Candy McDowall - my new life

Planning Ahead

2010-05-02T12:48:00.000-07:00

I had a great meeting today with Shelley, the Activities and Volunteer Coordinator of Sunrise Nursing Homes in Worthington.

I got a tour, met a lot of great people, and talked about where my research is headed.

Shelley is totally on board to help out with my proposed independent study for the fall. I am going to be spending 4-5 weeks as a volunteer at Sunrise in their memory assistance unit, called Reminiscence House. My goal is to participate, not as a researcher with a clipboard, but as a regular volunteer, in whatever capacity they need on that day. I want to see how the system functions from a staff and resident perspective.

I will be journaling this experience every week, and writing some kind of summary at the end as a deliverable for the independent study. The goal is to combine this experience with the research I am doing this quarter on Snoezelen rooms, to identify how my research study should come together and get a pilot study going for next school year.

one of these days I'll get the hang of this

2010-04-22T18:22:00.000-07:00

Ok, so I can't upload my own pdf of my presentation. I'll work on that tomorrow.

Suffice it to say for the moment that I have narrowed my focus to using design-research methods to evaluate comfort for residents in various stages of dementia.

I am intentionally staying away from the label of Alzheimers because it is only one in a long line of conditions which can cause symptoms of dementia. But I clearly understand it is the leading cause of dementia in older adults and will most likely be the population most served by this research. But I do not wish to dismiss those others who have related diseases or conditions and can also benefit from what happens here.

That being said, I think I need to clarify a few other things as well.

First, I need to define and narrow this issue of comfort. For the purposes of my research, I am concerned with the nature of emotional comfort. Not physical comfort (although they are frequently connected) because I am not researching pain management. That is a medical issue of which I am not qualified to explore. I am also not dealing in financial or other aspects of comfort. I am looking only to delve into emotional comfort and ways to identify what that means to a person suffering from dementia. From there I can look at how to translate that information into relevant and useful information for the nursing home industry and the design community.

Plenty of research has been done related to comfort in the dementia population using a scientific method for psychological, psychiatric, and medical information. This is the root of the evidence-based design movement. But I want to go back to the "fuzzy front end" of research and use different methods to evaluate this concept to see if we get any new results. I want to come at this topic from a different angle to make sure we are addressing all the needs of the population.
I don't know yet if this will involve make-tools in the way we have used them in class. It's possible, but I foresee huge obstacles, such as IRB approval in working with a clearly vulnerable population, and the issue of getting information from someone who has difficulty communicating. Not sure how that will work out. We may need to get creative in our methods.

One avenue I need to pursue immediately is this issue of the Snoezelen rooms. Snoezelen is a combination of 2 Dutch words meaning "to seek out" and "to relax". So in its basic form, Snoezelen is a method of seeking relaxation. The original pioneers of the movement noticed that stimulating the 5 senses in various ways helped some residents in various stages of dementia (and some Autistic children) to become calmer and more focused on the stimulus, therefore reducing anxiety and acting out behaviors.

This is an intrigueing concept which I stumbled across last quarter while doing research on sensory stimulation related to emotion. Then while at the Environments for Aging Conference in March, I was able to talk to a designer and phd student who had done quite a bit of research and work related to Snoezelen. The most common form of this therapeutic method is to build a "Snoezelen room" within a facility where residents and staff can go to interact with the various stimuli in order to produce a calming effect. An alternative method is to create, basically, Snoezelen on Wheels, so that the stimuli can go to the resident. This is a less costly approach and gets the benefits into the hands (so to speak) of non-ambulatory residents.

But as Addie Johnson and I were talking, she related that she wished there was a way to build this concept of the Snoezelen room into the entire environment of a facility. Why should these effects be limited to just one room? If the entire environment was designed to promote these same calming effects, wouldn't the benefit on the entire population be greater?

So this is where I am headed with this different approach. I want to build on my social-work and sociology background to connect in an empathetic way with the dementia population. And I want to be able to uncover information that we would not have otherwise had access to through the tradional scientific (EBD) methods that are being so fervently embraced in the industry. We might very well be missing something here.

Another important connection is that under the auspices of Culture Change, we in the senior care industry are supposed to be putting the needs and wants of the residents first, and de-institutionalizing and de-hospitalizing practice. But EBD is definitely an institutionally based model for conducting research. Don't get me wrong here, this is not a slam on EBD. It has a serious and effective place in healthcare research. But in the arena of senior care, when we are trying to move away from the clipboard and the stopwatch, I think a more intuitive approach to the research question at hand will fall more in line with the Culture Change principles.

