A Visionary Path to Culture Change: Pearl Merritt & Debby BurgettPresentation Transcript
A Visionary Path to Culture Change Texas Coalition for Culture Change San Marcos, Texas September 23, 2011 Pearl Merritt, EdD., MSN, MS, RN Regional Dean Texas Tech Health Sciences and Debby Burgett, LNFA Member of Pivot Senior Living Experts
The Beginning of a Journey "Vision without execution is hallucination.” — Thomas Edison
Analyze contributions of small houses for elders
Propose innovative strategies for ADL’s by CNA’s
Critique the role of the nurse in small houses
Questions and Answers
Small House Design
What is the definition of a small house?
Do you already have an existing campus infrastructure?
Will the design meet with regulatory guidelines?
Is the design financially viable?
Traditional Home Repositioning
Opens doors for increased opportunities
Better clinical outcomes
Lower staff turnover
Increased staff satisfaction
Increased campus census
Increased elder and family satisfaction
Better survey results
Changes negative image of long-term care
Creates a brand strength for your organization
Increase revenue if proves to be a good financial model
Buy-in from federal and state surveyors
Educate and keep surveyors informed of your adopted philosophy and practices
Design approval is required from the State of Texas.
Connect with TAHSA, TXCCC, SAGE, Pioneer Network
CMS offered its contribution to the movement by stating , “It is our goal to have State agencies assist innovative providers in determining how changes they wish to make to improve the lives of their residents can be compliant with the Federal regulations that protect all residents.”
Secure financing and fundraising
Operating and Projected budget
Timeline for completion of project
Care Givers in a Small House Home
The Direct Care Staff: Flexible, Talented, Multi-Taskers, Selflessness, Adaptable, Generous, Courageous, Trustful
Activities, Celebrations and Meaningful Engagement
Care Givers and Companions
“ Keepers” of the daily rhythm of the house
Work as a team with nurses, therapists and any clinical support member
Coordinate meals to include planning with elders, ordering, receiving and cooking of food.
Responsible for maintaining the house in a clean, neat and orderly.
They report to a coach, guide or mentor.
They are highly skilled with culinary talent, safe cooking practices, and CPR.
Time, Training and Method
Direct Care Staff, prior to opening, 2-4 weeks
Leadership, prior to opening, 4-12 weeks
Elder Centered Care
Developing Self-Led Teams
Regulatory Support/Survey Readiness
Time, Training and Method
Problem Solving Scenarios
Involvement from All
Begins as soon as possible
Realign vision and mission statements
Nursing in a Traditional Home
Nurses control all unit activity
Nurses are the “boss” of the nurse aides
Nurses are responsible for nurse aides scheduling and finding replacements
Nurses station is the center of most units
Nursing Charts and paperwork intensive
“ Giving nursing staff a voice in the organization’s decision making related to care practices and work process changes will influence staff retention—an integral part of maintaining quality care.”
– Barbara Bowers, PhD, RN, FAAN
Associate Dean for Research
Helen Denne Schulte Professor of Nursing
University of Wisconsin-Madison
Nursing in a Small House
Bureaucracy is flattened
Daily rhythm of the home is in the control of the elders
Nurses are not responsible for CNA scheduling or finding replacements
Nurses and Nurse aides work as a team; they are often described in a small house as educators.
The functions of the nurses station are provided, but the “look” is different
Home environment; the institutional look and feel is removed
Nurses truly are nurses and not supervisors
Institutional Features are Removed
On- Site Training
Research validates small house outcomes of improved quality of care and improved quality of life.
CNA’s through education and training maintain the home with the elders at the center of all decision making.
The role of a nurse in a small house home is crucial in maintaining quality of care.
The small house design can be financially viable.
State and Federal agencies are supportive of the small house model and culture change.