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A Good Welcome: The First 24 Hours

Facilitator Instructions for Starter Exercise

WHAT: This exercise starts a conversation and simultaneously activates a process for change. The exercise personalizes the experience of the first few hours in a nursing home to start the conversation about how to give a better welcome. As staff reflect on their own needs, they better understand their residents' needs and see how the change will benefit residents. Then they can think through how to make it happen.

WHY: Change is hard. Successful change requires discussion about why and how. Use this discussion to find out how the staff closest to the resident, who will implement a new approach, think it will work best. Have on-going discussions as the change evolves.

HOW: This guide includes discussion prompters to use after the personalized experience first to draw out staff's experience and reflections, and then to hear their ideas on how to do it. Allow time for each discussion. Hear from everyone. Ask for responses from quieter people. It may be tempting to brush off staff members who are openly skeptical, but putting into play major changes requires that concerns be welcomed as a contribution to the effort's success; get to the root of the concern, and note it as an area to keep an eye on.

RESOURCES: Toolkit Tip Sheet and Video Clip on A Good Welcome: The First 24 Hours

Entire Toolkit and Webinar Series available at Pioneer Network store.

Preparation: Review tip sheet and video clip on A Good Welcome: The First 24 Hours

Time: 15 - 20 minutes, depending on discussion time

Flip chart and marker

To provide a personal experience of what it is like for a person in their first few hours in a nursing home so staff can think through how to make a better welcome.


In pairs, have staff talk to each other about:
What would you need in the very first few hours if you needed to come into a nursing home for a short stay or to live for the long term?

Remind them that anything can happen to any of us in a moment that can put us in need of a nursing home. Think about this as a personal experience, not about your residents. What would you personally need?

Allow 2-3 minutes for the pairs to discuss the question. Then ask people to bring their conversations to a close.

Ask volunteers to share what they would need in those first few hours. You'll hear different answers because our needs are very personal.

Typical answers are:
  • Warm Personal Greeting
  • Orient me - Show me around and explain how it works here
  • A chance to settle in and put my things away
  • Help me get a bite to eat, go to the bathroom, or rest
  • Ask me my preferences - what I want to eat, when I want to go to bed, and when I'd like to wake up
  • To call my family or have them stay with me for dinner

After several people share, identify the themes you hear. Almost everything said will be about the need to acclimate, orient, gather oneself together, feel secure, and have connection. These are psychosocial needs at a time of great anxiety.

Point out the nature of the needs people identify and contrast these needs with the typical "admissions check-list" that includes actions that unintentionally heighten people's fears – such as full body skin checks, asking whether people want to be resuscitated, and which funeral home they have arrangements with – not exactly reassuring! While we go through our to-do list, we make a better welcome when we pay attention to people's human needs.

In an open discussion, ask the group:

What would happen for you if you didn't have those human needs taken care of?

What would you experience if over and over again you had to answer the same questions or tell new staff coming on what you needed?

In pairs: discuss what happens at your home now for people in their first few hours:
  • What works well?
  • What doesn't work well?
  • What would be an easy change to make that could do a lot of good?

Share in a go-round: Ask each pair to share one item that works well, one that doesn't, and one suggested change. Then ask the next pair to do the same. That way you'll hear from everyone. Keep going around until everyone's ideas are out, noting on flip chart.

Begin the discussion on how to make it happen. Ask:

Where should we start?

What would we need to make this work?

Download Facilitator Instructions for A Good Welcome: The First 24 Hours (PDF)

Starter Toolkit Home          Step One          Step Two          Step Three          Self-Assessment
Prepared by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS as the Engine for High Quality Individualized Care. Funded by The Retirement Research Foundation.