AN OVERVIEW OF CULTURE CHANGE

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 the predominating attitudes, beliefs, values and underlying assumptions that characterize an organization.” • Eden Alternative Training Manual

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

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

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

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

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

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

9. CC FOCUSES ON • Consistent assignments • Leadership training for direct care workers • Includes direct care workers on management team • Self-managed work teams‏ • Staff Self-Scheduling‏ • Enhanced dining experience • 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: • Management & Direct Care Staff • Families • Medical Professionals • Elders

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

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

13. NATIONAL CC INITIATIVES • CMS Liaison in each CMS Regional Office • Advancing Excellence in NH Campaign • QIO’s, AHCA, AHSA, SSA • 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

14. TENN. CC INITIATIVES • LTC Community Choices Act of 2008, PC1190 • 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 • TN Eden Alternative Coalition • Sponsors CEA & Other Trainings, Research • Quarterly Meetings • Culture Change Lending Library, free Eden Handbooks • 2 Green House Replication Initiative Projects • Ave Maria, Memphis • Jefferson Co. NH, Jefferson City

15. IMPLEMENTING CC Don’t be afraid to implement changes to enhance resident’s lives! Just remember to: • Communicate, communicate, communicate with: • SSA RO on planned changes • SSA FS & plans review staff on renovations • Families, residents & staff • Document, document, document in: • Resident’s record (choices, personalized activities, etc.) • Facility policies & procedures (dining, activities, menus, pets, etc.) • 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? • COMMENTS? • CC ACTIVITIES TO SHARE?