Person Centered Culture Change In Adult Day Services National Adult Day Services Association Annual Conference 2008 Presented by: LaDonna Jensen, RN Marilyn

Person Centered Culture Change In

Adult Day ServicesNational Adult Day Services Association Annual Conference 2008

Presented by:

LaDonna Jensen, RN

Marilyn Hartle, MSW, LCSW

Jentle Harts Consulting 2008 2

What is organizational culture?

Belief systems

Rules - both formal and informal

Norms


What is culture change?

Understand culture change is a

“persistent, subtle ingenious substitution of one way of being by another.”

Thomas Kitwood


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


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”


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


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


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


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


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


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.”


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?


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


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


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?


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

……..


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


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


Recruiting Staff Who “Get It”

Flexible Kind Empathetic Comfortable with participants Participant choice drives the program


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


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?


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


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.


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.


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


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


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


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!


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.


Contact Information

LaDonna Jensen, RNMarilyn Hartle, MSW, LCSWPO Box 551087Indianapolis, IN [email protected]@jentleharts.com

Documents

Person Centered Culture Change In Adult Day Services National Adult Day Services Association Annual Conference 2008 Presented by: LaDonna Jensen, RN Marilyn