(Editor’s note: This is the second in a two part op-ed piece by Marilyn Colton related to the transformation of long-term care homes. To read the first part, click here.)
Panmure resident Marilyn Colton, nurse administrator, retired from Almonte Country Haven in 2016. Previously, she was the community director, Waterside Retirement Community in Carleton Place, ON, and executive director, Central Park Lodge, Ottawa, ON. Marilyn is currently the chair of the Family Council at the Grove Long Term Care Home in Arnprior.
At a time when an older person is experiencing the most dramatic changes in their life, I insist they should not be placed in a situation where who they are, and have been, becomes secondary to the priorities and demands of where they are and who is caring for them.
Becoming older, living with dementia and/or having other conditions that are debilitating, and affect all ages, should never mean losing oneself or one’s humanity. I believe each person who moves to a second home must be able to embrace life and living as well as retain that distinct place they have held within their family, their community and within society, at large.
The transformation of our long-term care homes to a social model means a culture change, that is, a transformation in philosophy and practice to de-institutionalize care and create a person-centred approach to all aspects of life and living within the resident’s second home. A social model implies a focus on relationships, not tasks.
Caring is not about performing tasks; it is the art and heart of care that is the key to a person-centred approach. It is our relationships with the people, places and things that have shaped our life journey to make each of us who we are and to sustain our sense of personhood. Staff to resident relationships are not only encouraged; they are an expectation. And, yes, staff are expected to develop long-standing close relationships with the residents. As well, resident to resident relationships are developed through settings of eight or less residents, as opposed to 30, to facilitate communication.
Resident relationships to others, such as with pets and with children, is a continuation of everyday relationships residents have left behind. Nurturing these person-centred relationships is therefore key to sustaining individual well-being and developing an emotionally resilient culture of care within the home.
As part of the social model of care, community is better defined, and a real sense of home is created and maintained for the residents. For instance, the residents are able to identify what activities are meaningful for them so these activities can be incorporated in to their routines. I recall one resident who was an architect, had dementia, and whose only interest was in sketching architectural drawings. He had no interest in the common activities of the home. Thus, staff resourced an architect within the local community who willingly visited with the resident on a weekly basis, sharing sketches and chatting about ongoing projects within his company. This partnership provided for the resident to utilize his expertise and his prior experiences while validating the reality of living with dementia. The interactions were enriching and meaningful and, no doubt, slowed the resident’s progress of dementia.
Each resident’s routines are in line with their individual preference such as, the choice to wake up and go to bed at a time they choose or the choice not to eat breakfast but rather to just have a cup of coffee as per one’s usual routine.
On move-in to their home, the new resident receives a warm welcome with the goal of staff getting to know, and relate to, the person behind the illness or disability. This process must be initiated prior to move-in so the assembly-line approach is eliminated and the resident is received as an individual with unique interests, preferences, hobbies, personal history etc.
Residents are involved in their home, for example, delivering the mail, participating in the hiring of staff, and preparing for meals. As an example of meaningful occupation, one resident, whom I will call Winnie, was constantly going in and out of other resident’s rooms and always appeared sad. Winnie had late stage dementia. Staff asked her if she would like the task of picking up empty juice glasses from the three corridors for delivery to dietary where the cart would be cleaned and readied for the next pickup.
Winnie was delighted, accepted the task, and had her very own cart with her name on it which she kept in her room. She religiously did the pick-up three times daily. She no longer went in to other people’s rooms. Winnie had a purpose to her days, felt fulfilled and appeared much happier.
With the social model, residents are part of learning circles with staff to share ideas regarding improvements they identify relative to a more home-like environment. As an example, I recall residents asking to have a calendar of their activities and commitments (such as physio or hair appointments) posted in their own rooms. This was simple to do and provided for greater resident autonomy and personal responsibility.
With this cultural transformation, the dining experience is enhanced and potentially includes buffet-style dining, ladies’ afternoon tea, men’s breakfast club, menus, and expanded dining hours. But even more importantly, the wishes of the resident in terms of special diets are respected. For example, Jane, a 72 year-old woman had diabetes. Her physician had ordered an 1800 calorie diabetic diet. Jane was well educated, completely alert and intelligent. Nevertheless, she was non-compliant with the diet order. Jane related to the staff that she was aware of the dietary restrictions but chose to exercise her right to eat what she enjoyed. That was her decision; her life.
Prior to this cultural transformation, another resident with dementia, whom I will call George, was dissatisfied with the full breakfast he was told he should eat. After his wife, Harriett, informed staff of the breakfast George had every morning of their 60 years of marriage, he was able to have his usual breakfast of oatmeal porridge and coffee at his preferred time of 7 a.m. As well, knowing that George preferred a hot bath, rather than a shower, before bedtime on Saturday nights, the staff then shifted his bath time to 9 p.m. on the preferred day. Not surprisingly, the day went quite well for both George and his wife once routines were based on his preferences.
Neighbourhoods are created in the transformed home to indicate a sense of community. Small numbers of residents are grouped in to a single community based on room proximity. The neighbourhood is staffed with permanently assigned workers and shares communal activities. My vision is to have each front-line staff member qualified as a Personal Support Worker. All workers would then be cross-trained in dietary, housekeeping and laundry so they could perform the related functions in addition to carrying out activities with the residents.
This results in an integrated approach to serving the residents; the silos are eliminated. Would this not be a similar and a more familiar environment from which the resident came? Is this not promoting the continuity of community? Is this not what our residents want, expect and deserve within their second home?
Finally, I believe the core values that must be ‘lived’ by all staff, volunteers and families and which will be part of this transformation of our long-term care homes are: respect, choice, dignity, self-determination, a holistic approach, meaningful occupation and quality of life as well as quality of living.
As family members, friends, and staff, I challenge each of us to create a meaningful care culture where people feel free to be me. Your feedback is always appreciated. Please contact Marilyn at firstname.lastname@example.org.