Resident Center Culture & Management Relationship
Resident & Management Relationship University Local ExtensionCommunity Assessing ProgramsRelationship Emotional Wellbeing Resident & Staff Connectivity Physical Wellbeing Independent Living Assisted Living Social Connectivity Building Sustainable Senior Academics Spiritual Wellbeing Engaged Communities Community Vocational Living Skilled Living Connectivity Intellectual Wellbeing Village World ConnectivityEngagement Vocational Mentoring
RESIDENT ENGAGED RESIDENT CARE COMMUNITYCOMMUNITY Village Connectivity Emotional Wellbeing Vocational Connectivity Physical Wellbeing Social Connectivity Spiritual Wellbeing Resident/Staff Intellectual Wellbeing Connectivity
POST ACUTE CARE CHANGES WHAT IS BEING DONE? Quality of care in New Resident Care nursing homes must be Models addressed from all Pioneer Network angles: HatCH Model regulatory, Eden Alternative legal, advocacy, and Evergreen Model within the nursing home itself. To name a few models
Each person can and does make a difference :• 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 the person before the task• All elders are entitled to self-determination, wherever they live
• Establish resident direction in goal setting and care;• Re-organize and empower staff, focusing on responsibility, accountability and strong support to direct care workers (resident assistants);• Enable resident choice in aspects of daily life significant to the resident, such as time getting up and going to bed; eating; naps; times out-of-doors; favorite pastimes; times and methods of bathing; content of meals and the ways meals are served;• Emphasize the relationship between the resident and resident assistant as central to quality of life for both;• Create opportunities for relationships between hands-on caregivers and residents by using consistent assignment of staff
The Commonwealth Culture change or a Fund 2007 National resident-centered Survey of Nursing approach to care Homes Holistic Model of Care
Categories of Nursing Homes, by Extent of Culture Change Adoption Culture change definition* completely or for the most part describes nursing home Culture Change Adopters 31% Culture change definition* describes nursing home only in a few respects or not Traditional at all, and leadership is not 43% Culture change definition* very committed to adopting Culture Change describes nursing home only in culture change Strivers a few respects or not at all, but 25% leadership is extremely or very committed to adopting culture change* Culture change or a resident-centered approach means an organization that has home and work environments in which: care and all resident-related activities are decided by the resident; living environment is designed to be a home rather than institution; close relationships exist betweenresidents, family members, staff, and community; work is organized to support and allow all staff to respond to residents needs and desires;management allows collaborative and group decision making; and processes/measures are used for continuous quality improvement.Source: The Commonwealth Fund 2007 National Survey of Nursing Homes.
We are striving for …age-friendly communities, policies, services, settings and structures support and enable people to age actively by: respecting their decisions and lifestyle choices; protecting those who are most vulnerable; and promoting their inclusion in and contribution to all areas of community life.
Figure 2. Resident-Directed Culture Change Principles Currently Under Way Percent indicating that they are currently implementing the following initiatives: Enable residents to Actively involve Fully implement Currently determine residents in decisions “Bathing Without a implementing their own daily regarding their household/ Battle” techniques ALL THREE schedules neighborhood/unit^ resident-directed initiatives^ Neighborhoods: Areas in which traditional nursing unit is broken down into smaller functional units,in which ancillary services are shared with other neighborhoods; Households: Self-contained areaswith a full kitchen, living room and dining room, with a relatively small number of residents per household.Source: The Commonwealth Fund 2007 National Survey of Nursing Homes.
Guiding Principles of Eden Alternative The three plagues of loneliness, helplessness and boredom account for the bulk of suffering among our Elders – FFC, Loneliness, Isolation & Depression An Elder-centered community commits to creating a Human Habitat where life revolves around close and continuing contact with plants, animals and children. It is these relationships that provide the young and old alike with a pathway to a life worth living. Loving companionship is the antidote to loneliness. Elders deserve easy access to human and animal companionship.
Meaningless activity corrodes the human spirit. The opportunity to do things that we find meaningful is essential to human health. Medical treatment should be the servant of genuine human caring, never its master.
Figure 4. Culture Change Adopters Report Residents Are More Involved in Decisions About Their Home Percent indicating that decisions are usually made by residents and staff jointly for the following: Creating Planning Decorating Creating Planning Developing schedule for menus communal calendar for social events resident’s meals areas social events care planCulture Change Adopters = culture change definition completely or for most part describes nursing home. Culture Change Strivers = culturechange definition describes nursing home only in a few respects or not at all but leadership is very/extremely committed to the adoption ofculture change. Traditional = culture change definition describes nursing home only in a few respects or not at all AND leadership is less thanvery/extremely committed to the adoption of culture change.Source: The Commonwealth Fund 2007 National Survey of Nursing Homes.
