Aging in oregon

1. Aging in oregon Understanding Long Term Care Services for the Older Adult Module 4 –Culture Change & The Emerging Role of the Nurse in LTC

2. The Important and Emerging Role of the Nurse in Long Term Care • Nurses have had a presence in long term care for some time, particularly in the nursing facility. • As the population ages and nursing’s focus shifts toward care of the older adult, nurses have an opportunity to significantly influence care in the long term care setting. • The nurse’s role in long term community care is also emerging, especially in the assisted living and residential care environments.

3. Long Term Care Culture Change • What is culture change? • A national effort to make long-term care less ‘institutional’ and more ‘home-like’ for residents. This movement acknowledges that nursing homes are places where people live—often for many years. • What are some key components of culture change? • Resident directed (or resident centered) care—care that is provided in ways that the resident desires • Empowered ancillary staff—staff can modify care routines based on the desires of the resident, not what is most efficient for the institution • Home-like environment—physical environment is de-institutionalized (no more long hallways) VIEW the MOVE website for more information!

4. Person-Directed Care • A philosophy of Person Directed Care (PD) strives to implement and support the choices that the person being assisted makes and to keep all decision-making as close to them as possible. • The literature references person-centered and person-directed care. What are different nuances in these terms? Which term best reflects the type of care you observe in clinical settings?

5. Continuum of Change for Person-directed Care

6. Applying Person-Directed Care to the Care Planning Process • Click on this link to open a document from the Department of Human Services in Wisconsin that provides a good overview of how to apply person-directed care to the care planning process for an older adult with dementia (it will open in a separate window). • Pay particular attention to: • The Five Basic Needs of People with Dementia • The Well-Being Profile • Descriptive Language and Old & New Language

7. Culture Change in Oregon: Making Oregon Vital for Elders (M.O.V.E.) • M.O.V.E. is the Oregon culture change organization representing key stakeholders in LTC. The group offers approximately 4 seminars/workshops on a variety of culture change topics each year. • Building on principles of the Pioneer Network, Oregonians from a variety of organizations and experiences founded M.O.V.E., a coalition in which ideas and actions come together to create culture change for the benefit of elders and those who support them. http://orculturechange.org/

8. Culture Change in Oregon • In many ways, the LTC culture change began, particularly in Oregon, with the development of community-based care settings such as assisted living and adult foster care. The need to address issues such as privacy, respect,choice, and promoting independence are written into the Oregon laws governing these services.

9. Nurse Competencies for Nursing Home* Culture Change HOW WOULD YOU RATE YOUR COMPETENCY IN EACH OF THESE AREAS? • Models, teaches and utilizes effective communication skills such as active listening, giving meaningful feedback, communicating ideas clearly, addressing emotional behaviors, resolving conflict and understanding the role of diversity in communication. • Creates systems and adapts daily routines and “person-directed” care practices to accommodate resident preferences • Views self as part of team, not always as the leader. • Evaluates the degree to which person-directed care practices exist in the care team and identify and addresses barriers to person directed care.

10. Nurse Competencies for Nursing Home* Culture Change (cont.) • Views the care setting as the residents’ home and works to create attributes of home. • Creates a system to maintain consistency of caregivers for residents. • Exhibits leadership characteristics/ abilities to promote person-directed care. • Role models person-directed care. • Problem solves complex medical/psychosocial situations related to resident choice and risk. • Facilitates team members including residents and families, in shared problem-solving, decision-making, and planning. Note: although developed specifically for nursing homes, these competencies are relevant to nurses in other LTC settings such as ALF, RCF, AFC, Home care. Developed through a collaboration of Pioneer Network and Hartford Institute for Geriatric Nursing, 2010, www.pioneernetwork.net

11. Nursing Expertise in Assisted Living and Residential Care • Oregon was the first state to provide housing/care in assisted living facilities (ALF), often as a substitute for nursing home placement. • There is no “ceiling” on the level of care that can be provided in ALF in Oregon. Older adults living in ALFs have chronic conditions such as dementia, diabetes, and cardiovascular concerns that require complex clinical management and demand expert nursing oversight, observation, and intervention (Singer, McDaniel, & Hornby, 2002; McDaniel, 2003).

12. Nursing Expertise in Assisted Living and Residential Care (cont.) • Recent changes in Oregon ALF and RCF regulations require an increased level of nursing services and a nurse who is able to respond to complex resident care needs, including frequent change of condition assessments; medication, wound, and pain management, nursing delegation; end-of-life care; and directing unlicensed staff. • The knowledge and effectiveness of the nurse can make the difference for an older adult to age successfully in place.

13. Nursing Competencies • Four competency domains for nursing practice in the assisted living/residential care setting have been identified. • Care of Older Adults (care/clinical management) • Systems (policies, procedures, quality improvement, regulatory compliance) • People (interpersonal communication/supervision with staff, residents, families, and outside agencies) • Time Management (organization, planning, prioritization) McDaniel, 2009

14. In Their Own Words • Click on the youtube links below to hear nurses who are working in assisted living and long term care share their thoughts about this emerging and exciting nursing work and role. • Brad

15. Resources • Check out these great resources to enhance your learning and support your nursing practice with older adults. • Hartford Center for Geriatric Nursing • ConsultGeriRN.org • Oregon State Board of Nursing, Division 47, RN Delegation of Nursing Tasks to Unlicensed Persons • Nursing Delegation Self-Directed Course