Creating a Nursing Care Environment Where Staff Want to Continue Working —Medical welfare corporation Yujun Group Grandage Izumi

— Environment created together with staff who are so essential that not a single member should be lost

Grandage Izumi, Izumi City, Osaka Prefecture

As Japan enters a super-aging society where one in five citizens will be 75 years or older by 2025, we visited Grandage Izumi in Izumi City, Osaka Prefecture, a facility where almost no nursing care staff have quit over the past three years. How do they stimulate their staff’s motivation? What do they value? Mr. Tomokazu Iida, CEO of BRIGHT VIE Co., Ltd., a TRYT Group company that provides ICT services for nursing care facilities, explores the secret to their staff retention, including how to use ICT.

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(Iida) Please tell us how you got into the nursing care industry and what has motivated you to continue this work.

(Sakakibara) Initially, I worked in an industry completely different from nursing care, but when I saw my wife enthusiastically working as a childcare staff member at a daycare center, I decided to try the nursing care industry myself to be of use to others. Strangely enough, I didn’t feel hesitant to help elderly people bathe or change diapers. Before I knew it, I was absorbed in acquiring nursing care skills. Afterward, I began to work at a day care service facility. To help service users have as much fun as possible, I studied hard to learn about the history and culture of the times before and after World War II, which they had survived, as well as songs and movies that had been popular in those days. After a while, many service users told me that they could learn from my stories or they looked forward to listening to me. This increased my motivation. At the age of 30, I decided to pursue a professional career in the nursing care industry. More than 20 years have passed since then, but there has been no change in my determination, and I’ve been enjoying my work to this day.

(Hamasaki) When I was 17 years old, I helped my grandfather in the hospital and saw the joy he derived from my help. This experience left me a strong impression and aroused my interest in the nursing care profession. I became certified as a helper, and have been working at Grandage Izumi for seven years. At assisted living facilities for the elderly, residents spend a lot of time together with facility staff in various life occasions, so we place great importance on interaction and communication like those that we enjoy with our own family members. We provide nursing care not as part of our operations, but for the sake of each resident. This spontaneous feeling motivates us greatly.

(Ishihara) Before coming to Grandage Izumi, I had never been involved in nursing care. I joined this facility because I’m interested in hospitality being put into practice in the nursing care industry. When communicating with people with dementia, I listen to their stories from the past and try to convey to them what I’ve understood. I interact with them using my imagination. I hope their communication with me will help, even a little, to activate their brains and relieve their symptoms. They tell me that they are happy to be with me, which encourages me a lot and motivates me to work harder.

(Senmyo) I grew up in an area where we had a lot of interaction with the elderly, and one of my relatives was a care manager, so I was familiar with nursing care and welfare. Feeling that I might be suited to that kind of work, I majored in welfare at school. Since then, I’ve been engaged in this industry for over 11 years. Before joining Grandage Izumi, I worked at a special nursing home for the elderly. However, I joined this facility because I wanted to gain a different experience and sympathized deeply with the facility’s vision, to be realized by professional nursing care staff.

(Iida) Each of you has entered this industry with a different background and intention. Nursing care requires you to face each service user’s life, so I assume there are many daily worries and difficulties to deal with. Please tell us what you value when providing nursing care.

(Hamasaki) When providing daily nursing care, we communicate mainly with the residents, but behind them are always their families. We need to understand that we can provide nursing care to the residents thanks to their families. In addition, our interaction with the residents might have some impact on the relationships between the residents and their families. That’s why I interact with residents like I do with my own family, and place great importance on individualized care for each resident. Some of the facility residents have dementia. Regardless of their symptoms, I make sure to listen to them and understand their intentions and requests, which I think is a responsibility for caregivers. No matter how busy our work may be, we need to think about our work priority on the spot and judge appropriately what to do. I believe this is another important responsibility. For example, if a resident wants to go to the bathroom now but the request is postponed, that resident might move around alone out of the sight of the nursing care staff, which might lead to a falling accident. I always try to put our residents’ feelings first.

(Senmyo) When providing care, I also place the first priority on the residents’ feelings, and this is the major premise of my work. What we place particular emphasis on is that we are not only nursing care staff, but also human beings. We need to value the way we interact with others. In other words, it’s important to feel empathy for the lives of people with many experiences different from our own. Therefore, I listen to residents and learn about how they’ve lived and what they’ve valued, so that I can reflect these things in my nursing care for them. Fortunately, this facility enables me to provide the ideal care that I’ve always wanted to provide.

(Hamasaki) We often see the case that senior citizens suddenly become bedridden even though they had been able to walk normally until then without any need to use a wheelchair or receive toileting assistance. Such residents’ families request that I do everything within my power to make their lives as comfortable as possible, but considering their feelings, I’d like to help them return to their normal lives as much as possible. I’d like to make their families feel at ease, but at the same time, I’d like to support the resident’s independence. These two desires intersect, though honestly speaking, I feel it’s difficult to ensure that both are fully realized. When I feel any hesitation, I always respect what the residents want to do. I emphasize this point to the residents’ families and care managers, even if the resident has dementia. So, I listen to both the residents and their families and try to put them both at ease. I believe that pursuit of such communication determines the quality of nursing care.

(Iida) I myself have experienced and realized the importance of communication in nursing care to achieve nursing care with empathy for the life of each service user. I’ve always wanted to support such communication, even a little, through ICT. I’ve heard that the turnover rate of Grandage Izumi has decreased dramatically over the past few years. Could you share with us how you ensure the staff retention, especially how you use ICT to that end?

