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The Ripple Effect

A Story of Connection & Friendship by Vivienne Allanson

“At Maroba, we choose to lead the way in dynamic and passionate aged care”. 

This premise is reinforced when we see what influence we can have on others.

In 2013, Maroba’s CEO Vivienne (Viv) Allanson met Sister Lucia, a South African nun working in aged care, at IAHSA’s 2013 Global Ageing Conference in Shanghai, China. The two were introduced by Margie Van Zyl, IAHSA’s Immediate Past Board Chair, and have become fast friends and collaborators in aged care.

Viv learned that Sr. Lucia was sent to manage St. Antonine’s Home for the Aged, a poor, black, rural aged care community in KwaZulu, South Africa, even though, at the time, she had no experience or training in health or aged care. When Sr. Lucia arrived, she found St. Antonine’s in dire circumstances. She was given three months to turn it around or the government would close them down. Her qualifications in early childhood education were of little help to her in this challenge.

Years later, St. Antonine’s is thriving.  Much of its growth can be attributed to Sr. Lucia’s growing passion for older people and her determination to make a difference. The work of GERATEC in assisting the implementation of the Eden Alternative at St. Antonines has also given Sr. Lucia great courage to persevere and her passion has overflowed to the international aged care community with organizations such as Maroba extending a hand of friendship.

As the friendship between Viv and Sr Lucia grows, her story is shared, attracting even more practical support from around the world. A local consultant and her daughter put their creativity to work by developing a website for St. Antonines which has been a long held dream for Sr Lucia, but not within her grasp. Many more small contributions have been made in support of St. Antonine’s, adding to the “ripple effect” of a single connection.

Time to Thrive

Since 2013, Viv and Maroba have supported St. Antonine’s from afar, sharing knowledge and expertise and fundraising to address some of the community’s most urgent needs. In 2014, the staff and residents at Maroba were so inspired by Sr. Lucia’s story that invited her to Australia for a visit. Through Maroba’s fundraising efforts, Sr. Lucia was able to travel to Australia, and, hosted by Viv, stay for four weeks to learn from the aged care community and share her story.

A bonus while in Australia, Sr. Lucia was given opportunities for public speaking. She was guest speaker for Maroba’s 60th Anniversary Celebration. She was also accepted as a speaker for the joint ACSA-IAHSA international conference held the following year in Perth and, with a CommonAge scholarship, was able to experience the conference, learn from the international community and tell the story of St. Antonines home.

With mentoring from Viv and others on issues of direction, leadership and self-confidence, Sr. Lucia was empowered to change the lives of her residents, to share her story on the international stage and to be a strong voice for justice for those in her care.

Maroba continues to support St. Antonine’s however they can.  In August of 2015, Viv and a friend traveled to South Africa to visit St. Antonine’s staff and residents. Over a two-and-a-half-week program, they served Sr. Lucia’s community doing whatever was asked of them. During that time, they also helped to raise funds to install running water in St. Antonine’s 100-bed facility to replace the pots of water they carry on their heads to where it is needed. Now the home is not only able to provide water to its residents, but also to a nearby kindergarten and others in need.

The team painted the residents dining room among many other daily tasks to support staff and residents of the facility whilst staying at the home. It was a life-changing experience–a great opportunity to build new relationships and to experience the generous and gracious hospitality of Sr. Lucia’s staff and residents.

What’s Next?

One of the things that struck Viv during her visit was the smell of urine within the community (even though the care and cleaning regime was very thorough) and the visible signs of incontinence amongst the 70 plus residents.

Unfortunately for the residents, it was a matter of choosing between food or incontinence aids. The funding from the government is 100 RAN per month for each resident and the resident contributes the same amount. After that, it is a matter of goodwill and donations. Some of the residents have HIV, sadly passed on by grandsons who are taught by the village witchdoctor that they can be cured by raping their grandmother or a young child. (In 2016 this still happens.) St. Antonine’s rescues many older women and some men also, from abusive situations where little is understood about disease and ageing. In fact when someone develops Dementia it is often thought they are witches, and they are left to die or are mamed in some way.

St. Antonines is not only a home for the aged but a refuge for the poorest of the poor who, if left in their family setting, will continue to suffer unspeakable abuse and neglect.

