PowerPoint Presentation · control. Help them to find some peace. They’re part of the Care Team and, in some ways, they’re also being ‘cared for’. 3. When a Resident comes

3/29/2016

1

Senior Living success starts here.

1

Strengthening Resident Choice & Culture

of Safety Using FLS Engagement

Keeping the CARE and CARING Connected

6

Keeping the CARE and the CARING Connected

… but (MY hands are) stretched still …

Isaiah 9:12

Strengthening Resident Choice & Culture of Safety Using FLS Engagement

8

Today’s Agenda

1. Introductions: Me + You + Things That You Do For Your Residents

2. HATChTM: The Six Domains + The Key Responsibilities

3. Culture + Clinical Practices + Contractures + A Smile

4. Workplace Practices + Leadership + Empowerment

5. Community + Family + Technology

6. “Risk Enablement”

3/29/2016

2

10

The HATChTM Model Holistic Approach to Transformational Change

On December 9, 2014, Kara Butler of Healthcentric Advisors granted Direct Supply permission to use the HATChTM Model.

Copyright 2013 Healthcentric Advisors and Turnswing, Inc. Produced by Turnswing Studios

Helping Your STAFF Build and Sustain

Quality of Life and Quality of Care

for Your Residents –

Empower them to LEAD and

MAKE THE DIFFERENCE

Ray Miller

Direct Supply

Educator,

Story Teller,

& Grandpa

Healthcentric Advisors

is a nationally-recognized

non-profit health care quality improvement agency providing

consulting, research and educational

services to the health care community.

Healthcentric Advisors (QIO) 235 Promenade Street, Suite 500, Box 18 Providence, RI 02908

401-528-3221 or

[email protected].

http://www.healthcentricadvisors.org http://vimeo.com/57899184

11

“When I think of my Grandparents, I

think about how THEY would like to

be cared for.

So I care for my Residents like they

were my Grandparents.”

Good Samaritan Caregiver Kissimmee, FL

April 2015

12

mailto:[email protected]

http://www.healthcentricadvisors.org/



http://vimeo.com/57899184

3/29/2016

3

When thou wast young,

Thou girdedst thyself,

And walkedst whither thou wouldest:

BUT

When thou shalt be OLD,

Thou shalt stretch forth thy hands,

And another shall gird thee,

And carry thee whither thou couldest not.

An “Old Thought” About Aging In Place

John 21:18

14

What do Caregivers do for their Residents?

YOU

Staff Member

Miracle Max

Care Giver

Leader

Friend

Staff Members of:

Willowcrest, Milwaukee, WI

Guardian Care, Orlando, FL

BRIA Health, Geneva, IL

Kissimmee HCC, FL

Keystone Rehab, FL

Plus MANY Attendees At

State & National Shows

1. Help

2. TIME

3. LOVE

4. CARE

5. Honor

6. Safety

7. COOK

8. SMILE

9. Dignity

10. TEACH

11. Support

12. LISTEN

13. Respect

14. Advocate

15. Heal them

16. Fix Things

17. Encourage

18. PURPOSE

19. Greet them

20. Daily needs

21. Conversation

22. Be a FRIEND

23. Guide / advise

24. Jokes / humor

25. Rub their back

26. Sing and dance

27. COMFORT THEM

28. Adjust the temperature

29. Provide SPECIAL Events

30. Make them feel IMPORTANT

15

March 2015 Woodbury Senior Living, MN:

Sandy B. Receptionist*

1. I worked here before. I left to be a stay-at-home Mom for 7

years but the Residents pulled me back.

2. They’re not “just a Resident” to me.

3. Do NOT take them for granted. Engage with them -- DON’T

pity them. Show them respect, compassion, dignity -- call them

by their name.

4. HARDEST: Watching them struggle but not being able to help

5. MOST IMPORTANT: Be here – LISTEN – ACKNOWLEDGE

Them – They MATTER.

3/29/2016

4

16

Today’s Agenda







17

Key

Responsibilities

R

18

Key

Responsibilities

1. Body

2. Mind

3. Spirit

4. Emotions

Clinical Practice

R

3/29/2016

5

19

Key

Responsibilities

1. Do

2. Hire

3. Train

4. Mentor

5. Retain

Workplace Practices

R

+ + + =

20

R

Key

Responsibilities

1. Five Senses

2. Safety

3. Comfort

4. Cleanliness

5. Compassion

Environment

Shanti B., CNA (NS):

For 12 years I’ve

been on the night

shift. ... I have

learned to tap into

“individual

considerations”.

