This second part of Steve Moran’s interview with me on person centered care for his blog, seniorhousingforum.net, originally appeared on January 12, 2014.
You can read part one of this interview here.
As you know, a number of months ago, in an article I wrote about the nursing home industry, I made this statement: “Nursing Homes Suck” which got me in trouble with some people. What was your reaction to that statement and that article?
My initial reaction to that statement was that it hurt. As a former administrator, I know how hard people in nursing homes work. But I agree with your point that most nursing homes operate by getting through a checklist of tasks. When direct-care staff work as taskmasters, residents don’t have many choices or opportunities for meaningful lives.
There’s often a disconnect between what the leadership team thinks is happening and what actually is happening. For example: If your policy states that residents may sleep whenever they’d like like, but you don’t have systems to support that (or supervisors to help make that a reality), it won’t happen.
If I’m a nursing assistant and there’s no easy way to get a resident a late breakfast and my co-workers or supervisor will give me grief for letting someone sleep late, guess what’s going to happen? I’m going to wake that resident up, even if he wants to sleep in.
What are you doing to make the resident experience better for individuals living in skilled nursing and assisted living?
I speak to associations and groups to inspire them to think about their work differently. I share stories to help them visualize what is happening in their organization that they’re probably not even aware of, and how it can be different.
I also support individual organizations through leadership and staff development. I help them to determine the exact steps that will engage staff and support residents. Steps that are right for their unique situation, because although we can learn plenty from other organizations, each organization needs to follow their own path to person-centered care.
If someone took a hard look at their organization and felt they needed to make a change, how would you suggest they start?
I often tell people to start by looking in the mirror. If you’re seeing an outcome in your organization that you’re unhappy with and want to change, take a look and ask: What are we doing (intentionally or not) to support that outcome?
For example, earlier we talked about staff being “taskmasters.” Often when staff members start their jobs, they’re given a list of tasks. They’re evaluated annually based on a list of tasks, and their supervisors hold them accountable to….you guessed it…a list of tasks. Why, then, are we so shocked when people won’t step outside of their tasks?
There are plenty of free resources online that you can use as well. On my website, I have links to a few that I’ve had the honor of helping to create. These tools can help you assess where you are and give you ideas on next steps to take.
Is it possible to do person-centered care and still make money?
Person-centered care can actually make you more money. It creates an engaged workforce, which is proven to increase productivity. It also decreases turnover and its related costs. Engaged staff create a better experience for customers (patients, residents, and family members) who then tell their friends in the community. Referral sources hear these stories. Research shows that person-centered care communities have higher censuses, greater revenues, and better clinical outcomes.
One myth about person-centered care is that it requires a lot of money and huge environmental changes. That’s simply not true. It’s certainly ideal to make some renovations, but I’ve seen incredible changes in organizations that were focused first on renovating the systems, processes, and thoughts that stood in the way of change.
One of my favorite stories is of a CNA who identified a resident who was very unsteady after taking a certain medication. The CNA took it upon herself to tell the nurse. The reply? “What are you, the doctor?” The CNA felt so belittled that she vowed never to tell that nurse anything again.
Those five little words create a disengaged employee. If she’d felt comfortable sharing, who knows what could’ve happened? Maybe a fall could have been prevented, saving paperwork and more staff time (not to mention the resident’s health!). Maybe a readmission could’ve been avoided, which damages our reputation with the local hospital.
In the organizations I love to support, the first priority is and will always be the resident’s well-being.
That’s what person-centered care is all about.