Our hope is…

“As care givers, we need to be well grounded. Our hope is not in independence, but interdependence. Our primary task is not to control others or force others to be what we want them to be or do what we want them to do. It is to bring a deep unconditional love to those whom we serve. Our central purpose is not self-determination or self-reliance; it is a feeling of connectedness between those whom we serve and ourselves. Our central role is to express a profound sense of companionship and community. What we often think are our primary tasks will come in due course if those whom we serve feel safe, loved, loving and engaged.

We are community makers. Community is a gathering of gifts. Our gift in the act of care giving is the creation of companionship and the formation of community. Those whom we serve bring their mind-body-spirit, their dreams denied, and their hunger for love. They bring their troubles and sorrows, their life story, and their broken hearts. We are to bring a spirit of gentleness to mend their hearts.”

John McGee
‘Mending Broken Hearts: Companionship and Community’

Why a Culture of Gentleness Makes Good Business Sense

The following article addresses the culture found in residential settings where the quality of life is shaped by the multiple relationships between residents and direct care support staff. I was struck by the correlation between the elements of a culture of gentleness and what LaLoux has described in “Reinventing Organizations” as new level of organization emerging that holds great promise. (see “Book Corner”) The organizing principle in this new tier is the constellation of the deep values individuals are liberated to express in their work. – Clint Galloway, Editor

Those of us in the business of providing care for others often find ourselves trying to balance sound financial decisions with decisions that directly impact the quality of care provided. Tipping the balance negatively on the economic side (we can refer to them as “scale tippers”) include staff turnover, worker’s compensation claims, unemployment claims and the cost of training new staff, all of which can lead to increased anxiety for those we support, lower staff morale, reduced quality of care and increased expenses. If we can agree that the scale tippers attribute to a majority of the increased costs then we can agree that by reducing the incidents of scale tipping we will be making decisions that can lead to expansion, fewer vacancies and other business opportunities. Fortunately, we are learning that the same things attributed to reducing expenses are also attributed to increasing the quality of care for the individuals we support.

The ever changing landscape of our system of care pales in comparison to the changes experienced by those receiving care due to staff turnover. I recently went to my dentist and was informed that I would have a different dental hygienist. “What…no Dena?” I thought, “she’s been my hygienist for many years and suddenly they expect me to have my teeth cleaned by someone else?” (Maybe if I’d flossed regularly I’d be less concerned). The care that the new hygienist provided for me and my teeth was more aggressive than I’m used to, leaving me wanting Dena back. After my initial disappointment, I’m okay now with the notion of waiting six months to find out who will do my cleaning next. But I would be much less settled if I was to experience this uncertainty with every shift change, 547 times over the next six months. This uncertainty about whom we will be interacting with in a face-to-face relationship makes us feel less safe and precipitates negative feelings and actions. It invades the entire culture of care. It is an expensive drain on our resources as well as the peace of mind of those that we support.

Providers report an average turnover rate of 49% among frontline direct caregivers. For agencies that experience high annual turnover rates (hopefully you’ve calculated your annual rate, if not this would be a good first step to take), it is likely staff will leave within the first six months of employment. This is the period in which the initial, comprehensive training will occur for new staff. At an average replacement cost of approximately $3,500 per employee, these costs weigh heavily on the economic scale.

Other scale tippers that often appear in a workplace with excessive rates of turnover include worker’s compensation, health insurance premiums and unemployment claims. Worker’s compensation claims tend to increase when the people in our care feel unsafe and are more likely to be aggressive towards staff, resulting in injury. Insurance rates increase when claims expense increases, and conversely, rates remain more stable when claims expense decrease; in some cases refund checks are cut to providers when there is a well-established “culture of gentleness.” When excessive scale tipping is present we are more likely to find frivolous worker’s compensation claims. This can reduce morale, as well as your bottom line, due to time spent resolving the issues. Another hidden cost of high turnover is health insurance premiums. Decreased turnover means that a large health insurance claim can be absorbed over time if staff continues to be employed after the claim has been paid. Unemployment claims, whether you are reimbursing or a contributing provider can be incredibly time consuming and expensive, costing up to $10,000 a claim in some cases.

