Person-Centered Care

[PKinney]

The term culture change reflects changing from the traditional , institutional nursing home model of care to the more resident-centered model of care.

We would like to hear from you to share with facilities throughout New York some culture change ideas that have been successfully implemented in your facilities.

Lets begin the journey together...........................

[Scott Crespy]

Hello Nursing Home Quality Improvement Community!

We have begun a general discussion about patient centered approaches in the hospital setting in our Applying Motivational Interviewing Techniques (http://jeny.ipro.org/showthread.php?t=105) thread. It touches on the importance that these approaches play in enhancing patients' sense of control. As there is increasing emphasis on culture change in both the nursing home and hospital settings, I invite you to share in our discussion. I think there are likely to be many ways that this discussion can enhance the experience of residents and patients in both communities. Please share your thoughts and experiences today. Thanks.

Link: http://jeny.ipro.org/showthread.php?t=105 (Note: There are two pages of discussion in this thread, the patient centered topic begins on page two with a post from Linda Horton.)

I look forward to hearing from you.

Scott D. Crespy, PhD
IPRO Smoking Cessation Project Manager

[Marjorie Horner]

I am wondering what does this term means to the LTC folks or have you even heard of this term yet?

I would like to get a little discussion going if we could.

Can you write to me describing what the above term means to you. Have you attended any education sessions? Has the term been discussed at your Dept. meetings? Do you have any plans for the near future that would be seen as 'changing the culture' of your facility?

Let me know your thoughts, let's get some dialog going

[Maureen]

“I” Format Care Plans

Consider person directed care plans to enhance residents highest physical, psychosocial well being. Changing the style of care plan documentation assists to reflect the emphasis on the resident care from their personal perspective. The care plan is written from the resident’s point of view. Document assessments of the resident’s social history, communication ability, mobility, activities of daily living etc. as though the resident was talking. The care plan reflect a conversation with the resident regarding these key issues. For example, for Mobility; instead of “ambulation 2x/day”, a care plan would say “I like to walk. My favorite times for walking are after lunch and dinner. I usually walk about 15 minutes, but on nice days, I like to walk outside and stay a little longer” Goals: “ I want to remain as active and mobile as possible”. Areas that might reflect a decline such as Communication/Memory: “I use to communicate well and enjoy conversation with friends and family. I have become much weaker as my health has failed. Occasionally I have episodes of confusion. Sometimes I do not know where I am and I become frightened. Please provide orientation during these times and when you are providing my care. Let me know who you are and what you are going to be doing. When I am confused and frightened, I may strike out at you. Use calm gentle touch, and a soft spoken voice, while providing me reassurance.” Goals: “I don’t want my memory loss and confusion to interfere with my ability to accept the car I need.” These phrases address in the care plan, the residents assessed needs, interventions, and goals in a personal comment format.

Shared through Rhode Island Quality Partners is the attached powerpoint.

[Maureen]

