Person-Centered Caring and Culture Change in an Adult Day Setting: Best Practices

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PRESENTATION OBJECTIVES:

1.Increased Understanding of Person Centered Care and Culture Change in an Adult Day setting.

2.An Introduction to Best Practices for Healthcare Professionals for Integrating Person-centered Care into An Adult Day Center

3.Best Practices for Team-Building and Support of Care Professionals

4.Best Practices for Community Engagement in an Adult Day Setting

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INTRODUCE OUR WORLD

REVIEW CONCEPTS

REVIEW PHILOSOPHIES

SHOW TRANSLATION OF CONCEPTS AND INTEGRATION

OF PHILOSOPHIES AT AGP

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INTRODUCE OUR WORLD

REVIEW CONCEPTS

REVIEW PHILOSOPHIES

SHOW TRANSLATION OF CONCEPTS AND INTEGRATION

OF PHILOSOPHIES AT AGP

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ADULT DAY CENTERS

(ADC)

COORDINATED PROGRAM of

professional and compassionate services

for adults in a community-based group

setting.

SOCIALIZATION, PLANNED ACTIVITIES,

and SUPPORTIVE HEALTH

SERVICES in a safe and well

supervised environment.

ESSENTIAL SOCIAL and HEALTH

SERVICES NEEDED TO ALLOW ADULTS

TO REMAIN LIVING AT HOME

while providing support and respite to caregivers.

MAINTAIN HIGHEST LEVEL OF HEALTH

and/or INDEPENDENCE for the individual while

providing respite and support to caregivers

EMERGING PROVIDER OF

TRANSITIONAL CARE AND SHORT TERM REHABILITATION following hospital

discharge.

as PREFERRED PLATFORM FOR

CHRONIC DISEASE MANAGEMENT, adult

day centers are an interactive, safe, and

secure environment for individuals requiring

supervised daily care.

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A Grace Place Care Adult Center

www.agraceplaceacc.org/

A Grace Place Adult Care Center celebrates each individual, each caregiver and each employee through Person Centered Thinking and

Person Centered Care.

ESTABLISHED• Since 1976,

providing essential health and social services to support adults with disabilities and/or age-related conditions, while providing respite and support for their caregivers.

NON-PROFIT

• with a strong mission focus to strengthen adult caregiving and to maintain or increase the health, independence and quality of life of both the adult in care and the caregiver.

SERVING

• Over 210 individuals per day.

SEVEN• separate programs designed to meet the unique needs of each individual.

• AD, brain injury, stroke, PD, intellectual disabilities, autism, cerebral palsy, etc.

• Ages: 18 -- 100+.

INDIVIDUALLY-CENTERED PROGRAMS

• Provide a community–based alternative to institutional care.

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INTRODUCE OUR WORLD

REVIEW CONCEPTS

REVIEW PHILOSOPHIES

SHOW TRANSLATION OF CONCEPTS AND INTEGRATION

OF PHILOSOPHIES AT AGP

9Person-Centered Care

Person-Centered Culture

Culture Change

Institution-Directed vs. Person-Directed Care

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Social Confidence

Engagement

Personal Worth and Uniqueness

Independence

TruthfulnessRespect

Hope

PERSON-CENTERED CARE is an approach to care that respects and values the uniqueness of the individual, and seeks to maintain, even restore, the personhood of individuals.

We do this by creating an environment that promotes:

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The text demonstrFosters optimal aging and living for the individual

t will look when you replace the placeholder with

your own text.

Empowers

Core Values of

Choice,

Dignity,

Respect,

Self-Determination and

Purposeful Livingbe replaced with your own text.

Rooted in the work of Tom Kitwood*, a British gerontologist.

Care is driven by the individual

Person-Centered

Care

Person-Centered Care Attributes

Tom Kitwood (1937-1998 ) was a British social psychologist and psychogerontologist, author of the theory of person-centered care approach; together with Kathleen Bredin, he developed the method of Dementia Care Mapping.