An Elder-centered community creates opportunity to give as well as receive care. This is the antidote to helplessness. An Elder-centered community integrates 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.
An Elder-centered community honors its Elders by de-emphasizing top-down bureaucratic authority, seeking instead to place the maximum possible decision-making authority into the hands of the Elders or into the hands of those closest to them. Creating an Elder-centered community is a never- ending process. Human growth must never be separated from human life. Wise leadership is the lifeblood of any struggle against the three plagues. For it, there can be no substitute.
Figure 6. Staff-Related Culture Change Principles Currently Under WayPercent indicating that they are currently implementing the following initiatives: Consistent Staff Include direct Include Create Currently assignment of leadership care workers andcertified nursing self-managed implementing certified nursing training residents assistants in work teams ALL FIVE assistants to opportunities on senior resident-centered staff initiatives residents management care planning team sessions^^ For instance, utilizing the “I Care” or “First Person” approach.Source: The Commonwealth Fund 2007 National Survey of Nursing Homes.
Guiding Principles of Eden Alternative Modifications Housing is modified to meet senior needs Modifications are Affordable Equipment for Modification is Accessible Financial Assistance is Available Competent Assistance provided
Guiding Principles of Eden Alternative Aging In Place ◦ Housing is located close to services ◦ Services are Affordable and support senior to remain at Home ◦ Seniors are well informed of services to help them age in place ◦ Home-Care services are provided to support independence ◦ Respite care is provided on a “Care Sharing Model”
Active ageing depends on a variety of influences or determinants that surround individuals, families and nations They include material conditions as well as social factors that affect individual types of behavior and feelings The interaction between these factors play an important role in affecting how well individuals age.
Chart Rehab Adult Life Older Age Early Life Maintaining Maintaining Growth & highest independence Development possible level of and preventing function disability Range of Function Disability Threshold Rehabilitation and ensuring the quality of life
Village Connectivity Emotional Wellbeing Vocational Connectivity Physical Wellbeing Social Connectivity Spiritual Wellbeing Resident/Staff Intellectual Wellbeing Connectivity
Clothing Room Donation Room Community Care An Artist and … ….his Cat “Rocky” Spiritual Connectivity & Expression Gardening for the Community Caring Connections – re-cycled cards Dough-Nations, social responsibility Music Man delivers Holistic Therapy
Expand Clothing Closet (Activity has been operational since January, 2010) Sponsor and oversee a clothing donation and distribution program to provide appropriate clothing for residents in need. In addition to clothing – residents can use, radios, tape and CD players that you no longer need.
If the Walls of Ackert Park could Talk-!History if music reverberatesthrough the walls
Lou & RockyFriends for over 15 years…best plan for Lou’sRehabilitation Rocky moves in with Lou-!
Families need a friendBirthdays…or just a kind note, Dorothy isthere
Ackert Park sites along an old Trolley pathcalled Ackert Way. It serves as our WalkingRehab Trail, connection to Community Gardensand a place to shared nature with ourneighbors-!
Guiding Principles of Eden Alternative Community Integration ◦ Housing design facilitates continued Integration of seniors into the Fabric of the Community ◦ Transportation services supportive to Greater Community ◦ Employment, Enterprise, and Volunteerism is supported throughout the Community
Guiding Principles of Eden Alternative Living Environment ◦ Housing not Overcrowded ◦ Older people Comfortable ◦ Housing not in areas Prone to Natural Disasters ◦ Older people feel Safe! ◦ Financial Assistance for Housing Security measures
Guiding Principles of Eden Alternative Living Environment in Veteran Administration ◦ Overcrowded SNF’s ◦ 1700+ in MO ◦ Older Vets in SNF’s ◦ SNF’s filled with MEN ◦ 11% of current Military are Women ◦ 36% more likely to use Rehab ◦ Greenhouse Model in Convent
Guiding Principles of Eden Alternative Living Environment in Prisons ◦ Housing Overcrowded ◦ Older inmates @ risk ◦ Housing not an option ◦ Focus on their skills and natural abilities! ◦ Financial Assistance for Housing Security & Employment
Culture Change in Prison Educational and Offender Change Work and Vocational programs: Programs Adult Basic Education Building Maintenance General Education Diploma Roofing (GED) Siding Getting it Right Job Readiness Drywall Installation Stress and Anger Management Information Technology Intensive Out Patient Chemical Dependency Department of Natural Cognitive Behavioral Resources Forestry Treatment Workers Moral Recognation Therapy Community Work Crews (MRT) Institutional Support Jobs Dog Training and Adoption Sustainability Jobs Program