Person-Centered Caring
and Culture Change
in an Adult Day Setting:
Best Practices
PRESENTATION OBJECTIVES:
1. Increased Understanding of Person Centered
Care and Culture Change in an Adult Day setting.
2....
INTRODUCE OUR
WORLD

REVIEW CONCEPTS

REVIEW PHILOSOPHIES

SHOW TRANSLATION OF CONCEPTS AND
INTEGRATION OF PHILOSOPHIES AT...
INTRODUCE OUR
WORLD

REVIEW CONCEPTS

REVIEW PHILOSOPHIES

SHOW TRANSLATION OF CONCEPTS AND
INTEGRATION OF PHILOSOPHIES AT...
SOCIALIZATION,
PLANNED ACTIVITIES, and
SUPPORTIVE HEALTH SERVICES
in a safe and well supervised
environment.

COORDINATED ...
A Grace Place Care Adult Center

www.agraceplaceacc.org/
6
A Grace Place Adult Care Center celebrates each individual, each
caregiver and each employee through Person Centered Think...
INTRODUCE OUR
WORLD

REVIEW CONCEPTS

REVIEW PHILOSOPHIES

SHOW TRANSLATION OF CONCEPTS AND
INTEGRATION OF PHILOSOPHIES AT...
Institution-Directed vs.
Person-Directed Care

Culture Change

Person-Centered
Culture

Person-Centered Care
9
PERSON-CENTERED CARE is an approach to
care that respects and values the uniqueness of the
individual, and seeks to mainta...
Person-Centered Care Attributes
Core Values of
Choice,
Dignity,
Respect,
Self-Determination and
Purposeful Livingbe replac...
Having negative
image of adults with
a disability.
Example: “Over the
Hill” birthday cards and
in terms of people with
Int...
Autonomy vs. Risk
RISK =
Individual Safety and
Liability

RISK

AUTONOMY
AUTONOMY =
INDEPENDENCE

Surplus Safety* = Safety...
What happens when we create an
environment that is “too” safe,
where individuals have
no autonomy?

Using the Questions ta...
What happens when we create
an environment where staff
has NO voice?

Using the Questions tab of the Webinar’s Control Pan...
Person-Centered Culture
Direct care staff have a say in how work is
carried out and how decisions are made.
Individual pre...
Some of our
language is
“institutional”

Person with…
The language we
use is important
in providing
person-centered
care.
...
POLL
How do you refer to the
people to whom you provide
service?
A. Participant
B. Individual
C. Client
D. Patient
18
Heightened job satisfaction
Heightened self-esteem
Employees

Heightened life skills
Career opportunities

Less staff turn...
CULTURE CHANGE:
National movement for transformation of adult services across the healthcare continuum

Based on personcen...
Institution-Directed vs. Person-Directed Care:

What is the difference?

21
Institution-Directed Culture

Staff provides standardized
"treatments" based upon
medical diagnosis.
Work is task-oriented...
Person-Directed Culture

Individuals make decisions
every day about their individual
routines.

The staff makes decisions
...
Person-Centered Care: A Review

1
Enhancing
professional
caregiver’s
capacity to be
responsive

2
Enhancing facility
invol...
25
INTRODUCE OUR
WORLD

REVIEW CONCEPTS

REVIEW PHILOSOPHIES

SHOW TRANSLATION OF CONCEPTS AND
INTEGRATION OF PHILOSOPHIES AT...
Inclusion

Servant
Leadership

INFLUENCES
ON CARE
PHILOSOPHY

Eden’s
Philosophy

PersonCentered
Care
The three plagues of Boredom, Loneliness, and Helplessness account for the bulk of suffering
among our clients. *The words...
Know each person and employee
Each person can and does make a difference

The Values and Principles of the
Pioneer Network...
Social inclusion

A socially inclusive society is defined as one where all people feel valued, their differences are
respe...
Servant Leadership
Servant-leader focuses on the growth and wellbeing of people and the communities to which
they belong. ...
Mr. Carter was only ten years old in 1950 when he was committed to a
state training school. He had picked up a brick and t...
Leaders must lead*
• Create an atmosphere that celebrates
the vision and mission
• Solicit input from all stakeholders,
ca...
Leaders must
empower staff

Practical Strategies

• Create a culture that values every
voice, every opinion

• Frequently ...
Leaders must
create celebrations
• Reinforce accomplishments
• Highlight acts of kindness
• Create reflections
• Create fu...
Staff needs to be
constantly and
repeatedly grounded
in the agency’s
mission and vision.

Performance
Appraisals and
evalu...
INTRODUCE OUR
WORLD

REVIEW CONCEPTS

REVIEW PHILOSOPHIES

SHOW TRANSLATION OF CONCEPTS AND
INTEGRATION OF PHILOSOPHIES AT...
A Grace Place’s Values: How were they developed?
TRUST:
Assured reliance on
character, strength,
and truth

TEAMWORK:
Shar...
Does your agency’s mission
statement and its values
reflect what you feel your
agency provides?

39
It takes a village to support an
individual.

From the professional caregivers at A Grace
Place to family caregivers at ho...
The Person-Centered Team
A PERSON-CENTERED
PHYSICAL ENVIRONMENT

OTHER ADULT DAYS
(Advocacy + Civic)
BOARD OF
DIRECTORS
(B...
Best Practices based on
Person-Centered Care
Pet Therapy

Music Therapy

Validation Therapy

Best Practices
for
PersonCent...
What does Community Inclusion mean?

How can we promote it?
How do we build a world where
no one’s left out?

43
Best Practices for Community
Inclusion:

44
Best Practices for Inclusion found
at A Grace Place:
Inclusive Attitude  Everybody Matters
Everyone Is Ready
Everyone Can...
How do we create a
Person-Centered
Response to
Each Individual?

46
AN EXAMPLE OF INCLUSION:

By 2030,
between 3.6 and
7.2 million LGBT
Americans

45,000 Lesbian
and Gay
Households in
Virgin...
KryssAnne
A transgender female
who battles a terminal
illness, isolation and fear
of healthcare
professionals who
"don't w...
Hannah Green is forty five and has been working at A Grace Place for over
ten years. She works in the program that support...
People accept
individuals when
they have an
opportunity to know
them, identify with
them.
People connect with
real stories...
KNOW THE INDIVIDUAL
Client:
“I’m sorry. Sometimes it
takes a while for me to
get my words out…”

Caregiver:
“That’s okay,
...
EMPOWER

A hallmark of PCC is
empowering the
individual. It may take
more effort initially, but will
reap rewards in the l...
SUPPORT ROLE TRANSITIONS
Honor who they were, their
rituals, their occupations, their
roles. Role transition is one
of the...
ONE ON ONE CARE
A little more time and
effort on the front end
can have greater
positive health
outcomes in the long
run.
...
Team Approach
To Care

Calling After
Hours

“The Book”

Best
Practices
for Staff
Communication

Communication
Log

Informa...
A Person-Centered Response to
Each Professional Caregiver
Keep the engines
running!
• Within a work team model, staff
can ...
A Person-Centered Response to
Each Family’s Needs
Caregiver Support
• is essential to PCC. They spend as much time
with th...
How Does Such a Village Lead to A
Caring Response?

A family of
friends

Sharing and
delighting in
the
accomplishm
ents of...
How to Build a Village of Support:
Team-Building and Servant Leadership Practices
Know your care team
of care professional...
The Physical Environment of
AGP’s Village

Note the centralized intake area and the needs-based compartmentalization combi...
Community Partnerships
•
•
•
•
•
•

Youth Programs
United Way
Faith-Based Organizations
The Business Community
Other Adult...
Person-Centered Volunteers

62
Employee
Retention
Greater
understanding
from healthcare
teams about
personcentered care

Purposeful
Living for
Individual...
Opportunities and Challenges of Change

Change requires extra
time and commitment of
an already overwhelmed work force and...
REFLECTION
• What have you taken away from our
time together today?
• Can you share your valuable practices
to advance per...
Resources
• David Pitonyak article:
– http://www.dimagine.com/Toolbox.pdf

• Eden Alternatives
– www.edenalt.com

• Person...
www.agraceplaceacc.org/
www.sahp.vcu.edu/gerontology/

• Lynne Seward: lynneseward@agraceplaceacc.org
• Debbie Scott: debb...
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Person-Centered Caring and Culture Change in an Adult Day Setting - Best Practices

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Webinar presentation of October 23, 2013 featuring Jay White, MS, and Debbie Scott, MS, MA.

