Category Archives: Strategic Planning

News and Perspectives on Strategic Planning and Implementation Steps

Editors Note:  Periodically we post perspectives pieces in which we offer some broader thoughts on where our community is going.  We do this not only for each other, but to show our friends what is happening here.

As many know, our Strategic Planning document has been published, and concrete steps have been announced to move its items forward (see page 15 of our Courier dated Feb 26 to March 4).  This is a very important document for all of our lives, and not just because of the concrete steps, such as completely repositioning our health care, that are being and will be undertaken under its banner.

Every few weeks, the Committee, which is a Board Committee with heavy resident and staff participation, will be releasing an update on activities and plans in the Courier.  Residents will also be hearing about that in various fora, including the RA Council and the Community Meeting.

Indeed, such an update is in the most recent Courier.  It includes the very important news with respect to the critical health care partnership, that:

After a significant amount of due diligence, we have narrowed potential partners down to 3 providers. We are continuing due diligence and believe a final recommendation will be made to the Board in June for their endorsement.

Similarly with respect to the physical redesign of the Creighton Center (which is of course deeply integrated with our conceptual redesign:

A Request for Proposals (RFP) has been developed and has gone out to several national and local architectural firms. An ad hoc committee of the Strategic Planning Committee will oversee the RFP process and final recommendations on an architecture firm. We expect this process to be completed by the end of June as well. 

The is no need to note what a wonderful acceleration this represents.

The Report notes that the “Collington Culture and Stakeholder Engagement” implementation rollout will begin in September, and the other two will start in 2019. This delay will enable us to take full advantage of what we are learning about how best to work together in the initial groups and apply that will the next ones.

Speaking for my self, I feel very confident that these processes will be rich in resident input, and that the transformative quality will be clear from how things work out  Just look at the Landing Bistro and the new Physical Therapy staff and spaces.  These both reflect the values and principles processes established in the Srategic Planning process.  I hope that these will similarly increasingly influence everything here at Collington.

 

 

 

 

Vitalize360 Launching This Week — Meet and Greet Friday in the Game Room

This is the week that our Vitalize 360 program gets its real launch and sign-up opportunity.  A project of Kendal, it provides us Collington residents the opportunity to get a “life coach,” who will help us bring together whatever resources and help to decide what they want to achieve next in our lives.  If one of us does not yet know what this is, our new staffer Kim Rivers will help us figure that out too.  Once a goal is identified, Kim will help pull together the Collington resources, staff and residents, to support the process.

Often this is thought of in traditional medical terms, such as achieving a particular “vital sign” milestone, or getting physically strong enough to, for example, get on a plan to visit grandchildren.

But many of us feel that the most exciting engagements that this makes possible are more intellectual, political, academic, etc.  Dianna Cox, who runs the project, and was here for a great presentation yesterday, gave an example of a man who had decided to challenge his golf club’s men only policy, and did so successfully.  (Other more transformative possibilities might come to mind.)

Tomorrow, Friday March 9 at 10:30 in the Game Room, there will be a meet and greet to get to know  Kim and learn more about the project.

Here is the PowerPoint that Nancy Cox presented.

Here is a short video:

It is important to note that Vitalize 360 is a key pat of our strategic plan, both as a specific element, and as something that will help build culture-transformative energy.

Indeed, a recent article in the Journal of Aging Research and Healthcare, here, concludes:

In this project, COLLAGE [Vilalize at one location] 360, a comprehensive assessment system and wellness coaching program that focuses on prevention and wellness was implemented in one continuing care retirement community. Following completion of two assessment tools through directed conversations with a wellness coach, older adults developed an individualized vitality plan that outlined life goals, supporting goals and action plans for goal achievement. Results from this program suggest engagement in the assessment and wellness coaching process via the COLLAGE 360 program translated into sample older adults sensing that they live in a more supportive environment when compared with elders not receiving any wellness coaching. In addition, the older adults had positive responses in the areas of mood and life satisfaction. Strategies to improve health and well being need an extended focus beyond the older adult‘s medical conditions and consider psychological, spiritual and social needs with personal preferences being paramount. These issues are foundational to a person- centered, health promotion approach needed among older adults.

Do not miss the opportunity.

 

The Coming Decline of Hospitals and Implications for Our Strategic Plan

An important article in the New York Times highlights the the ongoing reduction of hospital admissions.

Consider this: What year saw the maximum number of hospitalizations in the United States? The answer is 1981.

That might surprise you. That year, there were over 39 million hospitalizations — 171 admissions per 1,000 Americans. Thirty-five years later, the population has increased by 40 percent, but hospitalizations have decreased by more than 10 percent. There is now a lower rate of hospitalizations than in 1946. As a result, the number of hospitals has declined to 5,534 this year from 6,933 in 1981.

In addition to the impact of increasing infection risks:

The number of hospitals is also declining because more complex care can safely and effectively be provided elsewhere, and that’s good news.

When [the writer] was training to become an oncologist, most chemotherapy was administered in the hospital. Now much better anti-nausea medications and more tolerable oral instead of intravenous treatments have made a hospital admission for chemotherapy unusual. Similarly, hip and knee replacements once required days in the hospital; many can now be done overnight in ambulatory surgical centers. Births outside of hospitals are also increasing, as more women have babies at home or at birthing centers.

Studies have shown that patients with heart failure, pneumonia and some serious infections can be given intravenous antibiotics and other hospital-level treatments at home by visiting nurses. These “hospital at home” programs usually lead to more rapid recoveries, at a lower cost.

