Person Centered Culture Change In Adult Day Services

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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

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What is organizational culture?

• Belief systems
• Rules - both formal and informal
• Norms

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What is culture change?

• Understand culture change is a persistent,
  subtle ingenious substitution of one way of being
  by another. Thomas Kitwood

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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 Alzheimers
  disease

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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

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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

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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

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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

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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

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Change in Language
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Change in Language, cont.
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Assessments for Care Planning
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Care Plans
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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

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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?

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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
• Reflectiveprefers to watch
• Prefers small, quiet groups
• Likes large groups with lots of noise and
  activity
• Example from
• Luther Manor Adult Day
• Wauwatosa, WI

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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

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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

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Recruiting Staff Who Get It

• Flexible
• Kind
• Empathetic
• Comfortable with participants
• Participant choice drives the program

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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 Association
• Training the Program Assistant in Adult Day
  Services, 2004

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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
  Association
• Training the Program Assistant in Adult Day
  Services,
• 2004
• Is This Good Enough?

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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

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Program Assistant Job Descriptions
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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.

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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

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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

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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 Manors exercises for Person Centered Care
  Staff

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Person 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!

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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.

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Contact 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