Advance for Nurses, in the June 13, 2005 *Vol 5* No 13 issue, highlighted Center for Nursing and Rehabilitation, Brooklyn, NY. The article "Be My Neighbor" discusses how they are changing the culture of long term care.
Brooklyn-based CNR's neighborhood concept helps its residents enjoy living in an atmosphere that resembles home.
The JCAHO-accredited, 320-bed skilled nursing facility is the first nursing home in New York City organized on the "neighborhood" model, which focuses on resident preferences rather than management and staff convenience.
"At CNR a resident doesn't get admitted to a room, he or she moves into a home," said Joyce Lusan, MSN, RN, neighborhood director.
Culture Change
"Nursing homes have a certain culture and routine, which we are changing to be more patient-centered," Lusan said. "Instead of a resident fitting into our routine, the nursing home fits into the routine of the resident as much as possible."
CNR is broken down into four neighborhoods:
The Penthouse Garden on the fifth floor for residents with Alzheimer's and other dementias;
Parkhaven on the fourth floor for geriatric residents;
Pleasantville on the third floor for residents requiring rehabilitation; and
Hope Garden on the second floor for sub-acute residents.
The first floor houses the administrative office, the food service department and staff cafeteria, and an activities atrium for residents.
The facility's physical changes include adding amenities, flowers and photographs to residents' bedrooms and bathrooms, renovated hallways to include a sitting room in each neighborhood, restaurant-style dining on placemats in the community dining room, and redesigned nursing stations that give residents and families easy access to staff. Residents and staff also enjoy the numerous couches and plants located throughout the building. And while CNR offers one and two bedroom options, most residents prefer to live with a roommate, Lusan said.
"CNR looks like a home instead of an institution," she said, adding residents have greater independence in matters of daily living and participate in decisions about how their neighborhood will conduct itself.
Working Together
At CNR, a neighborhood director oversees the neighborhood staff of RNs, LPNs, CNAs, social workers, recreational therapists, dietitians and activity staff.
In 1999, when the concept was initiated, a social worker acted as neighborhood director. Today, after realizing that the role requires someone well-versed in clinical issues, all four neighborhood director positions are staffed by RNs.
"Our neighborhood directors are accepting of the neighborhood responsibilities and are ready and willing to supervise someone out of their professional scope," said Clari Gilbert, RN, senior vice president of operations.
After being formally welcomed by the moving-in committee, a CNA conducts a mini-assessment with the new resident and reports to the LPN who follows up with an initial assessment. An RN on staff then performs a complete assessment and develops the care plan.
RNs and LPNs also dispense medications, monitor patients and make judgment calls about whether or not a patient needs to be hospitalized. CNR strongly believes in continuing education, and quarterly neighborhood planning meetings are held to review strengths, weaknesses, opportunities and threats.
Becoming Reality
CNR began offering the neighborhood concept in 1999 after realizing the facility's staff felt displeasure in terms of communication among disciplines and residents, Gilbert said. For example, when it came down to consent for any procedure, social workers felt it was the nurses responsibility to notify the family and vice versa.
"Now, under the neighborhood concept all disciplines work together and everyone knows his or her responsibility," said Gilbert, who read about the concept in a magazine several years ago and decided to learn more. She read about this new type of care happening at Providence Mount St. Vincent in Seattle, WA, and wanted to see it in action for herself.
"I thought it was an interesting idea because it brings the resident to the forefront and improves communication among everyone," Gilbert explained.
After meeting with Providence's administrators and spending time with each discipline, Gilbert figured out how the concept could be implemented at CNR.
While Providence renovated its building to create smaller neighborhoods of approximately 20 residents, CNR was landlocked and didn't have the financial resources to change the building structure.
"Given what we had we decided the concept would not be about the building but about change. Brooklyn is known for its large neighborhoods, so we have 80 residents in each of ours," Gilbert said.
In the meantime, Providence introduced Gilbert to an organization pushing the idea of resident-centered care and individuality Pioneer Network. Gilbert attended the organization's conference in Rochester, NY, along with CNR's director of nursing and director of staff development.
The Pioneer Network calls its work culture change, the transformation of traditional institutions and practices into communities in which each person's capacities and individuality are affirmed and developed. Pioneer Network points out that culture change has been shown to transform demoralized, dispirited staff into productive teams and dispirited, isolated elders into active members of engaged communities.
Moving Forward
Overall, it took CNR approximately 5 years to arrive at the ongoing success it experiences today. "It's a journey we are on; it's a continuous process," Gilbert said. "Along the way we meet roadblocks, such as when we hire a new person and need to take time to introduce them to the concept, but this culture change movement is changing the culture of our organization. It's difficult and takes time to change policies and procedures, but residents need the care they deserve," she concluded.
"When we talk about culture change you have to learn a new way to interact, but it's not as difficult as you'd think," agreed Lusan. "Residents are individuals and we need to incorporate their needs. It's rewarding to everyone when residents are happy."
For more information about the Pioneer Network, visit "http://www.pioneernetwork.net
Emily Marchesani is a freelance writer and former assistant editor at ADVANCE.
View the online version http://nursing.advanceweb.com/common/EditorialSearch/AViewer.aspx?AN=NW_05jun13_n5p14.html&AD=06-13-2005