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  • A Grace Place (AGP) and VCU’s department of gerontology partnered through a grant to create this curriculum on “Person-Centered Caring and Culture Change in an Adult Day Setting: Best Practices.” VCU’s team conducted three focus group sessions with staff at AGP to gain insight into how this philosophy is operationalized on a daily basis here. We’ll talk for about an hour today about what person-centered care is and then the next session (or hour, depending on how your training schedule works out) we will be going over the best practices used at AGP that show, or model, how the staff at A Grace Place practices PCC everyday, without even knowing it. (At this time, you may choose to have your audience give themselves a pat on the back for being here for the training and a round of applause for the hard work they continuously do within their organization. )
  • 1.) Increased understanding of Person Centered Care and Culture Change in an Adult Day setting2.) An introduction to Best Practices for healthcare professionals for integrating Person-Centered Care into an Adult Day Center 3.) Best Practices for Team-Building and Support of Care Professionals 4.)Best Practices for Community Engagement in an Adult Day Setting (How do we workwith the community… How to bring it in and how to help educate themabout what it is we do here and other adult days.)
  • Source: National Adult Day Services Association, http://www.nadsa.org/
  • A Grace Place Adult Center celebrates each individual, each caregiver and each employee through Person Centered Thinking and Person Centered Care. Wewill go into some of the influences that created this organization and show how it modeled such care through case studies found during focus groups.
  • A Grace Place has modeled PCC in adult day settings for many years. The real goal and mission of AGP has been to strengthen adult caregiving. They serve many, many different individuals with different disabilities and/or age-related conditions, as you can see; therefor every program is set up in different models and different treatment protocols to meet the unique needs of each individual. The variety of programs exists simply because caregiving is not specific- not to an age, a diagnosis, a care need, to a funding principle- caregiving is caregiving. If you’re really creating a community in which caregivers can flourish, as well as those receiving the care, where they can have their health and independence, as well as an opportunity to reach the highest level of their dreams, then you have to start really looking at being an open and flexible environment. Our care includes incontinence care, wheelchair transfers, bathing, dressing, grooming, feeding, and self-care. We will do whatever it takes to meet individual needs and interests. And as the client’s needs change or increase, we adjust or increase our support. We do not discharge the client.
  • It’s about restoring and supporting personhood. Person-Centered Care is an approach to care that respects and values the uniqueness of the individual, and seeks to maintain, even restore, the personhood of individuals.Ask:How many of you have seen the health of a client improve when they come here?How do you do this? By creating an environment that promotes:-Personal Worth and Uniqueness-Respect-Independence-Social Confidence-Truthfulness-Engagement-HopeSometimes our clients come in without any of these at first. Yet, thanks to your hard work, we can provide all of these things for our individuals.
  • What is Person-Centered Care (PCC)?The core values are choice, dignity, respect, self-determination and purposeful living. It fosters optimal aging and optimal living for the individual. It is empowering. The individual drives his or her own care. This can be quite challenging in settings like this where our clients may have disabilities or impairments and may have trouble communicating. However, you work to support these everyday, you work and exercise their voices. It focuses on all aspects of a person- biologically, psychologically, socially, and spiritually speaking. (Rooted in the work of Tom Kitwood*, a British gerontologist.)
  • These are some key vocabulary terms that also serve as influences on why person-centered care was created.Stereotyping: having negative image of adults with a disability. Example: (*Ageism is an example of stereotyping) “Over the Hill” birthday cards. But stereotyping expands beyond this, in terms of people with Intellectual or Developmental Disabilities, I am sure you have heard the word “retarded” or jokes being made or people assume that they are incapable of doing anything at all.Paternalism: behavior by one person that limits another’s freedom or autonomy. What happens when you do everything for an individual?Possible answers- you handicap them, create learned helplessness, “if you don’t use it, you lose it”Example: Staff make a participant stop playing cards and join in a Trivia game which the staff is leading and is a favorite of the staff.Autonomy: Independence or freedom to do as one wishes. This is what PCC is all about, exercising one’s own voice. Even if it just means picking between orange and yellow jello, you’re still allowing that individual to make a choice instead of choosing it for them. Example: Care Professional and Individual together selecting a time for one’s meals or activities rather than having it imposed.  Medical Model: suggesting a traditional approach (contrasted with a holistic approach) to the diagnosis and treatment of illness. The physician focuses on the defect, or dysfunction, within the patient, using a problem-solving approach. *This is the antithesis of PCC*We provide medical services here, but we are not institutionalized
  • There is natural risk for everyone, every day, associated with getting up in the morning, driving to work, etc. A hallmark of PCC is balancing such risks with our individual’s autonomy. It’s hard sometimes to exercise 100% autonomy all the time; we work with individuals everyday trying to be as independent as possible. But there are fall risks, there are risks of you being hurt (as a caregiver), etc. but you all have to go the extra mile to ensure these individuals can do things. We want to make sure they can work on their own terms as much as possible. Sometimes this can create a challenge. However, there is natural risk associated with getting up in the morning, driving to work, etc., that we balance everyday too. Ask audience: Do these individuals not deserve this same balance? Focus on the capabilities and not the disabilities of the people you care for and work with. A lot of the time they can do more than they even know if you just give them the opportunity and environment where they are supported to try new things.Here is an example: “There is a man here whohas a cane, but as he gets older, he’s a little unbalanced at times- like walking on a sidewalk, you have to watch him and be there and you can see him get frustrated because I guess it makes him feel like he’s getting older or weaker. He doesn’t identify himself as being a 55 year-old-man, he identifies himself being in his young 30’s.” Just because we identify the risk that he may fall, he is not forced into a wheel chair to cover safety. If he were put in a wheelchair he would likely stop walking all together. Can you think of the negative health aspects this type of institutional action could have one him? (Think psychologically, physically, and biologically).Ask audience for examples.
  • Who would want to go to work? Moral goes down. Same concept as with the individuals you’re working with- if you don’t get to exercise your voice, you lose it.DavidPitonyak writes, “Today, more than any time in history, professional caregivers are learning the importance of asking the recipients of services what they need and organizing supports accordingly. “ Support self-determination and empowerment of the individual. People who receive services should be in control of them as much as possible. The voice of the individual as well as the professional caregiver should be honored as much as possible.
  • Who would want to go to work? Moral goes down. Same concept as with the individuals you’re working with- if you don’t get to exercise your voice, you lose it.DavidPitonyak writes, “Today, more than any time in history, professional caregivers are learning the importance of asking the recipients of services what they need and organizing supports accordingly. “ Support self-determination and empowerment of the individual. People who receive services should be in control of them as much as possible. The voice of the individual as well as the professional caregiver should be honored as much as possible.
  • Person-Centered Culture involves not just the individual but yourselves (professional caregivers) as well. Always keep yourselves in mind too because if you’re not here, there can be no care. For the most part, staff organizes their routines to accommodate individuals’ routines. So- you guys work harder to ensure that your individuals have a better quality of life. There is flexibility- there are no consistent assignments. Sometimes it may take more work on the front end to do this, but it saves time in the end. Putting in this extra care can save staff from having to deal with an episode or an incident later in the afternoon. Direct care staff have a say in how work is carried out and how decisions are made- your voices are honored too. All staff in a person-centered environment should be comfortable enough to say something and have a conversation about any issue at hand with a coworker or supervisor. There is not an emphasis on hierarchy. If ever such a conversation turns into a confrontation, remember that there is usually a middle ground that can be reached. Lastly, individual preferences are the basis of care decisions.Lacy will review consistency
  • When we’re talking about the language of person-centered care, we’re talking about words that are used everyday. Some of this language is “institutional” and can be unintentionally demeaning to people. Therefore, it is important to use the correct kind of language. Can anyone give me any examples? (Some mentioned were: retarded, slow, deficits, compliant/noncompliant, etc.). Instead of saying someone is compliant or noncompliant, figure out why the individual is that way- what can I do in my role to help move them along the continuum.
  • Here’s a quick question for you all. Throughout developing this training we’ve tried out a lot of terms, client, individual, etc… if you had to pick, for the person you provide services to, which would you call them? There really is not a right or wrong answer here, but patient is generally a term used in institutions or hospitals. At the end of the day, they should be Misses jones, or John, or Buddy. However, nicknames you do have to be careful and sensitive about. It is not advisable to refer to everyone in generic terms such as “suga” and “honey” because they might really not like being called either. You have to make sure they want to be called things like “sweetie” beforehand, especially with our older clients. A hallmark of person-centered care is finding out what they want to be called.
  • So what are the benefits of all of this?One of the biggest things is that the employees feel honored when they are treated as individuals and when they are in a person-centered environment and their ideas can come and be celebrated and worked with so they have better job satisfaction, they feel better about themselves. One of the things we must do as leaders and teammates is when we ask the staff to do something we need to also ask what is it going to take to get that done. If Mr. Brown has problems with incontinence, are we asking as a team, “What can we do to make him more comfortable?” or are we going to send out a policy telling everybody that they have to bathroom somebody every 15 minutes?If we have a happy staff, we have happy clients. We have better care. This leads to satisfied and engaged individuals which allows caregivers to have an increased peace of mind. What people may not always think about are the extrinsic awards. Marketing- happy campers equal a full camp. Word of mouth is the best form of marketing there is. Because AGP is a nonprofit, they often consider donors. Having a model like this (PCC) allows you to tell people stories that enrapture them in the cause- they want to support you emotionally and financially.