Not to be forgotten in the discussion are wages and benefits. These are significant factors in finding and retaining qualified staff. According to the Michigan Assisted Living Association’s (MALA) 2009 Strategies for Improving Wages, Benefits, and Training to Staff Providing Community Mental Health Funded Residential Services, “Wages for direct care workers among the providers responding to this survey are as much as $3.25 per hour less than wages in other similar sectors of long-term care.” Although it will not bring parity to our Medicaid reimbursement rates, an established culture of gentleness will increase our ability to offer more attractive incentives for our employees.

Now that we’ve identified the scale tippers, how do we begin to tip them in more favorable directions? We cannot support the people we support without feeling supported by the people who support us.

That sentence will gain few points from English teachers, but it does offer insight into what our focus must be if we want to create a culture that is conducive for healthy bottom lines and healthy hearts alike.

Have you ever heard of “seagull management?” This philosophy is indicative of a culture that offers little or no proactive support, and when things are not going well—for example, if a group home is in chronic upheaval—management (the seagulls) intervenes by providing plenty of white droppings to go around. The flock then flies off, leaving those covered in white droppings to rectify the scale tippers. So where do we need to focus if we want to prevent the seagulls from disrupting our day at the beach?

Creating a culture of gentleness starts with the leaders of organizations recognizing that the way we train, support, and maintain our employees ultimately has a direct effect on both the quality of care provided and staff retention. Just as those we support in our system of care strive for unconditional valuing, uplifting interactions, and encouragement so do our employees. We all do. It is imperative that all levels of management have an understanding of the six elements (safe, valued, praise, demand, structure, and transitions) that lead to a culture of gentleness. The key to higher quality training includes finding quality trainers and materials. The Center for Positive Living Supports (the Center) has been involved with supporting staff in numerous Mobile Response Training Unit deployments. Overall, we find that without understanding, commitment, and congruent behavior from the host provider and CMH staff, we often find an increased amount of scale tipping.

For example, our home managers play a vital role. Staff often quit a direct care position, not because of the people they support in the home, but rather the way they feel devalued by management. Many home managers also feel devalued from lack of support from above. One way in which we demonstrate our appreciation of the value of employees is by providing tools that give them the confidence to help create a supportive culture under complex circumstances. These tools come in the form of training and gaining a basic understanding of what we can do. In a best case scenario, it is estimated that 2% of annual budgets are earmarked for training. To use this effectively we need to incorporate ongoing support within the day-to-day culture and focus less on the external classroom. This requires developing trainers and recognizing that mentors play a vital role in creating and sustaining a culture of gentleness.

When the going gets tough, the mentors get going. Not exactly the adage with which we are all familiar, but a culture of gentleness requires us to invest in some of the more skilled staff, enabling them to become mentors. They are able to assist in some of our more difficult situations that traditionally may have escalated into scale tipping events. If you can build a capacity of at least one mentor for every 50 staff you will be investing in someone who has the skill set to assist in our most complex situations. The goal of mentoring is to create a sustained environment that will begin to make everyone that lives and works in the setting feel safer, more valued and less volatile. MALA’s findings, from their aforementioned 2009 study, concluded, “Education related to this culture of “gentleness” should be broadened throughout the state.”

According to projections from Michigan’s Department of Labor and Economic Growth (DLEG), employment in the state’s long term care industry is projected to grow by 20 % over the decade from 2006-2016, adding nearly 25,000 new positions. May I take you back to the dentist chair experience for a moment? When it’s time to see your dental hygienist wouldn’t you rather have Dena, whom you have grown to trust and respect? Me too, and for the same reasons the people receiving our care and those we employ will look to you, and want to stay with you. We need entire organizations that embody the elements that constitute a culture of gentleness. Working within an organization built on trust, mutual respect and valuing, dedicated to quality service, is like a sunny day at the beach engaging in experiences that can be meaningful and fun without worrying about Seagulls hovering overhead. They have also learned the prerequisites for landing and being warmly welcomed on the beach.

