Page 25 - Tale of Transformation

How to Progress
From the Neighborhood to the Household Stage
in Staffing
Similar to Neighborhoods, the staff self-schedules, but staff is almost always cross-trained and versatile. This means that individuals can fill a number of slots as they schedule themselves into the block schedule.
With universal staff, caregivers usually perform direct care, activities, housekeeping and dietary, all within the same day. In other words, they do what needs to be done.
In contrast, versatile staff are individuals who become cross-trained in as many of the above functions as they wish. Once trained they may then fill a slot for that function for any given day – whether it be caregiver, kitchen assistant, homemaker, or activities. This assures the organization that the jobs are scheduled for and being accomplished each day and that an adequate number of hours are being spent in direct care – and yet allows for individuals to perform different functions.
This, with the 80/20 rule of thumb encourages a healthy staff team where no one claims “it’s not my job”. The 80/20 rule of thumb states that approximately 80% of my time today will be in my primary job function for the day; and approximately 20% will be helping the residents and the household in other ways that I am trained.
Because staff have training and practice in each others’ jobs they are respectful, knowledgeable, more willing to jump in, and have increased capacity to see a problem or deficiency and bring it to the household team or the QI team to address.
In the ideal household, all professional staff and all leadership are CNA certified; and versatility (cross-training) has increased to the degree possible, usually limited only by union contract and workforce availability.
ATTRIBUTES STAGE 4
Decision Making
• Group process used to decide issues affecting life
• Food choices become resident-directed
• ’Refrigerator rights’ and decides when & what to eat • More control over daily life
Staffing
• Workers permanently assigned to a household
• Household teams create work schedules
• Staffing mix evolves toward ‘versatile workers’ CNA
certification for all staff becomes vital
Physical Environment
• Renovated into self-contained households • Each has own kitchen
• Personal laundry done within the household • Common dining room and living area
Organizational Structure
• Traditional departments eliminated
• Restructured support services for each household • ‘Nurse leader’ reports to ‘clinical mentor’
• Household coordinator reports to ‘social mentor’
Leadership Practices
• New leadership team emerges
• Conflict management skills operational • Leadership skills are improved
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