House Rules -Everyone is normal, until you get to know them

Author: Mark Parkinson BsPharm:  President  AFC-CE

Credit Hours 2 - Approximate time required: 120 min.

Educational Goal

Discuss societal expectations for new residents and how to better utilize House rules for better communication

Educational Objectives

  • Discuss the role of societal expectations in AFC homes
  • How to utilize House Rules better
  • Tell of some socialization tips and tricks for caregivers

 

 

Procedure:

Read the course materials.  2. Click on exam portal [Take Exam].  3. If you have not done so yet fill in Register form (username must be the name you want on your CE certificate).  4. Log in  5. Take exam.  6. Click on [Show Results] when done and follow the instructions that appear.  7. A score of 70% or better is considered passing and a Certificate of Completion will be generated for your records.

Disclaimer

   The information presented in this activity is not meant contraindications may be of concern. All applicable manufacturers’ product information should be reviewed before use. The author and publisher of this continuing education program have made all reasonable efforts to ensure that all information contained herein is accurate in accordance with the latest available scientific knowledge at the time of acceptance for publication. Nutritional products discussed are not intended for the diagnosis, treatment, cure, or prevention of any disease.to serve as a guideline for patient management. All procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this article should not be used by care providers without evaluation of their patients’ Doctor. Some conditions and possible

 

 

 

Everyone is normal, until you get to know them.

Ways to Improve House Rules

 

I found this joke on one of those YouTube channels that specialize in funny signs collections.  It made me giggle as I thought about how true that is. The more I thought about it the more I laughed. Then light bulbs started to turn on in my head. This is true for residents of care homes as well. In-home care providers have to struggle with this principle every time they get a new resident. The more I thought about it, the more I realized that this would be a great topic for a CE lesson. How to better communicate with and integrate new clients into your homes. Everyone talks about the medical side of the business, but no one talks about how to socialize with your residents. So I will.

I need to say this right up front. This will not be an all-inclusive lesson that covers everything. This will be more like a tips and tricks type of lesson that will hopefully enhance your current skill set.

So let’s get started.

Social Expectations

To understand what I will be presenting to you we have to talk about some basic underlining concepts about how I think society exists today. Don’t worry, I won’t get all “psycho-social expert” on you because I am not a psychologist. The following is just my view on how people can live next to each other without killing each other every few months, (even though we may want to). You know what I mean, and don’t deny that you haven’t fantasized about taking out “ninja-style” that one neighbor who annoys you so much. The reason we all don’t have a secret stash of assassination equipment is that there is a social expectation that you can do whatever you want in your own home, just as long as it doesn’t affect mine. That expectation puts up a wall that protects us from the annoying actions of all those around us. 

I also believe that humans tend to think that everyone thinks like “me”. We go through life expecting our neighbors to act and think like we do.  We label ourselves “normal” and when they don’t act like us, we label that “abnormal”. Of course, we all know that’s just plain wrong but this fallacy is perpetuated because of the walls we put around ourselves. We can’t see into their homes, so we just assume they think like us and we all get along just fine. That’s why the above joke is so funny. Because it's soooo true. We assume that everyone is “normal” until we have to interact with them then everyone becomes “abnormal” because they naturally don’t think and act like we do. 

Free Portrait Woman photo and picture

We can still function around all these “abnormal” people because the rule of law, proper manners, and social etiquette force us to behave ourselves when we are around each other. Once we get behind the walls of our own home, we forget about all that and can relax into our “normal” selves. So can all those “abnormal” people relax into their abnormal selves, as long as they don’t affect us “normal” people. If we invite any of those abnormal people into our home, we expect them to respect our “normal” behavior. If we go into their home, we temporarily tolerate their abnormal behavior. 

I assume you already know all this stuff, but here comes my main point. What happens when there are no more home walls to retreat behind so we can relax into being “normal”. Like in a foster care home. You are inviting a bunch of abnormal people to live in your home. On the flip side, the new resident finds themselves moving into the home of an abnormal person. If there is more than one resident in the home, the abnormality of the situation is compounded. On top of all that, the State comes into your home, and other health providers are thrust into the situation and they all impose a bunch of rules and expectations that hinder your ability to be “normal” in your own home.  And how do substitute care providers fit into your “normal” home?

Those who agree to take money for caring for others in their home have to accept that “normal” has gone bye-bye. Those foster care providers who expect everyone to just adapt to their “normal” way of living usually have a lot of ongoing difficulty managing their homes and residents. Those providers who succeed are those who actively manage the situation so all the “abnormal” people quickly become “normalized” to their new environment.

Okay, that’s the underlying principles I want everyone to understand. You’d be surprised how often new care providers (foster care home owners and new employee hires alike) don’t get this. They constantly fumble around and complain that the residents aren’t “behaving normally” and are being difficult. I guess since it’s a home environment they think it will just happen all by itself. Well it usually doesn’t, so here are some ways to “make” it happen.

