Person centered care_web


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Presentation made by Lynne Seward, CEO, A Grace Place Adult Care Center and Jay White, MS, Virginia Commonwealth University, Department of Gerontology, October 31, 2012. Review recording of webinar at

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Person centered care_web

  1. 1. Lynne Seward, CEO, A Grace Place Adult Care Center Jay White, MS, Gerontologist and Director, Professional and Community Development, VCU Department of GerontologyPerson-Centered Caring and Culture Change in anAdult Day Setting: Best Practices 1
  2. 2. LEARNING OBJECTIVES Increased understanding of Person Centered Care and Culture Change in an Adult Day setting. An introduction to Best Practices for healthcare professionals for integrating Person-Centered Care into their workforce An introduction to issues related to LGBT and Aging An introduction to the curriculum “A Caring Response: Giving Care to the LGBT Older Adult” 2
  3. 3. Person-Centered Care is an approach to care that respectsand values the uniqueness of the individual, and seeks tomaintain, even restore, the personhood of individuals.We do this by creating an environment that promotes:Personal Worth and Uniqueness Social ConfidenceRespect TruthfulnessIndependence Engagement Hope 3
  4. 4. What is Person-Centered Care? Core Values of Choice, Dignity, The text demonstrFosters optimal Respect, Self-Determination and aging for the individual Purposeful Livingbe replaced with t will look when you replace the your own text. placeholder with your own text. Person- Centered Care Rooted in the work of Tom Empowering Kitwood*, a British gerontologist. Care is driven by the individualTom 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. 4
  5. 5. MEDICAL MODEL PATERNALISM AUTONOMY AGEISMAgeism: a Paternalism: Autonomy: Medical Model:stereotypical behavior by one Independence suggesting aand/negative image person that limits or freedom to traditional approachof older adults. another’s freedom do as one (contrasted with a or autonomy. wishes. holistic approach) toExample: “Over theHill” birthday cards Example: Waking the diagnosis andAnd in terms of people someone up from Example: treatment of illness.with Intellectual or sleep and making Selecting a time The physicianDevelopmental them have breakfast for one’s bath or focuses on theDisabilities, “retarded” before they are ready. meals rather than defect, orjokes or the assumption having it imposed. dysfunction, withinthat they are incapable the patient, using aof doing anything at all.. problem-solving approach. 5
  6. 6. Autonomy vs. Risk RISK = Resident 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. 6
  7. 7. What happens when we create an environment that is “too” safe where older adults have no autonomy? Using the Questions tab of the Webinar’s Control Panel, please type in your own examples. 7
  8. 8. What happens when we create anenvironment where staff have no voice? Using the Questions tab of the Webinar’s Control Panel, please type in your own examples. 8
  9. 9. Direct care staff have a say in how work is carried out and how decisions are made. For the most part, staff organizes their routines to accommodate residents’ routines. Person-Centered Culture Resident preferences are the basis of care decisions.Developed by Sue Misiorski and Joanne Rader. Retrieved from 9
  10. 10. Culture Change:National movement for transformation of older adult services across the healthcare continuum Consideration: Based on person- for elders, elder centered and directed caregivers and staff values and practices Deep system transformation that may require changes in organizational practices, physical environments, relationships at ALL levels and workforce models. 10
  11. 11. Long-Term Care and Person-Centered Caring Moving into many long-term care environments meansthat individuals lose “normalcy in their life” – their daily routines, interests, and preferences. Unintentional as it may be, our residences require individuals to conform to our institutional, efficient routines. The result is the resident’s quality of life being compromised. 11
  12. 12. Institution-Directed vs. Person-Directed Care: What is the difference? 12
  13. 13. Institution-Directed Culture Staff provide standardized Schedules and routines are "treatments" based upon medical designed by the community diagnosis. and staff, and elders must comply. Work is task-oriented and staff As long as staff know how to Institution- rotates assignments. perform a task, they can Directed perform it "on any patient" in Culture the home. Decision making is centralized. There is a hospital environment. Structured activities are There is a sense available when the activity of isolation and director is on duty. loneliness. Staff is disengagedFrom the Pioneer Network website 13
