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Feb 24, 2012 | Tom Zwicker

Commentary: A New Culture of Care at St. James House



It was really as a child that I began my career.  I say that because, as a child, my mother, Betty, would take me to nursing homes with her.  She was a graduate of Yale University--a mastered level registered nurse.  During her career, she surveyed nursing homes for the State of Wisconsin.  I was so proud of her.  I inherited my mother’s passion for elderly.


My presence in nursing homes continued when I was in college.  I worked as a housekeeper, activities assistant and certified nursing assistant.  During that time, what I valued most was not what I learned doing my job but rather what I learned from the elders, their stories.  They shaped my life.


It was no surprise that when I graduated, I decided to be a nursing home administrator.  I became an expert on regulations, leadership and balancing budgets but the more experience I gained; the more I understood in my heart-not my head-that something was missing. 


This troubling feeling became painful for me when I admitted my parents into my nursing home.  My father suffered a stroke and my mother lived with Alzheimer’s disease.  I accepted the fact that my parents were aging but most of my hurt was from the fact that my nursing home was misguided.  It supported a mission of medical treatment and not necessarily anything else.


It was an excellent nursing home by state and federal standards, deficiency free.  It was financially stable.  Yet, something was wrong.  Something from all my experience and training I couldn’t define.  And, if I couldn’t define it, how was I going to fix it?


About that same time, a passionate Texan by the name of Carter Williams was convening leaders in San Francisco; leaders she knew could make a difference if she brought them together.  Her goal was to change the way we viewed aging and the way we cared for people.  Those leaders in San Francisco were looking to define what was broken in nursing homes and fix it.  In many ways, she reminds me of Kathy Tellepsen, our board president, bringing leaders together to understand how it can be different.


I am here because of Kathy.  I am here because I share her commitment to transforming St. James’ House into neighborhoods that are person-centered and support, not only the medical model, but more. 


Person-centered care is about transforming caregivers, one at a time, to create a new culture to support human frailty—a culture that nurtures the human spirit through purposeful living, companionship and the unexpected.  Person-centered care is about making the bed you will one day lie in when you are old.


Person-centered care is challenging.  It is a process, not a program.  It has no end; it is organic, continually transforming, exactly like humans every moment they are alive.  Person-centered care entails resistance because change naturally creates resistance.  Resistance is healthy and invokes deep discussion and thoughtfulness.  Person-centered care changes the culture of treatment allowing for a healthy balance of giving care as well as receiving care. 


This new vision creates inclusiveness.  The training we are about to embark on is for caregivers, board members, elders, families and anyone from the community that is relevant to our mission.  This transformation requires 100 percent of the people who live and work in the community to be involved in the process. 


Our journey began with leadership committing to change and will really gain momentum when Action Pact starts training on February 2, 2012.  Action Pact is a company of trainers, educators and consultants who assist nursing homes and other elder care organizations in becoming person-centered.  They do that by encouraging the development of small, familiar communities (neighborhoods) that provide more opportunities for the elders to give care, made decisions and have control over their daily lives.  They work directly with organizations to help develop and implement their change plans for the organization and physical plant.  Action Pact is a company at the forefront of the culture change movement.


The journey of St. James’ House will be unique.  And, because language forms your reality, you will hear a lot of new words.  Words are fundamental to our transformation.  Once we begin to change our language we begin to look at things differently.  For example, when we say elder versus patient we begin to look at the people who live at St. James’ differently. 


As we define our neighborhoods (versus nursing wings) a paradigm shift occurs.  That one needs no explanation.  We will talk about change versus transformation.  When you change something, like changing your weight, it is usually temporary or at least, it can be.  But, when you transform something it can never be changed.  Like when a caterpillar transforms into a butterfly or wood burns and transforms into ashes. 


I was transformed in that once I experienced person-centered care I could never go back to the traditional model of care.  Kathy has talked about once she drove to St. Paul’s Nursing Homes in St. Paul, MN, and experienced neighborhoods she could never accept anything less.


The social movement to redefine aging continues to grow.  There are opportunities to learn from national networks and those close to home.  Texas now has a state coalition.  Leaders of the national movement have affected Medicare and Medicaid programs to the extent that they are rewriting policy to support the work.


In 1957, Bishop John Hines commissioned a team to evaluate the vastly growing needs of the elderly.  That team concluded that the Diocese of Texas had a very definite responsibility toward the establishment of a home to support the community.  Owned by the diocese, St. James’ House opened in 1960 on 10 wooded acres in Baytown.  Today, more than 100 elders live in St. James’ House and 40 independent residents live in Alexander Hall.  Person-centered care supports the mission of professional care in a loving, Christian environment continuing the vision of Bishop Hines.


Zwicker is executive director of the diocesan retirement community, St. James House, Baytown.