Destination: Person Directed Care in Iowa Presented in cooperation with the Iowa Person Directed Care Coalition “Empowering Iowans to direct their lives and care wherever they live”

Objectives Define differences between staff-directed culture and a person-directed culture Discuss the differences in care practices based on the person directed care approach

The Journey Waking Eating/dining Bathing Night time cares/assistance Consistent assignments

Waking Traditional Culture No knowledge or implementing of preferences Time up determined by staff convenience – some up at 6:00am to “help” day shift All staff come on at same time Everyone up for breakfast Care is routine, rushed Transformed Culture Staff know residents’ preferences Residents wake up on own schedule Staff “shifts” adjusted to residents’ needs Breakfast on demand Morning care is individualized and more relaxed Staff do own scheduling based on residents’ needs

Eating/ Dining Traditional Culture Few choices Served on trays Plastic dishware “Feeders” Staff talk around residents Large dining rooms Lots of special diets Lots of wasted food and weight loss Boring snacks and no access Transformed Culture Residents’ have choice of what and when (menu, buffet, family style) Dinnerware Staff interact with residents Smaller dining/cooking areas in the household Liberalized diets Less food waste, more weight gain Interesting snacks and 24 hour access

Bathing Traditional Culture A task to be done on a body Routine set up for convenience of staff Twice a week whether you like it, need it, want it No choice of type or time Staff feel forced Resident feels forced Damages relationship Potential for combativeness of resident and injury to resident and staff Transformed Culture A pleasant or tolerable experience in context of a relationship Choice and input about how, how often and when is it done Preserves and enhances relationships Redefine what “bathing” means Creates relaxed bathing experience

Night Time Care/Assistance Traditional Culture People are to sleep through the night Use restraints to prevent people from getting out of bed Staff make rounds and turn and change every 2 hours Staff turn on lights, talk Plastic mattress and pillow Thin gown and blankets All incontinence and skin care the same Medicate with sleep medication Transformed Culture If people are not sleepy, they may want and need to get up If they awaken frequently, need to assess if there is unmet need Enter quietly with low light Individualize the bed and sleep environment for comfort Incontinence and skin care is individualized Don’t awaken them for care unless there is a compelling health reason to do so More likely to medicate for pain than for sleep

Consistent Assignments Traditional Culture Nurses make assignments without input from residents or staff Staff rotate from unit to unit Staff stay on same unit but still rotate every 1-2 weeks Staff rotate from assignment to assignment every month Set shifts Set jobs. Transformed Culture Staff and eventually the residents choose with whom they will work, based on existing relationships Staff works with same group of residents at all times and coordinate with fill-in people Changes are made only at resident, staff or perhaps family’s request All shifts have consistent assignments Dietary, housekeeping consistently assigned Crossed trained staff can meet resident’s needs and wishes

For more information… Iowa Person Directed Care Coalition –

IPDCC Steering Committee ACBM Corporation Continuum Health Care Services Des Moines Area Community College Iowa CareGivers Association Iowa Department of Inspections & Appeals Iowa Health Care Association Iowa Veterans Home Leading Age Iowa Office of the State Long-Term Care Ombudsman Telligen (formally the IFMC)

Questions? This material was prepared by the Iowa Foundation for Medical Care, the Medicare Quality Improvement Organization for Iowa, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 8SoW-IA-PPT-NH-11/09-025b