vision of the future

Running Head: VISION OF THE FUTURE 1

Vision of the Future: St. John’s Home

Individual Assignment: Class 6

Emmalie Beaman

Medaille College

Author Note:

This paper was prepared on 19 April 2016 for MOL623X

MOL18RA, taught by Professor Ann Horn-Jeddy

VISION OF THE FUTURE 2

Abstract

St. John’s Home opened its doors over one-hundred years ago and still resides on its

current property at 150 Highland Avenue. Originally starting as a German Evangelical ran

Home for the Aging, it was operating far beyond it years even from the beginning. Nursing

homes were very much a progressive idea as health care and biological science evolved so too

did longevity and simultaneously, the need for hospital grade 24 hour care for the larger aging

population. Today, the spirit of innovation and guiding the light into the future are paramount to

the reputation and functioning of St. John’s. Presently we have the unique opportunity to forge

the way into patient centered care that nurtures not only medicinal needs but also the emotional

and companionship needs, much like the founders lit the way for aging care a century ago.


Vision of the Future: St. John’s Home

Introduction

The pride and reputation of St. John’s Skilled Nursing Home rests heavily on the patient

centered, individualized care that began one-hundred years ago on the same property that the

current campus still resides. St. John’s could not have accomplished and retained its eminence

without their unsurpassed dedication to innovation and altering their vision to align with the

current times and ever evolving needs of the elder community. This need for forging ahead into

the future is especially important as the Baby Boomers enter into elder hood and with them,

comes their generational expectations of independence and emotional nurturing. It is our

purpose, our job, our responsibility to evolve into the next hundred years and pave the way for

all senior communities. This evolution cannot be made possible without every employee

participating as a cohesive team and believing in and modeling this new vision through all

interactions and actions all day, every day.

The new path in senior skilled nursing that encompasses patient centered care that aims at

deinstitutionalizing and abolishing stereotypes is known as the Eden Alternative. The Eden

Alternative was developed by Dr. Bill Thomas, a geriatrician and pioneering force in patient

centered care (Peterson, 2016). In order to more clearly allow a visual representation of the Eden

Alternative and its need in the world, Dr. Thomas often offers his personal story that led him to

develop this new idea. Dr. Thomas began his geriatrician residency in a nursing home located in

Boston, one late night shift as he was doing his rotation, he stopped by the room of an elder

named Rose, he did his typical bedside manner, took her vitals, asked if she had any pain, or if

there was anything he could do for her, Rose’s haunting reply has stuck with me through the


years and cemented my attitude toward elder care ever since. That night Rose looked up at Dr.

Thomas with tears welling in her eyes, “do you have anything for loneliness?”

Before we look ahead to the future, it is important to know the past so we may learn from

it and improve on it. Everyone is familiar with the typical stigma attached to Skilled Nursing

Care, troves of hospital beds with sedated elders, eyes fused to the television, with exhausted

complacent nurses passing medications in small clear plastic cups, and mysteriously bland

tasteless food being distributed like an assembly line off of rigid silver racks. The question that

is posed in many minds is, well isn’t that the description of a hospital? Yes, it is, and that is

exactly the problem. This type of institutional setting was never meant to be for long term care

but rather short term visits out of medical necessity. The longer elders are able to be sustained

due to advancements in medicine the longer they will need to live where 24 hour care is

provided. Today, a person with a chronic condition can be stabilized and their life prolonged

through medical intervention and monitoring. This longevity and sustainability creates a need

for other parts of life to be fulfilled including companionship and leisure, every part of the

elder’s life should be taken into consideration, much like the ascent from basic needs to self-

actualization on Maslow’s hierarchy of needs (McLeod, 2014). And so from the ashes of the

hospital stereotype will rise the phoenix of the small home model that is the heart of the Eden

Alternative.

In order to truly begin looking into the future an alteration of the vision must be made

and in addition to, be encompassing of all aspects of the organization. The vision must be a

synergy of goals and a motto. A motto, that encompasses all employees can get behind and

visualize themselves as part of the entity carrying the organization toward the goal. In order to

genuinely focus all of our efforts on the mind, body, and soul care of the elders that can stand the


test of time, employees must see themselves in said vision and feel just as emotionally cared for

and supported by the administrative team. A servant leadership (Keith, 2013) model where

creativity and promotion is fostered will create a boosted morale and a family like atmosphere

for the staff that will trickle down to the care of elders. The largest pool of new residents coming

in comes from referrals, by word of mouth between families and neighbors, so every employee

must be a positive reflection of the organization as a whole. This particular leadership is

demonstrated at Southwest airlines who boast that if you take care of your employees, your

employees will take care of your customers, which will retain and generate new customers

(KnowledgeAtWharton, 2008). The new vision is a constant work in progress that requires

always improving ourselves individually and as an organization:

Vision

“To provide exceptional patient-centered care, encompassing all aspects of an

individual’s life, with a focus on aiding in declining capacities, which is a natural consequence

of elder hood; while encouraging new abilities and fostering independence in a familial home

like atmosphere.”

