Category Archives: staff empowerment

A Wide Movement

May

As I talk about CNA Edge more, there’s a question that keeps coming up: for whom am I writing? What is my target audience?

Whenever I’m asked, my initial reaction is always: “My audience is whoever reads it”.
But that’s a vague answer at best, and no answer at worst. There are some who tell me I should focus more on reaching policy-makers and people in positions of power. And I can follow their line of thinking and I agree with their points: there is a divide between direct care workers and those at the top. That divide hurts our residents, often badly. So yes, I would love to reach more policy-makers.
But not at the expense of also my reaching my fellow CNAs. To put it another way, I do not want to be the sole spokesperson for CNAs to policy-makers and administrators. 

Policies can change. Rules and regulations can be changed with administrations, and then swept away with the next changing wind of politics. I am not dismissing the importance of good policies and those who work so hard to affect change for long-term care. We need people fighting for good policies, and for responsible leadership. We also need people fighting to change the way CNAs think about themselves, to throw off the label of “nothing but an ass-wiper”. If I can do that, then I am not alone. One or even three CNAs speaking up can be ignored. We could even be silenced. How about one hundred CNAs? Or three hundred? How about a thousand, or a million?
That starts by letting CNAs everywhere know that they are not alone. Sometimes I think the worst affect of this broken system is that it makes people who work so closely with others feel utterly alone. We, who have the power to deeply impact the lives of our resident, are often made to feel helpless by all that we cannot change. We feel alone, helpless and burnt out. Silence and sullenness can and do follow.
But together and aloud…what can’t we achieve?
I do not ever want to talk over the heads of my fellow caregivers. I refuse to fall into the trap of thinking that I am somehow more than they are, or that they are something less than me. If I am intelligent, compassionate and eloquent, that does not make me unique among caregivers. Actually, I’d argue that makes me about average. If I stand out, it’s only because I speak out.

What we need now is change, both on a personal level and on a larger cultural one. Compassion, common sense, communication and critical thinking have got to be infused into this broken system. We have to have people dedicated to change on every rung of the ladder…including the one belonging to CNAs.
Just like a democracy cannot function without the active participation of ordinary citizens, neither can our long-term care system function without a principled and vocal base of direct care workers. CNAs who are willing and able to speak up for themselves and their residents.

Nursing-home-made

Sunflower May

In compliance with HIPAA, all resident names and identifying details have been altered or removed. 

It’s funny, how a person’s possessions can tell us so much about them. Most new residents come in with very little: just the clothes they wore in the hospital and maybe a small bag. Then, their families either start bringing in loads of stuff…or they don’t. I have seen rooms so crammed full of personal mementoes that it’s hard to care for the resident; so many clothes in the closet that the door won’t shut and every surface covered with knick-knacks.
I have also seen rooms bare weeks after the resident moved in, the only proof of occupation being the person in the bed. Only a few clothes, no knick-knacks…no decorations or pictures.

Mrs. L seems to be one of the latter category. After a week, she still only has the one bag that she had clutched so tightly on the first day, plus a couple outfits. They’re nice, but the kind of nice that has been worn for years and years. Her family comes often, but they seem more stressed each time and their visits get progressively shorter.
There’s always a learning curve, some time required to start feeling comfortable in the new environment…but Mrs. L doesn’t appear to be adjusting at all. She won’t leave the room, she hardly eats and from what I can tell, she seems to spend most of her days screaming into her phone and crying. I decide I can’t kept walking past such agony. We don’t know each other very well, but that’s about to change.
“Hey, can I sit down?” I ask, walking into her room and gesturing to the empty chair (provided by the facility) that sits by her bedside. She shrugs and I take that as permission. Good Lord, but it feels wonderful to get off my feet.
“I’m May, if I haven’t introduced myself before,” I add…although I’ve introduced every day this week. “Do you need anything?”
She shakes her head. I’m trying to decide between asking another question and telling a story about myself when she suddenly starts talking.
“You can’t help, nobody can help. Can you make me better? Can you tell the insurance company not to be assholes? Can you give my family a fortune so they won’t have to sell my house to afford ‘getting me the help I need’? Can you buy back everything of mine they had to sell, so I don’t have to look at bare walls while I wait to die?”

