Page 208 - In Pursuit of the Sunbeam.indd

“let” people live and work with those they love and still cover all the operational bases. We were no different at Meadowlark Hills. We did the first several months of planning for transition into households in 2001 with the idea we would place residents in specific houses based on their level of care.
In retrospect, we’re embarrassed to admit we spent so much time organizing around that assumption. But it made perfect sense at the time that level one people should be in one house, level two in the next and so on. We got so smart about it we figured we could staff lighter in level one and higher in the level four house. It made perfect sense. It took quite awhile to dawn on us it not only was a bad approach operationally, it was not even close to being resident-directed or even resident-centered.
For one thing, as we planned placement of each resident we realized their individual situations change frequently. At each planning meeting there would invariably be a team report like, “Mrs. Smith is now a level three instead of two.” Then the group would spend time reshuffling the placement lineup. After several months of this, somebody finally asked, “Is this how it is going to work? Every time somebody switches levels they move to another house?”
This spawned other questions. “Are people going to live in fear that every time they have a new set of needs they have to move?” and “I thought we were trying to create home; this doesn’t sound like home to me!”
We were thinking in a box without any new ideas for initial resident “placement.” Our thought process seemed perfectly logical in the healthcare world.
Finally somebody said, “Why don’t we arrange people based on who they want to live by?”
Well, that seemed completely impractical! How could it possibly work? But in absence of a better idea, we decided to survey residents about whom they would like for neighbors. The idea graduated to also asking residents who they preferred working in their house. It further evolved to asking staff which residents they felt close to and would like to serve. And finally, which coworkers would you like on your team?
After receiving survey responses from residents and staff, we began piecing the puzzle together, using relationships as the primary factor in determining staff and resident placement in the new households. It worked. In fact, it was much easier – and far more satisfying – to organize than before. People were able to live and work with whom they preferred. We also discovered the need to have a full compendium of staff (RN, LPN,
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