  • Culture change is a challenge because a lot of people have been delivering health care a certain way for a long time- using the medical model that we identified earlier. This is how it is at a lot of other adult days and living facilities in our area (Richmond, VA) still deliver care. The assembly line of care for individuals that the medical model created within our health system, charges staff to have consistent assignments everyday. Can you imagine doing the exact same thing every day?  Person-centered care is a national movement for transformation of adult services across the healthcare continuum. It creates a happy staff, which generates happy clients. People from all fields are realizing that the medical model must change because it does not yield itself to positive health outcomes. We have the Alzheimer’s Association adopting it, the intellectually disability community embracing it- in fact, the Department of Behavioral and Mental Health Services (DBMHS) state is requiring that people working with the I.D. community are trained in person-centered thinking and planning and have five modules of trainings available on their website now.  The whole idea of PCC is based on person-centered and directed values and practices. It involves consideration: for the individual, caregivers and staff, and anyone else who may be involved. It is a deep system transformation that may require changes in organizational practices, physical environments, and relationships at ALL levels and workforce models. History of Culture ChangeWhere culture change is in other areas of healthcare. Adult Day, Long Term Care, Regulations. Part of a movement.More examples of culture change: consistent assignment. Alzheimer’s Disease and how PCC is being operationalized
  • This is where we honor everyone’s voice. Not just the doctor because he’s wearing a white coat. In person-centered care, both the staff’s voice and the individuals voice are honored. People are not just pieces of paper. They are not just diagnoses. An example is, “My name is Joe, not, ‘the guy with the urinary continence.” –People are individuals. This is a ground up movement in which no one is treated like a chart or an ISP… these people have been here on Earth for upwards of 18 years and deserve more than to be reduced down to a piece of paper.
  • Institution-directed care is based on the medical model we reviewed earlier.Which culture would you rather be working in or getting services from? In this institution-directed culture, decisions are made from the topdown administratively speaking. We have to bring it back into focus, bring it down to the “bottom”, for lack of a better term, and empowering the individuals and staff to make decisions.Staff provides standardized "treatments" based upon medical diagnosis. So you have the same treatment for everybody based on a similar diagnosis. You could have someone with Parkinson’s related dementia and someone with Alzheimer’s related dementia, each person is treated the same way. How do you guys feel about that? Does any of this look or sound familiar? Work is task-oriented and staff rotates assignments. This can be a double-edged sword. At A Grace Place, people are able to be flexible enough to rotate assignments; for instance, someone from the memory program could see a fellow staff member needing help in another area and lend a helping hand. In institution-directed culture, this means people are taking shifts, getting inconsistent assignments etc. Decision-making is centralized.  Structured activities are available when the activity director or other activity staff are on duty. Ask staff what they would do if they only had one of their individuals in the room you are presenting in. In person-centered culture, the staff is encouraged to get creative. If there isn’t a TV, do a puzzle. Look at a book. Just talk to that individual. A Grace Place does use structured activities; however, many of the going-on’s here are made up on the spot and can be done at almost any time of the day. In the memory unit- those activities are not structured throughout the day. It depends on what the individual wants to do and when that person wants to do it.Staff is disengaged. If you’re not engaged, you don’t want to be here. It creates an attitude that says, this is not charging my battery everyday, so I’m just going to come in today and check off the ISP, get the work done and clock out. You guys work hard, you’ve got to be rewarded and feel good about what you do, you’ve got to be able to laugh throughout the day, you’ve got to recharge your battery. Otherwise staff can get lackadaisical and then clients end up suffering- it’s a lose/lose. Schedules and routines are designed by the facility and staff, and individuals must comply. Who would want to come here as an individual or care recipient if you had to comply with every single rule and regulation? It’s the same for you as the professional caregivers, would you want to come to work if your voice and ideas weren’t honored or respected? Same thing for the participants.As long as staff know how to perform a task, they can perform it "on any patient" in the facility.  An example: you’ve got someone who’s come in agitated in the morning… what’s the first thing you’re going to do? (Give participants a moment to answer)… but in a person-centered model the staff know to find out what’s going on, what happened that set off this behavior, what’s the backstory? You’re going to talk to the driver of the van that dropped the individual off or the group home or residence, mom or dad, a spouse, and find out what happened last night or this morning- why did Joe show up feeling this way? A lot of places don’t do that. They will take the individual and isolate them for the day. This creates a snowball effect- if Joe comes in agitated and nothing’s done to diffuse the situation, what’s going to happen? It gets worse. There is a hospital environment.  Example of how to change this environment: No one wears white coats or uniforms at A Grace Place. Does this look like a hospital or a home? We create a homelike environment. How many hospitals have dogs that visit and birds that live there?There is a sense of isolation and loneliness. Would anyone want to come to a place where they felt isolated and lonely? *This is a great place to say thank you again to all the participants in the training and for creating an atmosphere that is not isolated or lonely.
  • -Individuals make decisions every day about their individual routines.-The staff makes decisions every day and is empowered.-The staff organizes their schedules and assignments to meet the needs of the individuals they care for. You pull together, and get the work done.-The staff has relationships with the individuals so that they know their lifelong habits and honor them. How many people have been here for more than 5 years? More than 10? Even 2? In healthcare, we see a huge staff turnover in assisted living and adult day. You don’t really see that at A Grace Place. Why do staff members spend so many years here? Because the staff get to know their clients and develop those relationships- they become like family. Whereas in the institution directed model, they’re just another piece of paper. They’re not family, they’re not friends. So again, thank you for proving this home for everyone.
  • This is the end of Module I. This is a review to remind us of what’s needed to get the whole picture, or solve the whole puzzle.
  • Speaker Notes: What could you not live without? What are your personal preferences? How might aging impact what YOU want to do?If we as professional caregivers can’t live without something, then why should our individuals?Before we say “no”, consider the practical alternatives. How can we support the wishes of our individuals?Providing these things that help facilitate older adults to continue to have that choice and voice.
  • When a new CEO first got involved in adult day services 26 years ago, she wondered how she could create a model of care or treatment and how she could talk to her staff and donors about what we do. She thought a lot about inclusion (at that time in the 60’s they were really talking about the American Disabilities Act and the Civil Rights or Persons with Disabilities Act) and was heavily pulled into that direction. Furthermore, Inclusion and community integration is all about being person-centered. As she conducted research, she discovered Bill Thomas’s Eden’s Alternatives. ***Bill Thomas and Tom Kirkwood are contemporaries in terms of of building the knowledge base for creating culture change and really focusing our services on the individual rather than on the system. He identifies 3 plagues on the industry of long-term care which include loneliness, isolation, and boredom that you’ll see identified on the next slide.Staff came up with******Each member was asked to bring in one object that represented something they held near and dear to their hearts.. One person brought in a bible. One person brought in a wedding ring. Another person, a quilt. Each object represented a value. Then we went to what values we have here. 3 separate times and they were all alike. Board members did it too.Every agency can do this.Definitions: ADA as it influenced care philosophyCreeping into the DSS regulations. Inspectors talking PCCMCO…managed care organizations are discussing PCC in their RFP.Person-Centered Thinking in Behavioral HealthDMAS, CMS also have PCC in their literature
  • What is the antidote to loneliness? It’s being engaged, with people, people of all ages.You work with the clients every day, what are some Person-centered activities that you perform every day with the clients?Describe how this makes the client feel? How does it make you feel?Do you see anything different about the Client since we are using The-Eden-Alternative?Dr. William H. Thomas, M.D., Founded The Eden Alternative in 1991 after a patient pulled on his white jacket when he was leaving her room and said, “doctor I am dying of loneliness. Doctor Thomas began to look at other “non medical” problems that contributed to patients failing health. After much research he developed The Eden Alternative's as a medical practice for patience living in Nursing Homes. Now The Eden Alternative's is one of the fastest growing culture change philosophies now to be incorporated into long-term care communities across the globe.  Although this model started in Nursing Homes, all individuals feel this isolation without incorporating The Eden Alternative's into practice.Three plagues of Boredom, Loneliness, and Helplessness, that make life intolerable in most of today’s facilities. Facilities that have adopted The Eden Alternative typically are filled with plants, animals and are regularly visited by children. The Eden Alternative philosophy is centered around ten (10) guiding principles (below).  Although many communities have plants, animals and children, only those organizations that are willing to commit to striving for all ten principles are considered to be Edenizing.*The words create an acronym The Eden Alternative Ten Principles: B L and H = BLaH1. The three plagues of Boredom, Loneliness, and Helplessness account for the bulk of suffering among our clients.2. A Person-centered community commits to creating a Human Habitat where life revolves around close and continuous contact with plants, animals, and children.  It is these relationships that provide the young and old alike with a pathway towards a life worth living.3.A Person-centered community imbues daily life with variety and spontaneity by creating an environment in which unexpected and unpredictable interactions and happenings can take place. This is the antidote to boredom.4. Clients deserve easy access to human and animal companionship. Loving companionship is the antidote to loneliness.5. A Person-centered community creates opportunity to give as well as receive care. This is the antidote to helplessness.6. Meaningless activity corrodes the human spirit.  The opportunity to do things we find meaningful is essential to human health.7. Medical treatment should be the servant of genuine care, never its master.8. A Person-centered community honors its elders by de-emphasizing top down bureaucratic authority, seeking instead to place the maximum decision making authority into the hands of the Clients to care professionals.9. Creating a Person-centered community is a never ending process Link to Eden Alternative Video: http://www.youtube.com/watch?v=ZKRMd-r2dN8Link to Green House video: http://www.youtube.com/watch?v=l4Ap1ByNgKENote: The Eden Alternative principles are primarily focused on long term care and older adults, but may be applied to Adult Day settings and across the life span.
