Stories
Parade float travels over 100 miles for Person Directed Care awareness
Bright yellow floral sheeting surrounded the float that showcased the Person Directed Care philosophy to over 5,000 people along the parade routes for community celebrations in four North Central Iowa communities.
Achieving the 93 benchmarks to become a certified Person Directed Care home is the goal of Southfield Wellness Community, a long-term care facility in Webster City, Iowa, owned and operated by ABCM Corporation. A Person Directed Care committee has been meeting for five months to achieve the benchmarks and thought it was time to share the good news about Person Directed Care with people living in the area.
The Marketing Coordinator served as float committee chairman and suggested the Person Directed Care theme, “Choose Your Day Your Way.” The committee heartily endorsed the catchy phrase and brainstormed ways to display the choices that Southfield residents enjoy daily.
Activity, food and bathing options were segments featured on the float. Fishing poles, shopping bags, a Bible with large cross, a baby grand piano photo, bingo card, and Music Man community theater flyer showed the wide array of activities. Food choices displayed were an outdoor grill, snack ideas and bulletin board showing 2 menu options at every meal. A large whirlpool spa photo, a shower head, a hanging towel and basket of spa items showed the bath, shower and whirlpool options.
The float provided a visual awareness of Person Directed Care to thousands of people in North Central Iowa. Southfield Wellness Community also used several other venues to rally support for the choices concept. A sixty second radio ad featuring Frank Sinatra’s famous song, “My Way”, was developed, recorded, and played 36 times in July. The front page of the monthly Southfield newsletter featured an article with the benefits of Person Directed Care. It was distributed to approximately 400 present, former, and potential residents and tenants as well as families and community leaders. Person Directed Care brochures were distributed at Southfield’s Hamilton County Fair booth. The perks of the Person Directed Care philosophy are being emphasized during tours to potential new residents. Southfield has framed their Person Directed Care Commitment Statement and it is displayed in a prominent front door location.
With a passion for the “Choose Your Day Your Way” philosophy, Southfield Wellness Community is proud to be sharing the positive impact Person Directed Care has on their home and the long term care family. For more information contact Marilyn Middleton, Southfield Wellness Community Marketing Coordinator mmiddleton@abcmcorp.com
Principles of Person Directed Care are the Same No Matter Where!
….But It’s Not Any Easy Sell
This Spring the Iowa CareGivers Association held two regional conferences for direct care workers (DCWs) and partnered with Northwest Iowa Community College’s 10th Annual conference for DCWs. A total of 310 DCWs attended the three programs. All three programs featured a wonderful session on Person Directed Care by Deb Schaefer, Administrator: Julie Canfield, CNA, Northern Lights Neighborhood Leader: Brenda Huston, CNA, Sunny Oasis Team Member: Dolly Rasmussen, RN, Northern Lights Neighborhood Leader, Oelwein Health Care Center: and members of the Person Directed Care Coalition’s Speaker’s Bureau.
Those in attendance worked in a host of care and support settings that serve older Iowans and persons with disabilities.
Person Directed or Person Centered Care mean lots of different things to different people. Some argue technicalities in the language or philosophy. The Person Directed Care Coalition defines it as: Culture change in long term care is an ongoing transformation in the physical, organizational and psycho-social-spiritual environments that is based on person-centered values. Culture change restores control to elders and those who work closest with them. In person directed care, individual choice directs lifestyle, care, systems, and daily routine.
Those who serve persons with disabilities have been delivering Person Directed Care or Support for a number of years. Person Directed Care in the nursing home and other long term settings is a relatively new phenomenon. Some prefer to call it Person Centered Care since some individuals such as those with dementia may not be able to “direct” their care. Those in home care believe they have been doing person directed/centered care forever…but that may not necessarily be true. Regardless, the minor deviations in our definitions and philosophies…most are in agreement that Person Directed/Centered Care is all about empowering the resident or client. The goal is to ensure that Iowans are able to remain independent for as long as possible and have choices in their care and services regardless the setting.
