, seven days a week.
Staff had noticed that there were several night owls among the residents. “If you’ve always been a night owl, that doesn’t suddenly change when you move into a nursing home,” Dietary Director Trena Serrano said.
Of course, sleep patterns affect other patterns. “By sleeping in the day time and being awake at night, these residents’ eating cycles were non-traditional and accommodations needed to be made,” Mark King, Director of the nursing home said. The solution was to make a la carte menu available during night hours.
The work duties in the traditional nursing home kitchen center on preparation for opening and closing the kitchen. If the kitchen were kept open 24/7, it would no longer be necessary for second shift workers to complete duties such as preparation for breakfast before closing the kitchen. Cleaning schedules were adjusted as well. Since the third shift dietary worker would have time to do these duties on third shift, they could add this extra shift coverage without adding additional staff hours - merely reassigning one daytime worker to nights.
Leadership asked for a long-term, dietary daytime worker to consider reassignment to the hours traditional kitchens are closed (9 p.m. to 5 a.m.). They wanted someone who in addition to having short-order cooking experience, demonstrated concern for residents, was self-motivated, cleanliness conscious, and not afraid to work at night. Without much effort, one volunteered and took on the responsibility to work Sunday through Thursday. She is paid a shift differential and a part-time coworker covers Friday and Saturday nights.
The night owls benefitted right away. When everyone saw this, they decided to offer a la carte menu all day, every day, so that all residents might have the benefit of eating when it suits them. When a resident wants something to eat, a staff member calls the order down to the kitchen, the kitchen calls back when it is ready and then the staff member goes to the kitchen to bring the order back to the resident. “Sometimes it gets busy,” Trena says of the extra effort put on staff by the process, “But staff buy into the philosophy of doing what makes the residents happy. They don’t say, ‘We can’t do that!’ They say, ‘What can I do?’”
Perhaps as a direct result of this new availability of food, all current weight-loss can be tracked to illness. In fact they are seeing healthy weight gain among the residents, according to Trena. In July 2011, 569 a la carte orders were made.
From our Sept., 2011 newsletter
Lessons of a Lifetime
When Household Coordinator Jan Braun saw a story on TV about a young boy who writes famous people asking them what the most important thing in their life is, she thought “What is it about Tom Cruise or the Pope that is any more special than anyone else? Everyone has had their own successes and challenges.” And thus was born the “Lessons of a Lifetime” project at Shorehaven Health Center in Oconomowoc, WI.
Staff members were asked to ask residents, “What are the two most important things in your life you’d like to pass on?” Braun said it was a great way for staff to connect with residents and their family members, who were asked to help answer in cases when the resident was unable to talk. Staff were asked to answer the question as well. All the answers were then collected to be put into a booklet. Braun asked a resident who was a teacher to go through them all with a red pen and check for spelling and grammar errors. The resident also put them in order according to the age of the person who answered. The book starts with an entry from a resident who is 101-years old and continues on to include 18-year old staff members. Braun said that everyone, no matter their age, has things they have learned in their life.
Every resident was given a copy of the finished book that includes great candid photos from the households. Braun was pleased to be able to take a copy to the funeral of a resident who passed away to share with the family this special part of the person’s life.
The Lessons of a Lifetime project is a great way for people in the Shorehaven community to get to know one another both in the interview process and also after publication. As residents and staff pick up the book and flip through, they learn about each other and have things to talk about. It also honors every person involved by acknowledging the value in each person’s life, no matter age or role in the Shorehaven community.
From our June 2011 newsletter
Homelessness Skit -- Powerful Message now a Major Motion Picture!
The need for true home for elders living in nursing homes suddenly becomes urgent when one realizes the many similarities between these elders and the homeless. Lack of privacy, loss of personhood, feelings of powerlessness and dependency are overwhelming for those living in traditional nursing homes, and on the street.
Action Pact trainings often include an examination of these similarities to create motivation and momentum for culture change work. Two members of the Steering Team from Pilgrim Place in Claremont, CA (http://www.pilgrimplace.org/) decided to put together a skit to illustrate the similarities to their peers as part of this training. Independent Living resident Eleanor Scott Myers and Staff Developer Rachel Von Stein play a homeless person and elder in a nursing home respectively. The two characters have a frank and empathetic discussion about the parallel indignities in their lives. The skit was so well done and powerful, they were encouraged to video tape it to be used as part of the PersonFirst® trainings done throughout the organization. “[People in the trainings] see things they had never thought of before that a resident might feel because of things we do,” said Sue Fairely, VP of Health Services at Pilgrim Place.
