1. AN OVERVIEW OF CULTURE CHANGE Presented by The Tennessee Department of Health Carol Mace, BS July, 2008 Carol.Mace@state.tn.us

2. Definitions of Culture: Culture is a shared system of values, beliefs, symbols, and practices. Culture is a shared system of values, beliefs, symbols, and practices. Culture is the predominating attitudes, beliefs, values and underlying assumptions that characterize an organization. Culture is the predominating attitudes, beliefs, values and underlying assumptions that characterize an organization. Eden Alternative Training Manual Eden Alternative Training Manual

3. CULTURE CHANGE ADVOCATES Advocates Advocates Eden Alternative Eden Alternative Pioneer Network Pioneer Network Wellspring Wellspring TDH, BLHCF, HCF & CMS(!) TDH, BLHCF, HCF & CMS(!) Models Models Green House Green House Household Household

4. CULTURE CHANGE Brings the spirit of OBRA '87 fully to life Brings the spirit of OBRA '87 fully to life Involves the old keep them safe and healthy but adds happy Involves the old keep them safe and healthy but adds happy Emphasizes the resident by: Emphasizes the resident by: Not making the resident adapt to the institution, but rather Not making the resident adapt to the institution, but rather The institution adapts to the resident The institution adapts to the resident This is the basis of Resident-Centered Care This is the basis of Resident-Centered Care

5. CULTURE CHANGE De-emphasizes the medical institutional model that is: Based on hospital care Based on hospital care Takes over for a totally incapacitated patient Takes over for a totally incapacitated patient Takes full responsibility for patient's health Takes full responsibility for patient's health Emphasizes the Social Model which assumes: Residents are not patients but individuals Residents are not patients but individuals Residents are not totally incapacitated Residents are not totally incapacitated Resident can make decisions & choices Resident can make decisions & choices

6. Elements of Culture Change Resident-Centered care Resident-Centered care Empowerment of residents and staff Empowerment of residents and staff Consistent assignment Consistent assignment Encourages Growth for Staff Staff Residents Residents Allows/encourages Choices and Risks Allows/encourages Choices and Risks (to a reasonable degree) (to a reasonable degree) Universal Workers Universal Workers

7. Emerging Culture Change Trends Private resident rooms and bathrooms Private resident rooms and bathrooms Flexible dining hours and menu selections Flexible dining hours and menu selections Pets welcomed and encouraged Pets welcomed and encouraged Bathing done in private, warm rooms, or in residents room Bathing done in private, warm rooms, or in residents room Management that encourages resident & staff input Management that encourages resident & staff input Resident & staff empowerment Resident & staff empowerment

8. RESIDENT CHOICE Not defined, but encouraged, in the federal regulations Not defined, but encouraged, in the federal regulations Also not defined, but encouraged, in the state regulations Also not defined, but encouraged, in the state regulations

9. CC FOCUSES ON Consistent assignments Consistent assignments Leadership training for direct care workers Leadership training for direct care workers Includes direct care workers on management team Includes direct care workers on management team Self-managed work teams Self-managed work teams Staff Self-Scheduling Staff Self-Scheduling Enhanced dining experience Enhanced dining experience Breaking down large units into small Breaking down large units into small

10. CC LIMITATION... Culture change can only succeed if the culture surrounding places of LTC also changes. This requires engaging: Culture change can only succeed if the culture surrounding places of LTC also changes. This requires engaging: Management & Direct Care Staff Management & Direct Care Staff Families Families Medical Professionals Medical Professionals Elders Elders

11. CC TRICKLE DOWN THEORY As administration treats management staff, so shall management staff treat frontline staff As administration treats management staff, so shall management staff treat frontline staff As management staff treats frontline staff, so shall frontline staff treat residents As management staff treats frontline staff, so shall frontline staff treat residents

12. BENEFITS OF CULTURE CHANGE Reduced Staff Turnover Reduced Staff Turnover Reduced Use of Psychotropic Meds. Reduced Use of Psychotropic Meds. Reduced Use of Restraints Reduced Use of Restraints Reduced Training Costs Reduced Training Costs Reduction in Resident Behaviors Reduction in Resident Behaviors Increased Census Increased Census Increased Resident & Family Satisfaction Increased Resident & Family Satisfaction

13. NATIONAL CC INITIATIVES CMS Liaison in each CMS Regional Office CMS Liaison in each CMS Regional Office Advancing Excellence in NH Campaign Advancing Excellence in NH Campaign –QIOs, AHCA, AHSA, SSA CMS-Pioneer Network Conferences CMS-Pioneer Network Conferences –AIA Guidelines Re-write –NFPA Codes Re-write –Requested list of changes to CMS LTC rules RWJ Grant to NCB Capital for Green House Replication Initiative Project RWJ Grant to NCB Capital for Green House Replication Initiative Project

14. TENN. CC INITIATIVES LTC Community Choices Act of 2008, PC1190 LTC Community Choices Act of 2008, PC1190 Advancing Excellence in NH State Campaign Advancing Excellence in NH State Campaign –THCA, TNAHSA, THA, TDH, COAD, TNCARE, NH, Consumers BLHCF Grants first AIA waivers 7/9/08 for home-like duplexes replacement NH BLHCF Grants first AIA waivers 7/9/08 for home-like duplexes replacement NH TN Eden Alternative Coalition TN Eden Alternative Coalition –Sponsors CEA & Other Trainings, Research –Quarterly Meetings –Culture Change Lending Library, free Eden Handbooks 2 Green House Replication Initiative Projects 2 Green House Replication Initiative Projects –Ave Maria, Memphis –Jefferson Co. NH, Jefferson City

15. IMPLEMENTING CC Dont be afraid to implement changes to enhance residents lives! Just remember to: Communicate, communicate, communicate with: Communicate, communicate, communicate with: –SSA RO on planned changes –SSA FS & plans review staff on renovations –Families, residents & staff Document, document, document in: Document, document, document in: –Residents record (choices, personalized activities, etc.) –Facility policies & procedures (dining, activities, menus, pets, etc.) And help them dance! And help them dance!

16. CULTURE CHANGE WEBSITES TN DOH Eden Alternative Grant Assistance Program: http://health.state.tn.us/HCF/eden.htm Eden Green House Replication Initiative Project: http://www.ncbcapitalimpact.org/default.aspx?id=146 Eden Alternative Home Office: http://www.edenalt.org/ TN Eden Alternative Coalition: http://www.tneden.org/ Pioneer Network: http://www.pioneernetwork.net/ Advancing Excellence in NH Campaign: http://www.nhqualitycampaign.org/ CMS Survey & Certification Online Courses: http://cms.internetstreaming.com/nologin/

17. THE END! QUESTIONS? QUESTIONS? COMMENTS? COMMENTS? CC ACTIVITIES TO SHARE? CC ACTIVITIES TO SHARE?