Culture change resident relationship 2013

Resident Center Culture & Management

Relationship

Academics

Assessing

Building Sustainable Senior

Engaged Communities

Social

Connectivity

Resident & Staff

Connectivity

Vocational

Connectivity

Village

Connectivity

Intellectual

Wellbeing

Spiritual

Wellbeing

Physical

Wellbeing

Emotional

Wellbeing

Community Living

Independent Living Assisted Living

Skilled Living

Local Community Relationship

World Engagement

Vocational Mentoring

University Extension Programs

Resident & Management Relationship

RESIDENT ENGAGED COMMUNITY

RESIDENT CARE COMMUNITY

Village Connectivity

Vocational Connectivity

Social Connectivity

Resident/Staff

Connectivity

Emotional Wellbeing

Physical Wellbeing

Spiritual Wellbeing

Intellectual Wellbeing

POST ACUTE CARE CHANGES WHAT IS BEING DONE?

Quality of care in nursing homes must be addressed from all angles:

regulatory,

legal,

advocacy, and

within the nursing home itself.

New Resident Care

Models

Pioneer Network

HatCH Model

Eden Alternative

Evergreen Model

To name a few models

Each person can and does make a difference :

• Relationship is the fundamental building block of a transformed culture

• Respond to spirit, as well as mind and body

• Risk taking is a normal part of life

• Put the person before the task

• All elders are entitled to self-determination, wherever they live

• Establish resident direction in goal setting and care;

• Re-organize and empower staff, focusing on responsibility,

accountability and strong support to direct care workers (resident

assistants);

• Enable resident choice in aspects of daily life significant to the

resident, such as time getting up and going to bed; eating; naps; times

out-of-doors; favorite pastimes; times and methods of bathing; content

of meals and the ways meals are served;

• Emphasize the relationship between the resident and resident

assistant as central to quality of life for both;

• Create opportunities for relationships between hands-on caregivers

and residents by using consistent assignment of staff

The Commonwealth

Fund 2007 National

Survey of Nursing

Homes

Culture change or a

resident-centered

approach to care

Holistic Model of Care

Culture Change Adopters

31%

Culture Change Strivers

25%

Traditional 43%

Categories of Nursing Homes, by Extent of Culture Change Adoption

Culture change definition* describes nursing home only in a few respects or not at all, and leadership is not very committed to adopting culture change

Culture change definition* completely or for the most part describes nursing home

Culture change definition* describes nursing home only in a few respects or not at all, but leadership is extremely or very committed to adopting culture change

* Culture change or a resident-centered approach means an organization that has home and work environments in which: care and all resident-related activities are decided by the resident; living environment is designed to be a home rather than institution; close relationships exist between residents, family members, staff, and community; work is organized to support and allow all staff to respond to residents' needs and desires; management allows collaborative and group decision making; and processes/measures are used for continuous quality improvement.

Source: The Commonwealth Fund 2007 National Survey of Nursing Homes.

We are striving for …age-friendly communities,

policies, services, settings and structures support and

enable people to age actively by:

respecting their decisions and lifestyle choices;

protecting those who are most vulnerable; and

promoting their inclusion in and contribution to all

areas of community life.

Loneliness

Isolation

Depression

Figure 2. Resident-Directed Culture Change Principles Currently Under Way

Percent indicating that they are currently implementing the following initiatives:

Enable residents to determine

their own daily schedules

Actively involve residents in decisions

regarding their household/ neighborhood/unit^

Fully implement “Bathing Without a Battle” techniques

^ Neighborhoods: Areas in which traditional nursing unit is broken down into smaller functional units, in which ancillary services are shared with other neighborhoods; Households: Self-contained areas with a full kitchen, living room and dining room, with a relatively small number of residents per household.


Currently implementing ALL THREE

resident-directed initiatives

The three plagues of loneliness, helplessness and boredom account for the bulk of suffering among our Elders – FFC, Loneliness, Isolation & Depression

An Elder-centered community commits to creating a Human Habitat where life revolves around close and continuing contact with plants, animals and children. It is these relationships that provide the young and old alike with a pathway to a life worth living.

Loving companionship is the antidote to loneliness. Elders deserve easy access to human and animal companionship.

Guiding Principles of Eden Alternative

Meaningless activity corrodes the human spirit. The opportunity to do things that we find meaningful is essential to human health.

Medical treatment should be the servant of genuine human caring, never its master.

Figure 4. Culture Change Adopters Report Residents Are More Involved in Decisions About Their Home

Percent indicating that decisions are usually made by residents and staff jointly for the following:

Creating schedule for

meals

Planning menus

Creating calendar for social events

Planning social events

Decorating communal

areas

Developing resident’s care plan

Culture Change Adopters = culture change definition completely or for most part describes nursing home. Culture Change Strivers = culture change definition describes nursing home only in a few respects or not at all but leadership is very/extremely committed to the adoption of culture change. Traditional = culture change definition describes nursing home only in a few respects or not at all AND leadership is less than very/extremely committed to the adoption of culture change.


