Empathy by Immersion: Through the Eyes of Residents, Part Two

By Jim Nelson | December 6, 2024

“Loneliness does not come from having no people around you, but from being unable to communicate the things that seem important to you.”

That Carl Jung quote above gets to the heart of an experiment/contest that Leslie Pedtke and her staff undertook at the long-term care community where she was the administrator.

In her book, What Living as a Resident Can Teach Long-Term Care Staff — The Power of Empathy to Transform Care, Pedtke chronicles the profound experience that changed her and the staff at Aviston Countryside Manor nearly a decade ago.

In part one of this two-part interview, we learned how the passing of a longtime resident caused Pedtke to question whether she and her staff were doing enough to respect and show dignity to the people in their care. Pedtke’s response was to invite the staff to move into the nursing home and live as a resident, with whatever diagnosis they drew out of a hat, to learn firsthand what it’s like to be a resident dependent on their caregivers for so many things. Whichever staff member stayed in the longest would win a cash prize. Aspects of the contest were filmed, and highlights are available online.

One major change at Aviston as a result of this contest was the launch of a resident hiring committee. With the residents involved in hiring new staff and, as you’ll read below, those new team members being required to actually move into the nursing home and live as a resident for 24 hours, the result was less turnover. Because those new employees had already begun developing relationships with the residents during the hiring process and again by living in the community overnight, it became much more difficult for a staffer to impulsively quit.

Here is part two of our conversation with Leslie Pedtke.

SENIOR LIVING NEWS: How many team members wound up moving in with the residents for this contest?

LESLIE PEDTKE: I ended up having 15 people move in and immerse themselves. We recognized that not everybody had the ability to give up three days, five days, 11 days — like some people did — but we recognized that most people had the ability to give up 24 hours to move in, so we opened it up to those people. There wouldn’t be the grand prize of $500 at the end, but we paid them for eight hours; the rest of it was volunteer. I had a lot of people move in for 24 hours just to see what it was like. I moved in for 24 hours. I remember being so nervous. We were very successful in a lot of our culture change practices, things that we had done, and I was so nervous that I was going to see and experience things that I thought were happening and really weren’t. I was worried I was going to become unmotivated to keep going, that I was going to feel disappointed because I thought we were doing so good, but we really weren’t. But that never happened.

SLN: No one knew which diagnosis or challenge they were going to be confronted with, and you went big and bold. You had someone who wasn’t allowed to go to the bathroom alone or take a shower alone; one young lady had to experience blindness. You didn’t go easy on them, and they did these things. What were some of the most difficult things you put among the diagnoses and challenges?

LP: They would draw the challenge that they were incontinent of urine or incontinent of bowel, and while I never made someone actually urinate themselves or have a bowel movement on themselves, we would maybe pour warm water on them and make them sit in their wheelchair or in their bed. I had someone sit out in our living room, and I poured warm water on them and made them sit in that common area in front of people when they were noticeably wet. This particular staff member said that a resident came up to her and said, “You’ve had an accident. Do you want me to go tell someone to come and change you?” That staff member said, “I almost started crying to think that someone thought that I had really been incontinent. I felt embarrassed and humiliated.” And how often do you see that in long-term care? We think that incontinency is just the norm, and it shouldn’t be. We really decreased incontinency because of this contest, because even though they weren’t actually urinating themselves, people felt how undignified it was to sit there in front of people and to look like they had had an accident. That was really impactful. Being bathed by others, I did make them do that. Use bedpans. Have room changes. Wear body alarms. In long-term care, you can’t just go get your cigarettes and smoke. They had to ask the nurses for their cigarettes. One staff member was living with a resident that was wearing a body alarm, and that body alarm was always going off during the night, so she wasn’t getting a lot of sleep. And one of the challenges that she had drawn out of the hat was that when she asked for a cigarette the nurse couldn’t find them. Later that day, her second challenge was that her clothes got mixed up with her roommate’s clothes and her CNA put her roommate’s clothes on her for the day. The staff member said, “I’m out.” I said, “What do you mean you’re out?” She said, “I am not wearing her clothes.” I felt that was sort of an easy challenge. “Why not? They’re clean.” She said, “I don’t care.” I know this sounds terrible, and keep in mind she was exhausted and she hadn’t gotten her nicotine, but she said, “I know how incontinent she is because I’m her CNA, and even though I know those clothes are clean, I cannot put them on.”

SLN: What was your biggest takeaway?

LP: I noticed the relationships between the staff and the residents changed. It was no longer us and them; we literally became a community. That was the biggest thing that I really saw. Oftentimes you hear staff complaining about residents, but those types of comments no longer happened because even the people that didn’t participate learned from those that did. They saw what their peers were willing to go through and they learned lessons as well that were really impactful. That was the biggest takeaway. You saw on the video, when I asked the resident, “What do you think about this contest of the staff moving in and living like residents?” And he said, “At first I didn’t know what to think, but then when I thought about it, I thought, now each helpful person, whether they’re a housekeeper or a CNA, knows what I really need.” Bam, that was exactly what it was all about.

SLN: After the things you learned during this contest you also implemented a policy with regard to hiring people. You called it “elder shadowing.” How did that work out?

LP: We had made so many positive changes in our community and as we were hiring new staff, coming from maybe other nursing homes, we didn’t want this new staff to come in and negate the things that we had built. We wanted the staff to really own who we were, and we thought the only way to make sure that we were really hiring the right people was to have them move in and live like residents, so they could see things from the lens of a resident, so they could get started off on the right foot. When I proposed that idea to my leadership team, admittedly, there were a few people that said, “That’s never going to work. You must not want me to have any new staff in my department, because there’s no way I’m going to get a potential dietary aide that’s in high school to move in here.” We were willing to say, “If it doesn’t work, and you can’t get anybody, then obviously we will go back to the drawing board.” But we really felt it was important for us to start hiring the right people. I had some people that were there for the day shift and as it started to get dusk they were like, “I just don’t know if I can actually spend the night here. Is there any way that I could still work here without having to actually spend the night here?” And I would say, “I’m sorry, no. It’s non-negotiable.” We did have a handful of people that just wouldn’t do it, but most everybody did. And that really decreased our turnover.