Purposeful Interactions

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1 Our Culture Change Journey Relationships are not only the heart of long-term care; they are the heart of life. And life should continue, wherever we live. - Carter Catlett Williams Seniors Health and Continuing Care - Saskatoon

2 Objectives What are Purposeful Interactions? How are Purposeful Interactions different? Importance of the Observation experience Culture change journey Living by the Platinum Rule Overcoming challenges/evaluating outcomes

3 Music Video She calls me Raymond By Brett Eldredge Video

4 Why we are here

5 Long-term care is full of wonderful, loving staff. It is the system that is broken. - Dr. Bill Thomas Founder of the Eden Alternative

6 I did what I knew at the time, when I knew better, I did better. -Maya Angelou

7 What are Purposeful Interactions? Making connections with each resident Focus on connections and relationships versus tasks [Care team members] go about doing their job [focused] to get the work done, and don t realize that interaction is part of their job. - Ken Udell, Resident

8 What are Purposeful Interactions? Regularly checking on resident s needs Providing better than expected care The more knowledge that the staff has about me, as a person with a life history and experiences, can only translate into better care for us as residents. -Don Barrett, Resident

9 How is this different? Care team members may already interact regularly with residents while meeting their care needs The intention of Purposeful Interactions is to anticipate and individualize the response to the resident s needs

10 Resident-Directed Care Places maximum possible decision making into the hands of the residents. This means that residents direct their own care. Relationships and choice are of greatest value. Occurs when care team members encourage independence and support residents to participate in decisions affecting their environment; their home. Is based on: - Communication - Privacy - Respect - Autonomy - Choice - Flexibility - Independence - Security

11 Honouring Choices Not all residents are capable of communicating their needs. We need to become good detectives to try to determine what unmet needs the person is trying to communicate. Care teams must commit to know each resident and their unique needs. Respect their individuality and honour their choices.

12 Care Team Commitment Acknowledge Resident Rights & Responsibilities Commit to resident-directed care and demonstrate that commitment in day to day work. We should all know the three plagues of long-term care I believe [care team members] are very effective in combating these plagues. The problem is it is different everywhere Matt Proctor, Resident Loneliness Helplessness Boredom

13 What do Purposeful Interactions look like? Words make worlds The words that we use influence how we think and how we think influences how we act - Denise Hyde

14 I would like to say that living in long term care can be an enriching and fulfilling experience, it can also have its low periods and everything in between for many. I want you all to know that you are important and fundamental to the health and happiness of your residents You can make the changes and choose to be a blessing in other people s lives. I am not saying it is easy, for some it may be very difficult, but it is possible. You can make a difference. - Matt Proctor, Resident Photographs Courtesy of Rona Andreas

15 Observation Experiences & Reflections It was good to sit back and watch, and observe how much we do good in our home, and what we need to improve, opened my eyes, will help me be a better care aide. I thought the observation time to be long until we discussed it later and realized that time was needed to do proper observation. The whole experience was an eyeopener for me. I was amazed at how different the view of observer was compared to being a worker. I liked the observations; it was surprising to learn how some residents had no contact for over an hour. Participants, Purposeful Interactions, Lakeview Pioneer Lodge, Wakaw, Saskatchewan

16 What is Institutionalization? When someone in a position of power has control of your day-to-day life we need to abandon the institutional model which focuses on staff schedules, tasks, and scarcity we need to instead create a human habitat in place of the institution where the focus is always on the relationship with each resident, schedules are based on each resident s individual schedule/needs/choices, and focus is on abundance, not scarcity. Through the development of meaningful relationships residents feel safe and secure. -Robin Kitchen, Sherbrooke Community Centre Manager for Learning and Growth

17 What is our Current Culture? What are we doing well? What are our missed opportunities for making connections with residents? What is stopping us from doing this? What improves the experience of work life for care team members? How do we know residents are experiencing interactions in a positive way?

