An Ecumen Consultant’s Quest To Make Sense of Dementia

Tom Stober, an expert on process and efficiency, was routinely going about his work one day when he walked into a room and came face-to-face with something that “shook me to the core.”  It was not logical.  It was not rational.  The normal rules of organization did not apply.  On some deep level, it rocked his orderly world.

It was a memory care community, where residents with dementia live.

Tom works for Minnesota Lean Partners, which had been hired by Ecumen over a year ago to improve customer experiences by teaching staff how to focus on what is truly important—what really adds value— and eliminating unnecessary things that get in the way of that goal.  This was his first consulting assignment in senior services.   A mechanical engineer by training, Tom had worked for many manufacturing companies, most notably Toyota, where he first learned the principles of “lean” management from the masters.

The Ecumen training sessions Tom was conducting were going well.  He was teaching, and he was learning.  But that first exposure to memory care was life-changing for him.

“I had heard about Alzheimer’s and dementia,” he says, “but I was never truly exposed to the impact that this has on the residents as well as their families.”

After visiting the memory care community at Ecumen Detroit Lakes, Tom remembers going to his hotel room that night preoccupied with his experience.  He just could not get it out of his mind. “I was troubled by the degree that this bothered me.  I struggled with the fact that these crippling diseases destroy what was once functioning human beings as mothers, fathers, sisters and brothers.”

There was just no apparent logic to it.

Yet as Tom watched the caregivers at work, he was in awe of “how loving, caring and forgiving” they were— and how effective.

“I was amazed at the strength and caring of the Ecumen staff working in this environment day-in and day-out,” Tom recalls. “Being briefly exposed to some of the behaviors that Ecumen care providers experience daily, it had a sincere and profound impact on me. I have a much higher appreciation for their contributions to the organization and their dedication to providing a high quality care to those that truly need it.”   

A powerful emotion swept over him.  “What I saw made me more dedicated to the work Ecumen is doing and made me want to help the staff more,” he recalls. 

“I know caregiving is a job I could not do,” Tom says.  “It takes a certain type of person.”

But he realized he is the certain type of person who could make caregivers’ jobs easier.  That could be his way of coming to terms and making a contribution.

From Tom’s point of view, you can always make things better with organization, standardization and elimination of useless and wasteful practices—whether in a manufacturing plant or a memory care community. 

“This could be my small way of paying it forward,” he decided.

On the most basic level, he noticed right away that caregivers spent a lot of time just looking for things they needed, often going in and out of rooms several times looking for supplies and equipment.  So he helped staff systematically figure out how to put all the tools of care in the same place in every room.  With everything they need easy to find, they are freed up to spend more time in direct care. 

Then he started digging deeper.  How can we organize care around the biorhythms of the residents?  When is the best time of day to have activities?  How can space best be used to optimize residents’ enjoyment?  How can we improve the residents’ environment and create better experiences?  Recently, he worked with the memory care staff at Ecumen Pathstone Living in Mankato, Minn., to completely revamp the memory care community.  Go to Ecumen’s Changing Aging blog to read about this effort.

Over the past year and a half, Tom has trained more than 1,000 Ecumen employees in “lean” principles and has run more than 40 events to analyze situations and implement continuous improvements.  And his work continues— not only in creating better practices but also sustaining them.

As Tom was working with Ecumen and coming to grips with his reaction to observing dementia firsthand, his personal story took another turn.  Tom learned that his own father is now in the early stages of dementia.

The lean management expert bonded with the dementia experts at Ecumen.

“I have gained so much knowledge about dementia,” Tom says. “The Ecumen nurses have really helped me better understand what is happening with my father, and how it’s happening and the progression to expect moving forward.”

And the paying it forward continues.


Ecumen received a Performance-based Incentive Payment Program (PIPP) award from the Minnesota Department of Human Services beginning October 1, 2011 – September 30, 2015.  LEAN the Ecumen Way is a company-wide initiative to improve the way Ecumen delivers services in day-to-day operations. LEAN focuses on eliminating non-value added activities in our work— “wastes,” which get in the way of the more important value-added activities that customers desire.

In addition to improving resident experiences by introducing LEAN management techniques, Ecumen has pledged to reduce antipsychotics among people with dementia and improve lives in all Ecumen nursing homes through its Awakenings program (see  In 2010, Ecumen was awarded a three-year performance-based grant from the State of Minnesota’s Department of Human Services to expand its pilot Awakenings program to Ecumen’s 15 nursing homes.   Such grants help organizations expand innovative, results-based initiatives.  These homes serve more than 1,000 people, including some of society’s most challenging dementia cases.  The Minneapolis Star Tribune recently profiled the Awakenings program.