I have learned to

LISTEN.

WAIT

21

Key

Responsibilities

1. Team

2. Vision

3. Culture*

4. Finance

5. Education

6. Processes

7. Development

8. Physical Plant

9. Human Resources

Leadership

R

1. Trust

2. Quality

3. Patience

4. Sanctuary

5. Fulfillment

6. Friendship

7. Compassion

8. Engagement

CULTURE

S.A.

Esteem

Love & Belonging

Safety & Security

Physiological

3/29/2016

6

Aging “is an inevitable, mutual withdrawal or disengagement …”

It results “in decreased interaction between the aging person and others in the social system he belongs to".

The theory claims that “it is natural and acceptable for older adults to withdraw from society.”

The Disengagement Theory of Aging

Disengagement theory - Wikipedia, the free encyclopedia https://en.wikipedia.org/wiki/Disengagement_theoryWikipedia https://www.boundless.com/definition/activity-theory/

"Elderly Woman , B&W image by Chalmers Butterfield" by The original uploader was Sba2 at English Wikipedia Uploader notes: "Use this image as needed, but for uses other than personal, please credit as "Photo by Chalmers Butterfield"." - Transferred from en.wikipedia to Commons by gustavocarra.. Licensed under CC BY 2.5 via Commons - https ://commons.wikimedia.org/wiki/File:Elderly_Woman_,_B%26W_image_by_Chalmers_Butterfield.jpg#/media/File:Elderly_Woman_,_B%26W_image_by_Chalmers_Butterfield.jpg

formulated by Cumming and Henry in 1961 in the book Growing Old

https://www.google.com/search?q=b ell+shaped +cu rv e& espv=2&biw =1600&bih=775&tbm=isch&imgil=0f gtWplHL yBLx M%253A%253BLTdxSVSh GZYQ SM%253Bhttp %25253A%25252F%25252Fcondor.depaul.edu%25252Fsjost%25252Fit223%25252Fdocuments%25252Fcentral.htm&sou rc e=iu&pf =m&fi r=0 f gtWplHL yBLxM %253A%252CLTdxSVSh GZYQSM%252C_&usg=__3 WQ1X7yCYGGb vk2r6 v2qU6ryZBs%3 D&v ed=0 ahUK Ewjd442azqrJAhWSlIgKHSts DA0QyjcIJg&ei = Gyh VVp3qNZKpogSr2LFo #tbm =isch&tbs =rim g%3ACd H4LVqZR y8gIjgHHTL9lwQ G1_1ZFpk

3VW1Ar1mh9lnNhwwpBseUF5JjNVk33AGmhgWRfZy yBf1Ah9 YiD68dKLLOAPyoSCQcdM v2XBAbXEYiWO6GauptxKhI J9kWm TdVb UCsR33nP0z5ZiEYq Egn WaH2Wc2 HDCh H255pWO9X_1byo SCUGx5QXkmM1 WEW7A9UrznRSFKhIJTfcAaaGBZF8R AVomk YdZcU4q EglnLIF_1 UCH1iB HdWEa5 WfqAh SoSC YPrx0oss4A_1 EV _1Zb W1KbCiH&q=b ell%20shap ed%20curv e&imgrc =v6Vil31CT_HugM %3A

“Their argument, while logical, is not supported by empirical data. Thus, it

has largely been dismissed ...”

Source: Boundless. “Disengagement Theory.” Boundless Sociology. Boundless, 21 Jul . 2015. Retrieved 27 Nov. 2015 from https ://www.boundless.com/sociology/textbooks/boundless-sociology-textbook/aging-18/the-functionalist-perspective-on-aging-128/disengagement-theory-721-9147/

“The process of aging is greatly facilitated when older people pursue hobbies and relationships,

and generally lead a more active lifestyle.”

Dis-engagement

can and does

happen. But

NOT always and

NOT of necessity

“…it’s natural and acceptable for older adults to withdraw…”

“We can and should promote and facilitate

engagement.”

25

March 2015 Woodbury Senior Living, MN:

Rebecca, RN

1. Help the Residents to smile…to be happy...to be comfortable

... Learn from them.

