1. * Person-Directed Care: the Heart of Culture Change DADS Culture Change Initiative Presented by: Mary Valente, LBSW, MPA ff. www.dads.state.tx.us/culturec hange

2. * What is Person-Directed Care? Decision-making. Self Determination and Choice. Needs and comfort before the task. Promotes respect. www.dads.state.tx.us/culturec hange

3. * 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 www.dads.state.tx.us/culture change

4. “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?” www.dads.state.tx.us/culturechange *

5. Comparing Cultures Institution- Directed vs. Person-Directed www.dads.state.tx.us/culturechange * Reference: Pioneer Network, January 2012 Person-Directed Care: the Heart of Culture Change www.dads.state.tx.us/culture change

6. Institution-Directed Culture www.dads.state.tx.us/culturechange * 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 2012 www.dads.state.tx.us/culture change

7. Institution-Directed Culture continued Decision-making is centralized. A hospital-style environment. Structured activities. Sense of isolation and loneliness. www.dads.state.tx.us/culturechange *

8. 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, www.nursinghome411.org www.nursinghome411.org

9. I NSTITUTION -D IRECTED C ULTURE CONTINUED S OCIAL I NTERACTION * * Source: NY State Office for the Aging, www.nursinghome411.org. www.nursinghome411.org

10. Person-Directed Culture continued Caregiving relationship. Residents and staff design schedules together. Services are relationship-centered. Staff bring personal knowledge into the caregiving process. www.dads.state.tx.us/culturechange * Reference: Pioneer Network, January 2012 www.dads.state.tx.us/culture change

11. Person-Directed Culture continued Decision-making. The comforts of home. Spontaneous activities. A sense of community and belonging. www.dads.state.tx.us/culturechange *

12. P ERSON -D IRECTED C ULTURE CONTINUED O RGANIZATIONAL S TRUCTURE * * Source: NY State Office for the Aging, www.nursinghome411.org. www.nursinghome411.org Residents Family Members Nurse Aides Professional Nursing Staff Director of Nursing Administrator Nursing Home Owner

13. Person-Directed Culture continued Physical Structure * Source: NY State Office for the Aging, www.nursinghome411.org. www.nursinghome411.org * ^ Floor Plan of Missouri Veterans Home—St. James, Missouri, Architect: Kennedy Association Inc. * Source: NY State Office for the Aging, www.nursinghome411.org.

14. Person-Directed Culture continued Social Interaction www.dads.state.tx.us/culturechange *

15. * 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 www.dads.state.tx.us/culture change

16. * Low www.dads.state.tx.us/culturechange

17. * 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. www.dads.state.tx.us/culture change

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

19. www.dads.state.tx.us/culturechange * A Brief History The first nursing facility rules were created by the federal government in 1967. www.dads.state.tx.us/culture change

20. Nursing Facility Design Progression Institutional Model The hospital-style institutional models were built before the 1970’s and continues today. www.dads.state.tx.us/culturechange *

21. I NSTITUTIONAL M ODEL www.dads.state.tx.us/culturechange *

22. Nursing Facility Design Progression Additional Institutional Models Concept started in 1960’s and continues today. * Cartwheel Plan K Plan www.dads.state.tx.us/culturechange

23. Nurses’ Station - Institutional Model www.dads.state.tx.us/culturechange *

24. Kitchen - Institutional Model www.dads.state.tx.us/culturechange *

25. Nursing Facility Design ProgressionAlternate Institutional Models Concept started in the 1980’s and continues to the present day. * Courtyard Plan H Plan www.dads.state.tx.us/culturechange

26. Nursing Facility Design Progression Early Culture Change Model Neighborhood Plan Concept started in the 1990’s and continues to the present day. www.dads.state.tx.us/culturechange *

27. Nursing Facility Design Progression A Planned Culture Change Model Small House Plans Concept began in the 2000’s and continues to the present day www.dads.state.tx.us/culturechange *

28. S MALL H OUSE P LAN www.dads.state.tx.us/culturechange * Can you find the nurses’ station? www.dads.state.tx.us/culture change

29. 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. www.dads.state.tx.us/culturechange *

30. 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 www.dads.state.tx.us/culturechange *

31. 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 www.dads.state.tx.us/culturechange *

32. 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. www.dads.state.tx.us/culturechange *

33. Cost of Culture Change Activities Hospice Volunteers Homebound and Lonely Making a Difference Unplanned as well as scheduled www.dads.state.tx.us/culturechange *

34. Cost of Culture Change Building Relationships Fireside chats Supply changes Learning Circles Informal conversations to solve problems www.dads.state.tx.us/culturechange *

35. Culture Change and Direct Care Staff Reduces turnover. Increases retention. Improves job satisfaction. Highlights importance of building relationships. Gives a sense of ownership. www.dads.state.tx.us/culturechange *

36. Culture Change and Direct Care Staff Staff assignments. Involvement in plan of care. Flexible scheduling. Activities led by staff. www.dads.state.tx.us/culturechange *

37. The Language of Culture Change OLD Wing, Unit Diaper Shower room, Whirlpool Patient Admit Discharge www.dads.state.tx.us/culturechange * NEW Neighborhood Brief, Undergarment Spa Individual Move in Move out www.dads.state.tx.us/culture change

38. 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 www.dads.state.tx.us/culturechange *

39. 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. www.dads.state.tx.us/culturechange * Staff working at an Eden Alternative home. www.dads.state.tx.us/culture change

40. * 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. www.dads.state.tx.us/culture change

41. 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 www.dads.state.tx.us/culturechange *

42. Person-Directed Care: the Heart of Culture Change Questions? www.dads.state.tx.us/culturechange *

43. * DADS Culture Change - Support Questions for DADS experts, contact: DADSculturechange@dads.state.tx.us DADS website for culture change information www.dads.state.tx.us/culturechange/index.html

44. * References and Resources Center for Medicare & Medicaid Services (CMS), http://www.cms.gov/default.asp http://www.cms.gov/default.asp Texas Quality Matters, www.TexasQualityMatters.orgwww.TexasQualityMatters.org Edu-Catering and Action Pact: educational materials for Culture Change, www.culturechangenow.comwww.culturechangenow.com Pioneer Network, http://www.pioneernetwork.net/Providers/ http://www.pioneernetwork.net/Providers/

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