Viv is now seeking to further extend the “ripple effect” of this friendship by finding a donor of incontinence aids for St. Antonines. She is also planning a return trip to visit Sr. Lucia and her St. Antonine’s family in 2017.

For more information about Maroba and St. Antonines, please contact enquiries@maroba.com.au.

About the Writer

2015 Photo_VivAllansonViv Allanson was promoted from the Executive Director of Nursing position to the position of CEO of Maroba in 2000. Whilst beginning her career in the Public Health sector she has not looked back since she made the move to Aged care in 1992. Her qualifications are numerous including a Master of Health Management. She has served on the IAHSA Board of Directors since 2013.

Household Design: A Look at the Evidence Base

By Bob Lagoyda

An international case study on the household design was featured at the recent U.S. LeadingAge Annual Meeting in Indianapolis, Indiana.  The session was given by Howard Johnson, President & CEO, Baptist Housing Ministries Society, located in Delta, British Columbia, Canada, along with two architects: Leslie Moldow, Managing Principal at Perkins Eastman, housed at their San Francisco offices in California, United States, along with Patrick Cotter, Partner, ZGF Cotter Architects, of Vancouver, British Columbia, Canada.

Based on research from Simon Fraser University (SFU) the session explored the household/neighborhood design model in senior living environments. Undertaken by SFU’s Gerontology Research Centre, the longitudinal study evaluated if the housing model of care used on the award-winning The Heights at Mt View project contributed to positive outcomes for residents, staff and family members. The study benchmarked residents and staff coming from a traditional institutional environment and studied the impact of the changes, including looking at satisfaction levels amongst the three groups of building users. 

The results of the research evaluation providedevidence for establishing how the built environment can best support the development of home-like care settings for older adults transitioning into long-term care. The findings were significant for informing the aging-in-community agenda, in terms of how to ensure seniors are provided with everyday supports to facilitate independence, autonomy and well-being whilst residing in residential care.

View the full PowerPoint Presentation here.

To learn more about The Heights at Mt View please visit their website.

Choose Montreux! Jack York and the Global Ageing Conference Experience

At the recent LeadingAge Conference in Indianapolis, Jack York of It’s Never 2 Late shared his IAHSA conference experience and how making the choice to attend IAHSA’s Global Ageing Conference in 2015 has profoundly changed his life–on a professional and personal level. He urges all to choose Montreux in 2017.

Check it out!

The Case for Age-Friendly Communities

By Robert Lagoyda

The movement toward age-friendly communities is growing, with the key impetus being population ageing. In the United States alone, the population of 65 and older has grown from 4.1 percent in 1900 to 14.5 percent in 2015. By 2020, it is expected to increase to 16.1 percent, and by 2050, to 20 percent—which amounts to one in five Americans who are 65 and older.

Medical, public health, and technological advancements have led to increased longevity, with the years added extending middle age—the period when people are most productive and creative—rather than lengthening extreme old age. Beyond what individuals themselves can do to age optimally, the movement to create communities that are age friendly focuses on how the economic, physical, and social environments can be improved to address not only the needs but also maximize the assets of an ageing population, for the benefit of all.

An age-friendly community is one that is a great place to grow up and grow old. It has safe and accessible public transportation options; affordable, accessible, and safe housing; pleasant and safe parks and outdoor spaces; quality community and health services; sufficient employment and volunteer opportunities; and engaging social activities and events for people of all ages. The needs and preferences of older adults are taken into account. Older adults are respected, and their knowledge, skills, resources, and contributions are sought out. They are integrated into the fabric of the community.

The reasons why creating an age-friendly community makes good sense, economically and socially, were presented at a session at the recent U.S. LeadingAge Annual Meeting in Indianapolis, Indiana. These reasons – supported by research conducted by academicians, government agencies, nonprofit organizations, and corporations – are based largely on two key premises:

  • Unlike most natural resources, older adults are a growing resource. Thus, population ageing presents a set of opportunities, if handled well.

  • An “age-friendly” community can benefit people of all ages and abilities.