The skit is now available on YouTube: http://www.youtube.com/watch?v=Opd2cgN7Pnw
We encourage you to check it out and share it to awaken that urgency in your organization.
From our November, 2011 newsletter
Other Links and Resources:
From this page you can view Action Pact's e-newsletters prior to 2013.
In January of 2013 we moved to a new monthly email format which highlights events on our calendar and provides links to articles on our Neighbors Blog.
The archived newsletter links below contain news and views from the world of culture change, still relevant and interesting.
You can sign up to receive our newsletter by clicking here.
1. Winning Video Shares Special Culture Change Story
2. If You’re Considering Creating Households, Let Go of Preconceptions
3. Affirmation of a Job Well Done
1.The Household Tree
2. Pioneer Network Conference Early Registration
1.Knitting Up Connections
2.WANTED: Director of Nursing
3.GREAT IDEA! Households Sharing Insights and Info
September, 2005 (update)
Articles and Papers
Action Pact’s senior consultant Linda Bump, MPH, RD, helped draft the “New Dining Practice Standards” put out by the Food and Dining Clinical Standards Task Force. The work of the task force was sponsored by The Pioneer Network and The Rothschild Foundation. This work sprung from the 2010 national symposia “Creating Home II: Dining,” which was co-sponsored by CMS and the Pioneer Network to address the challenges of honoring resident rights and choice in dining, consistent with OBRA 1987.
Linda Bump also contributed a white paper, “The Deep Seated Issue of Choice,” as a background paper for the 2010 symposia.
Other articles of interest:
The New Dining Practice Standards, drafted & edited by Carmen Bowman
Dining at Home, an Action Pact collaboration
Person-Centerd Care Planning - Honoring Choice While Mitigating Risk, By: Margaret Calkins Karen Schoeneman Jennifer Brush Robert Mayer; Second Edition - The Mayer-Rothschild Foundation, 2017
Care Planning for Resident Choice - a Process, Rothschild Person-Centered Care Planning Task Force
Old Age in a New Age: An interview with author Beth Baker
Development of the Artifacts of Culture Change Tool by Karen Schoeneman and Carmen Bowman
A Stage Model of Culture Change in Nursing Homes by Leslie Grant, PhD and LaVrene Norton, MSW
Spotlight on Regulations
The Learning Circle
The Learning Circle is the cornerstone of communication in the Household Model and is used and referenced throughout our materials. Learn the basic concepts behind this great facilitation technique in this simple, one-page printable handout:
There are several variations on the learning circle that all hold the same principle value that every voice is important and should be heard. This handout gives guidance on these variations:
Ask Pact is our running "advice column" for culture change homes. Click on one of the individual topics below to download a printable version of a discussion to use in your trainings or to copy and hand out to staff.
Culture Change in Practice
The following are archived entries from our weblog, "Culture Change in Practice". Each opens as a PDF, ready to print for use in your training sessions, with your team or just for handy reference. All instructions and handouts are included.
Culture Change: you know what it is, you value its worth, but do you know how to actually jump in and direct change in your organization? Our workbooks are full of the practical information, tips and direction that you need: hands-on manuals for change, written by nationally recognized experts in the field.
We offer a selection of article reprints from professional journals on various subjects relevant to your Culture Change journey. If you have an interest in purchasing multiple copies for staff education, please contact us for competitive bulk pricing.
Kits and Packs
Sometimes it takes more than just a book or a video to really create an effective tool for education, and in this section you'll find just that: comprehensive multimedia packages, kits and inservices to help you bring culture change concepts to your home.
Videos & DVDs
Action Pact videos are an ideal way to learn about culture change in long-term care. We have the following topics in video: innovations in nursing homes, culture change, person-centered care for dementia and Alzheimer's person-centered care plans, Learning Circles, and implementation of the Ten Principles of the Eden Alternative.