(Sakakibara) I feel that the main key to ensuring that staff can work happily for many years is attendance management. First, we’ve corrected situations where staff cannot get paid leave easily, have to attend meetings even on their days off, or have to participate in facility events. To do so, we’ve adopted Carez Connect, provided by BRIGHT VIE, an attendance management system, making our attendance management far easier. Also, Carez Connect has a great function whereby I can give staff points for their behaviors, such as 1 point for coming to work, 2 points for posting a photo of delicious food on a day off, and 3 points for purchasing a reference book or participating in training. Thankfully, posts come up every day, and I comment on them in a playful way (lol).
Sometimes I can’t fully notice how staff are doing, but the system allows them to put a stamp showing their emotion that day at the time of arriving and leaving. I feel that this has been unexpectedly helpful. In the past, everyone used to put a smiley face stamp, but today many more staff put a tired face stamp or a sad face stamp. I’m pleased with such a change, because it shows that our staff are sharing their honest feelings. Also, we’ve had more opportunities than before to talk to staff who look less energetic. Over the two years or so since the introduction of the system, my communication with the staff has changed dramatically.

(Iida) You are making good use of Carez Connect. In particular, giving staff points for studying to improve their skills is a new approach. I’m surprised to learn how you motivate staff in a true sense. How is Carez Connect helpful in your practical operations?

(Senmyo) On the day before or early in the morning of my workday, I check the information handed over to me to see if there have been any changes in the residents’ conditions. Carez Connect allows us to check an operation schedule and handover information even at home, and this is particularly convenient. Previously, I had to come to work early in the morning and view everything on paper files. Today, however, the necessary data is available at any time and anywhere, which I’m sure helps to improve our operational efficiency. I heard that the system allows us to turn off the function of notifying resident information outside working hours, but since I’m concerned about residents’ conditions, I often keep the function on even outside working hours.

(Iida) It’s truly important to ensure an environment where nursing care staff can work without any worry. At Grandage Izumi, you’re working on this point in a variety of ways. How do you train and support nursing care staff?

(Sakakibara) To ensure that new employees will not get confused, we train them under the same direction, through the same approach, and in the same process. Our OJT is provided by the three members of Ms. Hamasaki and two nursing care leaders. I hear that the most common reason for people leaving their jobs is deterioration of interpersonal relationships. Some new staff might not be satisfied with not understanding the basic ideas of why they have to do a certain task or why their bosses are warning them. Such new staff might lose trust in their senior colleagues, experience deterioration in their interpersonal relationships, or eventually feel dissatisfied with their work. This is a risk that needs to be addressed.
Also, as a manager, I always try to analyze and ascertain what is happening on-site. Each nursing care staff has different personality and level of experience; his or her ways of communicating also vary greatly. Some say only the results, while others explain everything from 1 to 10. Some say positive things like “I’ll try it next time,” while others become anxious and say “I’m not sure.” I feel that in these settings, those in positions like Ms. Hamasaki’s and myself are required to demonstrate skills for judging whether or not they should go further. We also need to decide how much each staff says what’s really happening as it is or ask for further explanation.

(Iida) While developing nursing care ICT myself, I have many opportunities to learn from on-site workers about their needs and problems. I’ve felt that the nursing care profession is creative enough to address them. At Grandage, what do you think the nursing care profession is?

(Hamasaki) I think it’s natural to acquire nursing care expertise and medical knowledge. Above all, I believe that the very basics of how we should be as nursing care professionals are more important than anything else. From Director Sakakibara, who has deep knowledge and rich experience in both medical and nursing care, I learn about various examples and approaches. I’ve been thinking every day about what it means to be a nursing care professional. Although I’ve been appointed as a manager, I’m still learning about the depth and breadth of the field of nursing care. (Sakakibara) You can’t work as a nursing care staff member simply because you’re a kind person or just young. When I was in my 20s, I was asked why you like changing old people’s diapers. It wouldn’t be surprising if I had lost my motivation after hearing that statement, but I decided to become a professional nursing care staff member, like a craftsman making carpenter planes. As you study hard about medicine and welfare and accumulate experience in nursing care, you’ll gradually become a professional nursing care staff member. It is never enough to simply fulfill residents’ requests or provide convenient services, but more importantly, it is required to predict risks for our residents. If there are 100 residents, we need to have 100 different kinds of approaches. In such a situation, we need to consider how we can ensure communication using all the information available to us as well as to demonstrate imagination and creativity in cooperation with our residents.
For example, dementia care is now part of nursing care for the elderly. Although it depends on the progression, dementia is by no means a special disease. As indicated by the analysis stating that one in every five senior citizens has dementia, it is a common disease. There will be no future in nursing care unless we can address dementia. People with dementia have their own criteria for making decisions in the own worlds, so we need to understand their own views and join their worlds. It’s difficult, but that’s what needs to be done by a professional nursing care staff. I hope that all our staff will pass the test to become qualified dementia carers, and indeed, Ms. Hamasaki has already passed the test.

(Iida) Your comments have allowed me to fully understand how highly specialized the nursing care profession is and how creative and rewarding it is. Also, as many more senior citizens need nursing care, it would be great if there were many more facilities like Grandage Izumi, which demonstrates ingenuity to ensure that its staff members want to continue working and feel motivated about their work, around the country. Thank you very much for your time today.