On May 26, Marilyn Oelkfke shared the story of Perham Memorial Home with a MOVE audience in Woodburn
Marilyn Oelkfke had been the Director of Nursing at Perham Memorial Home (PMH) for a long time. The facility was well respected and had stellar surveys. Marilyn and her staff were justifiably proud of the quality of care they provided to residents. That is, until her mother moved into the facility. Then Marilyn realized that her mother’s life-long routines could not be maintained in their system of care. No longer was she able to have a shower at night or was she able to sleep in in the morning.
The change in routine was hard on her mother, and she began to have “resistive behaviors.” However, Marilyn felt she couldn’t expect the staff to extend special treatment or accommodations for her mother. After her mother’s death, Marilyn began asking her staff if they would want to live at Perham Memorial Home and the resounding answer was no. No longer satisfied with the way they had been doing things, the staff began a journey, now 10 years old, to change the way they thought about and provided care and support to residents.
Marilyn offered many practical and concrete suggestions for others on the journey. Some of the key points included:
- Involve everyone — residents, staff, family, community, board, and management
- Develop teams, seek high involvement of EVERYONE
- Relationships are key
- Always ask “why?” — balance quality of care and quality of life
- Move to a household model of care that emphasizes in real and meaningful ways resident-directed living, self-led teams, shared leadership, cross trained staff with permanent assignments, in the setting of “home.”
- Cross train staff so that all can meet resident needs as they arise.
- Home means eating what you want, when you want; getting up and going to bed based on a resident’s schedule, promoting sleep, primary staff assignments to a household, bathing upon requests, multiple opportunities for life (both planned and spontaneous activities), and incorporating resident choice in everything we do.
Outcomes & Lessons
Although PMH’s culture change involved significant remodeling, Marilyn stressed that implementation of culture change preceded any change in the physical environment. Changing the ways staff think about providing care, truly becoming resident centered, and making deep practice changes are critical — it is not possible to make culture change only by changing the physical layout of the facility.
Outcomes and lessons learned from the PMH experience include:
- Although there are initial costs (e.g., time for training and planning), this new model of care does not have to cost more
- Having choice and closer relationships with caregivers results in reduction of resistive behaviors, and fewer psychotropic and anti anxiety medications are needed
- Eating foods they like results in healthy weight gain, reduction in nutritional supplements, and less food waste
- Well rested residents(who get up when they are ready) require less assistance with eating, reduced risk of choking, and fewer mechanically altered diets.
- Lights are answered more quickly with everyone trained to help; one benefit is reduced urinary incontinence.
- Residents have more opportunities to give to others, giving purpose and meaning to life.
Those attending the workshop were inspired by the talk. The following comments reflect the experience of many:
Great speaker — knows her stuff.
I really enjoyed this seminar because it opened my eyes to what we could be doing to improve quality of life for our residents as well as being the solution to staff burnout.
Very practical, down-to-earth presentation makes all seem possible. Wonderful speaker — very engaging and positive. A very worthwhile day!
Thank you for sharing your journey with us! What an inspiration! Can’t wait to get started on making our own changes and taking those first steps.