  • Here is another resource, the Pioneer Network, that is similar to Eden Alternatives. But when doing trainings, consider skipping depending on the level of audience and the time constraints. All of these different organization are picking up this idea of person-centered care, so it does give another example of the enthusiasm behind this national movement.The Values and Principles of the Pioneer NetworkKnow each person and employee Each person can and does make a difference Relationship is the fundamental building block of a transformed culture- whether it’s with yourselves in this room or you and your clients, or with the community. The relationship with the community is the fundamental building block of culture change; so you all are out there walking the walk and talking the talk. By virtue of your examples people out in the community are learning about what an adult day is and how people who have intellectual, developmental, aging, or any disabilities are no different than anyone else. We are all one car wreck away from being in the same condition. Respond to spirit, as well as mind and body- spirituality is extremely important in PCCRisk taking is a normal part of life- remember to balance the risk taking with the preservation of the autonomy of the individuals you’re serving; we still have to watch for that fall or that wanderingPut person before task All adults are entitled to self-determination wherever they live- this is in an adult group home, an adult day, an assisted living, people aging in place with in-home care… wherever a person lives, they are entitled to self-determinationCommunity is the antidote to institutionalization- the great thing about adult day is that you guys provide an opportunity for people who often times don’t get out of the homes. So instead of being placed into a home, they get to come here and be here and be independent and then get to go back home- wherever that is. They don’t have to go to training school. Do unto others as you would have them do unto you Promote the growth and development of all- yourself and the individuals. You want your opinions valued, your voices heard, and want to feel like you have an impact on what happens here at A Grace Place (or your organization)Shape and use the potential of the environment in all its aspects: physical, organizational, psycho/social/spiritual- just look around where you are now and what you could do to engage with an individual- you use what’s at hand in your environment to stimulate that individual; you don’t have to have a prescribed activity, you don’t have to have coloring books at 10:00 o’clock and bible study at 11:00 o’clock and lunch strictly at noon. You do what comes naturally Practice self-examination, searching for new creativity and opportunities for doing better- how do you guys bring your talents and creativity to work? *Let audience participate and shout out some things. Answers we heard were singing, dancing, bringing a sense of humor in here. The thing is, we bring our own resources into A Grace Place, our own talents, our own visions, and we bring that together to support the most optimum health outcomes of our individuals. Staff here even brings their own families in. Recognize that culture change and transformation are not destinations but a journey, always a work in progress
  • In the first module we talked about how leaders must lead. One of the best practices utilized at A Grace Place, and in fact is being picked up by a lot of companies, organizations, and even corporations. It focuses on the growth and well-being of people and the communities to which they belong. While traditional leadership commonly involves the accumulation and exercise of power by the person at the “top of the pyramid,” servant leadership is different. The servant-leader shares power, places the needs of others first, and helps people develop and perform as best as possible.
  • People identify with stories.Reference this case study with inclusion slide.
  • Speaking of leadership, David Pitonyak wrote an article calledIssue Action Planning: Promoting Responsive Human Services in which he identified 3 things that were critical for providing person-centered care in a workforce and a work setting. They’re all things that we know- like leaders must lead. And what he means by leading is walk the walk, talk the talk. When you’re asking staff members to go out and do some risks and do some difficult things and perhaps make changes in the way things are done, you have to be right there beside them, rolling your sleeves up. Look for opportunities to work with your direct-care staff. Ask the audience to think about practical strategies in which a leader can successfully lead.Underneath Practical Strategies “what do you do?/would you do” (leave blank and then return to later)
  • We also know that leaders must empower the staff. Value every voice, every opinion, every idea.Listen, listen, listen- especially when it’s hard to hear because sometimes people don’t use the best language or the best expressions and they might be fuming with emotions. It may feel like you are being attacked sometimes, but as a leader you must learn and realize that whoever is talking is trying to convey something important and that you need to honor his or her voice. We spend a lot of time having our staff focus on the dreams and wishes of the individuals we serve and care for; sometimes it seems we forget to ask about the dreams and wishes of our staff members. How can you expect staff to be supportive of our clients and do all the things that are sometimes hard to do if the leader isn’t supportive to them as well? Do we still have procedures and protocols at AGP? Yes, you are always going to have rules and regulations, but if we can be supportive first and understand first (looking at the person, not procedure), then it makes a big difference. Do we set boundaries on clients? Yes. Staff? Yes. It all goes back to the safety versus risk ratio though and by first listening to the person and not the procedure, we are able to be more supportive to our clients and staff. Another important thing to do in a workplace is reinforce the mission. Use real experiences, anything that you can to boost morale and team building moments. Ask staff, how would YOU want our organization to do things?same
  • The last point David makes is that leaders must remember to create celebrations. Do we catch our clients and our staff doing things right? Do we highlight such actions? We ask our staff to work hard. We owe it to them to get to know them as individuals and people. We need them to know they do not work in a ghetto of support.same
  • Give examples of how managers can walk the walk and not just talk the talk.What do participants have to offer as examples?Industrial psychology- in order to lead you must model good behavior. Managers need to walk the walk to rejuvenate the mission- fire up the passion.
  • How were the agency’s values and mission developed?Staff came up with them.Being a leader and working in person-centered care for all of us, means really reinforcing our mission. You must help the staff identify with our cause. Use experiences. For example, when A Grace Place was developing its values and mission, they asked each member, of the both staff and board members, to bring in one object that represented something they valued and held near and dear to their hearts.. One person brought in a bible. One person brought in a wedding ring. Another person, a quilt. Each object represented a value to each person. Then we broke into small groups and asked, “What is it like to work here at A Grace Place?” and went into what values they held here to develop their own unique sets. This was done annually, 3 separate times, and even as the players changed, the values remained alike.Any agency can do this. You must reinforce the mission.
  • The person-centered approach realizes that it takes a village to support an individual. From the professional caregivers at A Grace Place to family caregivers at home to the drivers that drop their individuals off, we are all part of a team, a village.Villages are constantly changing. A staff member advised, “Working at an Adult Day Center, you’ll never is a stagnant environment. It is ever changing. What works today may not work tomorrow, but it could work next week. Keep trying new things and building a booklet of tools that you can pull from at anytime.” Example:“With connections, we feel that we want changes because if they get bored they won’t want to be in our program… and especially if they live at home and go home telling the family members that we’re doing the same things, they’ll pull them from our program. So we try new things. We love getting our individuals involved and we also deal with the human rights issue- if they want to try something, they have the right to try. We have to. We advocate for our individuals.”
  • The Person-Centered Team involves everyone in that village as we just stated. It starts with individual, but really involves and relies on much more.-INDIVIDUAL (inclusive, we rarely turn anyone away) -A Grace Place has an open door policy-CARE PARTNER (supporting them where they are)“Caregivers will come in and share stories with staff because they know we will share the humor and laughter, fosters connections. We share things with them because I know they’ll appreciate it.” - AGP Staff Member“And we have families that will call us asking did you know this happened last night? Were they acting funny yesterday? (Referring to a seizure that happened at home). This open a communication and families feel reassured that we’re seeing things they don’t see during the day and vice-versa (at night) so we can connect the dots. We’re all on the same page, on all on board.”-CARE PROFESSIONAL (Happy Employees)-BOARD OF DIRECTORS (Breakfast)Best Practice: Even though A Grace Place is supported through congregate meals, we find an opportunity to “spice” things up with pizza parties and sub parties to support the interests of the individuals for “something different.” We also use food as a means for socialization, not only with the individuals and professional caregivers, but with the Board of Directors. As mentioned, at least once per year, the Board of Directors comes in and cooks breakfast for the staff. This provides an opportunity for Board members to feel engaged within the organization and to show their appreciation to the staff.-OTHER ADULT DAYS (Advocacy + Civic)-A PERSON-CENTERED PHYSICAL ENVIRONMENT:Our 21,000+ square foot facility is bright and cheerful. It feels like a home. Each program is located in an area of the center specifically designed for the participants. It also features full kitchens, for food preparation and life-skills practice, a laundry area, and a specially designed ventilation system.
