10 Benefits of Culture Change on Skilled Nursing

Culture Change (also known as person-centered care or resident-directed care) transforms the traditional long-term care model from medical facility to a supportive home environment.  This movement is designed to change the overall mindset and environment of nursing homes into personal communities.  Culture change is designed to nurture the human spirit of aging residents as well as take care of their medical needs.  Its focus is on both quality of care and quality of life as guiding forces for improved life experience and life expectancy.

Within the culture change model, seniors have more privacy and choices, much like they would in their own homes.  They are given more control over their daily lives including meal and bed times and the caregivers are given more autonomy to care for residents in this flexible environment.  Residents’ needs and preferences come first, and care community operations procedures are shaped by this perspective.  Even the physical structures are changing from large hospital-like units to smaller communities resembling more of a group-home atmosphere in which they are cared for by a dedicated team of caregivers.

10 Benefits of Culture Change

  1. Respects the right of the resident to make their own decisions and honors their need for control over choices in their daily lives.
  2. Reduces boredom and helplessness in residents.
  3. Improves mental health (reduces loneliness, depression, behavioral issues).
  4. Encourages a personalized home atmosphere by allowing residents to create their own living style in their rooms.
  5. Increases enjoyment and life expectancy of the patients.
  6. Focuses on using person-centered language that respects and honors the patient by putting the person first and then the characteristic second.  For instance, instead of a wheelchair-bound resident, the description is modified to a person who uses a wheelchair for mobility and instead of a feeder the patient is referred to as someone who needs assistance with dining.
  7. Focuses caregivers on person-centered care, rather than completion of tasks.
  8. Individual care focusing on personalized needs and preferences of the staff and the residents creates a supportive environment that puts people first, over the facility.
  9. Promotes a dedicated team approach rather than rotating assignments for staff thereby creating personal connections and familiarity for the residents.
  10. Creates a team-building environment for the staff based on consistency of staff teams.
  11. Reduces employee turnover which in turn keeps a steady team of familiar faces rather than the need for temporary staffing agencies with training needs and learning curves.

The essence of culture change is about transforming philosophies and management style so that aging is no longer synonymous with decline and illness.  The principles of culture change are founded in a new way of caring and being cared for that is based on choice, creativity, and flexibility.  The future of culture change lies in the commitment to improve resident and staff quality of life through empowerment.

For more information on the culture change movement, visit the Pioneer Network.

Photo credit: K?vanç Ni?

HOW TO: Creating a Elder Care Support Network to Reduce Stress

It is important to remember that when caring for an adult parent that you also care for yourself as well.  Any form of elder care can be draining on an emotional, physical and time commitment level.  In order to be able to sustain your generous efforts, you need to seek out and be able to ask for assistance.  You will want a network of people and agencies you can rely on for consistent support, when you need a respite or in the event of an elder care crisis.

As you begin to develop the support team as described below, remember that the key to success lies in the ability to ask for help.  Even if other family members live farther away, still enlist their assistance and together you will come up with ways they can best support you.

Steps for Developing Your Support Network

  1. Make a list of each person who may be available to you such as family, friends, neighbors, members of your community groups and churches. For each person take note of the following:
  2. Phone number for easy reference
  3. What they are available and willing to provide in the form of help
  4. What days and times they can offer to you
    1. Check with your local Area Agency on Aging for respite and other assistance.
    2. Create a list of your regular responsibilities both in the role as caregiver and your personal duties to yourself and your immediate family.  Don’t forget to include activities such as picking up your children from school or practice or helping with other errands.
    3. Next to each task estimate the duration of time (including commute) so that you can provide a realistic time commitment to your network and you do not feel the stress of rushing around.
    4. Begin asking your network in what areas they would be most able to support you.  Because your list is detailed and specific it will be easier to get positive responses for these individual needs.

It really helps in sharing some of the responsibility if you make this list easily accessible to other members of your family so that if need be, they can make phone calls in case a change or crisis should arise.  Remember that just because you took the initiative to create the network system does not mean you have to manage it alone.

Other Resources

In order to help you create, complete and maintain a thorough and organized support system, I have developed easy-to-use worksheets in the workbook of The By Families, For Families Guide to Assisted Living Workbook.  While the book is written for assisted living, the worksheets are applicable to all levels of care.

photo: BrittneyBush

HOW TO: Using Lifeline to Monitor Caregiver Response

“How long does it take for a caregiver to help my mom or dad?”

This is a question I am frequently asked when I speak at assisted living communities.  Most communities offer some form of help button, usually in the form of a pendant or wristband worn by the resident.  When mom or dad needs help, they press the button.  A signal is sent to front desk where a receptionist or nurse dispatches assistance to the room.

Going back to my question, most community marketing staff will respond that help comes within 5 to 15 minutes.  But how do you verify this?  And what do you do if mom or dad says they ring the buzzer and nobody comes for an extended period of time?  What is your loved one has a poor perception of time?  Is there a way to monitor the situation without being annoying to everyone?

Finally… A Solution

The system is called Lifeline and it is made by Philips.  If you don’t remember, there used to be a commercial for Lifeline.  It showed an elder woman who fell. She presses a buzzer and says “I’ve fallen, and I can’t get up!”  I used to think that this system was only useful in the event of an emergency, but boy was I wrong.  Lifeline rocks!

