Page 6 - One Nursing Home's Journey

ing between her and a particular housekeeper. Meanwhile, resi- dents and family members love the new setup.
“We have eight residents who sit together each morning... they talk about the day and it’s like a little family,” she says.
Moreno, the Activities CNA, finds her initial fears about losing the companionship of others in her department were overstated. “We get together for lunch and again at three o’clock...and we still have the freedom to go to other neighbor- hoods and discuss things.”
III. Four Months After Move-in: The Honeymoon Is Over
As control gravitates to the neighborhoods, so does the weight of responsibility.
“The neighborhood coordinators are feeling over- whelmed,” says the Administrator
“Giving reports and being at seven different nursing sta- tions has been a real problem,” says the DON.
“I’m supposed to be coordinator in Camelot, but I’m never there...I feel like I’m cheating the residents and the other staff,” says the LPN.
“We are really scrambling in the morning,” says a CNA.
“The honeymoon is over, now we’re down to the meat and potatoes of it,” says the Clinical Dietitian.
Neighborhood Coordinators: A Bottleneck of Responsibility
The transfer of responsibility to the neighborhoods has hit a bottleneck, with coordinators like Hiltner and Raymond tak- ing on additional duties more quickly than they can unload to other team members.
“It’s frustrating knowing you still have your regular job to do, but you’re also responsible for making sure things happen in the neighborhood the way they’re supposed to,” says Hiltner.
Her dietitian’s duties extend to residents all over the build- ing and often take her out of her
serious disabilities.
Problem is, says Rathbun, acuity levels constantly change
for residents all over the nursing home, but staff numbers haven’t increased in some neighborhoods as residents in them have become more debilitated.
Plus, less help is available on weekends, and caregivers assigned to fill in during the regular staff’s days off are often unfamiliar with the neighborhood and its routine.
“Throw in an unfamiliar face and the residents get anx- ious,” says Rathbun.
Wish We Would Have...
“If I had it to do over,” says Aube, “I would try to clarify the neighborhood coordinator role better. It’s a new role, so it’s requiring the most work.”
Heath wishes there would have been a greater effort to impress upon caregivers that they have permission to visit and do things with residents, “and if someone gets up at 5 AM, to go and fix breakfast.”
Also needed, she says, is more education on food handling and infection control, and—since there is no activities person to engage residents during “off” shifts—activities training for nursing staff.
But no matter how good the pre-planning, some problems aren’t discovered until the new system is up and running.
“Sometimes you just have to do it and work on it as you go along,” notes Hiltner. “‘Work smarter, don’t work harder’ was Grandpa’s saying. That’s what we need to do.”
Positives Outweigh the Negatives
Though the honeymoon is over, Lenawee’s marriage with culture change is still solid after four months.
“I could never go to another nursing home and work where they are not delivering care this way,” says Heath.
home neighborhood.
“It’s difficult to coordinate and
not be in my neighborhood,” she says. CNAs like Rathbun would agree:
“We really need another person for a couple of hours in the morning,” she says. “Our coordinator is always hav- ing to be at meetings, so we don’t get their help.”
By now, the incidence of bruises is lower and resident falls are down by half. She credits the lower rates to getting rid of the bumper carts and the big nurses’ station, and establishing a separate area for elders who pace.
Hiltner has noticed a sense of
competition arising between neighborhoods and undermining the communitywide spirit of cooperation. Neighborhood coor- dinators need to bond, she says.
And, they must learn the regulatory limits in all areas they coordinate—from housekeeping, dietary and activities to care- giving—to ensure a safe environment while allowing maximum autonomy for residents and employees.
Meanwhile, dividing the licensed nurses among the neigh- borhoods “didn’t work as we had hoped,” says Heath. And with no centralized nurses’ station where everyone gathers, “we’re chasing each other to give reports.”
Getting the right number of nurses and CNAs into each neighborhood is like hitting a moving target. Initially, more caregivers were assigned to neighborhoods having a higher population of residents with severe dementia and other
By now, the incidence of bruises is lower and resident falls are down by half. She credits the lower rates to getting rid of the bumper carts and the big nurses’ station, and establishing a separate area for elders who pace.
“People running into each other trying to get in and out of that big dining room, that whole system is gone,” she says. Infection rates have also declined by half, and residents are gaining weight. Rathbun lauds the convenience and intimacy of neighborhood dining.
“I think the residents enjoy their meals a little bit bet- ter, it’s not quite so chaotic,” she says.
And, the staff is happier: “I had bickering between two CNAs this morning, the first I’ve had in months. We’re going to do a conflict resolution between the two of them. That’s how they decided they want to resolve it. That’s never happened before,” says Heath. Cont. on next page.
15