Assessing what matters

You expect me to assess yet something else? Yes, I am posing the question, so please hear why. So much of what we assess is driven by the MDS, and the MDS 3.0 is here. We are all getting familiar with it, and one of its new premises is hearing the voice of the resident.

Traditionally, however, we have only assessed and then care-planned what the MDS process leads us to. Go beyond the MDS! There is no reason why we can’t, and many reasons why we should. There is so much more to knowing a person than what is captured on the MDS. The MDS collects minimum information, as the federal government has admitted, since its inception, by calling it the Minimum Data Set. What is it mostly about? Physical needs. Those very private things that become not so private when people live in a nursing home. Are those what people want to be known for? Do they want some caregiver to read about their incontinence first, or get to know them as people first, and later, in getting to know them, learn about their physical needs? I recommend that we ask and learn about what matters most to those for whom we provide care. What are their preferences? What do they hate, what do they love, what are they passionate about, and what are their pet peeves? Do you inquire about whether they are lonely, and if so, do you ask what you can do to help alleviate that? Do you ask about and address what matters most?

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The American Association of Nurse Assessment Coordinators (AANAC) is a nonprofit professional association representing nurse executives working in the long-term care industry. AANAC is operated by nurses for nurses and is dedicated to providing members with the resources, tools, and support they need in their specialized role of leaders and managers in long-term care. To join or get more information, visit www.aanac.org or call (800) 768-1880.

I coauthored with Christine Krugh, MSW, a workbook and training DVD called SOFTEN the Assessment Process (Action Pact, 2009, www.culturechange.com), in which the “S” stands for Support Simple Pleasures. The Eden Alternative brought to light the idea that we each have a daily or simple pleasure. The Eden Alternative Trainers Guide (available at www.edenalt.com) suggests using “simple pleasures” as a tool to bring meaning to the life of anyone living in a nursing home:

Simple Pleasures are those things that make our day go a little better. They are those things that, without them, our day would not be quite as good. In our own lives we often take simple pleasures for granted because they are available to us without much effort. For many people it may be as simple as a cup of coffee first thing in the morning or a walk in the evening after dinner. The important thing about learning [one’s] Simple Pleasures is to discover the specific details…what flavor of coffee, what temperature and in what kind of container. It is the details which provide meaning.

We did some further thinking about this and came up with the following:

When a person moves into a long-term care setting for the first time, the setting holds no meaning. They have left all the meaning in their lives at their previous home. It is your conscientious actions which will implant threads of meaning into their new life situations. The process of assessing simple pleasures begins prior to admission. An interview with a family member, social worker, case manager or care provider can begin to give details into the daily life of a person new to your setting. When a person arrives, it is up to you whether to integrate simple pleasures into their new daily life or not. Through assessment more simple pleasures will be discovered.

The workbook stresses that it really doesn’t take much more work to discover what a person’s simple pleasures are. Your current assessment process will probably unlock it, quite possibly by accident. Whether you’re talking about food, bedtimes, bathing, or activities, you will naturally notice preferences or ask about them: “What is your favorite?”

What if, by more conscientiously seeking them out, you discover this new person’s simple pleasures before he or she moves in? What if the caregivers and professionals who will meet your new resident first are better prepared by knowing this information? What if the social worker says, “I would really like to get to know you better, and because I heard you love to read, I was wondering if you’d like to sit and visit with me in our library so I can familiarize you with it?” Probably the answer will be yes. What if the activity director discovered your new resident loves to meet new people and loves sweet tea, so she invites her to meet some other residents over tea in the private dining room? Probably the answer will be yes. What if the physical therapist, who has to assess your new resident’s walking anyway, invites him to walk to the garden since she heard he’s loved gardening all his life? If it were me, I think the answer would be yes. And how might a new resident feel if the day she walks into her new room, there were one or two gifts that represent her simple pleasures (instead of or in addition to the gift bag everyone gets)-something like the newest Nicholas Sparks novel (her favorite author) and her favorite version of M&Ms? Now we’re talking! Those are the things that will help a person feel welcomed and well known. Those are the things that matter.

Still feel overwhelmed? Here’s another solution for your consideration. I believe there is a gap in our assessment process and that is this: We are not asking the resident and/or their family/responsible party for as many details about this new person as we could be. If it were me, I would actually ask them to write down everything about themselves, if they can, or everything about Mom or Dad they can possibly think of, so that we can take the very best care of them by knowing them well. I think most residents and families will do this for you. Why? Because they feel guilty and worried, and usually they want the best for their family member. Some won’t, but they will be the exception, and maybe instead of asking them to do the writing you can ask them the questions. But I do not recommend a form. We have too many forms. Just invite them to share any detail they can think of. You will gift them by relieving some of the guilt in the process, too.

And one last comment: Are we “assessing” or are we getting to know a person? I have a hard time any more saying or writing the word assess. It’s too clinical, too medical, too impersonal. Notice that above I encouraged us to ask and learn and inquire instead. When I’m your new resident, I just want you to get to know me as friends do, not assess me.

Carmen Bowman, MHS, ACC, is the Owner of Edu-Catering: Education for Compliance and Culture Change in LTC, a consulting and training company in Firestone, Colorado. She can be reached at (303) 833-1492. Long-Term Living 2010 October;59(10):60-61

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