Page 83 - Life Happens in the Kitchen

CONSIDER THE OPTIONS
Page 77
TRADITIONAL
TRANSFORMATIONAL
NEIGHBORHOOD
HOUSEHOLD
Episodic, small steps– a place to start
Systematic changes in a home beginning to work on resident centered care
Creating home, cook to order, residents participate in preparation
True home, deep culture change
Most decisions are made by administration and department heads, based on regulations, efficiencies and external controls. In a progressive facility, some teams work
to move decisions closer to the elders, and when they succeed, it’s one decision at a time.
Millie is gotten up by 6:30
to be in the dining room for breakfast at 7:30. She is often dressed and lined up in her wheelchair in the hall waiting for the dining room doors to open. Perhaps, because she’s cooperative, she’s actually gotten up at 5:30 by the night shift and falls asleep waiting in the hall.
Essentially nothing changes because Millie comes to live in the facility, and nothing changes when Millie leaves.
Permanently assigned staff
get to know the needs of the elders they serve, and get to know each other better as they work together as a team. They know the individual choices of the elders they serve, and are in a better position to carry out the individual decisions of the elders.
Millie gets up at 6:30 because of breakfast at 7:30. But, because one of her daily pleasures at home has always been to have her first cup of coffee in her pajamas, her caregivers have gone the extra mile to figure out how they can provide that to her daily. And it wasn’t an easy task – they had to come up with a coffee pot, find a safe place to keep it, work with dietary to get the coffee, and a staff member found a lovely cup, which also meant the care givers washed and sanitized it each day.
Millie is known as an individual with individual preferences and choices, but her care team’s ability to individualize her care is hampered by systems of caregiving in the facility.
Millie, her family and her caregivers work together to make both individual and group decisions.
The neighborhood team discovered that Millie and others have different ideas about breakfast – what to eat, when to eat it. So, they met many times, studied regulations, determined resources available, worked with the dietitian and dietary supervisor and the other shifts. They figured out how to provide substantial snacks. Now Millie and her friends
in the neighborhood have coffee, cold cereal, toast and hard boiled eggs available and easily accessible to any elder upon request before and after their traditional breakfast.
Millie’s choices and preferences are known and honored by her care team. Her personality, and her person, impact daily on the life of the neighborhood.
Millie’s caregiving team has extensive authority to implement decisions initiated by the elders. They understand the regulations, budgets, clinical issues and resources available, and together with Millie, they are responsible for a wide scope of life.
Millie’s (and everyone else’s) breakfast is prepared to order
by any of the cross trained staff, upon request. The refrigerator
and cabinets are stocked with items known to be favorites of individual elders. Dishes (including Millie’s coffee cup) are washed in a dishwasher in the household, and as a result, they all enjoy beautiful and colorful dishes, often of their own choosing.
The household changes when Millie, in fact, when every new member comes, and when every member leaves. Their mark on the household endures long after they are gone.
Porch Swing SeriesTM Culture Change Workbooks ©2004-2005 Action Pact, Inc.
Choice and Decision-making