This has huge implications for the system as a whole.

As these trends accelerate, many of today’s hospitals will downsize, merge or close. Others will convert to doctors’ offices or outpatient clinics. Those that remain will be devoted to emergency rooms, high-tech services for premature babies, patients requiring brain surgery and organ transplants, and the like. Meanwhile, the nearly one billion annual visits to physicians’ offices, imaging facilities, surgical centers, urgent-care centers and “doc in the box” clinics will grow.

It also has huge implications for our already well-advanced planning for implementation of our strategic goals with respect to health care at Collington.  For example:

It will become possible for more and more of us to be treated for more contiditions as outpatients.

Our skilled nursing units will have new uses as lower levels of care during treatment are appropriate.

Potential medical system partners will become even more interested in Collington as “off-site partners.”

The need for focused research on the impact of these changes will be greater, making the appeal of a research friendly partner even greater.

Integration of our holistic services with broader service networks will become crucial and practical.

In other words, we are moving toward “modern gerontology” at just the point that other systems will need our partnership.

Stay tuned.

Preparing for Dementia — An Individual and Collective Responsibility at Collington

As we move forward with operationalising our Strategic Plan, a recent New York Times article on dementia specific advance directives may be useful. Specifically:

Dr. Barak Gaster, an internist at the University of Washington School of Medicine, had spent three years working with specialists in geriatrics, neurology, palliative care and psychiatry to come up with a five-page document that he calls a dementia-specific advance directive.

In simple language, it maps out the effects of mild, moderate and severe dementia, and asks patients to specify which medical interventions they would want — and not want — at each phase of the illness.

“Patients stumble into the advanced stage of dementia before anyone identifies it and talks to them about what’s happening,” Dr. Gaster told me. “At what point, if ever, would they not want medical interventions to keep them alive longer? A lot of people have strong opinions about this, but it’s hard to figure out how to let them express them as the disease progresses.”

As a community with a commitment to individual autonomy, I think the document will speak to many of our concerns, and perhaps most specifically the fear of wanting to reject additional treatment, but no longer having the capacity to communicate that.  As the article elaborates:

For each stage of dementia, the patient can choose among four options. “Full efforts to prolong my life” and “comfort-oriented care only, focused on relieving suffering” represent two ends of the spectrum.

Patients can also opt for lifesaving treatments — except when their hearts stop or they can’t breathe on their own, precluding resuscitation or ventilators.

Or they can opt to receive care where they live but avoid hospitalization. “For someone who doesn’t understand what’s happening, going to an E.R. or being hospitalized can be really traumatic,” Dr. Gaster said. The experience can lead to delirium and other setbacks.

There is debate about whether there should be a separate dementia advance directive, but the idea of specific focus on the issue has great value.  (I personally find the Maryland MOLST utterly incomprehensible, and do achieve that this document does within the MOLST would be a great feat of editing.).

In any event, our commitment to the value of the individual challenges us, in my opinion, to do what we can to make sure that those who wish have thought through these issues, and that our entire system support people in these choices, which certainly reflect only current law, and do not represent any change from that law.

There was at one point talk to Collington working to improve the MOLST.  Maybe now is the time, reflecting the leadership goal in our strategic plan.  Surely these issue have great implications for staffing, training, staff-resident relationships, and culture building.

Thanks, Collington, for being a place where these things are as much on the table as they are on our minds.

Did You Know Our Denny Klass is a Paradigm Shifter?

Many at Collington have had a major impact on thinking in their fields.  I had not till now realized the impact that “our” Denny Kass has had on the field of bereavement studies.  As the extract from the forward, written by professor Neil Thompson, at Wrexham Glyndwr University, for a new book Denny has co-authored states:

In the 20 years after Dennis Klass, Phyllis Silverman, and Steven Nickman introduced the concept into bereavement studies in Continuing Bonds: New Understandings of Grief, continuing bonds went from being dismissed and pathologized to being a fully recognized and accepted phenomenon in bereavement scholarship and practice. Indeed, continuing bonds can now be seen not just as a phenomenon in grief but as a way of characterizing and expanding on grief itself.

The concept of continuing bonds allows us to enrich therapeutic techniques that help the bereaved, to expand our ability to understand bereavement in other cultures, to focus the philosophic questions in bereavement studies, to transfer what we learn about bereavement to how we study other significant losses, as well as to begin to include a wider range of academic disciplines in the study of grief.

Contributors in Continuing Bonds in Bereavement: New Directions for Research and Practice provide a comprehensive overview of developments in the two decades after its inception. Clinically-based contributors show psychological counseling can be more effective when continuing bonds are included. Other chapters report on grief in different cultural settings, open the discussion about the truth and reality of our interactions with the dead, and show how new cultural developments like social media change the ways we relate to those who have died. .  .  .

In sum, in Continuing Bonds in Bereavement, Klass and Steffen offer a sweeping and substantial successor to the pioneering volume that initiated a paradigm shift in the study of grief and its therapeutic implications, consolidating a perspective that is likely to remain ascendant as the field of bereavement matures

While Denny developed these approaches before coming to Collington, the resonace with repect to the values and approach of our cmmunity is obvious.  Here we create bonds in a network, and nurture them when the network suffers a gash.  Smething to think about as we move forward with the relevant elements in our Strategic Plan.

The book is titled Continuing Bonds in Bereavement: New Directions for Research and Practice, Edited by Dennis Klass and Edith Maria Steffen.  Here is the Amazon link.