Having negative image of adults with a disability.

Example: “Over the Hill” birthday cards and in terms of people with Intellectual or Developmental Disabilities, “retarded” jokes or the assumption that they are incapable of doing anything at all..

Behavior by one person that limits another’s freedom or autonomy.

Example: Staff make a participant stop playing cards and join in a Trivia game which the staff is leading and is a favorite of the staff.

Independence or freedom to do as one wishes.

Example: Care Professional and Individual together selecting a time for one’s meals or activities rather than having it imposed.

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Suggesting a traditional approach (contrasted with a holistic approach) to the diagnosis and treatment of illness. The physician focuses on the defect, or dysfunction, within the patient, using a problem-solving approach.

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Key Terms

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Autonomy vs. Risk

AUTONOMY

RISK

AUTONOMY = INDEPENDENCE

RISK = Individual Safety and

Liability

Surplus Safety* = Safety trumps ALL

*Rooted in the teachings of Dr. Bill Thomas and the Eden Alternative as well as Dr. Judah Ronch.

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What happens when we create an environment that is “too” safe, where individuals have no autonomy?

Using the Questions tab of the Webinar’s Control Panel, please type in your own examples.

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What happens when we create an environment where staff has NO voice?

Using the Questions tab of the Webinar’s Control Panel, please type in your own examples.

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Direct care staff have a say in how work is carried out and how decisions are made.

Individual preferences are the basis of care decisions.

Developed by Sue Misiorski and Joanne Rader. Retrieved from www.pioneernetwork.net

Person-Centered Culture

For the most part, staff organizes their routines to accommodate individuals’ routines.

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The language we use is important in providing person-centered care.

Some of our language may unintentionally demean people.

Some of our language is “institutional”

The Language of Person-Centered Care

Person with…

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POLL

How do you refer to the people to whom you provide service?

A. ParticipantB. IndividualC. ClientD. Patient

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BENEFITS OF PERSON-CENTERED CAREINTRINSICEmployees

Heightened job satisfaction

Heightened self-esteem

Heightened life skills

Career opportunities

AgencyLess staff turnover

Less client turnover

Increased quality care

IndividualsIncreased satisfaction

Increased connections to others

CaregiversIncreased security, peace of mind

Increased financial support

EXTRINSICMarketingWord-of-mouth value; propelling agencies into

new partnershipsDonorsAttractive model to support emotionally and

financially

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Based on person-centered and directed values and practices

Consideration: for the individual,

caregivers and staff

Deep system transformation that

may require changes in

organizational practices, physical

environments, relationships at ALL

levels and workforce models.

CULTURE CHANGE:National movement for transformation of adult services across the healthcare continuum

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Institution-Directed vs. Person-Directed Care:

What is the difference?

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Institution-Directed Culture

Schedules and routines are designed by the facility and staff, and individuals must comply.

There is a hospital environment. 

Staff provides standardized "treatments" based upon medical diagnosis.

Decision-making is centralized. 

As long as staff know how to perform a task, they can

perform it "on any patient" in the facility. 

There is a sense of

isolation and loneliness.

Work is task-oriented and staff rotates assignments.

Structured activities are available when the activity director or other activity staff are on duty.

Institution-Directed Culture

From the Pioneer Network website http://www.pioneernetwork.net/Providers/Comparisons/

Staff is disengaged

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Person-Directed Culture

The staff has relationships with the individuals so that

they know their lifelong habits and honor them.

Individuals make decisions every day about their individual routines.

The staff organizes their schedules and assignments to meet the needs of the individuals they care for.

Person-Directed Culture

The staff makes decisions every day and is empowered.

