Chapter 3 Person-Driven Care

TABLE 3.2 Stages of Culture Change Stage

Stage I: The Institutional Stage II: The Transformation Stage III: The Neighborhood Stage IV: The Household

33

Description

Traditional medical model organized around a nursing unit without permanent staff assignments

Characteristic of permanent staff assignments, a physical environment that is less institutional, and awareness and knowledge of cultures spreads among direct-care workers and the leadership team

Breaks up traditional nursing units into smaller functional areas and introduces resident-centered dining. Neighborhoods are given unique identifiers or names.

Consists of self-contained living areas with their own full kitchen, living room, and dining room and cross-trained staff (26)

Source: Grant LA, Norton L. A stage model of culture change in nursing home facilities. Presented at the 56th Annual Scientific Meeting of the Gerontological Society of America. www.leadingageny.org/home/assets/File/n00002611.pdf Accessed January 25, 2016..

equipment, facility design, and dining atmosphere. Among dining style practice studies, restaurant style has been a popular theme (20,24,27-35). In one study, 24-hour dining was initiated after a facility owner was delivering breakfast trays and noted several residents sleeping and thought it ridiculous to wake someone just to eat (32). Another facility started with a continental

Figure 3.1 Continuum of Person-Directed Culture Provider Directed

Management makes most of the decisions with little conscious consideration of the impact on residents or staff.

Staff Centered

Staff consult residents or put themselves in residents’ place while making the decisions.

Person Centered

Resident preferences or past patterns form basis of decision making about some routines.

Person Directed

Residents make decisions every day about their individual routines. When not capable of articulating needs, staff honor

observed preferences and lifelong habits

Residents accommodate staff preferences and are expected to follow existing routines.

Residents accommodate staff much of the time but have some choices within existing routines and options.

Staff begin to organize routines in order to accommodate

resident preferences― articulated or observed.

Staff organize their hours, patterns, and assignments to meet resident preferences.

breakfast buffet and worked its way up to a trayless buffet for all three meals (24). Additional culture change ideas for the dining experience that have been used successfully are summarized in Box 3.2 (see page 34).

Low

Continuum of Person Directedness

High

Source: Developed by Mary Tess Crotty, Genesis Healthcare Corp, based on the Continuum of Person-Directed Culture Model, developed by Susan Misiorski and Joanne Rader, distributed at Pioneer Institutes, 2005. Reprinted with permission.