The Domain of Wellbeing SECURITY 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 Security by analyzing the Eden Alternative’s definition:

SECURITY

Freedom from doubt; anxiety, or fear; safe; certain; assured; having privacy; dignity, and respect

Security includes making my own choices

Dr. Judah Ronch a psychologist involved in the culture change movement has always asked, “Wouldn’t safety include making my own choices?” Isn’t that good? When you think about it, why yes, it absolutely does. Sadly, life in institutions is not known for lots of choices. To learn more about opportunities for choice, see the last article on Autonomy.

In your role, do your best to give choice in every interaction.

Would you like to sit here or there?

Would you like to come now or later?

Choice is healthy. We all want control. You can give control back to people every time you interact.  Do it on purpose. Care plan it. Be intentional. Autonomy, choice, control … all contribute to feeling secure, more assured and certain about life and themselves. Please also be aware of labeling people, for instance, hoarder. There is a saying, Label jars not people. People take things for a variety of reasons. If we hold off of labeling it and instead genuinely inquire and observe, we see often people take things so they have something to … be in control of. This totally makes sense. By giving choices all day, they will have perhaps less need to take things to be in charge of.

Security includes preferences known and honored

You hold the key for knowing some preferences. If you work in a nursing home some preferences appear in the MDS process. There are more preferences about people than that though. Don’t let yourself be boxed in by the MDS. Ask more questions. Ask often. Have an ongoing dialog with each person about who they are and their preferences. Pick it up next time/each time you are together. Preference dovetails with choice although they are not the same. True choice is getting to choose between more than one option that is preferred.

Security includes planning

Get ready for a crazy comment. Even though you get paid to plan… don’t. Reverse your thinking. Consider getting into a natural process of planning events on the calendar now for future events and future months. It is Dr. Ronch again who teaches that we all have a future self but older people living in institutions do not. How sad would it be to not have a future self! We each know what is on the calendar for today, for tomorrow, for the coming weekend and next, for our next vacation or we are in the process of … planning it. If the community (activity) calendar is the only calendar one has, that is not their calendar, that is not their life. The simple act of ensuring each person has their own calendar can lead to feelings of security. (The last four articles were dedicated to Don’t Plan: Give it back to those who live there.)

Security includes doing my own laundry

Yep. This is a culture change practice to find space in your building for a household washer and dryer. Just look at the opportunities. If a resident can, they can do their own laundry. Talk about security. I would want that, you? If they cannot, families can do the laundry and instead of shlepping dirty and then clean clothes (how much money does one pay to live in a nursing home or assisted living and families shlep laundry?) they can stay and be with instead of leave. Security. Not to mention you are more in charge of your clothes, they don’t get lost or ruined… even more security.

Security included relationship

As much as you can build relationships Introduce residents to one another. Be a catalyst for friendships. Help people be connected. Connect people more than you ever have before. (See past article about Connectedness as well.) Within your team try to have your teammates be with the same residents as much as possible, another key toward residents being well known and building feelings of certainty and assuredness. If you can lead consistent staffing, also called dedicated staffing, into your wider community, even better.

Please do all you can to think about security, talk about it, ask residents what security means to them, how individuals define it. Ask residents individually, in care conference, at resident council and other neighborhood or community meetings. Find out. Go deeper with people. Plus it is in the Intent of the Tag 679 Activities regulation! That’s what I call a good reg, lean into those. What a great opportunity to be on top of, compliant with, these good regs even if no one ever brings them up knowing, of course, they could.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 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