Intervention Models for Nursing Homes (II): The Pioneer Network

In the first part of this post, dedicated to intervention models for nursing homes that have recognized boredom as a risk factor capable of endangering dignified ageing, I analyzed the American initiative The Eden Alternative (TEA), promoted by Doctor Bill Thomas. That was the first that, following the standards of care and quality of life (QoL) established by OBRA, developed a training plan for caregivers of elderly in nursing homes based on 10 principles that are committed to active listening to the voice of inmates as method of prevention of the three plagues that plague the lives of those: loneliness, boredom and helplessness. Today I want to introduce you to another model, also from the United States, that subsequently came to light and that promotes improvements in the residential environment to combat these three pests.

This is The Pioneer Network (TPN), founded by Dr. Penny Cook. Although its journey towards the fight for cultural change in the transition from the hospital model to the person-directed care model began after that of TEA, specifically in 1997, TPN is considered the non-profit organization for-profit leader in the American sector when it comes to training nursing home caregivers in the values ​​of affirming life, satisfying the wishes of inmates, adopting a human point of view and promoting meaningful activities. Its core principles are as humble as soliciting and listening to residents' voices and respecting their personal choices. In addition to these, her philosophy is based on the following points: 

1. Know each resident

2. Accept that each inmate can and should make a difference

3. Promote social relations

4. Pay attention to spiritual needs as well as body and mind

5. Encourage risk taking as part of life

6. Think about the person before the task

7. Encourage self-determination

8. Build community

9. Treat others as we would like to be treated

10. Offer opportunities for personal growth and development

11. Use the environment in all its aspects (physical, organizational, psychological, social, spiritual)

12. Evaluate practice to do better

13. Recognize that cultural change is a work in constant progress

To deliver their message to interested caregivers, they make available to them a whole host of resources including conferences, webinars, symposia, books, toolkits, or DVDs.

Some of the most interesting practices that this organization promotes to improve the lives of residents in the centers for the elderly include accommodating the preferences of inmates when planning daily routines, consulting them in decision-making, taking into account their past routines, observing their reactions when they are unable to articulate their preferences and needs and make them possible; everything so that the elderly feel at home. Privacy, comfort and personalization are the pillars of this initiative.

Specifically, in some of the centers where the TPN model has been implemented, the changes included the elimination of the use of uniforms, the reorganization of the facilities and the decoration of the same by the residents, the permission for older people take their pets to the center or adopt, participation in laundry and kitchen tasks and menu design, the free choice of times for rehabilitation, the creation of sessions for inmates to get to know each other and also the staff, caring for children, plants, conducting questionnaires to find out their preferences regarding the organization of routines (see Figure 1), the integration of family and friends, the development of intergenerational workshops with members of the neighborhood, the organization of street markets, the approach to game hours with game consoles (Wii Wednesdays), computer classes to connect with loved ones who are far away you, travel, walks with caregivers, volunteer work, late-night activities for the most nocturnal, freedom to choose the time to wake up, exchanges between residences adjusted to this model or the celebration of funerals for the loss of community members and cultural events. Most striking is that many of these initiatives were promoted by the residents themselves!

The improvements speak for themselves. In the centers where this model has been applied, the number of residents who needed a permanent catheter has decreased from 12 to 1, participation in daily activities increased from 3 to 82%, the elderly stopped losing weight, many Fewer they needed to stay in bed, 100% of them felt treated with more dignity and more satisfied with their lives, combative or depressive behaviors decreased and many reported having made dreams come true that they could not carry out when young (ballooning, driving a Monster Truck, performing a play ...).

The weight that this model of residence shows when it comes to guaranteeing a dignified aging is appreciated when reading some of the testimonies of the elderly:

"When I first got in a wheelchair, I thought my life was over. I'm in pain, I'm in a wheelchair, I can't do much anymore. But, actually, I do a lot of things. I crochet, I work on the computer, I read. It's very different from what I imagined it would be, this is probably one of the happiest times of my life.

Providence Mount St. Vincent Resident

“There are many activities and I always participate. I danced at the Dancing with the residents event with my speech therapist's husband. He is only 40 years old, and I am 80! ”

Teresian House Resident

“All those social activities are not for me. I like to be in my room with the computer thanks to the Wifi network and the technical help of the staff. My brother is 90 years old and lives in another part of the country, but we communicate every day by e-mail ”

Teresian House Resident

“There are families that come often and prepare meals in the kitchen for the residents. It's fun!"

Teresian House Resident

How I wish I had heard my Tata say something like that! The Pioneer Network has not reached Europe yet, as The Eden Alternative has. What are we waiting for?

Figure 1. Example of a weekly questionnaire carried out to an inmate to find out their preferences