Person-Directed Care: the Heart of Culture Change DADS Culture Change Initiative Presented by: Mary Valente, LBSW, MPA ff

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Person-Directed Care: the Heart of Culture Change

DADS Culture Change Initiative

Presented by:

Mary Valente, LBSW, MPAff.www.dads.state.tx.us/culturechange

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What is Person-Directed Care?

•Decision-making.

•Self Determination and Choice.

•Needs and comfort before the task.

•Promotes respect.

www.dads.state.tx.us/culturechange

www.dads.state.tx.us/culturechange*

Person-directed care is a simple, easy, and a low-cost to no-cost approach that can help a facility meet or exceed state and federal regulations.



“Honey, I’ve been through two world wars, the Great Depression, taught 3,297

children, administered four elementary schools and

outlived every one of the pastors I worked with. I’m 89

years old and you’re telling me it’s bedtime?”

www.dads.state.tx.us/culturechange*www.dads.state.tx.us/culturechange

Comparing CulturesInstitution-Directed vs. Person-Directed


Reference: Pioneer Network, January 2012



Institution-Directed Culture


•Standardized "treatments" based on medical diagnosis.

•Schedules and routines are designed by the institution.

•Work is task-oriented with rotated assignments.

•Staff can perform similar tasks "on any patient" in the home.



Institution-Directed Culture continued

•Decision-making is centralized. •A hospital-style environment. •Structured activities. •Sense of isolation and loneliness.


INSTITUTION-DIRECTED CULTURE CONTINUED ORGANIZATIONAL STRUCTURE

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Nursing Home Owner

Administrator

Director of Nursing

Professional Nursing Staff

Nurse Aides

Residents

Family & Friends* Source: NY State Office for the Aging, www.nursinghome411.org

http://www.nursinghome411.org/

INSTITUTION-DIRECTED CULTURE CONTINUED SOCIAL INTERACTION

** Source: NY State Office for the Aging, www.nursinghome411.org.


Person-Directed Culture continued

•Caregiving relationship.

•Residents and staff design schedules together.

•Services are relationship-centered.

•Staff bring personal knowledge into the caregiving process.




Person-Directed Culture continued

•Decision-making.

•The comforts of home.

•Spontaneous activities.

•A sense of community and belonging.


PERSON-DIRECTED CULTURE CONTINUED ORGANIZATIONAL

STRUCTURE

* * Source: NY State Office for the Aging, www.nursinghome411.org.

Residents

Family Members Nurse Aides

Professional Nursing Staff

Director of Nursing Administrator

Nursing Home Owner


Person-Directed Culture continuedPhysical Structure

* Source: NY State Office for the Aging, www.nursinghome411.org. *^ Floor Plan of Missouri Veterans Home—St. James, Missouri, Architect: Kennedy Association Inc.

* Source: NY State Office for the Aging, www.nursinghome411.org.


Person-Directed Culture continued Social Interaction



Culture Change Goals

•The focus is on relationships; this is the heart of culture change.

•Keep the ‘I’ in individualized care.




Low



Person-Directed Care Pop Quiz

Would I want this style of care in my own home?

Use this ‘test’ question when thinking about current practices and how to change them.


COMPARE THESE PICTURES.WHICH STYLE WOULD YOU PREFER?

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A Brief History

The first nursing facility rules were created by the federal government in 1967.


Nursing Facility Design ProgressionInstitutional Model

The hospital-style institutional models were built before the 1970’s and continues today.


INSTITUTIONAL MODEL


Nursing Facility Design ProgressionAdditional Institutional

Models

Concept started in 1960’s and continues today.

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CartwheelPlan

K Planwww.dads.state.tx.us/culturechange

Nurses’ Station - Institutional Model


Kitchen - Institutional Model


Nursing Facility Design ProgressionAlternate Institutional

Models

Concept started in the 1980’s and continues to the present day.

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Courtyard Plan

H Plan


Nursing Facility Design ProgressionEarly Culture Change

Model

Neighborhood Plan

Concept started in the 1990’s and continues to the present day.


Nursing Facility Design ProgressionA Planned Culture Change

Model

Small House Plans

Concept began in the 2000’s and continues to the present day


SMALL HOUSE PLAN

www.dads.state.tx.us/culturechange*Can you find the nurses’ station?www.dads.state.tx.us/

culturechange

NURSING FACILITY DESIGN PROGRESSIONREMODELING TO

ACHIEVE CULTURE CHANGE

Wings of existing plans can be remodeled as neighborhoods.


Cost of Culture Change

•Building new homes is expensive.•Remodeling has many costs, but can be managed in smaller planned steps.

However:•Individualizing care is often COST FREE, and can START RIGHT NOW



Dining Experience•Choice of meals•Choice of meal times•Use of china and glass•Liberalized diets•Restaurant style dining•In-room dining choices•Small group setting



Bathing Experience•A person’s choice. •Warm/soft lighting.•Music or nature sounds.•Aromatherapy.•Clean and clutter-free.•Privacy and dignity.•Relaxing experience.



Activities•Hospice Volunteers•Homebound and Lonely•Making a Difference•Unplanned as well as scheduled



Building Relationships•Fireside chats•Supply changes•Learning Circles•Informal conversations to solve problems


Culture Change and Direct Care Staff

•Reduces turnover.•Increases retention.•Improves job satisfaction.•Highlights importance of building relationships. •Gives a sense of ownership.


Culture Change and Direct Care Staff

•Staff assignments.•Involvement in plan of care.•Flexible scheduling.•Activities led by staff.


The Language of Culture Change

OLD•Wing, Unit •Diaper •Shower room, Whirlpool•Patient •Admit •Discharge


NEW•Neighborhood•Brief, Undergarment•Spa•Individual•Move in•Move out


The Language of Culture Change

OLD•Lobby•Nurses station•Facility•Elopement, Escape•Dietary•Ambulate•Home-like

NEW•Living room•Desk, Work area•Community•Left the building•Dining service•Walk•Home


Benefits of Person-Directed Care

Individuals will experience:•Weight loss reduction.•Overall health stability.•Reduction of medications.•Improved social engagement.•Increased overall satisfaction.

Staff will experience:•Empowerment.•Reduction in turnover and retention improvement.•Increased overall satisfaction.

www.dads.state.tx.us/culturechange* Staff working at an Eden Alternative home.www.dads.state.tx.us/culturechange



Getting Started:•PLAN Form a committee, set priorities.•DO Assignments and leadership.•STUDY Are the changes working?•ACT Explore other possibilities.



How do I help if I’m not connected to a nursing facility? The short answer is: “Community Engagement”.•Voting•Social clubs•Business meetings•Scouting•School projects



Questions?


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DADS Culture Change - Support

Questions for DADS experts, contact:[email protected]

DADS website for culture change information www.dads.state.tx.us/culturechange/index.html

mailto:[email protected]

http://www.dads.state.tx.us/culturechange/index.html

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References and Resources

• Center for Medicare & Medicaid Services (CMS), http://www.cms.gov/default.asp

• Texas Quality Matters, www.TexasQualityMatters.org • Edu-Catering and Action Pact: educational materials for

Culture Change, www.culturechangenow.com• Pioneer Network,

http://www.pioneernetwork.net/Providers/

http://www.cms.gov/default.asp

http://www.texasqualitymatters.org/

http://www.culturechangenow.com/

http://www.pioneernetwork.net/Providers/


THANK YOU!

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Documents

Person-Directed Care: the Heart of Culture Change DADS Culture Change Initiative Presented by: Mary Valente, LBSW, MPA ff