  • A Grace Place demonstrates a commitment to provide evidence-based, innovative, and compassionate care by using the following best practices to approach person-centered care:Music Therapyis an evidence-based practice that engages older adults with a variety of cognitive impairments. Utilizing music that the individual enjoys provides a positive stimuli, can promote movement, breathing/respiration and interaction between caregiver and the individual. http://www.youtube.com/watch?v=a-5LdT9zHPM http://www.youtube.com/watch?v=6KjRD4ttqwMAsk for examplesValidation Therapy was developed for older individuals with cognitive impairments and dementia. Based on the general principle of validation, it incorporates a range of specific techniques that accept, or validate, the reality and personal truth of the participant’s experience.Ask for examplesReminiscence Therapy -Through Reminiscence Therapy (RT), clients participate in guided reminiscence. With the help of a therapist trained in RT, our Memory Support clients discuss past activities, events, and experiences with peers.Ask for examplesWellness Program- The holistic wellness activities A Grace Place has extends to their staff as well as their clients. We believe a healthy, happy staff makes for healthy, happy clients. All activities are supervised and adjusted for the individual’s ability. Our clients enjoy activities that include daily exercise programs, strength training, Wii-Fit for Fitness, nutrition classes, nature walks, and YMCA memberships. Activities for staff include a walking group, fitness classes, nutrition education, and weight loss challenges.Expressive Arts Program- This program is a powerful therapeutic tool and non-medical way to help improve mood and behavior. Even for participants with Alzheimer’s disease, music and art engage the parts of the brain that remain intact long after the onset of dementia. A Grace Place features a member choir, a drum circle, and other expressive arts activities. Clients also enjoy live performances by musicians, choral groups, dance troupes, and others who share their talents with the agency.Ask for examplesPet Therapy: This is the use of companion animals to aid people with special needs. It is based off the theory that everyone needs to feel love and self-worth and often times, if that sense cannot be met by humans, animals can fulfill it. We have parakeets here and a dog that visits every Monday.Example:One-on-One Care:Team-Work: “Everyone who’s dealing with the individual needs to do their job or the individual will not get the care he/she needs.”- AGP Staff Member.Example from the Connections side: “We have some individuals that have more significant behavioral problems (than daycare), and we’ve identified through time and through personalities, who works better with specific individuals. So if somebody is having an issue, we’ll pair the client with the staff member who works best with him or her. Sometimes this means a supervisor or someone from another team, but again, that flexibility and teamworkallows us to manage that.”Example #2:“Some clients won’t respond to me, but will respond to another and vice versa, so there are things that you learn. You learn and think, ‘Okay, well Harriet can take this client to bathroom a lot more quickly than me.’” You learn to know your team and individuals and work together for the greatest good to be brought about for all. Inclusion- A Grace Place has an open admission policy, which means they welcome everyone, regardless of diagnosis or funding ability. The Center is committed to ensuring that no person is excluded from participation in, or denied the benefits of its transit services on the basis of race, color or national origin, as protected by Title VI of the Civil Rights Act of 1964.
  • It is not enough to bring people into the community. Individuals must participate.Blend:Do not overload or overwhelm the environment. This is a two-way acceptance.An example of what not to do: “Once, I was at a restaurant and a big school bus pulled up. Getting out of it, I saw about 30 individuals that had bibs already put on them being shuffled out of the bus and into the shop in a line. How in the world is anyone supposed to feel normal and comfortable when overwhelmed like that? Why should every person on that bus be forced to wear a bib?” – AGP staff member
  • It is not enough to bring people into the community. Individuals must participate.Blend:Do not overload or overwhelm the environment. This is a two-way acceptance.An example of what not to do: “Once, I was at a restaurant and a big school bus pulled up. Getting out of it, I saw about 30 individuals that had bibs already put on them being shuffled out of the bus and into the shop in a line. How in the world is anyone supposed to feel normal and comfortable when overwhelmed like that? Why should every person on that bus be forced to wear a bib?” – AGP staff member
  • Ask the audiences: How do you create such responses?
  • According to the National Gay and Lesbian Task Force, there are currently between 1.4 and 3.8 million LGBT (lesbian, gay, bisexual, and transgender) Americans over the age of 65. By 2030, this number is expected to increase to between 3.6 and 7.2 million LGBT Americans. A Grace Place was shocked at the staggering amount of people that were aging in isolation because they were scared to seek help. They realized that Richmond ranks #16 nationwide in the number of Lesbian and Gay identified households.The agency wondered: What can we do to provide a person-centered response to these individuals?
  • KryssAnne was a transgender female who was into her twelfth month of an 18-month terminal diagnosis of lung cancer. She was afraid of healthcare professionals and being discriminated against. Acouple years ago VCU’s gerontology department partnered with A Grace Place to do a cultural competence training on the LGBT community; this center was one of the first community organizations to step forward and train their ENTIRE staff on issues unique to the LGBT and Aging population. There is an open door policy on admission here. Members of the LGBT population are welcomed. How is this an example of Person-Centered Care?.
  • An example of strong executive leadership and management.
  • Participant Exercise: If you could write down one item from our time together today on an index card and tape it to your computer monitor, the sun visor in your car or to your refrigerator as a reminder of what you learned today, what would it be?
  • Ask for examples on a daily basis of how you allcapitalize on individual’s strengths?A story from the focus groups revealed that a man who had been in a motorcycle accident had trouble communicating. A staff member said, “The most frustrating thing is trying to communicate with him because people will get impatient with him.But you just have to remember he has a brain injury and that sometimes communicating is going to be a slow process. You have to listen, and even though both parties are frustrated, you must reach even ground. It was something he was used to, being able to talk without taking a while and without problems talking. Even now though, he really is trying to speak- it just takes so long.” A fellow staff member knew which individual her coworker was referring to and revealed that the other day he apologized, saying, ““I’m sorry. Sometimes it takes a while for me to get my words out…” and she replied saying, “That’s okay, sometimes it takes me a while to get my words out, too!” In doing this, she made him feel better- she validated how he was feeling and was able to relate and identify him. She knew him well enough to use humor in this situation and joked with him, instead of knocking him down. This is an example of knowing the individual and understanding what that person is going through. Knowing the patient is key (how they receive or don’t receive humor) as well as knowing the family.Referencing that same individual, another staff member mentioned, “He’s good with the restroom, but he HAS to count out and wash his hands for 20 seconds. I don’t know if it was something drilled into his head at a young age but he HAS to do this. You cannot rush him during this or he will get aggravated.” This is another example of truly knowing that individual and his routines.
  • An example:“When a woman had first come in, she’d had a stroke. She had children and her husband was very beside himself and he didn’t know what to do, he needed help. When she first came in here she couldn’t move out of her chair at all, and I don’t think she was interested in trying to. She was angry at life at that point. Since then, she’s taken control of herself and loves coming here. Her children have gone to college. She has been able to do more and more over the years. We encourage her and make her not feel embarrassed. She didn’t want to be embarrassed and wasn’t comfortable asking for help. She’d go to the bathroom and make a mess, and sometimes she still might, but that’s okay,- she’s doing it independently. When she first came in her poor husband was so upset because she wouldn’t bear any weight at all (on side she couldn’t use due to stroke she wouldn’t bear weight on the bathroom bars to help pick herself up, so her husband literally had to pick her up each time). I told him that she could do more than what she’s showing you.” –AGP Staff MemberChange is hard, and this impairment was all new to her too… Continue to support patient to try new tasks and give positive reinforcement. Building a patient’s confidence is key. It’s like Henry Ford said, “If you think you can, you’re right. If you think you can’t, then you’re right too.” Example 2: “There’s one lady who loved to cook and owned a bakery before she retired. She had a stroke and was really depressed. Her husband wouldn’t let her bake at home because she made such a mess. She really missed getting her hands in the dough, and, I mean, she can really cook! We let her cook here. She was thrilled; it allowed her to get back to her norm (baseline!). Here, we don’t care how messy it is, we just want to make sure they’re enjoying what they’re doing. It doesn’t matter to me that you just put the spoon in your mouth; I’ll just take it out and give you a new one. Just the process of putting cookie dough on the pan is engaging and enjoyable for clients. We did an activity with her here with a cooking group and I looked over and a client was eating all of his Hershey Kisses before putting them on the intended cookie dough, but I didn’t care, he was doing what he wanted to do and he was enjoying it. He chose what to do with them. It’s their choice, I think that’s the biggest thing, that it’s their choice.”
  • Multi-Sensory Care and StimulationHonor who they were, their rituals, their occupations, their roles. Role transition is one of the most difficult parts of aging or change in cognitive status. Our roles are engrained into our essence. Into our being. Supporting the maintenance of these roles supports PCC and positive health outcomes.Case study: “There’s one lady who loved to cook and owned a bakery before she retired. She had a stroke and was really depressed. Her husband wouldn’t let her bake at home because she made such a mess. She really missed getting her hands in the dough, and, I mean, she can really cook! We let her cook here. She was thrilled; it allowed her to get back to her norm (baseline!). Here, we don’t care how messy it is, we just want to make sure they’re enjoying what they’re doing. It doesn’t matter to me that you just put the spoon in your mouth; I’ll just take it out and give you a new one. Just the process of putting cookie dough on the pan is engaging and enjoyable for clients. We did an activity with her here with a cooking group and I looked over and a client was eating all of his Hershey Kisses before putting them on the intended cookie dough, but I didn’t care, he was doing what he wanted to do and he was enjoying it. He chose what to do with them. It’s their choice, I think that’s the biggest thing, that it’s their choice.”
  • Referencing that gentlemen earlier that has trouble communicating. Being patient and allowing him to speak may require more time on the front end but can have greater positive health outcomes in the long run. For example, ask the audience: if you are impatient or try to finish his sentences or rush him as he tries to speak, will he really be able to say what he wanted to say in the first place? Will you ever know what he really wanted to say?Case study exemplifying the importance of having flexibility from staff member from the Adult Day Program: “There are times when the staff can take the extra time to sit down at an empty table and actually have a conversation with one of our individuals or play a game of cards with that person and get to have more intimate interactions. Then the staff can really focus on getting that person to recognize the cards numbers, lay the cards out, and things like that, direct attention. Then there are other times when we everyone is up on the floor doing a full interactive group activity, and the whole group is involved. During these group interactions we can pull individuals one at a time from that group to give each one individual time- we really a chance to get to know each person on a personal level. Sometimes our clients may reveal something to us that we don’t necessarily get when we’re in that larger group setting. Because of the flexibility, we can pull a client aside and say, ‘Okay while they’re doing that activity, I know that’s not one of your favorites so let’s play a game of cards, or let’s do what you want to do.”“In Memory Care, we watch as our individuals lose things throughout the months and years of their stays. I know each person and can figure out something for each person to do. To some people the things we do may seem childish, but they aren’t to the individual. I try to pair the complexity of the task to the needs of the individual, gradually making tasks easier, but still making them feel productive. Sometimes it could be as easy as simple hand eye coordination, just to keep them from sitting there and keeping them engaged.”
