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Recipes for Environmental Change



RESOURCES

Getting Started: Before you choose your ingredients and start cooking, it's important to address the culture change concepts and the reasons why you are engaging in change in the first place. Core practices of choice, relationships and creating home are the "ingredients" that are necessary for your implementation recipe and at the heart of any culture change implementation. Without adding these ingredients into the mix, you might find that  the most beautiful environment is not pleasing when residents don't have the choice on when or how to use it.  We found some great resources to get you started on examining these core ingredients in your organization. Choose one or more, but don't miss out on this most important preparation step.  It's the KEY to your success!

Get Cooking on the Environment: Once you've explored the ingredients in your organization, it's time to get cooking. This is the opportunity to explore the supportive practices in the Environment that will help maintain choice, relationships and creating home for residents. For the Environment Toolkit, we have a few ideas to get you started. Some are easier and some are harder. Or, maybe, you'll want to go a completely different direction. Just like browsing through a cookbook, these thoughts just may provide the inspiration that moves you forward  in your planning process.





Tools (links to resources in green)

 
 
      
Low Cost Practical Strategies (Lois Cutler and Rosalie Kane) 
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2010 Stakeholders Survey: Culture Change and the Household Model (UWM)

  
 
  
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A Stage Model of Culture Change in Nursing Facilities (Action Pact) Δ         
A Tale of Transformation (Action Pact) Δ     
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Access to Nature (accesstonature.org) 
 
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Artifacts of Culture Change (Centers for Medicare & Medicaid Services) Δ         
Bathing without a Battle (University of North Carolina)    Δ
     
Center of Design for an Aging Society  Δ
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Creating Home in the Nursing Home I (Pioneer Network)   
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Culture Change Consensus and Household Model Think Tank (UWM) 
     
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Culture Change Education Modules (Kansas PEAK Nursing Home Initiatives) Δ         
IDEAS Institute 
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Dementia Design Info
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Design for Generations    Δ      
Design on a Dollar (Pioneer Network) ΔΔ
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Getting Started (Pioneer Network) Δ         
HATCh Model (Healthcentric Advisors, formerly Quality Partners of Rhode Island) Δ         
Household Matters Toolkit (Action Pact) Δ Δ
       
In Pursuit of the Sunbeam (Action Pact)      
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Long-Term Care Improvement Guide (Planetree and Picker)
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Path to Mastery (Eden Alternative) Δ         
Society for the Advancement of Gerontological Environments       Δ  Δ 
THE GREEN HOUSE® Project     
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The Household Model Business Case: An Editorial and Technical Brief (Action Pact)          Δ

REGULATIONS

Would you believe that regulations support many of the changes highlighted in Toolkit resources? We thought that you would want to know, so we highlighted a few important regulations below. As you discuss your changes with regulators, bring them to the table by stating your intent to honor regulatory guidelines. 

 Change AreaCenters for Medicare & Medicaid Services Regulation
 DecoratingF252 Environment:  The facility must provide a safe, clean, comfortable and homelike environment, allowing a resident to use his/her personal belongings to the extent possible. "A 'homelike environment' is one that de-emphasizes the institutional character of the setting, to the extent possible, and allows the resident to use personal belongings that support a homelike environment."
 Overhead PagingF252 Homelike Environment:  "Some good practices that serve to decrease the institutional character of the environment include the elimination of: overhead paging and piped-in music throughout the building…"
 Adaptive
F246 Accommodation of Needs:  "Resident bathroom mirrors are wheelchair accessible and/or adjustable in order to be visible to a seated or standing resident."
 AdaptiveF246 Accommodation of Needs:  "Sinks used by residents have adaptive/easy-to-use lever or paddle handles"
 AdaptiveF246 Accommodation of Needs:  "Adaptive handles, enhanced for easy use, for doors used by residents (rooms, bathrooms and public areas)."
 Resident RoomsF461 Resident Room:  "Closets have moveable rods that can be set to
different heights."
 AdaptiveF246 Accommodation of Needs:  "Chairs and sofas in public areas have seat heights that vary to comfortably accommodate people of different heights."
 Nurses' StationF463 Resident Call System:  "In the case of an existing centralized nursing
station, this communication may be through audible or visual signals and
may include wireless systems. In those cases in which a facility has moved to decentralized nurse/care team work areas, the intent may be met through other electronic systems that provide direct communication from the resident to the caregivers."

RESULTS

If a recipe is a hit, it could become a regular staple. At the same time, you wouldn't want to keep using a recipe that doesn't work.  That's why it's important to measure results proactively and share what you find with the organization. This is your chance to keep tweaking until you get it right. Why not give it a go?

 Examples of Early to Mid-Implementation Impact (0-2 Years)
 Quality of LifeIncreased levels of resident satisfaction formally (surveys) and informally
(verbally to peers and staff); Increased levels of engagement (especially in
residents with chronic health conditions or dementia); Emphasis by residents and staff on relationships and community; Descriptions of the organization
as "home" or "family."
 Quality of CareResidents may rate clinical care higher (due to improvements in their overall experience). In addition, as the quality indicator most correlated with resident centered principles and care, use of restraints should decline. Improvements in weight loss, falls, agitation, pressure ulcers, and time in a bed or chair are also potential areas of impact. Of course, the level of clinical improvement depends predominantly on the organization's performance pre-implementation as well as the support of clinical leadership (Medical Directors and Directors
of Nursing) for resident centered care.
 StaffingIncreased levels of staff satisfaction formally (surveys) and informally (verbally to peers and leadership team); Active understanding of culture change and resident centered principles by the majority of staff; Formal recognition of employees for excellence in resident centered care; Self-motivation, critical analysis, and problem-solving by front-line staff to incorporate resident centered principles.
 OrganizationalIncreased levels of occupancy; Reduction in the use of agency staff; Increases to operating margins; Waiting lists for residents; Reduction in turnover of leadership team; Reduction in turnover of direct care staff; Strengthening of outside community support and volunteers.

Download Just In Time Toolkit - Recipes for Environmental Change