I can’t. I can’t wave a magic wand and sort out the economy, endow her with the money she needs to have a good life even though she is now elderly and disabled.
The only magic I have at my disposal are my imagination and my hands. I stay for a few minutes, now holding her hand as she cries yet again, then I slide off the chair and leave the room.
It only takes a few words in the right ears. When I come back, I’m not alone and we aren’t empty-handed.
We disperse over the room, laying out our various offerings. The Laundry department brought up clothes that have been donated to the nursing (usually by families of resident who have passed away in our care); Activities gave several left-over decorations from the various Arts-and-Crafts over the years. Nursing gathered personal care items from the supply room and arranged them in her drawers. Staff from every department drew pictures and scribbled down nursing-home-made Get Well cards…but the best bit came from a fellow resident. She heard of my cheering-up campaign and told me to pick out the prettiest flowers from the bouquet she got for her birthday and give them to that “poor lady”.

Small acts of kindness in Long-Term Care are not whistling in the dark. With each act of compassion, we light a candle. True, it will take a lot more candles than I can personally light to lift the shadow of greed from our broken system…but that’s the funny thing about kindness. Even when it’s not enough to turn the tide, change the culture or right the wrongs of this world––it is still appreciated and it can still mean the world to that one person.

My hope is that, one day, we will have more to give than what we can scrape up. I hope that one day, compassion will be considered along with costs, that questions of ethics will be given equal standing with questions of economics. 

Bad Boss Part 2: Consistent or Crazy

Sunflower

May

I tip my chair back, enjoying this. I had to take my lunch late due to craziness on the hall and it appears as though I wasn’t the only one. The break room is packed; everyone is eating and enjoying this chance to relax. Conversation is flowing smoothly–we’ve hit on a great topic, one with legs that could run around the world.
“Oh, I’ve got one and it’ll top May’s story!” T says between bites of her casserole. “So I had this supervisor once, who decided she was going to ‘whip us into shape’. She started disciplining people up over rules that hadn’t been enforced in so long that we’d forgotten what they were. So here she is, a holy terror over everything…until one day she asked why we were so short every shift. Then we had to remind her she’d fired half the staff.”
I choke on my baked potato. “Yeah, I’d say that tops mine.”
“You’d think she would have noticed,” mutters A.
“At least she was trying,” says P, a new aide. I haven’t known her long enough to decide if she’s optimistic or naive.
“The problem,” I sigh, “is consistency. At some point, even a crazy boss is tolerable…as long as they are consistent. If I’m allowed to do something on Monday, I’d at least like to know that I’m not going to get in trouble over it on Wednesday.”
“Only for the boss to decide that the next aide can get away with it on Friday,” T finishes.
“Hard to toe the line when it keeps shifting under your feet,” A agrees. “So which do you all think is better: the boss who never comes out of the office and lets the staff get away with anything or a micromanager?”
“I don’t know about better,” P says, “but based off your stories, I’d rather deal with an absent boss than one who is all up in my business.”
“Yeah, second that,” I say. “I’ve had enough bad bosses to learn it’s best if I just take personal responsibility for my own work ethic.”
T shakes her head slowly, like she’s thinking really hard. “That works for you–and everyone in this room–but what about the bad aides? The ones who don’t care about the quality of their care?”
Three voices rise in unison: “Then they shouldn’t be CNAs!”
“Which,” I add drily, “means that either we step into the gaps they leave or the residents go without.”
“Those kind of aides should just go flip burgers,” A spits out. “They’d make about the same and our folks wouldn’t suffer from their apathy,” P agrees.
There’s silence for a few minutes. Everyone goes back to chewing their food. Thoughts are churning ceaselessly around in my head and, from the expressions on their faces, the others are thinking just as hard. Eventually P breaks the quiet, an almost desperate look etched on her face. “Please tell me you’ve all at least had one good experience with a supervisor.”
I smile at her. “Of course. Matter of fact, we’ve got a pretty good one now.”
“Yeah,” T agrees. “He’s doesn’t do the drama, doesn’t play games and he helps.”
“He’s looking pretty stressed out lately,” A sighs. “I hope he’s not on his way out.”
All four of us look at each other in horror. Truth is, as much as we boast about our ability to self-direct and self-discipline…it’s nice to have a supervisor who can take up the slack. It’s nice to have someone who will listen when we speak, pull us aside when something needs to be addressed. It’s nice to have rules that don’t change with the wind, nice to have someone who doesn’t play favorites and isn’t afraid to be stern when he needs to be. Who isn’t afraid to joke with us when he doesn’t need to be stern. Who we can trust to be fair.
“Oh, God I hope not,” I say fervently. “Let’s go write him Employee of the Month recommendations before we get back to the floor!”