Culture Change Now! Magazine
Culture Change Now! is Action Pact's periodical for long term care professionals interested in Culture Change. It is filled with how-to information and articles of inspiration. All levels of staff and families will will enjoy the only publication solely dedicated to culture change!
As the only consulting company that has direct and current operating experience
in the Household Model and the full continuum of senior housing services,
Action Pact Development provides operational assessments to those organizations
that are looking to implement or have implemented the Household Model. We have
operated the Household Model in a retirement community for the last 10 years and
have extensive experience in terms of how providers should organize themselves
and operate. This includes the revenue base, staffing patterns, and other operating
expense levels necessary to succeed financially.
Following the conclusion of the IPA process, if the client wishes to proceed with the project and move forward with full design, construction, and implementation of the model, Action Pact Development can act as the project development coordinator. Services that APD can provide include, but are not limited to:
- Development team coordination
- Development budget creation, draw schedule, and cost tracking
- Regulatory approvals
- Furniture, fixture and equipment acquisitions list and budget
- Architectural design assistance
- Construction and project schedule monitoring
- Design plans for employees, board members, and residents to live/work in new model
- Develop management and administrative systems and tools needed to manage the campus
The development process was greatly simplified with APD on board for Matthew Bogner, CEO of Kansas Masonic Home. Read what he says here.
Better Than We Ever Dreamed
Spotlight on Storytelling
The Three Rs
Spotlight: Meadowlark Hills
Tales of Transformation
Spotlight: Old Age in a New Age
Interstate 85: Highway to Culture Change
Cancellations must be requested at least two weeks prior to the workshop. No refunds will be issued after that point. All refunds are subject to a 20% processing fee.
If you wish to transfer your registration to another session, you may do so at no charge, but we must know at least two weeks in advance so we can attempt to fill your seat. Transfers in the last two weeks before the session are only allowed if an annual state survey is in progress at your facility. Transfers within the two weeks prior to the event are subject to a surcharge of 20%.
Substitutions (sending a different person to take your place) are always accepted at no charge, even at the last minute.
Mail: Print an Order Form
Check, Money Order, or Invoice
Shipping Shipping Plans
Our books offer opportunity for in-depth study of the need for culture change in long-term care and the possibilities for better living for elders in the Household Model. Great for "book club" study in your organization.
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Action Pact has developed a full catalog of resources offering guidance, inspiration and practical information about a wide variety of culture change topics.
* Questions? Problems? Please contact Marsha Poulsen
ARCHIVED WEBINARS: If you are interested in viewing our past shows, we offer recorded broadcasts on many topics.
Learn more about our services
Contact LaVrene Norton
or Steve Shields
Over the years, Action Pact has developed and accumulated a vast store of knowledge and tools relevant to culture change. On this page you will find many training and educational handouts. They are yours to use in your facility, or in your practice if you are a trainer or consultant. Visit us often, as we will be adding new items in each category regularly.
Welcome Home: a video story of transformation to Households from Perham Memorial Hospital and Home (now Perham Living)
In most nursing homes, and in many assisted living services, a very important element has been forgotten: home. Without it, our elders experience a loss of joy and meaning in their lives. We know you believe that they deserve better. So do we. Action Pact can see you through every step of transforming an institution into true home, and restoring the pleasures of daily life to our elders.
For more information on any of these events, please call Action Pact at 414.258.3649 or email email@example.com. We also invite you to contact us if you would like us to bring one of these workshops to your organization, or to host a public workshop in exchange for registration discounts.
About Action Pact
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’s expertise and scope of service include: pre-feasibility analysis (integrated financial, design and programming); full design and development; and consultation and training to transform the organization’s culture, structure, and household operations. The result: Aging and frail seniors enjoy all that home offers, direct their own lives, experience daily pleasures and continue to live with meaning and purpose.
Action Pact Consulting works with clients to redesign the way the organization itself functions, moving from traditional top-down management towards a collaborative effort of self-governing teams. We work with the organization in a seamless fashion at any and all points along their journey from early vision through the development of new environments, to living in homey spaces with meaning and purpose and pleasure in daily living. Read more...
Action Pact Development offers a truly comprehensive suite of services for organizations with a vision of transformed elder care, from the very first steps of project scoping, to design assistance, financial modeling and operational expertise, Additional services include strategic planning, board development, design and build. Whether building from the ground up or retrofitting an existing campus, organizations can now partner with Action Pact throughout the entire process. Read more...