Example: Ayanna is extremely bright, has a wonderful sense of humour, likes to shop, and cares deeply about her family. She has had over 15 different placements over the past several years and more recently spent two-thirds of a year in psychiatric hospitals. Ayanna spent 45 days at the Transition Home and her future caregivers attended the preliminary training offered by The Center. When Ayanna moved to her new home, our staff worked for approximately three weeks with her caregivers during which time the six elements were demonstrated, coached, and observed by the Mobile Response Team Mentor. Her current provider remains committed to supporting her in her home and for the past year she has lived successfully in her home having only been hospitalized for a week.

Ed Kiefer, B.S., L.B.S.W
The Center for Positive Living Supports, an affiliate of Macomb-Oakland Regional Center.

 

Connections Help Build Relationships

The relationships and communication I maintain with the individuals I support have helped me establish a gentle, secure and caring presence within the homes of these individuals. By taking the time to get to know these people, I have learned how some of life’s little problems can build into a bad day. By being consistent, enthusiastic and a positive support, I have been able to help small problems stay small!

Sometimes, a little space and time to think is all that is needed to bring someone back to their personal best. It could be a trigger that can be removed from the environment, or even small talk about the Roughriders or Regina Pats. Knowing each of the people I support has taught me to truly consider how the world is uniquely different from everyone’s perspective and just because a problem may not seem like a big deal from my view point, it may be a crucial crutch in these people’s world view.

When I enter the homes of the individuals I support, I bring a friendly and supportive person into their lives. I have a lot in common with each person I support; these connections have helped build our relationship. It has been a wonderful experience to learn from these people and it continues to provide me with the opportunity to help someone see that there are a lot of great things in life and hopefully I can help make it a good day!

Mickey, COR Support

History Changes Our Perspective

History. Everyone has one, yet most of the time they are hidden like little secrets that blow in the wind. When you meet a person it isn’t the first thing that typically comes to mind.

If I was to meet a stranger on the side of the road (because that’s my normal hangout spot 🙂 they would most likely notice that I am a pretty outgoing guy, I like to smile and find joy in the small things and hopefully notice that I am kind in spirit. At first glance you wouldn’t know that I’ve moved half a dozen times in my life, travelled as a musician for year or had an eating disorder in my teenage years. You wouldn’t be able to tell whether or not my parents were married or divorced and what my relationship with them is like. You wouldn’t be able to tell that art is soothing to my soul, or that my wife was the second woman I had ever dated and the only one to capture my attention and keep. You wouldn’t be able to tell that over the past three years mild health problems have led to intense bouts of anxiety. You wouldn’t be able to tell that I have been in six car accidents and have a perpetual fear of sitting in the passenger seat. And you wouldn’t be able to tell that one of those car accidents was because of a grasshopper that latched itself to my eye—this has caused a lasting fear of insects like grasshoppers and lady-bugs.

Contrary to popular belief my goal is not to expose my soul to the eyes and ears of our internet readers: rather to challenge our ideas of “history” and how it effects the way that we communicate and relate with each other. If a person knew that I had an eating disorder as a teenager, the likelihood of them teasing me about being overweight, fat or “chunky like a monkey” most likely wouldn’t happen. Why? Because when you know a person, your response changes. The person becomes less of a stranger; they have shared the intimacy of their life with you—they reach out with open hands asking you to be careful as they seek to trust you in relationship.

As we know, not everyone is willing to share freely about their life and its past events—this makes our job as a people difficult because regardless of who you are and where you came from, you have a history—stories upon stories that have come to shape your life, beliefs and character. Our job, though difficult, is exciting! Learning to approach people with unconditional love which knocks on the door of their lives asking to be part of their story, in true and honest relationship in a manner in which we are constantly learning about who they are as people, and not who they are on paper.

Ben, Director of Culture and Mentorship

It’s all about your pace.

Have you ever stopped to think about the way that you walk?

