person-directed care: the heart of culture change dads culture change initiative presented by:...
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Person-Directed Care: the Heart of Culture Change DADS Culture Change Initiative Presented by: Mary Valente, LBSW, MPA ff. *. What is Person-Directed Care?. Decision-making. Self Determination and Choice. Needs and comfort before the task. Promotes respect. *. - PowerPoint PPT PresentationTRANSCRIPT
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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
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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.
Person-Directed Care: the Heart of Culture Change
www.dads.state.tx.us/culturechange
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“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
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Comparing CulturesInstitution-Directed vs. Person-Directed
www.dads.state.tx.us/culturechange*
Reference: Pioneer Network, January 2012
Person-Directed Care: the Heart of Culture Change
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Institution-Directed Culture
www.dads.state.tx.us/culturechange*
•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.
Reference: Pioneer Network, January 2012
www.dads.state.tx.us/culturechange
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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
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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
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INSTITUTION-DIRECTED CULTURE CONTINUED SOCIAL INTERACTION
** Source: NY State Office for the Aging, www.nursinghome411.org.
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Person-Directed Culture continued
•Caregiving relationship.
•Residents and staff design schedules together.
•Services are relationship-centered.
•Staff bring personal knowledge into the caregiving process.
www.dads.state.tx.us/culturechange*
Reference: Pioneer Network, January 2012
www.dads.state.tx.us/culturechange
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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
* * 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
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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.
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Person-Directed Culture continued Social Interaction
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Culture Change Goals
•The focus is on relationships; this is the heart of culture change.
•Keep the ‘I’ in individualized care.
Person-Directed Care: the Heart of Culture Change
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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
Concept started in 1960’s and continues today.
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CartwheelPlan
K Planwww.dads.state.tx.us/culturechange
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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
Concept started in the 1980’s and continues to the present day.
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Courtyard Plan
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
www.dads.state.tx.us/culturechange*Can you find the nurses’ station?www.dads.state.tx.us/
culturechange
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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
OLD•Wing, Unit •Diaper •Shower room, Whirlpool•Patient •Admit •Discharge
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NEW•Neighborhood•Brief, Undergarment•Spa•Individual•Move in•Move out
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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
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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 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
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Person-Directed Care: the Heart of Culture Change
Getting Started:•PLAN Form a committee, set priorities.•DO Assignments and leadership.•STUDY Are the changes working?•ACT 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
• 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/
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Person-Directed Care: the Heart of Culture Change
THANK YOU!
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