How to increase staff autonomy and person-centered care

autonomyOne of the best ways to increase your team’s participation in providing person-centered care is to increase their autonomy. By definition autonomy is:

  • n. The condition or quality of being autonomous; independence.
  • n. Self-government or the right of self-government; self-determination.

Encouraging independent, creative thinking in your staff not only gives you more freedom but is a fundamental of continued motivation in the workplace. Working with a team of people who feel autonomous has multiple positive repercussions. In today’s video I talk about how to increase autonomy with the goal of increasing the ability to engage in person centered care by asking questions. Questions that start with how, what, and when are great starters.

Increase staff autonomy by asking questions:

Decrease employee stress and increase their engagement

medblogRecently I calculated that 9 out of 10 people whom I have had in staff trainings in the past year – including managers – are not breathing in a healthy way.

So what? Why should you care how your employees breath? And why do I teach healthy breathing and meditation in every training I do? Because the rhythm and quality of your employees’ breath directly affects how they think, feel and act.

The depth of your breath affects the patterns of your thoughts and in turn the choices you make, about actions you take. If your breath is shallow and rapid your mind will follow with racing thoughts, looking for potential threats. Shallow breathing triggers your sympathetic response system (your fight or flight system). For example, imagine someone approaching from behind at night. You jump, lift your shoulders up, and take a quick shallow inhale of breath. This is fear, and it triggers a fear response. The body triggers that system any time you are breathing shallowly, because it thinks you are in a stressful situation or might need to react quickly. Many people feel a contact low-grade level of stress because their breathing is continually shallow.

When you breath deeply and fully, your mind calms, and your thoughts are more clear. When you breathe deeply and engage your diaphragm (this muscle is key to healthy breathing), the body triggers its parasympathetic system, which then releases calming chemicals into your body. A common example would be when you get angry and someone suggests you “count to ten”. The idea is to breathe deeply and slowly while counting to ten, giving your body time to trigger the chemicals in the body that will calm the body and angry thoughts. You can feel the calming affects moving through your body as you slow down and deepen your breath.

If your employees are more aware of the depth of their breath, they will be more in control of their state of mind, which in turn, will affect their choices, actions, levels of attention, engagement, emotions and interactions with others. Deep breathing will help them to be more clear-minded overall.

Decrease employee stress and increase their engagement with an employee meditation practice.

I wrote my book, How to Lead Meditation Groups for Seniors, not just for groups of seniors but also so that the people who are working with seniors would have access to these tools as well. This short book will tell you how to encourage deep breathing and it includes 5 recorded lessons. Give it to an interested staff member and ask them to lead a group for the staff. Give them a resource that will affect their work and their life.



A family member shares a story of “The anonymous caregiver”

anonymouscgvrThis is not my normal blog style but when my friend Sean shared with me the story of his mother’s death I was so grateful to hear how much his family appreciated the caregivers that I asked him to share it with you. He told me how deeply his brothers were affected at the moment the caregivers expressed their love for his mother. What surprised his siblings was that the paid caregivers loved his mom so much and they hadn’t expected it nor considered such an outpouring of love.

Many people are surprised at the level of love shared with their family member by staff in senior communities. I think that the label of professional often implies  boundaries that exclude emotion. But in senior communities, professionals are caring for seniors in such intimate ways that being vulnerable and open are to some degree requirements to do the job well. Public opinions about caregivers are often leaning towards the negative and have an element of fear. Sharing stories like Sean’s can help people see the beauty in the profession of providing care.

The anonymous caregiver by Sean Daly

My wife and I received the call at 4am with the news. My mom had been placed on hospice a month earlier, and now her breathing had altered. We quickly changed and headed down to the care facility that she called home. I resisted the idea that she had aspirated and had pneumonia and that, most likely, she would never return to health. When we arrived I found a faceless, nameless, caregiver standing by her side like a daughter might.  I felt ashamed that I didn’t know the woman who so closely attended to my mom, this comfortable looking, heavyset, Hispanic caregiver with a solemn look on her face. She was just one of the many workers who had cared for my mother’s needs over the last 18 months, many of who I knew, but I didn’t know this one. Like all of them, she helped my mom out bed in the morning, dressed her, bathed her, fed her, and then returned her to her room in the evening.

My mom’s eyes were closed and her head lay back in the pillow positioned as if looking up at the ceiling. She looked agitated and in pain. It was shocking to see my mom breathing so quickly. With a mixture of embarrassment and gratitude I thanked the caregiver whose name I didn’t know. My wife, who is in the health care business, asked the questions.

“What is her temperature? How long has she been in distress? When did you first see her like this? “ I stood in the background feeling helpless.

