Transcript Person-Directed Care: The Heart of Culture Change

Person-Directed Care:
the Heart of Culture Change
DADS Culture Change Initiative
Presented by:
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www.dads.state.tx.us/culturec
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Mary Valente, LBSW, MPAff.
What is Person-Directed Care?
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Decision-making.
Self Determination and Choice.
Needs and comfort before the task.
Promotes respect.
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Person-Directed Care:
the Heart of Culture Change
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.
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www.dads.state.tx.us/culture
www.dads.state.tx.us/culturechange
change
“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?”
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Person-Directed Care:
the Heart of Culture Change
Comparing CulturesInstitutionDirected vs. Person-Directed
Reference: Pioneer Network, January 2012
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Institution-Directed Culture
Reference: Pioneer Network, January 2012
•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.
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Institution-Directed Culture continued
•Decision-making is centralized.
•A hospital-style environment.
•Structured activities.
•Sense of isolation and loneliness.
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INSTITUTION-DIRECTED CULTURE CONTINUED
ORGANIZATIONAL STRUCTURE
Nursing Home Owner
Administrator
Director of Nursing
Professional Nursing Staff
Nurse Aides
Residents
Family & Friends
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* Source: NY State Office for the Aging, www.nursinghome411.org
INSTITUTION-DIRECTED CULTURE
CONTINUED
SOCIAL INTERACTION
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* Source: NY State Office for the Aging, www.nursinghome411.org.
Person-Directed Culture continued
Reference: Pioneer Network, January 2012
•Caregiving relationship.
•Residents and staff design schedules together.
•Services are relationship-centered.
•Staff bring personal knowledge into the
caregiving process.
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Person-Directed Culture continued
•Decision-making.
•The comforts of home.
•Spontaneous activities.
•A sense of community
and belonging.
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PERSON-DIRECTED CULTURE CONTINUED
ORGANIZATIONAL STRUCTURE
Residents
Family Members
Nurse Aides
Professional Nursing Staff
Director of
Nursing
Administrator
Nursing Home
Owner
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* Source: NY State Office for the Aging, www.nursinghome411.org.
Person-Directed Culture
continuedPhysical Structure
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* Source: NY State Office for
^ Floor Plan of Missouri Veterans
Home—St. James, Missouri, Architect: Kennedy Association Inc.
the Aging,
* Source: NY State Office for
the Aging, www.nursinghome411.org.
www.nursinghome411.org.
Person-Directed Culture continued
Social Interaction
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Person-Directed Care:
the Heart of Culture Change
Culture Change Goals
•The focus is on relationships; this is the heart
of culture change.
•Keep the ‘I’ in individualized care.
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Low
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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.
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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.
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Nursing Facility Design
ProgressionInstitutional Model
The hospital-style institutional models were
built before the 1970’s and continues today.
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INSTITUTIONAL MODEL
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Nursing Facility Design
ProgressionAdditional Institutional
Models
Cartwheel
Plan
Concept started in
1960’s and
continues today.
K Plan
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Nurses’ Station - Institutional Model
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Kitchen - Institutional Model
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Nursing Facility Design
ProgressionAlternate Institutional
Models
Courtyard
Plan
Concept started in
the 1980’s and
continues to the
present day.
H Plan
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Nursing Facility Design
ProgressionEarly Culture Change
Model
Neighborhood Plan
Concept started in
the 1990’s and
continues to the
present day.
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Nursing Facility Design
ProgressionA Planned Culture Change
Model
Small House Plans
Concept began in
the 2000’s and
continues to the
present day
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SMALL HOUSE PLAN
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Canwww.dads.state.tx.us/culture
you find the nurses’ station?
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NURSING FACILITY DESIGN
PROGRESSIONREMODELING TO ACHIEVE
CULTURE CHANGE
Wings of existing plans
can be remodeled as
neighborhoods.
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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
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Cost of Culture Change
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
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Cost of Culture Change
Bathing Experience
•A person’s choice.
•Warm/soft lighting.
•Music or nature sounds.
•Aromatherapy.
•Clean and clutter-free.
•Privacy and dignity.
•Relaxing experience.
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Cost of Culture Change
Activities
•Hospice Volunteers
•Homebound and Lonely
•Making a Difference
•Unplanned as well as
scheduled
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Cost of Culture Change
Building Relationships
•Fireside chats
•Supply changes
•Learning Circles
•Informal conversations to solve problems
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Culture Change and Direct Care Staff
•Reduces turnover.
•Increases retention.
•Improves job satisfaction.
•Highlights importance of building
relationships.
•Gives a sense of ownership.
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Culture Change and Direct Care Staff
•Staff assignments.
•Involvement in plan
of care.
•Flexible scheduling.
•Activities led by staff.
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The Language of Culture Change
NEW
OLD
•Wing, Unit
•Diaper
•Shower room, Whirlpool
•Patient
•Admit
•Discharge
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•Neighborhood
•Brief, Undergarment
•Spa
•Individual
•Move in
•Move out
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The Language of Culture Change
OLD
NEW
•Lobby
•Nurses station
•Facility
•Elopement, Escape
•Dietary
•Ambulate
•Home-like
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•Living room
•Desk, Work area
•Community
•Left the building
•Dining service
•Walk
•Home
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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
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in turnover and retention
improvement.
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Staff working at an Eden Alternative home.
•Increased overall satisfaction.
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Person-Directed Care:
the Heart of Culture Change
Getting Started:
•PLAN
•DO
•STUDY
•ACT
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Form a committee, set priorities.
Assignments and leadership.
Are the changes working?
Explore other possibilities.
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Person-Directed Care:
the Heart of Culture Change
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
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Person-Directed Care:
the Heart of Culture Change
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
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References and Resources
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Center for Medicare & Medicaid Services (CMS),
http://www.cms.gov/default.asp
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Texas Quality Matters, www.TexasQualityMatters.org
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Edu-Catering and Action Pact: educational materials for
Culture Change, www.culturechangenow.com
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Pioneer Network,
http://www.pioneernetwork.net/Providers/
Person-Directed Care:
the Heart of Culture Change
THANK YOU!
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