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1 2 3 4

Returning control to individual

Establishing a home-like

environment

Enhancing facility involvement

Enhancing professional caregiver’s

capacity to be responsive

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Person-Centered Care: A Review

Relationship means knowing the individuals.This starts with their preferences for care, their daily routines, etc. It also means getting to know individuals on a deeper level (their history, their stories, etc)

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Recognizing and using employee

strengths

Help Individuals Continue to Have

both a CHOICE and a VOICE

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INTRODUCE OUR WORLD

REVIEW CONCEPTS

REVIEW PHILOSOPHIES

SHOW TRANSLATION OF CONCEPTS AND INTEGRATION

OF PHILOSOPHIES AT AGP

INFLUENCES ON CARE

PHILOSOPHY

Inclusion

Person-Centered

Care

Eden’s Philosophy

Servant Leadership

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EDEN ALTERNATIVE PRINCIPLESThe three plagues of Boredom, Loneliness, and Helplessness account

for the bulk of suffering among our clients. *The words create an acronym B L and H BLaH

A Person-centered community commits to creating a Human Habitat where life revolves around close and continuous contact with plants, animals, and children.  It is these relationships that provide the young

and old alike with a pathway towards a life worth living.A Person-centered community imbues daily life with variety and spontaneity by creating an environment in which unexpected and

unpredictable interactions and happenings can take place. This is the antidote to boredom.

Clients deserve easy access to human and animal companionship. Loving companionship is the antidote to loneliness.

A Person-centered community creates opportunity to give as well as receive care. This is the antidote to helplessness.

Meaningless activity corrodes the human spirit.  The opportunity to do things we find meaningful is essential to human health.

Medical treatment should be the servant of genuine care, never its master.

A Person-centered community honors its individuals by de-emphasizing top down bureaucratic authority, seeking instead to place the maximum decision making authority into the hands of the Clients

to care professionals.

Creating a Person-Centered community is a never ending process.

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The Values and Principles of the Pioneer Network

Know each person and employee

Each person can and does make a difference

Relationship is the fundamental building block of a transformed culture

Respond to spirit, as well as mind and body

Risk taking is a normal part of life

Put person before task

All adults are entitled to self-determination wherever they live

Community is the antidote to institutionalization

Do unto others as you would have them do unto you

Promote the growth and development of all

Shape and use the potential of the environment in all its aspects: physical, organizational, psycho/social/spiritual

Practice self-examination, searching for new creativity and opportunities for doing better

Recognize that culture change and transformation are not destinations but a journey, always a work in progress

www.pioneernetwork.net

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Social inclusionA socially inclusive society is defined as one where all people feel valued, their differences are respected, and their basic needs are met so they can live in dignity.

Social exclusion is the process of being shut out from the social, economic, political and cultural systems which contribute to the integration of a person into

the community (Cappo 2002).

The Values that Underpin Social Inclusion developed by Scottish Human Services Trust (2005)Everyone Is Ready

None of us has to pass a test or meet a set of criteria before we can be included.

Everyone Can LearnAs human beings we all grow and change and make mistakes: and we

are all capable of learning.

Everyone Needs SupportSometimes some of us need more support than others.

Everyone Can CommunicateNot using words doesn’t mean we don’t have anything to say.

Everyone Can ContributeWe need to recognize, encourage and value each person’s

contributions - including our own.

Together We Are BetterWe are not dreaming of a world where everyone is like us - difference

is our most important renewable resource.

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Servant Leadership

Servant-leader focuses on the growth and well-being of people and the communities to which

they belong. While traditional leadership commonly involves the accumulation and exercise of power by the person at the “top of the pyramid,”

servant leadership is different.

The servant-leader shares power, places the needs of others first, and helps people develop

and perform as highly as possible.

-Check your ego at the door(Rooted in Robert K Greenleaf’s work in the Center for Servant Leadership)

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Mr. Carter was only ten years old in 1950 when he was committed to a state training school. He had picked up a brick and threw it at a child, who was Caucasian, who was teasing him. Mr. Carter, who was African American was “slow” and had little family support.