[Kathy Jo]

“I” Format Care Plans

Consider person directed care plans to enhance residents highest physical, psychosocial well being. Changing the style of care plan documentation assists to reflect the emphasis on the resident care from their personal perspective. The care plan is written from the resident’s point of view. Document assessments of the resident’s social history, communication ability, mobility, activities of daily living etc. as though the resident was talking. The care plan reflect a conversation with the resident regarding these key issues. For example, for Mobility; instead of “ambulation 2x/day”, a care plan would say “I like to walk. My favorite times for walking are after lunch and dinner. I usually walk about 15 minutes, but on nice days, I like to walk outside and stay a little longer” Goals: “ I want to remain as active and mobile as possible”. Areas that might reflect a decline such as Communication/Memory: “I use to communicate well and enjoy conversation with friends and family. I have become much weaker as my health has failed. Occasionally I have episodes of confusion. Sometimes I do not know where I am and I become frightened. Please provide orientation during these times and when you are providing my care. Let me know who you are and what you are going to be doing. When I am confused and frightened, I may strike out at you. Use calm gentle touch, and a soft spoken voice, while providing me reassurance.” Goals: “I don’t want my memory loss and confusion to interfere with my ability to accept the car I need.” These phrases address in the care plan, the residents assessed needs, interventions, and goals in a personal comment format.

Shared through Rhode Island Quality Partners is the attached powerpoint.

My facility is currently beginning to implement culture change both through the Quality First program (AAHSA) and the "Best Friends" program. We are beginning to creat Neighborhoods to encourage staff to harbor "ownership" of their area. We have encouraged our staff to come up with names for the units to attempt to get away from the institutionalized stereo type. Of course some staff are resistant and some are excited. Careplanning has been discussed in terms of a standards of care criteria but this is the first I have read about the "I" careplanning. I love it. It would go along with our "Life stories" we are starting on each unit. How is NYS or any other regulatory agencies viewing this idea? Have you had any feedback from them? I am highly interested in more information on this.

[Melissa]

We remodeled all of our shower and tub rooms to be more homey. We added plants, vanities, shower curtains, pictures, shelves and nick nacks.

[lhung]

I am very interested in Peson-centered care. I am totally inspired by the concept about the positive and humanistic approach. However, I am not sure how and where to start. Any tips?

[Maureen]

Almost Home

There will be a special encore presentation of Almost Home
on Tuesday April 4th at 10 pm .
Channel 13 WNET New York
This is a Public Broadcasting Channel (PBS), the INDEPENDENT LENS series.

Check your local listing for appropriate time and channel. http://itvs.org/shows/broadcast.htm?showID=1055 (http://itvs.org/shows/broadcast.htm?showID=1055)

Almost Home is a report on the culture change journey of one nursing home. Every person who works in a nursing home, every department, should see this movie.

Please view it. Tell every member of your staff to watch this program. Ensure that every staff member sees it.

ALMOST HOME (http://www.pbs.org/independentlens/almosthome/index.html) by Brad Lichtenstein and Lisa Gildehaus
”Meet the residents, family members and employees of a vibrant retirement community—Saint John’s on the Lake— as they reveal, with unflinching honesty and humor, what it’s really like to grow old. The film “bravely challenging stereotypes with humor, heartache and truth, ALMOST HOME offers an intimate, thought-provoking look at the way we approach aging today. Quality of life
“Culture change” is the name of a grassroots movement to transform the culture of aging. Through culture change, nursing homes and other senior living facilities change from hospital-like institutions to communities that more closely resemble home. In ALMOST HOME, filmmakers Brad Lichtenstein and Lisa Gildehaus chronicle the daily lives of staff and residents at Saint John’s On The Lake, a retirement community in Milwaukee, Wisconsin whose leaders are striving to improve quality of life for residents and staff. And social, spiritual, emotional, occupational, recreational and cultural needs were deemed as important as physical needs.”

For more information see http://www.almosthomedoc.org/ (http://www.almosthomedoc.org/)

[SophiaWyman]

I am very interested in Peson-centered care...iam very much inspired!!:)