2. Care for the family. They’re struggling with Mom’s loss of

control. Help them to find some peace. They’re part of the

Care Team and, in some ways, they’re also being ‘cared for’.

3. When a Resident comes to you for care, it’s a CRITICAL

TRANSITION.

It’s a time to heal, to manage chronic AND acute conditions,

to access Therapy and their doctors. While LIVING here,

these are much more available.

https://en.wikipedia.org/wiki/Disengagement_theory













https://www.boundless.com/definition/activity-theory/




https://commons.wikimedia.org/wiki/File:Elderly_Woman_,_B&W_image_by_Chalmers_Butterfield.jpg/media/File:Elderly_Woman_,_B%26W_image_by_Chalmers_Butterfield.jpg

https://commons.wikimedia.org/wiki/File:Elderly_Woman_,_B&W_image_by_Chalmers_Butterfield.jpg/media/File:Elderly_Woman_,_B%26W_image_by_Chalmers_Butterfield.jpg

3/29/2016

7

26

Key

Responsibilities

1. HOME

2. Society

3. Connection

4. Engagement (RSF)

5. -

6. -

Community and

Family

R

27

Key

Responsibilities

1. Knowledge

2. Awareness

3. Experience

4. Preparation

5. Consistency

Compliance

R

28

The HATChTM Model

Holistic Approach to

Transformational

ChangeTM

Copyright 2015-2016 Direct Supply, Inc. All rights reserved

R

3/29/2016

8

29

What Matters the Most?

1. Knowledge

2. Awareness

3. Experience

4. Preparation

5. Consistency

Compliance

1. HOME

2. Society

3. Connection

4. Engagement (RSF)

5. -

6. -

Community and Family

1. Trust

2. Quality

3. Patience

4. Sanctuary

5. Fulfillment

6. Friendship

7. Engagement

8. Compassion

CULTURE

1. Team

2. Vision

3. Culture*

4. Finance

5. Processes

6. Education

7. Development

8. Human Resources

9. Physical Plant

Leadership

1. Five Senses

2. Safety

3. Comfort

4. Cleanliness

5. Compassion

Environment

1. Do

2. Hire

3. Train

4. Mentor

5. Retain

Work Place Practices

1. Body

2. Mind

3. Spirit

4. Emotions

Clinical Practice

Let’s take a look at a

few examples

30

Today’s Agenda







31 Copyright 2015-2016 Direct Supply, Inc. All rights reserved

Nate Sproat, UW Eau Claire

Health Care Administration

President - ACHCA Student Chapter

[email protected] (920) 883-9183

“This is the young boy I noticed across

the street with the sores on his feet”

The Journey of Culture

mailto:[email protected]

3/29/2016

9

32

This was at a natural water spring

nearby the village of Kilo 16.

“This was a makeshift kitchen

at Francisco’s old house.

The Journey of Culture

33

Pastors of the local church decided which families received new homes. This is the inside of the house that a single mother and 4 small

children lived in. This is the house that we built for them.

34


The bed legs were sawed down,

you can still see some rust.

“This is the gentleman

tied to the wall ...”

The Journey of Culture – “Institutionalized”

“These are the pictures from the nursing home.”

3/29/2016

10

35

Culture Contractures +

+

The HATChTM Model HOLISTIC Approach to Transformational Change

37

Fishing

Pole

Analogy

USED WITH PERMISSION: by Karen L Bonn, President, Restorative Medical, Inc.; 270-422-5454; 800-793-5544; www.restorativemedical.com . Copyrighted

copyrighted by RMI

So how does it work?

Prolonged, low-load, passive stretch

over time (6 weeks)

15-20 minutes (on the Golgi Tendon Organs)

will allow the Resident to reach the

point of “Muscle Inhibition” (Relaxation)

Orthopedic: Rehab (quick + surgery + painful therapy)

Restorative: disease process, CNS injury, neurological

38

Golgi Tendon Organ

Proprioceptive sensory

receptor organ

They are located at the insertion of

skeletal muscle fibers into the tendons

of skeletal muscle.

3/29/2016

11

39

Ms. Bessie

USED WITH PERMISSION: by Karen L Bonn, President, Restorative Medical, Inc.; 270-422-5454; 800-793-5544; www.restorativemedical.com .

