De-institutionalizing the nursing home
What would you do if you could no longer choose what time you went to bed? What if you had to eat at a certain time, whether you were hungry or not, and you had to eat whatever was put in front of you, allowing you no choice? What if you did not know, from day to day, who would be taking care of your basic needs? Residents of nursing homes face these situations every day.
Person-centered care honors and respects elders and those working closest with them. It involves a continuing process of listening, trying new things, seeing how they work and changing things in an effort to individualize care and de-institutionalize the nursing home environment. Nursing home regulations have supported person-centered care since the federal Omnibus Budget Reconciliation Act (OBRA) of 1987, which contained the Federal Nursing Home Reform Act.
In a nursing home that institutes person-centered care, residents make decisions about their schedules. Delivery of medications, meal times and activities are scheduled according to residents' needs and desires, rather than strict adherence to programmed timetables. Residents are given meal options and are served buffet or family style. Residents have individual plans, receive information about their condition, prognosis and treatment plan and are included on the planning team. Residents are given information about benefits and risks so they can make informed choices.
In many situations, person-centered care involves changing the culture of a nursing home. Historically, nursing homes have followed a medical model, with strict schedules and procedures to ensure resident care. Movements, such as the Pioneer Network, gather professionals in long-term care to advocate for change from an institutional, provider-driven model to person-directed care. Along with the Advancing Excellence Campaign, person-centered care supports the goals of enhancing choice, strengthening the workforce and improving clinical outcomes for the more than 1.5 million American nursing home residents.
Nursing homes that have implemented person-centered care practices report that after the initial start-up and culture change, the new practices decrease staff turnover and save money while improving communication and satisfaction for both residents and staff. For example, nursing homes that have developed flexible dining for residents, allowing them to eat on their own schedules and make their own food choices, report that residents lose less weight, less food is wasted and residents are happier with their dining experience.
Staff are empowered to know their residents intimately and care for them like family. Consistent staffing, with teams of caregivers assigned to groups of residents, allows staff members to really get to know their residents, to take ownership of the residents' care plans and to work as a team.
Most nursing homes begin by making changes in care practices, workplace practices or the physical environment, such as:
- Bathing: Institute flexible bathing schedules and make inexpensive changes to add luxury, privacy and comfort to the experience.
- Dining: Create a flexible dining experience for residents so they can live and eat on their own schedule and make their own choices.
- Sleeping and waking: Reorganize priorities and work functions to allow residents to go to sleep and wake up when they want to.
- Medication: Change medication schedules to accommodate residents - "upon arising" for example, rather than 6:00 a.m.
- Consistent staff assignment: Encourage relationships between staff and residents by assigning staff members to a consistent group of residents.
- New hires: Get staff members off on the right foot by providing them with standardized orientation, a peer mentor and an on-the-job support system.
If consumers, families, providers and advocates are interested in culture change, they can join the Ohio Person-Centered Care Coalition and visit the website to register for the coalition and access resources and information. Included on the site is the "Artifacts of Culture Change" tool, which includes a checklist that nursing homes can use to determine what, if any, person-centered practices they have in place and more importantly, what new person-centered practices they want to implement.
The Office of the State Long-term Care Ombudsman is coordinating the Ohio Person-Centered Care Coalition. The mission of the ombudsman program is to seek resolution of problems and advocate for the rights of consumers receiving long-term care services with the goal of enhancing the quality of life and care of consumers. If you have any questions regarding long-term care, please call the ombudsman program at 1-800-282-1206.
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