Providing Resident Centred Care

Kathy PeriSchool of Nursing

Faculty of Medical and Health ScienceUniversity of Auckland

Patient centred Resident centred is there a difference?

• The principals are the same

• Being resident centred defined as older people living in long term care facilities

Literature Review

• Quality of life in long term care institutions can be affected by a number of factors including the physical social and health care environments (Kane 2001).

• Work force issues in residential care impact on quality of life for residents (Foner 1995).

• A number of studies suggest quality care equals improved quality of life and life satisfaction (Tobin 1999).

• ADL impairment has a strong influence on the relationship between social engagement and mortality – including mental health (Kempam 1999).

Key Principles

• Having a non judgmental acceptance of the uniqueness of each person

• Respecting the past experiences and learning of each person

• Seeing the whole person with emotional physical and spiritual needs

• Focus of a person’s positives – abilities• Staying in communication means being flexible,

thinking laterally and listening to the other point of view.

Key Principles

• Nourishing attachments – ensuring people feels welcome and included

• Creating a sense of community gives us the sense of belonging and knowing where we fit in and what is expected of us

• Maximising freedom for people to contribute to their work or care and minimising unnecessary controls

• Allowing ourselves to receive from others and valuing what they have to give

• Building / maintaining an environment of trust

The International Picture

• The Eden Alternative Foundation (Thomas; New York)

• Providence Mount St Vincent (Boyd; Seattle)

• Wellspring Innovation Solutions (Eastern Wisconsin)

• The Pioneer Network (Williams,1997 & Lustbader 2000))

The National Picture

• Promoting Independent Living Study (PILS) and the Promoting Independence in residential care study using a goal setting approach to improve quality of life and function (UOA research project)

• Adoption of the Eden Model (several individual facilities)

• Living Independently and having Fun in Elder Care:LIFE (For profit Chain)

Practical application

Is this possible?

Randomisation (no statification)

Randomly selected: rest-homes in Christchurch and Auckland Organisational Culture survey,

Falls surveillance begun, Baseline Data (Fnc QOL) collected

Outcome evaluation •Function, QOL 6m•Organisational culture survey•continued falls surveillance 1yr•(12m all measures)

Methods

Social Group•Everyday worlds interview x2•falls surveillance

Activity Group•PIRC, goal set, functional assessment, PIP to caregiver • falls surveillance

Intervention

• Goal setting with resident

• Goal activitiy individualised program devised by research team

• Care plan developed and owned by residents

• Implementated by caregivers

• Goals modified and renewed as required

Goal Domains

• Independence day to day functioning (walk to toilet, shower, walk to dining room, walk to craft room)

• Social activity (visit relatives, attend opera, play piano, gardening, outings in van, dine out attend church services)

• Leisure activity (play snooker, shopping, attend computer classes, dancing)

Outcomes

• Improved quality of life; SF36 physical component (PILS)

• Improvement of function; functional measure of the late life disability instrument. (PIRC)

• Improvement in quality of life; EQUOL(PIRC)

• What are the ingredients in order to change care practices in residential care settings?

Resident centre ness

Returning locus of control to residents

• Assist residents in determining their own daily schedules

• Restore choices about eating

• Support continence as long as possible

• Promote all remaining capacities for self care and mobility

Establishing home like environment

• Implement cross training for all staff levels

• Include family members in decision making

• Promote a sense of community

• Create a human habitat

• Redesign traditional structures.

Enhancing staff capacity

• Flattening a facilities administrative structure

• Commit to consistent assignment

• Involve nursing assistants in care planing and care conferences

• Enable nursing assistants to set their own schedules

• Support team development

Strategies for changing the culture in long term care facilities

• Encourage frank dialogue

• Supporting staff in developing new models of supervision

• Communicating a clearly defined alternative to the status quo

Conclusions

• Providing those who live in residential care individualized care based on their choice and personal control will provide unlimited opportunities for growth in body, mind and spirit

• Acknowledgment to all older people who unconditionally provided me with knowledge and information that supports my presentation today.