  • A Grace Place utilized a daily documentation that the staff refers to as, “the book” (includes ISP). Each patient has an individualized book that includes:• Particular disability• Medical information• Information about behaviors and behavior patterns• Personal information and/or preferences• A list of outcomes and what they work on a daily basis or bi weeklyThis allows all staff members to refer to each client’s book and change how they care for the individual as the individual changes.Communication log: “Some of us have communication logs we send home because we need to know about their night up until the morning they come in. Not every client has one, it’s usually the high intense behavioral problems so we know what mood that individual is in. The slightest thing can set her off, so if her transportation is late, I need to know about it. If she wanted to put on shorts that morning and she didn’t get to, I need to know. This helps us know what she will and won’t do today.”Team Approach to Care:“If it weren’t for the floor staff, the program directors and nursing staff would probably miss things. Nurses can’t be everywhere at one time. Our staff knows when an individual is off, down to the level of detecting if someone is not blinking correctly.”Calling after hours: During the focus group meetings, we found that it is not infrequent for staff members from A Grace Place to call each other after hours to inform them of anything going on with an individual. For example, if one staff member had to leave early and an individual that staff member was close to had an incident or got really upset or frustrated, another staff member would likely call to let them know what happened and what to maybe expect when that person comes in the next morning. Even though the staff is not on duty or even necessarily getting compensated, they take time out of their days to practice this person-centered care. They know it is a win/win, it will make everyone’s day better tomorrow when we just put a little more work in the front end.
  • Best Practice: At A Grace Place, we work with many individuals with aggressive behavior. Our professional caregivers are sometimes assaulted. We understand that this is part of the job. It is part of giving care to the individual. However, the care team will still come together to support this care professional, including a phone call and card from the CEO.“When frustrated, you just have to learn to roll with things, getting that flexibility. Take yourself out of the moment just give it time to decompress, don’t just react, take a step back versus being all wrapped up in it all the time. This is bad, but the weather will change in 5 minutes.” Case Study: Teamwork is a huge component of A Grace Place. If one of our professional caregivers is not feeling well, the others immediately pick up on it and will step in to help.”Case Study: “I came in the other day nor feeling too well and one of the men I work with asked me, “What’s wrong, sugar?” Our moods directly impact those to whom we give care and it is important that we work together as a team to ensure that our bad day is not transferred to our individuals. They are very sensitive since we are around each other so much.Best Practice: Often sick leave and vacation is not taken simply because it is in abundance and the care professionals enjoy what they do.
  • Caregiver Education Program:This program helps caregivers develop the skills to directly assist their loved one with personal care needs, as well as to help teach daily living skills. We provide workshops for our caregivers and the community, as well as maintain a large caregiver resource section on our website.Telephone Support for Caregivers:In a partnership with the VCU Department of Gerontology, A Grace Place worked with students to make caring phone calls to family caregivers at times that were convenient for them. The caregivers appreciated the opportunity to share their feelings and students learned more of what it is like to be a family caregiver, to work full time, to have multiple generations living under one room and to, in general, be more person centered in their approach to care.
  • This Person-Centered Village Leads toA Caring ResponseCrystal’s story. A dear member of the professional caregiver team at A Grace Place recently passed away. She did not show up for work one morning, which was uncharacteristic. Her home was called, the police were called and finally she was located, having passed away in her car at her second job. The team and family at A Grace Place created an award in her honor, attended her funeral, even one of the individuals and her mother, to whom Crystal has given care, attended the funeral. This is person-centered care.“If I feel under the pressure of stress, I just find some one to confide in... I just find that one touchstone I can process with.” I remind myself, ‘I'm their only family, and when clients smile whatever was stressing me goes out the window.’ An example from the Explorers program- “When we’re out in the community and someone wants to go find that SPECIFIC color of green pant, being able to go to Aeropostle store and buy green sweatpants, I can see, ‘Okay I’m complaining about my stress, but if I put myself in any of their shoes and had to deal with what they deal with everyday… it’s just so rewarding to know we’re bringing enjoyment to their lives.”“They don’t have anyone else… You are responsible for feeding them, getting them their snacks, and getting them to the bathroom, or do an activity with them. A lot of the time we spend more time with them than the families.”
  • “Teamwork is a huge component of AGP practices. If one person is not feeling well, the other staff immediately picks up on it and will step in for each other. At AGP each employee knows each client so it’s easy to step in for one another.” Best Practice: Celebrating birthdays, anniversaries. Program Managers and CEO are actively listening to every day challenges. Use mediation and reticulation exercises to help ensure that you understand. If an care professional comes to management with a problem, listen to what they are saying. Take notes. Rearticulate what they are saying to you, back to them. “I enjoy coming here because it’s not all policy. It’s different every day. Different people require different things, and it’s always different. I never have the same day, as opposed to the nursing homes with such strict regimens.” “We know each other’s hardships and help work around them.” “Our CEO is like having another mother, you can walk in and she’ll ask how a situation turned out. She’s what the agency is all about really. She’s unbelievable.” Our “CEO’s” policy: “You would want somebody just as sympathetic, and someone that knows both the clients AND staff. She has been in every position from the bottom up, and I think she can sympathize with all of us. She’s also sincere. Keep that PCC thinking for staff and clients.”
  • Note the centralized intake area and the needs-based compartmentalization combined with a good amount of outdoor space.Each program was designed with the unique needs and strengths that caters to each group.Space is person-centered, too.i.e. Adult Day Health is all about living community-style, with therapeutic recreation and nursing support in bright, spacious environment that encourages social interactions, as well as intellectual and physical activity. Participants enjoy field trips to local destinations such as museums, parks, restaurants, and stores. The space enables small group activities such as cards, games, and conversation, as well as large group activities ranging from entertainment to exercise to educational events. There’s also a fully accessible kitchen for preparing snacks and meals, as well as developing independent living skills. Whereas our Memory Support program is located in an area specifically designed to ensure participants feel comfortable, safe, and supported. The home-like furnishings are more than décor. We choose and prepare each item to ensure the safety and success of the clients. The patio provides an additional home touch, with a sensory herb garden, and a vegetable and flower garden. The building has a supervised pacing path and a specialized alarm system. An example of a Best Practice: When A Grace Place underwent a renovation, the staff were involved in color choices for paint. The staff suggested that ceilings be painted and decorated for individuals who lack muscle control and therefore their eyes look at the ceiling all day. Because staff had such an active role in the creation of the environment, they are more engaged in keeping it clean, safe and inviting.
  • Creating community partnerships is key as we emphasized. Here are some examples of the partnerships that exist with A Grace Place. What are your partners?Best Practices: Youth at Deep Run High School and their Dance-A-Thon. The service ethic is instilled early and continues through a lifetime.Faith-Based organizations offer people power and a critical mass of people who want to initiate a caring response.The Business Community is a great source not only of funding, but of volunteers. Days of Caring, Individual Volunteers (Peter Perkins), evidence shows that businesses that allow their employees to volunteer in meaningful activities also benefit.We asked earlier, how do we build a world where no one is left out? Now we ask, what does it take for people to get it? We think that community outreach is the answer. Inclusion. Volunteerism. Engagement. It takes experience to get it.Outreach: “We have invitations we send out to businesses and group homes to come see what a regular day here at AGP looks like. For instance, they had a general manager from Foodlion to come in and see exactly what they do there. We invite places we regularly go to come see our site. We’ve invited some of the public to our monthly tours to interact with us. Examples of good relations: YMCA, Straighter Lanes (bowling ally- they are great with our individuals), Brick Oven Pizza, Cici’s Pizza, Chik-fil-a, and Golden Coral.”
  • Note that the volunteers supports individual choice in topping selection for the cookies. Volunteers aren’t just making cookies FOR the individuals, they are making cookies WITH the individuals.Volunteers are vital to person-centered culture.Best Practice: Use of volunteers. Volunteers spend over 4,000 hours per year at A Grace Place. Even the volunteers ascribe to a person-centered philosophy with the individuals at A Grace Place.
  • PCC ResultsEmployee RetentionGreater understanding from healthcare teams about person-centered careGreater understanding of inclusion of all populationsMarketingEmployee CreativityPurposeful Living for Individuals and Care Professionals
  • Anytime you’re working with culture change you’re going to run into opportunities and challenges that often require some extra time and commitment. However, now the work is out there- the person-centered care philosophy is pretty common. We have the Alzheimer’s Association adopting it, the intellectually disability community embracing it- in fact the state is requiring that people working with the I.D. community are trained in person-centered thinking and planning. It’s here. There will be communication problems that arise that you work though and of course there will always be the overlay of government policies, but when you’re person-centered, you’re creative. You don’t think, “Oh the government won’t let me do this.” We approach it the other way, thinking, “How can I do this? What do I need to do in order to make this happen.”It’s a work in progress. Things are constantly changing. Everyone is building a responsive
  • Make a list of 2 things you would like to change at your facility based on this training.
  • Robert K. Greenleaf Center for Servant Leadership. (n.d.). What Is Servant Leadership? Retrieved from https://www.greenleaf.org/what-is-servant-leadership/
  • Person-Centered Caring and Culture Change in an Adult Day Setting - Best Practices

