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Caregivers Corner - June, 2001
Dream a Little Dream:
Can There Be an Ideal Nursing Home?

This spring the Institute for Caregiver Education hosted educational retreats in Florida, Massachusetts and Pennsylvania attended by management teams from 26 nursing homes for which the Institute provides educational consulting.  Susan R. Misiorski, RN, BSN, who is Long Term Care Operations Specialist for Paraprofessional Healthcare Institute (PHI), presented the workshops with Institute President Carol Tschop.  Misiorski is a leading proponent of the growing Pioneer Movement comprised of people across the country who recognize the need to create ways of living and working together different from the traditional models of long term care.  

Seminar participants focused on values and guiding principles central to transforming the long-term care workplace and caregiving practices with a goal of replacing the traditional medical model with a community model. These two models of care result in significantly different living and working environments for the residents and frontline caregivers:

Medical Model: Community Model:
Staff provide traditional care and treatments Individualized care meets residents' medical and spiritual needs
Residents must follow facility/staff routines Staff follow and support residents' routines
Staff float in their resident assignments Staff have consistent assignments & know their needs
Staff make decisions for residents Residents make as many of their own decisions as possible
The facility belongs to the staff The facility is the residents' own home
Structured group activities are scheduled by staff Spontaneous opportunities are available around the clock based on residents' interests
Departmental focus TEAM!!
Staff know patients by diagnosis Staff have meaningful personal relationships with residents and family

 

The community model starts with �Putting the Resident First� � (Contemporary Long Term Care magazine�s May 2001 issue cover story).   Pioneering long term care facilities such as the Crestview Nursing Home in Bethany, MO, featured in the article, are implementing extremely successful models of the new culture.  Called the �Ideal Nursing Home� program, Crestview�s bottom line results attest to the fact that this is an affordable approach to care that results in extremely satisfied staff and a residential population that is enjoying a much higher quality of life based on the foundation of person-centered planning. 

Measurable outcomes for Crestview (July 2000) have included:

A decrease in the number of residents suffering from significant weight loss
A reduction in the number of dietary supplements prescribed by physicians from 72 to 14
A doubling of staff productivity with turnover down to 9.4%
A reduction in the number of residents using briefs from 53 to 3
Significant reductions in the numbers of sleep, psychotropic and anti-anxiety medication prescriptions
A drop in the incidence of pressure sores from 11 to 0

Misiorski spoke to workshop participants from her experience leading nursing homes from Apple Health Care, a small New England-based chain, through a similar transition.  �The process requires staff to abandon many of their traditional routines and examine how current practices fall short of meeting the quality of life needs of their residents.  While this examination process has reaffirmed that staff were providing good care, they  have found that, in many ways, they were missing the boat in terms of quality of life.  There is no pill that can be prescribed for loneliness, helplessness or boredom,� said Misiorski. 

Responding not only to the needs of the mind and body, staff began to develop resident-centered planning to meet the needs of the human spirit as well.  Staff were taught to view the nursing home through the eyes of their residents � to see what they see when they�re looking up at the walls or out the window from their beds; or to feel how they feel while waiting with nothing to do while their next meal is being prepared. Residents were encouraged to bring their own room furnishings and decorate their surroundings to provide a homey atmosphere.  Many other examples of successful implementations of changing the culture were shared including dining service and bathing practices.  For example, instead of requiring residents to follow a strict bathing schedule, staff began following their residents� individual bathing preferences.

By the conclusion of the workshop, facility managers had been given a vast array of ideas and the opportunity to brainstorm specific goals, current barriers, and actions plans for changing the culture of care in the hope that they will be able to begin implementing some of these initiatives back in their own centers.

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