So there is my rationale. If you read all the way through that, then more power to you. Now comes the hard part...figuring out how to make this happen.

2010-04-22T18:09:00.000-07:00

Oh Research Blog...how I have missed you...

It's not that I haven't been thinking of you, it's just that life and other classes have gotten in the way of our relationship. But have no fear, I'm back. And if I have any hope of graduating before I'm dead, it will be for good this time.

Boy have I got a lot of catching up to do.

lightbulbs going on

2009-12-01T16:38:00.001-08:00

My conversation with Linda today sparked some new ideas about defining my research topic. I think my research question needs to change.

"How can design support Culture Change in Memory Support environments?"

I know that I will need to define Culture Change as well as Memory Support as being a part of the larger senior care community.

My hypothesis will change too.

"Residents in Memory Support environments can benefit from the principles of Culture Change, despite their cognitive challenges."

I have a lot of work to do tonight to get this presentation ready in 2 days!

community contacts

2009-12-01T16:29:00.000-08:00

I had a great conversation over lunch today with Linda Gabel of NBBJ (thanks, Liz) about research directions and her thoughts on senior care. One of her concerns in the healthcare market is the issue of bariatrics as an underserved and underresearched population.

Some of the questions that came out of that discussion are:
How are blended units working with Alzheimers/Parkinsons/mental health issues?
What is comforting or means home to residents vs. family members? (facilities are really marketing to families)
How are the concepts of culture change going to apply to dementia care residents?

She had great contacts for me too, such as Jane Rhoady and Betsey Brawley, Donna Mullins, and Lisa Cini of Mosaic. I will definitely be following up with these people as I go.

expressions of love

2009-11-27T14:43:00.000-08:00

Nursing Home
by Lillian Morrison

My mother is all bones
and eyes.
She doesn't notice
her clothes anymore
who had loved beads and bright colors
or glance at the racketing dayroom TV
who had watched her "stories" every day.
"These are my company."
Just people she wants
to greet and joke with,
to cry a little.
She wants them to smile
and to love her.
She asks for her father and mother.
I touch the baby skin,
the meaningful face
and look in the eyes that say
"I'm still fighting
in this narrow place."
and I hug
the fragile bones.

more hmmmmmm

2009-11-27T14:21:00.000-08:00

"Old age is not the source of our problems; it is where we will find the answers we need. Indeed, it has been the source of all our answers from the moment we first learned to grow old."

- Dr. Bill Thomas, founder of the Eden Alternative

a little rework is in order

2009-11-27T14:11:00.000-08:00

I'm still concerned that my research question "How can design best support the evolving senior care market?" is the weak spot in my presentation. And since it is the cornerstone of everything I do from here, that is a little disconcerting.

After some encouragement from my fellow students and a little tweaking, I am feeling better about it. But the main response I got when we were going over our presentations for next week was that the contextual rationale for a senior care overhaul is where my strength is. So I may want to move that to the front and really emphasize it, get people involved and caring about my topic right up front. So I will spend tonight moving some things around and seeing where this goes.

But my question may go something like "How can design best support skilled nursing care in the senior living environment?"

things that make you go "hmmmm"

2009-11-21T14:47:00.000-08:00

"We would never purposely design a nursing home system like we have if we imagine ourselves in its care." - Steve Shields

changing my key words

2009-11-21T13:30:00.000-08:00

Old key words:
senior living
medical model
culture change
person-centered care
Greenhouse model
Household model
Eden Alternative

New key words:
health care
senior living
nursing homes/skilled nursing
evidence-based design
culture change
person-centered care
post-occupancy evaluations

aging with humor

2009-11-18T17:51:00.000-08:00

things are a-changin'

2009-11-18T17:47:00.000-08:00

enough said

2009-11-18T04:54:00.001-08:00

conversation of the day

2009-11-17T16:09:00.000-08:00

The conversation of the day centered around the use of my final slide, the one I affectionately entitled, "Lady Bird." (an elderly lady giving the camera the finger). I wanted to upload the photo here, but it says it can't load because of an internal error. It doesn't say what the error is or how I should fix it, so I'm not sure what to do about that.

Anyway, I asked my fellow students if the slide should stay or go for the final presentation. I love it, because I think it conveys a powerful message about how the elderly feel about nursing home care. But I am a little worried about looking unprofessional during the final, considering the number of faculty who will be in attendance.

