person centered culture change in adult day services national adult day services association annual...
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Person Centered Culture Change In
Adult Day ServicesNational Adult Day Services Association Annual Conference 2008
Presented by:
LaDonna Jensen, RN
Marilyn Hartle, MSW, LCSW
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What is organizational culture?
Belief systems
Rules - both formal and informal
Norms
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What is culture change?
Understand culture change is a
“persistent, subtle ingenious substitution of one way of being by another.”
Thomas Kitwood
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What is culture change?
Widespread movement within the field of aging and care for persons with dementia
Movement to profoundly change systems and to transform care organizations to be driven by the choices and needs of the people they serve
Person Centered Care is driving the change in facilities that care for people with Alzheimer’s disease
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What is Person Centered Care?
“Person Centered Care is a combination of theories based on ethics and values - as well as care techniques - that guide care practices. It is based on the belief in the inherent value of an individual. PCC takes the perspective of the person with dementia and creates a social psychology of care that supports well-being.”
“Jentle Harts Consulting”
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Person Centered Care
Person Centered Care is an ongoing process of compassion, education, modeling, evaluation and monitoring engaged in for the purpose of improving the health and well-being of all persons involved in the giving and receiving of care.
Luther Manor Adult Day Services
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Elements of Old Culture: Environment
Ring of recliners around a television Bathrooms partially used as storage rooms Staff specific badges that emphasize position/job title
Organization Hierarchal staff structure Decision making occurs from top down
Outcome measurements Focus on physical outcomes of care, i.e. falls, weight , skin
breakdowns, nutritional intake Emphasis on medical monitoring
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Elements of Old Culture, cont. Program
Herd mentality-everyone must do the same thing at the same time in the same place
Unchanging, repetitive calendar Staff lead all activities Limited access to outdoors Little or no participant input into program choices Therapeutic fibbing as an unquestioned approach for
people with dementia
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Why Change?
Consumer demand Third party reimbursement expectations Upgraded expectations of services by the baby boomers Accrediting bodies have changed expectations What once was standard of practice is now considered
deficient practice It is the moral and ethical thing to do
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Change in Language
Old Language Person Centered Language
Admit Join
Discharge ADS no longer meets their needs
Allow Facilitate
Adult Day Care Adult Day Services
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Change in Language, cont.
Old Language Person Centered Language
Clients Participants, guests
Activities Meaningful occupation, engaged
Caregiver Care partner, carer
Traditional Care Plan Language
“I” Care Plan
Alteration in thought process
“I have problems with my memory.”
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Assessments for Care Planning
Traditional Assessments Person Centered Assessments
Medically based Person based
Emphasis on symptoms, impairments, deficits
Acknowledge losses but emphasis on strengths
Minimal psychosocial history Life story emphasized
Family structure What does family mean for this person?
Does the person “fit” in the program
How can our program support the well-being of this person?
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Care PlansTraditional “I” Care Plans
Based on medical/nursing care plan
Uses first person narrative
Used solely to direct medical care
Used to support quality of life
Intended for nursing or medical staff use only
Intended for use by all staff who are involved in the person’s care
Based on problems Based on strengths
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Why “I statement” Care Plans?
Strives to put the person back in charge of their own life
Supports & documents our efforts to advance person centered care/individualized care planning
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How do we facilitate “I” Care Plans
Is the participant consulted? Is their involvement facilitated regardless of their level of
impairment (physical, cognitive or mental)? Are we too busy filling out forms to learn the essence of
this person? What are their hopes? What brings them joy? What are their dreams? What do they worry about?
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Examples of things to ask: Name of choice. Is this name appropriate for all staff to use? Preference in group dynamics
Likes to be in the center of things Reflective—prefers to watch Prefers small, quiet groups Likes large groups with lots of noise and activity
Example fromLuther Manor Adult DayWauwatosa, WI
……..
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If they were writing their own care plan, what would it look like?
People (staff) remember the details of stories more than statistics or lists of tasks
When staff know something about the people they interact with, they can move beyond being task focused
My Personal Care Plan
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Person centered outcome measurements
Quality of life indicators Dementia care mapping
Attempts to take the perspective of the person with dementia
Evidence based, observational process Can be used in several ways for quality improvement
processes as well as individual care planning
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Recruiting Staff Who “Get It”
Flexible Kind Empathetic Comfortable with participants Participant choice drives the program
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Typical Program Assistant Job Descriptions Lists skills & competencies needed with corresponding
responsibilities Participate in assessment/care planning Assist in developing the activity plan Carry out plan of care Carry out recreation activities Observe and report observations
National Adult Day Services AssociationTraining the Program Assistant in Adult Day Services, 2004
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Observe & Report Observations
Current standards require observation at minimum of: Skin tone Strength Flexibility Signs of physical discomfort Changes in abilities, behaviors, appearance
Program Assistants should be able to conduct calm observation & report detail in times of crisis, reporting only what is seen, heard & done
National Adult Day Services AssociationTraining the Program Assistant in Adult Day Services,
2004
Is This Good Enough?
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Potential Additions to Job Description to Support Person Centered Care
A primary responsibility is to get acquainted with the participant and work on establishing a relationship with him/her & their family
Observe for evidence that a person experiences particular pleasure in a specific activity & report that during care plan meeting
Observe & report signs of emotional discomfort whenever they occur with a participant
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Program Assistant Job Descriptions
Traditional Job Description
Person Centered Job Description
Assist and supervise activities of daily living
Facilitate independence and coach through activities of daily living. Assist only when necessary.
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Performance Expectations
When person centered care is embedded in an organization, the primary performance expectation is that the goals of person centered care will be pervasive in all interactions with participants.
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How Can Staff Deliver Person Centered Care? Must be modeled by supervisors Must be a core value & underpinning philosophy
of all care Must be understood-what does this mean for me
in my position? Must understand what is different-not just doing
“the same old thing” but calling it by a different name
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How Can Person Centered Care Support Be Offered to Staff?
Well-being of staff a priority Education/training to do job well Clear job expectations Equipment adequate, appropriate &
available Accoutrements/accessories available to
personalize care
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Person Centered Care for Staff
Basic understanding by managers/administrators of what staff is experiencing in care Sorrow Sense of loss Fear of situations that are beyond their control Fear of aggression from participants
Managers recognize stress, strain and/or burnout of staff before critical stage (resignation)
Luther Manor’s exercises for Person Centered Care Staff
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Person Centered Care for Families Families respected as care partners
Seek family input regularly Be sensitive to the family’s perspective on care Be sensitive to fears
Positive relationships are nurtured between staff and family members
Communicate, communicate, communicate!
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Bibliography
Kitwood, Tom, Dementia Reconsidered, Philadelphia: Open University Press, 1998.
Krugh, Christine, MSW and Bowman, Carmen S., Changing The Culture of Care Planning: A person-directed approach, Milwaukee: Action Pact, Inc. 2006.
Shields, Steve & Norton, Laverne, In Pursuit of the Sunbeam: A practical guide to transformation from institution to household., Milwaukee: Action Pact Press, 2006.
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Contact Information
LaDonna Jensen, RNMarilyn Hartle, MSW, LCSWPO Box 551087Indianapolis, IN [email protected]@jentleharts.com