Question One.
As CEO of the Living Hope CCRC, our goal is to give residents a sense of home when they choose to live in our facility. The entire campus is in a circular design on 50 acres in Clarksburg, MD, housing 500 residents and employing 400 staff. The residents are all 55 years of age and older, and have multiple options for their dwellings depending on their needs; their initial choice in their home style can be changed as they continue to reside at Living Hope over time. There are greenhouse style cabins along the outskirts of the campus with between ten to fifteen residents per cabin. There is also a main building that houses our dementia residents in a safe environment with 24-hour nurse care. For the residents that prefer to have their own space, we also offer apartment style buildings for those that prefer to have their own space.
The nursing team at Living Hope makes up 20% of the staff because at this current time, only 10% of the residents need consistent medical attention and 5% need moderate attention. The other staff includes grounds people that take care of the campus, students that are pursuing nursing education, gerontology or aging studies, and many workers from overseas that have credentials in taking care of the residents. Living Hope prides itself on its training program for all staff members to undergo that includes teachings of the life course perspective, physiological changes in health that our residents may exhibit, and a mandatory exam that requires the staff member to meet with a resident and learn about their life history to not only get to know them better, but to humanize the relationships with the residents as well. We post advertisements in local newspapers and also do guest lectures at the local colleges to reassure that the campus is a fun place to learn and grow as a person.
Aside from providing housing, there are also many indoor recreation buildings scattered throughout the campus. Some of the recreational activities offered in the buildings include table pool and bridge tables, as well as cozy living rooms with fireplaces for the knitting community to get together. The different activities offered are changed throughout the year according to the season, but we get most of the ideas from the residents through polls on what they would like to have available on campus. The idea was sparked from a discussion with Mark Embley, the financial advisor for multiple successful CRCCs in MD, whom explained that through residence satisfaction surveys it is the most direct way to determine the overall health of the community and what changes need to be made (Embley, 2017). In comparison with our sister community, Buckingham’s Choice, located in Adamstown, MD, we offer shuttle services monthly to take a tour of the “42 scenic acres … [that] overlook the Sugarloaf and Catoctin Mountains” for hiking, or simply enjoying the view from their café (Buckingham’s Choice, 2017).
To be part of the community, we require an entrance fee of $300,00 per individual. Per an interview with Bill Holman, the average entrance fee in 2010 was $250,000, so we believe that we are charging a fair rate (Holman, 2017). Other documentation that needs to be filed include a residence and care agreement, which explains that the resident agrees to give their entrance fee within the first 30 days of residing at Living Hope and also agrees to give their monthly installments in exchange for guaranteed housing for the rest of their life. As a CARF-CCRC accredited community, we believe that we can uphold the standard that our residents desire. Each year, we work on a “Quality Improvement Plan after [having received] the accreditation report” to ensure that we are doing our best (CARF, 2017). Through the entrance fees and donations from the families of our original tenants, Living Hope has provided a home for nearly 50 years, and we plan to be open for many more. Our statements prove that we are a safe choice, we have liquidity and solvency, and we are ready for any new residents to join us in a new home away from home.
Question Two.
Hooyman describes culture change as the revamp of nursing homes to become “more homelike and less institutional, [all while providing] residents with greater decision-making autonomy” (Hooyman, 2016). Specifically for elder care, it falls upon improving the quality of life for older adults and eliminating the stereotype of a nursing home as a corrupt, end-of-life place to leave ailing family members that cannot take care of themselves. The levels of organizational culture were developed by Edgar Schein, a former professor at MIT, in which he describes the three levels as artifacts and behavior, values, and assumptions (Faculty & Research, 2017).