The opportunity to have a good dialogue about Person Directed Care became a valuable learning experience for those present, the presenters, and the ICA. Below, for your review and consideration, are but a few of the observations, quotes, or remarks from the conference participants:
- Person Directed Care may not resonate with those who are unable to direct their own care (clients with Alzheimer’s Disease or other dementias). Person Centered Care may be a better choice of words.
- Person Directed Care is also used in the disability “consumer choice” world and more should be done to enhance understanding between the disability and aging communities. They are not necessarily mutually exclusive.
- When the Coalition speaks only from a nursing home perspective, those who work in home care, group homes or other settings automatically assume that the Person Directed Care discussion does not apply to them.
- Participants were much more receptive and engaged when speakers stated up front that Person Directed/Centered Care is what it is, regardless of the setting because it is all about empowerment of the resident, client, consumer, or patient. The principles are the same no matter where.
- Some direct care workers reported that in the setting where they work, three DCWs are caring for 60 residents. This makes PDC virtually impossible.
- Other comments regarding barriers were consistent with the findings from the Iowa Person Directed Care Coalition’s recent survey on PDC. The dialogue revealed a disconnect between management and direct care workers and their perception of whether their organization had fully implemented PDC.
- Some believe that those who work in home care have always done person directed care. That is not necessarily the case. Even those who work as home health or home care aides may still not fully understand the concept of empowering residents to do as much for themselves as possible and make decisions or choices in their care/support.
- Direct Care Workers serving both disability and elderly populations seem to agree that their education and training about the concept of Person Directed/Centered Care could and should cross settings or populations served.
- There was disparity between administration and direct care workers on whether they had “implemented” Person Directed Care at their places of employment.
Respectfully submitted by
Di Findley, Executive Director, Iowa CareGivers Association.
Deb Schaefer, Administrator, Oelwein Health Care Center
Julie Canfield, CNA, Northern Lights Neighborhood Leader
Brenda Huston, CNA, Sunny Oasis Team Member:
Dolly Rasmussen, RN, Northern Lights Neighborhood Leader, Oelwein Health Care Center
Iowa CareGivers Association
Direct Care Worker Resource & Outreach Center
1211 Vine Street #1120
West Des Moines, Iowa 50265
515-223-2805
Real Lessons in Real Culture Change Part 1 of 3
By Janice McCoy, ABCM Corporation
Before I took my current position I was a private consultant working with several nursing homes on their Person Directed Care Culture Change efforts. Below is an excerpt of an introductory piece I wrote for a corporate manual on PDC.
…While the three facilities were very different, they all faced very similar challenges in their pursuit of Person Directed Care. The one thing that was consistent for all three facilities was abundant frustration and many mistakes. Often the mistakes and frustration were born of assumptions and naivety. But through it all, through the many mistakes and oft frustration, many lessons were learned.
Below I have attempted to list a few of the major lessons learned from my experiences in attempting to change a culture. I do so in hopes of helping others avoid the same mistakes and frustrations I experienced, however….
Lesson # 1: There will always be mistakes and frustrations; learn from them!
Lesson # 2: Change is hard.
Probably the most frustrating part of implementing Person Directed Care was trying to understand the resistance that was immediate and fierce. Having been given the many reasons for the need for a shift in culture, how could anyone not see the benefits and the possibilities? It is after all for the betterment of the residents and employees. Why were people fighting it?
Change is hard. No matter the reasons, motives, needs… The key is to combat the fear of change with knowledge and power. Even with all the education and involvement you could possibly implement, there will still be fear and thus resistance.
Lesson # 3: Change is especially hard for residents.
Lesson #4: Choosing not to change is still a choice.
