Positive PEER pressure.

If residents have difficulty resolving problems at Tel Hai Retirement Community in Honey Brook, Pennsylvania, then Charles "Charlie" Caldwell is their go-to guy, along with 10 other state-certified resident ombudsmen. To keep resident problems and/or concerns from escalating from minor annoyances to hostile confrontations necessitating the intervention of a state ombudsman, Laurie Sisak of the Pennsylvania State Ombudsman's Office has created the PEER (Pennsylvania Empowers Expert Residents) project, which trains long-term care residents to become resident-advocates to work within the facility. Intended to improve quality of life by opening the lines of communication between residents and administrators, the PEER project, through the use of resident-advocates, hopes to see more self-resolution at the facility level, thereby eliminating the need for outside intervention.

Tel Hai is one of three pilot facilities in the state. "What is unique about our involvement," comments Terri Potrako, Tel Hai's director of community relations, "is that we are the only facility in the program that has an assisted living element to it. The other two facilities are nursing homes in Schuylkill and Cambria counties."

Located in rural Chester County in southeastern Pennsylvania, Tel Hai (from the Hebrew phrase meaning "hill of life") is home to more than 500 residents across the continuum of care. When the PEER concept was presented to the resident councils, Potrako recalls, it was met with great enthusiasm and support. Eleven resident volunteers (four in assisted living and seven in the healthcare facility) participated in the training led by Sisak and Chester County Ombudsman Donna Eaves.

PEER training began in March of this year. "The training is structured as four 2-hour classroom sessions," explains Amy McCormick, Tel Hat's director of activities, "and the trainers, through the extensive use of videos, overheads, and handouts as teaching tools, inspired these resident-advocates. They saw the opportunity to make a difference in the quality of life for all residents at Tel Hai." During lectures, the residents took notes to supplement the information presented in class and their discussion groups.

The first session focused on the role of resident-advocates--what their duties are, what resources are available to them, what problems might be encountered and how, armed with information, they can use their abilities to help fellow residents. "The video we were shown demonstrated how we, as residents, can help one another. Our job as Tel Hai ombudsmen is to be available to those who need help," remarks Caldwell.

Subsequent sessions taught the advocates-in-training how to negotiate with facility management, introduced them to specific techniques that help them build conflict resolution skills and, finally, cautioned and advised them on the importance of ensuring confidentiality and adapting to the ethnic, cultural, and religious diversity among the Tel Hai population. To gain listening and negotiating experience, facilitators presented participants with sample scenarios at the end of each session. In a roundtable format, they analyzed each scenario and determined how to resolve the issue in question. For example, the issue might involve resident rights, matters of dignity, or well-being. If they witness any concerns, resident-advocates are encouraged to follow a step-by-step "Ladder of Resolution" to solve the problem. At this point, the facilitators critiqued the residents' approaches and offered suggestions to improve their techniques.

The final session was themed "The sky is the limit for PEER." McCormick (director of activities) remarks that although this program is in its infancy, the firsthand experiences and developing sells of these pioneer advocates will be invaluable in refining and growing the program for years to come. "Initiatives like PEER help all residents across the long-term care continuum to have a better, safer quality of life," she adds.

In May, these residents were certified by the state to act as facility ombudsmen, and it was time to let the rest of the Tel Hai community know that the service is available. "At graduation," says Caldwell, "each graduate was given a badge identifying him or her as a Tel Hai ombudsman. Signs were made for us to put on our doors to let people know who their ombudsmen are and that we're here for them." Because Tel Hai is strongly behind the program, administration has been quite active in getting the word out; for example, they have placed photos of the ombudsmen in activity areas so residents can connect names with faces.

"Part of the reason Tel Hai was selected for this program," remarks David Dunn, vice-president of health services, "is that we have always been proactive in addressing our residents' needs and concerns at the facility level. We make widespread use of suggestion boxes and resident and family surveys; our various resident councils are another valuable conduit for receiving and disseminating information to our Tel Hai community."

"Now, when a resident has an unresolved issue, possibly a personality conflict with an aide," says Caldwell, "he comes to me. I find out the facts and arrange a meeting with the person in charge of the area, whether the problem involves nursing, laundry, housekeeping, the business office--whatever. Generally, the resident will accompany me to the meeting and together all parties involved will do their best to find a satisfactory solution."

Potrako (director of community relations) realizes that this program is too new to have any hard statistics but still she sees positive results: "Not only are we building a partnership with the state office, but our resident advocates are deriving benefits, as well." Because many of these pioneer advocates serve on resident councils, they already function as liaisons, and this experience provides a natural link to PEER. "Because they are empowered not only by the facility but also by the state, I've seen self-esteem flourish among the residents involved with PEER. And their willingness to dedicate their time has added an important new service to the Tel Hal community," she adds.

The state will continue to monitor the program and Sisak, who created the program, will return for a follow-up session. "This will be an ongoing process; our local Chester County ombudsman will continue to work with the PEER residents," says McCormick.

According to Dunn (vice-president of health services), problems may not have to escalate to the point of calling a state ombudsman. Tel Hai believes that most grievances can be satisfactorily resolved at the facility level. To illustrate this, Caldwell says that the first question he asks a disgruntled resident is, Have you talked to David (Dunn) yet? At Tel Hai Retirement Community, this is the first step to arbitration, the most important step in communication, and the best chance for a local solution.

For more information, contact Terri Potrako, director of community relations, at [phone], fax [phone], or visit www.telhai.org. PEER Project Manager Laurie Sisak can be reached at [phone]. To comment on this article, please send e-moil to [e-mail].