An Elder-centered community creates

opportunity to give as well as receive

care. This is the antidote to helplessness.

An Elder-centered community integrates daily

life with variety and spontaneity by creating

an environment in which unexpected

and unpredictable interactions and happenings

can take place. This is the antidote to

boredom.

An Elder-centered community honors its Elders by de-emphasizing top-down bureaucratic authority, seeking instead to place the maximum possible decision-making authority into the hands of the Elders or into the hands of those closest to them.

Creating an Elder-centered community is a never-ending process. Human growth must never be separated from human life.

Wise leadership is the lifeblood of any struggle against the three plagues. For it, there can be no substitute.

Figure 6. Staff-Related Culture Change Principles Currently Under Way

Percent indicating that they are currently implementing the following initiatives:

^ For instance, utilizing the “I Care” or “First Person” approach.


Staff leadership

training opportunities

Include direct care workers and

residents on senior

management team

Include certified nursing

assistants in resident-centered

care planning sessions^

Create self-managed work teams

Consistent assignment of

certified nursing assistants to

residents

Currently implementing

ALL FIVE staff initiatives

Modifications

Housing is modified to meet senior needs

Modifications are Affordable

Equipment for Modification is Accessible

Financial Assistance is Available

Competent Assistance provided


Aging In Place ◦ Housing is located close to

services ◦ Services are Affordable and

support senior to remain at Home

◦ Seniors are well informed of services to help them age in place

◦ Home-Care services are provided to support independence

◦ Respite care is provided on a “Care Sharing Model”


Active ageing depends on a variety of

influences or determinants that surround

individuals, families and nations

They include material conditions as well as social

factors that affect individual types of behavior and

feelings

The interaction between these factors play an

important role in affecting how well individuals age.

Gender

Culture

Chart Rehab Early Life Growth & Development

Adult Life Maintaining highest possible level of function

Older Age Maintaining independence and preventing disability

Disability Threshold

Rehabilitation and ensuring the quality of life

Range of Function

Village Connectivity Emotional Wellbeing

Vocational Connectivity Physical Wellbeing

Social Connectivity Spiritual Wellbeing

Resident/Staff Intellectual Wellbeing

Connectivity

Clothing Room

Donation Room

Community Care

An Artist and …

….his Cat “Rocky”

Spiritual Connectivity & Expression

Gardening for the Community

Caring Connections – re-cycled cards

Dough-Nations, social responsibility

Music Man delivers Holistic Therapy

Expand Clothing Closet (Activity has been operational

since January, 2010)

Sponsor and oversee a clothing donation and

distribution program to provide appropriate

clothing for residents in need.

In addition to clothing – residents can use, radios,

tape and CD players that you no longer need.

If the Walls of Ackert Park could Talk-!

History if music reverberates through the walls

Lou & Rocky Friends for over 15 years …best plan for Lou’s Rehabilitation

Rocky moves in with Lou-!

Families need a friend

Birthdays…or just a kind note, Dorothy is there

Ackert Park sites along an old Trolley path called Ackert Way. It serves as our Walking Rehab Trail, connection to Community Gardens and a place to shared nature with our neighbors-!

Community Integration ◦ Housing design facilitates

continued Integration of seniors into the Fabric of the Community

◦ Transportation services supportive to Greater Community

◦ Employment, Enterprise, and Volunteerism is supported throughout the Community


Living Environment ◦ Housing not Overcrowded

◦ Older people Comfortable

◦ Housing not in areas

Prone to Natural

Disasters

◦ Older people feel Safe!

◦ Financial Assistance for

Housing Security

measures


Living Environment in

Veteran Administration ◦ Overcrowded SNF’s

◦ 1700+ in MO

◦ Older Vets in SNF’s

◦ SNF’s filled with MEN

◦ 11% of current Military are

Women

◦ 36% more likely to use

Rehab

◦ Greenhouse Model in

Convent


Living Environment in

Prisons ◦ Housing Overcrowded

◦ Older inmates @ risk

◦ Housing not an option

◦ Focus on their skills and

natural abilities!

◦ Financial Assistance for

Housing Security &

Employment


Culture Change in Prison Educational and

Offender Change

programs:

Adult Basic Education

General Education Diploma

(GED)

Getting it Right Job Readiness

Stress and Anger Management

Intensive Out Patient Chemical

Dependency

Cognitive Behavioral

Treatment

Moral Recognation Therapy

(MRT)

Dog Training and Adoption

Program

Work and Vocational

Programs

Building Maintenance

Roofing

Siding

Drywall Installation

Information Technology

Department of Natural

Resources Forestry

Workers

Community Work Crews

Institutional Support Jobs

Sustainability Jobs

Kendall Brune, PhD, MBA, FACHCA [email protected] 314-757-0131

Documents

Culture change resident relationship 2013