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The Small House

Explore the history of nursing homes, challenges faced by residents, and innovative solutions such as the Green House Project. Learn about experts Dr. Rosalie Kane and Dr. Robert Kane who advocate for improved care and working conditions. Discover a new vision focused on person-centered care, individualized approaches, and staff empowerment. Find out how to implement positive changes through a conceptual model emphasizing staff training, structural design, and personalized care plans.

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The Small House

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  1. The Small House

  2. History of the Nursing Home SS & Medicare Penicillin & Medical Renaissance Baby Boomers

  3. The Nursing Home as Institution A ‘total institution’ is ‘a place of residence and work where a large number of like-situated individuals, cut off from the wider society for an appreciable period of time, together lead an enclosed, formally administered round of life that is controlled by a bureaucratic administration with set schedules and requirements and marked with depersonalization.

  4. Symptoms of Homelessness • Failure to thrive • Depersonalization • Loss of self esteem • Depression • Loss of appetite • Disengagement

  5. Problems Loss of dignity Decreased sense of value & respect Low levels of choice Loss of the privileges of adulthood Loss of home

  6. Culture Change – Pioneer Network Live Oak Regenerative Community Mt St Vincent (early neighborhoods) Eden Alterative

  7. SLOW incremental ADOPTION

  8. De-institutionalizationcreate a new normal Restore Home Improve clinical Care Improve working conditions for staff

  9. Green House Project Rosalie Kane, PhD professor in the division of health policy and management of the School of Public Health at the University of Minnesota, past editor-in-chief of both Health and Social Work, and of The Gerontologist. Robert Kane, MD Geriatrician Minnesota Chair of Aging and Long-Term Care at the University of Minnesota's School of Public Health  Author, Clinical Geriatrics

  10. For the Organization Vision Success Excellent clinical, financial, quality of life and satisfaction outcomes.

  11. Conceptual Model

  12. Homea vessel for the most positive elderhood possible • Architecture that supports • Elements of home • function of the elder • Work of the staff

  13. Free Standing Houses in clusters Otterbein Neighborhoods, Ohio Perkins Eastman

  14. Urban High Rises Jewish Home Lifecare Perkins Eastman

  15. Front door

  16. For the staff A satisfying job in a serene work environment where they feel empowered and valued

  17. Staffing Model • Separate schedules by house • Consistently assigned to same house • 1:5 ratios

  18. Organizational structure

  19. Ceiling Lift Lifts are key to staffing ratios and outcomes

  20. For the elders

  21. Kane Domains of Quality of Life Comfort Functional competence Autonomy Dignity Privacy Individuality Meaningful activities Relationships Enjoyment Security Spiritual well being

  22. Person CenteredNothing about me without me RESPONSIVE KNOWING & Individualized Normalization Life History Individualized mornings Food preferences Lifelong Engagement Patterns End of life wishes Sleeping patterns Care preferences

  23. Normalized Diets

  24. Convivium + Family Style Dining

  25. Individualized Care • Re- evaluate all of the “everyone” practices • Bathing • Weights • Blood pressures • Glucometer testing • And more

  26. Evidence based practices CAM Advance directives No restraints No alarms NDDC dementia care Incontinent /skin care Infection control – UTIs Diabetes Falls program

  27. Person Centered Medication Plans Reduce Polypharmacy Person centered administration times – aim for BID Decrease crushing Eliminate unnecessary medications

  28. Lessons and Challenges

  29. Interconnected outcomes

  30. Overcoming the ideology of comfort and the tyranny of custom

  31. Staff Training

  32. Phases of Implementation Feasibility Implementation Actualization Conceptualization & Strategizing Explore Model details Select architect Select consultants Obtain stakeholder buy–in Financial feasibility modeling Identify site Regulatory review Regulatory Meetings Design Refine financials Secure financing Map project activities Create Timeline Construction Systems mapping Staff reconfiguration Policies & Procedures Training Plan Training deployment Move in plan Quality plan Move-in Continuous coaching on adaptive changes

  33. DiscontinuousDisruptiveMessyParadoxical Change

  34. Execution - What does it Take? Disciplined thought Disciplined people Disciplined actions

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