In the 1990’s, he was identified as misplaced in a state training school and was going to return to the community. A social worker contacted me to see if we could serve him. I immediately said yes and shared the information with the staff. The staff’s reaction was strong and I was told, “We do not accept the mentally retarded.”I was two years into the job and was unaware of any such procedure. What would you do in my place?

A. Contact the social worker and  relate that we are unable to accept him in our program at this time

B. Reinforce my leadership and authority and express that we are going to do things differently now that I am in charge.

C. Tell the back story of Mr. Carter and build a connection. 

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• Create an atmosphere that celebrates the vision and mission

• Solicit input from all stakeholders, caregivers, staff, volunteers, individuals, donors, regulators

• Build a high energy work force

• Model expectations

• Provide support to Professional Caregivers

• Serve as the Cheerleader for all

• Be a visionary

*David Pitonyak, Issue Action Planning: Promoting Responsive Human Services

Leaders must lead* •Ask work force, in small groups, to develop a set of values that describe the work culture, ask each person to bring in an object that best represents their belief system and then ask them to explain it. Use this to formulate the values for their agency.

•Maintain an “open door policy”

•Roll up your sleeves, help staff do their work, work with individuals

•Build ownership

•Keep staff informed, have lots of meetings and talk about “Our Business”

•Know everyone’s name

•Develop wellness teams for staff and let them decide what strategies they want to work on for their health

•Make coming to work fun, something to look forward to

Practical Strategies

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• Create a culture that values every voice, every opinion

• Listen, Listen, Listen! especially when it is hard to hear!

• Encourage “dreams” and wishes

• Build trust, build teamwork

• Drive our fear

• Focus on the sincere belief that all employees are capable, honest, trustworthy and very capable.

• Manage by consensus and build decision making from the “bottom up”. The people closest to the individuals know the situation best and can with support and confidence from the manager, make best decisions

• Reinforce identification with mission

Leaders must empower staff

• Frequently ask for suggestions and be sure to act on some

• Form self-directed work teams to carry out important work i.e. Wellness program, customer satisfaction team

• Compliment staff on good work

• Empower staff to explain program services to guests

• Encourage staff to decide furnishings, colors, equipment they need

• Ask for input and involvement on policies/procedures before you issue a “regulation”

Practical Strategies

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• Reinforce accomplishments

• Highlight acts of kindness

• Create reflections

• Create fun

Leaders must create celebrations

• Develop contests such as mission moments where staff are divided into teams to create a visual depiction of the Mission Statement/Values (Quilt, sculpture, DVD)

• Give kudos at staff meetings

• Write personal handwritten notes from CEO

• Celebrate everyone’s birthday

• Know your employee’s family, who is graduating, who has grandchildren

• Have “All Hands on Deck” meetings quarterly and celebrate staff’s family’s milestones, “shout out” on graduations, births, etc.

Practical Strategies

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Lessons Learned

A successful work culture starts with

the interview, hiring process.

Staff needs to be constantly and

repeatedly grounded in the agency’s

mission and vision.

Performance Appraisals and evaluations reflect each employee’s ability to support the mission, values of organization.

Managers must “walk the walk” – not just “talk the

talk”.

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INTRODUCE OUR WORLD

REVIEW CONCEPTS

REVIEW PHILOSOPHIES

SHOW TRANSLATION OF CONCEPTS AND INTEGRATION

OF PHILOSOPHIES AT AGP

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RESPECT: Valuing difference and allowing for

compromise

TRUST: Assured reliance

on character, strength, and truth

TEAMWORK: Sharing individual skills and talents

to reach a common goal

PROFESSIONALISM

Be the best you can be in conduct, appearance, and

attitudeFLEXIBILITY:

Ability to adapt to changing needs of the members

and the organization

EMPATHY: Care with

understanding hope

DEDICATION: A steadfast

commitment to an optimal quality of

life for our members, their families, & each

other

EMPOWERMENT: Practicing the belief that each individual can

make their own decisions and act

on them

INCLUSIVE: Embracing each individual as part

of the whole

HUMOR: Loving and playful

approach to challenges

IMAGINATION: Creating new and

spirited approaches that

further independence

PERSEVERANCE:

Doing what it takes to realize

dreamsPRIDE IN PLACE:

Demonstration of respect we show to our members,

peers, and community

A Grace Place’s Values: How were they developed?