“On the bed checks,” she said, and she felt my mom’s forehead. My mom’s breathing rate and fever confirmed what I had feared. My mom was in the process of dying, a process I had never witnessed, nor knew anything about.  That day I went to work but later in the evening her situation had deteriorated. She had been given morphine to reduce her pain which manifest itself in the rapid breathing. I called my brothers and let them know that they needed to come if they wanted to see mom again. In the mean time I sat by her side, talking to her, holding her hand, as she started, what was to become a four day journey. The caregivers of course would arrive; pop their heads in to check on “Breda” with equal amounts love for her and empathy for me. I always welcomed their arrival. Often they offered me food or something to drink. Every few hours, two lovely little Mexican women would ask me politely to leave. I would step outside in the breeze way, and like a fly on the wall, I’d watch the other caregivers attend to the residents. I saw them prepare food, participate in activities, clean up, all while the caregivers “freshened up” my mom. This usually meant they would change her position, brush her hair, and add a new cold towel on her forehead. The love they poured was not just into a job, but into my mother. The woman who immigrated with my dad, raised four boys, put us through college, and then helped raise our own kids. When they left I waited in the room for my brothers to arrive from all over the world.

Once we were all together we hung around her bed, telling stories and laughing, but we felt relieved when one of the staff members, most of whom we didn’t know, would arrive and shoo us out so they could do their job. They were professional yet loving. They understood the gravity of the situation, and entered the sacred space with a real sensitivity while performing their jobs barely above minimum wage I would guess. When the time came closer they asked if they could come and say their “good-byes”. This moment was charged with so much emotion that I, along with my three brothers, either left, or looked away as they blessed my mom, made the sign of the crossover her, or some other personal devotion. Finally, they left the room and in their wake left such an appreciation for the service they provided, something which you can’t place a value on. They even helped prepare us for what was to come.

To read more by Sean Daly please find him at:

Caregivers or Care Partners – What’s the word?


Last year I attended an excellent conference called the Pioneer Network Conference. After one of the fabulous sessions I spoke with the leader who is well-respected in the Culture Change movement. When she heard my company name she looked at me and said, “Did you like the session? We use the word Care Partner.” Honestly, at the moment, her snarky tone was so light that I almost didn’t catch it and I felt a little confused. From this brief exchange, it seemed the title Care Partner was superior and Caregiver was frowned upon.  I have worked with seniors since 1997 and during her session was the very first time I had heard the title Care Partner in exchange for Caregiver. This conference of Culture Change was so exciting for me that I was hearing many thought provoking ideas, this was just one of them.

The fundamentals of the Culture Change movement teachings were not new to me. They are what I have been talking about and sharing for years. These ideas are exactly why I founded but what was new to me about the Culture Change movement was the language.

Since the conference, I have thought a lot about using the words Care Partner in place of Caregiver. I agree, the title focuses on partnership and implies that the senior is actively engaged in any care they receive which is really important in person-centered care. So mostly I love it.

On the other hand, this title will take time to effectively integrate into main stream professional senior care corporations and systems. Now, every time I speak I am making a decision about which title to use.  In the senior care world I came from, Care Partners are those people, organizations and services that are part of helping a senior but are “outside” services – such as hospice, PT, OT RT, neuropsychologists, etc. So choosing to use the term Care Partners rather than Caregivers in a conversation can create more confusion that is alleviates.

Caregivers or Care Partners – What’s the word?

Words have power. I think using the title “Care Partners” is a great way to change the conversation about the role of the people who care for our seniors. I spend a section in my upcoming workbook addressing this topic because I do believe, how we talk to and label people matters. I also believe we can create a revolution and change our senior care culture, while continuing to call people Caregivers – because the value we place on someone and their work day-to-day transcends the label we put on the job. And I believe that is where true change comes from.

So until a time when Care Partner becomes ubiquitous, I will continue to use the title Caregiver with the utmost respect and continue to value the people who do this important work.

Setting 2014 Intentions with Your Team – worksheets included :)

emplintentI can not tell you the last time I set “New Year’s Resolutions” and actually succeeded in sticking to them. I am not a resolution setter. Never have been. But what has always worked is getting in line with what I want to feel, setting intentions and moving towards them.

Something that can bring a team together is to set intentions together. Have the staff come together during a start of the year meeting (or a few so all the shifts can participate) and set intentions for the year ahead. Attached is a worksheet you can print and give them.

Getting clear on what you want to feel is the foundation for successfully creating a life that is meaningful and fulfilling. Happy, healthy, successful, loved, at ease, abundant, joyful, playful, etc. I suggest starting with the question “what do I want to feel this year?”

