Page 27 - Tale of Transformation

How to Progress
From the Neighborhood to the Household Stage
in Organizational Structure
In the household model all of the primary skills and services are part of the household. This usually includes nursing, dietary, social services, activities, housekeeping and sometimes laundry. As a result, these departments are eliminated and the functions report into the household. Maintenance and other service areas are often assigned though their work is primarily outside their own house. These assignments strengthen the liaison between the household and the service areas.
Clinical nursing skills in the household: The household needs an RN focused on the residents in the house. Knowing each resident’s needs through assessment & care planning, the RN is able to oversee meds & treatment, to teach, coach and monitor quality clinical care. The RNs in each of the houses join together in a team approach for developing clinical approaches, for regulations and other training, for their own education, and to assure, through scheduling that there is always sufficient RN coverage in the facility. While each RN has on-going responsibility for the residents in their household, they are expected to provide services in other households as determined by their facility’s organizational design and structure. This Nurse Leader reports to the DON (Clinical Mentor).
Dietary knowledge and skills in the household: The household needs a Homemaker Guide (with CDM training), focused on the needs of the residents and household. This provides an excellent opportunity for career advancement for paraprofessional staff. This position should be skillful in overseeing regulatory compliance, resident directed food choice, and smooth operations of food services. If the facility is of the size to have a full time dietitian on staff, s/he will often be located in one of the households but have responsibilities for the clinical assessments and planning for all households as well as mentoring the Homemaker Guides in each household.
Social Services and Activities: Three configurations have been noted among organizations with households. One is to blend
the responsibilities of the social services and activities directors with the role of household coordinator. This brings a strong social awareness to daily household life. The other is to develop activities aides among caregivers, dietary and housekeeping via specialized training. The third configuration cross-trains social workers as activities professionals and activities professionals as social service designees. This often provides the opportunity for a full-time professional per household, with at least 70% of their time in the household, and the balance providing mentoring to other households in their professional capacity.
Homemaker: Many organizations develop a new position for households, staff cross-trained with dietary and housekeeping skills and called a homemaker. The Homemaker Guide is responsible to guide adn coach the Homemakers in their household.
Household Coordinator: The household coordinator has leadership responsibilities for the residents and the household, oversees and problem-solves the schedule, helps make appointments, assures activities, is responsive to resident and family concerns. Guiding the household team, the coordinator should work with other coordinators to assure that there are household leaders in the building seven days a week for much of first andat least half of the second shift. The Household Coordinator often reports to the Administrator.
The above Household organizational structure was developed by Action Pact as it has guided clients moving toward the Household Model. For more information visit www.culturechangenow.com or contact this author, lavrene@actionpact.com.
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
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