Page 4 - One Nursing Home's Journey

The Long, Winding Road to Households
Chronicle of Lenawee Medical Care Facility’s Journey Through Culture Change
I. Two Weeks Before Move-In: Hopeful But Skeptical
Suzanne Hiltner was intrigued by the prospect of work- ing in a “cutting edge” culture-change organization when she applied for a position at Lenawee. But as the day approaches for moving into neighborhoods, she grows anxious.
As Clinical Dietitian, her responsibilities have typically revolved around nutritional needs assessments, quality assur- ance and inventories. She has worked at the nursing home for less than two years and never in a leadership role with staff outside her department.
But now she is about to wade into the broader stream of people and everyday events at Lenawee by becoming a neigh- borhood coordinator and receiving CNA training. Her main concern: Building relationships with residents, family members and other staff.
“My first love and training is as a clinical dietitian, so to be asked to supervise the kitchen or coordinate an activities per- son or housekeeper, those kinds of requests are way outside the box,” she explains.
Some residents, especially those liv- ing with Alzheimer’s, are upset, making it more difficult to care for them.
“I’m hoping for the best, but I’m skepti- cal,” Rathbun replies when asked about her own state of mind.
Kathy Aube, Administrator, fears
the transition to neighborhoods will be chaotic despite months of preparation and training. She is concerned about the need for CNAs to reorganize their day.
“Any change in routine is tough,” she says. “Now they will have to do things according to the residents’ schedules instead of their own.”
Convincing caregivers to give up
the old ways also worries Deb Heath, DON: “How are we going to get staff to quit thinking we just hurry up and get people to meals and back, and instead to listen and take time with the residents?”
And, how will her job change after the centralized nurses’ station is gone
and nurses are dispersed into neighborhoods, when there are seven areas to go to for charts and information rather than only one?
“They’re all going to want the same thing and I’m not going to know,” she frets.
Rather than caring for a couple dozen residents in one hallway, nurses will work in two neighborhoods of about 12 residents each.
“They see it as, ‘Oh, I have two units,’” says Heath. “They don’t have any more people to take care of than before, but they see it as more.”
Indeed, finding time to do everything weighs heavily on the mind of Jeanette Raymond, LPN. While providing nursing care in one neighborhood, she also will serve as Neighborhood Coordinator in another.
“It is a little bit scary because you don’t know what you’re getting yourself into,” she says. “The neighborhood I’m going to will have only 12 residents, and now I have 26. But if some- thing happens, if somebody falls or gets sick, it can really put you behind.”
Even the most stalwart advocates for change are nervous as the sun sets on the worn-out but familiar institutional model.
Julie Moreno, an Activities CNA, worries about losing the companionship of her peers in the Activities Department after they are assigned to separate neighborhoods.
“We used to work and plan a calendar together. Now we’re going to be on our own.” She ponders how having open break-
Even the most stalwart advocates for change are nervous as the sun sets on the worn-out but familiar institutional model. Can we give residents choice and still get everything done? How will my job change? Will co- workers pick up the slack? Is this really going to work?
And with move-in postponed for a few weeks due to con- struction delays, tension mounts.
“The families are real nervous, says Deb Rathbun, a CNA and 26-year veteran caregiver. “We had a little incident today where the family just couldn’t understand what we are doing and why.”
fast where residents eat when they wish will complicate the planning of group activities. Also, can appropriate activities be provided both for residents living with dementia and for those more highly cognizant?
“We’re going to have to improvise...we’re going to have to have something for both,” she says.
Preparing breakfast-on-demand in the neighborhoods is a main concern for many CNAs and cross-trained staff members. Currently, meals come from the centralized kitchen on pre- assembled food trays that, in most cases, are merely handed to residents. Cont. on next page.
13