Sunday, March 22, 2015


Entitled To Be Heard + Taken Seriously

---Let us first state what we think that folks need to hear and be taken seriously about. I think that most people want to know they are OKAY! That it is okay to be who they are. A simple ‘yes’ may NOT be sufficient. Folks need to be convinced that it is ALRIGHT to be who they are. Of course the answer is ‘yes’…but, it is amazing that when push really comes to shove…how much that FACT is NOT known.

---The unfortunate part that can happen is that one begins to compete + compare himself with his neighbor to discover the answer to this question. He looks AT his neighbor and answers his own question. He answers the question by knowing if he is doing better than the neighbor…or, if he’s a better person than his neighbor. The answer comes in terms of how he is doing compared to his neighbor and is really NOT the answer he is looking for. (It is about doing/being the best you possibly can be as opposed to how one is doing compared with everyone/anyone else.)

---Being convinced that he is heard and taken seriously frees one to then leave that question behind and be secure with who one is. When someone truly knows that it is okay to be himself…NOT just in comparison to others, one begins to enjoy living fully. He no longer needs to prove what he hopes the answer to be…and moves on to enjoy his new found freedom.

---When one is truly heard and taken seriously…he now has more quality in his life. He has been freed from discovering that answer to the dynamic which plagues most people until they answer it. Am I ’GOOD ENOUGH?’ When he is convinced beyond a shadow of a doubt that the answer is YES...he will be free. Until then, everything that he does will always have that as part of what he wants to know - am I good enough?


Resident Care Team
---Your Care Team, [IDT], or ''Interdisciniplinarian Team,'' is made up of physicians, nurses, dieticians, activity therapists and other staff. It is where the rubber meets the road. Your Care Plan will be developed for you based on your clinical's team assessment of you. Your needs + preferences are, also, taken into consideration. You are allegedly residing in a unit that best meets your clinical needs. Your active participation with your care planning is encouraged, valued and will help make your care plan more effective. Your family or other relations involved in making decisions regarding your care, called surrogate decision makers, may also contribute to your care planning. You and your surrogate will be notified by your social worker of all quarterly team meetings.

---Your Care Team will meet with you regularly to evaluate your appropriate level of skilled nursing care and clerical needs. If the assigned Care Unit is no longer the optimal place to address your needs, you may be relocated to a more appropriate unit. Your cooperation and input within this process is greatly appreciated.
---Someone from your Care Team is assigned to be your ''Go-To'' person. He or she will meet with you on a bi-monthly schedule to keep the tenets of your last Care Team Conference and your next RCC ongoing and fresh in your mind. He or she jots down requests or questions that you may have over the course of the month. He or she is responsible for ''how things are going for you...on the unit (and the hospital) overall.''

Saturday, March 21, 2015



---We have been asked to make the concept of symbiotic very simple.

---In case you don't know, symbiotic – simplified is where the staff depends on the resident as much as the resident depends on the staff. To go a step further...the patient needs the staff to lead as normal a life (for him) as possible. The opposite is true for the staff. His job depends on the patient.

---The goal of the Nursing Home is for the patient to reach the highest and truest of himself. The patient should thrive + prosper according to his abilities, needs and preferences. The job of the staff is to make that happen...for the patient. Be Well.

Friday, March 20, 2015


Relating To A Member
of the Underserved Population;


---What I have been working on for a long time has finally become clear to me. It is one of those answers that is so obvious that I'm almost embarrassed to talk about it. But...that doesn't hold the final card, so I guess I'll just say it.

---The secret to having a hospital patient be happy and satisfied is to simply ask him what he wants and give it to him. (You may have to massage this dynamic a bit to get the desired response.) The patient may have NOT had his preferences cared about for a long time. He may be out of practice with the very basic art of being civil. Or, it is possible that this was never his strong suit. Have NO FEAR...he will eventually respond in an appropriate manner if you are sensitive to his situation. Eventually, together, there will be something realistic you are able to work with.

---That will usually ellicit a smile and a thank you. He will then be set up for a friendship if one cares to pursue it. Simple supply and demand. Probably the same thing that works on you and your whole family. I majored in economics...I should have gotten to this much sooner.

