Page 47 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHAT MAKES NEW IDEAS DIFFICULT?
leadership and the participative management style” of culture change appear to support two additional essential elements of a quality job. (Paraprofessional Healthcare Institute, 2007)
Resident autonomy and self-direction is not costly, is clearly supported by OBRA’87, and as one CNA so powerfully expressed, “Finally I get to do what my resident wants instead of trying to make her do what ‘they’ (administration) want!”
All providers should mindfully consider that pioneers in culture change have demonstrated through case studies and anecdotal evidence that culture change can result in positive resident and staff satisfaction outcomes in individual facilities, even with limited physical plant improvements and within current staff education and training budgets; that it can be budget neutral with existing staffing, and budget neutral with programming and ancillary costs in practice, and that based on individual facility quality indicator data, it can do so with concurrent positive impact on quality of care. Recognizing that caution must be applied to generalize from such information, as research continues to validate best practice and policy recommendations are developed to support it, organizations must begin to make positive changes to increase true and meaningful resident choice and self-determination, using the experiences of the early adopters as approaches to consider for implementation.
OBRA ‘87 SUPPORTS CULTURE CHANGE – SURVEY BARRIERS OFTEN IMPEDE IT
In Regulatory Support for Culture Change, How OBRA ’87 Regulations Support Culture Change, Bowman notes that F242 Self-Determination and Participation is “the shining star regulation for culture change. It not only supports culture change, it leads to it.” (Bowman, 2006)
Survey Focus Can Be A Barrier
Shields and Norton, In Pursuit of the Sunbeam, suggest that the real problem is that systems in the traditional model were designed for the traditional context of, “We know what’s best for you,” and in the new context, old tasks continue, but must be reframed in the new context of, “This is your home, how can we best serve you?” They stress it is important that providers anchor the organization in standards of practice that fit the philosophies and practices of the new culture, and that regulators do the same. (Shields and Norton, 2006, p 21)
Franco Diamond, Administrator at Idylwood Care Center in Sunnyvale, CA has, for a number of years used food as a focus to feed his residents’ lust for life. Residents share gardening, cooking, and eating in a celebration of life. Building on his conviction that food holds an answer for almost every ailment of institutional living, his residents transformed a weed patch into a beautiful garden where they grow produce for their group cooking activities, the facility’s regular
Recommendation: Providers act now to assess their organization and its climate, to study what the early adopters have done and take action to increase resident self-determination
in their facility.
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