  14. 14. Person-Directed CultureResidents make decisions every The staff have relationships withday about their individual the residents so that theyroutines. know their lifelong habits and honor them.Staff make decisions every day Person-and are empowered. Directed CultureStaff organize their schedules andassignments to meet the needs ofthe residents they care for. 14
  15. 15. The Language ofSome of ourlanguage is Person with… Person-Centered“institutional” The language we Care use is important in Some of our providing person- language may centered care. unintentionally demean people. 15
  16. 16. POLLHow do you refer to the people to whom youprovide service? A. Resident B. Individual C. Client D. Patient 16
  17. 17. The Language of Person-Centered Care (medical model) Old Word Suggestion wing, unit household, street, neighborhood, avenue pad, brief, disposable brief, brand names, diaper incontinence garment the elderly elders; older adults, people, or individuals resident (some think this is passé), patient individual, elder person who needs/ people who need assistance a feeder/the feeders, feeder table with dining, dining table a diabetic, a quad, a CVA a person who has (whatever condition) nurse aide, CNA, nursing assistant, resident assistant, certified resident assistant front line staff (sounds like war) admit, place move in discharge move out lobby, common area living room, parlor, foyer nurses station work area, desk facility, institution, nursing home home, life center, living center dietary services, food service dining services 17
  18. 18. Using the Questions tab of the Webinar’sControl Panel, please suggest additional words which reflect the Language of the Person-Centered Care 18
  19. 19. Know each person and employee Each person can and does make a difference The Values and Principles Relationship is the fundamental building block of a transformed culture of the Pioneer Network Respond to spirit, as well as mind and body Risk taking is a normal part of life Put person before task All elders 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 work in progress 19
  20. 20. Important Components of Person-Centered Caring Environments 1 2 3 4 5 6 Enhancing Establishing a home Returning control Recognizing and Enhancing direct Relationship community to residents using employeecare staff’s capacity means knowing involvement strengths to be responsive the residents. This starts with their preferences for care, their daily routines, etc. It also means getting to know residents on a deeper level (their history, their stories, etc). 20
  21. 21. 21
  22. 22. A Grace Place Care Adult Center 22
  23. 23. A Grace Place Adult Care Center celebrates each individual, each caregiver and each employee through Person Centered Thinking and Person Centered Care. • 46 years+ , providing essential health and social services to support adults with disabilities and/or age-related conditions, while providing respite and support for their caregivers. • Serve >210 individuals a day. • 7 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+. • Non-profit 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. • Provide a community–based alternative to institutional care.
  24. 24. Influences on Care Philosophy Influences on Care Philosophy
  25. 25. Eden Alternative Principles An Elder-centered community commits to creating a human habitat where life Loving companionship is the antidote to The three plagues of loneliness, revolves around close and continuing loneliness.helplessness, and boredom account for contact with plants, animals, and the bulk of suffering among our older children. adults. It is these relationships that provide the Elders deserve easy access to human young and old alike with a pathway to a and animal companionship. life worth living. An Elder-centered community imbues Meaningless activity corrodes theAn Elder-centered community creates daily life with variety and spontaneity by human spirit.opportunity to give as well as receive creating an environment in which care. unexpected and unpredictable interactions and happenings can take The opportunity to do things that we place. find meaningful is essential to human This is the antidote to helplessness. This is the antidote to boredom. health. An Elder-centered community honors its Elders by de-emphasizing top-down Creating an Elder-centered community Medical treatment should be the bureaucratic authority, seeking instead is a never-ending process.servant of genuine human caring, never to place the maximum possible its master. decision-making authority into the Human growth must never be separated hands of the Elders or into the hands of from human life. those closest to them. Wise leadership is the lifeblood of any struggle against the three plagues. For it, there can be no substitute. 25
  26. 26. Building a Person CenteredWork Culture/Place Search $$$ Win-Win ADA Article Consistency IndividualFlexibility Sharing Workplace Recognition Control Change 26
