CFO: What happens if we train them and they leave? CEO: What happens if we don’t and they stay? -Author unknown

This quote has gained so much popularity recently that it almost seems cliché in business boardrooms. The increased emphasis on improving quality in long-term care has led to a greater focus on effective staff development and thus produced the same question in our homes. If we invest a larger portion of our limited resources on staff development what is to keep staff from leaving our home? Honestly? Nothing. However, the benefit that a well-prepared caregiver has on the quality of care provided to our elders far outweighs any risk.

Although we have always had excellent people providing outstanding care in our homes new initiatives, guidelines and regulatory processes have compelled a change in the culture of staff development. This change requires the use of practical and relevant staff development techniques and approaches. When choosing fresh methods for staff development, consider methods that produce skills and knowledge that staff can apply immediately. Staff development that inspires caregivers to apply it to what they do every day has the most benefit for our elders.

Wanda Bryant, LPN from Magnolia Health and Rehabilitation attended Dementia training provided by the Arkansas Quality Partners. Wanda has incorporated the “hand under hand” technique in the dining room. She stated that one of her more independent residents has not been eating as well. With the “hand under hand” technique, the resident feels as though she is feeding herself and has been eating much better.

Wanda tells of another resident who has more advanced dementia. The resident will cry when she comes to the dining room because she does not understand what she needs to do. Wanda has applied this “hand under hand” technique to assist with eating. The resident has a sense of being involved in the care and providing assistance “with” the resident rather than “to” the resident has helped this individual have an improved dining experience.

Wanda agrees that when using an unfamiliar care technique, you will need to develop your skill and comfort level with the technique by starting with the less challenging individuals and practice, practice, practice.

The Arkansas Quality Partners is focused on providing additional tools and techniques that will aid in connecting the individual providing the care with the individual receiving the care.

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The Barber Pole

When I entered Capital Health and Rehabilitation Center in Little Rock, I was greeted by a person named “Niki,” who I found to be beautiful inside and outside. Nikitia Brown worked on the 11 – 7 shift as an CNA who just happens to be a licensed beautician since 1994. She has been working as a CNA in LTC for 26 years. Niki heard that Capital H & R was part of the 2017 culture change program. After finding out that the home was without a beautician, Niki went to the administrator and asked if she could do her part in the Culture Change program. That’s how it started folks … Niki got the job in July and is actively on the Culture Change Committee. In addition to changing the hairstyles of the residents, Niki is working on changing the culture of her home.

The beauty shop is open during the week from 7 a.m. until 3 p.m.; however, the hours may change depending on the needs of her residents. Tim Gunter, the facility’s maintenance supervisor, located a barber pole light on Ebay, installed it and when the light comes on, Niki is open for business. “There is no charge to any of the residents, even if they want to pay,” Niki said. She purchases all supplies and Capital Health & Rehab reimburses her. Staff at the home also donate supplies to Niki, because who can resist her smile?

“I schedule one hall per day, reminding residents of appointments letting them know there is never a charge to come to the beauty shop,” Niki explains. Friday is the “free day,” as she calls it, explaining that’s a make-up day for anyone who was unable to attend on their scheduled day due to illness, visiting family, doctor appointments, etc. “They get pampered and spoiled,” Niki proudly admits. Men enjoy the hot towels, the barber brush and shaving cream, the shave and aftershave, and even hair dye. Some residents refuse to have anyone else provide shaving service ̶ they want to wait for Niki. The services for women include color, perms, extensions, wash, cut and style. There is a refrigerator set up with drinks, finger sandwiches, snacks and candy. Music and magazines are provided, and plans are to add a flatscreen TV to the wall. Residents like to sit outside of the beauty shop door to listen to the music.

“For residents who cannot come to the beauty shop, I go to their room,” Niki said as she displays the equipment she uses to provide in-room service. When leaving the facility, I was told by one of the nurses that a family member brought their parent to Capital Health and Rehabilitation because of the free beauty shop. This person-centered project has been great success.


Meet Niki Brown, CNA and Licensed Beautician




Niki has created  a true salon experience for the residents. . There is a refrigerator set up with drinks, finger sandwiches, snacks and candy. Music and magazines are provided, and plans are to add a flatscreen TV to the wall. Residents like to sit outside of the beauty shop door to listen to the music.


Tim Gunter, the facility’s maintenance supervisor, located a barber pole light on Ebay, installed in and when the light comes on Niki’s salon is open for business.