<oOo>

What makes a bad boss? If only I knew. As it is, I have only guesses…thoughts inspired from seeing events from below, glimpses into Management through cracks in the floor. I can only assume it’s the same stresses that make a bad aide. There’s too much to do, not enough time to do and precious recognition or thanks. It’s an impossible job. Only instead of taking care of far too many people for far too many hours, they are juggling the constantly changing demands of Medicare, Medicaid and the Health Department–and keeping the floor in some semblance of function.

There’s also disconnect between the care plans and the living people they represent. It’s a disconnect that in some ways can’t be helped in the current system. Charts can’t convey the reality of long term care, not alone. Accurate documentation of my shift as a CNA would mean writing a novel each day before I go home–there’s just no way to communicate the reality on a glorified spreadsheet.

And in some ways, it’s a disconnect that can very much be helped.

There’s a culture of enforced silence among direct care workers, learned in the dark hours of neglect when speaking up meant losing your job. It’s a habit we’re still trying to break, to speak our truths and tell our stories. There’s a culture of enforced deafness among managers, learned in the dark hours of greed when listening meant being mocked by your peers. It’s a habit we’re still trying to break, to listen with wisdom and compassion.

If all you look at are care plans, then you haven’t seen the person. If all you look at are numbers on page, then you haven’t experienced the toll those ratios take on your employees and residents. The best of bosses know the people they are responsible for, both residents and caregivers. They are the ones who can read on my face when I’m about to break down, who care about me enough to step in and say: “What can I do to help?” But that takes time. That takes energy.

That takes a real dedication and devotion to the art of caregiving. To all good managers and bosses–thank you from the bottom of my heart for all you do and risk for me. It does not go unnoticed and, I hope, does not go un-thanked.

Back to the Floor

May.                          Sunflower

It would appear as though my residents missed me.
To show how much they missed me (or perhaps to convince me never to go away again), they’ve apparently decided to throw a call-light party, complete with a few alarms…you know, just to complete the experience. The party entertainment seems to be in the form of the guest of honor, aka me, running around like a chicken with its head cut off. I’m running from room to room, sweat dripping off me and breathing hard; it’s been non-stop all day long–and the day is still young. This shift ain’t over yet and I already feel as though I need another vacation. No sooner do I answer one light than five more go off.
This is getting ridiculous.
I swing into the next room, turn off the call light and ask (in a slightly breathless voice): “Whatcha need? Are you ready to get up now?”
“No,” says Mrs. H. “Not ready to get up yet.”
“Okay then, ring again when you’re ready, good to see you and bye!”
“Stop!!” she shrieks. “Come back here!”
I stop as ordered, skidding forward just a bit from excessive momentum. Thankfully the door frame is there to help me redirect back into the room. “Yes?” I ask.
“Sit down,” she says, or rather, orders. “Sit down and tell me about your vacation. I haven’t seen you in a week!”
“That’s why you put on the call light?”
“Well, duh! I heard your voice out there and figured you were back. So sit down little girl and tell me all about your trip.”
I glance out in the hall. There’s only one other call light going off and I catch a glimpse of my hall partner heading towards it…so I close the door and sit down as requested/ordered. “It’ll have to be quick,” I tell Mrs. H. She nods and settles back against her pillows, eagerly awaiting my story.
I grin. Ah, yes. The best and worst of my job were waiting for me today: everything I can’t stand and everything I love both wrapped up in this one shift, my first back from vacation. Still, it’s good to be back.