1] Ask him/her what he/she wants and supply it. If this is done you will receive a smile at the very least.

2] Listen to what he/she has to say AND hear what he/she is really saying

3] Take him/her seriously

---If these steps are followed, I guarantee that you will see changes in your relationships. The more your heart buys into this will be the greater the rewards you reap from doing it. Be Well.

Understand that I am NOT talking about Medical Needs. I am speaking about the patient's communication with his team.

Thursday, March 19, 2015

Dr. Lissa Rankin - Mind Over Medicine: Scientific Proof That You Can Heal Yourself

---Watch at least some (if not all) of this video. Her point of view is very similar to the way I see things.



---We the people of The HOSPITAL (staff, residents and volunteers) in order to give the taxpayer his fair shake in all-of-this provides that we will all do the best job possible to create a therapeutic environment that bespeaks ‘’wellness’’ at every turn.

---Our objective is to get the best from each resident as they heal in our hallowed halls. We realize that each patient/resident is equipped differently and brings his own set of needs and preferences with him, for better or for worse, is pointed toward improving the quality of his/her life…no matter what that may be.

---It is understood and accepted that the staff and volunteer are here to best make that happen in a way that brings results that are agreed upon by the parties concerned. That includes the resident/patient himself unless a different course of action is in play (conservator, etc.)

---We understand and accept that a certain amount of funds are set aside for this purpose. The funding is used to create that therapeutic environment aforementioned.

---The purpose of this document is to clarify our purposes for being here in the first place and to make a harmonious environment through our interactions that has therapeutic as a common goal.


’Residentology 101’’

Dilemma and/or Dynamic

---I’m talking about being a resident…ANYWHERE. It could be a resident in a house, a street, a city, county, state, country or planet Earth…itself. We ALL have the same thing in common. It is the dilemma we as a people, we as a person - HAVE IN COMMON. It is this dynamic...


---If this happens properly, then the being in question can  ‘’move on’’ to his next step. If this doesn’t happen the way it should - ‘’That’s When The HEARTACHES Begin.’’

 ---The bad times begin or continue, because we will spend ALL of our time trying to be heard and/or being taken seriously. The ‘’enjoying living’’ part has yet to kick-in. Ultimately it is YOU that has to be satisfied + convinced that you are heard and being taken seriously. But, here is why other folks are so important in the scenario -



It really doesn’t work any other way.

---This really is self-acceptance. Once this dynamic is in place the amount of worry and grief that one has goes down immensely. Learning how to listen is a great + necessary skill.


---If I was officially working for a company as an undercover agent…and my job was to file a report about what would be a huge benefit to the residents of the hospital where I live.

---The first priority of the hospital should be the resident happiness and doing as well as he can. It doesn’t and won’t trickle to the resident as it is somehow thought. If you think that it works that way than you have a rude awakening. Resident well-being + happiness should be what everybody is striving towards. This should really be the concern of all staff (within the realms of possibility) and the ADL’s should be accomplished throughout.

---The residents ALL have needs + preferences. The needs are basically taken care of by the hospital…itself. The food, clothing and shelter are provided by the hospital. I know that some residents have trouble with these, but they should speak with those in charge of each department…AND work on getting satisfaction that way.

---The residents, also, have preferences. I feel a lot could be done here. To me these can make or break the relationship between the resident and his immediate staff. Preferences can be the nuts + bolts of it all. The way a patient is met on the preference level can have much to do with his overall progress. If the resident has a ‘’good’’ relationship with his immediate care partner and he has NONE of the glaring loose ends that leave him in an almost constant state of tension, upheaval and flux…with peace being an elusive entity, his general mood easily accepts the healing and doesn’t thwart his getting well. Any disruptions that occur are at a bare minimum if they occur at all. His relationships with everyone deemed as his team is good and beneficial to his happiness and well-being. He easily participates in the wellness.

---This article was first published in Jan., 2013.


