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Darcy Grabenstein: Hello, from SmartLinx Solutions! In today's podcast we'll talk with Penny Cook, the new president and CEO of Pioneer Network. This organization is at the forefront of changing the culture of aging, long-term care, and support of elders in America. A growing network of organizations and individuals across the nation and beyond, Pioneer Network is dedicated to making fundamental changes in values and practices to create a culture of aging and long-term care that is life affirming, satisfying, humane and meaningful.
Penny may be new to Pioneer Network, but she is by no means new to long-term care. She previously served as manager of the Long-Term Care Ombudsman Program in the Denver metropolitan region and as the executive director of the Colorado Culture Change Coalition. Most recently, she was the director of Long-Term Services and Supports for Colorado Access, where she managed a state Medicaid contract to connect individuals to long-term services and supports. Welcome, Penny. We're honored to have you as our guest today.
Penny Cook: Thank you so much, Darcy. I'm really pleased to be here.
DG: Let me start, Penny, by asking you about culture change itself. We hear this phrase thrown around a lot in the corporate world, but how would you define it in terms of long-term care in America, and how does it impact quality improvement and quality of care?
PC: Well, you're exactly right, Darcy. We've been hearing about culture change in all different arenas. I think that the concept is actually the same. It's really changing the culture of an organization or a system, and that's the beliefs and practices, and even the language of that culture. What we really mean when we're talking about long-term care is changing from this more institutional culture, where long-term care started, into a culture that is really centered around people themselves, that is really about community. I think that we're trying to change this culture because nursing homes, for instance, really started as an outgrowth of hospitals. They were sort of institution-like. There were long hallways that were modeled after hospitals. There were many people living in the same room. I think we began to realize that this isn't the culture that we really want as people are living out the older years of their life.
What we're talking about is really, sort of, changing that 180 degrees. Instead of creating institution, really this idea of creating community. We're looking at people as individuals. We're really creating home because people are living in nursing homes and assisted living communities. It's not just somewhere they're going for a few days or a few weeks. We're talking about changing the language of nursing homes. People aren't patients, they're residents. They're elders who live there. I think it really is changing all these different aspects of the beliefs and practices of long-term care.
DG: Right, you're so right. I noticed in the news release announcing your new role — congratulations, by the way — at the helm of Pioneer Network, it was referred to as the organization's "crusade." Do you see your role as a continuation or outgrowth of previous roles that you've held, or as something completely different, and why?
PC: Thank you. I really see this as a continuation of the path that I've been on. As you said in the introduction, I have worked in the Long-Term Care Ombudsman Program. That role, I was really advocating for people who lived in assisted living communities and nursing homes, really to help them have a voice and creating the type of home that they wanted to live in. As the executive director of the Colorado Culture Change Coalition, that was an organization that was smaller but similar to Pioneer in the state of Colorado. We were really working to change the culture of aging and of long-term care. In that role, too, I was an advocate and I was an educator, and I was trying to help to move this transformation along. I really see that as being a very similar role with Pioneer, just on a much broader spectrum, and I really feel honored to be able to do that.
DG: It's so important. Someone needs to advocate for this segment of our society. Early in your career, you were a social worker, Penny. How did that experience prepare you for your current efforts with the aging population?
PC: I always say that having a social work degree is one of the best degrees to have. It's so applicable in so many different areas. In all of my work as a social worker, I actually worked with older adults. My first job was at a hospital, and I worked on the hospital unit where people were staying until they could move into a nursing home. Since people were in a hospital, they were patients, but they were living there for weeks and sometimes even months, waiting to move into a nursing home. That really had a huge impact on me because I really saw the loss that people were facing as they came into the hospital, and then, all of a sudden, they didn't know where they were going to live next.
Then I became a social worker, working with people who lived in their own homes. Again, I saw that experience of people just sometimes struggling, and then having to move out at a time when they didn't necessarily choose. That really impacted me going forward as I started working in the roles of advocate and educator and trainer. It's had a huge impact throughout my career, and I've been so fortunate to have those early experiences.
DG: Sure. We're going to put you on the spot here, Penny. What would you say are your immediate and your long-term goals as head of Pioneer Network? You have coalitions in most states. Is your goal to have a presence in all states?
PC: I'll answer the second part of that question first. We would love to have coalitions in all states. Every state is very different as to what they're doing to work towards changing the culture of long-term care. In some states, there's more of an emphasis working with nursing homes, in some it's assisted living communities, in others it's working with elders who are living in their own homes, and changing the culture, for instance, of home and community-based services. We would love to have coalitions in every state because they're really doing a lot of the hard work in their own states.
Another one of my immediate goals as the head of Pioneer is really looking to our August conference. It's actually in my home state of Colorado this year, so I'm very fortunate. We're really hoping to make that conference just such a successful experience for attendees who are there. We're offering some new and innovative programs that are going to be there. We're offering some site visits to some different places than Colorado. We're actually offering a new tech experience, so that people can experience the latest and greatest that has to do with aging and technology. That's one of my immediate goals.