Copyrighted

Cervical Extension (“tone” in the spine)

Staff could not get enough nutrition into her to sustain life

Ms. Bessie Ms. Bessie was to have surgery to put in a feeding tube

40

Ms. Bessie

USED WITH PERMISSION: by Karen L Bonn, President, Restorative Medical, Inc.; 270-422-5454; 800-793-5544;

www.restorativemedical.com . Copyrighted

Immediately after fitting 20 minutes later

41

Thinking of the Resident Holistically



Breathing

Circulation

Elimination

Orientation

Dignity

Self-Esteem

Hygiene

Skin Tissue

(Wound)

Nutrition

Loss of Range of Motion

(contractions)

3/29/2016

12

42

Thinking of the Resident Holistically



Breathing

Loss of Range of Motion

(contractions)

Circulation

Elimination

Orientation

Dignity

Self-Esteem

Hygiene

Skin Tissue

(Wound)

Nutrition

? ? ? ?

47

Today’s Agenda







50

Alone in Eden: Care Aides’ Perceptions of Consistent

Assignments

“Although care aides initially welcomed the restructuring, they described

gradually becoming overwhelmed by the work, confined by consistent

assignments, and isolated from colleagues and other residents.”

Elizabeth Andersen and Jude Spiers West J Nurs Res, March 2015; vol. 37, 3: pp. 394-410., first published on February 11, 2014

22 care aides from 5 nursing homes

in a western Canadian city

3/29/2016

13

Chris Perna, CEO Eden Alternative®:

“What the researchers can conclude is that the organizations involved did

not do a very good job implementing these changes.

“The testimony from these aides underscores that simply implementing

consistent assignment is not guaranteed to improve outcomes or staff

satisfaction — it must be done properly,”

Tim Mullaney, Associate Editor Consistent assignment study shows need for careful

culture change implementation, McKnights, 25 Feb 2014

My Belief:

The better the Staff know their residents,

the better the Staff can care their Resident.

Ray Miller

52

Empowerment =

“Making” Them Leaders

1. Trust

2. Quality

3. Patience

4. Sanctuary

5. Friendship

6. Fulfillment

7. Engagement

8. Compassion

CULTURE

+ 1. Vision

2. Team

3. Culture*

4. Finance

5. Processes

6. Education

7. Development

8. Human Resources

9. Physical Plant

Leadership

Leadership + Culture

53

You asked me 4 questions about my job: *



Shelly B. RA Woodbury Senior Living,

Tealwood Inc, MN

BEST

HARDEST

MOST

IMPORTANT

MOST

FRUSTRATING

A Resident said, “I knew I’d be

OK because YOU are here.”

1 - We need to stay out of the

“factory care” approach.

2 - Transitions between shifts.

RELATIONSHIPS

When I KNOW something needs

to change but no one listens ...

3/29/2016

14

55

“When I know something needs

to change but no one listens.”

http://www.apbs.org/conference/denver/files/A18-Bird.ppt#369,13,Federal Regulations: Potential areas of citations


Level of Authority Degree of Familiarity

Administrator

RNs / LVNs

Therapies

CNAs

Seeking

Permissions

CNAs

Therapies

RNs / LVNs

Administrator

Gathering

Information

When you empower Staff, you achieve quality and culture.

+

57

What we can try our best to do:



1. Identify some of the Resident’s old

Friends and invite them to play cards

every Tuesday night like they use to.

2. Invite the Family to bring their pet for a

visit. Pets don’t come as often as they use

to – remember, residents left their pets

behind.

3. Encourage kids from local schools to

come for visits. They don’t come as often

as they use to. EVERYTHING stops when

Children visit.

Shelly B. RA Woodbury Senior Living,

Tealwood Inc, MN

60

…Though (my) outward man perish,

YET (my) inward man

is renewed day by day.

The “Profession of Caring”

2 Cor. 4:16; 8:14

… Now … your abundance may be

a supply for (my) want,

that (my) abundance ALSO

may be a supply for YOUR want.

