Beyond The Medical Model Person Directed Care - Beyond The Medical Model Keith Savell, Ph.D, CTRS Geriatric Healthcare Consultants, LLC Mariposa Training, Inc. Michael D. Splain, LCSW www.michaelsplain.com Keith@Mariposatraining.com (510) 387-8130

absolutely have to have to be happy living in a nursing home What would you absolutely have to have to be happy living in a nursing home

Computer - with wireless internet access Good coffee Caring staff My own pillow Good food My favorite chair Pets Computer - with wireless internet access

Is this realistic? Is this achievable?

From a provider perspective, is this quality care?

From a regulatory perspective, is this quality care?

Person Directed Approach to Care: We do “for” a resident. Person Directed Care Versus the Medical Model – When the Medical Model Does Not Work Medical Model: We do “to” a resident. Person Directed Approach to Care: We do “for” a resident. Delivery of care is based on the assessed needs, interests, customary routines and personal preferences of the individual resident.

Person Directed Care Versus the Medical Model - When the Medical Model Does Not Work Health promotion, discharge potential The Skilled Nursing Facility or Alzheimer’s Care Unit is a hospital in which to regain health and function. Quality care is a function of discharge potential

Person Directed Care Versus the Medical Model - When the Medical Model Does Not Work Living in a nursing home is the resident’s reality - with limited potential for significantly enhanced health or discharge potential. The SNF, therefore, is not a hospital in which to recover, but a home in which to live a meaningful life.

Person Directed Care Versus the Medical Model - When the Medical Model Does Not Work If the nursing home truly is the resident’s new home, then the scope of services available must reflect the resident’s needs, interest, customary routines and personal preferences. In short, the SNF must provide an environment and opportunities for engagement which are meaningful to the individual resident.

Person Directed Care Versus the Medical Model - When the Medical Model Does Not Work From a Person Centered - or Person Directed model, quality care is defined not only by measures of health or discharge potential, but also by Quality of Life as measured by meaningful engagement in daily life.

Meaningful Engagement: What is “meaningful engagement” Meaningful Engagement: Assumes that each event, encounter and exchange in a resident’s daily life has the potential to be of meaning … regardless of context. Every event, encounter or exchange is an activity, be it a bath, meal, song or smile. The scope of activities is limitless and does not only include scheduled events provided by activity staff, but every interaction with staff, relative and others with dementia.” Alzheimer’s Assoc.

What is “meaningful engagement” Meaningful engagement simply means engagement in life interests that are intrinsically satisfying to the individual resident. Is it likely that a 65year old male resident will find the same engagements as meaningful as an 85 year old female?

A Person Directed Approach The bottom line? Person Directed Care acknowledges that each individual resident has a personal identity and a history of life experiences which includes far more than simply his/her medical condition or functional impairment.

A Person Directed Approach From this approach to care, we come to know our residents as individuals … rather than as a diagnosis. For example, who is our new admission? Is he the amputee in 6B who keeps asking for pain meds, or is “Mike” the guitar playing veteran who recently lost his leg to peripheral vascular disease and also lost his home in Napa to the fires in northern California?

So, what does this mean for me - in the job that I perform? From a Person Directed perspective, the central focus of all staff interaction is to facilitate the resident’s pursuit of meaningful engagement in a manner which accommodates his/her needs, interests, routines, preferences and history of life experiences. The delivery of all programs and services, regardless of professional responsibility should be person directed, person specific and person appropriate.

Key Elements Comprehensive Assessment Person Directed Care Plan

1. Comprehensive assessment Within the model of Person Directed Care, the delivery of all services should reflect an assessment based understanding of the specific needs, interests, routines and preferences of each and every resident. Why do we assess? Interdisciplinary Care Planning Activity Programming Staff to Resident Interaction

1. Comprehensive assessment How do we assess? Collect assessment information from as many sources as possible …. including the resident!

1. Comprehensive assessment How do we assess? Think beyond the words on the assessment form. What does the assessment information tell you about the resident’s needs, interests, routines and preferences? If a newly admitted resident indicates she spent much of her time volunteering at church or the senior center, what might this indicate about the psychosocial needs of the resident?

1. Comprehensive assessment How do we assess? Utilize interview skills to gather information. Remember the deep dive! While surface information may be interesting, it may not be very helpful. Identify strengths and coping skills - especially those residents with chronic mental illness.

Key Elements Comprehensive Assessment Person Directed Care Plan

2. Person Directed Care Planning The needs, interests, routines and preferences identified within the assessment should provide the foundation for inter-disciplinary Care Plans.

2. Person Directed Care Planning Individualized approaches (which reflect resident needs, interests, routines and preferences) should be utilized for all care plan problems which are amenable to psychosocial (behavioral) intervention. This is especially important in behavioral interventions utilized to support the reduction of pharmacological intervention, or in place of pharmacological interventions for Mood and Behavior Care Plans.

2. Person Directed Care Planning Depression •Pain Agitation •Physical Decline Anxiety •Cognitive Decline Insomnia •Constipation * This is a partial list and does not reflect all potential Care Plan Problems which may be individualized per resident interests/preferences/routines

Insomnia - Why is Mrs. Robinson having trouble sleeping? Assessment to Care Plan - Example Insomnia - Why is Mrs. Robinson having trouble sleeping? Pain? Unresolved issues? Fear? Change in environment? Prior life patter? Utilize the information gathered during the assessment and don’t forget to ASK THE RESIDENT why she is not sleeping. The resident has been married for 55 years and has always shared her bed with her husband. Would her sleep be more restful if she was provided with a full body pillow?

2. Person Directed Care Planning The Inter-Disciplinary Care Plan will need to: Support a continuation of life roles, consistent with resident needs, interests, routines, preferences and functional capacity How can we support a Resident who was a “social butterfly”? (Resident Council, Friendly Visitor, etc.)?

2. Person Directed Care Planning The Inter-Disciplinary Care Plan will need to: Identify adaptations and adaptive equipment necessary for meaningful engagement What adaptive equipment will a life long poker player need who finds himself unable to use his left arm following a stroke?

Key Elements Comprehensive Assessment Person Directed Care Plan

Communication of Resident Needs, Interests, Routines, Preferences And now, the question of the day….. How do we communicate assessment findings concerning the resident’s needs, interests, routines and preferences to those who need the information the most …. the front line care providers? The same question applies to how we communicate Care Plan Approaches…

Communication of Resident Needs, Interests, Routines, Preferences Information concerning the needs, interests, preferences and the personal routines of each resident must be communicated to the “front line” care providers to assist them in the delivery of ADL care. - Care Plan - ADL Flow Sheet Cardex - Huddle - Information sheet inside of the resident’s closed door (covered).

Person Directed Care – Conclusion We must all come to know our resident as individuals - beyond medical terms and physical needs. This should be reflected in assessments, care plans, and interactions with the resident. We must all communicate individualized information with all involved staff to ensure continuity of care and consistently work to ensure that this understanding is reflected in the care we provide.

Person Directed Care – Conclusion Above all else, Person Directed Care is just that….care directed by our understanding of our resident as a person!