I think my longer term and broader goal for Pioneer is really to expand even more what Pioneer Network has been doing. We've learned so much in working with the nursing homes and changing the culture of care. We have so many best practices that I think are very applicable to assisted living communities and home- and community-based services. I'd like to see Pioneer expand the breadth of what it's been doing. I think that the world of long-term care is so fluid these days, and so we have a lot to offer in a number of different settings.
DG: Speaking of offerings, what types of resources do you offer to long-term care professionals?
PC: We offer a variety of different things. We have a monthly webinar series that's very popular. People can register for one webinar or do a package of webinars. We have people who register as individuals, but then we have long-term care communities register and they use it for education and training of their own staff. We offer some guides that go with their webinars, so if they can't attend the webinar at that time, they're able to use it anytime and show it to their staff, and have their staff participate in training.
We also have a wonderful resource page on our website, where we offer a variety of different things. We have the artifacts of culture change, which is a tool for providers to assist in really looking at their readiness and implementation for person-centered care. We offer a dining tool kit, an environmental tool kit. We offer tips and resources to help with care planning and quality improvement, a variety of different things. Some of those are a cost, but a lot of our resources are free.
We also have an information email. This is a great opportunity if people have any questions or if people want to network with other people around the country. We have resources around the world for people that have different questions about culture change and person-directed care. We really help to connect people, so I'm very proud of that resource that we offer also.
DG: That's great. Penny, in your opinion, how far have we come as a nation in recent years, as far as changing the culture surrounding aging and care? I know we've come a long way, but how much more do you think we have to accomplish?
PC: I think we have come a long way. I'll tell you, I remember as a little girl going into nursing homes and — both because I was little, but I think because of the environment, too — they were kind of scary places at times. We had people, multiple people, living in one room. I remember seeing four people living in one room, and everyone's schedule as dictated by the nursing home itself. There wasn't choice. There wasn't freedom. I think we've come such a long way in that.
I'm so proud of us, that we've been able to do that, but I'll tell you, I think we have a ways to go. For instance, now sometimes we have two people living in a room with only sometimes a thin sheet between them.
DG: That was my mother.
PC: Yes, and I think that those are the things that we still need to change. I think we have a lot of work that we have left to do, but we can't disregard how far we've come, too. I think that if you look at our society and our views on aging, we have a long way to go there, too. We have, sort of, this anti-aging message in a lot of our society, I think, if we look at anti-aging products and things like that. I think that that's something that we can work to change.
DG: Definitely. Penny, I have one last question for you. Could you give me an example of a long-term care facility that successfully underwent a culture change, and how that change impacted both residents and staff?
PC: Oh, of course. There's a wonderful community here in Denver that's really near and dear to my heart because it taught me so much, especially when I was an ombudsman. The name is Rowan Community. It's a small nursing home that's in a residential area of Denver. This was a nursing home that actually was threatened to be closed. It had just a few handfuls of people who lived there, and it was in dire financial straits. It was taken over by a Colorado-based management company that really believed in culture change and person-centered care called Pinon Management. There was an administrator there, Maxine Roby, and Maxine was a huge believer that if you invested in staff and residents that you could change the culture of the nursing home.
This was a home that was built in the late '50s, early '60s and, unfortunately, she couldn't tear down the building and start from scratch again, so she had to make do. Maxine did things with her dedicated maintenance staff like putting in porch lights, instead of call lights, and putting in doorbells in front of residents' rooms because you would ring a doorbell if you entered somebody's home. She just invested in staff because she believed that if you treated your staff members, your team, with dignity and respect and loyalty, that that of course was the way that they would care for and support the residents who lived there.
This home became a home that not only did residents want to get into — there was a waiting list — but there was a waiting list for staff who wanted to work there. It was pretty amazing. It was also a home where 90 percent of the people who lived there paid for their stay through Medicaid. It was a home that made money. I know that for a lot of people, that's one sign of success. It was all these different person-centered practices that were put into place, and I have to say probably the one that sticks with me the most is that every six months, every year, Maxine ended up moving offices, to the point where her office was the size of a small coat closet because she really believed that this wasn't her home.
She didn't need a big office; this was somebody else's home. This was the home of the residents, and they needed the space. She was never in her office. She was having lunch in the dining room; she was meeting with people in their "homes," so the office space wasn't important to her. I think that really exemplifies her attitude and what this home did.
DG: It does. That was a big risk for that company to take over a failing nursing home.
PC: It really was, but the success that they had in so many ways there, it's definitely a great story and it really shows that it can be done.
DG: It is, and it does. Thank you, Penny, so much for taking time out of your busy schedule to join us today. To all our listeners, thank you for taking the time to tune in. For more information on the Pioneer Network, visit PioneerNetwork.net. If you'd like to learn more about SmartLinx Solutions and our fully integrated suite of workforce management solutions, visit us online at SmartLinxSolutions.com.