Why is Pilgrim Place undertaking this “culture change” at the Health Center?
Pilgrim Place’s decision to move toward a “resident-centered, household-oriented” model of care is to enhance and improve the way our residents are cared for at our Health Services Center. Our goal is to establish intimate neighborhood environments that provide opportunities for residents to have more control over their lives and to be a participant in daily decision-making. In this “resident-directed” care model, emphasis is placed on skilled care that responds not only to residents’ medical needs, but also to their spiritual, emotional and social needs.
Explain what is meant by “losing one’s humanity” in a nursing home. How will it be restored in the household model?
The traditional model of nursing homes was built on a hierarchical model which dictated that the best way to care for elders was to provide standardized “treatment” based upon a medical diagnosis with schedules and routines designed by the institution and staff to maximize efficiency and care within strict work schedules where the elder had no input. Staff had to complete their routine work in order to move to the next task and there was no time or incentive to personally interact with elders. Gradually residents lost their ability to make decisions, change the routine, or feel as if they had any dignity or respect.
In the household model emphasis is on person-directed care where staff enter into a caregiving relationship based upon individualized needs and personal desires. Both staff and elders design schedules that reflect the personal desires and comforts of each elder through relationship-centered decisions based on respect and dignity. Staff come to know the resident personally as work assignments are consistent and activities are not based on rigid hierarchical schedules and rules. Elders are seen as persons who prefer to live as closely as they can to daily activities they had when living at home, deciding when to rise in the morning or sleep at night.
How is a neighborhood or household formed?
When a larger institution like a nursing home is broken into smaller communities with fewer residents, staff and residents get to know each other around common dailyactivities and sharing in their own common living, dining and kitchen areas. They begin to have a sense of belonging and empowerment. These smaller neighborhoods and households begin to feel like the type of life they, the elders, enjoyed before,incorporating the daily pleasures and activities that turn an institution into a home, a place where elders have a voice in decision-making and are respected.
Households and neighborhoods are different in size. Many traditional nursing homes will transition first to a smaller neighborhood model and then to an even smaller household structure. Pilgrim Place’s neighborhood model will be configured along currently existing hallways with empty spaces being made into shared living or dining areas. The Environmental Design Action Team is developing plans for best use of our existing space.
What is expected to be the size of each household?
Households usually consist of 12-16 persons, however the size of Pilgrim Place households will not be decided until thetransition from “neighborhoods”into “households” is about to begin.
Will there be an attempt to “match” residents for compatibility?
In ordinary towns, neighborhoods are formed “by chance.” We do not choose who our neighbors will be.We come to enjoy some neighbors more than others but strive to get along with all. Such will most likely be the case in the Health Services Center neighborhoods and households.
How will an introvert be incorporated into a household?
Introverts may stay in their rooms more than extroverts. They are free to choose to join in the living room activities with others, just sit and observe others or remain in their rooms. In some instances it has been observed that introverts gradually begin to take part in more activities as members of the households get to know each other better.
How will a cognitively impaired resident be incorporated into a household?
This type of situation may differ quite a bit depending on the abilities of each individual. According to many on-going households, members often assist those who cannot function on their own and help them do what needs to be done. It has also been noted that in a caring household, such elders tend to become more able to function on their own as they are integrated into the household.
How will members of a household strike a balance of being respectful of a resident’s privacy – yet supportive during a resident’s transition?
Members of a neighborhood or household will regularly meet together to discuss how to help each other, to work together, and integrate new residents. Staff will also be trained in ways to work with residents on delicate issues. Each situation will be unique.
How are decisions made in a neighborhood or household?
As in any household, a time for people to gather together is set and each person is given an opportunity to express his or her opinions, feelings and ideas about various issues. Decisions can be made based on these “learning circles” and activities can be either planned or spontaneous. Family members and staff can also be involved in such discussions but the elders have a definite say in making the decisions.
How will the “death experience” be shared within a household?
As many of us have experienced, upon the death of a friend or relative, what is shared and celebrated are the many interesting and happy events of that person’s life. The same will occur in the households and neighborhoods. This will be done in a special ritual as we currently have in Pilgrim Place. Elders will share in the whole experience.
If residents live in neighborhoods or households that are separate entities, can individuals who live in one neighborhood communicate or visit with their friends in another neighborhood? If so, how is this accomplished?
Residents are encouraged to carry on their lives just as if they were living in actual neighborhoods. An elder from one neighborhood can visit a friend in another one, talk with their friend in a quiet corner of the living room, join in a lively discussion or game with others at a large table, or enjoy supper with the friend and then return home when she/he wants.
Are non-residents welcome into neighborhoods?
Visitors and families are welcome into a neighborhood or household if the elders want to have them come in. They can also be invited for special occasions, meals or activities. Staff from the Health Services Center or other parts of the Pilgrim Place community can also be invited to participate in such activities or arrange to visit on a regular basis. Interaction between various people is encouraged as they would be in regular neighborhoods.
Will staff be willing to be cross-trained, becoming a “versatile worker,” i.e., how will a CNA respond to being asked to prepare a snack for a resident?
Cross training of staff to become “versatile workers” will be offered first to those who volunteer for such positions. These staff will be trained in aspects of the work of another staff position, i.e. a CNA may learn dietary rules of sanitation in order to help prepare meals during 20% of the day while doing CNA type jobs the remaining time. Or a housekeeper may learn how to help care for certain elders so that they can get to know individual elders better as friends. Currently, some HSC staff are already responding to the needs of HSC elders whenever needed rather than making them wait for the “assigned” staff person. This concept of shared responsibilities will eventually be expected of all staff.
How are staff going to learn new ways of working with elders after having worked so long in a hierarchical system?
Through being on the Steering Team and Action Teams where each person is equal to everyone else,some staff, as well as non-staff, have already begun learning different ways of working. They have experienced the flattening of the hierarchical model. Such “learning circles” are where people learn to listen to each other, respect the ideas and feelings of others, and also assume leadership roles. Those staff who are on such teams become role models for other staff, sharing in any type of work.
How will the life and work of each neighborhood be coordinated?
Each neighborhood will have a “Coordinator” who will work either full time or part time in that role. TheCoordinator is not necessarily a RN or C.N.A. but could also be a dietitian or housekeeper. The Organizational Design Action Team is working on the description of staff needed in each neighborhood.
What if there are not enough RNs for each neighborhood?
RNs can spend time in different neighborhoods thus covering the medical needs of elders in all neighborhoods or households. Medical needs in neighborhoods or households will by no means be compromised.
How may I receive more information about the Pilgrim Place Culture Change process?
For more information on Culture Change at Pilgrim Place, please contact one or more of the following resource people:
- Bill Cunitz, President and CEO * 909-399-5577 * wcunitz@pilgrimplace.org
- Sue Fairley, Vice President for Health Services * 909-399-5536 * sfairley@pilgrimplace.org
- Joyce Yarborough, Director of Advancement * 909-399-5511 * jyarborough@pilgrimplace.org
- Sue Likens, Coordinator of Communications *909-399-5573 * slikens@pilgrimplace.org
Is there a web site with more information?
Yes, you may find additional information on the Pilgrim Place website at:
- www.pilgrimplace.org/hsc - General information about the Health Services Center
- www.pilgrimplace.org/services - Services provided at the Health Services Center
- www.pilgrimplace.org/culturechangeqa - Frequently Asked QuestionsPilgrim Place
