Change in Delivery of Care!

[michael79]

I currently work as a supervisor at an ALF. My boss recently approached me and asked if I would like to take on the position of director of our memory care unit. It is a 30 bed unit with residents that have some form of dementia or Alzheimer's. I happily agreed as this is my favorite population to work with. Then we had a meeting with an Alzheimer's consultant. She went over her plan for a revision in the delivery of care. It is a huge change from the way our staff currently conducts care delivery. A few examples, it would all be resident centered care such as letting the resident wake up when they want to as opposed to getting them up at a certain time to be in the dining room for meals. Decreasing CNA ratios to 4:1 as opposed to 6:1 to allow more time to allow the residents to independently do as much as possible. And the biggie is having the CNA's actively participate in the activity program. They are to be engaging the residents and treating them like a friend or companion. Currently they are only civil and have slim to no participation in their daily activities other than toileting, feeding, dressing, etc. I think most of these changes are great. Unfortunately, I think the aspiratations are a little grandiose. HOw do you change an entire culture of a uni?. We have some CNA's that have been there forever and are not going to change any time soon. THey are going to see having 4 residents as a dream and continue to do a full assist when the resident can be independent. It just takes more time. Also, they are only going to increase my salary from $39,200 to $40K. I think that it deserves more to take on such a huge responsibility. What do you think about any or all of this? Thanks and sorry so long!

[CapeCodMermaid, RN]

Culture change is coming no matter where you work. There are several LTCs where the CNAs participate with the activities department. MY CNAs would think they were in heaven to have 4 residents...they usually have 10. I'd caution the encouragement of having the CNAs be friends with the residents. They are NOT their friends nor are they their family. They are caregivers and once that line is crossed there are usually problems. I have n ever worked in an ALF so I can't really comment on the salary.

[ltcconsultant]

The thought of having to change a unit's culture is scary. I've got some good stuff on culture change via implementing resident centered care that you would probably find to be very helpful. Drop me an email and I'll send it to you. My gut instinct is that the CNAs may not have as hard of a time adjusting as you think. I imagine that they will relish the idea of being able to meet the resident's psychosocial needs as well as the physical ones. I agree with capecodmermaid that there needs to be boundaries set.

[eldragon]

I always heard that Alzheimers patients need a strict routine for meals, bedstime, etc?

Is that not the case?

[ltcconsultant]

With any sort of dementia, it is helpful to have some sort of routine. It works better if the person's usual routine (the one they followed at home) is continued on in some way after they are admitted to a nursing home.

[Baelyll]

I think this sounds so ideal. The only thing I would be concerned about are mealtimes. If the patients all got up at different times I would not be able to ensure they all ate properly. I have problems with weight loss now on my unit. But if the staffing ratio was 4:1 maybe it wouldn't be a problem.

Actually 6:1 sounds good to me. Right now we are working with one 4 Cna's and 2 nurses on my unit. On really really good days we have 5 CNA's. We have 60 Alz/Dementia patients.

Where do you work?? It sounds awesome to me.

[MedicalLPN, LPN]

I'd caution the encouragement of having the CNAs be friends with the residents.

That's exactly what I was thinking, in my opinion you have to keep the relationship strictly cargiver/patient, if goes beyond that you're just asking for problems.

[KrisMis]

I think this sounds wonderful! I moved to our Alzheimer unit a year ago and implemented on my shift many of the changes you mention. The morning shift was already doing it, but the evening shift was not.

I had one CNA who was reluctant to assist with activities. (She had managed to not do them with all of the other nurses that had been on this shift before.) She did come around & will often do something to engage the residents in an impromptu activity, even if it is just a sing a long.

As far as residents getting up at different times for meals we had several options-Save their plate & warm it up in the microwave, keep a stock of snacks & sandwich making foods, cereals, juices, soups, etc. so that staff could make a meal for them later, or have the kitchen wait to prepare their meal until they were ready to eat.

I hope this helps. Change isn't easy but it is very doable & our unit was a lot more fun & relaxed after these changes were implemented.

KrisMis