  27. 27. Mr. Carter was only ten years old in1950 when he was committed to a stateinstitution. 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 hadlittle family support.In the 1990’s, he was identified as misplaced and was going to return to thecommunity. A social worker contacted me to see if we could serve him. Iimmediately said yes and shared the information with the staff. The staff’sreaction 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. Whatwould you do in my place?A. Contact the social worker and relate that we are unable to accept him in our program at this timeB. 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. 27
  28. 28. Leaders must lead* Practical Strategies• Create an atmosphere that celebrates the • Ask work force, in small groups, to develop a set vision and mission of values that describe the work culture, ask• Solicit input from all stakeholders, each person to bring in an object that best caregivers, staff, volunteers, individuals, represents their belief system and then ask them donors, regulators to explain it. Use this to formulate the values for• Build a high energy work force their agency.• Model expectations • Maintain an “open door policy”• Provide support to staff • 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 • Make coming to work fun, something to look*David Pitonyak, Issue Action Planning: Promoting forward toResponsive Human Services 28
  29. 29. Leaders must empower Practical Strategiesstaff• Create a culture that values every voice, • Frequently ask for suggestions and be sure to every opinion act on some• Listen, Listen, Listen! especially when it is • Form self-directed work teams to carry out hard to hear! important work i.e. Wellness program,• Encourage “dreams” and wishes 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, • Encourage staff to decide furnishings, colors, trustworthy and very capable. equipment they need• Manage by consensus and build decision • Ask for input and involvement on making from the “bottom up”. The policies/procedures before you issue a people closest to the individuals know “regulation” the situation best and can with support and confidence from the manager, make best decisions• Reinforce identification with mission 29
  30. 30. Leaders must create Practical Strategiescelebrations• Reinforce accomplishments • Develop contests such as mission moments• Highlight acts of kindness where staff are divided into teams to create a visual depiction of the Mission• Create reflections Statement/Values (Quilt, sculpture, DVD)• Create fun • 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. 30
  31. 31. Benefits of person-centered care INTRINSIC EXTRINSIC Employees Marketing •Heightened job satisfaction •Word-of-mouth value; propelling •Heightened self-esteem agencies into new partnerships •Heightened life skills •Career opportunities Agency Donors •Less staff turnover •Attractive model to support •Less client/resident turnover emotionally and financially •Increased quality care Individuals •Increased satisfaction •Increased connections to others Caregivers •Increased security, peace of mind •Increased financial support 31
  32. 32. Lessons Learned A successful work culture starts with the interview, hiring process 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. Managers must “walk the walk” – not just “talk the talk”. 32
  33. 33. PARTNERSHIP 33
  34. 34. LGBT Older Adults75% living alone Older Adults in33% General Population living alone LGBT Older Adults who90% have no children Older Adults in20% General Population who have no children LGBT Older80% Adults who are single Older Adults in General40% Population who are single 34
  35. 35. By 2030, between3.6 and 7.2 millionLGBT Americans 45,000 Lesbian and Gay Households in Virginia by 2030 Richmond ranks #16 nationwide in the number of Lesbian and Gay identified households 35
  36. 36. 97%Curriculum developed ALL staff at A Grace Place 97% Efficacyby the trained in 5 separateVCU Department of trainings inGerontology, Winter/Spring 2011Mad Stu Media and theLGBT Aging Project in2010-2011 36
  37. 37. 37
  38. 38. Lois and SheriA lesbian couple who have been together for over 40 years share concerns about aging in place and who will come to their aid. 38
  39. 39. Alexandre and LawrenceA gay couple together since the mid-1970s who battle Alexandres progressing Parkinsons Disease and an unwelcoming long term care environment. 39
  40. 40. KryssAnneA transgender female who battles a terminal illness, isolation and fear of healthcare professionals who "dont want to touch my body.” 40
  41. 41. MelA gay male who reflects on his relationship with his late partner, Walter, and their fear of coming out in a relationship that "the pendulum might swing the other way." 41
  42. 42. 42
  43. 43. What are we talking about? women attracted to other women men attracted to other men attraction to both men and women refers to gender identity 43
  44. 44. What percent of the population is considered to be gay, lesbian, bisexual, or transgender? a. 5% b. 10% c. 25% d. 50% 44
  45. 45. LGBT older adults have an increased risk of untreated serious illnesses? TRUE FALSE 45
