Posts

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

Patience and Empathy have Great Value!

As a support person at COR, I have been privileged with the opportunity to support six incredible individuals so far. The way I try to create/maintain a culture of gentleness is by being patient, empathetic and having high energy. I’ve found that no matter how bad my day has been, any time I’m supporting I am much happier. Staying patient with the individuals I support has gone a long way for me in building trust and a relationship with them.

Because these individuals have been through so much in their lives, I try to empathize with them when they are having a rough day, rather than  look down on them. This method has helped me as a support, but also as a person outside of COR. I find being patient and empathetic to everyone has great value and has made me a better person, friend, teammate, support and leader. Being high energy is important because many of the people I’ve supported feed off of that energy and it makes them happy or wanting to do something with me because they know I will be engaged and putting my full energy into supporting them.

Caleb, COR Support

Exploring our Vision, Mission and Values Statements

In celebrating our fifth anniversary, COR’s Board of Director’s and Management Team took time to reflect on our efforts to forge out meaningful opportunities for people experiencing disability in Regina, SK. If you have ever wondered what COR’s Vision, Mission and Values Statements are, look no further!

Vision Statement

COR will foster a culture of gentleness by nurturing authentic relationships, embracing diversity and supporting people to live the life they choose.

Mission Statement

COR develops innovative support that facilitates opportunities for personally meaningful growth and interdependent relationships where people feel safe and valued.

Mandate Statements

  • COR will provide support in accordance with the contractual obligations of its funders within the framework of Gentle Teaching and Person Centeredness.
  • Support through COR is tailored to reflect the individuality of people.
  • COR is a culture of continuous learning that puts people’s dignity and respect as its foundational principle.

Values Statements

  • COR respects the value and individuality of all people.
  • COR values interdependence and recognizes the strengths of all.
  • COR values the opportunity of full participation for every citizen.
  • COR fosters a culture of ongoing reflection and continuous learning.
  • COR respects the autonomy of every individual.
  • COR seeks to empower individuals to live the life they choose.

Goals

  • To develop and facilitate flexible, personalized supports for individuals experiencing disability.
  • To support an individual regardless of their abilities when appropriate resources are available.
  • To ensure support is designed to meet what matters most to the individuals we serve.
  • To collaborate with an individual’s personal and professional network to promote success.
  • To welcome, encourage and support the involvement of families and personal networks in the lives of the individuals and all aspects of the organization.
  • To develop partnerships with community organizations who share a common vision.
  • To maintain a fiscally responsible organization.

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

What Makes COR Different?

I began supporting with COR in April 2014. Being close to completing my Social Work degree and having years of previous experience in working with those with different abilities, I thought I had a good expectation and understanding of what this job would entail. Little did I realize that being a support for COR would not only change how I viewed working in this field, but also shape who I am as a human being.

I love working at COR because those we support are given so many opportunities to achieve, succeed, and feel proud of themselves in many areas of their life and community. Often people with exceptionalities have limits placed on them given their physical state or cognitive functioning, but rather than focusing on a ‘disability’, COR focus on the abilities that a person has and realizes their potential for achievement and fulfillment. I love that we are not ‘working with people with disabilities’, we are being a friend and extending support.

Working at COR has been very rewarding, but there have also been challenging moments. However, these challenging moments have always turned out to be entirely beneficial in the end because they have taught me more about myself then I could have ever imagined. COR is different than any other place I have worked because the philosophy is not centered around changing those we support – it is about accepting and loving them for who they are, and instead changing ourselves to better understand and care for those we support. Supporting at COR has taught me that although a person may be shaped by their past and their history, expressing unconditional kindness and acceptance has the potential to turn a person’s day and even their life around. The lessons I have learned at COR have transferred into my personal life, my professional perspective, and my overall understanding of human interaction.

Those I have met through COR and the philosophy and culture of gentleness that I have learned to practice will stay with me forever. Through supporting at COR I have learned what it truly means to be a friend, a caring professional, and part of the community.

Kasey, COR Support

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

It’s the little things that make the biggest difference in all relationships

Throughout my nearly three years as a Support Person with COR I have had the pleasure of supporting several individuals with varying interests, strengths, challenges, and needs.  The one thing that has always remained constant is that each and every person I have supported has needed to feel safe and loved unconditionally.  I am fortunate in that I have been able to support a few individuals for the entirety or better half of my employment at COR and have been able to build amazing relationships with them.

Every Support Person will have a different relationship with the same individual, and every Support Person will approach building that relationship in slightly different ways.  While at first I found it challenging to build relationships, by choosing to be myself and treat the individuals I support like my close friends and family members I found things flowed as naturally as any other relationship would and true friendships were born.  People can sense when you are not being genuine towards them and they will withdraw from you because they do not feel safe.  Just because somebody has an intellectual disability does not mean they deserve to be treated as less of a person or talked to differently than anybody else you interact with in your day.

Throughout my employment at COR I have considered the people I support to be real-life friends and I have really tried to show them that I value their friendship and truly believe we are all equals.  I know that a lot of the individuals COR supports still call their Supports their “Workers” because their entire lives they have known that most of the people in their lives are paid to be there.  While I am employed by COR I do my best to tell them through my words, actions, and body language that we are friends first and foremost and nothing they can do or say will make me not want to be their friend.  Friendships may have ups and downs, but unconditional love doesn’t falter.

I also truly believe that it’s the little things that make the biggest difference in all relationships.  Introducing the people I support as “my friend” instead of “the person I work with”.  Offering hugs and not shying away from them after a challenging day.  Actively listening to how they are telling me they feel in that moment instead of dismissing it.  Not altering my voice to sound like I’m talking to a small child.  These are all little things I make a conscious effort to do to help grow my relationships and over time I have seen the people I support reciprocate my offerings of friendship and love.

Allison, COR Support

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

Gentle Teaching Practicum: August 28, 2014

Gentle Teaching Practicum Poster 2014