Business leaders and private sector investors, government officials and staff, philanthropists, educators, civic groups, advocacy organizations, service organizations and providers, and residents themselves can use the information presented to take advantage of the resource that older adults represent and shape places that work not only for residents who are older now but also for residents across the life course. Reasons for creating an age-friendly community can be categorized in four broad areas: 1)economic benefits, 2)social capital benefits, 3)opportunities related to innovations in housing and physical infrastructure, and 4) health and other benefits.

At this LeadingAge session, Professor Margaret Neal, Director, Institute on Aging, Portland State University School of Community Health, in Portland, Oregon, gave a formal presentation on findings from her research on this topic, followed by panel discussion comprised of a diverse panel of aging services providers on their experiences being involved in the age-friendly movement, including the many benefits and increased quality of life that age-friendly communities provide to a wide range of older persons. The discussion, moderated by IAHSA Education Manager Bob Lagoyda, featured:  Amy Schectman, President/CEO, Jewish Community Housing for the Elderly, located in Boston, Massachusetts; Steve Ordahl, Senior Vice President of Business Development, Ecumen, headquartered in Shoreview, Minnesota; and Marvin Kaiser, CEO. Mary’s Woods, at Maryhurst, In Lake Oswego, Oregon.  

Professor Neal’s full report can be found here.

How To Redefine the Role of Nurses in Aged Care

By Geralyn Magan

Aging services organizations should stop defining the role of the registered nurse (RN) in terms of the physical labor involved in clinical tasks, or the emotional labor involved in keeping residents and family members happy.

Instead, says Christine M. Merzeder, clinical coordinator at Paracelsus Recovery in Zurich, Switzerland, RNs should be encouraged to focus their energies on “intellectual labor.”

“Before you do something hands-on, before you engage emotionally, you have to think about what you are going to do,” said Merzeder. “This is the equivalent of a chief executive officer’s (CEO) work. CEOs need to delegate. They need to plan. They need to distinguish between the operational level and the strategic and visionary level. So does a nurse.”

Merzeder was one of numerous speakers from Canada, Spain, Switzerland, and the United States who shared their research during a recent Global Ageing Applied Research Forum sponsored by IAHSA. The forum took place in late September in conjunction with the annual meeting of the European Association of Homes and Services for the Ageing.

An Expanding Role for Nurses in the Nursing Home

With the right training, nurses can build a knowledge base that gives them the tools to carry out their intellectual labor, said Merzeder. That labor includes:

  • Assessing and diagnosing health care needs.

  • Evaluating the effectiveness of care.

  • Monitoring residents’ physical condition and behaviors.

  • Working to help residents maintain their current abilities, prevent functional decline, and regain functionality after a health crisis.

  • Directing palliative care.

  • Performing some hands-on tasks that are beyond the skill level of direct care workers.

“The nurse’s role must be knowledge-based and not skill-based,” said Merzeder. “The skills can be taught to others. The skills can be supervised.”

Merzeder acknowledged that the enhanced professional role of nurses might be more acceptable in some countries than others, depending on their regulatory environments and ability to adequately compensate RNs for the additional training and advanced degrees that their expanded role might require. Such a role might be challenging to implement in the United States and the United Kingdom (UK), for instance, where RNs have a limited presence in nursing and aged care homes.

Despite a dearth of RNs in the UK’s aged care homes, Julienne Meyer, IAHSA vice chair and a professor of nursing at City University in London, agreed that “we’ve got to get nursing input into every care home, whether it’s a nursing care home or it’s a residential care home, because people are going in later, sicker, and more frail.”

Nurses must become “leaders who nurture the natural leadership in others within these settings,” said Myer, who led the research forum.

What is an Effective Nurse Supervisor?

Catherine McGilton, an associate professor of nursing at the University of Toronto, and Montserrat Gea-Sánchez, a professor of nursing and physiotherapy at the University of Lleida in Spain, shared their work to develop and validate a scale that measures how well RNs are carrying out their supervisory roles.

McGilton’s review of the literature led her to conclude that effective supervisors share certain characteristics. They are generally dependable and empathetic, respect others, communicate effectively, and are willing to offer personal support, counseling, and guidance to those they supervise.

Using these characteristics as a guide, McGilton developed a 50-item scale to gauge how direct care workers rate their supervisors. The scale includes such statements as “My supervisor recognizes my ability to deliver high-quality care,” and “My supervisor tries to meet my needs in ways such as informing me of what is expected of me.”