The general consensus was that the slide should stay. But Bruno had an excellent idea to move it to the first slide, instead of the last one. It sets a mood, gets people's attention, and I have an opportunity to explain its context while everyone is listening. Last time I was trying to talk about it while we were transitioning to the next presenter, so the conversation may have gotten lost.

So that's it. Lady Bird stays, AND gets an upgraded seat. Not bad for someone her age.

Musings about POEs and the definition of healthcare

2009-11-15T17:04:00.000-08:00

So, I'm having a thought here... I think I need to take a look at current Post Occupancy Evaluations as they are being used in senior care. Who is creating them? What kinds of things are being studied? How far "post-occupancy" are we talking about? Who is conducting them? How is the information being collected? Where does the information go? Are there holes or gaps? Do we need to take another look at them from the standpoint of person-centered care to make sure we are measuring the appropriate things?

Which lead me to another thought... senior care is generally considered a subset of the healthcare industry. Many of the standards being set forth in research and legislation of senior care facilities are based on the larger healthcare model. But healthcare, more often than not, is referring to hospitals and medical management, based on the "sick-patient" concept. It's goals are institutionally based.

By definition, the culture change movement in senior living is anti-institutional. The entire concept is to get away from the "sick-patient" concept and get to a "whole-person" concept. These residents may also have ailments that need to be treated, but that is not the focus of their daily lives.

So how can the goals and models developed for the larger healthcare system really be addressing the needs of the senior care community. I have a feeling we are working at cross-purposes here. Which is why a larger review of something like post-occupancy evaluations may be in order.

some people design with words

2009-11-12T10:08:00.000-08:00

On Aging

When you see me sitting quietly,
Like a sack left on the shelf,
Don't think I need your chattering.
I'm listening to myself.
Hold! Stop! Don't pity me!
Hold! Stop your sympathy!
Understanding if you got it,
Otherwise I'll do without it!

When my bones are stiff and aching
and my feet won't climb the stair,
I will only ask one favor:
Don't bring me no rocking chair.

When you see me walking, stumbling,
Don't study and get it wrong.
'Cause tired don't mean lazy
And every goodbye ain't gone.
I'm the same person I was back then,
A little less hair, a little less chin,
A lot less lungs and much less wind.
But ain't I lucky I can still breathe in.

-Maya Angelou

can we try that one more time?

2009-11-12T06:41:00.000-08:00

http://www.myinnerview.com/_media/doc/general/CultureChange123105.pdf

let's see if this one works...

link to research somebody else already did for me

2009-11-11T18:09:00.000-08:00

http://http://www.myinnerview.com/_media/doc/general/CultureChange123105.pdf

Why didn't that link in the last post?

a place to start

2009-11-11T18:02:00.000-08:00

So, I tried to post my entire powerpoint presentation on my Statement of Intent, but clearly I have more to learn about this whole blogging thing.

Instead, let's just dive right in to my research question...

"How can design best support the evolving senior care market?"

I know, I know. It's broad. But it will be narrowed as I do more research and talk to more people.

How about my hypothesis...

"Culture Change itself needs to be more clearly defined in terms of management structure, facilities, goals, etc."

But guess what I found today? Somebody already did that.

http://www.myinnerview.com/_media/doc/general/CultureChange123105.pdf

So where do I go from here?

Onward and Upward

2009-11-11T11:19:00.000-08:00

Ok, so I opened this blog way back when as an experiment, which clearly didn't go very far.

But while I have one, and now that I need one, I may as well use it.

So here goes.... I am going to attempt to turn this into a design blog related to my master's thesis in design. Wish me luck.

The Last

2008-02-20T08:25:00.000-08:00

It’s good to note the firsts in your child’s life, but watch out for the Last. It sneaks up on you and gets past you before you realize it was the Last, and It has long past and now you can’t remember when It happened. But you really wish you could get It back just one more time.

- the last time he fell asleep in your lap
- the last picture you put on the refrigerator
- the last time you tied her shoes
- the last time he asked to be carried
- the last night before the first boy called for her
- the last time you were referred to as “Mommy” instead of “Mom” (or the more exasperated “Mother!”)
- the last ride on your shoulders
- the last boo-boo you fixed with a kiss (teen-aged broken hearts aside)

Feel free to add...

I got nothin'

2008-02-19T10:09:00.001-08:00

I'd love to tell you something really interesting, but I used up all my good material writing my profile.