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.
As an organization begins to dig into culture change and the Household Model, we often hear the question “What about our short-term rehab unit? It’s different!”
It’s true. We’re not trying to create a home for people who come to us for rehab. People are with us to do the work and go home to somewhere else, not to cozy into a household. It’s a fast-paced environment with people coming to us for only a few weeks.
And yet the principles of person-directed care and self-led versatile work teams are as critical in the rehab environment as they are in the long-term care environment.
The following are three of the pitfalls of the institutional model in short-term rehab, and how culture change adds value for our guests.
Knowing the Person, Working Seamlessly
Institutional approach:
Staff members work in departmental silos and assignments may vary from day to day. CNAs, medication aides and floor nurses rarely know a guest’s rehab goals or full plan of care. Rehab therapists rarely know all the concurrent conditions that person is experiencing, how they are sleeping, or what social, emotional and spiritual needs might be impeding progress.
Culture change antidote:
Everybody belongs to a small-size rehab house. A permanent team is in place in each house. Everyone participates in knowing the guests and following their progress. CNAs cross-train as rehab aides, assist with assessments, follow guests into the gym, and help continue the plan of care 24 hours a day. Household teams work to understand and meet the needs of the whole person. Therapists and the rest of the team work shoulder-to-shoulder with each other and the guest as care managers.
The Environment for Friends and Family
Institutional approach:
The rehab unit rarely has adequate space or hospitality for family and friends to join a guest for a meal or visit outside the guest’s bedroom. The support of family and friends is often critical to the speedy recovery of a guest, and often there has been little thought to making room for this to happen.
Culture change antidote:
Create space at the table for family and friends. Make 24-hour hospitality centers with coffee, juices and snacks. Build in living room spaces for gatherings outside the bedroom. Have homemakers in each rehab house who are trained as certified dietary managers and hospitality specialists. Have household coordinators who assure that a welcoming and convivial environment is maintained.
Promoting an Upward or Downward Spiral
Institutional approach:
Practices used for the convenience of staff often do not promote independence and recovery of function. This includes unnecessary assistance with bathing, dressing and other activities of daily living, as well as the use of wheelchairs for staff convenience to speed transport of guests. Interrupted sleep also prevents optimal recovery. This includes loud paging systems and bells, late-night treatments and medications that could be given on other shifts, third shift entry into rooms to restock supplies and clean equipment, and frequent turning on of lights to check for guest safety and feel for urinary incontinence. Exhausted guests do not do well during gym workouts!
Culture change antidote:
Reorganize so that administrative nurses, recreation/life enrichment staff, social workers and administrative staff spend at least part of their time attached to one house to help with household duties. They sometimes cross-train in another job to free up CNAs and nurses to take the time to allow guests to “do for themselves.” Work to eliminate the use of wheelchairs as much as possible, and reassess this on a daily basis. Eliminate all unnecessary nighttime disturbances and practices.
Bev Cowdrick received her Masters in Public and Private Management from Yale and is a licensed nursing home administrator. While a consultant for Action Pact, Bev guided many nursing homes through their transformation to households. She is currently the Associate Director at Glenaire, a continuing care retirement community in North Carolina.
Neighbors blog - from Action Pact 