ANY AGENCY

CAN DO T

HIS!

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Does your agency’s mission statement and its values reflect what you feel your agency provides?

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Villages are constantly changing.

From the professional caregivers at A Grace Place to family caregivers at home to the drivers that

drop our individuals off, everyone is entitled to a person-centered response..

It takes a village to support an individual.

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The Person-Centered TeamA PERSON-CENTERED PHYSICAL ENVIRON-

MENT

INDIVIDUAL (Inclusive, we rarely

turn anyone away)

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Best Practices for

Person-Centered Care

Expressive Arts Program

Team-Work

Music Therapy

Reminiscence Therapy

Inclusion(Both within organization &

throughout community)

Validation Therapy

Best Practices based onPerson-Centered Care

Wellness Program

One-on-One Care

Pet Therapy

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What does Community Inclusion mean?

How can we promote it?

How do we build a world where no one’s left out?

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Best Practices for Community Inclusion:

It is not enough to bring people into the community. Individuals must participate.

Blend:Do not overload or overwhelm the environment.

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Best Practices for Inclusion foundat A Grace Place:

Inclusive Attitude Everybody Matters

Community-normalized: – Transportation Assistance– Eating Style– Dress Code– Business Cards

Everyone Is Ready

Everyone Can Learn

Everyone Needs Support

Everyone Can Communicate

Everyone Can Contribute

Together We Are Better

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How do we create a Person-Centered

Response to Each Individual?

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By 2030, between 3.6 and 7.2 million LGBT Americans

45,000 Lesbian and Gay Households in Virginia by 2030

Richmond ranks #16 nationwide in the number of Lesbian and Gay identified households

AN EXAMPLE OF INCLUSION:

AGP first agency to provide Person-Centered Care Training for Direct Care Support Professionals providing Care in Adult Care Services Facilities

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KryssAnneA transgender female who battles a terminal

illness, isolation and fear of healthcare

professionals who "don't want to touch my

body.”

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Hannah Green is forty five and has been working at A Grace Place for over ten years. She works in the program that supports adults with intellectual disabilities and has a very good work record. She is a valued employee and is well liked by her peers, and the individuals she supports.

When Hannah heard at a staff meeting that the agency was going to offer training in LGBT in long term care and that attendance was compulsory, she became very concerned. Her supervisor overheard her say to her peers that she “was not going to attend even if it cost her, her job.”

How would you handle this?  

A. Talk with the employee and allow her to be absent based on the strong religious objections she expressed.

B. Require her to be present.  

C. Take no action and see what she does

D. Open up a dialogue with the employee and see where “the middle” is

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Lessons Learned

People connect with real stories of real

people and this connection is vital to

overcoming prejudices and discrimination.

People accept individuals when they have an opportunity to

know them, identify with them.

Assumptions can be broken down

individual by individual.

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Caregiver: “That’s okay,

sometimes it takes me a while to get my

words out, too!”

Client: “I’m sorry. Sometimes it takes a while for me to get my words out…”

Get to know their back-stories: who they were, who they are, and who they would like to be. They are more than diagnoses.

KNOW THE INDIVIDUAL

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A hallmark of PCC is empowering the individual. It may take more effort initially, but will reap rewards in the long run.

Honor their individual experiences. Listen to who they are. Understand who they were, who they are and who they want to be. Learn to listen.

EMPOWER

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Honor who they were, their rituals, their occupations, their roles. Role transition is one of the most difficult parts of aging or change in cognitive status. Our roles are engrained into our essence. Into our being. Supporting the maintenance of these roles supports PCC and positive health outcomes.

