As a child, Ed Fitzpatrick remembers visiting his grandmother at the convalescent home. It was cozy, with a kitchen close by the living room, where residents sat in stuffed chairs and the caregivers seemed more like family than staff.
He knew without a doubt that this was grandma’s home.
Nursing homes, given today’s highly regulated environment, cannot return to that casual era, said Fitzpatrick, director of Springbrook Center for Nursing and Rehabilitation on Spring Street in Westbrook.
“We can’t throw the clinical out the window,” he said. But what can be done, and must be done, he said, is for nursing homes to take major steps to change the image of long-term care.
Two years ago, Springbrook was one of three nursing homes in Maine invited to participate in a culture change initiative led by the Northern New England LEADS (Leadership, Education, Advocacy for Direct Care and Support) Institute. The 123-bed facility was chosen for the pilot projectalong with The Cedars in Portland and the Mid Coast Senior Health Center in Brunswick, because of their reputations as recognized leaders in progressive long-term care.
Think of culture change as a major attitude adjustment, a change of heart in which care is scheduled and tailored around the different needs of each resident, instead of the focus on efficency. Think of it also as a change in which direct care workers – the CNAs on the front lines – are recognized for their key role in bringing about this transformation and are, for the first time, given an equal voice.
What if, for example, Bill likes to walk the hallways in the wee hours of the morning. No one will put him back to bed. Everyone on the direct-care staff knows he was a third-shift worker at the mill.
Say that Betty likes to skip breakfast and sleep in most mornings. Not a problem. The staff will wait until she’s ready to rise. When she does awake, no one will rush her. And instead of being scolded for wasting time, they’ll be praised if they take the time to sit with her and learn more about her life.
Such a change requires a major de-emphasis on top-down decision-making in favor of a team approach where staff leadership and peer mentoring for direct-care staff is emphasized.
When the institutional, hospital-like approach came into being not too long ago, it was praised as a major improvement in nursing-home care.
But under the new model, life and death no longer revolves solely around disease treatment. Quality of life under culture change restores the balance between medical and emotional care, where it belongs.
Direct-care workers still have to answer to the chain of command, where nursing staff direct the clinical needs as ordered by the resident’s doctor. But under culture change, the CNAs who know the most about residents’ emotional needs and preferences are listened to, as well, in regular unit-based monthly meetings involving all staff, including housekeeping and dietary.
Marge Ellis, a CNA/med tech and LEADS coordinator at Springbrook, thinks it’s great that the industry is finally coming around to her way of thinking.
“I’ve always worked around the rules,” she said, when the rules left compassion out of the equation.
“When I was trained 20 years ago, everything was on a schedule set up to benefit nursing homes,” she said. That always seemed wrong to her. Why not set up schedules to benefit the residents instead?
Changing the mindset of some staff that are accustomed to the assembly-line model of care was a challenge at first, she said. They thought they would have to work harder and scramble more to meet the basic needs of residents. What they found, however, was that the changes allowed for more quality time with residents and a higher sense of job satisfaction.
Culture change also benefits by lessening the trauma factor and need for medications for residents – who, because of their frailty, are no longer in charge of their life.
“No wonder you had behavior problems and residents who become combative and depressed,” Ellis said. “Who wouldn’t be depressed?”
One major benefit of culture change, she said, is that it has given gives the front-line workers a voice.
“Instead of just giving lip service to the workers, we are actually working collaboratively on issues,” Ellis said.
Emphasis is also placed on providing consistent assignments for staff, so the same staff are working with the same residents. There is also less need to rely on agency staff, who are unfamiliar with resident routines. Early signs show that culture change pays off in attracting and retaining quality workers, who will be needed more than ever in coming years.
While Fitzpatrick sees definite progress in transforming the institutional structure at Springbrook, he acknowledges that much more needs to be done.
“This is about taking some baby steps back to an emphasis on compassion, and providing a homelike environment where people want to live and work.”
Gail Geraghty, a Norway resident, is a freelance writer contracted by the Muskie School to provide public awareness about the LEADS Project in Maine.
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