In his book, Organizational Culture and Leadership, Schein explains the different ‘levels’ of organizational culture in detail. In the surface level of organizational culture is artifacts, which includes the physical senses that are affected when a person experiences an unfamiliar culture. The physical senses include sight, hearing, and touch. While artifacts represent the most apparent between the three levels, it is difficult for the individual to distinguish “important underlying assumptions” (Schein, 2004). The belief and value level of organizational culture relates to the influence an individual may have over others in the group. For example, if one older adult addresses in their poll that they would like to have ‘Bingo Night’ on a weekly basis and there are no other statements that counter or encourage the activity and thus Bingo Night is a weekly occurrence with a decent turnout, the value expresses may be that older adults all enjoy bingo when in fact it was initiated by merely one person. The beliefs do not necessarily stem from all the elderly adults, but they enforce a truth because of the action. The final level is assumptions, which pertains to creating truth out of theory. In particular, if a “hypothesis” continues to be proven correct over a period of time, it “gradually comes to be treated as a reality” (Schein, 2004). In another sense of what the assumption level entails, Schein continues to explain that if there is a particular belief that is followed by the group, it becomes difficult to imagine an alternative (Schein, 2004). If young adults believe older adults to be stuck in their ways and unable to learn new technologies, then it becomes the reality.
Culture change is also related to person-centered and strengths-based care. In person-centered care, residents are asked what they prefer when it comes to their caretaking. For example, they may request to take a bath in the evening as opposed to early in the morning. These options in nursing homes help to personalize each resident’s experience rather than treating them as a task list that needs to get finished. Strengths-based care focuses on bringing the individual “strengths and capabilities that can transform the lives of people in a positive” way (Hammond, 2017). Specifically in dementia patients, it helps encourage their positive attributes and have hope as opposed to always being reminded by the subtle actions of their caretakers that they are ill.
In Living Hope, it would be critical to incorporate person centered care through taking surveys of the residents to learn about their preferences. Also, the sensitivity training that is required for all of the residents could incorporate a training of strengths-based care to prevent elder speak and other habits that infantilize the residents. Overall, the biggest factor is to get feedback from the residents themselves to see what it is they would like to see incorporated at the CCRC because they will be directly affected by what activities are offered. Rather than holding meetings with the board to see what would be done next, we would go to the ‘field’ and speak with the residents to get to know them and how to improve Living Hope.
Question Three.
Design think is the way in which “designers apply [cognitive activities] during the process of designing” (Madjaroff, 2017). The goal is to create a product that has an implicit function that is natural for the brain to process. Don Norman, author of the book Design of Everyday Things, explains how some doors do not guide the user towards the purpose of the door. More specifically, a handle that is parallel to the inside edge of a door would give the user the impression to pull the door open. However, there are many doors with this design that are meant to be pushed to open. The term Norman Door is coined because of this flaw in the designing phase that does not align with design think.
In regard to products designed for the elderly, one product stands out compared with others. The company MedSignals developed what they refer to as ‘the smartest pillbox available’ and claim that it helps the “forgetful patient … [with a] ‘smart’ reminder system (MedSignals, 2017). The design from first glance appears to be straightforward: there are four compartments for the medications to be put in and controls for each product. However, it is not straightforward how to program the medications for particular times of day and to let the user know what quantity to take. The description explains how the user needs to only listen as the device lets them know which compartment will open and the quantity to take, refill when empty, and keep it plugged in to a power source. It does not explain how the user or caregiver can set up the product and set the times needed for the product.
For this reason, I do not believe that this product is a perfect example of design think because the target market would need assistance from someone that is technologically-inclined to set up the process. If the system were to be mechanically simpler where above each compartment the user can set up a visual timer so that the user wouldn’t need outside assistance, then it would be a good product for this market. There are still many changes that it should undergo.
Although the product itself is not perfect, it still follows some principles of design think such as identifying a problem and working towards a solution and for this reason it is a decent first prototype. Also, the product could be useful once it is programmed for the individual because it is straightforward: blinking lights and beeping let the user know to take their medication and a voice says how many to take at that time.
In Living Hope, it may be a product for some residents that are independent and able to take care of themselves to use because it keeps their medications organized and lets them know how many to take at the alarm sound. Traditional pillboxes keep a full days’ worth of medication in each container but do not let the user know when to take which, whether it is with a meal or on an empty stomach, so this could be a useful product for residents that simply have too many medications and cannot be bothered to remember when they should take each. It would not be used for residents that need extra assistance because there is enough staff to keep track of the residents’ medication intakes. There are almost as many staff members as there are residents, and in the departments where there are residents that need more assistance there are enough staff members that can provide the medications and stay organized so that everyone knows what times, which medication, and how much of it were taken.
