Transformation of the Culture of Nursing Home Care

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Transformation of the Culture of Nursing Home Care

• In the State Veterans Home Program

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YES, in the SVH Program

• Christa M. Hojlo, PhD, RN, NHA
• 810 Vermont Ave, NW (114)
• Washington, DC 20420
• 202-461-6779

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Objectives

• Define culture transformation in nursing homes
• Purpose
• Framework Form Follows Function
• Practical
• Application and impact on SVH

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What is Culture Transformation

• National effort
• Pioneer Network
• Centers for Medicare and Medicaid Services (CMS)
• VHA
• Other National Nursing Home Organizations

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What is Culture Transformation

• Transforming the way we (care givers and
  providers) THINK about how we deliver care
• From Medical Model
• To model driven by resident needs

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Purpose

• To deinstitutionalize nursing homes
• To improve the quality of life of residents
• To provide care and services that give voice to
  the resident/place the resident at the center of
  care
• To dismantle the negative stereotypes about
  nursing homes in this country

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Transformation of Form and Function

• Function

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Traditional TransformedMEDICAL
New Model

• Staff provide treatments
• Residents follow facility routine
• Staff float
• Staff make decisions for residents
• Facility belong to staff
• Structured activities
• Departmental focus
• Staff know resident by dx

• Nurture the human spirit
• Facility follows residents routine
• Permanent assignments
• Residents make their own decisions
• Facility is residents own home
• Spontaneous activity 24 hours
• Team!!
• Staff know residents

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The Form (structure)

• Traditional
• Hospital model
• Long corridors
• Poor lighting
• Sterile
• Efficiency is the goal

• Transformed
• HOME (not-home-like)
• Cues about home behavior
• Soothes, comforts, heals
• Personalized CARE is the goal

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Framework for Function

• HATCh Model (CMS)
• (Holistic Approach to Culture Change)
• In the model the resident is at the center!

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HATCh Model

• Helps translate theory into practice

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Practice

• Transformed practice

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Work Practices

• Management style-empowerment
• Stability of staff (low turnover)
• Creative staffing
• New staffing patterns
• Consistent assignments
• Self scheduling
• Unit management

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Care Practices

• Good medical care important but
• NOT Enough!
• Examine and create new systems of care
• Systems of care that restore
• Move away from rigid schedules
• Change outmoded practices
• Its a pleasure to serve you!

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Environment of Care

• Transformed environments
• Soothe
• Promote wellness
• Provide comfort
• Encourage socialization
• Are home
• Encourage appropriate behaviors

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Impact on SVH

• CARE
• New roles staffing implications
• Resident rights (bathing schedules)
• Meaningful use of time
• Refining dining
• Medication administration
• Sleep/wake cycles

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Impact on SVH

• Survey greatest impact on this process
• New interpretive Guidelines from CMS
• 24 hour access to visitors (with reasonable
  restrictions
• Choice of roommates
• Dignity
• Eliminating bibs/clothing protectors
• Staff sit rather than stand to assist with eating
• Staff interact with residents rather than with
  themselves while providing care
• Speaking respectfully with and about residents
  (feeders)
• Personal grooming hand washing after hands
  soiled
• Right to make choices
• Schedules including sleep/wake/bathing etc

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Impact on SVH

• New interpretive Guidelines from CMS
• Individualized personal surroundings
• Notification when roommate changes
• Creating home
• No overhead paging or music
• Remove trays for meals
• Eliminating central nurse stations
• Eliminating medication carts
• Eliminating wide spread use of bed and chair
  alarms
• Lighting
• As much day light as possible
• Eliminating glare

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Impact on SVH contd

• New interpretive Guidelines from CMS contd
• Lighting contd
• Night time way finding
• Reading light
• Dimming switches rather than sudden onslaught of
  light
• Clothes racks and shelves accessible to resident

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Impact on SVH contd

• Staffing
• Universal workers
• Role of RN clarified
• Interdisciplinary team efforts more obvious

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Culture Transformation is on its way

• Culture transformation is a reality that will
  keep pace with the new generation of residents in
  nursing homes
• Who would not want what was just described?
• For self
• For mother

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Summary and conclusions

• The culture of care in Nursing homes is not
  CHANGING it is TRANSFORMING

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• Transforming the culture of care requires
• New knowledge
• Seeing with new eyes
• Hearing the voice of the resident through the
  voice of the resident.
• New THINKING about CARE
• New ways to survey e.g. LOOK at the care

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Cultural Transformation

• Transform your ways of knowing
• and seeing
• and hearing
• and you will transform
• the delivery of care

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• Thank you