---The EDEN ALTERNATIVE is making a big mark on long-term care. Speaks of three plagues of ELDERS as being - loneliness, helplessness + boredom

Wednesday, March 18, 2015






---Recently…it has been asked of me what do I mean by communication? This was my answer. It is when the two sides have reached a unity of sorts on the subject they are speaking. The two have dealt with the walls that separate both factions and are now more together.

---Usually, we find folks so far apart that a different language may as well be spoken by each. Or, they can be of one mind - connected with very little (or zero) separation. Communication falls within these endpoints.

---The less interference and clearer the signal allows for a clear transmission and receiving of the information. When the information, itself, is copacetic between the two factions…we are ‘in like Flint.’

---The more open-minded we are finds us able to receive the transmission more clearly. The more narrow-minded we are usually means that we will less be able to consider the transmission made to us.

---The more honest that we are finds us to be more able to honestly communicate without trying to manipulate the other with some agenda that we may have. Most folks don’t communicate on that level of honesty. Many times others will try to get you to side with them trying to convince you that they, themselves, are correct. It is rare to find someone who is not selling a point-of-view or something that makes himself be right. Caveat Emptor - let the buyer beware. In this case…if you deal with honesty, a lot, it is easier to see when someone is just trying to sell you a bill of goods or being honest. The more honest and intelligent the TLC involved…the more open the lines of communication. Be Well.

[In the Kurt Vonnegut story (below) we see that if the Trafalmagorian was able to simply communicate that the house was on fire…it would have produced a much different outcome.]

The Planet Trafalmador -
''Communication Failure''
by Kurt Vonnegut
''Breakfast of Champions''


---Trafalmador is a distant planet. They are a peaceful lot who communicate by tap dancing and barking. They have heard of the problems that we have on Earth and feel they have answers to these.

---They sent a Tralfamadorian down to Earth in a flying saucer to help. He landed on a golf course. When he arrived he found the golf pro's house to be on fire. He lived right off the course and it happened to be at night. The pro was asleep inside.

---The Trafalmadorian saw the plight of the situation and went to awaken the golf pro. He rushed into the house and found the golf pro asleep. He wanted to tell him what was going on, so, he awakened the golf pro by tap dancing and barking by his bed. The golf pro got up and killed the Trafalmadorian with a five-iron BEFORE he realized that the house was on fire.

---Ladies + Gentlemen: this has got to be the most tragic case of failure to communicate that I have ever heard.

---By Kilgore Trout
---CENSOR: Paul H.


''Whew! That example was 'ORIGINALLY' way over-the-top!''



Secrets To Upgrade Communications
w/Underserved Population
---Get to know the Needs + Preferences of the subject. Most Needs are provided in the Hospital setting. It is in the Preferences where the uniqueness comes out. If one assists another with getting at least some his Preferences met regularly (and, since we are putting NEEDS in a GIVEN category)…one is well on his way with knowing about that person.

---We ALL have Needs + Preferences. How these are met usually denote the QUALITY OF OUR LIFE. If these are met regularly we are probably doing pretty well. If these are NOT known AND are not addressed at all then the person can easily feel disenfranchised and disconnected. We are trying to state how important and significant these conditions are. And, once again, we assume that the Needs are addressed in a hospital setting. Needs in general have to do with food, clothing and shelter. It is the preferences we are focusing our concerns.

---In the world of desire systems we know that one does better if he truly has NO DESIRE. The less desire would next be preferable. In the world where most of us realistically dwell…N’s + P’s are much as I have stated. A preference that is met and satisfied far outweighs one that is NOT met and left to exist in ALL its UNMET GLORY. A goal in this could be to refine preferences overtime to be things that the subject really enjoys participating.

---One is truly more at home with himself if his life is set up to meet his preferences in the course of his regular day. If someone enjoys what he does and has his Needs + Preferences met in the natural course of his living…he, as we have previously stated, is probably doing pretty well. The other side of that coin would be - if one N’s + P’s are left unmet and hanging loosely, one probably does NOT enjoy living to a great extent at all.