Business Infrastructure

When we first start up our foster care business we think, - “This going to be easy. I’ll just clear out some rooms and people will move in and pay me money to live with my family.” It will be easy to take care of them because everyone already knows how to live in a home environment. All I have to do is what I normally do. No sweat. After all, clients want to live in a warm and cozy home environment instead of a cold sterile nursing home business.”  After a few months, reality kicks in and you think this is not what you signed up for.

And what is that reality? Once you agree to take care of someone you no longer have a home. You have a medical care business, pretending to be a home. So my first tip is- Stop running your home as a home. Run it like a business set up to attract and retain money-paying customers who want to stay in a “home-like” environment but want a medical expert to take care of them. The following are a few tips on how to do that.

 

 

Being Predictable

What turns a home into a business? Rules and procedures. Predictable, repeatable actions that govern everything that goes on in your home. You have to list all the things that you normally do in your home and distill them down to repeatable “To Do” lists. I even suggest that you place a check-off box next to each item and laminate the paper. Then you can use a dry-erase marker and physically check each box as the chore is accomplished. At the end of the day, you erase the checkmarks so you can start over the next day.

What are the benefits of your check-off list?

  • Your home runs more smoothly. Nothing is forgotten or left for another time in the future.
  • Less effort is put into running your home as efficiencies are found and best practices are established.
  • Training and governing employees or substitute caregivers becomes a whole lot easier.
  • The most important item though is that you become predictable. Your clients know what to expect out of you. They know what is going to happen next and more easily adapt their behavior to it. Your normal becomes their normal much quicker when they know what is coming next.
  • Bonus- You will also find that county inspections of your home (business) are accomplished so much easier and faster. Who doesn’t want that?

 

House Rules

You probably know the House Rules just as something the State makes you print out and post in a place where the county inspector will look but nobody else will. It wouldn’t surprise me that some of you are thinking, “We have a list of house rules? Where? What do they say?” In my opinion, House Rules is probably one of the most underutilized communication tools in your business. You read that right. The House Rules is a communication tool that is supposed to help the customer know what is expected of them and what you will do for them. I hope you are having an “I get it now”, light bulb turning on above your head moment, right now. House rules are not a list of restrictions, they are an instruction manual on how to fit into your home. In essence, it tells anyone (resident and employee) how to be “normal” in your home. So, here’s tip number two.

Don’t write the house rule like a prison warden. Write them like a cruise director or advertising agent.

No one likes to be told what they can and cannot do. We all have an inner self who will naturally think, “You’re not the boss of me” and promptly tries to ignore all documents of such nature. Admit it. You probably struggled a lot even writing the dumb thing in the first place. You are also probably avoiding it like something that will make you nauseous just by reading it.

I suggest that you scrap your “can’t do this or that” list and start completely over. Write your new list like an instruction manual on how to easily fit into your cozy home environment. I also suggest that you don’t post it on a board nobody looks at. Print it on nice paper in friendly colors and add some graphics. Put it in a nice frame and place it in each room and dining area.

You want their inner voice to think, “Well that was sure helpful, I’m glad I read that.” Here are some wording suggestions.

  • We want our home to be your home. You will find it helpful if you…place rule here
  • We want your stay with us to be as pleasant as possible. We respectfully ask that you…. Place rule here
  • Use words like refrain instead of can’t or do not.
  • For the safety and comfort of yourself, other residents, and the staff please abstain from ……
  • If you have any concerns, questions, or suggestions, we want to hear from you.
  • Meals (insert any service or activity that you want to emphasize) are served promptly at ….
  • You can expect … list restriction or service to be provided

For example- You can expect that your stay here will be smoke-free. For those wishing to smoke, an area will be provided for you that will not impose on those who have health issues aggravated by cigarette smoke.

  • List any requirements as a service to others not as a restriction.

For example- Your efforts to be respectful of others’ need for privacy will be appreciated. They will also respect your need for privacy in return.

  • Instead of phrases like “home phone use will be restricted only to business hours” use phrases like home phone use are available between the hours of ….
  • Before you write your house rules think “What does the customer need and want to know in order to be comfortable here”

Living Documents

Tip number three. Always be willing to adapt and improve your business practices. It is very unrealistic (and lazy) to expect that your Check Off list and House Rules will never have to be changed from time to time. Write the document on your computer and save the file. It will be easier to make needed changes that way. Review your procedures regularly, on at least a yearly basis. Also, see difficulties that you encounter as opportunities to improve your procedures. Ask yourself, why did that happen and what can I do to prevent it in the future?

 

Competitive Edge

Don’t blow past this and ignore what I just said. You are a business and need to have a competitive advantage over other businesses providing the same medical care. Think of it this way. You want your competitors to have haphazard business practices and house rules that could be used in the state prison system, not you. That way it will be easier to obtain your paying customers away from them.