    1. 1. Person-Centered Caring and Culture Change in an Adult Day Setting: Best Practices
    2. 2. PRESENTATION OBJECTIVES: 1. Increased Understanding of Person Centered Care and Culture Change in an Adult Day setting. 2. An Introduction to Best Practices for Healthcare Professionals for Integrating Person-centered Care into An Adult Day Center 3. Best Practices for Team-Building and Support of Care Professionals 4. Best Practices for Community Engagement in an Adult Day Setting 2
    3. 3. INTRODUCE OUR WORLD REVIEW CONCEPTS REVIEW PHILOSOPHIES SHOW TRANSLATION OF CONCEPTS AND INTEGRATION OF PHILOSOPHIES AT AGP 3
    4. 4. INTRODUCE OUR WORLD REVIEW CONCEPTS REVIEW PHILOSOPHIES SHOW TRANSLATION OF CONCEPTS AND INTEGRATION OF PHILOSOPHIES AT AGP 4
    5. 5. SOCIALIZATION, PLANNED ACTIVITIES, and SUPPORTIVE HEALTH SERVICES in a safe and well supervised environment. COORDINATED PROGRAM of professional and compassionate services for adults in a community-based group setting. EMERGING PROVIDER OF TRANSITIONAL CARE AND SHORT TERM REHABILITATION following hospital discharge. ESSENTIAL SOCIAL and HEALTH SERVICES NEEDED TO ALLOW ADULTS TO REMAIN LIVING AT HOME while providing support and respite to caregivers. ADULT DAY CENTERS (ADC) MAINTAIN HIGHEST LEVEL OF HEALTH and/or INDEPENDENCE for the individual while providing respite and support to caregivers as PREFERRED PLATFORM FOR CHRONIC DISEASE MANAGEMENT, adult day centers are an interactive, safe, and secure environment for individuals requiring supervised daily care. 5
    6. 6. A Grace Place Care Adult Center www.agraceplaceacc.org/ 6
    7. 7. A Grace Place Adult Care Center celebrates each individual, each caregiver and each employee through Person Centered Thinking and Person Centered Care. ESTABLISHED NON-PROFIT • Since 1976, providing essential health and social services to support adults with disabilities and/or agerelated conditions, while providing respite and support for their caregivers. • with a strong mission focus to strengthen adult caregiving and to maintain or increase the health, independence and quality of life of both the adult in care and the caregiver. SERVING • Over 210 individuals per day. SEVEN • separate programs designed to meet the unique needs of each individual. • AD, brain injury, stroke, PD, intellectual disabilities, autism, cerebral palsy, etc. • Ages: 18 -100+. INDIVIDUALLYCENTERED PROGRAMS • Provide a community– based alternative to institutional care.
    8. 8. INTRODUCE OUR WORLD REVIEW CONCEPTS REVIEW PHILOSOPHIES SHOW TRANSLATION OF CONCEPTS AND INTEGRATION OF PHILOSOPHIES AT AGP 8
    9. 9. Institution-Directed vs. Person-Directed Care Culture Change Person-Centered Culture Person-Centered Care 9
    10. 10. PERSON-CENTERED CARE is an approach to care that respects and values the uniqueness of the individual, and seeks to maintain, even restore, the personhood of individuals. We do this by creating an environment that promotes: Personal Worth and Uniqueness Social Confidence Respect Truthfulness Independence Engagement Hope 10
    11. 11. Person-Centered Care Attributes Core Values of Choice, Dignity, Respect, Self-Determination and Purposeful Livingbe replaced with your own text. Rooted in the work of Tom Kitwood*, a British gerontologist. The text demonstrFosters optimal aging and living for the individual t will look when you replace the placeholder with your own text. PersonCentered Care Empowers Care is driven by the individual Tom Kitwood (1937-1998 ) was a British social psychologist and psychogerontologist, author of the theory of person-centered care approach; together with Kathleen Bredin, he developed the method of Dementia Care Mapping. 11
    12. 12. Having negative image of adults with a disability. Example: “Over the Hill” birthday cards and in terms of people with Intellectual or Developmental Disabilities, “retarded” jokes or the assumption that they are incapable of doing anything at all. . Behavior by one person that limits another’s freedom or autonomy. Example: Staff make a participant stop playing cards and join in a Trivia game which the staff is leading and is a favorite of the staff. Independence or freedom to do as one wishes. Example: Care Professional and Individual together selecting a time for one’s meals or activities rather than having it imposed. MEDICAL MODEL AUTONOMY PATERNALISM STEREOTYPING Key Terms Suggesting a traditional approach (contrasted with a holistic approach) to the diagnosis and treatment of illness. The physician focuses on the defect, or dysfunction, within the patient, using a problem-solving approach. 12
    13. 13. Autonomy vs. Risk RISK = Individual Safety and Liability RISK AUTONOMY AUTONOMY = INDEPENDENCE Surplus Safety* = Safety trumps ALL *Rooted in the teachings of Dr. Bill Thomas and the Eden Alternative as well as Dr. Judah Ronch. 13
    14. 14. What happens when we create an environment that is “too” safe, where individuals have no autonomy? Using the Questions tab of the Webinar’s Control Panel, please type in your own examples. 14
    15. 15. What happens when we create an environment where staff has NO voice? Using the Questions tab of the Webinar’s Control Panel, please type in your own examples. 15
    16. 16. Person-Centered Culture Direct care staff have a say in how work is carried out and how decisions are made. Individual preferences are the basis of care decisions. For the most part, staff organizes their routines to accommodate individuals’ routines. Developed by Sue Misiorski and Joanne Rader. Retrieved from www.pioneernetwork.net 16
    17. 17. Some of our language is “institutional” Person with… The language we use is important in providing person-centered care. The Language of Person-Centered Care Some of our language may unintentionally demean people. 17
    18. 18. POLL How do you refer to the people to whom you provide service? A. Participant B. Individual C. Client D. Patient 18
    19. 19. Heightened job satisfaction Heightened self-esteem Employees Heightened life skills Career opportunities Less staff turnover INTRINSIC Agency Less client turnover Increased quality care BENEFITS OF PERSONCENTERED CARE Increased satisfaction Individuals Increased connections to others Increased security, peace of mind Caregivers Increased financial support Marketing EXTRINSIC Donors Word-of-mouth value; propelling agencies into new partnerships Attractive model to support emotionally and financially 19
    20. 20. CULTURE CHANGE: National movement for transformation of adult services across the healthcare continuum Based on personcentered and directed values and practices Consideration: for the individual, caregivers and staff Deep system transformation that may require changes in organizational practices, physical environments, relationships at ALL levels and workforce models. 20
    21. 21. Institution-Directed vs. Person-Directed Care: What is the difference? 21
    22. 22. Institution-Directed Culture Staff provides standardized "treatments" based upon medical diagnosis. Work is task-oriented and staff rotates assignments. Schedules and routines are designed by the facility and staff, and individuals must comply. Institution -Directed Culture Decision-making is centralized. Structured activities are available when the activity director or other activity staff are on duty. As long as staff know how to perform a task, they can perform it "on any patient" in the facility. There is a hospital environment. Staff is disengaged There is a sense of isolation and loneliness. From the Pioneer Network website http://www.pioneernetwork.net/Providers/Comparisons/ 22
    23. 23. Person-Directed Culture Individuals make decisions every day about their individual routines. The staff makes decisions every day and is empowered. The staff has relationships with the individuals so that they know their lifelong habits and honor them. PersonDirected Culture The staff organizes their schedules and assignments to meet the needs of the individuals they care for. 23
    24. 24. Person-Centered Care: A Review 1 Enhancing professional caregiver’s capacity to be responsive 2 Enhancing facility involvement 3 Establishing a home-like environment 4 5 Returning control Recognizing and using employee to individual strengths 6 Relationship means knowing the individuals. This starts with their preferences for care, their daily routines, etc. It also means getting to know individuals on a deeper level (their history, their stories, etc) 24
    25. 25. 25
    26. 26. INTRODUCE OUR WORLD REVIEW CONCEPTS REVIEW PHILOSOPHIES SHOW TRANSLATION OF CONCEPTS AND INTEGRATION OF PHILOSOPHIES AT AGP 26
    27. 27. Inclusion Servant Leadership INFLUENCES ON CARE PHILOSOPHY Eden’s Philosophy PersonCentered Care
    28. 28. The three plagues of Boredom, Loneliness, and Helplessness account for the bulk of suffering among our clients. *The words create an acronym B L and H  BLaH EDEN ALTERNATIVE PRINCIPLES A Person-centered community commits to creating a Human Habitat where life revolves around close and continuous contact with plants, animals, and children. It is these relationships that provide the young and old alike with a pathway towards a life worth living. A Person-centered community imbues daily life with variety and spontaneity by creating an environment in which unexpected and unpredictable interactions and happenings can take place. This is the antidote to boredom. Clients deserve easy access to human and animal companionship. Loving companionship is the antidote to loneliness. A Person-centered community creates opportunity to give as well as receive care. This is the antidote to helplessness. Meaningless activity corrodes the human spirit. The opportunity to do things we find meaningful is essential to human health. Medical treatment should be the servant of genuine care, never its master. A Person-centered community honors its individuals by de-emphasizing top down bureaucratic authority, seeking instead to place the maximum decision making authority into the hands of the Clients to care professionals. Creating a Person-Centered community is a never ending process. 28
    29. 29. Know each person and employee Each person can and does make a difference The Values and Principles of the Pioneer Network Relationship is the fundamental building block of a transformed culture Respond to spirit, as well as mind and body Risk taking is a normal part of life Put person before task All adults are entitled to self-determination wherever they live Community is the antidote to institutionalization Do unto others as you would have them do unto you Promote the growth and development of all Shape and use the potential of the environment in all its aspects: physical, organizational, psycho/social/spiritual Practice self-examination, searching for new creativity and opportunities for doing better Recognize that culture change and transformation are not destinations but a journey, always a work in progress www.pioneernetwork.net 29
    30. 30. Social inclusion A socially inclusive society is defined as one where all people feel valued, their differences are respected, and their basic needs are met so they can live in dignity. Social exclusion is the process of being shut out from the social, economic, political and cultural systems which contribute to the integration of a person into the community (Cappo 2002). Everyone Is Ready None of us has to pass a test or meet a set of criteria before we can be included. Everyone Can Learn As human beings we all grow and change and make mistakes: and we are all capable of learning. The Values that Underpin Social Inclusion developed by Scottish Human Services Trust (2005) Everyone Needs Support Sometimes some of us need more support than others. Everyone Can Communicate Not using words doesn’t mean we don’t have anything to say. Everyone Can Contribute We need to recognize, encourage and value each person’s contributions including our own. Together We Are Better We are not dreaming of a world where everyone is like us - difference is our most important renewable resource. 30
    31. 31. Servant Leadership Servant-leader focuses on the growth and wellbeing of people and the communities to which they belong. While traditional leadership commonly involves the accumulation and exercise of power by the person at the “top of the pyramid,” servant leadership is different. The servant-leader shares power, places the needs of others first, and helps people develop and perform as highly as possible. -Check your ego at the door (Rooted in Robert K Greenleaf’s work in the Center for Servant Leadership) 31
    32. 32. Mr. Carter was only ten years old in 1950 when he was committed to a state training school. He had picked up a brick and threw it at a child, who was Caucasian, who was teasing him. Mr. Carter, who was African American was “slow” and had little family support. In the 1990’s, he was identified as misplaced in a state training school and was going to return to the community. A social worker contacted me to see if we could serve him. I immediately said yes and shared the information with the staff. The staff’s reaction was strong and I was told, “We do not accept the mentally retarded.” I was two years into the job and was unaware of any such procedure. What would you do in my place? A. Contact the social worker and relate that we are unable to accept him in our program at this time B. Reinforce my leadership and authority and express that we are going to do things differently now that I am in charge. C. Tell the back story of Mr. Carter and build a connection. 32
