Title: Creating Home: The New Quality of Life Revisions to the LTC Surveyor Guidelines
1Creating Home The New Quality of Life Revisions
to the LTC Surveyor Guidelines
- Part 1 Making Changes and Adapting the Physical
Environment - Barbara Frank
- B F Consulting
- www.BandFConsultingInc.com
2Developments in the Field of Long-Term Care that
Contributed to OBRA 87, Culture Change, and to
continued development of our understanding of
good practice
3National Symposium on Quality Care The
Residents Point of View, 1985
4A Consumer Perspective on Quality Care The
Residents Point of View NCCNHR 1985
5OBRA 87
- Each facility must provide
- care and services to
- attain or maintain the highest practicable
physical, mental and psycho-social well-being of
each resident.
6Physical, mental, and psychosocial well-being
- Quality of Care Quality of Life
- not
- Quality of Care vs. Quality of Life
7BF Consulting
82004-05, CMS funded QIO pilot, Improving the
Nursing Home Culture, staffed by Quality Partners
of Rhode Island, in which 254 nursing homes in 21
states, individualized care, significantly
reduced turnover and improved clinical outcomes.
9- CMS Surveyor Training Series
- From Institutional to Individualized Care
- Part 1 Individualizing Care (Mornings, Alarms)
- Part 2 Transforming Systems (Nights, Meals,
Consistent Assignment, Quality Care Implications) - Part 3 Case Studies (Mornings, Meals, Med Pass,
Medical Perspective) - Part 4 How of Change (Inclusive Leadership,
Consistent Assignment, Staff Stability) - Videotapes can be purchased from
- www.Pioneernetwork.net
10From Institutional to Individualized Care
- Also available from
- National Technical Information Services
- 5285 Port Royal Road, Rm. 1008, Sills Bldg.
Springfield VA 22161 - Phone (703) 605-6186
11Additional Resources
- RI Dept. of Health Individualized Care Pilot
http//www.health.ri.gov/nursinghomes/individualiz
edcarepilot/ - Quality Partners of Rhode Island
www.riqualitypartners.org - HATCh Change Ideas
- Individualized Care Curriculum
- Pioneernetwork.net
12How of Change
- Quality, the result, is a function of quality,
the process - A people paradigm Cannot continuously improve
interdependent systems and processes until you
progressively improve interdependent,
interpersonal relationships - Covey, 1991
13Key Systems to Individualize Care
Collaborative problem-solving within and across
departments ask how can we get this done?
Inter-shift Communication So Staff have 24/7 view
of residents
Start of Shift Rounds So Staff Work Together,
Share Information
Consistent Assignment So Staff Know Residents
Individually
14F242 Self-Determination and Participation
15F242 Self-Determination and Participation
- Rights to make choices over
- Activities
- Schedules
- Health care
- Interactions with members of the community
- Aspects of his or her life that are significant
to the resident - Choices over schedules is specified to include
schedules of waking, eating, bathing, and going
to bed at night, as well as health care schedules
16Gathering and Using Information
- Facility must
- Actively seek information
- Be pro-active in assisting residents to fulfill
their choices - Make residents choices known to caregivers
17Where is Info on Residents Choices?
- Resident, and family/friends
- MDS
- Social Work Assessment
- Social History
You have the information in hand, but do you have
it in the hands of those who need it?
18Just-in-time communication
- Flow of info First 24 hours is key
- Who needs what information by when?
- Is there coordination between Social Worker and
hands-on care-givers? - Start-of-shift stand-up
- Shift-to-shift hand-offs
- Hand-offs to Weekend Staff
19To honor residents choices, you need to know
residents well individually. To know residents
well individually, you need to use consistent
assignment of staff.
20Basics for Consistent Assignment
- Fair distribution of work
- Matches work for residents and staff
- Adjust as needed
- Include nurses, housekeeping, others
- Resource Consistent Assignment Change Idea at
www.riqualitypartners.org (HATCh)
21The How of Change
- Personalize/See Through Residents Eyes
- What do you need for a good start to your day? (a
good nights sleep, when do you like to eat what,
whats a good bathing experience for you?) - What happens when you dont get it?
-
Ask residents What was your morning routine
before you lived here?
22Quiet time, coffee, and a newspaper
23How of Change, continued
- 2. Compare to what is currently happening. Keep
what works. Examine what doesnt - How does it work now?
