Culture Change in Nursing Homes
Culture change in nursing homes refers to the new and revolutionary patient care practices developing in modern long term care. The overarching goal is to transform these facilities from institutions into real homes and communities.
This change is guided by a shift in focus aimed at enhancing the respect and care given to elderly patients. Culture change stresses the importance of patient choice, dignity, autonomy, and purposeful living. One of the goals of this movement is to expand patient care beyond just physical boundaries; the patient’s mental and emotional well-being also becomes a priority. By attending to every aspect of a patient’s needs while maintaining high respect for the patient, more trust is established between patient and caregiver and the patient will be more satisfied with the care that he or she is receiving.
Healthcare facilities and nursing homes that are involved in this culture change will notice that small changes can lead to big results. For example, changing certain aspects about the language used in the workplace will create a community atmosphere where patients and workers are known as “friends.” Referring to patients as “friends” or “neighbors” and nursing homes as “communities” or “life centers” is a subtle way to deinstitutionalize the atmosphere.
Personalized Care is the Most Important
Creating “neighborhoods” within the nursing home, consistently staffed by the same caregivers, helps enhance the relational aspect of the culture change. Personalized one-on-one care is an important part of nursing home culture change. By having the same caregivers care for the same group of patients, the patients become more familiar and friendly with the workers, and healthy relationships are encouraged.
Also, many times nursing homes that are creating these neighborhoods will allow the staff of each area to maintain high levels of self-management, which increases job satisfaction.
Patient choice plays an important role in nursing home culture change. Certain choice options, such as allowing patients to choose what to eat for dinner, what activities to participate in, or when they would like to go to bed can go a long way toward improving the patients’ perceived quality of life. Also, more nursing homes are making efforts to provide each resident with a private room, as this allows the patient to feel more independent.
New Technology Assists in Nursing Home Culture Change
New remote patient monitoring technology, such as Dalcon Alert!, helps nursing homes “deinstitutionalize” and create a homelike environment by eliminating loud alarms and the need to use the overhead pager. The system also greatly improves staff communication and the quality of care.
The culture change in long term care movement is gaining momentum, mostly because of the benefits that it brings to both residents and employees. Nursing homes that adopt the principles of culture change often see improvements throughout the entire organization, such as reduced operational costs, increased staff retention rates, higher occupancy rates, and increases in overall competitive position.
Creating a Homelike Environment in Nursing Homes with New technology
In June 2009, the Centers for Medicare & Medicaid Services (CMS) issued new revolutionary guidelines for long term care facilities (nursing homes) that receive federal funds. These guidelines called upon nursing homes to create a “Homelike Environment” for residents; creating a call to action to deinstitutionalize these facilities by making changes such as:
• Removing overhead paging and piped in music.
• Removing institutionalized signage and labeling (such as closet and bathroom labels).
• Removing medicine carts and large centralized nursing stations.
• Discontinuing long term use of patient monitoring systems that use audible alarms.
• Eliminating mass-purchased furniture displayed throughout the building.
Dalcon’s unique patient care communications solution, Dalcon Alert!, is designed to help nursing homes make several of these changes. As a result, facilities using the Dalcon Alert! system will meet numerous new CMS Homelike Environment guidelines, and their quality of patient care will drastically increase.
Dalcon Alert! provides a communications platform that eliminates the need for:
- Overhead Paging
- Audible patient monitoring alarms
- A large centralized nursing station
How Does Dalcon Alert! Eliminate Audible Alarms?
Dalcon Alert! is a patient care communications system that has several features. The system provides Remote Patient Monitoring and Alarm Management by integrating with patient monitoring devices including but not limited to:
• bed exit pads
• bed fall pads
• IV-Pumps
• Patient Nurse Calls
When an alert is created by any integrated device, Dalcon Alert! routes that alert to a remote nursing station where it can be actively managed on a PC monitor using Dalcon Alert!’s alert management software. Dalcon Alert! also sends that alert to select staff carrying fully functional wireless phones via text message, so they are immediately made aware of that alert regardless of their location—and without the use of audible alarms.
How Does Dalcon Alert! Reduce the need for Overhead Paging and a Large Centralized Nursing Station?
Equipping vital staff with wireless phones is a central piece of the Dalcon Alert! system. These phones allow staff to receive important alerts regardless of their location. Caregivers can be reached remotely by phone, vastly eliminating the need for overhead paging.
A key component of the successful implementation of a decentralized nursing station system is staff communication. Dalcon Alert! provides staff with an effective decentralized communications platform, built around fully functional wireless phones. Also, Dalcon Alert!’s alert management software is accessed via a browser, and there is no limit to how many computers can be logged on to it at once. Thus, each decentralized nursing station can be actively managing alerts at any given time.
New CMS Guidelines: Homelike Environment for Nursing Homes
The Center for Medicare & Medicaid Services (CMS) creates guidelines for long term care facilities (nursing homes) that receive federal funding via Medicaid and Medicare. Licensed state surveyors perform annual checkups on nursing homes to make sure that these facilities are meeting the expectations of CMS—if not, those facilities are ineligible for CMS reimbursement.
In June 2009, CMS updated their guidelines for long term care facilities (nursing homes) in several ways. Out of the many changes made, the new “Homelike Environment” guideline is one of the most revolutionary.
Section §483.15(h) Homelike Environment
The actual CMS guideline reads, “The facility must provide a safe, clean, comfortable and homelike environment, allowing the resident to use his or her personal belongings to the extent possible.” CMS interpretation of this guideline suggests that, “A ‘homelike environment’ is one that de-emphasizes the institutional character of the setting, to the extent possible, and allows the resident to use those personal belongings that support a homelike environment.” What this means for nursing homes across the nation, is that sweeping changes will have to be made gradually to transform and deinstitutionalize these facilities.
Some of the more drastic “homelike environment” changes include:
• Removing overhead paging and piped in music.
• Removing institutionalized signage and labeling (such as closet and bathroom labels).
• Removing medicine carts and centralized nursing stations.
• Discontinuing long term use of patient monitoring systems that use audible alarms.
• Eliminating mass-purchased furniture displayed throughout the building.
Homelike Environment Compliance Expectations
Obviously, many of these CMS homelike environment suggestions represent sweeping changes for many nursing homes throughout the nation. CMS has stated that these guidelines have been effective since June 12, 2009; but in their own words they don’t expect most nursing homes to be able to meet them immediately. However, they are expecting nursing homes to actively pursue the new guidelines—or face the consequences:
“Many facilities cannot immediately make these types of changes, but it should be a goal for all facilities that have not yet made these types of changes to work toward them. A nursing facility is not considered non-compliant if it still has some of these institutional features, but the facility is expected to do all it can within fiscal constraints to provide an environment that enhances quality of life for residents, in accordance with resident preferences.”
Meeting Homelike Environment Expectations
New technologies exist, such as Dalcon’s patient care communications system Dalcon Alert!, that help nursing homes meet numerous “Homelike Environment” expectations. However, CMS has also stated that physical changes alone won’t fit the bill of a “Homelike Environment.” They are expecting serious culture change by nursing home staff; including a shift towards person centered care, and quality staff-to-resident relationship building.