Employees you’re not off the hook. You have to contribute to the above as well. Because your continued paycheck depends on the business out-competing all others in the area. Besides, a happy well-adjusted client is an easier to take care of client. Who doesn’t want that?

 

Going from Guest to Resident

Let us go back to social expectations again. When you visit someone else’s home, you can fit in by temporarily tolerating all their abnormalities. That’s what polite guests do.  When you move into someone else's home you are no longer a guest. You are a resident which comes with an entirely different set of expectations. You can choose to let the new resident figure things out on their own or you can guide them in the transition. Guess which happens quicker and easier. Duh, right? So what are your business procedures that make it happen? Oh, you don’t have any? No wonder you have experienced some difficulties in the past. Duh, right? So here are some tips to help you establish your transitioning procedures. Many of them are designed to take advantage of the social expectations that are already present in the new resident’s behaviors.

Tip number 4. Get the Paradigm right.

Start with the right state of mind. The fancy word for it is, what is your paradigm?

  • Don’t be a dictatorship. It is my experience that dictators are always followed by rebellions. Remember the “You’re not the boss of me” social expectation.
  • You are not a Bed and Breakfast where every visitor is a guest to be pampered and pandered to. Guests are not expected to change their behaviors.
  • I suggest the middle ground of becoming a Benevolent and wise ruler. You are in charge, but your intent is to benefit all your subjects. You actively guide the new resident in acclimating to your home.

Tip number 5. Bring their Stuff with them

Bring in as much “normal” as you can from the resident’s old home. Allow, even insist on the new resident bringing in:

  • Pictures for the walls
  • Familiar pillows and comforters for the bed.
  • Recliners
  • Photo albums
  • Bedside lamps and clocks or other frequently used electronic gismos

Tip number 6. Polite Expectations

Take advantage of the “you’re a guest in my normal” period of the transition to eliminate disruptive behaviors. Remind them that they chose to move into your home, so it is just polite to respect what’s “normal” behavior in your home. They are already socially trained to think that way so take advantage of it. 

Tip number 7. Playing Host

In the later part of the transition period invite lots of visitors.

Showing off the resident’s new place of domicile is a powerful social reinforcement of “this place is now my place” kind of thinking. Encourage the resident to invite their friends and family over for dinner or throw a housewarming party. When the resident acts as a host for visitors they are socially saying to themselves, come visit me at “my” place. You have to make them feel like they are playing host though or they might just want to use the visit to complain that everyone is being “abnormal” around them.

Holidays are great times to play host to visitors. Take advantage of the social expectations inherent in these events. 

Tip number 8. I’ve got your back, Jack.

It has been my experience that no one yells at someone trying to be helpful. Socially it is counterproductive to hinder someone attempting to be an advocate for you. When residents see that you are actively working for them against someone or something that is being “abnormal”, they will calm down or at least let you get on with what you are doing. Be vocal in your advocating efforts. Let them know that is what you are doing. Do it often enough and the new resident readily becomes a member of your team, easily deferring to you instead of acting on their own. Thus your “normal” has now comes to be their “normal”.

Can you think of other ways to take advantage of already present social expectations? If you can, turn it into a repeatable action and you’re acting like a skilled business professional.

 

U safe Iron Metal Tool Box, Size: 17 Inch at Rs 4500/piece in Mumbai | ID: 15472203412Socialization Toolbox

Just like a professional carpenter has a toolbox full of tools he uses to shape a piece of wood to fit into whatever he is building at the time; caregivers can also do the same to enable new residents to fit into your home. A tool may not be used in every situation but having it before it is needed is a good thing. Here are a few more socialization tools to add to your caregiving toolbox.

Assessing the ability to adapt

Most if not all of your clients will suffer from one or more handicaps that prevent them from behaving as a normal person would. No matter what social expectations we have for them. It could be a physical health, mental health, or developmental health issue. You have to adapt your expectations and practices to accommodate for those handicaps. You’ll have a much easier time if you accept that fact as part of doing In-Home caregiving.

Tool number 1 Assessing for inability to act normal

I suggest that you include in your new move-in process an assessment of the ability to adapt to the new environment. The old saying is “forewarned is forearmed”.  Do they have dementia, mental issues, developmental issues, or similar items?

Tool number 2 Teaching Patience

This is a big issue for new to the business caregivers and new employees. Newbees to the profession are not used to lowering or adjusting their social expectations to accommodate for handicaps that lead to abnormal behaviors. Adult Foster Care business owners have to expect that fact and actively train newbees how to adapt their preconceived notions about client behaviors.  Teach them to extend the time frame aloud to change their behaviors to the new normal.

