Page 26 - Tale of Transformation

ATTRIBUTES STAGE 4
Decision Making
• Group process used to decide issues affecting life
• Food choices become resident-directed
• ’Refrigerator rights’ and decides when and 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
25
How to Progress
From the Neighborhood to the Household Stage
in Physical Environment
The quality of life is enhanced dramatically in the household model because of consistent care from a small cross-trained staff; everyone focused on resident direction; and the physical elements of a.) an increased number of private rooms and b.) life centered around a kitchen, dining room and living room.
Private Rooms: We all want private rooms for our residents but often can not imagine how it is possible. However, the combination
of a depressed market with more beds than people who need them; incentives by states to ‘buy back’ beds or financially encourage facilities to take them out of service; and the effort to create smaller households are all playing together to create the right time for organizations to consider increasing the number of private rooms. Don’t turn your back to this idea until you have run the numbers. While for-profit facilities whose assets are valued by the number of beds may not be able to seriously consider this option, community based and not-for-profit homes may seriously consider the possibility. And finally, many facilities, for-profit and not-for-profit are moving to private rooms in their renovations and then adding on to the building with new households making use of the balance of their beds. This strengthens the value, improves one’s edge in the marketplace, and attends to the quality of daily life for the residents.
An ideal household size is perhaps 16 residents. This number is ideal for closeness with staff, for friendships to form among elders and for socializing in friendship groups as well as operationally ideal for staffing.
Kitchen, Dining Room, Living Room: If possible these common ‘family’ areas should be near the outside door of the household,
so that visitors do not need to walk down hallways past resident rooms to gain access to the living room. This greatly enhances privacy.
While kitchens are rarely used for preparing every meal, the capacity to do so allows the household the freedom to decide on special meals, to deter from the prepared menu, to assist in the meal preparation, to celebrate together.
Laundry: Personal laundry is often done in the households, using home model washer and dryers. Residents are happier with the care of their personal things, and they and their family can participate to the degree that they would like.