18 Who are we doing things for and what is best for?

19 How to Implement Purposeful Interactions Four P s: Positioning Personal Needs Pain Proximity of Personal Items

20 What do Purposeful Interactions look like? Smile Observe Interact Closing Interaction

21 Living by the Platinum Rule Treat others how they would like to be treated The Platinum Rule means we need to ask, listen, and deliver care that is guided by each individual resident s needs and preferences

22 Identified Actions Right Now Homes immediately began modelling and mentoring quality interactions, seizing every opportunity. Immediate positive feedback to staff recognizing and appreciating caring connections and individualized care in the moment. Soon Examining bathing, individualized time to awaken/retire, explore options for meal wait times, and practice customer service principles. After Research and Planning Improvements to the welcoming process for new residents, implementation of relaxed breakfast and flexibility around shift expectations.

23 Barriers & Challenges Resistance to change Rigid schedules and routines Informal culture Peer pressure Focus on task vs relationship Engrained within the institutional model of care Availability of resources

24 Keys to Success Engaged Leadership Educated care team members Initial and continued involvement of Residents/Families Self awareness of the home s current culture and actions for improvements Concrete actions to address barriers/challenges

25 Evaluation- Antipsychotic Use 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Manitou Lodge Antipsychotics Provincial Average Manitou Lodge Target LAUNCH FEB 2017 FY 15- FY 15- FY 15- FY 15- FY 16- FY 16- FY 16- FY 16- FY 17- FY 17- FY Q1 16 Q2 16 Q3 16 Q4 17 Q1 17 Q2 17 Q3 17 Q4 18 Q1 18 Q2 18 Q3

26 Evaluation- Antipsychotic Use Mennonite Nursing Home Antipsychotics Provincial Average Mennonite Nursing Home Target 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% FY Q1 FY Q2 FY Q3 FY Q4 LAUNCH MAY 2016 FY Q1 FY Q2 FY Q3 FY Q4 FY Q1 FY Q2 FY Q3

27 Evaluation- Bladder Continence 35% 30% 25% 20% 15% 10% 5% 0% Quill Plains Centennial Lodge Bladder Continence Worsened Provincial Average Quill Plains Centennial Lodge Target LAUNCH OCTOBER 2016 FY 15-FY 15-FY 15-FY 15-FY 16-FY 16-FY 16-FY 16-FY 17-FY 17-FY Q1 16 Q2 16 Q3 16 Q4 17 Q1 17 Q2 17 Q3 17 Q4 18 Q1 18 Q2 18 Q3

28 Evaluation- Bladder Continence 35% 30% 25% 20% 15% 10% 5% 0% FY Q1 FY Q2 Samaritan Place Bladder Continence Worsened Provincial Average Samaritan Place Target FY Q3 FY Q4 LAUNCH MAY 2016 FY Q1 FY Q2 FY Q3 FY Q4 FY Q1 FY Q2 FY Q3

29 Positive Experiences There has been a significant change in the culture. I do notice a big change in that I see staff speaking with residents, and it makes me feel good to know they are engaging my mom even though she may not be completely aware. As family, it takes some of the sadness away for us. Human touch and voice are so integral as people go deeper and deeper into dementia. - Roxane Grambo, LTCAC Family Advisor

30 How are we sustaining Purposeful Interactions?

31 Contact Information & Resources Lynda Blevins, RN, BN Supportive Care Projects Coordinator Seniors Health & Continuing Care Saskatoon Saskatchewan Health Authority I Lynda.Blevins@saskhealthauthority.ca Jan Berger, RN, BSN Supportive Care Projects Coordinator Seniors Health and Continuing Care Humboldt Saskatchewan Health Authority Jan.Berger@saskhealthauthority.ca

32 Thank You A resident noticed more of the care team members taking time during meals to assist our residents and they really are engaging with them. It feels more like a normal meal, like with family, than care teams performing a task. -Parkridge Centre