If I had to pick one word to describe the Pioneer Network Conference, I would have to go with “thought-provoking”. (Then I’d have to argue that yes, that is one word thanks to the hyphen, thank you very much, Grammar hounds.)
Over the course of four days, I had so much information thrown at me, engaged in so many conversations, asked and answered so many questions…it was a lot.
I learned new things.
I received confirmation for ideas I’ve long held without any proof.
I heard things that made me change my mind on certain issues.
I listened to arguments for certain things that did not change my mind, but showed me how other people were convinced.
I walked away with a thousand ideas for change, and 30 or so blog post ideas.

It was rather odd, sitting shoulder-to-shoulder with administrators, DONs, ombudsmen, policy makers, and other people whose spheres of influence are much larger than my own. It was odd, noticing that we took notes at the same time during a session. I guess I had rather expected to feel small, sitting with the movers and shakers, but I didn’t. Different, maybe, but not smaller. Perhaps that was the best part of the conference: hearing other people’s perspectives and actually listening. Having other people listen to my perspective.
My sphere of influence might be comparatively small, but it does have the advantage of being personal. I can’t change whole long term care facilities, or alter policies or build new facilities based on new models of care…but I can adjust my own personal style of caregiving to better suit the needs of my folks. I can take the big picture things I’ve learned and use them to make the day-to-day lives of my residents better. I can use what I’ve learned to stretch my own assumptions and perspective, use them to formulate and articulate new blog posts.
It might only make a difference to a few people, but it will make a world of difference to those few…and that’s totally worth it for me.

In the end, it’s the people who are important. The system should serve the people, not steam-roll them into molds with labels slapped on top. For me, the system will only be fixed when it empowers people to do and be their best whatever their role, whether it be resident, CNA, DON, RN, administrator or policy makers. For me, the best system is the one that encourages connections between people, no matter their social status or job title.
Systems break down, technology becomes outdated, but those personal connections?
That’s always been the thing at the heart of caregiving. It’s certainly why I do what I do.

Worth the Hassle: the Importance of Training

Sunflower

May

“I hate training!” says my coworker. “I really, really hate it. I mean, all it does is slow you down! I can’t get my work done while somebody’s following me around like a puppy. It’s just a hassle.”

“I get your point,” I say slowly…and I do. I really do. Training slows you down. You’ve got to stop and explain everything that has become muscle memory or second nature to you. You’ve got to watch people try to do things the wrong way, the way you’ve learned is no good. You have to hear all these “new ideas” that you’ve heard a thousand times before. You’ve got to watch the shock roll through the new person, as they stumble upon the grief, the horror and the frustrations that still eat away at you.

You’ve got to be patient.

And that is much easier said than done! It’s hard to be patient; it’s hard to let go of that frantic timer inside our heads. It’s hard to take the time to explain everything the right way. It’s just plain hard to find time, period. And it’s a bit discouraging: to take all the time out for the newbies, to be patient and then to have so many newbies just walk away…often without giving notice.

All that time and energy you invested in them: gone and all for nothing. Oh well. Try again and better luck next time.

Is it any wonder that so many aides just say: “Screw the next time! Why bother?” Yeah…I get her point. Training is quite a hassle, when you put it like that. And yet–and yet, even while I get her point, I can’t agree with her.

Attitudes like that are the reason so many new aides are left to flounder. It’s sink or swim in the nursing home; if you’re not perfect right off the bat it’s out the door with you! How many potential good aides do we bury under the  never-ending landslide? How many potential good aides walk away in a fit of frustration?