McGilton and Gea-Sánchez worked in their respective countries to validate the scale as an accurate tool for evaluating supportive supervisors. That validation process, which involved conducting focus groups with providers and workers, was an important step in ensuring that the scale can be used in practice settings, said Robyn Stone, senior vice president for research at LeadingAge and a forum speaker.

“Measuring how supportive the supervisor is can tell you whether you have the right person in the job, or whether you risk potentially losing workers because you’ve got a bad supervisor,” she said. “But you must use a scale that is valid and reliable, or else you don’t know what you’re measuring. Bringing researchers and providers together to test the scale is critical.”

The Role of Nurses in Home Care

Having nurses with strong supervisory skills is especially important in the home care setting, said Stone in the final segment of the forum.

“Home care workers work in widely dispersed settings, which makes their job very solitary,” said Stone. “Unlike direct care workers in a nursing home, home care workers lack a community of peers, so they depend even more on their supervisors for support and guidance.”

Stone shared LeadingAge research showing that consistent assignment and the availability of career ladders could have a role to play in reducing worker turnover in home care settings.

LeadingAge is currently seeking funding for a new initiative to study the characteristics of a supportive home care work environment. The initiative, which will involve conducting case studies of highly effective home care programs, is part of a new strategic focus on workforce issues at LeadingAge.

“Workforce development, and the role of nursing in particular, is so central in our sector,” said Stone. “We can’t continue to take it for granted. Instead, we need to focus squarely on training, education, models for delivery, articulation of staff roles, and issues around management, coaching, and nurturing. We have a growing body of quantitative and qualitative research in this area. Our job now is to get that research integrated into practice around the globe.”

IAHSA Forum Explores the Role of Nurses in Aging Services

By Geralyn Magan

The role of nurses in the field of long-term care was the topic for discussion in late September when the IAHSA held a Global Ageing Applied Research Forum in Lyon, France. The forum took place in conjunction with the annual meeting of the European Association of Homes and Services for the Ageing.

Julienne Meyer, IAHSA vice chair and a professor of nursing at City University in London, led the forum. Speakers from Canada, Spain, Switzerland, and the United States shared their research on the important role that nurses can play in guiding and supervising direct care workers in the nursing home and home care environments.

An Expanding Role for Nurses in the Nursing Home

Christine M. Merzeder, clinical coordinator at Paracelsus Recovery in Zurich, Switzerland, recommended redefining the role of the registered nurse (RN) in long-term care by encouraging nurses to “work within their professional boundaries.”

RNs and the organizations that employ them should stop defining the nurse’s role in terms of the physical labor involved in clinical tasks, or the emotional labor involved in keeping residents and family members happy, said Merzeder. Instead, she said, nurses should focus their energies on “intellectual labor.”

“Before you do something hands-on, before you engage emotionally, you have to think about what you are going to do,” said Merzeder. “This is the equivalent of a chief executive officer’s (CEO) work. CEOs need to delegate. They need to plan. They need to distinguish between the operational level and the strategic and visionary level. So does a nurse.”

With the right training, nurses can build a knowledge base that gives them the tools to carry out their intellectual labor, said Merzeder. That labor includes:

  • Assessing and diagnosing health care needs.

  • Evaluating the effectiveness of care.

  • Monitoring residents’ physical condition and behaviors.

  • Working to help residents maintain their current abilities, prevent functional decline, and regain functionality after a health crisis.

  • Directing palliative care.

  • Performing some hands-on tasks that are beyond the skill level of direct care workers.

“The nurse’s role must be knowledge-based and not skill-based,” said Merzeder. “The skills can be taught to others. The skills can be supervised.”

Merzeder acknowledged that the enhanced professional role of nurses might be more acceptable in some countries than others, depending on their regulatory environments and ability to adequately compensate RNs for the additional training and advanced degrees that their expanded role might require. Such a role might be challenging to implement in the United States and the United Kingdom (UK), for instance, where RNs have a limited presence in nursing and aged care homes.

Despite a dearth of RNs in the UK’s aged care homes, Meyer agreed that “we’ve got to get nursing input into every care home, whether it’s a nursing care home or it’s a residential care home, because people are going in later, sicker, and more frail.”