Just as amazing to me as the resistance from the staff to Person Directed Care was the resistance from the residents. Again, thinking we were making so many improvements, giving so many more choices that would only enhance their lives, we were constantly confronted with “there is nothing wrong with the way you do it now” or “sure I used to do things differently, but I don’t want to change again”. When we went to open dining in one facility I had a lady who used to get up at 9:00 a.m. at home, tell me “it was too late” she was already “institutionalized” (her exact word) and despite having a choice now, would still get up at 6:00 a.m. But she well understood what we were trying to do and thought it was “great” for future residents.
The dining room is probably the place we see the biggest choice of not to change. Everyone still wants to sit where they used to, with whom they are used to at the time they are used to. And this is fine.
Real Lessons in Real Culture Change Part 2 of 3
By Janice McCoy, ABCM Corporation
This is a continuation of my list of lessons learned in attempting to implement Person Directed Care in the early days-though the lessons remain the same regardless of the stage of culture change one is in!
Lesson #5: Don’t take votes or surveys!
Empowering the residents and employees to have input into decisions that impact them is a key component of Person Directed Care. However, eliciting their opinions too early can backfire on you. In one facility we surveyed the residents about the medication pass system. No one had any problems with the system of getting medications in front of everyone else in the dining room. In fact no one wanted to see it changed. But we did it (moved medications to individual rooms for dispensing) anyway. After a couple of weeks the residents agreed what a more pleasant dining atmosphere it was not to have the medication carts in the dining rooms and nurses standing over their shoulders as peers counted the number of pills they took. In another facility the residents voted overwhelmingly against adding cats to the home. Against every principle of Person Directed Care we did it anyway, getting the cats for the residents who were unable to vote and would benefit most from the pets due to their physical and mental conditions. We ended up having to get more cats, for the residents who voted against the pets ended up monopolizing them.
If you feel a need to take votes or surveys, do so only if you plan on acknowledging them and then only after the participants have been well informed of the issues. Always keep in mind those who cannot speak for themselves.
Lesson #6: Empowering staff does not mean giving them absolute power.
Remember the responsibilities of “empowerment” (for it is a responsibility) may well be new to the staff and they may not know what to do with it. I have seen bad decisions and worse yet, no decisions made when left up to the employees. Start slow, not with giving decision-making power to staff, but empower them by getting them involved in the decision-making process. Continue to build on their decision-making skills through education, practice and confidence building and guide them into making informed decisions.
Real Lessons in Real Culture Change Part 3 of 3
By Janice McCoy, ABCM Corporation
This is a continuation of my list of lessons learned in attempting to implement Person Directed Care in the early days-though the lessons remain the same regardless of the stage of culture change one is in!
Lesson #7: Tearing down the nurse’s station and spa bathing are not Culture Change.
I have visited facilities that were renowned for their innovations and leading the industry in culture change. They had no nurse’s stations; they had buffets and open dining, consistent staffing and pets. Yet as the administrator would lead the tours I would see him/her walk by residents, staff and visitors without greeting them. I’d see staff walk by residents without acknowledging them. I’d see residents sitting, leaning over in their wheelchairs without being engaged. Physical plant changes and programming does not make Person Directed Care. It is the people who make it and when it’s right, you may not be able to see it, but you will feel it.
No experience made me feel more inadequate in my Person Directed Care efforts than the man who complained of a cold shower room. Through our Person Directed Care steering team we spent much time and money on refurbishing the shower rooms, making what we thought was a warm, pleasant atmosphere with towel warmers, heat panels, aroma diffusers, art, and plants. But with one sentence, we discovered we totally missed the point. Upon completion of our project, I went to the above gentleman to ask him about the shower room. While I was expecting praise and expressions of gratitude, I instead received an answer that I will never forget: “You can fix it up as much as you want, but it still doesn’t make up for the indignity of a 16 year old stripping you.” Wow. How do you answer that? See Lesson # 8.
Lesson # 8: The right people in the right seats is essential.
