Resident Centered Care

nightmare, RN · Jul 22, 2009

Their own pictures and possessions in the room. Coloured bedlinen and even painting the walls different colours in the rooms.

Long Term Care Columnist / Guide · Jul 22, 2009

Allowing residents to eat and sleep according to their own preferred schedules, not facility convenience. Pets. Plants. Carpeting. Their own furniture. Staff in street clothes instead of scrubs. All of which de-medicalize the setting and make it more homelike, which is a lot of what culture change is about. :heartbeat

ktwlpn, LPN · Jul 22, 2009

Allowing residents to eat and sleep according to their own preferred schedules,:heartbeat

How does this work? Do have buffets for a few hours at each meal time? We don't even have table linens..

husker_rn, RN · Jul 22, 2009

Check out info on the Eden Alternative. Worked at a facility that espoused this and I loved it.

Trishalishus, PhD, CNS · Jul 23, 2009

We started using the Eden Alternative at the LTC where I work.

The staff grew to love it (everyone hates change to start with) so much that it is hard to get them to do shifts in areas which aren't "home" to them. On the plus side, the EA methodology/philosophy - which is totally resident-centred - is brilliant, just superb. Individuals remain individuals for longer and staff grow so fond of the residents in their area that I think the residents receive better care (from the perspectives of emotional commitment from staff; because it is easier to tell if something is wrong/going wrong when you know someone well; and because residents feel happier and have more certitude - sinnce they know exactly what they can expect per shift). I give the method 100%

On the negative (?) side - implementation involves big changes - in practical terms and in the psychology of residents and staff (although, if you have a good corporate culture I imagine it would be FUN). Staffing can become a bit of a problem - you may end up having to get really tough when you're short-staffed, in getting people to swap out of "their" area. Staff cliques can form - whereby some staff start to (maybe even unconsciously) rort the system - they get themselves into such a comfortable place they take short cuts and stop noticing things about their residents that strangers can see (eg a gradual deterioration can be missed); they can also become "uberpowerful" and scary to other staff members who venture into their little kingdoms.

I could go on and on.

Good luck

bluegeegoo2, LPN · Jul 25, 2009

My facility does the resident centered care thing, and it's a far better place to work than the "regular" LTC type facilities for a variety of reasons: There are no "get up" lists for 3rds, so no resident is stuck having to get up at 5 AM every day. Instead, I (3rd shift nurse) have my 2 aides pick 3 people each that are willing to get up early every day, allowing the others to sleep in. Our breakfast time runs from 7-9a, so residents can mosey on down to breakfast when the feel like it. They still have the option of having meals served in their rooms, of course. The aides act as servers, and literally take orders. We have everything from sweet rolls to grits to biscuits and gravy available. Name a drink for breakfast. We have it. Lunch and supper are done a bit differently, more like a hospital where you circle from a group of choices what you want for the next day. Meal time is from 11-1p, and supper is from 4-6p. Anyway, upon admission, one of our (many) papers to fill out is a "resident preference" list, that asks questions like: When do you prefer to get up in the morning? Do you take a nap? When? How long? Do you shower daily? What time? etc. That way, we can tailor our care to what they prefer by adding their preference info on the aides care sheet. Naturally, we can't cater to every whim and fancy, but the residents here seem way more relaxed and happy than at other facilities I've worked for. Good luck with your endeavor. It's worth it in the long run.

CapeCodMermaid, RN · Jul 26, 2009

I understand the theory behind resident centered care...the facility is home...you should have choices about when to get up, when to eat and the like. BUT I have a hard time reconciling this with the sometimes complex medical needs of many of the residents especially on a subacute unit. It's hard to care about what time Mary wants to play BINGO when her room mate Gladys is going into flash CHF or the guy down the hall appears to be throwing a clot. Perhaps segregating residents/patients according to their length of stay (short term vs. long) is the only way this will really work.

bluegeegoo2, LPN · Jul 28, 2009

I understand the theory behind resident centered care...the facility is home...you should have choices about when to get up, when to eat and the like. BUT I have a hard time reconciling this with the sometimes complex medical needs of many of the residents especially on a subacute unit. It's hard to care about what time Mary wants to play BINGO when her room mate Gladys is going into flash CHF or the guy down the hall appears to be throwing a clot. Perhaps segregating residents/patients according to their length of stay (short term vs. long) is the only way this will really work.

