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Providence Mount St. Vincent

Resident Systems Transformations

Below is an Example of Marketing Information on The Mount's Nursing Neighborhoods

"You can have all of the best intentions in the world, but without the systems and structure to maintain the change, it won't last." - Charlene Boyd

An organization has to "find the initial fit and then keep going back and implementing changes to support the needs of the organization."  

To achieve this type of continuous implementation, new systems are constantly developed in each area of the community based on residents' and staff members' needs. Staff at The Mount then share successful transformations so the larger network can benefit and adopt best practices when possible. 

Based on case study findings, the below examples expand on the list of Resident Systems from Assessing Impact (previous page) and describe systems discovered through The Mount's ongoing organizational transformations. These are the systems identified as most likely to affect resident and family outcomes.

The below transformations are based on the Resident Systems table (displayed on the Assessing Impact page) and are those most likely to affect resident and family outcomes. Examples are listed below each strategy.

1) Create an inclusive community and "home" for residents, families, and the outside community that is constantly communicating and reinforcing resident-directed choice and focus. 

  • A resident-directed focus is utilized in marketing materials, so that residents and families are introduced to expectations regarding resident-directed care at an early stage.  
  • There are no uniforms at The Mount to delineate between community members and staff. 
  • Resident choice is respected. "I don't want to work somewhere without banana ice cream." - A staff member commenting on how happy a resident was when her favorite ice cream was ordered for her. Other examples: residents' dogs and cats are welcome and each neighborhood has a "neighborhood cat"; residents' preference of no cell phone use is respected.
  • Payment for services is transparent to all residents and most staff (i.e. others do not know which residents are utilizing Medicaid). When residents spend down in community areas such as Assisted Living, they stay in their apartments and utilize Medicaid as a payment source. 
  • Family education regarding person-directed care and support is a priority. 
  • Death and dying are honored. "We want to be with them, particularly in their final journey." - Sister of Providence 

2) Work is organized around maintaining resident's autonomy and preferences with inclusive language supporting residents to be "known" as individuals instead of medical conditions.  

This will vary by the needs of each community area. Examples below:

  • Nursing Care Neighborhoods  - The Mount utilizes consistent assignment of residents with care assistants which leads to a relationship and "knowing" individual preferences. Staff are cross-trained and able to help residents with multiple requests (going to the restroom, brewing coffee, doing laundry, fixing a sandwich, and eating). Activities are meaningful. Residents maintain personal schedules based on preferences. Each neighborhood maintains mixed acuity levels. Resident choice is documented in the care plan. "We encourage residents to tell us how they want it." - Neighborhood Coordinator. 
  • Short-term Sub-acute Medical Rehabilitation - Unlike other parts of the community, this area still has a clinical focus and older adults utilizing sub-acute, short-term services prefer to be called "patients" instead of residents. In addition, the rehabilitory and therapeutic nature of stays requires a more structured schedule. To accommodate a person-directed focus, therapy will ask individual preferences and schedule services accordingly. For example, if a patient is not a "morning person" therapy will be scheduled in the afternoon. Older adults also have choice on elements from diet to meal times and bring in their own street clothes.
  • Assisted Living Apartments - The Mount's assisted living apartments operate with a "Hand in Hand" program. Along with family members and staff, each resident (even the frail and those with dementia) help to determine how much assistance he or she needs.  All residents pay one fee and receive however many or few services they need or desire based on the negotiated service plan. As long as the assisted living program is able to meet their needs, residents move from their apartment only if they choose to do so themselves. "It's not modeled after a hotel like other places. You can have chandeliers and pianos, but without relationships, it won't work." - AL staff member.  

3) Inter-disciplinary, cross-trained teams operate throughout the organizational structure with an objective of putting residents before task and taking advantage of synergies in the organization. 

  • Each neighborhood has a shared staff of about 18 people including: a neighborhood coordinator, resident assistants, recreational therapists, food and nutrition workers, a social worker, nurse, spiritual care worker and housekeeper. Similar types of coordination occur in other parts of the community.
  • The inter-disciplinary team also allows for organizational balance where staff are empowered to concentrate on more than one aspect of the community. "Clinical still cares about clinical and regulatory but we also balance that with caring about our 'home' for residents." - Neighborhood Coordinator (and RN).

4) A relatively flat organizational structure with the resident at the top of the organizational chart is prioritized (allowing for effective communication among and between inter-disciplinary teams and residents).

  • We are always trying to make life better for the residents. When I have new ideas, our administrators listen." - Resident Assistant.
  • Tom Mitchell, The Mount's Administrator, attends resident council meetings to understand pervasive concerns and act on resident needs (during the case study visit, initiatives in dining and laundry were as a result of this attendance). 
  • "This is the residents' house, and we work to meet their needs. They are the boss." - Resident Assistant. 

5) Staff-resident interaction is a priority and staff "know" residents. 

  • It is an expectation that staff and residents alike learn about one another's lives, hobbies and interests. "I'm committed to the resident, respect, compassion and a good relationship. We get along well and I want them to be happy." - Resident Assistant (of 20+ years).

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