Action Pact Design is an architectural firm with a difference. They know the Household Model inside and out, and use their deep understanding of its principles and practices to create spaces where elders can lead rich, full, rewarding lives. As part of the Action Pact family, they work hand in hand with Action Pact developers and consultants to ensure that these spaces are also financially sustainable and capable of providing the highest quality care. Read more...
Action Pact is the leader in Household Model development and implementation. We work 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.
We articulate, size and scope expansion, retrofit and ground-up innovation projects on a variety of campuses that serve seniors, including but not limited to: CCRC, assisted living, nursing home, and small group homes. In addition to serving the senior living industry, our IPA process (described below) has been adapted for use in other environments such as physician practices, home health agencies, facilities for early childhood development and organizations for adults with physical disabilities. Read about organizations using the IPA.
Integrated Prefeasibility Analysis (IPA)™
The Integrated Prefeasibility Analysis (IPA) integrates professionals from a variety of disciplines to form a team responsible for developing a project plan that is designed to provide the optimal mix of architectural, operational, cultural, and financial variables. This front-end process helps you evaluate the feasibility of a major project before committing substantial resources.
The IPA approach should give you an integrated, clear view of the potential for the repositioning of your campus through:
- An architectural footprint
- A project scope, budget and timeline
- An operational budget with a 10-year forecast
The client heads the process with assistance from APD and the IPA team, The IPA team consists of an architect, contractor, operations and culture change expert, and a financial forecaster. This process can save the organization much money and unintended mistakes while integrating the cultural, environmental and financial elements of the project. When an organization’s leadership is decisive, the IPA team can produce a viable transformation project in three to ten full-day sessions, depending on the complexity of the existing campus. The results of this very important process will lead to the ultimate design, renovation and/or new construction.
Action Pact Development is renowned for our work in using the IPA process in the integration of the Household Model into existing or new senior living campuses.
When using the process to move to the Household Model, the process is driven by five integrated principles.
- Home – residents direct their own lives.
- Leadership is values driven (belief shaping) and resource bearing (growing skills and judgment).
- The organizational structure is made up of decentralized, self-led teams.
- The physical and cultural designs reflect home.
- The capital and operational model is financially viable and sustainable.
Shawn Sullivan and Matthew Bogner of Kansas Masonic Home are enthusiastic about our IPA process. Read what they say.
For Samaritan Bethany, the process inspired stakeholders to think beyond their comfort level and look at other possibilities … options they never knew existed before interacting with consultants during the IPA. Read more.
“I’ve worked with large financial-planning firms and boutique ones, and the work we did with Steve, Martin and the Action Pact Development team is as good as any I’ve ever done,” says Gavin Kerr, President and CEO of the Inglis Foundation in Philadelphia. Read more
As the waves of change in senior housing and services make way for an unheralded number of elders in the generation to come, planning is an integral component of any successful senior living organization. We help elder service organizations understand their current realities, anticipate the future trends of consumer desires, and organize their purposes, people and processes to create a preferred future. Comprehensive strategic planning is a complex and ongoing process of organizational change. Our role is to listen carefully, coordinate a planning process, and to advise and ultimately assist you and your organization in articulating your future. We have developed an extensive, 5-day process that involves all of the stakeholders of an organization - leaders, staff, board members, residents, and community. Within a one-week period, a comprehensive strategic plan is created and presented to the stakeholders for formal approval.
Shawn Sullivan and Matthew Bogner of Kansas Masonic Home are enthusiastic about our Strategic Planning services. Read how Action Pact Development helped them look ahead to plan for their future.
From the very first steps of project scoping, to design assistance, financial
modeling and operational expertise, Action Pact Development offers a truly
comprehensive suite of services for organizations with a vision of transformed
Additional services include strategic planning, board development, design and build. Whether
building from the ground up or retrofitting an existing campus, organizations can now partner
with Action Pact throughout the entire process.
