The Domain of Wellbeing IDENTITY in CMS Regulations

The Eden Alternative developed what are called the seven Domains of Well-being®.

CMS actually included the Eden Domains of Well-being in the “new” (2016) regulations.

And, of all places, at the Activities tag!

F679 Activities.

INTENT §483.24(c)

To ensure that facilities implement an ongoing resident centered activities program that incorporates the resident’s interests, hobbies and cultural preferences which is integral to maintaining and/or improving a resident’s physical, mental, and psychosocial well-being and independence. To create opportunities for each resident to have a meaningful life by supporting his/her domains of well-being – security, autonomy, growth, connectedness, identity, joy and meaning.
(emphasis added)

In this article, we’ll look at Identity. Let’s start with the Eden Alternative’s definition:

IDENTITY
Being well-known; having personhood; individuality; wholeness; having a history

Being well-known, isn’t that what we all want? That should be the goal and focus of all nursing homes and assisted living. Being well known is a premise of culture change and transformation. We want to leave that institutional culture that treats people often as things and puts tasks before people. We want to change and transform to a culture that knows and honors the person, their personhood, their individuality, as a whole person both who they were and who they are, having a history, their one of a kind identity.

The Pioneer Network is the national organization representing the culture change movement. When it came into being in 1997, the smart original pioneers decided and agreed upon 13 core values one of which is to Know the person. Here is an example that weaves this value with our service to people living in nursing homes and assisted living. I got to spend a week at Perham Living (used to be Perham Memorial Home, how’s that for non-institutional language?), one of the first household model nursing homes in Perham, MN. One day I observed team members (staff) ask Charles if he would like to vacuum.

I watched Charles answer with “hmmff.” Now what do you think “hmmff” means? What does is sound like? Yep, it sounds like “uh, no.” However, we don’t KNOW Charles. What it really means is – and I know because my grandma was from Perham too – “hmmff” means “Don’t you young people know how to vacuum?” however, it didn’t stop him as he proceeded to take the vacuum and vacuum. Meaning and purpose. Contributing. And such a good example of both the culture change core value Know the person. as well as the Eden Alternative domain of wellbeing Identity. His care givers knew him well, so they asked every day even though the reaction seemed to be no. Because they knew him well, they knew it did not mean no.  Get to know people better, deeper, go into the details of their lives. Know who they were as well as who they are. Challenge yourselves to keep learning then share what you learn so that all know without any surprises each person’s unique identity. Know your residents well and know it’s okay to ask if they want to vacuum. It’s their home. They should be able to if they want to, if it’s part of their identity past, present and maybe future.

Note: If you want to learn more about the seven domains of wellbeing see past articles, Eden’s white paper at edenalt.org, and Dr. Allen Power’s book Dementia beyond Disease: Enhancing Wellbeing. Each chapter is dedicated to each of the seven domains.

Carmen Bowman, MHS, Regulator turned Educator of Edu-Catering: Catering Education for Compliance and Culture Change, seeks to inspire everyone to chip away at institutional culture by laying a strong foundation of knowing regulatory requirements – blending innovation with regulation.  Activity consulting, personalized continuing education and live instruction also available. “Cutting edge-ucation” nominal pay-per-view training and free sample videos at www.patreon.com/educatering, carmen@edu-catering.com 303-981-7228  www.edu-catering.com The Culture Change Minute for free www.facebook.com/Edu-catering