It Takes The Whole Team

Last week long-term care organizations around the country were celebrating National Nursing Home Week with a theme of “Team Care”. At Action Pact, we think every week is a week we should be concentrating on our teamwork. We have always said that it takes involvement from everyone in the nursing home to change its culture and the work of a team of caregivers to create home on a daily basis for and with elders. That is why in the Household Model decisions are made by the household team and not in departmental silos.

We’ve created a podcast for you to hear more about this philosophy and how it works in real nursing homes across the country. We think it is kind of fun, especially since it features participants from our Choreography of Culture Change intensive sharing their stories.

CMS Supports New Dining Practice Standards

The Centers for Medicare & Medicaid Services recently published a memorandum to surveyors regarding long-term care organizations’ implementation of the New Dining Practice Standards. CMS also provided a training video to its surveyors on new recommended nursing home dining practices that focus on resident choice and limiting the use of restricted diets. Continue reading “CMS Supports New Dining Practice Standards”

When Hierarchy Reigns, Culture Change Efforts Flounder

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We can create homey spaces, offer elders more choice and change long standing institutional practices, but culture change and the Household Model will not be effective unless we flatten the organization. As long as hierarchy reigns, elders will not be in control of their own lives. And as long as departmental silos dictate the way things are done, staff closest to elders will not be able to do what they can to help elders live a meaningful life in a place that truly feels like home. A nursing home can have a warm appearance, a friendly atmosphere, do fun and interesting things with its residents, but unless the decisions of daily life are made by elders and those closest to them, the culture is still one of one-size-fits-all-this-is-just-the-way-it’s-done.

Elders can’t make choices in the moment when what they want needs to be OK’d by three different people, one or two of whom may not even know them. One of the things we all enjoy about being in our own homes as opposed to work, a hotel or even at a friend or family member’s home, is the freedom to make spontaneous decisions, to have things the way we like them and go about our day according to our own schedule.  A household or neighborhood team comprised of staff from all disciplines that makes decisions together and is responsible to one another can most effectively meet elders needs. Cross-training and versatile workers within the team allow more people within the team to respond to the elder in front of them instead of having to go find someone else who can do the job. It can also be a great benefit at the busiest times of the day when extra help is needed in one particular area.

Only when the household or neighborhood teams have the responsibility, authority and flexibility to make decisions can they reach their full potential for giving individualized care and creating true home for the elders they serve.

The process of flattening the organization is not something that is done overnight. I suggest 3 steps to move forward with this process.

  1. Make your organization one of Shared Leadership.
  2. Use Learning Circles to help staff communicate.
  3. Create an environment of High Involvement.

We will go into more detail about each of these steps in upcoming blog posts. Please share your own challenges and successes in flattening the organization in the comment section.

LaVrene Norton is the founder of Action Pact, an organization devoted to changing the culture of care environments for elders – making it possible to live in a homey place & have a good day every day, no matter how frail one becomes.  Action Pact has assisted care organizations on their journey to households since 1997. Norton is co-author with Steve Shields of In Pursuit of the Sunbeam, and publisher of a variety of educational books, workbooks and videos focusing on the Household Model.

If You’re Considering Creating Households, Let Go of Preconceptions

People often have more doubt than hope when they call Action Pact Development.  They presuppose what kind of project they can afford based on misinformation and myth. Continue reading “If You’re Considering Creating Households, Let Go of Preconceptions”

Promoting Adequate Sleep in the Nursing Home

This story about adjusting overnight practices to allow residents to sleep without being woken up throughout the night was originally published in our October NewsletterPat Maben, RN, MN, comments on the effectiveness and particulars of these practices.
Continue reading “Promoting Adequate Sleep in the Nursing Home”

A New Awakening

This story about adjusting overnight practices to allow residents to sleep without being woken up throughout the night was originally published in our October Newsletter.

Mr. W. spent most of his days mostly asleep. He was sluggish, had a hard time getting up and ready for the day and required assistance eating. Then the folks of the Miller’s Crossing neighborhood at Rosedale Green in Covington, KY decided to individualize sleep plans for their residents Continue reading “A New Awakening”

An Environment Where Elders Living with Dementia Make Decisions

Megan Hannan, creator of PersonFirst®, addresses the need to create an environment where people living with dementia can make decisions and experience life like an adult.

What a Difference a Decade Makes…Transformation of Dietetics in Long-Term Care

As the new millennium dawned, the household model introduced resident-directed dining. Visionaries in the field began to promote new approaches to dining in long-term care as part of the shift from institution to home, by focusing on relationship instead of task and offering point-of-service choice instead of tray service.

Continue reading “What a Difference a Decade Makes…Transformation of Dietetics in Long-Term Care”