Niki runs a full service salon. For the women – color, perms, extensions, wash, cut and style and for the men – a haircut, hot towels, the barber brush and shaving cream, the shave and aftershave, and even hair dye!

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“Don’t put a limit on anything. The more you dream, the further you get” – swimmer Michael Phelps

In June we had our Champions of Change symposium. What a great turnout! Here are some of the exciting pictures of that event. Featured speaker Angie Norman wowed us with information. A gallery of our homes showed us how they were making changes. Drums Alive gave us the beat to free our innovative souls.

And more excitement is happening  this year. We welcome 11 more homes into our culture change program.

Join us Aug. 30 to welcome these homes and hear a speaker from one of our first year culture change homes.

The Extra Mile: It’s Not that Far

Download the workshop flyer

Featured speaker …

• Jonas Schaffer, LNHA, administrator and operator of Greenhurst Nursing Center in Charleston. Schaffer earned a BSBA degree in computer information systems and another in marketing from the University of Arkansas. Schaffer has been a key driver of culture change in Arkansas nursing homes, particularly in the areas of care, community integration and customer service

Tuesday, Aug. 30 • 9 a.m.–3 p.m. • Little Rock Baptist Health Medical Center, Gilbreath Conference Center, 9601 Interstate 630, Exit 7

Here our new culture change program homes for the year 2016-2017:

Alma Healthcare and Rehabilitation Center
Beebe Retirement Center
Belle View Estates Rehabilitation and Care Center
Chambers Nursing Home Center, Inc.
DeWitt Nursing Home
Highlands of Little Rock at Cumberland Therapy and Living Center
Presbyterian Village
Prescott Manor Nursing Center
Searcy Health and Rehab
Willowbend at Marion
Autumn Place at Oak Ridge
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“What we need is a radical reinterpretation of longevity that makes elders (and their needs) central to our collective pursuit of happiness and well-being.” – Dr. Bill Thomas

its-about-time-headerWe are so excited to have a conference coming to our state that embodies everything our culture change homes believe in for continued improvement in our nursing homes. We have many homes in Arkansas that everyday use their “out of the box” thinking to provide quality care and improve the well-being of their residents.

We have as a state embraced the idea of well-being is essential for the continued growth of staff and our residents. That we still have a journey ahead of us, is clear to all of us that work in health care.

We have joined with other organizations to provide education on individualized care. We have provided training on understanding dementia and how to decrease medication. By joining together we have found we can educate our staff on a budget…we can provide on site training….get staff to mentor other staff.

All these things, we are doing in Arkansas are in line with the need of providing a collective pursuit of improving the lives of our elders, our residents and our staff. We are trying to make the difference in the mindsets of other health care partners, that aging is a growth period, a time for change….just an important time as the periods of our youth.

Yes, we are excited in Arkansas to have a conference that speaks to the need for change……..


Eden Mission statement..To improve the well-being of Elders and their care partners by transforming the communities in which they live and work.



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“Our greatest glory is not in never falling, but in rising every time we fall.” – Confucius

Nursing home residents have a tendency to fall, and that is a big problem homes must face. The Centers for Disease Control and Prevention (CDC) says 1,800 residents die from falls each year, and those who survive have injuries that reduce their quality of life.

Fall prevention in nursing homes presents many challenges. Of all the research accumulated so far, the most effective intervention found is the use of a multidisciplinary team approach for fall prevention. This goes back to what many innovators for change have been saying for years: we are all in this together to improve quality of care.

Fall interventions that are evidence-based include:

Investigating reasons a fall occurs

Assessing residents after a fall

Educating staff about the root cause of the fall (not just what caused the fall)

Making interventions that fit the root cause, not just a care plan fill-in or one to respond to a possible state survey

Creating a true team approach for fall prevention

Many of our homes are using tools and services from our web site to help prevent falls. These tools are developed by people in the industry who have real research data to support the use of these tools. All of our tools have one thing in common: a focus on a team-based approach to decrease falls.

Many of our homes in the Culture Change project are using different team strategies to decrease falls. Team programs that feature data collection and competition encourage good results of monitoring and investigation of falls.

One of these homes is Grace Point in El Dorado. This team approach program includes sharing and investigating information about falls from shift to shift and also area to area. The falls team is managed by the activity director, and the CNAs make up the majority of the team.