How many potential advocates do we silence in our own impatience?

Yeah, training takes time and energy…time and energy we often don’t actually have. True, not every newbie I train is going to stick with it; not every newbie I train is actually going to be worth the effort of training. But for the ones that are good, for the ones who stay, the ones who will become advocates and caregivers of quality…

Oh, yeah. You are definitely worth the hassle. Please come. Please bear with me as I try to snatch the time to dance on the ropes of long term care so you don’t fall.

 

Top Ten Things To Remember While Training

Sunflower

May

I started training other aides by default–by that I mean, I was trainer by default of being the aide with the most experience that day. Six months after I started my first aide job.
To say I was a little startled would be an understatement. I was not at all certain that I knew enough to be training other aides, and I probably was right. However, I fudged my way through, with missteps and mistakes but apparently doing enough right to asked to do it again. I guess my constant mental refrain of “Be like A, not V!” was indeed helpful. I’ve been training ever since. It has been a good experience for me, and I sometimes think of it as the first step towards writing on CNA Edge, because the thing about training is you have talk somebody else through the job.
I learned slowly, one trainee at a time, what works and what doesn’t. Here’s my Top Ten Things To Remember While Training:

  1. Slow down.
    This one is hard for me, even to this day. I talk fast; I’ve got a long stride and move like Speedy Gonzales…or so I’ve been told. One day I was explaining the fire policy to my trainee and all of a sudden I became aware of this wheezing behind me. Naturally I thought a resident was having difficulty breathing–but when I spun around, there was no one around except my trainee. Her hands were on her knees and her face was bright red. “Do you think you could slow down just a bit?” she gasped. “I can’t make out anything you’re trying to show me beyond the human-shaped blur.”
  2. Show and tell.
    “How about you take this one?” my trainee laughs, nodding at the next resident in our rounds. “I’ve done almost all the changing today!”
    “Correction,” I say, “you’ve done almost all the work today. I believe in hands-on learning: think of me as your training wheels, there if you need me, but meant to be phased out. If all you did was watch me do the work, all you’d learn is how I do it. I want you to learn how you do it.”
    Normally, I show once or twice, then I talk my trainee through it step-by-step. As the training progresses, my verbal instructions become verbal cues and then, on the last day, simply confirmation or critique.
  3. Encourage initiative.
    To survive in long term care, you’ve got to think on your feet. The earlier you learn creative problem solving, the easier it will be to take the pressure without breaking. I try to give my trainees first go at a problem, encourage them to think how bend so you don’t break.
  4. Take the time to explain “why”.
    I noticed pretty early on that people would respond better if I could tell them why they needed to do something a certain way, instead of just telling them that I knew best and they needed to do as I said.
  5. Don’t swoop in and finish a job you set them unless it’s an emergency.
    This one was hard for me: I like things done right. Also, there’s always a clock ticking instead my head, reminding me of much time is slipping away, how many more residents I have to do. However, I had to learn not to swoop in and snatch the job away from my trainees…especially if they were struggling. All that did was reinforce the feeling of “I can’t do this”.
  6. Don’t sugar-coat the reality.
    I was terrified the first few times I trained–not of training, but terrified they would think it too hard and leave. We were extremely short-staffed at the time and I was terrified of losing these new aides before they even finished training. I tried to make everything run smoothly, busted my behind to create a good day around them. The first time they worked without me, they were shocked and horrified to learn that things didn’t run so well outside my little umbrella of forced calm. I learned the hard way not to sugar-coat things; let the newbies see the reality of what they were getting into before we were dependent on them to pull their own weight.
  7. Set realistic expectations and be patient.
    “Faster, faster, faster,” was V’s constant refrain while I was with her. “Come on girl, you’ll never make it if you don’t speed up. 15 minutes per shower, come on, let’s go.” Sadly, V was not the only aide from whom I have heard this. Many newbies, like myself once upon a time, find this extremely frustrating: to be brand new at a job and expected to keep up with the most experienced aide in the building. It feels like you’ve been set up to fail and nobody likes that. “Slow down, learn it the right way,” I say. “Speed will come with experience. It’s a lot of information being thrown at you all at once, but don’t worry. Give it a few weeks and you’ll get it. I don’t expect you to be Superaide right out of the gate.”
  8. Set a good example.
    I hope that I’m a fairly pleasant and polite person to begin with, but I’ve learned to keep a cheerful demeanor while training no matter what my personal emotions are that day. Like it or not, I am the face of my nursing home while I’m training…the face of long term care even, when I’m training brand new aides. Constantly griping or focusing on the negatives is setting a bad example of what is acceptable from a caregiver. Constantly freaking out about all the work we’ve got left…doesn’t quite inspire confidence, either in you or their own ability to do the job. Grace under pressure is the goal, I tell myself. Grace under pressure and show these new initiates how to handle a bad day.
  9. Follow the rules.
    This one hurt a bit to learn. Look, any aide who has survived for any length of time in this business has probably bend (if not broken) a few rules. Unfortunately, that’s the way the system is set up: doing it the “right” way is always difficult, if not impossible. At first, I cut corners in front of my newbies. That stopped the first time one ratted me out to my supervisor–over a minor infractions, but whatever. Lesson learned. Follow the rules, be friendly but don’t assume this is your new best buddy at work.
  10. Draw your line in the sand and stick to your guns.
    There’s a few important things you cannot budge on. For me as a caregiver, these are body mechanics and how you treat my residents. My trainees learn quickly that I’m strict when it comes to good body mechanics and treating my residents with respect and empathy.
    I warn them about the statistics on CNA back injuries; I tell them not to be a number on that graph. I remind them constantly to talk to resident during care, to remember that it’s not the dirty brief that is important: it’s the person who wears the brief.
    Protect your back.
    Remember: residents are people too.
    Simple to say, not so simple to practice. As a trainer, I try not to let newbies start any bad habits. There’s no “just this once” for bad body mechanics and being mean to residents.