I know that it is a strange question and if you chose to stop reading here I would likely understand. But  I promise you, I’m on to something. Now I am not talking about the physicality of your walk: do hips sway with a hoola-hoop like action, or is one leg shorter than the other causing a noticeable limp. More so, when you walk with a friend or companion, do you walk as if it is the end of the world and speed to wherever your destination may be or do you walk intentionally taking in your surroundings and the conversation that you may be having.

For the past three years I have been married to the love of my life. It has been an incredible adventure and we have enjoyed every minute of it: including the bountiful walks that we have taken. However one of the things that I noticed early on into our marriage is that my wife walks as if she is an Olympian speed walker–it eventually got to the point where I had to tenderly grab her hand and ask her to slow down. To ally my naysayers out there, it wasn’t because I couldn’t keep up to her, rather I didn’t like the feeling of being rushed in moments where I felt like I could relax.

I have been thinking about this idea of “pace” for a long time and it finally struck me: the way we pace ourselves not only determines when we finish the proverbial race, but also how we finish it.  As supports, friends, family and others associated with COR and the Gentle Teaching movement has this idea fully penetrated our hearts and minds, thus being embodied in our words and actions?  I ask this because I was convicted about it in my own heart, when I began noticing the young man that I support was always a few steps behind me. At first I didn’t think much of it, but as time passed I was frustrated: not at him, but myself. I had become the ‘Olympian’, though accomplishing much, missing the view.

So do me a favor, after reading this blog: stop whatever you are doing and ask yourself a few questions:

  1. What is the pace you are moving at?
  2. Are you noticing the ‘view’ and slowing down to assist others?
  3. Take a few moments to review the four tools of Gentle Teaching  and honestly ask yourself how you are doing in each of the following areas.

a)Loving Eyes/Gaze

b) Hands

c) Loving Words

d) Loving Presence

 

Ben, COR Support

Gentle Teaching: A Magical Transformation

“Gentle Teaching has evolved into a dyadic process; it encompasses an approach in which the caregiver is transformed, as well as the brokenhearted person. The transformation process has to start with the caregiver, but reaches outward to the broken hearted person. It is not an approach that presents fixed and immutable answers that caregivers follow in a lock step manner. It is one that asks caregivers to interact within a broad framework based on the prevention of harm and the expression of unconditional love. Harm’s prevention often initially involves giving the person what he/she wants, as long as it is not harmful, so that the caregiver can enter the person’s space and begin to teach

“When you are with me, you are safe and loved.”

It is not an approach that centers itself on behavioral change. It is an approach that beckons spiritual or internal change. Just to make it clear, this internal change can be translated into concrete and measurable behaviours, yet we must recognize that their origin is spiritual and moral in nature.”

John J. McGee

We cannot know who the “other” is unless we have some insight into who we are.

Spreading John’s wisdom… We cannot know who the “other” is unless we have some insight into who we are.

Gentle Teaching is grounded in the whole person and who the person is. A key assumption, especially when supporting those who are extremely violent toward others or harmful to themselves, is the understanding that behaviors have their origin in moral development—how human beings throughout their lives are in the process of learning how to interact with others and how each of us sees ourself and others. This moral development is inside of us and encompasses the memories that have been formed from the first moments of life to the present moment.

Moral memories are how we spiritually interact with the world. When these memories are sad and disorienting, they reside like haunting ghosts in the hidden corners of our being and, in a sense, whisper to us what clinicians will later call behaviors. Behaviors are the visible part of toxic weeds; memories are the roots. They are deep, often not known, and not intellectual, but moral memories. The use of behavioral techniques is like pulling out the surface of weeds but leaving the roots intact. Gentle Teaching goes for the creation of new moral memories that eventually lead the person to feel safe and loved and then “behaviors” begin to fade away.

John J. McGee

Above All No Harm

In Gentle Teaching caregivers become aware of how their interactions decrease the probability of violence by focusing on:

• The need to teach a culture of trust, companionship, and community through the creation of new memories based on feelings of being safe and loved.

