There's No Place Like Work!
An Eliza Jennings Nursing Home Success Story

What do you imagine when you hear the words “household” or “neighborhood”? Do the words “nursing home” or “long-term care facility” invoke the same images in your mind? While the former may encourage warm feelings of comfort and nostalgia, the latter may conjure up visions of white walls, sterile hallways, and medical equipment. However, if you work at Eliza Jennings Nursing Home in Lakewood, Ohio, you might think differently.

Putting “Home” Back Into Nursing Home
Mark Beggs is passionate about employee empowerment, setting different expectations, and feeling at home in the workplace. When he took over as Executive Director of the 150-unit residential community a few years ago he set out to change the culture of the Home based on these core values.

Established in 1888 as a residential community for older adults, the Home currently provides a complete range of nursing services – from respite and rehabilitative care to intermediate and skilled care. But Beggs felt that a dedication to providing progressive nursing care alone wasn’t enough to match the values which he passionately set out to pursue. He felt it was important that his employees contribute their thoughts regarding the purpose and direction of the organization.

Under the direction of the CEO, Deb Hiller, the organization’s employees spent more than a year rewriting their mission statement which now reads, “Our mission is to affirm the dignity and individual worth of older adults, enabling the people we serve to attain the highest possible quality of life by nurturing and sustaining their physical, emotional, intellectual, social and spiritual health.”

Beggs explains, “I wanted employees to define how they see the organization.”

Based on their feedback, it became clear that Eliza Jennings boasted an excellent staff, warm and inviting facilities, and appreciative patients, but there was still something missing.

While today many long-term care facilities seem to concentrate on making themselves look and feel more like a hospital, Beggs felt Eliza Jennings had a unique opportunity to do something different. Since the Home was originally established as a residential community only, Beggs believed that it was important to have a workplace and residential environment that was more reflective of its early history. As a result, Beggs implemented a new management strategy that divided the Home into “Households” in order to facilitate an atmosphere that would make residents and employees feel more “at home”.

Neighborhoods and Households
“I wanted to keep it true to what it already was,” Beggs explains about his Household approach. “This [change] was not a transformation but an enhancement of what was already there.”

The Home is divided into five different sections called “Households”. Each Household operates as a self-managed entity and consists of 20 to 32 residents, 2 to 3 State Tested Nursing Assistants (STNAs), a Housekeeper, Dietary staff, a Life Enrichment Coordinator, and other general employees who may choose to be in a particular household such as Billing, Maintenance, and Management staff, and the Executive Director. Everyone employed by the Home belongs to one Household and must spend at least an hour each day in their respective Household interacting with residents.

The responsibilities of each Household employee also blend together. For example, while the tasks of assisting patients with daily functions such as eating and using the restroom traditionally lie with the STNAs, in the Household environment, a Director of Nursing may choose to take food orders and serve breakfast to the patients instead. Each individual employee is able and encouraged to spend time with patients and interact with them on a more personal level than simply performing the responsibilities of their position.

Ideally, the Home would like all their employees – even Housekeepers and Maintenance Workers – to be STNA certified, since uncertified individuals are not able to perform functions such as serving food or feeding patients. As an added incentive to current employees to help fulfill this goal, Eliza Jennings will provide all its employees an opportunity to receive their STNA certification free of charge.

Head of the Household
Each Household also has a Household Coordinator, who is responsible for running their particular Household and for being that area’s “go to” person. In line with Beggs’ focus on empowering employees, the opportunity to become a Household Coordinator was initially opened to all employees. Half the current Coordinators held non-management positions before being promoted. The current roster includes two STNAs and one former Housekeeper, and each newly promoted Coordinator was compensated with an extra two dollars an hour.

In addition to strengthening teamwork and empowering the staff to make decisions on its own, the primary objective of each Coordinator is to help residents feel more at home and to help transition the organizations away from the “institutional” look and feel that traditionally have been associated with nursing homes and assisted living communities.

Feels Like Home
Not only have expectations and the management structure been altered as a result of the Household approach, but the physical environment has also been upgraded to create a more home-like atmosphere. Patients are encouraged to bring their furniture, pictures, electronics, and other accessories to make them feel more at home in their rooms. Similarly, the staff is encouraged to decorate the surroundings in an aesthetically pleasing and creative way.

For example, Linda Shear, Household Coordinator, envisions a more unique decorative feel for the communal restroom in her Household. “I would like to create a jungle theme in here. So we’ll buy some shower curtains, colored towels, and window decorations. It’s going to make the residents feel more at home…because how many people actually use white towels at home? I know I don’t.”

Decisions such as these are typically made within the Households and do not have to be approved by management. Households often organize fundraisers to generate petty cash for similar projects, field trips, and other activities. These small personal touches go a long way in making residents and employees feel more comfortable. As Kathy Grose, STNA, states, “Just add a pool and a Jacuzzi and I’ll live here!”

