The GROWTH Domain of Wellbeing part of CMS Regulations

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

If you want to learn them, Eden has a white paper at www.edenalt.org.

Another highly recommended resource is Dr. Allen Power’s book Dementia beyond Disease: Enhancing Wellbeing. Each chapter is dedicated to each of the seven domains.

Did you know CMS included the Eden Domains of Well-being in the new, 2016, regulations?

And, do you know where…? 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)

Since we started this series CMS added this to its guidance referencing the Eden Alternative,

GUIDANCE §483.24(c)

Opportunities for each resident to have a meaningful life may be created by supporting his/her domains of well-being (e.g., security, autonomy, growth, connectedness, identity, joy and meaning) as identified by the Eden Alternative philosophy of care. More information may be found at: http://www.edenalt.org/about-the-eden-alternative/theeden-alternative-domains-of-well-being/ ) (10-21-22)

We have been working through each of the seven domains and now turn to growth.

The Eden Alternative? definition of growth is

GROWTH: development; enrichment; unfolding; expanding

I’ve heard psychologists in the culture change movement say that we should be growing and developing at every stage of life, at every age. However, you don’t hear many talk about growing and developing when you are 80, 90 and 100 years old.

If you get to interact with people older than you, with beautiful older people, with elders, talk with them about these concepts. What does growth, development, enrichment, unfolding and expanding mean to them.

Sometimes growth means learning something new but not always. Maybe at this point in life it means teaching more than learning. Would they like to be teaching something to someone? Leave a legacy, tell their story or their stories? Share lessons learned? I love asking older people for their wisdom, their opinions, what they would like others to know…

For fourteen years my daughter Ellie and I and any friends that would join us went twice a month to a local nursing home. Learning from the Eden Alternative, I knew to not let it be just another program or performance or paying a visit. We went to BE WITH each other. We didn’t rush. We all took our time around the circle to share names. Our kids learned that they may have to say their name 10 times and if so to say it kindly each of those 10 times! The heart of our time together was to come up with a question asking the elders for their advice. What advice would you give the kids, give all of us, on how to be a good friend or how to be good with money, or how to spend summer break, anything. I have a wisdom book! I have chapters on all these subjects. You could too. Don’t let wisdom be warehoused. Draw it out and collect it. Sell your Wisdom Books for fund raising. Everyone will want one. Some families might want 20 of them with grandma quoted in them!

I think the very best way to depict Growth is with the definition of an elder that elders themselves crafted with Debby and Barry Barkan in the 1970s as part of the Life Oak Project…

The Live Oak Definition of an Elder

An elder is a person who is still growing,
still a learner, still with potential
and whose life continues to have within it promise for,
and connection to the future.
An elder is still in pursuit of happiness, joy and pleasure,
and her or his birthright to these remains intact.
Moreover, an elder is a person who deserves respect and honor
and whose work it is to synthesize wisdom
from long life experience
and formulate this into a legacy for future generations.

Many communities read this every morning at their community meeting. Imagine you are an elder living in a community that reads this every morning! And now perhaps become the one to make that happen…

Additionally, the Eden Alternative suggests that care plans become growth plans. Wow. And similarly, employee evaluations also become growth plans. Those are some powerful ways to emphasize growth. Join us in growing the GROWTH domain of well-being.

Carmen Bowman, MHS, is a former activity director, the first certified activity professional to be a surveyor, worked at CMS Central Office trainings surveyors and is an Eden Alternative Associate and Mentor. She has fun calling herself a Regulator turned Educator as owner of Edu-Catering: Catering Education for Compliance and Culture Change. She hopes to inspire chipping away at institutional culture with a strong foundation of regulatory requirements – moving away from traditional activity programing to offering real life.  Activity consulting, personalized continuing education. Compliance and culture change workbooks at www.actionpact.com.  “Cutting edge-ucation” nominal pay-per-view training 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