The passengers on the Person Directed Care bus are the single most important factor in determining the success or failure of culture change. There are 3 kinds of passengers: 1) those who get it; 2) those who can be nurtured to get it; and 3) those who will never get it. Put the first ones in leadership seats and have them work closely to nurture the second ones. Be prepared to escort the third set of passengers off the bus; they are in need of a different route.
Lesson # 9: Changing a culture is very hard.
Are you seeing a theme (refer back to Lessons 2-4)? Yes change is hard. Changing a culture is very hard. Because we not talking about tearing down the nurse’s station and adding spa bathing, we are talking about changing the assumptions, beliefs, attitudes and behaviors of people, diverse people. This will not happen over night. It takes years to achieve true, deep culture change and just as we think we might be getting close, more change will be needed as our resident population and employee pool change.
Lesson # 10: Do it for the right reasons
Deep culture change will only happen if the administration is leading from their hearts. Person Directed Care will not “take” if it is being done because it is the latest craze, is what corporate or regulatory agencies expect or if it is implemented for marketing purposes or to build up a resume. (See Lesson #7) Person Directed Care must be felt.
We have a 60 year old resident with advanced Parkinson's disease. His disease had progressed to the point that he was no longer able to get around or take care of himself, prompting his admission to Westwing. His routine prior to coming to us was to walk to his sister's house everyday to spend time with her or just in the yard and then walk back. He stated that if he was no longer able to walk there by himself it was "not worth going on". The staff made it their mission to get him to the point of being able to walk that distance again. PT worked with him and our restorative supervisor walked with him the total distance (about a mile) to make sure he was safe. We then worked with administration to allow him to leave by himself once he was up and going, even though it could be a risk for us if he got hurt. While allowing a resident to walk that distance by himself is not the norm, in this situation, his quality of life depended on being able to do this independently. He is really happy.
Carrington Place Staff Retention Success Story
| Submitted by: | Karen Etzel, RN, DON |
| Facility: | Carrington Place of Toledo (formerly Grandview Acres) |
| 403 Grandview Drive Toledo, IA 52342 | |
| 641-484-5080 |
Timeframe: 2006-2007
Brief Description: To reduce staff turnover, Carrington Place looked at their processes of hiring, awards and recognition, and termination to determine why staff was leaving. During the prior year staff retention was at 59 percent.
Our Story:
Hiring Process: When a person applies for a position at Carrington Place, an interview is conducted. If the person interviews satisfactorily and is a prospect for hire, it is the facility’s practice to have drug screening, background and reference checks completed on every applicant offered a position. If the applicant passes, they are hired and orientation begins. Orientation begins by having a mentor lead, direct and guide the new hire. The new employee orients on every shift, so they have an understanding of what tasks the other shifts have. The mentor stays in contact with the new employee through the 90-day probation period. Upon completing 90 days, input is derived from co-workers, supervisors and mentors and the new hire is evaluated. Counseling may be needed and the probation period may be extended an additional 30-days. Carrington Place is thinking about developing a 30-day evaluation checklist to catch problems earlier.
Rewards & Recognition Process: Both full-time and part-time new hires receive a hiring bonus after successfully completing the probationary period. Annual reviews result in merit based pay increases and monetary seniority bonus’ are given at 1, 3, 5 years and every 5 years after. Agency staffing is never used. Instead, double time pay is offered for extra shifts or for staying late or coming in early. Benefits include paid vacation, sick time/personal days, holidays, bereavement leave and perfect attendance bonus’. The facility provides good medical, vision, and dental insurance plans and contributes 75% of the employee’s health coverage. They also provide free life insurance to all full-time employees. The administrative team makes special efforts to celebrate the nurses and CNAs during the national recognition weeks and throughout the year. They keep a bowl filled with candy, have an open-door policy, allow staff to vent when needed, and ask staff to present a solution when they present a problem. They make every effort to accommodate vacation and other special requests. They provide team-building education, a clean environment to work and pleasant surroundings. They encourage relationship building with the residents and each other.