Other aspects of life and work that have been affected by the Household approach include food service, entertainment, and daily activities.

While most traditional assisted living facilities schedule specific times that all residents must attend breakfast, lunch, and dinner; Eliza Jennings instituted a more flexible and unique meal arrangement for residents. Instead, their residents have the ability to have a meal at a time that fits their own schedule and to eat at their own pace. The Dietary staff is available from 5:30 AM to 7:00 PM and the refrigerator is always stocked with food.

In addition, because each Household is self-managed, it is easier for Household Coordinators to plan field trips and other entertainment and activities for their residents. The Coordinators are encouraged to plan activities independently rather than being forced to seek permission from management staff. In some cases, they simply need to reserve a bus to transport the residents to an event.

Some examples of recent activities include happy hours, barbeques, picnics, poker games, holiday gift exchanges, birthday celebrations, and trips to bars, parks, and downtown Cleveland to enjoy the Christmas lights. The Home also hosts other special events such as musical performances that are open to the entire Neighborhood where all Households are invited to attend.

Staff and residents interact on a unique level as well. Employees will often ask residents if they would like to help with Household tasks such as doing laundry, preparing meals, and planting and caring for flowers and vegetables. This provides opportunities for residents to contribute to their community and ease into their transition from living independently. This also provides opportunities for employees to impact the lives of their residents on a more personal level than if they were to simply perform all the Household tasks on their own.

Does a Happy Home Make a Great Workplace?
While the changes implemented by Beggs and his staff have had a clearly visible affect on the culture and daily life of Eliza Jennings’ residents, has the Household approach impacted the effectiveness of the Home’s ability to live up to its mission, serve its residents, and to better attract and retain top performers?

Since the implementation of the Household approach, the Home has seen a marked increase in their resident’s overall health and happiness. There has been a sharp decrease in resident accidents, a decrease in skin problems (often associated with static and inactive lifestyles), and a decrease in weight loss. Similarly, through the use of satisfaction questionnaires, the Home has observed in increase in overall resident satisfaction as well. As Martha Lowry, STNA, states, “I have a 105-year-old resident and she always tells me that we’re a good team. When I ask her, ‘What will you do when I retire in a few months,” she tells me, ‘Well, I’m going to come with you!”

Eliza Jennings has also found that happy residents breed happy employees. Employee surveys have confirmed that staff satisfaction is on the rise and the number one reason why non-management level employees stay is because of their relationships with their residents.

Similarly, when asked why they decided to work for Eliza Jennings, the Home has received responses such as:

• “It was destiny.”
• “As soon as I stepped foot into Eliza Jennings Nursing Home, I felt at home.”
• “No institutionalization, no sterile environment, no hospital smell, and no dress code.”
• “It is much ‘homier’ here. We are not paid a fortune, but some people will come in on a day off to check up on a resident.”

Some current employees enjoy their work so much that they have even recruited their family members and friends to work at Eliza Jennings.

However, the employees understand that this workplace environment may not be for everyone. As Edna Torres, STNA, mentioned, employees coming from other nursing home environments are often not accustomed to working in a Household setting, and to ease the transition, Eliza Jennings offers a mentoring program to help assimilate employees into their unique culture.

In terms of retention – the results are quite impressive. Since the Household approach was implemented two years ago, the Home’s employee turnover rate has dropped by more than 10% to a remarkably low 25.44%. That’s incredible considering that the average turnover rate for other long-term care facilities tends to range from the upper 30s to the lower 40s! In 2005, Eliza Jennings was also recognized with the NorthCoast 99 Award which honors 99 great workplaces for top talent in Northeast Ohio.

Future Initiatives
Mark and his staff are not finished yet! A number of other changes are on the horizon including the complete transition of recruiting, selection, and retention processes to each individual Household. Mark believes that if current employees are leading the recruitment and hiring process from the beginning, they will be more invested and dedicated to the success of their new hires from the beginning. Shirley Edwards, STNA, is anxiously awaiting this next step.

He also admits he would like to take himself out of the process altogether. “We are trying to flip the hierarchical organization upside down.”

Another change includes building in more flexibility so that employees can schedule their work and lunch breaks around their residents’ lifestyles. Households would be responsible for formulating their own schedules, allowing residents greater opportunity to continue a normal living pattern.

The continuous culture change spearheaded by Mark Beggs seems to have taken on a life of its own at The Eliza Jennings Nursing Home. Employees are excited about the initiatives, are excited about their jobs, and are even recruiting relatives and friends to be a part of their workplace. When asked, most employees sing Mark’s praises, exclaiming that he is the only administrator they have seen “on the floor” and that they haven’t seen anything he won’t do. For Mark it’s all about his residents and his employees and as a result, the culture at Eliza Jennings allows its staff more freedom to better serve their customers and makes everyone feel more at home.

This story was compiled by ERC and is the property of ERC and the NorthCoast 99 program. Any reproduction or distribution of the information included in this report is prohibited without express written consent of ERC.