The values associated with this new and improved vision include:

Respect

Teamwork

Empathy

Caring

And Fun!


The values of an organization breathe life into the vision and are connotations associated

with modeling the vision every day. Respect and empathy go hand and hand and are related not

only to the care of the elders but the administrators and supervisors care of their subordinates.

Respecting the elder is about remembering that this person is dependent on you for some aspects

of daily life, some parts they may be helpless in due to physical limitations, you serve the role as

their eyes, hands, and muscles at times. This is where empathy becomes tethered to respect,

empathize that many of these limitations are a normal part of aging and one day, we will be in

this same position. The golden rule is beckoned from these two values; do unto others as you

would want them to do to you. A more tangible way to look at this would be to imagine this

elder is your own grandparent, aunt, mother, or father, how would you want a nurse, dietary aide,

or maintenance worker to treat them? If this mentality is used consistently and appropriately then

ethics will be of no question, but engrained and practiced by every staff member. Both the

family and the elder are the mercy of your own compassion, the family has entrusted you with

this vulnerable individual that they love so dearly. By admitting this person into your care they

are admitting as well, but in a different way, admitting that they do not have the skills to care for

this elder, but they trust you can. This transition into senior housing is a very transformative

time in many aspects; first the roles become reversed between parent and child which can be a

heartbreaking and difficult change, second, the elder is made fully aware of their inability to be

independent which can be a depressing transition for them. Imagine today that a family member

took away your driver’s license and car, the feelings or betrayal and helplessness do not change

with age. This is how we evoke a sense of empathy and understanding that crosses over into

care. Replacing the activities that are no longer realistic for an elder with new hobbies and

opportunities is not simply for distraction reasons, but to give elders a new sense of purpose in


this later stage of life. Maybe they cannot drive any more but they happen to be fabulous at

knitting, perhaps your encouragement causes them to knit hats for babies up at the hospital,

elders want to know they are still making a difference and have purposes, like we all crave in

life. Elder hood is a transition, not a decline, and this is where the value of fun is most

important. The values and vision combined becomes the product that is, core purpose.

The core purpose and organizational philosophy of the vision of the future for St. John’s

is to “embrace living” (Lehr, 2002). Embracing living is being an advocate for each elder every

single day. This is where the new training procedure comes into play. Each staff member will

have the opportunity to participate in a training program that allows them to learn how to cater to

all aspects of an elder’s life. The staff will not migrate mindlessly between floors and shifts but

instead stay on the same floor and same shift with the same elders every day. This familial

interaction will nurture relationships and ease anxieties for both parties. Instead of nurses (RN),

social workers, and therapeutic recreation (TR) personnel being locked away in their respective

offices, each floor that will only have 15-20 elders will have their own social worker, their own

TR, their own RN, who will get to know each elder, their needs, their likes, their baseline. This

integration creates a true system as proposed by Russell Ackoff in which the success of the

system relies on the parts working interpedently toward a common goal (Allio, 2003). This will

give rise to faster reaction times when the baseline changes and more opportunities for

spontaneous activity. This is the elder’s home; it is our job to make it feel that way. The CNA’s

will participate in the aforementioned training where they will learn to not only perform daily

activities such as dressing and treatments but how to cook for the elders and how to organize

crafts and activities, much like a private home aide. Each floor will have its own kitchen and its

own activity room, further breaking from the institutionalized model of the past. This will in


turn lead to employees feeling like a vital force in the organization. By making the floors into

the small home model the employees feel they have more flexibility in decisions and are more

trusted to run these small homes because they know the elders best due to daily interaction. The

small homes model makes each floor integrate together as the larger Skilled Nursing Home, a

living breathing social system where far more then medical needs are met.

