The nurse managing the Dementia Care neighborhood describes how adjusting their care to the resident's routine reduced his agitated behaviors and their use of antipsychotic medications.
This video was produced as part of an initiative by the Pioneer Network, Engaging Staff in Individualizing Care.
An administrator, a DoN, front-line staff, and a resident describe how everyone looks forward to their meals now that they are decentralized and individualized. They've improved care, reduced plate waste and use of supplements!
This video was produced as part of an initiative by the Pioneer Network, Engaging Staff in Individualizing Care.
An administrator describes how her team gets to know residents and makes them comfortable during that crucial first 24 hours.
This video was produced as part of an initiative by the Pioneer Network, Engaging Staff in Individualizing Care.
A nursing home administrator and a CNA describe the why and how of individualizing morning routines through "gentle awakening."
This video was produced as part of an initiative by the Pioneer Network, Engaging Staff in Individualizing Care.
Here how the team from a New Orleans area nursing home learned how to prevent use of antipsychotic medications by tracking and trending to understand what residents' behaviors mean.
Engaging Staff in Individualizing Care
Read More“Each facility must provide care and services to attain or maintain the highest practicable physical, mental and psycho-social well-being of each resident.”
When we go by the normal rhythms of a resident, individualizing their care, we support their experience of being at home. When we don’t, we induce agitation and despair, without ever intending to.
We wake people out of a sound sleep in the morning so that we can get them to breakfast at a set time. We shower people on the facility’s schedule, not according to their own routines. We even have people go to the bathroom based on when we’ve determined it’s time for them to go. A woman on her second day living in a nursing home told Carter Williams, “You haven’t lived til you’ve gone to the bathroom on someone else’s schedule.”
While institutional care may seem efficient, it really isn’t. Homes that have individualized their care have found that they actually have more time, and better quality time, with residents. Instead of a rush hour getting everyone up, washed, dressed, and transported to the dining room where they fall back to sleep waiting for their food trays to come, staff at homes that have gone to having people awaken of their own accord, find that they actually have more time to help each resident start their day.
MaineGeneral Rehab and Nursing Care at Glenridge, Augusta, ME
Their journey was chronicled in Culture Change in Long-Term Care: A Case Study, created by the American Health Quality Foundation to guide Quality Improvement Organizations and nursing homes interested in using a quality improvement approach to individualizing care and initiating culture change. Funding for this film was provided by The Commonwealth Foundation and Quality Partners of Rhode Island. B&F Consulting guided the production of this film as a model for an effective change process that starts with nursing, and relies on inclusive and empowering leadership.
St. Camillus Health Center, Whitinsville, MA
St. Camillus Health Center has been on its culture change journey for about 5 years. In From Institutional to Individualized Care, Sandy Godfrey, Director of Nursing, describes their process of working through issues with staff and residents. Staff initiated the decision to begin consistent assignments as a way to know residents’ individual routines. Nurses monitored issues such as weight loss to ensure no negative outcomes. Administration talked through changes with families. The process was successful, and a building block to further efforts to individualize care.
Both nursing homes used very systematic, interdisciplinary, and inclusive processes to make their changes.
This excerpt offers guidance on low cost changes to the physical environment that can help residents be more at home, whether their stay is short or long term. It draws from the research of Judith Carboni, a nurse gerontologist, who saw alarming parallels between the experience of homeless people on the streets of Boston and the experience of people living in nursing homes in 1987.
She documented the “psychic despair” among nursing home residents who felt a sense of displacement in their physical environment. This clip describes her research and uses pictures of residents’ bedrooms, dining methods, shower rooms, and common areas, to demonstrate the range of ways the physical environment can support residents in being at home.
This video clip features surveys from Rhode Island’s Department of Health, speaking about their experience in the Individualized Care Pilot, funded by The Commonwealth Foundation. They heightened their attention to residents’ choices about waking and going to bed, eating, and bathing.
These ideas developed for Rhode Island’s nursing homes were a collaborative effort from Quality Partners of Rhode Island, along with B&F Consulting, and the RI Department of Health. These ideas provide guidance for:
Consistent Assignment
Dining
Individual Choice
Pleasant Bathing
Waking & Sleeping
A Case Study from MaineGeneral Rehabilitation & Nursing Care at Glenridge
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