You inspire me

Sunflower

May

She looks shocked.
I really don’t know why: all I said was “You inspire me.”
“Oh, no,” she replies, laughing a little, but it’s a nervous little laugh. “You’ve been a CNA for years, I’ve only been one for a few months–”
“So? You handled that situation better than I did,” I say. It stings coming out–but it is the truth. I didn’t handle that situation very well. I lost my cool and she didn’t. Sometimes I think I’m told too often that I’m a great aide; it’s true I’m good at my job but there’s always room for improvement. Today, I was shown in area in which I need to improve by this new CNA. It’s a bitter pill to swallow–but I believe in giving credit where it is due.
“I’ve never been told that before,” she tells me. “Mostly I’m just told ‘Don’t tell me how to do my job’ or ‘Listen here I’ve been doing this for far longer than you’.”
“Well, I have been doing this longer than you,” I reply with a laugh. “That doesn’t mean I know everything and I’ve got nothing to learn. Today I learned how to keep my cool. Tomorrow maybe I teach someone how to make a resident laugh. We’re a caregiving team: we either make each other better or we make each other worse.”

God knows I’ve got my flaws, but I hope the day never comes when I was “too good” to learn something. I never want to be of those aides you can’t say anything to.

Let’s Prove Them Wrong

photo

 

Alice

    We have received some wonderful and articulate emails from a reader who posed this question:  How do we make life better NOW for those living with dementia? She went on to explain how advocacy is what drives the flow of funding and most of the funding is going towards finding a cure for Alzheimer’s disease. While vitally important, it does nothing to help those currently living with the disease in the long term care communities. Who is speaking up for them? Who us speaking up for us?