3/29/2016

15

62

HARDEST: “Transitions between shifts”

“Every Good Boy Does Fine”

+ “FACE”

“ROYGBIV”

Handoff Mnemonics

63

1. AIDET

2. ANTICipate

3. ASHICE

4. CUBAN

5. DeMIST

6. GRRRR

7. HANDOFFS

8. I PASS the BATON

9. Just Go NUTS

10. MIST13

11. PACE

12. PEDIATRIC

13. SBAR

14. I-SBAR

15. SBARR

16. SBAR-T

17. SHARED

18. SHARQ

19. SIGNOUT

20. SOAP

21. STICC

22. 4 P’s

23. 5P’s

The Pivotal Role Of The Nursing Home Administrator, Provider Magazine, August 2014

The Quality of Care in Nursing Homes -- The University of Scranton – A Jesuit University

“Hand-off” Mnemonics

64

I-PASS the BATON

Introduction

Patient

Assessment

Situation

Safety

concerns

Background

Actions

Timing

Ownership

Next

introduce yourself and your role

name, identifiers, age, sex, location

current status and circumstances; including codes status, eval of certainty, recent changes, and response to treatment

critical lab values and reports, socioeconomic factors, allergies, alerts (e.g. falls, isolation)

which were taken or are required, providing brief rationale

level of urgency, explicit timing, and prioritization of actions

who is responsible (eg, nurse, doctor, team), including patient or family responsibilities

what happens next (eg, any anticipated changes in condition or care, the plan, any contingency plans)

presenting chief complaint, vital signs, symptoms, diagnosis

comorbidities, previous episodes, current medications, family history

3/29/2016

16

65

Just go NUTS

Name

Unusual

or unique

Tubes

Safety

of resident, diagnosis, room number

such as IV, NG, catheters, drains, ostomies

concerns such as falls, medication

variances identified on the individual care

plan including critical lab values, pain

management, etc

66

I-SBAR

> Introduce

> Situation

> Background

> Assessment

> Recommendation

SBAR

> Situation

> Background

> Assessment

> Recommendation

SBAR-T

> Situation

> Background

> Assessment

> Recommendation

> Thank the Residents

SBAR-D

> Situation

> Background

> Assessment

> Recommendation

> Documentation

“Hand-off” Mnemonics

“Hand-off” Mnemonics S-BAR Iterations*

67

Today’s Agenda







3/29/2016

17

70

Community and Family: Technology Can

Improve the Quality of Residents’ Lives*

LeadingAge Magazine July / August 2014: Fighting Isolation With Technology

by Linda Barbarotta; http://www.leadingage.org/Fighting_Isolation_With_Technology_V4N4.aspx

Technology-based Solutions For Social Isolation

Shirley: "I look at the calendar

before I go to sleep to see what

programs are on the next day.”

“This program has enriched my life.

I have friends I can talk with every

day."

71

Insert Resident

Technology

Adoption

Video

72

“Our video, LIFELONG LEARNERS,

challenges the myths of aging, shows a

bit of our process and how some

residents are now using the new

technology and enriching their lives.

“We have 167 independent living

apartments at Clermont Park. To date

90% of them are using the tablets.

“As they became more comfortable

with the tablets, the residents began to

feel more empowered and willing to try

more things on the tablet and in the rest

of their world.

“The ‘Yes, I can!’ attitude now

permeates our entire campus.”

Mary Johnson, 77

Resident, Clermont Park

Retirement Community

3/29/2016

18

73

“Teaching is what I did—do. Who I am is a teacher. My

field of expertise is the education …. I have a Master’s degree

in Humanistic Education from Webster U.

“In my 43 years in the field, I concentrated on Kindergarten

and 1st grade. I have this itch that says, ‘Learning and teaching

stuff’ is what you do so for goodness sake sign up for the pilot

group and see where it takes you.”

Teacher …

AGAIN!!!

Mary Johnson, 77 *

74

Today’s Agenda







78 Copyright 2015-2016 Direct Supply, Inc. All rights reserved

3/29/2016

19

81

Falls and the

Dignity of

Risk*

82

Today’s Agenda – In Review

Do You Have Thoughts or Questions







Was This of Worth?

In large measure that depends on what you do with it.

86

Keeping the CARE and the CARING Connected

… but (MY hands are) stretched still …

Isaiah 9:12

Strengthening Resident Choice & Culture of Safety Using FLS Engagement

Documents

PowerPoint Presentation · control. Help them to find some peace. They’re part of the Care Team and, in some ways, they’re also being ‘cared for’. 3. When a Resident comes