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A Visionary Path to Culture Change
Texas Coalition for Culture ChangeSan Marcos, Texas September 23, 2011
Pearl Merritt, EdD., MSN, MS, RN Regional Dean Texas Tech Health Sciences
andDebby Burgett, LNFA
Member of Pivot Senior Living Experts
The Beginning of a Journey
"Vision without execution is hallucination.” — Thomas Edison
OBJECTIVES
• Analyze contributions of small houses for elders• Propose innovative strategies for ADL’s by
CNA’s• Critique the role of the nurse in small houses• Questions and Answers
Small House Design
• What is the definition of a small house?• Do you already have an existing campus
infrastructure?• Will the design meet with regulatory guidelines? • Is the design financially viable?
Traditional Home Repositioning
Assisted Living
Mall
House A
House BHouse CHouse D
MyHouseNursing
Houses E/F
IL
Support
Assisted Living
Mall
House A
House BHouse CHouse D
MyHouseNursing
Houses E/F
IL
Support
Outcomes• Opens doors for increased opportunities
– Better clinical outcomes– Lower staff turnover– Increased staff satisfaction– Increased campus census– Increased elder and family satisfaction– Better survey results
• Changes negative image of long-term care• Creates a brand strength for your organization• Increase revenue if proves to be a good financial
model
Cultivating Relationships
• Buy-in from federal and state surveyors• Educate and keep surveyors informed of your adopted
philosophy and practices• Design approval is required from the State of Texas. • Connect with TAHSA, TXCCC, SAGE, Pioneer Network
CMS offered its contribution to the movement by stating, “It is our goal to have State agencies assist innovative providers in determining how changes they wish to make to improve the lives of their residents can be compliant with the Federal regulations that protect all residents.”
Financial Viability
• Market study• Financial pro-forma• Secure financing and fundraising• Operating and Projected budget• Timeline for completion of project
Care Givers in a Small House Home
The Direct Care Staff: Flexible, Talented, Multi-Taskers,
Selflessness, Adaptable, Generous, Courageous, Trustful
Activities, Celebrations and
Meaningful
Engagement
Care Givers and
Companions
Self-Led Team• Team scheduling• “Keepers” of the daily rhythm of the house• Work as a team with nurses, therapists and any
clinical support member• Coordinate meals to include planning with
elders, ordering, receiving and cooking of food. • Responsible for maintaining the house in a
clean, neat and orderly. • They report to a coach, guide or mentor. • They are highly skilled with culinary talent, safe
cooking practices, and CPR.
Time, Training and MethodTIME• Direct Care Staff, prior to opening, 2-4 weeks • Leadership, prior to opening, 4-12 weeks
TRAINING• Culinary Skills• Food Safety • CPR• Conflict Resolution• Communication• Elder Centered Care• Support –VS-Accountability• Developing Self-Led Teams• Team Scheduling• Ageism• Regulatory Support/Survey Readiness
Time, Training and Method
METHOD• Classroom Instruction
– Role Playing– Lecture– Videos– Brainstorming– Active Participation– Power Points/handouts– Problem Solving Scenarios– Involvement from All
Leadership Development
• Begins as soon as possible
• Key stakeholders– SWOT– PDSA – Realign vision and mission statements– Strategic planning– Readiness Assessment
Nursing in a Traditional Home
• Steep bureaucracy• Nurses control all unit activity• Nurses are the “boss” of the nurse aides• Nurses are responsible for nurse aides
scheduling and finding replacements• Departmental • Regimental• Nurses station is the center of most units• Institutional feel• Nursing Charts and paperwork intensive
“Giving nursing staff a voice in the organization’s decision making related to care practices and work process changes will influence staff retention—an integral part of maintaining quality care.”
– Barbara Bowers, PhD, RN, FAAN
Associate Dean for Research
Helen Denne Schulte Professor of Nursing
University of Wisconsin-Madison
Nursing in a Small House • Bureaucracy is flattened• Daily rhythm of the home is in the control of the elders• Nurses are not responsible for CNA scheduling or finding
replacements• Nurses and Nurse aides work as a team; they are often
described in a small house as educators.• The functions of the nurses station are provided, but the
“look” is different• Home environment; the institutional look and feel is
removed• Nurses truly are nurses and not supervisors
Nursing Stations
Technology
Institutional Features are
Removed
On- Site Training
Conclusion• Research validates small house outcomes of improved quality of care and improved quality of life.
• CNA’s through education and training maintain the home with the elders at the center of all decision making.
• The role of a nurse in a small house home is crucial in maintaining quality of care.
• The small house design can be financially viable.
• State and Federal agencies are supportive of the small house model and culture change.