By Patricia Yannotta, CALA, CDP
Director of Hospitality & Lifestyle, Fellowship Senior Living
Most people would not have guessed six months ago that we would be facing a public health crisis in our own homes and in the communities where we work. And because we never expected such instability in our lives, we’ve woken up to new rules and new limitations. Everything is suddenly different. Work is different. Eating dinner is different. Grocery shopping is different. Life is different. And getting used to living with the new precautions to prevent getting sick is taking a while, perhaps too long.
In senior living communities, the approach to create engagement and meaning for our residents, families and our team members while maintaining the quality of care and quality of life under these circumstances is now different, too. For starters, there are no more group gatherings under the current guidelines from the CDC and the local and state health officials.
For those of us who are committed to culture change in transforming care for our seniors from an institutionalized care model to one that is person-centered, transitioning to isolation and reverting to hospital-like practices are necessary to keep residents safe. In some ways, this might seem as if we are taking steps in the opposite direction.
Whether we like it or not, we are living a culture change right now. This is a huge shift that we are now embracing with social distancing, washing our hands constantly, using hand sanitizer when we can find it, taking our shoes off outside the door when we get home, sanitizing our mail, and washing our groceries when we get home. Those of us on the front lines know all too well how difficult it is to adapt to these changes in our everyday routine to ensure the safety of our residents and our own families at home. But this is our new reality, at least for now. It is a huge shift, and you are doing it. Right now.
According to the Pioneer Network, the culture change movement to person-centered care is alive and well under these circumstances. The good news is that “for those communities that have a firm foundation of a relationship-based, person-directed culture, it is one of the things that is guiding and sustaining them through this crisis,” according to their newsletter article dated April 15, 2020, written by Joan Devine, Director of Education.
For many of the communities where the model is in place, it is likely the model was implemented long ago under better times. In the person-centered model, relationships with residents and families already have a strong foundation, as are the relationships with team members and leadership. For example, at Fellowship Senior Living, three households are now in place—one for Assisted Living, one for memory support and the other for Skilled Nursing. Three more households are under construction and slated to open in 2020.
The household model supports person-directed care in an environment that resembles a home. It fosters relationships and better understanding of the resident’s preferences. It helps eliminate loneliness and boredom by having the home-like setting with others living in the household with them for companionship, engagement and friendship. There are smaller groups or smaller areas to conduct engagement while limiting exposure and making “sheltering in place” easier. The caregivers and homemakers already have established relationships with the residents and already know what they enjoy and when they like to eat meals. The one-on-one time is already part of the culture. The team on the front-line IS family for theses residents; they are familiar faces during the best of times and now in the time of a crisis. This is a crucial part of the culture change because resident families are not permitted to visit under the current CDC precautions. This is an unprecedented time in our lives and in the lives of our residents. Your community may be implementing aspects of the person-centered culture because of the precautions and you might not even realize it.
“This person-centered culture change puts residents’ at the heart of their care. You adapt your service, culture, and physical environment to their expectations and preferences, not the other way around. Doing so enables residents to retain their dignity, independence, and lifestyle during an already challenging time. Rather than a person feeling hindered or constrained by their current situation, you help them live a fulfilling life that is meaningful to them,” says Brian Lawrence, President & CEO of Fellowship Senior Living.
If person-centered care isn’t part of your community’s model, maybe now isn’t the best time to implement it, but it is a good time to ask what you are already doing in response to the COVID-19 pandemic that is person-centered. Then think about what is stopping your organization from adopting at least some of the principles of this culture change when the pandemic subsides and ends. If you are hosting facetime calls, setting up zoom meetings for residents and increasing your one-on-one visits, you’re already well on your way.
At this point, since there is no communal gathering for meals, if you are asking residents what they would like to eat and bringing it to them when they want to eat, you are implementing the person-directed approach. Maybe the resident cannot eat with their friends right now, even if that is their preference, and that is just for life safety. Perhaps you are delivering trays at the same time because it is convenient, and you don’t have the resources to adjust for personal preferences. It might not be realistic under the circumstances to adjust the time of food delivery, but awareness of the difference in approach is the first step. The second step is to visualize how it would work in your community.
Does culture change happen overnight? No. It took the tri-state area a few weeks to adapt to the COVID-19 crisis and implement a “stay-at-home” order to which many people refuse to adhere. But if wearing a mask is going to be our new norm, why not consider making person-centered care your new norm in your community? You can start with a few subtle shifts in the way you communicate with your residents, families and your team.
For example, read aloud this statement: “My mom lives in a facility a few miles from here.” Now read this statement aloud: “My mom lives in a community a few miles from here.” Which one sounds like a place where YOU would want to live? Do you see how one word makes all the difference? What comes to mind with the word facility? Instead of using the word “unit” try referring to where someone lives as their “home.” Instead of saying someone is an “employee,” using the term “team member” to imply they are an important, valued part of an organization. These are just some examples.
Being part of the movement is not a radical change but embracing a new language and culture change will not be possible without a language shift. Consider how one small change with your organization’s culture that will come about just by simply changing the way you communicate with your residents and your team. Small changes have a life-changing impact. Your team and the residents deserve the best and the making the change is worth the effort.
The Culture Change movement is a huge shift, just like the one we are living right now. If you can survive the pandemic in your community, you can adapt to the Culture Change movement, too. Why not make person-centered your new “normal” when it comes to care?
A culture change shift will have an immeasurable impact on the lives of those you care for and serve. If you’d like to be part of this movement and be the change you want to see in your community, please consider joining the NJ Alliance for Culture Change (NJACC) or looking into some of their suggestions. This organization serves as a resource and an inspiration to those who are new and to those who are already practicing culture change in their communities. Please visit www.njculturechange.org for more information.