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Person-Directed Care: the Heart of Culture Change
DADS Culture Change Initiative
Presented by:
Mary Valente, LBSW, MPAff.
www.dads.state.tx.us/culturechange
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What is Person-Directed Care?
•Decision-making.
•Self Determination and Choice.
•Needs and comfort before the task.
•Promotes respect.
www.dads.state.tx.us/culturechange
www.dads.state.tx.us/culturechange*
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/culturechange
“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*www.dads.state.tx.us/culturechange
Comparing CulturesInstitution-Directed vs. Person-Directed
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Reference: Pioneer Network, January 2012
Person-Directed Care: the Heart of Culture Change
www.dads.state.tx.us/culturechange
Institution-Directed Culture
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•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/culturechange
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*www.dads.state.tx.us/culturechange
INSTITUTION-DIRECTED CULTURE CONTINUED ORGANIZATIONAL STRUCTURE
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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
INSTITUTION-DIRECTED CULTURE CONTINUED SOCIAL INTERACTION
** Source: NY State Office for the Aging, www.nursinghome411.org.
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/culturechange
Person-Directed Culture continued
•Decision-making.
•The comforts of home.
•Spontaneous activities.
•A sense of community and belonging.
www.dads.state.tx.us/culturechange*www.dads.state.tx.us/culturechange
PERSON-DIRECTED CULTURE CONTINUED ORGANIZATIONAL
STRUCTURE
** Source: NY State Office for the Aging, www.nursinghome411.org.
Residents
Family Members Nurse Aides
Professional Nursing Staff
Director of Nursing
Administrator
Nursing Home Owner
Person-Directed Culture continuedPhysical Structure
* Source: NY State Office for the Aging, 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.
Person-Directed Culture continued Social Interaction
www.dads.state.tx.us/culturechange*www.dads.state.tx.us/culturechange
www.dads.state.tx.us/culturechange*
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/culturechange
www.dads.state.tx.us/culturechange*
Low
www.dads.state.tx.us/culturechange
www.dads.state.tx.us/culturechange*
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/culturechange
COMPARE THESE PICTURES.WHICH STYLE WOULD YOU PREFER?
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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/culturechange
Nursing Facility Design ProgressionInstitutional Model
The hospital-style institutional models were built before the 1970’s and continues today.
www.dads.state.tx.us/culturechange*www.dads.state.tx.us/culturechange
INSTITUTIONAL MODEL
www.dads.state.tx.us/culturechange*www.dads.state.tx.us/culturechange
Nursing Facility Design ProgressionAdditional Institutional
Models
Concept started in 1960’s and continues today.
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CartwheelPlan
K Plan
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Nurses’ Station - Institutional Model
www.dads.state.tx.us/culturechange*www.dads.state.tx.us/culturechange
Kitchen - Institutional Model
www.dads.state.tx.us/culturechange*www.dads.state.tx.us/culturechange
Nursing Facility Design ProgressionAlternate Institutional
Models
Concept started in the 1980’s and continues to the present day.
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Courtyard Plan
H Plan
www.dads.state.tx.us/culturechange
Nursing Facility Design ProgressionEarly Culture Change
Model
Neighborhood Plan
Concept started in the 1990’s and continues to the present day.
www.dads.state.tx.us/culturechange*www.dads.state.tx.us/culturechange
Nursing Facility Design ProgressionA 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*www.dads.state.tx.us/culturechange
SMALL HOUSE PLAN
www.dads.state.tx.us/culturechange*Can you find the nurses’ station?www.dads.state.tx.us/
culturechange
NURSING FACILITY DESIGN PROGRESSIONREMODELING TO
ACHIEVE CULTURE CHANGE
Wings of existing plans can be remodeled as neighborhoods.
www.dads.state.tx.us/culturechange*www.dads.state.tx.us/culturechange
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*
www.dads.state.tx.us/culturechange
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*www.dads.state.tx.us/culturechange
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*www.dads.state.tx.us/culturechange
Cost of Culture Change
Activities•Hospice Volunteers
•Homebound and Lonely
•Making a Difference
•Unplanned as well as scheduled
www.dads.state.tx.us/culturechange*
www.dads.state.tx.us/culturechange
Cost of Culture Change
Building Relationships•Fireside chats
•Supply changes
•Learning Circles
•Informal conversations to solve problems
www.dads.state.tx.us/culturechange*
www.dads.state.tx.us/culturechange
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*www.dads.state.tx.us/culturechange
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*www.dads.state.tx.us/culturechange
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/culturechange
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*www.dads.state.tx.us/culturechange
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/
culturechange
www.dads.state.tx.us/culturechange*
Person-Directed Care: the Heart of Culture Change
Getting Started:•PLAN Form a committee, set priorities.
•DO Assignments and leadership.
•STUDY Are the changes working?
•ACT Explore other possibilities.
www.dads.state.tx.us/culturechange
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*www.dads.state.tx.us/culturechange
Person-Directed Care: the Heart of Culture Change
Questions?
www.dads.state.tx.us/culturechange*www.dads.state.tx.us/culturechange
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DADS Culture Change - Support
Questions for DADS experts, contact:[email protected]
DADS website for culture change information
www.dads.state.tx.us/culturechange/index.html
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References and Resources
• Center for Medicare & Medicaid Services (CMS), http://www.cms.gov/default.asp
• Texas Quality Matters, www.TexasQualityMatters.org • Edu-Catering and Action Pact: educational materials for
Culture Change, www.culturechangenow.com• Pioneer Network,
http://www.pioneernetwork.net/Providers/
Person-Directed Care: the Heart of Culture Change
THANK YOU!
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