Taking Care of Family Being a Partner A Webinar on Culture Change Please read below carefully; these are the directions to access the Webinar. This is how you will get information on signing in to the webinar. Yes, it says to register on GoToWebinar - you ARE registered with DHCC and will NOT be charged again at this site. YOU SHOULD DO THIS NOW. PLEASE, contact me directly with any questions. carlsonmom@mchsi.com Marla Carlson DHCC Executive Director To receive your sign in information needed to access the webinar on 28 April 2011: Please go to the following link: https://www1.gotomeeting.com/register/799084473 Enter your name, phone # and email address. If you have been successful in registering, your unique sign in information will be emailed to you from GoToWebinar. ALL OF THIS MUST BE COMPLETED TO RECEIVE THE INFORMATION AND FOR YOU TO BE ABLE TO ACCESS THE WEBINAR. On the day of the webinar you will be able to listen either through your computer speakers/headphone or telephone If you do not have computer speakers/headphones, a call in number will be provided for your use. NOTE this is NOT a toll free call and charges will apply to the phone being used. Check the times carefully as they will be different depending on where you live and the time zone of your location. When signing in, Please sign in as a participant, NOT as an organizer. Check the times carefully if you have questions on time zones please email carlsonmom@mchsi.com. CPEU Certificate attached with handouts.
Taking Care of Family: Be a Partner Dietitians in Health Care Communities Candace S. Johnson, RD, CSG April 28, 2011 Objectives and Today s Program List of organizations leading the culture change movement Develop a plan to start or to continue culture change in facilities Compare regulations for application in facilities for culture change We will have a fifteen minute question and answer period at the end of the program. The Start of Culture Change CMS Regulations: OBRA 87 requires that each nursing home care for residents in such a manner and in such an environment as will promote maintenance or enhancement of the quality of life of each resident. Provide services and activities to attain or maintain the highest practicable physical, mental and psychosocial well being of each resident in accordance with a written plan of care The Beginning In the early 90 s long term care pioneers started to work to fundamentally change values practices and cultures of organization who care for the elderly. Goal was to change from places to decline and die to living and growing. In 1997 the Pioneer Network was established for the culture change movement. What is Culture Change Transforms the long term care medical model to one that nurtures the human spirit as well as meeting medical needs. It is a work in progress, evolving to meet resident needs May be called person centered care or resident directed care It is about living and working in a home like place Overall View of Culture Change Renews spirits of staff and residents Renovates the home Reframes the organization Starts with a clear vision, shared by all Requires all staff buy in Know Thy Resident PASSION for Resident: Would I live here? 1
Familiar Names for Culture Change Pioneer Network Eden Alternative Wellspring Action Pact State Coalitions for Culture Change Common Words: CHOICE, Dignity, Respect, Self determination: Hear voices, respect words The Right to Folly Goals of Culture Change Resident control over daily living Respect rights of decision making Involve all levels of staff in care process, honor those who work closely with residents Include friends and family in team approach to care Provide a familiar and hospitable environment Provide a supportive workplace Responsive environment for individualized care practices focusing on needs and desires of people Keys Questions What do residents want? What was home to them? Is home like possible here? What do staff need and want? How to Start, how to keep growing If you are new.. Resident interviews, staff education Why Food? Getting involved: It starts with residents and empowerment of their choices Levels of involvement: Operations, physical plant, capital budgets Can you be the active family member? Operations Staff attitudes and values The importance of all staff participation Administration support Selling new roles, new ideas, projects Resident participation and input with staff support Operations Start with an idea, discuss with residents and staff, no idea is wrong or off limits Plan the idea don t linger and don t run Start small and grow with confidence, change what doesn t work after a good trial Evaluate with residents and staff Don t give up, remember PASSION 2
Continuing Operations Check to see if practices are continuing to meet residents needs and preferences Ask residents, family, staff Expand, change as resident and staff populations evolve Look at the whole picture: daily living, schedules, structures, activities Aware of personal and resident safety with quality of life: culture change is about improvement but not to endanger the resident. Ideas for Operations Words: NEVER use feeders, calling persons by their diet, bibs, assisters Names of halls, dining rooms, areas Ask for resident preferred names and staff all know FOOD CHOICES!!!! Menu review and incorporating changes Wake at will, bathing times, personal preferences known by staff, choice of where, when to eat More Ideas Expand meal times, explore openness to food with times, choices, cooked to order Look at community choices, rooms, support individual activities with food Staff choices for meals, schedules, health Children, pets, plants, outings, overnight trips Could your facility to something different? If you are in a new building.. If you have an aging building.. Physical Plant Kitchen layout what can be moved, changed Cooking equipment and placement Venting?? Food storage: Central or smaller areas Dining room changes Alternate dining areas Capital Budget Think ahead, know your budget cycle Discuss ideas with administrator, owner, regional managers, other team members May be physical changes, staffing Discuss with team members, residents If you do not ask, the answer can never be yes 3