- When we individualize now, how do we do it?
- What are the obstacles and considerations?
24Individualizing MorningsObstacles and
Considerations
- Breakfast times and central delivery
- Early risers coffee breakfast cart, carafe
- Late risers breakfast decentralize food
supplies and equipment - Breakfast buffets
- Clinical and Operational Benefits
- Less agitation, better appetite, less plate waste
25A breakfast buffet allows you to extend hours of
services
26You can provide equipment and food to cook and
serve where residents live
27Equipment is inexpensive, easy to use and meets
fire safety standards
28My name is Ilda Ford. I am 95 years old. I have
been eating my eggs soft side up most of my life
and I am not dead yet
29Resources for Individualized Mornings
- From Institutional to Individualized Care (FIIC)
Parts 1 and 2 - Culture Change A Case Study, available thru your
QIO or with FIIC Part 1 - QPRI Change Idea Waking and Sleeping
30Individualizing Food (not just meals)
- What do you like to eat, when?
- Breakfast foods available time and place
- Staff access to sandwich foods and soups
- Microwaves, coffee pots, Forman Grill
- In-room refrigerators
- Late night snacks
- Resource FIIC 2 3 Change Idea on Dining
31A pantry where residents and their families can
get anything they want, thats stocked with the
foods they like
32Steam table allows a longer period for meal
service and more resident choice
33Individualize the Med Pass
- Individualize schedule
- upon rising and before going to sleep
- Before meal/after meal
- Benefits Opens schedule, frees up nurses
- Resources
- FIIC, Part 3
- Pioneer Network Newsletter, Summer 2008
34Individualized Bathing
- Dignity Webinar Part 2
- Bath, shower, bed bath, wash-up
- Time of day and Frequency Opening rising and
bed times, opens possibilities for evening bath,
morning shower. - Methods Resource www.bathingwithoutabattle.unc.ed
u/
35How of Change, continued
- 3. Bring people together to figure out how to
make changes. - What issues do they see?
- Encourage open dialogue and debate.
- Use concerns as to-do list
36Include People Affected by Change
- Individualized Mornings
- Residents and their families
- CNAs and nurses working nights and days
- Housekeeping
- Maintenance (floor cleaning)
- Food services
- Therapies (esp. important for short-term rehab)
- Medical Director (for med pass and diet Qs)
37How of Change, continued
- 4. Pilot changes
- Start with easy changes that are building blocks
(one care area, coffee cart, residents who can
easily tell you) - Evaluate impact on residents and staff (weight
loss, agitation levels, staff time, med pass) - Adjust operations and evaluate again
- Learn and spread
- Resource FIIC Part 4
38Remember
- Residents choices can change
- Residents may have special needs on a given day
- Residents have adapted to your schedule. Youll
have to make sure they know that they can have
their own schedule without losing out on meals,
appointments
39Individual Routines Improve Outcomes
- Better Sleep Better Mood
- Better Healing
- Improved Appetite
- Reduced Agitation Less Depression
- Fewer Falls Better Balance and Mobility
- Fewer Pressure Ulcers
- Better transition home from sub-acute care
40F246 Accommodation of Needs
41Accommodation of Needs Tips
- About relationship of person to environment
- Consistent assignment is key
- Use red flags like falls (do root cause analysis)
- Special focus when a resident moves in
- Interdisciplinary collaboration
42Creating Home The New Quality of Life Revisions
to the LTC Surveyor Guidance
43- Home
- Identity
- Connectedness
- Lived Space
- Privacy
- Power/Autonomy
- Safety Predictability
- Journeying
Judith Carboni, 1987
44- Homelessness
- Non-Personhood
- Disconnectedness
- Meaningless Space
- Without boundaries
- Powerless/Dependence
- Insecurity/Uncertainty
- Placelessness
Judith Carboni, 1987
45Home Homelessness Continuum
HOME Strong, intimate, fluid relationship with
the environment
Weakened, impaired relationship between
individual and environment
Damaged relationship between person and
environment
HOMELESSNESS Severely damaged and tenuous
relationship between person and environment
Judith T. Carboni, 1987
46Feeling at Home
- A strong, intimate, fluid relationship between
the individual and their environment
47BF Consulting 2006
48For more information, contact Barbara Frank B
F Consulting bfrank1020_at_aol.com www.BandFConsultin
gInc.com