Nurses must become “leaders who nurture the natural leadership in others within these settings,” said Myer.

 What is an Effective Nurse Supervisor?

Catherine McGilton, an associate professor of nursing at the University of Toronto, and Montserrat Gea-Sánchez, a professor of nursing and physiotherapy at the University of Lleida in Spain, shared their work to develop and validate a scale that measures how well RNs are carrying out their supervisory roles.

McGilton’s review of the literature led her to conclude that effective supervisors share certain characteristics. They are generally dependable and empathetic, respect others, communicate effectively, and are willing to offer personal support, counseling, and guidance to those they supervise.

Using these characteristics as a guide, McGilton developed a 50-item scale to gauge how direct care workers rate their supervisors. The scale includes such statements as “My supervisor recognizes my ability to deliver high-quality care,” and “My supervisor tries to meet my needs in ways such as informing me of what is expected of me.”

McGilton and Gea-Sánchez worked in their respective countries to validate the scale as an accurate tool for evaluating supportive supervisors. That validation process, which involved conducting focus groups with providers and workers, was an important step in ensuring that the scale can be used in practice settings, said Robyn Stone, senior vice president for research at LeadingAge and a forum speaker.

“Measuring how supportive the supervisor is can tell you whether you have the right person in the job, or whether you risk potentially losing workers because you’ve got a bad supervisor,” she said. “But you must use a scale that is valid and reliable, or else you don’t know what you’re measuring. Bringing researchers and providers together to test the scale is critical.”

The Role of Nurses in Home Care

Having nurses with strong supervisory skills is especially important in the home care setting, said Stone in the final segment of the forum.

“Home care workers work in widely dispersed settings, which makes their job very solitary,” said Stone. “Unlike direct care workers in a nursing home, home care workers lack a community of peers, so they depend even more on their supervisors for support and guidance.”

Stone shared LeadingAge research showing that consistent assignment and the availability of career ladders could have a role to play in reducing worker turnover in home care settings.

LeadingAge is currently seeking funding for a new initiative to study the characteristics of a supportive home care work environment. The initiative, which will involve conducting case studies of highly effective home care programs, is part of a new strategic focus on workforce issues at LeadingAge.

“Workforce development, and the role of nursing in particular, is so central in our sector,” said Stone. “We can’t continue to take it for granted. Instead, we need to focus squarely on training, education, models for delivery, articulation of staff roles, and issues around management, coaching, and nurturing. We have a growing body of quantitative and qualitative research in this area. Our job now is to get that research integrated into practice around the globe.”

Take a Stand Against Ageism

By Katie Smith Sloan

The International Day of Older Persons in early October focused on the World Health Organization’s campaign against ageism – Take a Stand Against Ageism. On October 6th at the U.N. Headquarters in New York, ambassadors from Argentina and Singapore joined the chorus of NGO’s and others in advocating for a “whole society approach”  or a “networked approach” to addressing biases against ageing. To change attitudes, we need to start with the uncomfortable notion of looking at our own biases.

Nicodimus Chipfupa from HelpAge International in South Africa reminded the diverse audience of advocates that if a country is proud of who they are, they should highlight the contributions of older people, as it is these contributions that made the country what it is today. He suggested that we need to look at older persons as partners rather than beneficiaries.  Alana Officer, Senior Health Advisor at WHO, remarked that the extent to which societies benefit from longevity depends on the health of the elderly. While there are no global prevalence figures about ageism around the world, in the World Values Survey, 60% of people from 57 countries reported that older people are not respected. We need to build and embed a new attitude about aging. Officer said  “we live in an ageing world; it doesn’t have to be ageist.”

IAHSA has joined WHO and others in its campaign to Take a Stand Against Ageism–and we encourage you to join us!

Learn more about how you and others in the community can join the movement against ageism here.

Following Our Own Advice About Strategic Planning

By Majd Alwan, Executive Director, Center for Aging Services Technologies (CAST)

It’s hard to be successful in the field of aging services without also being attuned to the importance of strategic planning. That’s because our field is always changing — and those changes require a deliberate effort on the part of successful organizations to change along with it.

