Title: Person Centered Culture Change In Adult Day Services
1 Person Centered Culture Change In Adult
Day Services
- National Adult Day Services Association Annual
Conference 2008 - Presented by
- LaDonna Jensen, RN
- Marilyn Hartle, MSW, LCSW
-
2What is organizational culture?
- Belief systems
- Rules - both formal and informal
- Norms
3What is culture change?
-
- Understand culture change is a persistent,
subtle ingenious substitution of one way of being
by another. Thomas Kitwood
4What 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 Alzheimers
disease
5What 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
6Person 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
7Elements 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
8Elements 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 -
9Why 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
-
10Change in Language
11 Change in Language, cont.
12Assessments for Care Planning
13Care Plans
14Why 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
15 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?
16Examples 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
- Reflectiveprefers to watch
- Prefers small, quiet groups
- Likes large groups with lots of noise and
activity - Example from
- Luther Manor Adult Day
- Wauwatosa, WI
17If 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
18Person 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 -
19Recruiting Staff Who Get It
- Flexible
- Kind
- Empathetic
- Comfortable with participants
- Participant choice drives the program
20Typical 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 Association
- Training the Program Assistant in Adult Day
Services, 2004
21Observe 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
Association - Training the Program Assistant in Adult Day
Services, - 2004
-
- Is This Good Enough?
22Potential 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
23Program Assistant Job Descriptions
24Performance 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.
25How 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
26How 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
27Person 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 Manors exercises for Person Centered Care
Staff
28Person Centered Care for Families
- Families respected as care partners
- Seek family input regularly
- Be sensitive to the familys perspective on care
- Be sensitive to fears
- Positive relationships are nurtured between staff
and family members - Communicate, communicate, communicate!
29Bibliography
- 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.
30Contact Information
LaDonna Jensen, RN Marilyn Hartle, MSW, LCSW PO
Box 551087 Indianapolis, IN 46205 317-255-2248 la
donna_at_jentleharts.com marilyn_at_jentleharts.com