---The behavior of the subject will be ‘nicer’ and ’gentler’ through this. He will be happier and firing on more cylinders. You will see more niceness gushing forth. A greater degree of satisfaction will permeate all he does. This tends to ‘upgrade’ his general mood and lightens the load which he is carrying.

---If ALL is done intelligently…one learns how to massage his interaction with subject to get the maximum response from him. The goal is to get him thinking and doing for himself...being as independent as possible. Depending where the subjects starts, but great strides are very possible if done correctly. (The right tool for the right job!)





---This anecdote involving lollipops may clear up what I’ve been trying to say. There was a nurse one time who use to come to the General Store on a daily basis. She bought bags of lollipops. At the time we were able to sell 25 lollipops per $0.25 bag at one cent per pop. A VERY GOOD DEAL INDEED.

---She was in charge of a very difficult unit at the hospital. We knew that. One day we asked her what she did with the pops? She found that dispersing them in a timely manner and using them as a reward mechanism for positive behavior, she was able to get the patients on her unit to focus attention and concentrate for increasingly longer periods of time.

---She was using behavior modification and found it working very well. She had a happier and more satisfied bunch due to using the lollipops wisely.

---The lollipops were doing much the same thing that I see the preferences are able to do. It is amazing what could be done with a one penny lollipop. When you swap the lollipop (which has an almost universal appeal) for something that the patient actually wants and desires (a particular preference) - one is able to easily see that getting the patient to behave in a more civil manner is very possible. Instead of being on the verge of tantrum and panic most of the time the patient is calmer and acts more reasonably.

---On the unit I stay, a man brings one pre-wrapped sugar free chocolate candy for each patient once a week. The mood created by the chocolate for a period of time is something to behold. Everyone smiles and is happier for a short period. The affect is much the same as stated above.

---If we use his own preferences (things that he/she has a desire for of sorts in the first place) the sky is the to speak. I feel the amount of behavior modification possible through the intelligent use of preferences has the ability to make big changes in the behavior of the underserved population. The objective of this (and I firmly see its possibilities) is to upgrade the countenance and demeanor of the patient and make him more prepared to receive the healing he is given. He acts positively to things and his automatic negative thinking seems interrupted. He now responds more positively.

Someone has to go into each person and find what he responds to. In this way, I think that more folks will receive the positive reinforcement that benefits them the most. Individually he/she will be happier and more satisfied and hence this will reap benefits for the hospital as a whole.


See My PICs on GOOGLE.
---GOOGLE wheelchair quarterback OR wheelchair qb. See Pics.

At GOOGLE - Click IMAGE/PIC you wish to see. Opens below. Click ''view image'' and you unblurry version of Pic.

Example of PIC:

Monday, March 16, 2015



---I was talking to a member of the Zen Hospice Volunteers and the subject of Green Gulch and Dr. Grace came up. He mentioned that he hadn't seen the movie of her life at this point. Many people that he knows have seen it...and liked it, but he hasn't seen it yet.

---To refresh your memory: she is the LHH doctor who was involved in a head-on collision on the Golden Gate Bridge. She lapsed into a coma. It was touch and go for a long while after the collision. Nobody knew if she'd retain her brain functions again...enough to even speak. It was a very hairy time for awhile as she recovered. We didn't know too what extent the recovery would happen. To make a long story short, she now drives a power wheelchair and works in our pain clinic

---She was my doctor at the time of the accident. She was very personable and we had a good relationship. It was her leaving for awhile to recover from the collision that then caused my new doctor to be Dr. Victoria Sweet. This was a year-and-a-half before she left to write ''God's Hotel.'' I'm sure you know...the book ended up being a best seller putting Laguna Honda and Dr. Sweet on the map. It also resulted in a TEDtalk from Victoria Sweet and all sorts of notice.

---When all of this was going down, I remember my own take on what's happening. After being assured that Dr. Grace was going to recover...I became elated with an undeniable fact that would be a huge result from this. Dr. Grace will NOW experience life as a patient and would vindicate the fact that being forced to see a hospital from the pov of a patient would result in a big change in the staff/patient relationship that was very much needed. The resident would now have someone to champion their cause.

