Household Formations at Landis Homes
By Eva Bering
On behalf of management staff, the department directors and other staff, I would like to express appreciation for the many hours of volunteer work, support and service offered by the volunteers to the residents and to Landis Homes.
Sue has asked me to briefly speak about households. You may hear this word frequently and may see it imprint in LH news or Horizons
What are households and why is Landis Homes involved in this change?
First of all, it seemed like the right thing to do.
Our philosophy of care at Landis Homes recognizes and advocates for health and wellness. This is spiritual wellness, physical wellness physiological wellness, social wellness, Aging is unavoidable, however it is our belief that aging is not synonymous with isolation and physical frailty and lack of ability or desire to make personal decisions. Aging is complex, progressive, irreversible and a natural process.
It is our philosophy that individuals continue to desire friendships, the ability to make choices about what happens to them, the desire for relationships and socialization. Our goal is to provide an environment where that process of again occurs naturally and does not encourage regression. We believe that adults can and do age with a high degree of mental and physical function. We also believe that when physical ability declines it is not the end point necessarily of someone's contribution to life.
Landis Homes has been involved with a person centered or resident focused care initiative for health care since late 2005. We were selected by the Quality Improvement Organization in PA as one of 51 sites nationally to participate in an initiative looking at changing and improving the way nursing home care happens. Areas studies included turnover of staff, quality outcomes of care and staff satisfaction. The study showed that transformational changes within a nursing home will positively affect the lives of residents and improve the working environment for staff.
Landis Homes has always provided good care and has had and still has a reputation for doing so. We were and are blessed with staff who "really care" about what happens to residents and to their co workers. But we also were very much like every other nursing home in so many ways.
Routinely in a nursing home, resident schedules were formed on an industrial model of routine tasks to be done in a shift of work. There was a time for meals, there was a medication administration time, there was a time to wake up and a time to go to bed. Certain things happened at certain times of the 24 hour day. There were routines. Everyone had a very detailed list of tasks called a job description. The assignment for staff was based on a "tour of duty". The resident's home life and personal routine would have been an intrusion if it interrupted the staff routine. But just think about it. when you take a medication one time a day at home , no one wakes you to tell you to take it at 8AM. You take it whenever you wake up, which could be 6:30 AM , 8 AM or 9 AM or 10 AM. You wake up whenever you normally would like to or need to, but no one wakes you up every day so that you are dressed by a certain time so you can have breakfast by 8:30.
You may talk a bath daily or several times a week, It may be in the AM one day and in the PM another day, but it is not on a schedule dictated by someone else.
Landis Homes was no different. The resident schedule was set, built around work to be done. In addition, it was built around tasks to be done by a certain time. This contributed to loneliness, boredom and depression for the resident and lack of social relationships. It was a model built on separation of resident and the staff . There were few relationships that developed. There was little to no flexibility in the day, and limited choices in care decisions.
The resident who lived in a nursing home was essentially stripped of their very being, their personhood. These are individual who have lived a life, raised families, held jobs, made life decisions, shared the gospel in lands we would never go an yet when they entered a nursing home, they were unable to make the most base decisions about their care.
The Federal government has taken a serious look at the nursing home environment and realized that people in a nursing home needed more. The household model is a means to change this. It is promoted and encouraged by the Federal government and state licensure agencies. This encouragement to focus on the resident has driven various models of care...all with the intention to provide a more home like setting for nursing homes, and create a more resident focused environment rather than a staff focused environment.
So what is a household? It is a model intended to create a more natural environment where residents have a say in what happens. It may involve physical changes, but it is not only physical change. It is deep seated change that builds relationship between staff and resident, between staff and staff, and between resident and resident.
As the evolution of the journey continued, certain tasks became evident that they contributed to lack of personal relationships with residents and were preeminent in the day's priorities.
Landis Homes' initiative is titled "Honoring Lives". This clearly fits with our mission statement of The ministry of Landis Homes is to serve aging adults and their families by honoring and enriching their lives in a community of Christ-like love.
The three principles of the Honoring Lives initiative are Serving together; building relationships and enriching lives.
These changes have created a new way of thinking. One department director stated it this way "LH staff would always respond with a "Yes" to a resident request. now they should be adding "and what else may I do for you?" It has created changes in language:
• Unit to house or household
• Tub room to spa
• Feeding to dining or assisting with dining
• Bibs to clothing protector or napkins
It has changed other areas: consistent staff assignments in nursing, in social services and in dining, Meals are served at a more flexible time, so breakfast may be at 7:30 or it maybe a 9 am. Breakfast is made to order in the individual houses, medications are administered closer to when the person would have taken it at home. Staff do not awaken residents every two hours at night to make sure they are OK.
Staff relationships are different and more team oriented : roles are blending so that everything that can be shared would be shared....nursing may help to set tables for meals, housekeeping may help to clear tables, social workers may receive nurse aide certification so they can assist with some one from a bed to a chair without calling for a nurse. Activities are individualized and based on what the resident wants to do. They may be performed by a social worker, or a maintenance person.
There are many examples within the industry today to help guide nursing homes on their culture change journey. There is no "cookie cutter" model that fits everyone - every organization must decide for itself what mix of elements will work best in its own unique environment.... after all, there is no place like home. Nonetheless there is a replicable process for creating a shared vision and moving forward as an organization to create a home environment.
So how can you as a volunteer contribute your gifts to a household whether that be Oregon house, Manheim house, Ephrata house Lancaster house, Conestoga house, Aspen house, Birch house, or Cedar house.
There is a hope to have a consistent group or one volunteer per house that would become an integral part of the team. Areas to contribute may include conversations with some, reading to others, setting tables, clearing tables, pouring coffee, transfers, playing games, leading a hymn sing, helping with special meals.
I have a few stories.
1. An Italian woman said she had not made nor eaten home made pasta nor made homemade sauce for some time. Staff bought the ingredients and the woman made home made spaghetti in the house and it was served to all residents and staff that wanted it.
2. Another resident had made apple dumplings in her past for many affairs and socials. So apples were brought in, and the residents cut the apples, prepared the dumplings, the dough was made from her recipe and the apples dumplings were served to all both staff and residents.
3. Birthday parties for staff and residents are often held on the houses.
4. Bridal showers and baby showers have been held on the houses.
5. Several residents wanted to have a small coffee pot in their room to make coffee before they got dressed. staff are empowered to say "yes" top that rather than ask permission.
6. Door privacy hangers are made available so that a resident can have privacy.
7. Locks have been added to the health care doors so that a resident can lock their door if they desire privacy.
8. The Spring Fling in Personal Care last evening with club sandwiches, pizza and ice cream floats for residents and families. It is easy for most of you to go to a restaurant and order pizza, but it is difficult for many residents in personal care to do that independently.
9. There was one resident who had spent her life as a missionary sharing the Gospel. She is now confined to a wheelchair and unable to communicate for the most part. One day she was being wheeled by a staff member to another area when she saw another resident in the bed. She tried to go into that resident's room. The staff member was unsure if she should allow that since the other resident was dying, so the staff member left to ask the charge nurse whether or not she could take the wheelchair bound resident to the bedside.
By the time the staff member and returned, the wheel-chair bound resident had wheeled herself into the room and was holding the hand of the dying resident. She looked at the nurse and said "she is dying." I tell you this to demonstrate that physical frailty is not a reason to withdraw from sharing gifts of comfort to someone else.
There are still areas to develop, a simple task of taking a dining cart from one house to another by a different staff person may upset a normal routine and is being worked on through negotiation.
Again, I encourage you to consider how you can contribute your many gifts to a house. Please get in touch with either Sue or Joyce if you have an interest.
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