Call Steve Shields, CEO at 785.313.4059
- ACTION PACT LEADERSHIP -
- LOCATIONS -
Action Pact Corporate Headquarters
4016 Washington Street, Suite 200
Kansas City MO 64111
Steve Shields, CEO firstname.lastname@example.org
Dylan Sultzer, CFO - email@example.com
Chris Cole, Chief Development Officer - firstname.lastname@example.org
Action Pact Consulting Office
7709 W. Lisbon Ave.
Milwaukee, WI 53222
Phone: (414) 258-3649
Fax: (414) 444-8815
LaVrene Norton, Founder - email@example.com
Action Pact's Development and Design Teams
4016 Washington Street, Suite 200
Kansas City MO 64111
Steve Shields, CEO - firstname.lastname@example.org
Chris Cole, Chief Development Officer - email@example.com
# # #
Action Pact - Atlanta office
368 Moreland Avenue NE, Ste. 210
Atlanta GA 30307
Martin Dickmann - firstname.lastname@example.org
Executive VP Development, Planning and Financial Services
For design and development inquiries, call our corporate office at (816) 359-3898
For questions about consulting services, workshops or our products, call (414) 258-3649
Action Pact Services
In the midst of the daily work of running a nursing home, it can be hard to find the time, energy, knowledge and perspective to figure out how to lead your organization to households or even advanced neighborhoods. Action Pact can help by bringing thoughtful resources and respected expertise to your efforts through a variety of consulting services. Jump start your journey and get everyone involved. Develop a well-thought out, long-term plan for transforming your organization. From one-day workshops to ongoing in-house custom consulting, we provide guidance and education for every step in your unique culture change journey.
For more information on Action Pact's consulting services, contact LaVrene Norton, Founder
For more information about workshops and webinars, contact email@example.com
Every change needs a catalyst. Action Pact workshops will get you excited about the possibilities for better daily life for elders in long-term care. Packed full of information, ideas, exercises and practical planning, each workshop focuses on a specific aspect of culture change and how you can get started right away.
Action Pact offers dynamic 1-day workshops on a variety of topics to inject your efforts with new ideas, energy, practical information and strategies.
For more information about workshops, contact Marsha Poulsen: firstname.lastname@example.org
While each organization’s culture change journey and outcome are unique, study and exploration of other organizations’ struggles and triumphs on the journey can help build momentum and offer food for thought. Also, the sharing of stories helps everyone learn, grow, grapple with possibilities and celebrate. Here we share stories of homes that have embraced the goal of true home for elders and the many facets and stages of transformation.
About Culture Change
Nursing homes are changing into personal communities households and neighborhoods, staffed by familiar caregivers who are there to assist residents as they live lives of meaning, value and joy. They have private spaces and family places and a chance to continue to live life with some measure of independence and responsibility. Led by human compassion and economic foresight, facilities are applying historically successful, common sense approaches to living and caring for elders. The result: long-term care communities where elders choose to live their lives with staff who enjoy assisting them.
These communities provide the best personal, health and medical services any community member, however frail, will need. Some have gone as far as giving each their own homey kitchen, dining room and living room, where staff and elders prepare and eat meals together. Each day is informal, like a day in our own homes, and results in a truly rewarding and satisfying daily life for elders and staff alike. It’s not home-like, it’s home.
Culture change is a process and movement of transforming traditional, institutional long-term care facilities, into true homes. It involves a change of environment, systems and attitude. It’s not just a change you can see, it’s a change you feel; a change elders feel as they direct their own lives and staff feel as they are empowered to help them do so.
Steve Shields, CEO
2505 Anderson Avenue, Suite 202
Manhattan, KS 66502
Martin Dickmann, CFO
160 Clairemont Avenue, Suite 200
Decatur, GA 30030
Why would we ask anyone to give up home, just when they need it the most?
In the Household Model, long-term care homes adopt a person-centered approach that shapes the physical environment, organizational structure, and interpersonal relationships in ways that create an atmosphere of genuine home, while providing elders with clear opportunities to direct their own lives.
The Household Model breaks down a traditional facility or new development into households of 14-20 residents, with their own kitchen, dining room, living room and often the extra small cozy spaces you’d find in any home (den, patio, front porch).
Each household has decision-making autonomy and is consistently staffed. Residents get up when they want, bathe how and when they want, go to bed when they want, eat when and what they want and decide how they will spend their day. Household life is “normal,” spontaneous and full of new experiences. Quality of Care and Quality of Life are of the highest and benefit from a symbiotic relationship.