Regulations Are general as written Know the intent and interpretation Call and ask if you are unsure Remember, safety first and CMS want resident centered care It is up to the professional to lead and direct Regulatory Compliance F360 Appropriate Dietary Services The facility must provide each resident with a nourishing/palatable/well balanced diet that meet the daily nutritional and special dietary needs of each resident F361 Qualified Dietitian F362 Sufficient Support Personnel More F Tags F363 Menus and Nutrition Adequacy Assure meals served meet nutrition needs Menus are followed A standard meal planning guide: not intended to need nutritional needs of all residents The menus must be adjusted to consider individual differences Continuing F Tags F364 FOOD Prepared by methods to conserve nutritive value, flavor and appearance Is palatable, attractive, proper temperature: Is food served at preferable temperature as discerned by resident and customary practice? Not to be confused with proper holding temperature F365 Food Form Meets Individual Needs F366 Substitutes are Similar Nutritive Value More Dietary F Tags F367 Therapeutic Diets Prescribed by the physician F368 Frequency of Meals Residents receive meals at a time most accepted by the community F369 Adaptive Eating Equipment If adaptive eating device recommended but not used, determine if this is by resident s choice F372 Proper Disposal of Garbage Food Safety and Sanitation F 371 Sanitary Food Procure /Prep /Dist and Storage All residents have the right to accept food brought to the facility by visitor(s) for any resident. The facility has the responsibility to Help visitors understand safe food handling practices (e.g., hold PHF over 41degrees F) When assisting visitors with reheating or food preparation activities, facility staff must use safe food handling practices 4
F325 Nutrition F325 Nutrition Based on the resident s comprehensive assessment, the facility must ensure that a resident Maintains acceptable parameters of nutrition status such as body weight & protein levels, unless the resident's clinical condition demonstrates that this is not possible Receives a therapeutic diet when there is a nutritional problem F325 Nutrition The intent statement states: Care & service be consistent with the residents comprehensive assessment The therapeutic diet takes into account the resident s clinical condition and preferences Goals and prognosis refer to a resident's projected personal and clinical outcomes. These are influenced by the resident s preferences (e.g., willingness to participate in weight management interventions or desire for nutrition support at end of life) Resident has dislikes, preferences and preferred portion sizes F241 Dignity F241 Dignity The facility must promote care for residents in a manner & in an environment that maintains or enhances each resident s dignity & respect in full recognition of his/her individuality Dignity in dining Day to day use of plastic cutlery & paper/plastic dishware Clothing protectors instead of napkins (except by resident choice) Staff standing over resident while assisting them to eat Staff interacting/conversing only with each other rather than with residents while assisting residents F241 and 242 F241 Dignity, con t. Speaking respectfully Avoid the use of labels for residents such as feeders Never refer to a resident by diet or diagnosis F242 Self Determination & Participation The right to make CHOICES about aspects of their lives that are significant to them Schedules Choice over schedules includes Daily waking, bathing times Eating Time to go to bed Staff Take a look at staff and food Meals Choice of food They are your food ambassadors Healthy Options HR Policies Schedule involvement and taking care of the same resident group Benefits of Culture Change Residents: less loneliness, helplessness, boredom, improved physical and mental health, less weight loss or gain Staff: less turnover, overtime, workman s compensation, sick days Overall: Increased satisfaction from residents, staff and family Positive culture change may be best source of census building and positive business atmosphere 5
Questions and Answers You can be a partner in the care facility; taking care of your resident family! Thanks for attending the Dietitians in Health Care Communities Webinar Candace S. Johnson, RD, CSG 303 875 9858 6
CERTIFICATE OF COMPLETION - CDR Taking Care of Family Be a Partner 28 April 2011 Date of Completion Dietetics in Health Care Communities - DHCC Commission on Dietetic Registration CPE Accredited Provider AM003 CPE Provider Accreditation Number CPE Accredited Provider Participant s Name Has successfully completed 2 CPEUs (Level II) DHCC DPG #31, Brenda Richardson, MA, RD, LD, CD Chair Signature of CDR CPE Accredited Provider, Date 28 April 2011 CERTIFICATE OF COMPLETION - State Taking Care of Family Be a Partner 28 April 2011 Date of Completion Dietetics in Health Care Communities - DHCC Commission on Dietetic Registration CPE Accredited Provider AM003 CPE Provider Accreditation Number CPE Accredited Provider Participant s Name Has successfully completed 2 CPEUs (Level II) DHCC DPG #31, Brenda Richardson, MA, RD, LD, CD Chair Signature of CDR CPE Accredited Provider, Date 28 April 2011