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Creating Home: The New Quality of Life Revisions to the LTC Surveyor Guidelines

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Creating Home: The New Quality of Life Revisions to the LTC Surveyor Guidelines Part 1: Making Changes and Adapting the Physical Environment – PowerPoint PPT presentation

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Title: Creating Home: The New Quality of Life Revisions to the LTC Surveyor Guidelines


1
Creating 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

2
Developments in the Field of Long-Term Care that
Contributed to OBRA 87, Culture Change, and to
continued development of our understanding of
good practice
3
National Symposium on Quality Care The
Residents Point of View, 1985
4
A Consumer Perspective on Quality Care The
Residents Point of View NCCNHR 1985
5
OBRA 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.

6
Physical, mental, and psychosocial well-being
  • Quality of Care Quality of Life
  • not
  • Quality of Care vs. Quality of Life

7
BF Consulting
8
2004-05, 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

10
From 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

11
Additional 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

12
How 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

13
Key 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
14
F242 Self-Determination and Participation
15
F242 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

16
Gathering and Using Information
  • Facility must
  • Actively seek information
  • Be pro-active in assisting residents to fulfill
    their choices
  • Make residents choices known to caregivers

17
Where 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?
18
Just-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

19
To honor residents choices, you need to know
residents well individually. To know residents
well individually, you need to use consistent
assignment of staff.
20
Basics 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)

21
The 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?
22
Quiet time, coffee, and a newspaper
23
How 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?

24
Individualizing 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

25
A breakfast buffet allows you to extend hours of
services
26
You can provide equipment and food to cook and
serve where residents live
27
Equipment is inexpensive, easy to use and meets
fire safety standards
28
My 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
29
Resources 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

30
Individualizing 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

31
A pantry where residents and their families can
get anything they want, thats stocked with the
foods they like
32
Steam table allows a longer period for meal
service and more resident choice
33
Individualize 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

34
Individualized 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/

35
How 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

36
Include 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)

37
How 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

38
Remember
  • 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

39
Individual 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

40
F246 Accommodation of Needs
41
Accommodation 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

42
Creating Home The New Quality of Life Revisions
to the LTC Surveyor Guidance
  • Part 2 Feeling at Home

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
45
Home 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
46
Feeling at Home
  • A strong, intimate, fluid relationship between
    the individual and their environment

47
BF Consulting 2006
48
For more information, contact Barbara Frank B
F Consulting bfrank1020_at_aol.com www.BandFConsultin
gInc.com
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