After all, change is part and parcel of the work you do every day as you serve adults with changing needs, test and adopt new care models, adapt to new payment systems, and anticipate serving a dramatically changing consumer as the baby boomers age.

The most successful organizations have a pretty good idea of how the future is likely to unfold — and how they can prepare for that future. Strategic planning is the key to acquiring that knowledge. That’s true for your organization. It’s true for CAST, IAHSA and LeadingAge as well.

Who Else is Taking CAST’s Advice?

There are strong indications that the larger U.S. ageing services organizations are following our strategic planning advice.

They are building their competitiveness by building the sophistication of their corporate-level employees. And the C-suite increasingly includes a chief information officer (CIO).

Why is this significant? Because a CIO is someone whose job is focused squarely on strategic IT planning. Basically, the CIO is the person that organizations rely on to help them understand how technology can help their organizations meet their strategic goals.

CAST has developed a number of other tools to help provider organizations sort through technologies, including electronic health records, shared care planning and coordination, telehealth and remote patient monitoring, medication management, and functional assessment and activity monitoring. Each is accompanied by a white paper describing provider experience with these technologies in their communities. They provide valuable information about how to use technology to improve quality and operational efficiency.

You can check out these valuable resources here.

IAHSA’s U.S. Members Welcome International Guests

As part of a tour of elder care services and supports in North Carolina, 20 delegates from the Korea Association of Senior Welfare Centers,  recently visited Carolina SeniorCare, a program of all-inclusive care for the elderly (PACE). The international group is exploring ways in which they can better serve and support a rapidly ageing population in South Korea. Hosted by Carolina SeniorCare’s Executive Director, Thomas Chang, the group was provided with an overview of the program and an immersive tour of the community with the hope that they would pick up ideas that might help them address the social and economic impact of an older population.

In Washington D.C., Stoddard Baptist Homes welcomed a group from the Chengdu Municipal Commission of Health and Family Planning Delegation in China. The visit was part of a short study trip for the group to learn about the development of General Physicians. The group toured and met with Stoddard staff to learn about aging services and the healthcare for the elderly–with a specific focus on the development of geriatric physicians and nursing staff, coordination of care as well as general care practices to address everyday needs.

Cross-country connections are integral to the development of sustainable and innovative systems of care and services for older adults around the world.  Countries look to one another for best practices spanning the continuum of care to address the growing healthcare and lifestyle demands of a rapidly ageing population. IAHSA’s Global Connections Program is one way in which IAHSA members can engage, learn from one another and advance evidence-based solutions, innovations and care practices that help to address the unique needs and challenges in their countries.

The Chinese Bamboo Story

A Reflection by Richard Semanda, IAHSA Board Member

There was a Chinese farmer who planted the Bamboo seeds for his family to survive. He watered and provided care day after day for a year and–NOTHING.

Two, three, five years and still…NOTHING. The farmer grew tired of keeping his dream alive and seeing no results.

In the sixth year, they saw green sprouts emerging from the barren ground and they became so excited. The Spot became a place for everyone in the village to come and see the miracle bamboo. In six weeks, the bamboo sprouts had grown 90 feet tall!

Reflecting on the Bamboo Story and IAHSA’s vision–

“A world in which all people have access to the highest quality care, services and housing in late life”

IAHSA has planted the seeds with determination and courage and is waiting patiently. IAHSA as the “Global Ageing Network ” has brought sprouts with deep roots in different parts of the world, becoming a place for everyone to come for Connections, Research, Education, Innovation and Quality care.

[IAHSA] has done this through positive reaction, believing in the vision and taking time to nurture the roots [of our community] to grow.

In the context of developed countries, the story illustrates the courage and strength needed to facilitate true cultural change.

In the context of developing countries, it demonstrates the inner strength and vision to overcome the challenges of scarcity, illiteracy levels, going beyond survival and becoming a thriving community that is inclusive for all.

About the Writer

2015 Photo_RichardSemanda

Richard Semanda, B.A Public Administration and Management Kampala International University, holds a Dip in Mass communication, Professional Teacher, Executive Director and promoter of the Geriatric Respite Care Foundation – Uganda (G.R.C.F-U). Co-founder, The Aged Family Uganda (TAFU).  He has served on the IAHSA Board of Directors since March 2016.