What is resident-centered eldercare?
“Resident-centered eldercare” refers to a quality-of-life approach offered by select nursing homes within our company. This approach moves away from the traditional institutional skilled nursing facility to one that is focused on providing residents with the opportunity to make more choices and to participate in more purposeful activities. Ultimately, this approach leads our residents to achieve increased satisfaction in daily life.
Unlike the traditional nursing home that encourages staff members to adhere to routines designed to be efficient for the staff who provide the needed care, the nursing homes that shift their focus to a resident-centered care model encourage their staff to work with the residents to determine what works well for them. Additionally, some elements of the Eden Alternative, such as including greenery and animals throughout the home, are incorporated into the new model to provide a more homey setting.
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What changes take place when a nursing home transitions to resident-centered care?
Nursing homes are transformed into small communities, or neighborhoods, that consist of residents and caregivers. The transformation takes place in three phases: renewal, reorganization and renovation.
- Renewal — The primary focus of this phase is to create an environment that emphasizes greater respect for the residents, empowering them to make decisions about how their day is spent. For example, instead of being awakened each morning at a specific time, residents are able to wake up when they are ready. And they are able to have morning routines that replicate their desired lifestyles, not adhere to a routine mandated by the staff. Also, instead of scheduled mealtimes with limited food options, each resident chooses when he or she wants to eat, and is offered additional food options. During this phase, residents, their families and staff members are encouraged to create their ‘community’ or ‘family,’ developing relationships with those who will be their companions and support group.
- Reorganization — In this phase, the employees are empowered to create a core team, previously referred to as department heads. While this is not considered a “universal worker” concept, caregivers are cross-trained so they can serve a variety of the residents’ needs, and they are assigned permanent positions within the “community.” This not only helps maintain continuity of care, but also further emphasizes the importance of a homey, family environment. Caregivers who have participated in the reorganization phase tend to realize greater job satisfaction. They also take a more personal interest in ensuring that their “families” are receiving the care and services needed, including social and relationship needs
- Renovation — This phase identifies areas of the nursing home that can be physically altered to better reflect the needs of the residents and staff, to better accommodate the renewal and reorganization phases, and to facilitate the transition to “community.” The physical changes that take place when transitioning nursing homes to resident-centered care homes vary from home to home, in part due to the layout of the facility and the feasibility of executing the changes, but also because some changes are incremental and managed by the nursing home itself.
We know it takes more than the physical environment to create “community” or a sense of being at home, but the way the environment is constructed and used directly affects the processes and relationships that take place within that space. While completely renovating the entire building may not be possible, we consider which areas can be created for more privacy. Even small changes, such as warming the bathing area and putting out easily accessible snacks, begin to create an atmosphere of home.
It’s important to remember that significant physical changes are not needed to realize a successful transition to resident-centered care.
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Why are your nursing homes making the change?
We recognize that the traditional nursing home model may not serve the needs of all of our residents. By creating an environment that provides our residents with greater opportunities to express individual choices, as well as encourages family relationships, we can help to increase satisfaction not only with the residents and their families, but also with our caregivers. The resident-centered care nursing home model provides our customers with another option to consider as they are making decisions regarding the long-term care services needed for their family members. It also helps to eliminate objections to the institutional nursing home, which can ultimately lead to an improvement of our presence in our given market.
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How long does it take to implement the resident-centered care model?
The implementation timeline varies from nursing home to nursing home, and is based on resident, family, employee and community support. What’s important to note is that the transition is an ongoing, continuous process to change the culture of nursing home care, not just the home itself. As we meet new families and residents, we learn what they want and need, and we’re always changing to incorporate new ideas.
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How do nursing home employees receive training in resident-centered care?
We use a “change agent” model for training. Over a one-year period, members of the nursing home leadership team attend 10 two-day off-site training sessions conducted by Action Pact, a recognized professional leader in culture change. Following training, they work closely with their employees to deliver the facility-based training necessary to begin implementation.
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What resources do you use to implement the resident-centered care model?
We use a combination of internal and external resources and support. With respect to internal resources, ongoing support from nursing home, district and regional leadership is critically important to a successful implementation. Quality-of-life consultants are another internal resource that provide valuable assistance throughout implementation. External resources, such as the Eden Alternative and Action Pact, are also used. Action Pact is a company of trainers and consultants that focuses on training sessions such as staff empowerment and team building.
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Can resident-centered nursing homes take care of residents receiving rehabilitative services or needing medically complex care?
Definitely. Regardless of the resident’s acuity level, treatment plan or length of stay, a resident-centered care environment is more homey, comfortable and familiar, resulting in increased satisfaction for residents in their daily living.
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Can a resident-centered care nursing home also have a specialized Alzheimer’s care unit?
Absolutely. The social model approach used in our “Enabling Freedom” model for Alzheimer’s care complements totally the resident-centered care approach.
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Does Medicare support the resident-centered concept?
Our feedback from the Centers for Medicare and Medicaid Services -- both the federal agency and the local state agencies -- has been positive. We take a proactive approach by regularly communicating with them about the specifics of this concept as well as our implementation efforts. Making sure there is a clear understanding of the concept and implementation timeline is key to gaining Medicare support.
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Where can I learn more about the concept of resident-centered care?
You can contact the administrator at any of our Resident Centered Care nursing homes. He or she will be happy to speak with you at length about resident-directed care at their building and answer any questions you have.
You can also visit the Web sites for Action Pact, the Eden Alternative and Green House Project. These sites provide information about the nursing home culture change, other nursing homes that use the resident-centered care model, local initiatives and links to other informative Web sites.
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