A true Household Model is built through the development of the three components that support a home where elders are in the driver’s seat:
Renewal of the Spirit
100% of the people who live and work in the organization are involved in the transformation process and in sustaining daily household life. Staff, residents and families work together to create purpose and meaning within the nursing home.
Reframing the Organization
Traditional departments are eliminated to integrate disciplines with the self-led household team structure. In retirement communities the system-wide departments (facilities and grounds, dining services, marketing and sales) often change their nomenclature from “departments” to “services,” further strengthening the philosophy resident-directed community and resource-bearing leadership.
Leadership is spread throughout the organization. Frontline staff, residents, family members, managers and executives share leadership responsibilities and are all empowered to make life-impacting decisions as a team.
Renovating Into Home
Reshaping the physical environment into neighborhoods or households with their own living room and dining room, and -- in households -- a kitchen. Homey spaces and furnishings must be a part of any renovation.
In their book, In Pursuit of the Sunbeam, LaVrene Norton and Steve Shields give us “The Essential Elements of the Household Model,” illustrating the depth and nuance of thinking that goes into making the model a success:
- The household is each resident’s home and sanctuary.
- The people who live here direct their own lives, individually and collectively.
- The boundaries of the person and his/her home are clear and respected as a matter of course.
- Grace, a shared sense of what is sacred about the household and its people, is deeply valued, consciously created and preserved. Ritual, spontaneity, friendship, spirituality, celebration, recreation, choice, interdependence, art, and humor are all manifestations of a culture of grace.
- The people who live here are loved and served by a responsive, highly valued, decentralized, self-led service team that has responsibility, authority, and accountability.
- Leadership is a characteristic, not a position. Leaders support and are supported by values-driven, resource-bearing principles and practices as a way for each person to actualize his or her full potential.
- All systems, including treatments, exist to support and serve the person within the context of his or her life pursuits.
- We build strong community with one another, our family, neighbors, and town. Each household is part of a neighborhood of households, dedicated to continuous learning.
- The physical building and all its amenities are designed to be a true home. Institutional creep in design and culture is treated as a wolf at the door.
- The establishment of a healthy and sustainable home comes through the integrated balance of resident-driven life, leadership, organizational structure, physical environment and financial sustainability.
LaVrene Norton and Action Pact were the first to speak of the Household Model. They defined it and articulated its philosophy and values. In 1997, the first households within this model opened at Northern Pines (now Bigfork Valley) in Bigfork, MN, developed by Linda Bump and guided and supported by Action Pact. LaVrene Norton immediately encouraged Bill Thomas (Green House) and Steve Shields (Meadowlark Hills) to visit this innovation. They went on to develop their own successful household environments and soon the long-term care world was buzzing about the possibilities for a real home to replace the nursing home. Each small group of residents (10 – 20) living in private rooms around a shared kitchen, dining room, living room, front door and back yard. Since then, Action Pact has guided scores of nursing homes across the country in their transformation from institution to Household Model.
Action Pact consultants pair extensive and first-hand knowledge of nursing home operation and transformation with resources and facilitation skills to help move your organization along its culture change journey. From getting the ball rolling, to moving into households, our consultants offer customized guidance, training and a road map for involving everyone in your organization in the transformation to home.
Call LaVrene Norton, founder of
Action Pact at 414.258.3649
or email: LaVrene@actionpact.com
Transformation to Households
The physical reconfiguration of households must be supported by strong, healthy household teams, elder-directed daily life, organizational redesign and transformational leadership. Action Pact’s Household Model training and consulting works the organization through the model’s many facets, involving everyone in creating and sustaining the profound change.
The 18- to 24-month process includes:
(To be added on top of Changing Culture to Neighborhoods trainings)
10 days of educational sessions and operational redesign consulting on:
- Teams renovating into home
- Holistic view- encouraging meaning and purpose through a new Quality of Life team approach
- Reframing the organization to move decisions back to the elders
- People skills for households
- Household leader training
This option includes: one tuition for workshops: Household Leader Training for Mentor, and Nurse Leader Training for nursing executive.
Changing Culture to Neighborhoods
Neighborhoods can be a destination or a transition stage on your way to households.
Action Pact offers resources and trainings to help develop neighborhood teams, offer more resident choice, grow leadership and high involvement throughout the organization, share decision making, create home, build community and make dining more pleasurable along with a host of other skills necessary to bring about and sustain culture change.