    33. 33. Leaders must lead* • Create an atmosphere that celebrates the vision and mission • Solicit input from all stakeholders, caregivers, staff, volunteers, individuals, donors, regulators Practical Strategies • Build a high energy work force • Ask work force, in small groups, to develop a set of values that describe the work culture, ask each person to bring in an object that best represents their belief system and then ask them to explain it. Use this to formulate the values for their agency. • Model expectations • Maintain an “open door policy” • Provide support to Professional Caregivers • Roll up your sleeves, help staff do their work, work with individuals • Serve as the Cheerleader for all • Build ownership • Be a visionary • Keep staff informed, have lots of meetings and talk about “Our Business” • Know everyone’s name • Develop wellness teams for staff and let them decide what strategies they want to work on for their health *David Pitonyak, Issue Action Planning: Promoting Responsive Human Services • Make coming to work fun, something to look forward to 33
    34. 34. Leaders must empower staff Practical Strategies • Create a culture that values every voice, every opinion • Frequently ask for suggestions and be sure to act on some • Listen, Listen, Listen! especially when it is hard to hear! • Encourage “dreams” and wishes • Form self-directed work teams to carry out important work i.e. Wellness program, customer satisfaction team • Build trust, build teamwork • Compliment staff on good work • Drive our fear • Empower staff to explain program services to guests • Focus on the sincere belief that all employees are capable, honest, trustworthy and very capable. • Manage by consensus and build decision making from the “bottom up”. The people closest to the individuals know the situation best and can with support and confidence from the manager, make best decisions • Encourage staff to decide furnishings, colors, equipment they need • Ask for input and involvement on policies/procedures before you issue a “regulation” • Reinforce identification with mission 34
    35. 35. Leaders must create celebrations • Reinforce accomplishments • Highlight acts of kindness • Create reflections • Create fun Practical Strategies • Develop contests such as mission moments where staff are divided into teams to create a visual depiction of the Mission Statement/Values (Quilt, sculpture, DVD) • Give kudos at staff meetings • Write personal handwritten notes from CEO • Celebrate everyone’s birthday • Know your employee’s family, who is graduating, who has grandchildren • Have “All Hands on Deck” meetings quarterly and celebrate staff’s family’s milestones, “shout out” on graduations, births, etc. 35
    36. 36. Staff needs to be constantly and repeatedly grounded in the agency’s mission and vision. Performance Appraisals and evaluations reflect each employee’s ability to support the mission, values of organization. A successful work culture starts with the interview, hiring process. Managers must “walk the walk” – not just “talk the talk”. Lessons Learned 36
    37. 37. INTRODUCE OUR WORLD REVIEW CONCEPTS REVIEW PHILOSOPHIES SHOW TRANSLATION OF CONCEPTS AND INTEGRATION OF PHILOSOPHIES AT AGP 37
    38. 38. A Grace Place’s Values: How were they developed? TRUST: Assured reliance on character, strength, and truth TEAMWORK: Sharing individual skills and talents to reach a common goal PROFESSIONALISM Be the best you can be in conduct, appearance, and attitude FLEXIBILITY: Ability to adapt to changing needs of the members and the organization EMPATHY: Care with understanding hope DEDICATION: A steadfast commitment to an optimal quality of life for our members, their families, & each other EMPOWERMENT: Practicing the belief that each individual can make their own decisions and act on them INCLUSIVE: Embracing each individual as part of the whole HUMOR: Loving and playful approach to challenges IMAGINATION: Creating new and spirited approaches that further independence PERSEVERANCE: Doing what it takes to realize dreams RESPECT: Valuing difference and allowing for compromise PRIDE IN PLACE: Demonstration of respect we show to our members, peers, and community 38
    39. 39. Does your agency’s mission statement and its values reflect what you feel your agency provides? 39
    40. 40. It takes a village to support an individual. From the professional caregivers at A Grace Place to family caregivers at home to the drivers that drop our individuals off, everyone is entitled to a person-centered response.. Villages are constantly changing. 40
    41. 41. The Person-Centered Team A PERSON-CENTERED PHYSICAL ENVIRONMENT OTHER ADULT DAYS (Advocacy + Civic) BOARD OF DIRECTORS (Breakfast) CARE PROFESSIONAL (Happy Employees) CARE PARTNER (Supporting them where they are) INDIVIDUAL (Inclusive, we rarely turn anyone away) 41
    42. 42. Best Practices based on Person-Centered Care Pet Therapy Music Therapy Validation Therapy Best Practices for PersonCentered Care Reminiscence Therapy Team-Work One-on-One Care Inclusion Wellness Program Expressive Arts Program (Both within organization & throughout community) 42
    43. 43. What does Community Inclusion mean? How can we promote it? How do we build a world where no one’s left out? 43
    44. 44. Best Practices for Community Inclusion: 44
    45. 45. Best Practices for Inclusion found at A Grace Place: Inclusive Attitude  Everybody Matters Everyone Is Ready Everyone Can Learn Everyone Needs Support Everyone Can Communicate Everyone Can Contribute Together We Are Better Community-normalized: – – – – Transportation Assistance Eating Style Dress Code Business Cards 45
    46. 46. How do we create a Person-Centered Response to Each Individual? 46
    47. 47. AN EXAMPLE OF INCLUSION: By 2030, between 3.6 and 7.2 million LGBT Americans 45,000 Lesbian and Gay Households in Virginia by 2030 Richmond ranks #16 nationwide in the number of Lesbian and Gay identified households AGP first agency to provide Person-Centered Care Training for Direct Care Support Professionals providing Care in Adult Care Services Facilities 47
    48. 48. KryssAnne A transgender female who battles a terminal illness, isolation and fear of healthcare professionals who "don't want to touch my body.” 48
    49. 49. Hannah Green is forty five and has been working at A Grace Place for over ten years. She works in the program that supports adults with intellectual disabilities and has a very good work record. She is a valued employee and is well liked by her peers, and the individuals she supports. When Hannah heard at a staff meeting that the agency was going to offer training in LGBT in long term care and that attendance was compulsory, she became very concerned. Her supervisor overheard her say to her peers that she “was not going to attend even if it cost her, her job.” How would you handle this? A. Talk with the employee and allow her to be absent based on the strong religious objections she expressed. B. Require her to be present. C. Take no action and see what she does D. Open up a dialogue with the employee and see where “the middle” is 49
    50. 50. People accept individuals when they have an opportunity to know them, identify with them. People connect with real stories of real people and this connection is vital to overcoming prejudices and discrimination. Assumptions can be broken down individual by individual. Lessons Learned 50
    51. 51. KNOW THE INDIVIDUAL Client: “I’m sorry. Sometimes it takes a while for me to get my words out…” Caregiver: “That’s okay, sometimes it takes me a while to get my words out, too!” Get to know their back-stories: who they were, who they are, and who they would like to be. They are more than diagnoses. 51
    52. 52. EMPOWER A hallmark of PCC is empowering the individual. It may take more effort initially, but will reap rewards in the long run. Honor their individual experiences. Listen to who they are. Understand who they were, who they are and who they want to be. Learn to listen. 52
    53. 53. SUPPORT ROLE TRANSITIONS Honor who they were, their rituals, their occupations, their roles. Role transition is one of the most difficult parts of aging or change in cognitive status. Our roles are engrained into our essence. Into our being. Supporting the maintenance of these roles supports PCC and positive health outcomes. 53
    54. 54. ONE ON ONE CARE A little more time and effort on the front end can have greater positive health outcomes in the long run. 54
    55. 55. Team Approach To Care Calling After Hours “The Book” Best Practices for Staff Communication Communication Log Informal Professional Caregiver Meetings each morning 55
    56. 56. A Person-Centered Response to Each Professional Caregiver Keep the engines running! • Within a work team model, staff can take a break when they need it and the collective team steps in until the professional caregiver returns Respite! • A Grace Place offers 3 weeks of annual vacation, holidays and 3 hours of sick leave accrued biweekly • Everyone is willing to do 2 on 1, supervisors are always willing to switch sides if support is needed 56
    57. 57. A Person-Centered Response to Each Family’s Needs Caregiver Support • is essential to PCC. They spend as much time with their loved one as we do and can often provide information that is vital to their well-being. Caregiver Education Program Telephone Support for Caregivers 57
    58. 58. How Does Such a Village Lead to A Caring Response? A family of friends Sharing and delighting in the accomplishm ents of each individual Home away from home Encouraging that one-onone relationship “The individuals- you get attached, it’s hard not to. To us, we’re family to them. A lot of them don’t have any other family. This is all they know- it is their home away from home.” -AGP staff member “I love helping them discover something they didn’t realize they could do. Like handing money to a cashier. Or ordering their own meal when they are out. You’d think it was Christmas.” -AGP staff member 58
    59. 59. How to Build a Village of Support: Team-Building and Servant Leadership Practices Know your care team of care professionals like you know the clients Have strong executive and management support and leadership • “We know each other’s hardships and help work around them.” –AGP staff member • If a care professional comes to management with a problem, listen, take notes, rearticulate out loud what is being said to you, to ensure that you understand. Be flexible Have team meetings and consistent communication 59
    60. 60. The Physical Environment of AGP’s Village Note the centralized intake area and the needs-based compartmentalization combined with a good amount of outdoor space. 60
    61. 61. Community Partnerships • • • • • • Youth Programs United Way Faith-Based Organizations The Business Community Other Adult Day Centers Volunteerism 61
    62. 62. Person-Centered Volunteers 62
    63. 63. Employee Retention Greater understanding from healthcare teams about personcentered care Purposeful Living for Individuals and Care Professionals PCC Results Greater understanding of inclusion of all populations Employee Creativity Marketing 63
    64. 64. Opportunities and Challenges of Change Change requires extra time and commitment of an already overwhelmed work force and can be exhausting and cause stress. Communication between departments can be daunting. Governmental regulations and policies may require additional effort and demand creativity. On-going training and support of staff are vital to success. Staff may lack selfconfidence and emotional support needed to change/embrace new ideas. Reflection and Evaluation among individuals and work teams may be inconsistent Will we lose clients? Will we lose staff? Positive health outcome for individuals Higher work satisfaction for employees Purposeful living for individuals Higher census through word of mouth marketing, plus reduced advertising expenses More effective work teams 64
    65. 65. REFLECTION • What have you taken away from our time together today? • Can you share your valuable practices to advance person centered care? • How can we support you? 65
    66. 66. Resources • David Pitonyak article: – http://www.dimagine.com/Toolbox.pdf • Eden Alternatives – www.edenalt.com • Person-Centered Care and Dementia Care – http://www.alzheimers.org.uk/site/scripts/documents_info.php?doc umentID=1191&pageNumber=3 • Patient Centered Care Improvement Guide – http://planetree.org/wp-content/uploads/2012/01/Patient-CenteredCare-Improvement-Guide-10-28-09-Final.pdf • The Pioneer Network – https://www.pioneernetwork.net/ • Servant Leadership – https://www.greenleaf.org/ 66
    67. 67. www.agraceplaceacc.org/ www.sahp.vcu.edu/gerontology/ • Lynne Seward: lynneseward@agraceplaceacc.org • Debbie Scott: debbiescott@agraceplacecc.org • Jay White: 804-828-1565 whitejt2@vcu.edu Please fill out your survey! 67

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