My facility does, to a point. We have the "walkie-talkie" rehab unit, 2 assisted living units, and the "not-so-walkie-talkie" long term care/rehab unit. The AL residents do as they please, when they please, and the others are offered opportunities to participate in activities. It's very much like a traditional LTC facility, but the ambience is much more relaxing. One thing I find rather disturbing, however, is when we get a new admit, we have a list of facility diet orders we are to get the MD to sign off on. Simply put, regardless of the diet they are admitted with, we are to get it changed to "regular". Period. Which means the brittle diabetic can have all of the cherry cheesecake she wants. The Na+ restricted resident can have a salt lick if he so fancies. All in the name of "resident centered care". "If the resident wants, the resident gets", is not the very best environment for being a nurse. I try to dissuade the diabetic's away from sweets, and get warned that I'm "violating the residents rights". Hell with it. Here's a tub of Ben & Jerry's. I'll be waiting over here with the Novolog...

missyd1991 · Jul 30, 2009

I work in a Eden Alternative home and we have been and are still going through the growing pains but it really does make a difference. You will always have staff that wont buy into what you are tryning to accomplish and others that will use it as a crutch. I am of the mind that there should be a happy medium between medicl model and home model. Our residents are here because they could no longer care for themselves at home or their family's could no longer care for them. I don't think this should be looked at in a bad way. I love longterm care and I'm glad the home I work where I do. We started slowly with fixing up our tubrooms to be more home like, then we went to a buffet on Thursdays that our residents pick the menus, we now have 2 cats and 1 dog. We have several birds and a fish tank. The residents have family pics in room, some who were artists have pics hung in our dining room. It doesn't take much to start change and we were told you will never be finished with change because there will be some other area that can be improved. So embrace the changes and remeber to support one another along your journey and good luck! :yeah:

Dixiecup · Aug 1, 2009

We moved our nurses station out of the middle of the lobby into a enclosed room so visitors can't see it when they first walk in.

calypte · Aug 1, 2009

I'm a student and I've been doing a practicum in a really wonderful LTC facility that bases its philosophy in part on the Eden Alternative. A few things that really stood out for me:

- as has been mentioned previously, residents are allowed to wake and eat on their own time. For most people this is between 0800 and 0900, so it's not as demanding in terms of shifts in the dining room as one might expect. For the few that like to wake early or sleep in, it seems to significantly enhance comfort, and makes the dining room overall less chaotic

- instead of a set menu, residents in the dining room are offered a selection of food choices in steam trays that rotates through the dining room on a cart. There is a fruit and beverage cart that makes rounds as well... I think the moving bev cart is a great idea because I've often found those items on carts in the first place! For many residents, visual choice is easier to comprehend than a list of options, and people are not forced to eat overly large portions or foods they don't enjoy. I have found so far that residents are more likely to choose beverages other than or in addition to coffee/tea if they see the choices. The fruit is display with a cutting board, so that people can choose just a little fruit instead of "the whole thing"... for some tiny ladies this is more appropriate and ensures that they actually have some fruit :)

- residents have a locked glass display case outside their rooms to display photos, precious objects, medals, etc... i think this is wonderful because one is reminded immediately that there is a complex person behind every door, one who is very unique... I've seen variations of this with a photo display on doors as well. Many people have photos of themselves as young adults which is really fascinating...

- instead of storing small pieces of medical equipment or supplies in obvious places in resident's rooms, things are placed in cupboards or left on the linen carts. For example, briefs/incontinence pads etc. are not stored in one's bathroom in an obvious way, but are left on the linen carts. Night shift will put out pads/briefs for the resident for the day on the bedside table @ their last round of checks for the am shift to use for the resident before breakfast. People who change their own briefs have them in small cupboards usually brought in by family.

- staff are encouraged to contribute to the home-like environment through their unique talents. One person plays the piano for the residents if they have some downtime (and since the staffing ratio is very appropriate given the residents needs, this is certainly possible). Others have contributed artwork, people bring in fruit + flowers from gardens etc. etc...

- there is a "men's club" and a "ladies club" once a week for residents to socialize in common area... the men who are allowed get a small glass of beer!