  46. 46. Modeling PersonCentered Care 46
  47. 47. Hannah Green is forty five and has been working at A Grace Place for over tenyears. She works in the program that supports adults with intellectual disabilitiesand has a very good work record. She is a valued employee and is well liked byher peers, and the individuals she supports.When Hannah heard at a staff meeting that the agency was going to offer trainingin LGBT in long term care and that attendance was compulsory, she became veryconcerned. Her supervisor overheard her say to her peers that she “was notgoing 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 doesD. Open up a dialogue with the employee and see where “the middle” is 47
  48. 48. Resolution As a result of the Cultural Competence training, we saw that: Employee was counseled by the Director of Human She was told that she HR Director followed up Resources who did not have to later with employee and explained that this compromise her faith was told “It was not at training was required and belief system as an all what I expected. Ijust like other trainings individual, but she had am glad I went.and that she needed to to respect the rights of “I still believe this lifeattend. She was asked all persons who choice is wrong, but Iwhy she did not want to needed/gave care at the had no idea of the attend. agency. struggle and suffering.” Her religious “rights” Employee came to and objections were training stayed the acknowledged. entire time and become visibly moved by the story of Chris Ann. 48
  49. 49. Lessons Learned: People connect with real stories of real people and this connection is vital to overcoming prejudices and discrimination. People accept individuals when they have an opportunity to know them, identify with them. Assumptions can be broken down individual by individual. 49
  50. 50. 97% efficacy through trainings of over 500 healthcare professionals Curriculum Results Greater Greaterunderstanding understanding from healthcareof inclusion of teams about minority person- populations centered care 50
  51. 51. WIN-WIN Reaching out to a population as a means of census generation Training staff(not only healthcare professionals) in areas of cultural competence which result in universal positive health outcomes Reaching out to an under-served population 51
  52. 52. RECAP: Steps for Success I discussed the training I was approached by with Director of HR and Advisory Group was Film and curriculum were Department of then the entire agency composed of leaders in the reviewed and feedback Gerontology to serve on Leadership Team to build community and included sought on marketing to LGBT Advisory group the “buy in”. Question adults who were LGBT. other care facilities. project was: do we make the training mandatory? Team decided to require mandatory attendance Each supervisor discussed Group size was held to 20 Employees were mixed based on the agency’s training in their individual to allow for maximum between units, belief in inclusion, best team meeting. discussion and impact. departments. practices and our core values. I attended every meeting andintroduced speakers + reinforced HR Director reviewed Training included Only one staff of 95 voiced the value of the training by personnel policies and reflection, audience objections, but cameemphasizing this as another best brochures, marketing data practice and the role our agency participation, discussion anyway, one staff stood to be sure agency was had in civil rights justice and and a very moving film. away from group. person centered care. welcoming to LBGTAgency revised our policies to clarify LBGT inclusion. 52
  53. 53. Reflection and Evaluation among individuals and work teams may be inconsistent Staff may lack self-confidence and emotional support needed to Will we lose clients? Will we lose change/embrace new ideas. staff? On-going training and support of staff are vital to success. Positive health outcome for individuals Governmental regulations and policies may require additional Higher work satisfaction for effort and demand creativity. employees Communication between departments/units can be $$$$ More effective work teams daunting.Change requires extra time andcommitment of an already over- Challenges/ Higher census through word of mouth marketing, plus reducedwhelmed work force and can be exhausting and cause stress. Opportunities advertising expenses 53
  54. 54. AWARDS AND RECOGNITION FOR THIS COLLABORATION• A Grace Place received the VCU Department of Gerontology’s TIME Award for Theoretical Innovation and Maintaining Evidence Based Practice• Tracey Gendron received the Burnside-Watstein Award for creating a more LGBT-friendly environment on and around VCU• Asked to present this training throughout Virginia and to the Kent School of Social Work at the University of Kentucky, as well as at conferences in North Carolina and California. 54
  55. 55.• Lynne Seward:• Jay White: 804-828-1565/ Please fill out your survey! 55