Tool number 3 Adapt to their reality superficially

Simply put, some of your residents can’t act normally. Lower mental capacity due to poor health prevents them from doing so. It’s okay to let them think you agree with their abnormal behavior while you help them act normal. You are not really lying to them, you as just making accommodations for their inability.  I know that sounds bad and purposely vague. Here are a couple of examples of what I mean.

An elderly dementia patient wanders around looking for the upstairs in a single-story house. Instead of arguing with him about there is no stairs, tell them, “OK I’ll help you find the stairs”. As you walk around the house ask them what they are looking for. If it is an item tell them “Oh I know where that is, no need to go upstairs” then lead them to the item. If it’s a person they are looking for say “Oh, they are not here now they might be a work or something. Let’s watch some TV while we wait for them to return.”

If they repeatably act in an abnormal behavior because of memory loss then say, “Don’t you remember, you told me just yesterday that you were going to (insert normal behavior) You told me to remind you if you forgot.” Make them think it was their idea in the first place, they just forgot.

Tool number 4 Defer to authority

Conflicts over whose “normal” behavior standards are going to be followed (yours or theirs) can sometimes be resolved by deferring to the definition of what is “normal” to someone the resident respects or trusts.  That could be family members, nurses, therapists, or doctors. It could also be from unusual sources of authority such as the Fire Marshal.

For example, It’s ok with us if you smoke but the Fire Marshall has told us that it has to be outside. We’ll lose our business if we go against the Fire Marshall.

This caregiver tool can be tricky to use effectively because you never know who the new resident respects enough to change their behavior for. It requires you to use some skillful questioning before you need to use it.

The principles that make this tool work in my opinion is:

  • Find out who they respect enough that they will follow their recommendations.
  • Interject that authority’s orders into an argument in such a way that the new resident is not arguing with you anymore but with someone who is not there to argue with.
  • You have to show that you also respect that third party's authority.
  • Overuse of the tool makes you look weak. It makes it harder to gain the resident’s respect if you are consistently deferring to someone else.

Tool Number 5 Mirroring

Do you remember the old saying “Birds of a feather flock together”? It refers to how people are more comfortable around like-minded people. We naturally communicate better with people who have the same communication styles that we have. It’s that, our definition of what’s “normal” thing, again. It will be easier to show you than to tell you about this concept. Watch the following video.

 

Funny video right, and oh so true. In the joke, the husband asks a simple direct question and wants a simple direct answer. The wife needs to talk about her experiences and feelings while answering the question.  If you want your resident to be comfortable with you so you can influence them, copy their communication style. If they are a talkative storyteller, let them tell their story then you tell a story back. If they are all about emotions and feelings say I understand how you feel a lot. Then tell them how their words make you feel. If they are short and direct, answer with direct responses.

Mirroring Body Language: The Hidden Code of Connection - BECOME MORE COMPELLING

Tool Number 6 Reflecting

Reflecting is similar to mirroring, but you use body language on top of what you say. Most experts call this mirroring too, but I changed the name so you can more easily keep them straight in your head. As before, I am going to use a video to show you what I mean.

 

Body language is a subtle but powerful way of influencing another person. Just be careful not to reflect negativity back or you have negated any benefit in communication.

Tool Number 7 Paraphrasing response

Paraphrasing is summing up what you just heard and repeating it back. The purpose is to give the talker the opportunity to tell you if you got it right or wrong. You start your paraphrasing response with, let me get this straight, or I think you mean, or Did I hear you right? You said….

By repeating back what you think they said, it shows them that you are trying to understand what they are saying. It also shows them that you respect what they have to say.

As you get better at paraphrasing you can subtly guide a conversation in two ways.

  1. You paraphrase two responses and let them tell you which is right. “Are you trying to tell me, this or that? Of course, you phrase your desired response favorably and the unwanted response negatively.
  2. You include in your paraphrase an interpretation that is favorable to your way of thinking. If you’re good enough, agreeing with your paraphrase leads them to agree with your side of the story.

 

Conclusion

Well, I just gave you some of my best tips and tricks on how to turn all those abnormal people into normal residents of your home.  They are based on my years of experience and a lot of trial and error. I hope you find them useful. You certainly won’t get this training elsewhere. These are my tips and tricks, make them your tips and tricks by purposely using them and practice, practice, practice.

As always Good Luck in your caregiving efforts.

Mark Parkinson BsPharm

 References:

  1. Social Expectations Influence Behavior. American Psychological Association.Org. April 14,16. https://www.apa.org/pubs/highlights/peeps/issue-67
  2. How to Use "Mirroring" to Build Rapport | The Body Language of Business. Jan 5,10. https://www.youtube.com/watch?v=rqhSWI4-hnA
  3. Vanessa Van Edwards. Mirroring Body Language: 4 Steps To Successfully Mirror Others. Science of People.com. 2023 https://www.scienceofpeople.com/mirroring/

 

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