---Her statement was this (giving a talk to the doctors upon her return to LHH) – she learned that the most important relationship that a patient has in the hospital is not the doctor/patient relationship, but the relationship that the patient has with his nursing assistant. He/she can really make or break your time spent in a hospital.

---I felt that the statement was 100% accurate BUT was NOT emphasized to be as important as it IS. To me and my own experience...experiencing many of the same things first-hand and witnessing many others in the same boat. If that relationship is good the experience is positive. If that relationship suffers (in any way) the experience suffers accordingly.

---Let us put a microscope on that for a minute. The most important relationship that a patient has is with his nursing assistant. For awhile, the patient relies on this person to be his eyes + ears for him. Here is the part that always seems to be short-sheeted...''the caliber of that relationship and if that person (the nursing assistant) has the ability to truly be your eyes + ears.'' Wherein that relationship lies is the foundation that the whole hospital experience is built. For awhile anyway, he or she can make or break your hospital experience. They are responsible for our pee and poop. How much more intimate do you want to get?

---As important as that relationship is NOT given MUCH importance as to being sure that the two people involved are two people who work together in tandem for the optimal result of making the patient as well as he possibly can be. The objective is to rehabilitate the whole patient. More time and consideration should be paid to the relationship that has the most influence. The Nursing Assistant AND The Patient.

---This applies to most of us!

---When that relationship works we will probably have a success story. If that relationship doesn't work we will have a patient who doesn't recover as fully as he should. Be Well.

Sunday, March 15, 2015


---We wish to encourage teamwork!

ETIQUETTE: What the professionals say -

Professional Etiquette for Nursing Homes (Click)

You will do more than hold their hands...

Aides do a variety of tasks. Depending on the facility aides may:
  • Make beds
  • Clean rooms
  • Check vitals
  • Shower or bathe residents
  • Dress and groom residents
  • Serve and feed meals
  • Help with toileting
  • Help with ambulation
  • Provide certain nursing care under supervision of a nurse.

Rather than offer a detailed list of how a nursing assistant should behave while performing each task, I am going to break this up into four categories.
Interactions with Residents and or Patients



---Communication is the cornerstone of ALL relationship. The rapport created by the interaction is of utmost importance. The
objective of ALL communication is to convey one's message or thoughts clearly to another in as pleasant a manner as possible.
---The role of the resident is to clearly convey his thoughts and message as clearly + as briefly (to the point) as possible. To be willing to work out (through a kind of compromise) a pleasant solution (for a timeframe the PCA is able to carry out the needs and preferences of the resident.) The commitment is the fact that this is what the care partner's job description says that he/she is hired to the very least. (The quality of the interaction is the measure of the degree of the pleasantness involved.)
    1. Communication - To convey WHAT is necessary as clearly and briefly as possible
    2. Compromise - WHEN the task can be carried out. It is worked out to maintain a copacetic environment. (Remember that that particular resident is NOT the care partner's only patient.)
    3. Commitment - The quality of the interaction is simply the PLEASANTNESS of the exchange.

    1. Resident/Patient isn't many times clear on his/her needs + preferences. He can hem + haw a lot.
    2. Care Partner's turn to hew + haw about how busy they are. Patient usually say that need for item is immediate. The argument between the two can easily last longer than task argued about.
   3. OFTEN enter into dealings with each with MANY ASSUMPTIONS...that are NOT accurate. Neither side is very objective...much of the time.

Notes from a couple of recent meetings.

Saturday, March 14, 2015



---If we have a canary in our charge to care for, we would be concerned with his food, water and condition of his cage. We would, basically, want the canary to be out of harm’s way - especially when the care of the canary is our responsibility.

---These are ALL very necessary things to be concerned about.

---If our concern was for the canary’s happiness…we would be sure that the bird had a chance to fly and sing. If the things of the first paragraph are not in place, then flying and singing are compromised.

---A well-rounded bird has everything in place…the basics and the things that make him happy. A well-rounded bird sings a happier tune than one who is NOT allowed to sing and fly.

---Where do we see our responsibility? An even worse scenario is a bird that doesn’t know he is able to fly and sing