• Initially lowering expectations and increasing hope. Although caregivers often have seemingly reasonable expectations, the brokenhearted are not ready to do what is expected because they do not feel safe and loved within the caring community. There is little reason to trust a caregiver without these new feelings. Without a strong foundation based on trust, high expectations shatter. The first dimension of caregiving is to establish trust and this arises out of feelings of being safe and loved. If caregivers are too pushy, this could easily spark violence.

• Within this construct, the caring community has to slow down and understand that “The slower we go, the faster we will get there.”

• The avoidance of any compliance attitudes that push brokenhearted individuals into a corner and provoke violence.

• The use of our very presence, words, gazes, and touch in a manner that uplifts each person along with a tender and genuine tone turning each syllable, touch, or gaze into the moral equivalent of an embrace.

• The avoidance of attitudes such as so-and-so knows better, just wants attention, or is manipulative. These can be true but are irrelevant in Gentle Teaching; the focus has to be on feelings and teaching each person to acquire a sense of feeling safe and loved. The healing must be found in the heart, not the head.

• The avoidance or prevention of caregiver violence in common practices such as the use of isolation, time out, token economies, verbal reprimands, grabbing and shoving, physical management, mechanical restraint, cattle prods, chemical restraint, the ease of psychiatric hospitalization as a holding tank, and even phone calls to the police to “manage” someone through the use of stun guns and other methods of control.

• Practice, practice, practice. The best way to prevent harm is through a sharp focus on the tools that have been bestowed upon us. First, our intention has to be to bring and share the gifts of creating a sense of security and a feeling of being loved. Then, within these parameters, caregivers have to become intuitively practiced and skilled at teaching these good memories. This approach is in and of itself the most encompassing way to prevent violence.

John J. McGee, 2012

The Core of Gentle Teaching: Safe and Loved

Gentle Teaching is not about behavioural change.

It is not even about getting rid of behaviours. These will disappear or diminish as time goes by as a result of the person trusting us. It is not about any behavioural techniques that might be spelled out in a behaviour plan. If a caregiver enters anyone’s space with such intentions, the time spent will have nothing to do with Gentle Teaching. It is a contradiction to anxiously lead with an attitude of, “I have to change this behaviour or that one.”

The central and guiding focus for all caregivers is to help the person learn to feel safe and loved and this requires the prevention of any sort of harm. It is simply wise to not provoke any violence. Prevention gives caregivers the opportunity, space, and time to teach new memories of feeling safe and loved. Doing this dissipates or eliminates maladaptive behaviours as a direct result of feeling safe and loved. This has to be part and parcel of the caring community.

John J. McGee, 2012

Overflowing Gratuity

The first image that is most likely to come to mind when I say ‘gratuity’ is that of a monetary tip at a restaurant. While in one sense, this is the very definition of the word; I believe that there is more to it than that. If you were too look up the definition of the word, you would first find:

1. a gift or reward, usually of money, for services rendered; tip quickly followed by;

2. to give something freely without claim or obligation.

As a former waiter I loved my job and the tips were amazing. But all too often that small (or large) monetary tip became an expectation. Fellow co-workers would often be found cursing out guests who didn’t leave anything; going so far as asking guests for tips. I found this strange and semi-disturbing.

This post isn’t to blab on and on about my past work experience, rather to challenge those in COR, and those reading, to make a conscious effort of living a life that is overflowing with gratuity. To clarify, I am not referring to tipping waiters and waitresses, rather to live life as an active giver. To the clerk at the grocery store give your smile. To the homeless man asking for money, give your time (and maybe a cup of coffee too!). To the sad and broken-hearted, lend your ear. To the stranger you just met who is cursing you out, be kind, compassionate and hold your words carefully.

The majority of us out there have heard the famous phrase by Mahatma Ghandi, “Be the change you want to see in the world.” While this isn’t an earth-shaking challenge, it is a world changing one! What will it take for the person looking back at you in the mirror to take the plunge, go all in and risk it all? When you give generously and graciously the world around your starts to change — and it’s a beautiful view!

Ben, COR Support