SUPPORT ROLE TRANSITIONS

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A little more time and effort on the front end can have greater positive health outcomes in the long run.

ONE ON ONE CARE

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“The Book”

Communication Log

Informal Professional

Caregiver Meetings

each morning

Calling After Hours

Team Approach To Care

Best Practices for Staff Commu-nication

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A Person-Centered Response to Each Professional Caregiver

Keep the engines running!

• Within a work team model, staff can take a break when they need it and the collective team steps in until the professional caregiver returns

• Everyone is willing to do 2 on 1, supervisors are always willing to switch sides if support is needed

Respite!

• A Grace Place offers 3 weeks of annual vacation, holidays and 3 hours of sick leave accrued bi-weekly

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A Person-Centered Response to Each Family’s Needs

Caregiver Support• is essential to PCC. They spend as

much time with their loved one as we do and can often provide information that is vital to their well-being.

Caregiver Education Program

Telephone Support for Caregivers

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How Does Such a Village Lead to A Caring Response?

“The individuals- you get attached, it’s hard not to. To us, we’re family to them. A lot of them don’t have any other family. This is all they know- it is their home away from home.” -AGP staff member

“I love helping them discover something they didn’t realize they could do. Like handing money to a cashier. Or ordering their own meal when they are out. You’d think it was Christmas.” -AGP staff member

A family of friends

Home away from home

Encouraging that one-on-

one relationship

Sharing and delighting in

the accomplishments of each

individual

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How to Build a Village of Support: Team-Building and Servant Leadership Practices

Know your care team of care professionals like you know the clients• “We know each

other’s hardships and help work around them.” –AGP staff member

Have strong executive and management support and leadership• If a care professional

comes to management with a problem, listen, take notes, rearticulate out loud what is being said to you, to ensure that you understand.

Be flexible

Have team meetings and

consistent communication

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The Physical Environment of AGP’s Village

Note the centralized intake area and the needs-based compartmentalization combined with a good amount of outdoor space.

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Community Partnerships

• Youth Programs• United Way• Faith-Based Organizations• The Business Community• Other Adult Day Centers• Volunteerism

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Person-Centered Volunteers

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Change requires extra time and commitment of an

already over-whelmed work force and can be exhausting

and cause stress.

Communication between

departments can be daunting.

Governmental regulations and policies may require additional

effort and demand creativity.

On-going training and support of staff

are vital to success.

Staff may lack self-confidence and emotional

support needed to change/embrace new

ideas.

Reflection and Evaluation among

individuals and work teams may be inconsistent

Will we lose clients? Will we lose staff?

Positive health outcome for individuals

Higher work satisfaction for

employees

More effective work teams

Purposeful living for

individuals

Higher census through word of mouth

marketing, plus reduced advertising expenses

Op

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and

Ch

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es o

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REFLECTION

• What have you taken away from our time together today?

• Can you share your valuable practices to advance person centered care?

• How can we support you?

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Resources• David Pitonyak article:

– http://www.dimagine.com/Toolbox.pdf 

• Eden Alternatives– www.edenalt.com

• Person-Centered Care and Dementia Care– http://www.alzheimers.org.uk/site/scripts/documents_info.php?doc

umentID=1191&pageNumber=3

 • Patient Centered Care Improvement Guide

– http://planetree.org/wp-content/uploads/2012/01/Patient-Centered-Care-Improvement-Guide-10-28-09-Final.pdf

• The Pioneer Network– https://www.pioneernetwork.net/

 • Servant Leadership

– https://www.greenleaf.org/

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www.agraceplaceacc.org/

www.sahp.vcu.edu/gerontology/

• Lynne Seward: lynneseward@agraceplaceacc.org

• Debbie Scott: debbiescott@agraceplacecc.org

• Jay White: 804-828-1565 whitejt2@vcu.edu

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