Creating Households. Struggles and Successes 4 Years In: Renovation and Change

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2 Creating Households Struggles and Successes 4 Years In: Renovation and Change The intent is to help you learn from our successes, struggles, and processes.

3 Presbyterian Homes Inc.

4 History 1993 All Private Rooms Medical Model/Hospital

5 Glenaire Over time Glenaire added more beds in the Health Center. Large nurses stations right in the middle Bustling/Busy hallways Does any of this look or sound familiar?

6 Culture Change 2011 Glenaire embarked on the journey of Culture Change. Household Model- Action Pact 20 Room Houses, Kitchen-Dining Room Center of the House A system that promotes resident engagement and choice. Emphasize Person Centered Care

7 Glenaire Bottom Line- Changing Culture doesn t happen over night. Operational, Nursing, Architectural, and Physical Plant/Construction input Question Where do we start??????

8 Should we embark on culture change? What model? Rebuild or renovate? Pros cons

9 Prepare for Change Don t overlook the importance of preparing your organization Are we ready/do we have capacity for change Define the vision- design goals, org goals Build a strong coalition Craft a change message Communicate, communicate, communicate Educate, educate, educate

10 Why does change fail or fall short? Most change management programs initiated by leaders in organizations fail.... They fail fundamentally because it is conceived as an outside-in process, moving about parts of the organization, rather than an inside-out process which focuses on change within individuals. - Kotter

11 Our Defined Vision & Goals Break the nursing center into households Understand the needs and desires of the people in each home Make those preferences the highest priority Re-think operational systems and architecture Re-think staff roles and functions

12 Craft a change message Clarify the current vs the desired state. Define what could be improved and why change is needed. Must be compelling Convince people that the change can be successful This is the right change There is support from the highest levels Address the question: What about me?

13 Create a Powerful Coalition Senior management throughout Middle management CNA s Nurses Housekeepers Dietary Aides Visits

14 Set short-term goals Eat an elephant one bite at a time Establish new leadership structures and developing new leaders Do away with tray line, implement more choice at point of service Household scheduling

15 Empower broad-based actions Create action teams Involve people that actually do the work involved

16 The Result Everyone understood the need to change and the opportunity Everyone understood what we were doing/where we were headed There was clear evidence that this can work and work well. It can deliver the results we want. Everyone knew that this was not a passing phase. This was happening People were excited and eager

17 What was our change message? Medical model is limiting and in some aspects harmful There is a new way. Its radical. It does work. It can work here. We can improve the lives of the people we serve. Our vision New organizational structure, explained Privacy- no more walking by rooms Deinstitutionalize More choice dining, bathing, medications, etc. Elements of home

18 GLENAIRE HEALTH CENTER RENOVATION Architectural Changes

19 Glenaire

20 Main Building ASSISTED LIVING INDEPENDENT LIVING APARTMENTS COMMUNITY CENTER HEALTH CARE INDEPENDENT LIVING APARTMENTS

21 Health Care Center 20 SNF 11 SNF 40 MUAHS (20 PER FLOOR) 20 SNF 9 AL COMMON/SERVICES COMMON/SERVICES 20 SNF

22 Health Care Center Dining 20 SNF 11 SNF 40 MUAHS (20 PER FLOOR) 20 SNF 9 AL SATELLITE KITCHEN TO MAIN KITCHEN 20 SNF DINING LOCATIONS

23 HOUSEHOLD RENOVATION

24 The New Households North East Central South

25 Existing Household Core

26 Typical Core Renovation Pantry Open Kitchen Living/Dining Charting Activity Room

27 Front Door

28 Nurses Station Before After

29 Nurses Station Before After

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33 Kitchens Back of House Front of House