If you get to the core of what you want to feel, then you can make your day-to-day decisions from a place of intention. For example, if I intend to feel healthy, I choose whether having a soda will get me closer to feeling healthy or not. If I want to feel loved, I decide not to expend energy on friendships that feel exhausting and spend more time with friends that freely express that they love my company.

There is nothing wrong with having resolutions but many times they are rigid and we get off course and give up on them completely within a couple of months of the new year. Setting intentions to move towards what we want to feel is a way to keep us on task – it is not a win or lose situation but a constant movement forward. If we make a choice that moves us away from our intention we simply go back to our intention and examine our next choice.

For example: I intend to be in a loving, kind relationship. Everyday I have choices to make that will get me closer to that or not. I choose what to say and do based on this intention. If an action is not kind I choose not to take it – no criticism, no yelling, no sarcasm, no dishonesty. If I know my partner likes tea in the morning, I can turn on the water so it is hot when he gets to the kitchen. If I make an unkind choice, I make the next one so that I can move again in the direction of kindness or I make a plan to learn how to make better choices – I can make amends, take an anger management class, practice doing things that are kind. You get the idea. I make choices that will keep me in line with my intention and let go of habits and patterns that will move me away from what I want to feel.

Setting 2014 Intentions with Your Team

Below I attached Intention Worksheets for you and your staff to use at your next meetings. The worksheets include intentions for work and personal life….because as I address in my Spunky Caregiver Method Workbooks (to be released soon!) personal life and work life are intertwined. Empowering people to live well, empowers them to work well!

To access the intention forms – CLICK HERE

Have a Happy, Abundant, Successfully, Loving, Fun, Lively 2014!




Using a Leisure History to Empower Staff and Employees (form included)

leicrpIn a seemingly previous life, I was a Recreation Therapist(CTRS). It was a great profession to be in. I worked on an acute rehab unit, and AIDS/HIV unit(now long closed) and a SNF. I worked with amazing professionals. As I reflect on how that career led me here, I realize that the very foundation of Recreation Therapy is what we now call Person-Centered Care. The interests of each individual were at the core of the treatment program I designed. Every part of their life was taken into consideration during sessions I had with them and was fundamental in every decision we made about their care. And that continues to be what I see as the path to empowering the people we work with to live a rich meaningful life.

At the initial meeting with every patient we would complete a Recreation/Leisure assessment to discern what was functionally important to that person and what brought meaning to their lives. From there we would plan out their therapy regime, intending to get them back to doing what made their life worth living.

Completing a Leisure History with seniors can be really powerful. When I was at University I had to do a leisure history of an elder. I chose to interview my grandmother. I found out SO much information about her youth…they used to roast chestnuts in the gutters in Philadelphia as a teenager, her future husband used to walk 5 miles to her house (and back) to see her, they loved to dance, her house was one of the early houses on the street to have TV, she traveled by train when he joined the military during WWII ….etc. That interview changed our communication. We got closer and we had new things to talk about.

This week I made a mini-version that can be used in Long Term Care communities where therapy is not the primary goal but living a meaningful life is. I called it a ‘Leisure History’ and modified it to a simple form that can be used by any staff member and should be in turn be shared with every staff member. You can mark it up and then use the back for extra notes and interesting stories to share. Please feel free to use it and pass it on to anyone else.

Using a Leisure History to Empower Staff and Employees

Two ways to use this form:

  1. Fill it out with every senior that moves in. Make it a policy that it is completed by a staff member and shared with the rest of the staff within 3 days of arrival. I would ideally suggest the day after move in. At least 20 minutes should be set aside to complete it. This form should be a conversation starter, not simply a check list. It is a way to open the door to get to know someone. Sit down and offer them some tea so it becomes a visit rather than another requirement during their move. If they can not communicate, engage a family member in the process. As a new person moving into a foreign, scary place mostly likely in a time of great change, having a 20+ minute conversation with one person can give them a friendship, an anchor in what is about to be many weeks of adjusting to change. This completed form should be available for staff members to see so they can create a relationship based on commonalities and interest of the individual. Activities offered should be based on the information gathered in the leisure history. For example: If in the notes the person said they hate Bingo, then the staff should try to convince them to play Bingo. If they like music, it should say what kind, so offer to put that kind of music on their radio. If they have always chosen to be alone, give them them the final choice when asking them to join groups.  A leisure history is an intimate view of what makes up this person’s life and puts the focus on the unique individual.
  2. I would like to suggest that using this form is highly beneficial to your staff as well. If you ask people that work in long term care what they like about their job most will tell you it’s the seniors. Getting to know our elders is the best part of our jobs. We laugh at their stories, we cry with their pain and loneliness, and we are let into their most intimate daily routines. Having a full leisure history allows us to more deeply connect with them. We can know them better and have deeper relationships. Having good relationships at work makes us happier at work. Every staff member should fill one of these out for themselves. It is a great reminder of what makes us happy and that can be shared with the seniors. It also can generate conversations and relationships between co-workers and be the foundation for upcoming employee appreciation.