The program’s title, “Don’t stand for it!” is a great reminder that we all are necessary in providing a safe haven for our residents. The results of this program have been very rewarding to residents and staff. This program provides staff a teamwork approach while allowing for some good natured competition. Management posts team results in the nursing home halls. Each team is eager to have good results and to have decreased resident falls. A reward of pizza party spices up the incentive for working as a team on each hall, shift or designated area to decrease falls.

The program uses staff closest to the resident to gather data, propose interventions and carry through with interventions, making the end result of decreased falls a true team victory.

Again, it takes a team to make our residents quality of life great. We salute those homes that continue to try innovative ways to improve our residents lives. Kudos to the homes in the culture change program for continuing to use evidence-based research to improve the life of our residents.


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“I’ve never responded well to entrenched negative thinking.” David Bowie

This year has brought many changes already, both in health care and in the world. We have already lost many of our musical lights and people who have inspired us to think in new and exciting ways. What makes many of these people special is not only their talent in their field but the ideas that they shared with us.

The Centers for Medicaid and Medicare Services (CMS) has also started sharing some new direction for health care, including new programs and innovative ideas to improve the quality of life for the aging population.

The Department of Health and Human Services has released information to improve our nation’s health care by setting clear, measurable goals and releasing a timeline to move Medicare and the health care system toward paying providers based on the quality rather than the quantity of care. This quality care is based on resident, patient and family involvement in health care decisions. It’s also based on a team approach to planning care, involving all health care workers who are providing the day-to-day care.

Does this sound familiar? Person-centered care, person-directed care and culture change … all these terms reflect the basic idea that we must change the way we provide health care. Positive changes start with encouraging staff to participate in new programs and ideas, doing away with entrenched negative thinking. It’s no longer acceptable to say, “We have always done it that way, why should we change” or “Our workers will never give us input on that program.” That kind of negative thinking prevents bright, innovative employees from shining in our homes.

As leaders, we should be inspiring our staff to make positive changes. And as one innovative person once said, “We can be heroes if just for one day.”

Encourage your staff to be heroes, even if just one day or with one project. Give them positive encouragement to change things and improve the quality of life for our residents. Above all, provide them with the guidance and tools they need to make positive changes in our health care system. Then we all will be heroes. At least for one day.




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“The only person who is educated is the one who has learned how to learn and change.” Carl Rogers

People living with various forms of dementia often exhibit emotional behaviors, such as anger, sadness, fear, frustration or anxiety. But so do people without dementia. So why do we put such a stigma on these behaviors when they are exhibited by a person living in our nursing home? One of the reasons could be that we don’t understand these emotions in relation to how they are being expressed by our residents. We often think that our residents are “acting out” or “being difficult” with caregivers. What they often lack is the ability to communicate their feelings. Dementia robs the brain of the ability to communicate and take in information, sometimes slowing down the resident’s ability to process thoughts and language.

How can we help our residents with dementia continue to have a high quality of life? One way is to continue to educate care partners on how to assist residents with everyday tasks. Our health care workers need to look at how they are providing care and change the way they think about a task. There are several programs and educational trainings going on all over Arkansas that address caring for residents with dementia.

With our culture change group, we are setting up an educational training with a certified dementia instructor to educate our caregivers on this misunderstood disease. Many of these trainings have already had success all over the state in helping nursing homes reduce the use of drugs. We are changing the way we learn and preform our tasks. That is an innovative way of thinking, and Arkansas is all about innovation.




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“Never believe that a few caring people can’t change the world. For, indeed, that’s all who ever have.” – Margaret Mead

The medication pass in a nursing home is often a labor-intensive activity, taking up a big part of a nursing home nurse’s day. A number of homes are looking at changing this to allow more flexibility for activities, special events and sleep. By looking at individual medication plans, some of the nursing homes in Arkansas have been able to reduce their med pass time.

Some of our homes in Arkansas, especially those in the culture change program, have looked at their medication times and are able to individualize the plan of care for their residents. With new technologies, such as computerized medication records, some homes are changing the way they view the medication pass. This way, they begin to change the focus to more individualized care.

We saw last month that many homes are thinking outside the box with activities, community involvement and resident involvement. This innovative thinking brings with it a need to look at the medical model of how we give resident quality care and still have quality of life.