I recommend every resident in assisted living get Lifeline for a variety of reasons, including:

  • Vocal system: Your loved one gets to request assistance from a real person rather than a pendant.  The fact is, even with a pendant, you never know if they message was received and how it is interpreted.  Configured correctly, you can have the Lifeline people call the assisted living front desk and ask for help.  And they keep calling until the reach someone.  That’s what they are there for.  Your mom or dad benefits from acknowledgment of their need and the ability to community to the urgency – something helpful to the community as well.
  • Third-party verification: Every time your loved one calls Lifeline, they track everything that happens.  Each action is stamped with a date and time.  From the second the button is pressed until the reset button is pressed, you have access to an objective party’s view of what happened.  The case is not closed until someone in your loved one’s room presses the reset button and/or your loved validates that they have been helped via a phone call.
  • Audit trail: A more detailed report is sent to your Lifeline sales rep that indicates example to whom your loved one spoke, who at the assisted living was contacted and when the reset button was pressed. In the event something doesn’t go as your service plan provides, you’ll know exactly who did (or didn’t) do what.
  • Passive: The system gathers this information without being intrusive into the daily life of your loved one.
  • Friendly, caring people: The people at Lifeline are really helpful and genuinely concerned.  I have gotten several calls from them personally when the community front desk is not responsive or does not react with urgency when they make a request on the behalf of my mother.  My mother loves them, because they always call back to check and make sure she has been helped.

How it Works

Lifeline connects to a standard telephone line.  They offer the device and several more advanced phones that include the Lifeline device integrated with a telephone.  My mom has the cordless phone version.  Your loved one is provided a pendant they can wear around their next or wrist.  The cost is around $35 per month with a $25 activation fee.

When the button is pressed, the Lifeline device calls Lifeline’s call center.  The device is placed into speaker phone mode so your loved one can make a request without being close to the phone.  The speaker phone has an extra-sensitive microphone in the event your loved one is in the bathroom or far from the phone.

The vast majority of the time, your loved one will respond and make a normal request.  In this case, the device will automatically call Lifeline back in 30 minutes if the device has not been reset (i.e a caregiver presses the reset button).  For the 1% of the time something is medically wrong, 911 is called.

Setting it Up

Lifeline allows you to set up your account with a number of notifiers.  These are people that need to be notified every time there is a call.  Our account is set up to call the assisted living front desk first.  This ensures a caregiver is routed to my mom’s room.  In parallel, a fax is delivered to me that indicates the following:

  • When the call was made
  • What the request was about
  • When Lifeline was reset

My Lifeline sales rep is awesome (if you live in SoCal and want her name, email me).  She receives detailed reports of exactly what happened on each call.  This is great for trying to understand if there was a gap in care, delayed response or caregivers who were not accomodating.  She forwards them all to me.  I keep the ones that look out of the ordinary in the event a pattern emerges.   To be fair, the vast majority of the time, the caregivers are prompt, friendly and do a great job.

Benefit to Us

Lifeline has provided an extra degree of peace of mind for my family.  The community knows I have the device, so they know there is a objective monitor measuring response times. My mom knows something is tracking everything.  If she loses track of time, she is much more likely to ask me how long something took than to be upset if it seemed like it took a long time.  By skimming the reports, I have the peace of mind that mom is doing well, getting out of the house, going to activities, etc.

If you click on this image, you can see a sample actual report.  The names have been scrubbed to protect their privacy.

lifeline-example-tn

I can’t recommend this enough. And I recommend you also use the pendant, because they Lifeline only works in your room.  For around $35 a month, it such a stress-reliever.

Four Ways a Long-Distance Family Member Can Be An Effective Caregiver

Proximity is just one of the considerations that families take into account when it comes to choosing an assisted living community for an elderly loved one. In fact, in our recent Assisted Living Family Attitudes and Preparedness Report, 77% of respondents said that proximity to their home is among their top three considerations. And subsequently, a corresponding number will choose a facility within 25 miles of their home.

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Caregivers Do More Than Give Care

At lunch this week, a co-worker overheard me talking to my mom’s caregiver. When I hung up, he asked me, “What exactly does a caregiver do?” While at first I thought the answer to be pretty obvious, I realized it is more complex.

I learned over the last few years that the right caregiver can do far more than provide care.

My mom’s caregiver plays a number of different roles, including:

  • A friend. Just like having a roommate, the caregiver and your loved one will spend a lot of time together. And just like a roommate, a caregiver and your loved one can become great friends (or not, but that’s a different discussion). My mom and her caregiver have become very good friends, going to events together, watching movies together and chatting like good friends do. At many times, the “caregiver” side of their relationship is minimized, and they are friends. This is a good thing!
  • A listener. The transition to assisted living can be difficult for many people. You’ve probably read my mom’s story. It was especially difficult for her to move from being so independent to becoming so dependent. Caregivers can be great listeners and counselors. In many cases, their experience gives them a far greater understanding of these challenges than you, and they can be a great resource for your loved one to talk through the issues.
  • A cheerleader. It can be tough to get motivated for the activities of the day, physical or occupational therapy or just to get out of pajamas in the morning. It’s often tough for all of us. Caregivers can serve as a great cheerleader, giving pep talks when necessary to get out and enjoy the activities of the day.
  • A big brother or sister. Often in assisted living, the squeaky wheel gets the grease. A caregiver can be the first line of defense to ensure your loved one gets what they need, when they need it.

For families, caregivers can play a whole different set of important roles, including:

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