Click on the icon below to get your form:


In Long Term Care the focus should be on the person, not the diagnoses. The Leisure History gives you and your staff an opportunity to engage more fully with every person in the community and make their lives more meaningful.


5 Ways To Engage More Merrily This Holiday Season

holiengageI have worked in and with enough long term care communities to know that the winter season is not all merry and bright for seniors and their care partners. As you know, the winter season can be a time of great loneliness and loss due to illness. So mixed in with the sense of excitement at the holiday season is also a sense of “here we are again, let’s see how we fare this year”.

There are lots of great qualities about the holiday season, it brings together family and community which can be a huge positive. It is also the time of year when many people remember their losses and loneliness. And it is also the season for sickness and death. Many of our elders are living their last days with us. So how can you engage everyone more in this holiday season filled with so many ups and downs?

Mer·ry ˈmerē/ adjective:  cheerful and lively.

Here are 5 ways to engage more merrily this holiday season:

  1. Ask what the people want – People tend to celebrate the holidays in different ways and actually celebrate many different holidays. Start asking now what the seniors would like to have happen this holiday season. They may surprise you with some fun new traditions to include … maybe they want to create some new traditions. Assuming that holiday trees, turkeys and pie are what they want is like telling your kids what the plans are and they have no choice but to go along to the relatives house. It’s their home, make them such an integral part of the planning that they feel like it would not come together if they were not in the planning. Maybe they want to be old school this year and string cranberries and popcorn, or make handmade cards or maybe skip a tree and simply put up lights.
  2. Don’t be fake – That sounds pretty direct but often when the holidays roll around people put on a fake smile and try to be cheerful. We tend to push aside the pain and try to cheer everyone up. But when we are truly caring for each person, we focus on each person and where they are right now. For example, if Sally loves the holiday and is getting excited, there is an opportunity to engage in all the holiday activities with fervor. If Bob feels sad this season because 3 of his fellow seniors have died in rooms nearby, acting as if the holiday is a time to feel cheerful will give Bob the impression that he is alone in his grief. Ask Bob how he feels and perhaps what he needs to feel supported and then listen.
  3. Help families know what to bring – The person living in long term care may have taken up a new hobby this year or expressed interest in learning something but they did not share that with family or said to a nurse that they really have been craving a particular pie this season. Share that with a family member so they can give a meaningful gift. Unless you love funky socks, getting another pair of socks from a friend or family feels hollow and sad. Receiving a gift that means something makes us feel connected to those around us. This can be especially challenging for people with dementia. Family members may be wondering what if anything they should get for their parent. Share with them what makes the person with dementia light up or engage recently…even if it is something simple like folding laundry, counting bingo chips or listening to specific music. With that in mind family can give something that may evoke that same feeling. Or you can refer them to check out an engagement activity kit that can help them have meaningful interactions with their family members.
  4. Engage co-workers in the festivities – Holidays are for family and community. Everyone caring for our elders are a vital part of their lives. This is a great time for a caregiver or nurse to share with the seniors a tradition that they have at home. Holiday parties are not as much fun if the staff is standing on the sidelines serving. Get them engaged and create a true sense of community. This is particularly important for those that have no family. The more connected everyone is, the better care that is given. My family lives on the other coast, holiday parties with the seniors have always been a meaningful part of my own winter season.
  5. Create the seasonal events for the people who want them – Creating the seasonal events for the people who want to be festive creates an authentic vibe for the event. Nothing is worse than having half the group siting there when they would rather be in their room. There is a fine line between encouraging someone to partake in festivities and disrespecting their choice to stay away by pushing them to join in. Let them say no and still love them. Bring them a piece of pie or let them come to the party and leave at their own pace.

Cheerful & Lively. How do you get to cheerful & lively? Particularly for me during the holiday season I like certain things and I avoid certain events. Force me to do too much mingling and I will lose my merry. Ask me to go to a party when someone I see everyday is ill or died, I may say yes and I may say no. Give me meaningless gifts and I will feel less connected. Give me a funky pair of knee-high socks and you make my day. Everyday is different. For the people we work with, every day is different. We forget sometimes and get caught up in the rush of the season.  All of the festivities are for the enjoyment of the people we work with. What do they want? 

Merry Winter Season,