Theological Reflection on the Project’s Intentions

At the start of this new website blog, I would like to state up front that my orientation to this project is unabashedly spiritual. The ideas for Mister Woods come from transcendent moments in providing spiritual care for elders, in struggling with my despair and frustration and wanting to see change happen, and from visions and messages. Guiding me is the question I can ask myself: “What would I want for myself when/if I am unable to care for myself and have no financial resources to do so?” In other words, application of the Golden Rule. Another question guiding me also is one I often ask myself: “What is my most beautiful intention here?”

What is my most beautiful intention?

Checking in with myself to see what is my most beautiful intention in any given moment of choice is one of the ways that I can align myself with that “Place of the Greater Good”, or God, or the Spirit of Life (the list goes on…) Well, often that might first require digging around to find what your hidden intention is (hidden to yourself, that is), assessing what your need is, and then adjusting the dial so that it becomes your most beautiful intention. When you “hit” the inner knowing of your most beautiful intention it feels “right”. There can be a warm glow, a sudden flow of energy, a sense of creativity opening up, a sense that you are coming from your best self. For me, this felt sense that I experience marks that I am on the right path, the Red Road. There is wind in my sails. Proceed this way.

As we move forward with manifesting a new creation, we stay on course by being directed by this intention and we stay on course by holding before us our “high resolve”. One of the co-founding ministers of the church I belong to – The Church for the Fellowship of All Peoples – was Howard Thurman (1899-1981) . Thurman was a prolific writer in the mystical tradition, one of the top 12 ministers of his era according to Life magazine, and the spiritual advisor to Martin Luther King Jr. and many others in the Civil Rights Movement. Thurman bolsters us with these words in those times when our spirits are flagging:

 “In the quietness of this place, surrounded by the all-pervading Presence of God, my heart whispers: Keep fresh before me the moments of my High Resolve, that in fair weather or in foul, in good times or in tempests, in the days when the darkness and the foe are nameless or familiar, I may not forget that to which my life is committed.

Keep fresh before me the moments of my high resolve.” 

(Meditations of the Heart, Beacon Press, 1953, p. 210)

Howard Thurman

So what are my most beautiful intentions? I want to see a community like this for several reasons: to serve the social and human needs of people – especially those who have no/low resources, to keep alive a vital and responsible connection to the earth, and to nourish the spirits of our children, our infirm and our elders. As this project discussion unfolds, I hope to bring in the voices of some of the clergy members who I have had the good fortune to interview as well as insights from other theologians and fellow seminarians from various schools affiliated with the Graduate Theological Union. I hope that many of you will share your reflections as well.

Some of the upcoming areas of discussion from me will be around these ideas:

• The Mister Woods intergenerational care community as a reflection of our interdependent nature (Buddhist, quantum, defying isolation), our need for interconnectedness, Relationality theology.

• Presence in nature provides opportunity for inner spaciousness, transcendent experiences.

• Ritualizing our life passages

• Ideas on spirituality in the late stages of life, (Lars Tornstam’s Gerotranscendence, i.e.)

• Children, Nature and Spirituality ( Edward Hoffman and others)

• Spiritual connections between children and seniors.

• The elders: Wisdom keepers

• Nature as scripture: what the plant nation can teach us.

Interview with Clara Allen: Managing a Skilled Nursing Facility

In order to get some sense of the basic administrative structure of a skilled nursing facility, I spoke with Clara Allen in November of 2012, then the Administrator of the San Bruno Skilled Nursing Hospital in San Bruno, California. 

claraLR

It needs stating right off the bat that this institution is a for-profit model, a division of Meridian Foresight. Nevertheless, the size of this organization seems very manageable and we can learn some basic proportions of staff to patients and how the various departments break out. This five star (top rating) facility houses 45 residents, has a staff of 58 (both FT and PT plus on-call staff), and eight departments: nursing (5-6 RNs, 5-6 LVNs, 25 CNAs), social services, maintenance, dietary, activities, housekeeping, staff development and business office. They are accountable to Clara and each department (which has its own budget) gives her a spend down report on their expenses twice a month.

They have an IDT – an Interdisciplinary Team – that meets to discuss things like falls, patient weight loss or gain, new admits. Everyone works together to find solutions, see how different elements are contributing to a problem.

They have three different committees that meet monthly: Customer Service (plans big events like karaoke, bingo night, dances) and one that plans bigger outing events like picnics. The Quality Assurance Committee (lab, pharmacy, others) meets quarterly to address infections, falls, budget overviews. There are also monthly General Staff Meetings to discuss issues that concern every department, like personnel policy changes, or culture change. 

Culture change is an action-oriented collaboration that seeks to transform the institutionalized culture of a nursing home. The goal is to create a person-centered and resident-directed environment to help improve staff retention and resident care in nursing homes.  – California Culture Change Coalition 

As part of her duties, Clara is also in charge of marketing, oversees maintenance projects and does the admission paperwork with new patients and their families. She does the long and short-term planning. She is also in charge of customer care, responding to comments and complaints that are submitted on their surveys.

The big responsibility (for any SNF) is the state and federal mandated annual survey, which means a team of inspectors is in the building for 4-5 days and examines the following things:

• up to 30 patient charts are audited

• all required proper documentation is on file; compliance with forms

• activities match what the residents want

• Rx dosages are reduced as possible (not overly medicated)

• discharge planning

• hygiene

• kitchen; food has proper textures

• emergency responses and procedures in place

2567” is the name of the form that is used by the state to inform each facility what deficiencies were found during their annual survey. It’s mailed approximately one week after the survey concludes. A plan of correction (POC) must be submitted, usually within 10 days of receiving the 2567. On of the advantages of being owned by a larger corporation is that Clara has the assistance of doing a “pre-survey” to prepare for the annual survey, which helps to make sure everything is in place. Last year San Bruno had no corrections and received the top possible rating of 5! As a non-profit organization, where might we find alternative systems of support that a parent corporation provides? How does this staff structure seem to you?