Question Four.
Two films that show the realities of dementia and Alzheimer’s are “Alive Inside” and “Robot & Frank”. While the way that the films were captured were in different styles – Alive Inside was more of a documentary while Robot & Frank is cinematic – the goal is to get the viewer aware that illness does not make a person less human, but that their way of life is different.
The main theme of Alive Inside focused on the power of music on afflicted individuals and how it brought the residents in a nursing home ‘back to life’. In particular, the benefits of music therapy were broadcasted and through a simple experiment of an iPod Shuffle that carried songs from the resident’s childhood, their persona broke through the dementia and came through. In contrast, Robot & Frank focused on an individual who refused to acknowledge that he had dementia. He had a burning desire to stay relative in his family’s lives and would partake in breaking and entering from his neighbor’s home to prove that he was still capable beyond how his children made him feel When he first receives the robot, he denies the need for companionship or that he needs someone to take care of him. By the end of the film, he accepts that while he does have dementia and may need specialized care, he also learns that they are not casting him aside so that they don’t have to deal with him by putting him in the home.
The aging experience is filled with twists and turns, often unexpected. In Alive Inside, the residents that have dementia can no longer live as they once did and require simplified routines. Colorful people change as a result of dementia, but through the neural signals from music, the individuals are brought back to a memory in the early part of their life. It is a full circle on life and appreciating what has happened so far. For Robot & Frank, the refusal to accept that he has dementia is a reality for many. By accepting dementia, it could translate as accepting that the individual person is not as capable either. However, through studying aging research shows that adults are continuing to work beyond retirement years and not necessarily because they need to (although that makes up approximately 36% of this group) (Madjaroff, 2017). The reality of aging that was defined by ultimately going to a nursing home to face demise is not the true picture of what to accept for aging and that nursing homes have improved significantly in efforts to reduce the stigma associated with them.
Overall, one of the major takeaways of the film Alive Inside is that illness is not the main label that a person should have. As the movie depicted, something as simple as music helped to overcome the illness for a short period of time and encourage the individual to focus on the positive. Similarly, Robot & Frank explained that the family dynamic when someone has dementia does change, but it doesn’t mean that the love between them changes. Through the trial and tribulation, the Frank’s family is able to discover that rather than blame and feel that they are not doing enough for Frank, the just need to focus on the positive and have hope. The single message that both films hope to reach the viewers is to not let an illness define an individual because they are more than their dementias have made them.
References
Embley, Mark. (2017). The 4 R’s of CCRC Finance. Lecture presented in Maryland, Catonsville.
Faculty & Research. (n.d.). Retrieved December 14, 2017, from http://mitsloan.mit.edu/faculty-and-research/faculty-directory/detail/?id=41040
Hammond, W., & Zimmerman, R. (2017). A Strengths-Based Perspective. Resilience Initiative. Retrieved December 18, 2017 from https://www.esd.ca/Programs/Resiliency/Documents/RSL_STRENGTH_BASED_PERSPECTIVE.pdf
Holman, Bill. (2017). Aging Services Overview. Lecture presented in Maryland, Catonsville.
Buckingham’s Choice. (n.d.). Retrieved December 14, 2017, from https://buckinghamschoice.org
Hooyman, N. R., Kawamoto, K., & Kiyako, H. A. (2016). Aging matters: an introduction to social gerontology, Boston: Pearson Education.
Madjaroff, G. (2017) Aging 200 In Class Lectures. Lecture presented in Maryland, Catonsville.
MedSignals. (2017) Retrieved December 15, 2017 from http://www.medsignals.com/medsignals-pill-case
Rossato-Bennett, M. (Director). (n.d.). Alive Inside [Video file]. Retrieved October 19, 2017.
Schein, E. H. (2004). Organizational Culture and Leadership (3rd ed.). San Francisco, CA: Jossey-Bass.
Schreier, J. (2012). Robot & Frank [Video file]. Retrieved November, 2017.
What is the CARF accreditation process? (n.d.). Retrieved December 16, 2017, from http://www.carf.org/Accreditation/AccreditationProcess/