Have any Eden facilities changed over to 2 times a day med passes - am and pm?

Staff want to have parties for residents/family and staff. Our HR dept. cautions us on staff coming into the facility on their time off without paying them. He's been advised that this presents a potential labor mgmt risk. Staff could perform some small task e.g. help set up a residents meal tray and then say later that they had to work and we didn't pay them. (We're Union facilities so we have needed to be cautious. We could pay them, it would often be overtime and we're trying to keep this project close to budget neutral at these early stages.) On the other hand many of our staff want to come in on their own time to participate and that seems so inline with Eden Principles. Any suggestions?

Also on a different note, I've been encouraging teams to work their way through the principles before making big changes. I heard a number of people share this sentiment at the Eden conference I attended in Tacoma. We have a lot of people that want to make changes now e.g. pilot a more universal worker concept. With Unions you have to be thorough in letting the Union in on changes to job descriptions etc. I have been suggesting moving slow but I'm running into to some frustration with teams that want to move faster. They'd like us to suggest job description changes. Not all teams are able to move this rapidly, we don't want to stifle creativity, we want a thorough understanding of the principles etc. etc. etc. I'm running on here, but could use some input from more experienced people.

Thanks Tiffany
tiffanyb@halemakua.com

Hello Tiffany!
Email me and we'll set up at time to talk and do check us out on the web!
Yours in Eden,
Wendy Vaughn
Eden Educator and Mentor
wvaughn@rollingfields.com
www.rollingfields.com
814-587-2012

Hey Tiffany - how's life going at Hale Makua? Been thinking about everyone this weekend, especially because it is very cold and snowy this winter in Omaha. Sounds like it may be running a bit 'hot and cold' in your facility too. What an adventure implementing Eden can be!

So, on the issue of Bid med dosing. I did work on that at our home. It was wonderful and really freed the med aides up to be more involved with day-to-day care. Challenges were two-fold: (1) the elders are very attached to their med schedule because passing a medication is a chance for companionship for them. It took some work to reassure them that we were not neglecting our 'care' for them, but rather freeing them and their caregivers to have more meaningful interactions. (2) the med aides and nurses are very attached to the med administration process! To reduce their time on the "cart" is to challenge them to find new ways to spend time with the elders. Some preferred the task focus and it took a lot of coaching to help them to move past that. The same thing can happen when the nurses station goes away.

That said, before we started to change everyone's med times, I spent a great deal of time doing education with the nurses, med aides, doctors and nurse practitioners explaining why we needed to make the change. Then we picked a place to start and just a few elders to begin with. That way the caregivers kind of eased into the change without it just happening on one day. That pace also made it easier for us in the pharmacy because changing all the med cassette colors and labels takes time and we had a large facility. Also, we could more easily work out the glitches when we just had a few to work on at a time. It also took some creativity to figure out some of the special needs of some medications. For example, we always received PT times at 5pm, so we dosed Coumadin in the evening so we could adjust the dose late in the day after the labs came back. I did some research to find some alternative dosing for meds given more then twice a day to see what med changes we could make. It is also helpful to pay attention to whether these changes may cause an increase in cost for the elders. Once a day meds can sometimes be more expensive than the meds given more than once a day.

We also had a union at our home and if staff came in on their time off they worked out an agreement with their supervisor beforehand to determine if they got paid or not. Some were happy not to get paid, others wanted to get paid, and the supervisors had to balance that out. I have seen other Administrators bring up issues of liability if a staff member or an elder is injured if their interaction is a voluntary activity. One Administrator I heard of actually banned any employees from volunteering to spend time with elders off the job in order to limit their risk. Others have written policies and created agreements for staff and elders to limit risk. I think learning circles about the vision of where you are going, the role of volunteerism and the risks would be a good place to start. Obviously the union will have a role and it should be some interesting discussions!

Not having been in the Administrator's role, my opinion about the growth of teams may seem a bit off. But what happened at our home was that the Administrator tried to force all the teams to grow at the same rate. For example, one team worked out a way for the CNAs to self-schedule. Yeah! But because the other 2 neighborhood teams were not yet ready to take self-scheduling on, the first team was told 'NO'. It didn't take too many more times of being held back, before they just threw their hands up and walked away from making any progress at all. The best approach I've seen to have the leader/manager/supervisors create a unified vision with the teams. Then together they define the parameters of what authority and responsibility the team has and where their boundaries are. So this is principle 8 stuff, empower them by providing them with the knowledge, information, resources, skills and training, and support they need to be successful. No two children in a family grow up to be identical in their life choices and direction. The same is true with organizational teams. Each will grow in its own unique way. Our challenge as leaders is to give them what they need to do it successfully and then get out of their way. If their hearts are focused on the best for the elders, they won't go wrong. Again, use learning circles to enhance communication, build understanding and make sure everyone really is on the same page.