       The frustration is that here on our level, there is little meaningful conversation of such things. We are expected to show up and take what is dished out. We don’t do it for the money, they say. It’s just a “stop-gap” job. If they were smart, they would have furthered their education. Treat someone as disposable for long enough and they begin to feel disposable; begin to act disposable. Is that what we want? Disposable people caring for the most vulnerable section of our society in their hour of greatest need?

      Or maybe it’s an indication of something deeper. They treat us as disposable because on some level they feel that those within our care are disposable. They have aged out. They no longer contribute to our society. Wisdom, experience, history, dignity are not valued commodities in this fast paced world of “me first and the give me! give me! mentality. Old, sick people barely make the priority list and those of us who care for them don’t make the list at all.

      No one SAYS that of course. I have never once seen a bumper sticker that reads Old People Suck and yet the situation in which many seniors and people with disabilities are forced to live is heartbreaking. There is no other word for it. They devalue them and by doing so they devalue us. And I’ve got news for you, folks…we allow it. Hell, sometimes we encourage it by our own behavior.

      One in four seniors will suffer from elder abuse. I’m no statistician, but I would say there is a probable correlation between quality of care and treatment of the work force. One in four. The injuries caregivers suffer on the job is sky rocketing. Again, this is supposition, but I would say exhaustion due to being forced to pull double shifts or multiple jobs to barely make ends meet would contribute to this. The standards for certification is low, the wages are low, the work is difficult, and the turnover is high. Why, why, why would ANYONE choose this quagmire? Because someone has to. Because those of us in the know have a moral obligation to do everything we can to be a part of the solution. Because it’s a battle worth fighting.

         How do we make life better NOW for those living with dementia? For all of those living with a disability that requires care? I have no idea. I’m winging it. I give the best possible care to my client. I write for this blog. I notice lonely people and try to make them less lonely. That’s the only way I know to make any difference that counts. I’ll tell you this though, the most meaningful changes are going to begin with us or not at all. They think we’re disposable. Let’s prove them wrong.       

How the Green House Model Makes Staff Empowerment Possible

DSC00999

 

Yang

In my last post, I began looking at the second core value of the Green House Project: empowered staff. This features an organizational structure that “flattens” the traditional hierarchy and leaves the responsibility for day to day decisions in the home to direct care staff (shahbazim). How and why the Green House model makes this organizational structure viable from a caregiver’s perspective will be the subject of my next two or three posts.

There are three tangible and interrelated ways in which the Green House model makes it possible for the Shahbazim to perform this expanded role. First, as previously noted, the shahbaz to elder ratio is 5-1. In most LTC settings that ratio is much higher, sometimes 10-1 or more on the day shift and higher on the evening and night shifts. The higher ratios guarantee that a caregiver in a traditional setting is going to be overwhelmed with basic daily care concerns and is not a position to take on the additional burden of assuming responsibility for matters not directly related to care. The 5-1 ratio allows a shahbaz the flexibility to effectively deal with these additional responsibilities.

Second, along with the CNA requirement, shahbazim receive an additional 128 hours of training specifically related to their expanded role. This includes instruction in safe food handling, culinary skills, first aid, basic home maintenance and management skills. Shahbazim also receive instruction in dementia care, critical thinking, communication, teamwork and policies and procedures. The shahbaz builds on this foundation of knowledge and develops professionally through a combination of practical experience, coaching and peer networking. There is an expectation that with proper support, caregivers can and will grow into the expanded role.

Third, Green House homes are limited to 10-12 elders. The small scale significantly changes the nature of the problems and decisions faced by the Shahbazim as opposed to what managers deal with in large institutions. For example, nutrition in a traditional institutional setting involves a whole range of problems such as large scale procurement, storage, inventory control and staff management, not to mention the difficulties involved in preparing and delivering large volumes of food. While preparing meals for a home of 10-12 people is not a small job, the problems revolve more around individual preferences and are thus more similar to what a shahbaz experiences in his or her own home.

While we can point to these more tangible factors that make staff empowerment possible, the dynamics that really make the whole thing work are a little harder to define. But I’ll give it a shot in my next post.