15 days of educational sessions and consulting centered on PersonFirst® training plus 4 key two-day visits (topic 1-4 below)
- Leadership – Challenges of leadership Introduction to culture change (2 days)
- Homeless to home – leading through change to create home (2 days)
- Through New Eyes - studying changes in process and systems (2 days)
- Creating the self-led teams (2 days)
- PersonFirst® renewing our commitment through new skills (7 days)
This option includes one tuition for Choreography of Culture Change and one tuition for Life Happens in the Kitchen.
You’re ready for change, but where and how to start? An Action Pact consultant can offer a fresh and knowledgeable look at your organization; what you’re already doing well, opportunities for growth and some good places to begin your work.
The assessment provides 40 – 80 hours of on-site observation, interviews and a review of documents, resulting in a deep discussion of appropriate possibilities and an extensive report that can be used to guide your culture change journey - with or without physical renovations; with or without Action Pact consult and training on organizational and cultural transformation. Report is 15 + pages of detailed observation, interpretation, recommendations. Ask for references to explore the value of this process and report.
Culture Change Immersion
Involve everyone immediately in your culture change commitment. Work out a schedule that allows every single employee (and interested families and residents) to participate in a 4- to 6-hour workshop over a 2- to 3-day time period. The results are powerful:
- Everyone feels rewarded and attended to;
- Everyone comes away with the same understanding of why the Eden Alternative is worth all the trouble;
- Real issues and concerns are brought out and discussed;
- New team skills are learned that benefit the facility immediately; and
- Excitement is channeled into real possibilities.
This course is a Trainer Training program that licenses your organization. Action Pact grows and certifies 25 folks in your organization to have a special expertise in PersonFirst®, that is, in putting the person first. It is of value in relationships with all residents but is of particular impact in relationships with people living with cognitive loss.
The students in this course become the trainers. As PersonFirst® trainers they will, in the future, train 100% of your existing staff, as well as all new staff who come on board. They will also educate as many Independent Living residents and friends and family members of nursing home residents who are interested.
The method focuses on how to help the nursing home resident feel good about oneself, to be in the moment, to talk and relate, and to have a lovely time. This results in the nursing home resident being in a good place, and equally important, the visitor, friend or caregiver being in a good place as well.
Your team of 25 Trainers and Community Builders work together after being certified by Action Pact to establish Action Plans that promote this new way. (Community Builders are those who take the course but then decide that they prefer to nurture PersonFirst® practices through hands-on role-modeling rather than teaching others.)
The result: many more people feeling comfortable relating to residents living with dementia, talking to all nursing home residents more easily, and being willing to gather nursing home residents in small community circles to carry on pleasant conversation.
Megan Hannan, MS, senior consultant with Action Pact, is the designer of this enriching program of relationship building. In the 12 years that Action Pact has provided this signature training, organizations around the country have expressed their love of this experience, as they have found it truly life changing.
Deep change requires deep learning. The Household Model, in particular, requires completely new ways of looking at the operational systems in a nursing home; clinical care, leadership, teams, choice, dining and much more. Action Pact intensives are expert-led and facilitated, multi-day workshops that will help you grow the skills needed for your organization’s transformation and learn how to share them with others. No sitting back to listen to someone talk for days here. High involvement, essential for an organization’s transformation, is the name of the game at intensives too. Be prepared for an engaging, interactive learning experience.
This is Channel content
|6||CULTURE CHANGE 101: A Primer for Rookies||1-Day Workshop||Rochester, MN|
|12||Critical Thinking Skills||1-Day Workshop||Portland, ME|
|15||Conversations with Carmen: Upcoming events||Webinars|
|20||The Recipe for Self-Led Teams||1-Day Workshop||New Holland, PA|
|17||Conversations with Carmen: Upcoming events||Webinars|
|21||Conversations with Carmen: Upcoming events||Webinars|
|23 - 27||Life Happens in the Kitchen||Intensive||Milwaukee, WI|
|23 - 27||The Choreography of Culture Change||Intensive|
|7 - 9||Nurse Leader Intensive||Intensive||New Holland, PA|
Learn more about our services
Contact LaVrene Norton
or Steve Shields