Softening the assessment process

The culture change movement has taught us so much, causing us to think twice about what we do. We’re finding, unfortunately, that many of the processes we employ in long-term care are institutional and dehumanizing. As with restraints, we never intended any harm to our precious residents, but many of our institutional ways have indirectly created it.

Let’s look at “the assessment process.” Have you ever thought about it? Is it also very institutional? Has the person become lost? When I ask an audience, “What is institutional about our assessment process?” comments such as the following pop up: “burdensome,” “overwhelming,” “bombardment,” “impersonal,” “a task to be done,” “many people asking the same questions,” “maddening.”

What does that first week look like for a person new to living in long-term care? Isn’t it often a bombardment of professionals coming and going, asking a bunch of questions and filling out their forms? Have you ever had a new resident say to you, “Someone just asked me that same question.” And then, what is the next week like for them? Typically now, no one comes. All that assessing stops and the person is often left alone.

Softening the experience

On the Centers for Medicare & Medicaid Services (CMS) satellite broadcast aired in 2006 regarding the new Psychosocial Severity Outcome Guide, psychologist Dr. Judah Ronch stated that moving into a nursing home is one of the hardest things anyone will ever have to do, “one of the most traumatic experiences in life.” But is that the degree to which we treat it? Not that I’ve seen. Do you agree it could use some softening, some personalization, tenderness, and understanding? Don’t we have an obligation to our parents, grandparents, and all those who have built this country to soften and humanize this heart-wrenching experience? I bet you’ve been wanting to do so, if you haven’t already. So what can we do to soften this process?

Meeting a new neighbor

Something interesting to think about is how you meet a new person in the neighborhood where you live. Do you grab your clipboard and form and go ring the doorbell? Maybe you wish you did. There are perhaps some things we would each like to know before someone moves in, i.e., do they have dogs that bark or teenagers who have loud parties? But really, isn’t this precisely what we do to people who have just moved into a nursing home? Bombard them with some pretty personal questions? In our neighborhoods, we welcome and get to know someone, maybe even over coffee or a beer. Some people, although not many, still bake and take cookies to new neighbors. This, sad to say, is a dying art. When I ask all over the country, who still actually bakes cookies, not many raise their hands. So I ask you, could you get to know a new neighbor in the nursing home over coffee instead of over a form? How are new residents welcomed into your community? Is anything done to welcome them? Some homes offer a gift bag with toiletry items or directories, which are nice, but would you agree that we can do better? We want to encourage you here. This idea is considered so important we included it in the Artifacts of Culture Change measurement tool which I codeveloped with Karen Schoeneman under contract with CMS in 2006. Have you tried a “buddy system,” whereby residents who have lived in the home for a length of time and are willing and able become a buddy to new residents-showing them around, checking in on them, explaining where things are, and who is in charge of what? Wouldn’t you love to be a mouse in the corner on some of those conversations?

Events to welcome

Welcoming parties or events could be held where other residents, staff, and families are invited to come and get to know the person new to them. What about inviting other new residents, and staff for that matter, to help others get to know them during community meetings? In Kansas, a new resident held an open house when she moved into the nursing home! Now that will change the perception of what it’s like to move into a nursing home! Have you ever asked your residents their ideas on smoothing this difficult transition? Family and staff have great ideas, too. Consider convening Learning Circles to ask your residents, families, and staff to bring their ideas on what you can do as a family to welcome newcomers into your facility. Who better to tell you their ideas on making what is normally a difficult experience into the best it can be?

Here are some questions and answers to help you soften your assessment process for new residents.

Q: If I want to quickly learn more about softening the assessment process where do I go?

A: the American Association of Nurse Assessment Coordinators (AANAC) developed a free downloadable manual called The Softer Side of the MDS that was funded by a grant from Nurse Competence in Aging. The manual is available from AANAC at and explores the MDS and culture change. Action Pact, Inc., a training and consulting company, also sells a user-friendly workbook with examples, policies and procedures, exercises for staff to think through, and how regulations support innovative care planning called, Changing the Culture of Care Planning: A Person-Directed Approach. It is available at or (414) 258-3649.

New Webinar offering: In January, Action Pact started a monthly Web talk show called Conversations with Carmen: Changing Culture in Long-Term Care. Christine Krugh, MSW, and I discussed softening the assessment process. For more information, go to Watch this column for more on this subject in the future, too.

Q: How do I see the CMS satellite broadcast about the Psychosocial Severity Outcome Guide?

A: CMS aired a satellite broadcast introducing the Psychosocial Severity Outcome Guide to surveyors on March 24, 2006. Part of the broadcast included an excellent training session on psychosocial well-being by psychologist Dr. Judah Ronch if you can get your “eyes” on it. All CMS satellite broadcasts are aired for a certain time period on

Q: How do I learn more about the Artifacts of Culture Change measurement tool?

A: The Artifacts of Culture Change tool was co-developed by Karen Schoeneman of the CMS and myself. There is a full report called Development of the Artifacts of Culture Change tool which explains why the tool was created, the rationale behind it, the point scale, and a large Source Information table giving backup for each item, where it might be found as well as any research found for each item. The Development report and the Artifacts tool itself are both available at For more information, contact Karen Schoeneman of CMS at (410) 786-6855 or or me through the contact information following.

Carmen Bowman, MHS, ACC, is the Owner of Edu-Catering: Education for Compliance and Culture Change in LTC, a consulting and training company in Firestone, Colorado. She can be reached at (303) 981-7228 or

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Long-Term Living 2009 May;58(5):34-35

Topics: Articles , MDS/RAI