Page 21 - Tale of Transformation

How to Progress
From the Transformational to the Neighborhood Stage
in Physical Environment
This is an exciting time for the neighborhood. The team has begun to work well together, has involved residents regularly, and is holding occasional family gatherings, using this time to educate and involve families in the transformation. Discussion centers around shaping our social and interpersonal needs. There are many physical environment changes that the team can focus on in this stage.
Our animations in the video represent our imaginations, our desires. They show a number of ‘pleasant’ physical changes, all of which do not meet CMS Life Safety Code. As you begin to get excited about possibilities remember that CMS Life Safety Code restricts items (examples: potted plants, park benches, awnings, hanging plants, streetlights) from obstructing corridors or protruding more than 3 1/2 inches into the corridor. (Note the attractive street lamp on the inside back cover, a mural that delineates the neighborhoods, and is, of course, compliant). Life Safety Code also tells us that nothing may interfere with the required headroom or obstruct sprinkler spray patterns. Mailboxes which create identity and daily pleasure, should be residential, not rural as they may not protrude more than 3 1/2 inches. Look for alcoves to place storage and decorative items. Use floor patterns to demark the seating in corridors in order to maintain the corridor width. Seek advice immediately as your team begins to express homey ideas. Do it in a way that does not subdue excitement, but encourages the team to learn about the regulations. Whoever seeks advice (by reading, by talking with authorities, by attending coalition meetings) should bring their new knowledge back to the team so that everyone learns together.
Here are areas that teams often study and make decisions about:
Redesign the Nurses’ Station. Want to use that enormous floor space currently occupied by the nurses station? It may be possible to substitute a homey desk, or dramatically reduce the size -- but be sure you have carefully reviewed your state regulations. Must the ‘nurses’ station’ be permanently attached? Must all resident doorways be visible? What other requirements need to be considered? Do not attempt this without involving the facility-wide Steering Team in this project. They will be needed to provide resources (expertise, dollars, knowledge of regulations and process) and to assure compliance.
Decentralize dining and increase residents’ food choices. It is ideal if there is sufficient space for the neighborhood to have its own dining. If not, the team can look at ways to bring some dining experiences into the neighborhood – a continental breakfast, an occasional lunch on the patio, a small room that can serve a few residents. Examples of this are varied – premier dining for those who can walk to lunch and eat unassisted; a lunch café that serves residents when eating with family members; a quiet lunch for those who may need special assistance. Examples have included converting the ‘nourishment station or room’ to an ice-cream shop or country kitchen; creating a resident team to determine items to be kept in the neighborhood refrigerator (provide a ‘shopping list’ form with dollars included so they can keep their choices within a budgeted amount); a baker’s shelf with small table and chairs near the nurses station; refrigerators in the rooms (be sure to have a maintenance and cleaning plan that meets all codes and regulations).
Improve the bathing experience. See page 14.
Consider residents’ private spaces. Neighborhood teams often ask the residents how they can help the resident make their personal spaces more conducive to pleasant daily life. Border paper, small shelves, attractive bedding, availability of a chair for visiting are some of the possibilities residents request.
ATTRIBUTES STAGE 3
Decision-Making
• Learning circles and other group processes
encourage real input – it’s no longer symbolic
• Daily life decisions determined by group process
Staffing
• Staff are permanently assigned and rarely float across neighborhoods
• Work in self-directed teams lead by coordinator
• The administrator, DON and Dept. heads may work
evenings shifts and/or weekends
• Staffing schedules are more flexible
Physical Environment
• Decentralized dining offered without full kitchen • Some food prep is done closer to the residents • Nursing stations and med carts are still used but
often less intrusive and more home compatible
Organizational Structure
• Neighborhood coordinator position is formalized
and added to the worker’s primary duties on the
neighborhood team
• Org chart emphasis is resident-centered
• Neighborhoods are often named by the people
who live and work within to create identity and a sense of community
Leadership Practices
• Leadership becomes more decentralized
• Many decisions made by consensus in neighborhood teams
• Leaders develop skills in conflict management
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