34 Dining Before After

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37 Bathing Before After

38 Bathing Before After

39 Medications Before After

40 Resident Room Before After

41 Resident Bathroom Before After

42 HOUSEHOLD PRIVACY CHALLENGES AND SOLUTIONS

43 Health Care Center 20 SNF 40 MUAHS (20 PER FLOOR) 20 SNF 20 AL COMMON COMMON 20 SNF PRIVACY PROBLEM AREAS

44 Bypass Corridors New Rooms Bypass Corridors Offices

45 Bypass Corridor 1 Offices Bypass Corridor

46 Bypass #1 Before After

47 Bypass #2 Bypass Corridor 20

48 Bypass #2

49 THE TOWN SQUARE

50 Lobby Area Existing Plan

51 Town Square Activity Room Therapy Room Salon

52 Building Challenges Determine how to Phase the Renovation Minimize # of Rooms out of Service Optimize the Schedule

53 GLENAIRE HEALTH CENTER RENOVATION Building Challenges

54 Building Challenges Develop Phasing Plan Taking into account Interim Life Safety Measures Maintaining Clear Paths of Egress Isolate Dust & Noise with Barriers Investigate, Plan & Communicate for Temporary Loss of Services

55 Phasing Plan

56 Phasing Plan Overlay by Household Phase

57 Building Challenges Working in an Occupied Facility Working in someone s home! Being sensitive to work hours

58 Building Challenges Dealing with Existing Conditions Precon Recon!

59 Building Challenges With a Household complete, what s next?!

60 IMPLEMENTING THE HOUSEHOLD MODEL

61 Traditional Organization Charts Top Down Silo d Restrictive Promotes stay in your lane thinking

62 HEALTH SERVICES AT GLENAIRE CENTRAL HOUSE Residents, Families Nurse Mentor Household Coordinator Household Nurses Caregivers Homemakers NORTH HOUSE Residents, Families Nurse Mentor Household Coordinator Household Nurses Caregivers Homemakers The Glenaire Clinic SOUTH HOUSE Residents, Families Nurse Mentor Household Coordinator Household Nurses Caregivers Homemakers COMMUNITY COUNCIL Nurse Mentors, Household Coordinators, Social Work Mentors, Staff Development Coordinator Dining Mentor, Life Enrichment Mentor, Environmental Services Mentor, Director of Nursing, and Administrator SERVICE TEAMS THERAPY SERVICES DINING SERVICE ENV L SERVICES SOCIAL WORK LIFE ENRICHMENT MAINTENANCE CENTRAL SUPPLY MEDICAL RECORDS ADMIN. SERVICES encompass WELLNESS EAST HOUSE Residents, Families Nurse Mentor Household Coordinator Household Nurses Caregivers Homemakers ASSISTED LIVING Residents, Families Nurse Mentor Social Worker Life Enrichment Coordinator Household Nurses Lead Caregiver, Caregivers Dining and EVS staff The Glade Adult Day Program

63 3 Main Objectives Reframing the organization Increasing choice (renewing the spirit) Re-thinking systems

64 Reframing Leadership Roles Nurse mentors Household Coordinators Homemakers Job Descriptions Steering Committee Action Teams

65 Increased Choice Dietary Changes Medication Administration Changes Changes in "routine" schedules such as showers, sleep (am wake times and pm bedtimes), meal times Activities

66 Dietary Changes

67 Old Way Menus completed 7-14 Days In Advance Very little real choice No sights and smells of home Institutional

68 New way

69 New Way- Flexibility and Elements of Home Choice of entrée in real time Ability to cook to order- range, sandwich Cook a meal in the house Smells of home Particularly breakfast

70 Increased Choice Dietary Changes Medication Administration Changes Changes in "routine" schedules such as showers, sleep, meal times Activities

71 Activities One Household Coordinator is the activities mentor But everyone does activities Training Whiteboards- big calendar but also household specific activities

72 Activities Pics Training Whiteboards- big calemndar but also household specific expecations

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75 Nursing "System" Changes Goal: Self-led teams and localized decisionmaking Household Budgets Household Scheduling MDS Completion Care Plan Process

76 Language Systems and Physical Plant changes are not the only important factors in Person Centered/Resident Directed care. Language enforces the "internal" change and dedication to creating/making the skilled facility a true home.

77 Life Happens Electronic Health records implementation New HRIS/Payroll/timekeeping system Staff changes

78 Questions