Aloha, and keep growing. Hope these ramblings are helpful,
Denise Hyde

Hello Tiffany -
You are right to influence people to go slowly. Rather than say wait for those suggested job description changes, create a process or system in which to record and capture the suggestions. It can be made public - on a bulletin board, in a book in the break room. In this way you are engaging those people who are excited and using their excitement to engage others in thinking through this idea of more versatile work.
You can use similar processes for other ideas that are being generated.

What/how/who make the final decisions? Do you have a Core or Steering team? This team needs to be clear about the process with which to make final decisions. They need to have a plan of action to address suggestions - a time frame - some way to react or respond to the suggestions.

Keep up the good work!
Megan

cende wrote:
Have any Eden facilities changed over to 2 times a day med passes - am and pm?

Staff want to have parties for residents/family and staff. Our HR dept. cautions us on staff coming into the facility on their time off without paying them. He's been advised that this presents a potential labor mgmt risk. Staff could perform some small task e.g. help set up a residents meal tray and then say later that they had to work and we didn't pay them. (We're Union facilities so we have needed to be cautious. We could pay them, it would often be overtime and we're trying to keep this project close to budget neutral at these early stages.) On the other hand many of our staff want to come in on their own time to participate and that seems so inline with Eden Principles. Any suggestions?

Also on a different note, I've been encouraging teams to work their way through the principles before making big changes. I heard a number of people share this sentiment at the Eden conference I attended in Tacoma. We have a lot of people that want to make changes now e.g. pilot a more universal worker concept. With Unions you have to be thorough in letting the Union in on changes to job descriptions etc. I have been suggesting moving slow but I'm running into to some frustration with teams that want to move faster. They'd like us to suggest job description changes. Not all teams are able to move this rapidly, we don't want to stifle creativity, we want a thorough understanding of the principles etc. etc. etc. I'm running on here, but could use some input from more experienced people.

Thanks Tiffany
tiffanyb@halemakua.com

I work at a 118 bed, 4 Neighborhood (unit) nsg home. We encourage our neighborhoods to hold "neighborhood parties" at least a couple of times per year. Staff who are scheduled to work at that time/day are paid, but we also open it up to any staff who want to volunteer. Our rule of thumb on volunteering is that staff are allowed to volunteer as long as they are doing a task that is not something they would typically get paid for. Ie...if a c.n.a wanted to volunteer for a neighborhood party, they may volunteer to serve the food or assist with an activity vs. assisting with feeding or toileting etc. An activity person may volunteer to bar-b-que or feed a resident vs. running an activity etc. I should also mention that we are not union. Don't know if this helps, but we are able to make it work here. We typically have anywhere from 10-30 "volunteer staff" (depending on the event) who choose to help out for these functions.

Hello,
our home is in England, we are about 18 months into our 'edenising' and one of only a handful of homes in the whole of the UK to recognise Eden. Changing attitudes and culture has taken the best part of the 18 months and it only now in the last few months that those attitude changes have really made a difference. It has been an emotional rollercoaster for me as the manager of the home, the feelings of frustration sometimes have been overwhelming.However we are getting there and when positve comments from residents start to come through and the moral of the staff is at a high it is all worth it. My comments on the question of staff being payed for coming in their own time are these..
If they are payed for volentary work, then it isn't their own time. I have never mentioned payment or material rewards if staff want to come back the home in their own time. I think of it like this, I don't expect to get payed to see my friends or socialise with them, I don't want payment to help my grandmother with her garden or when I take her out to the garden centre or the shops. If staff feel they need payment for things like this then they, in my view, still haven't 'got it'. No one where I work is expected to give any more time than their contracted hours of work, if they choose to come back in their own time that is their choice, and some do and some don't, and thats fine too. No one is judged if they don't and no one is favoured if they do. The rewards for 'going the extra mile' are not finacial but personal not just for them but for the residents and that is what eden is about. Of course eden training, meetings and other 'non hands on' things are payed time, but what we have found is that the change in people and their happiness at work and the atmosphere in the home has increased so much since Eden has been introduced has changed peoples attitudes to work, staff bring their children in on their days off on their way to the park or shopping, not because they feel like they have to or that they will get payed for it, they do it because they want to introduce them to the people who are part of their lives. Our residnets have become part of our staff's lives not on a work basis but on a personal basis and thats the difference. Personaly if feel like my/our home is like an extention to my family and friends. People either 'get this' or they don't. We have a way to go too, we are only in infancy really with edenising but it is exciting and rewarding and I can feel the changes every day when I got throught the door, the staff feel that too I know. What really makes my day is when something happens and you see another lightbulb go off over a care assistants head! They 'get it' and their is no going back!
Take care
Sara