Destination: Person Directed Care in Iowa

Presented in cooperation with the Iowa Person Directed Care Coalition

“Empowering Iowans to direct their lives and care wherever they live”

Objectives

• Define differences between staff-directed culture and a person-directed culture

• Discuss the differences in philosophies and care practices based on the approach

Holistic Approach to Transformational Change (HATCh)

IPDCC: Moving Iowa Toward Person Directed Care

Individual determines own schedules, activities meals and caregivers.

Individual is offered more choices, often including when to wake, eat and bathe. Surroundings are more like home.

Individual’s input is sought and some preferences are applied. Environment in common areas is more inviting.

Schedules and routines are dictated by the facility. Surroundings are drab and uninviting.

Waking to Change

The Journey

• Waking

• Eating/dining

• Bathing

• Night time cares/assistance

• Consistent assignments

Waking

Traditional Culture

• No knowledge or implementing of preferences

• Time up determined by staff convenience – some up at 6:00am to “help” day shift

• All staff come on at same time

• Everyone up for breakfast

• Care is routine, rushed

Transformed Culture

• Staff know residents’ preferences

• Residents wake up on own schedule

• Staff “shifts” adjusted to residents’ needs

• Breakfast on demand

• Morning care is individualized and more relaxed

• Staff do own scheduling based on residents’ needs

Eating/ Dining

Traditional Culture• No choice• Served on trays• Plastic dishware• “Feeders” • Staff talk around residents• Large dining rooms• Lots of special diets• Lots of wasted food and

weight loss • Boring snacks and no access

Transformed Culture• Residents’ have choice of

what and when (menu, buffet, family style)

• China dishes• Staff interact with residents• Smaller dining/cooking areas

in the household• Liberalized diets• Less food waste, more

weight gain• Interesting snacks and 24

hour access

Bathing

Traditional Culture• A task to be done on a body• Routine set up for convenience

of staff• Twice a week whether you like

it, need it, want it• No choice of type or time• Staff feel forced• Resident feels forced• Damages relationship• May cause combativeness and

injury to resident and staff

Transformed Culture

• A pleasant or tolerable experience in context of a relationship

• Choice and input about how, how often and when is it done

• Preserves and enhances relationships

• Redefine what “bathing” means

• Creates a relaxed experience

Night Time Care/Assistance

Traditional Culture

• People are to sleep through the night

• Staff make rounds and turn and change every 2 hours

• Staff turn on lights, talk

• Complete flip side to side

• Plastic mattress and pillow

• Thin gown and blankets

• All incontinence and skin care the same

• Medicate with sleep medication

Transformed Culture• If people are not sleepy, they may

want and need to get up • If they awaken frequently, need to

assess if there is unmet need • Reposition only as much as necessary • Enter quietly with low light• Individualize the bed and sleep

environment for comfort• Incontinence and skin care is

individualized • Don’t awaken them for care unless

there is a compelling health reason to do so

• More likely to medicate for pain than for sleep

Consistent Assignments

Traditional Culture

• Nurses make assignments without input from residents or staff

• Staff rotate from unit to unit

• Staff stay on same unit but still rotate every 1-2 weeks

• Staff rotate from assignment to assignment every month

• Set shifts

• Set jobs.

Transformed Culture• Staff and eventually the residents

choose with whom they will work, based on existing relationships

• Staff works with same group of residents at all times and coordinate with fill-in people

• Changes are made only at resident, staff or perhaps family’s request

• All shifts have consistent assignments

• Dietary, housekeeping consistently assigned

• Crossed trained staff can meet resident’s needs and wishes

Web Site

Iowa Person Directed Care Coalitionwww.iowapersondirectedcarecoaltion.org

See our website for more valuable resources and websites.

IPDCC Steering Committee

• ACBM Corporation• Continuum Health Care Services• Des Moines Area Community College• Iowa CareGivers Association• Iowa Department of Inspections & Appeals• Iowa Health Care Association• Iowa Veterans Home• Leading Age Iowa • Office of the State Long-Term Care Ombudsman• Telligen (formally the IFMC)

Questions?

This material was prepared by the Iowa Foundation for Medical Care, the Medicare Quality Improvement Organization for Iowa, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.

8SoW-IA-PPT-NH-4/08-025a