Fortunately, there are many resources available to our homes that want to look at different ways to individualize care for our residents. From sleep studies that encourage homes to change the way we assess our residents ( to toolkits that are available to help change the way we assess our residents (

We have a lot of research and toolkits available today that will allow us to change the way we are providing health care for our residents. We have no excuses. We must look at the way we are providing quality care to our residents. Remember, evidence-based care equals quality care. Just as we are trying to decrease the use of some medications in our older population, we are also trying to change the way we give that medication.

If changing the way we think about care allows more flexibility, more resident time and better outcomes for our residents, why would we not change?

Here are some of the resources and ideas available to help us all continue to change our mindset to resident-centered care. These are just a few web sites that will point you in the right direction.

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“You have to have a canon so the next generation can come along and explode it. ” Henry Louis Gates

Studies show that active and engaged older adults remain in better health than those that are not active and that older adults who volunteer live longer and with better physical and mental health than their non-volunteering counterparts.

Even residents in nursing homes have better outcomes when they lead active and engaged lives.

Many Arkansas homes have intergenerational programs that allow the young and old to interact, resulting in residents feeling needed and connected to their community. Several of our homes have sewing clubs, “pack the backpack” programs and trick- or- treat programs. These are often resident-led activities supported by nursing home staff, providing valuable assistance to the local community.

Some nursing home administrators are thinking outside the box. They are developing intergenerational programs that are a departure from the old institutional mindset. Charlene Boyd, administrator of Providence Mount St. Vincent in Seattle and one of the original pioneers to help found The Pioneer Network, is one of these administrators.

This home is world-famous, for its many elder-centered practices and for its amazing on site intergenerational learning center.

Watch the trailer for the upcoming film about this program.

One of our culture change program homes, Ozark Health and Rehabilitation in Clinton, is the pilot home for the Music and Memory program in Arkansas. We’re beginning to see other homes around the state implement this program, which helps residents become engaged through music. Some of the homes are taking the program a step further and developing intergenerational programs based on music.

The Alive Inside Foundation is a nonprofit organization dedicated to using the power of music to expand intergenerational human connections and develop empathy between youth and elders. The foundation understands that kids are the best at implementing music and memory programs in nursing homes.  What about the kids?  Well, studies show that children benefit profoundly from the experience of interacting with older adults. Take a look at the foundation’s new documentary.

Are you considering an intergenerational program for your nursing home? Go to the Changing Aging website and spread the information.

Before you start any program remember, intergenerational magic does not just happen by bringing old and young together! Preparation, planning and training are necessary for any successful program.

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“Food is our common ground, a universal experience.” – James Beard

One fifth of all regulatory violations at New York nursing homes in the last quarter of 2011 were related to food service.1 In Arkansas nursing homes, we also see a lot of regulatory violations that are tied directly to dietary issues. But that number only scratches the surface. When researchers started asking nursing home residents about their food choices, their answers were telling:

  • One resident said he resorts to drinking nutritional drinks instead of eating the meals in the home.
  • Several residents complained that the high-carbohydrate meals made it difficult to manage their weight or diabetes.
  • Many residents complained they were rarely served fresh fruit or vegetables; in some homes, it was only when a state inspector was present.
  • Residents complained about inflexible meal times, strictly assigned seating in the dining room and not being allowed to invite guests to meals
  • Many residents said they use much of their limited incomes to purchase food outside the home.
  • More than a hundred residents of one home signed a petition to upgrade the quality of the food, which was described as “bankrupt.”
  • Residents of another nursing home got so fed up with conditions, they brought a class action lawsuit against the home. Part of the basis for the lawsuit were the unsanitary kitchen conditions and poor food storage detailed in violations from the state department of health.

Are you starting to see how important it is to pay attention to the food we serve in our homes? This all ties back in to culture change, too. It’s not just changing what we serve based on residents’ wants and needs, but it’s also running a tight ship in food preparation and storage. There are plenty of examples of Arkansas homes doing wonderful work in this department. We have homes growing their own food, offering flexible dining times, making healthy meals to encourage weight loss and decreasing the need for nutritional supplements. There are also homes holding picnics, barbecues and other celebrations centered around food, which helps grow a sense of community and togetherness in the home.

Still, there is always room to grow. Many of our surveys show food preparation is a key area for improvement in Arkansas. One of the best ways to show growth in this aspect is staff education. There are training sessions and food preparation resources available from our food suppliers at the links below. Remember, food is our common ground. Let’s make sure it’s also a key component of continuing our culture change journey.


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