When employees feel like part of the bigger functioning system and not being

micromanaged by authoritative CEO’s who look down at them from their pyramid employee

morale and satisfaction will flourish. Employees will be able to work closely with those above

their rank, the RNs, Social workers, and TR’s and may find interests in accelerating their career

down those paths. This is where the mentoring and coaching in the newly created Learning and

Development department will step in. Learning and Development will hold a quarterly one on

one interview with each staff member in order to not only evaluate their performance but allow

the staff member to evaluate the organization, make suggestions, and voice their future endeavor

desires. Learning and Development will encourage internal promotion by having those

interested in positions that reside in the Home engage in the “Follow the Leader” (Beaman,

2016) program where the staff member will have the opportunity to shadow and be mentored by

a person in their desired career path. This program will both encourage staff to stay within the

organization in the future while making the staff feel cared for like family. Satisfaction for those

who do not wish to move to a different career will come in the form of compliment cards

available in all elder rooms designed for easy access for both family and elders to compliment

staff members. Change can only truly be accomplished through a reciprocated relationship

between supervisors and employees, this will further propel employees toward the vision and act

as a catalyst for values to be developed and prolonged.


The view of the Home in the larger community is of a high importance as well, if we

truly wish to succeed in breaking the stigma attached to Skilled Nursing Homes. The Home will

begin a new program open to the community known as “Adopt a Grandparent” (Beaman, 2016).

This program is meant to integrate the community with the elders that built the community. The

Lilac Festival will be a good introduction to this program since Highland Park is across from the

Home. A booth will be set up to encourage festival goers to volunteer to simply push an elder in

a wheelchair, with a nurse present as well, or sit down on a bench and learn the story of an elder

and talk about life. This companionship is highly craved by some elders who do not have

families in town, or children of their own at all. It is a simple gesture that truly means the world

to the elders, many do not think that remarkable things they have done in their past are important

at all, but maybe it’s because no one will listen. “Adopt a Grandparent” can one day expand to

High School senior volunteer projects, churches, and senior centers that operate with recently

retired elders. This program will make not only St. John’s more visible in the community, but

the elders in general, which is the true customer we serve. It will have a reciprocating affect for

both parties and will make St. John’s name the top of the list for any person seeking Skilled

Care, not only based on reputation but visibility and integration with the larger community.

Due to the fact that St. John’s is a non-for-profit organization the major stakeholder are

and will remain to be a Board of Directors. The Board of Directors is a volunteer group from the

community, members are often sought out due to reputation, skills, and community standing by

the executives to be responsible for decision making within the organization. These facilitates an

unbiased supervisory group that is responsible for collecting and allocating resources and capital

and are the final decision makers for the annual budget. In another sense of the term stakeholder,

which as defined as: a person or group that has an investment, share, or interest in something, as


a business or industry (Dictionary.com, 2016), we are indeed all stakeholders and all share the

responsibility to function to the highest of our ability, to provide the upmost multi-dimensional

care to the elders and each other. This emotional investment is paramount to the continued

success both for occupancy and revenue sake.

Through all of these vessels running like parts in a well-oiled machine organizational

excellence is imminent. The achievements of all those working toward the goal will be noticed

by other communities who can use benchmarking to attempt to absorb some of our practices. At

St. John’s we will aim to stay the first, stay the best, and stay one step ahead of the competition.

Other communities are welcome to attempt to emulate the small homes model but few will

probably be able to look through the layers and see how a true system performs and works that

will make our success stand above all others. Cohesive teams, patient-centered care, employee

responsibility, and employee satisfaction are all the cornerstones that will support the revolution

of Nursing Homes in the future and beyond.


References

Allio, R.J. (2003). Russell L. Ackoff, iconoclastic management authority, advocates a

“systematic” approach to innovation. Strategy & Leadership, 31(3), 19-26. doi:

10.1108/10878570310472728.

Dictionary.com. (2016). Definition of “stakeholder”. Dictionary.com. Retrieved from:

http://www.dictionary.com/browse/stakeholder?s=t

Lehr, T.K. (2002). Lighting the way: A history of the first one hundred years of St. John’s Home

Rochester, New York. Franklin, VA: Q Publishing, LLC.

McLeod, S. (2014). Maslow’s hierarchy of needs. Simply Psychology. Retrieved from:

http://www.simplypsychology.org/maslow.html.

Peterson, K. (2016). Exploring life beyond adulthood with Dr. Bill Thomas. Retrieved from:

http://changingaging.org/about/

Senge, P.M. (2006). The fifth discipline: The art & practice of the learning organization. New

York: Doubleday.

http://www.simplypsychology.org/maslow.html


Keith, K. (2013). Key practices of servant leaders. Retrieved from:

http://www.greenleafasia.org/key-practices-of-servant-leaders.html

KnowledgeAtWharton. (2008, July 8). Southwest Airlines' Colleen Barrett on Servant

Leadership. Retrieved from: https://www.youtube.com/watch?

feature=player_embedded&v=6TgR95vnM0c

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