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

2. What is organizational culture? • Belief systems • Rules - both formal and informal • Norms Jentle Harts Consulting 2008

3. What is culture change? Understand culture change is a “persistent, subtle ingenious substitution of one way of being by another.” Thomas Kitwood Jentle Harts Consulting 2008

4. 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 Jentle Harts Consulting 2008

5. 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” Jentle Harts Consulting 2008

6. 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 Jentle Harts Consulting 2008

7. 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 Jentle Harts Consulting 2008

8. 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 Jentle Harts Consulting 2008

9. 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 Jentle Harts Consulting 2008

10. Change in Language Jentle Harts Consulting 2008

11. Change in Language, cont. Jentle Harts Consulting 2008

12. Assessments for Care Planning Jentle Harts Consulting 2008

13. Care Plans Jentle Harts Consulting 2008

14. 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 Jentle Harts Consulting 2008

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? Jentle Harts Consulting 2008

16. 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 from Luther Manor Adult Day Wauwatosa, WI …….. Jentle Harts Consulting 2008

17. 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 Jentle Harts Consulting 2008

18. 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 Jentle Harts Consulting 2008

19. Recruiting Staff Who “Get It” • Flexible • Kind • Empathetic • Comfortable with participants • Participant choice drives the program Jentle Harts Consulting 2008

20. 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 Jentle Harts Consulting 2008

21. 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? Jentle Harts Consulting 2008

22. 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 Jentle Harts Consulting 2008

23. Program Assistant Job Descriptions Jentle Harts Consulting 2008

24. 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. Jentle Harts Consulting 2008

25. 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 Jentle Harts Consulting 2008

26. 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 Jentle Harts Consulting 2008

27. 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 Jentle Harts Consulting 2008

28. 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! Jentle Harts Consulting 2008

29. 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. Jentle Harts Consulting 2008

30. Contact Information LaDonna Jensen, RN Marilyn Hartle, MSW, LCSW PO Box 551087 Indianapolis, IN 46205 317-255-2248 ladonna@jentleharts.com marilyn@jentleharts.com Jentle Harts Consulting 2008