Person-Directed Care: the Heart of Culture Change DADS Culture Change Initiative Presented by: Mary Valente, LBSW, M

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

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/culturechange

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

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 www.dads.state.tx.us/culturechange

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

6. Institution-Directed Culture Reference: Pioneer Network, January 2012 • 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.  * www.dads.state.tx.us/culturechange www.dads.state.tx.us/culturechange

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 www.dads.state.tx.us/culturechange

8. Nursing Home Owner Administrator Director of Nursing Professional Nursing Staff Nurse Aides Residents Institution-Directed Culture continuedOrganizational Structure Family & Friends * * Source: NY State Office for the Aging, www.nursinghome411.org

9. Institution-Directed Culture continuedSocial Interaction * Source: NY State Office for the Aging, www.nursinghome411.org. *

10. Person-Directed Culturecontinued Reference: Pioneer Network, January 2012 • 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 www.dads.state.tx.us/culturechange

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 www.dads.state.tx.us/culturechange

12. Residents Family Members Nurse Aides Professional Nursing Staff Director of Nursing Administrator Nursing Home Owner Person-Directed Culture continuedOrganizational Structure * Source: NY State Office for the Aging, www.nursinghome411.org. *

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

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

15. Person-Directed Care: the Heart of Culture Change Culture Change Goals • The focus is on relationships; this is the heart of culture change. • Keep the ‘I’ in individualized care. * www.dads.state.tx.us/culturechange www.dads.state.tx.us/culturechange

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

18. Compare these pictures.Which style would you prefer? *

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

20. 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

21. Institutional Model * www.dads.state.tx.us/culturechange www.dads.state.tx.us/culturechange

22. Nursing Facility Design ProgressionAdditional 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 www.dads.state.tx.us/culturechange

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

27. 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

28. Small House Plan Can you find the nurses’ station? * www.dads.state.tx.us/culturechange www.dads.state.tx.us/culturechange

29. Wings of existing plans can be remodeledas neighborhoods. Nursing Facility Design ProgressionRemodeling to Achieve Culture Change * www.dads.state.tx.us/culturechange 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 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 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 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 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 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 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 www.dads.state.tx.us/culturechange

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

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

40. Person-Directed Care: the Heart of Culture Change Getting Started: • PLAN Form a committee, set priorities. • DO Assignments and leadership. • STUDYAre the changes working? • ACT Explore other possibilities. * www.dads.state.tx.us/culturechange www.dads.state.tx.us/culturechange

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

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

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