* Person-Directed Care: the Heart of Culture Change DADS Culture Change Initiative Presented by: Mary Valente, LBSW, MPA ff. hange

* What is Person-Directed Care? Decision-making. Self Determination and Choice. Needs and comfort before the task. Promotes respect. hange

* Person-directed care is a simple, easy, and a low-cost to no-cost approach that can help a facility meet or exceed state and federal regulations. Person-Directed Care: the Heart of Culture Change change

“Honey, I’ve been through two world wars, the Great Depression, taught 3,297 children, administered four elementary schools and outlived every one of the pastors I worked with. I’m 89 years old and you’re telling me it’s bedtime?” *

Comparing Cultures Institution- Directed vs. Person-Directed * Reference: Pioneer Network, January 2012 Person-Directed Care: the Heart of Culture Change change

Institution-Directed Culture * Standardized "treatments" based on medical diagnosis. Schedules and routines are designed by the institution. Work is task-oriented with rotated assignments. Staff can perform similar tasks "on any patient" in the home. Reference: Pioneer Network, January change

Institution-Directed Culture continued Decision-making is centralized. A hospital-style environment. Structured activities. Sense of isolation and loneliness. *

I NSTITUTION -D IRECTED C ULTURE CONTINUED O RGANIZATIONAL S TRUCTURE * Nursing Home Owner Administrator Director of Nursing Professional Nursing Staff Nurse Aides Residents Family & Friends * Source: NY State Office for the Aging,

I NSTITUTION -D IRECTED C ULTURE CONTINUED S OCIAL I NTERACTION * * Source: NY State Office for the Aging,

Person-Directed Culture continued Caregiving relationship. Residents and staff design schedules together. Services are relationship-centered. Staff bring personal knowledge into the caregiving process. * Reference: Pioneer Network, January change

Person-Directed Culture continued Decision-making. The comforts of home. Spontaneous activities. A sense of community and belonging. *

P ERSON -D IRECTED C ULTURE CONTINUED O RGANIZATIONAL S TRUCTURE * * Source: NY State Office for the Aging, Residents Family Members Nurse Aides Professional Nursing Staff Director of Nursing Administrator Nursing Home Owner

Person-Directed Culture continued Physical Structure * Source: NY State Office for the Aging, * ^ Floor Plan of Missouri Veterans Home—St. James, Missouri, Architect: Kennedy Association Inc. * Source: NY State Office for the Aging,

Person-Directed Culture continued Social Interaction *

* Culture Change Goals The focus is on relationships; this is the heart of culture change. Keep the ‘ I ’ in individualized care. Person-Directed Care: the Heart of Culture Change change

* Low

* Person-Directed Care Pop Quiz Would I want this style of care in my own home? Use this ‘test’ question when thinking about current practices and how to change them. change

C OMPARE THESE PICTURES. W HICH STYLE WOULD YOU PREFER ? *

* A Brief History The first nursing facility rules were created by the federal government in change

Nursing Facility Design Progression Institutional Model The hospital-style institutional models were built before the 1970’s and continues today. *

I NSTITUTIONAL M ODEL *

Nursing Facility Design Progression Additional Institutional Models Concept started in 1960’s and continues today. * Cartwheel Plan K Plan

Nurses’ Station - Institutional Model *

Kitchen - Institutional Model *

Nursing Facility Design ProgressionAlternate Institutional Models Concept started in the 1980’s and continues to the present day. * Courtyard Plan H Plan

Nursing Facility Design Progression Early Culture Change Model Neighborhood Plan Concept started in the 1990’s and continues to the present day. *

Nursing Facility Design Progression A Planned Culture Change Model Small House Plans Concept began in the 2000’s and continues to the present day *

S MALL H OUSE P LAN * Can you find the nurses’ station? change

N URSING F ACILITY D ESIGN P ROGRESSION R EMODELING TO A CHIEVE C ULTURE C HANGE Wings of existing plans can be remodeled as neighborhoods. *

Cost of Culture Change Building new homes is expensive. Remodeling has many costs, but can be managed in smaller planned steps. However: Individualizing care is often COST FREE, and can START RIGHT NOW *

Cost of Culture Change Dining Experience Choice of meals Choice of meal times Use of china and glass Liberalized diets Restaurant style dining In-room dining choices Small group setting *

Cost of Culture Change Bathing Experience A person’s choice. Warm/soft lighting. Music or nature sounds. Aromatherapy. Clean and clutter-free. Privacy and dignity. Relaxing experience. *

Cost of Culture Change Activities Hospice Volunteers Homebound and Lonely Making a Difference Unplanned as well as scheduled *

Cost of Culture Change Building Relationships Fireside chats Supply changes Learning Circles Informal conversations to solve problems *

Culture Change and Direct Care Staff Reduces turnover. Increases retention. Improves job satisfaction. Highlights importance of building relationships. Gives a sense of ownership. *

Culture Change and Direct Care Staff Staff assignments. Involvement in plan of care. Flexible scheduling. Activities led by staff. *

The Language of Culture Change OLD Wing, Unit Diaper Shower room, Whirlpool Patient Admit Discharge * NEW Neighborhood Brief, Undergarment Spa Individual Move in Move out change

The Language of Culture Change OLD Lobby Nurses station Facility Elopement, Escape Dietary Ambulate Home-like NEW Living room Desk, Work area Community Left the building Dining service Walk Home *

Benefits of Person-Directed Care Individuals will experience: Weight loss reduction. Overall health stability. Reduction of medications. Improved social engagement. Increased overall satisfaction. Staff will experience: Empowerment. Reduction in turnover and retention improvement. Increased overall satisfaction. * Staff working at an Eden Alternative home. change

* Person-Directed Care: the Heart of Culture Change Getting Started: PLANForm a committee, set priorities. DOAssignments and leadership. STUDY Are the changes working? ACT Explore other possibilities. change

Person-Directed Care: the Heart of Culture Change How do I help if I’m not connected to a nursing facility? The short answer is: “Community Engagement”. Voting Social clubs Business meetings Scouting School projects *

Person-Directed Care: the Heart of Culture Change Questions? *

* DADS Culture Change - Support Questions for DADS experts, contact: DADS website for culture change information

* References and Resources Center for Medicare & Medicaid Services (CMS), Texas Quality Matters, Edu-Catering and Action Pact: educational materials for Culture Change, Pioneer Network,

Person-Directed Care: the Heart of Culture Change THANK YOU! *