Resident Directed Care
by Charlene Boyd
Resident directed care is a care plan and schedule based on the preferences of each individual resident.
Across the country, a silent revolution in elder care has been under way for more than a decade. Here in the Puget Sound area, Providence Mount St. Vincent in West Seattle was one of the first long-term care providers to join the revolution. Driven by the Sisters’ of Providence mission of compassionate care, “The Mount” began a process of organizational and cultural change in the early 1990s. The process transformed both the philosophy and model of care, as well as the physical environment at The Mount. A team of professionals is now working to implement the model at the new Vashon Community Care Center. Here’s a look at how this national revolution in elder care began:
Many people say they “...would rather die than be put into a nursing home.” Why do we fear traditional long term care in America? How have we come to hold stereotypical images in our minds of pungent smelling corridors dotted by slumping old people in wheelchairs and stories of abuse and neglect. What has gone wrong in extended care facilities to make them a place where people go to die, rather than to live the rest of their lives as fully as possible? Consider the following facts:
Nursing homes are generally associated with a decline in physical and cognitive function as well as increased depression. Studies show 65 to 75 percent of waking time is idle. Residents express loss of control and choice in basic activities for daily life. Even with the best intentions, staff tend to reinforce dependent behavior.
Beginning in the mid-1960s, public policy and economic pressures compelled most long-term care facilities to adopt medical model or hospital-like operations. Aging adults and others who were no longer able to care for themselves received nursing care delivered within a hierarchical organization, aiming to achieve staff efficiencies and meet patient’s medical needs. Little room existed within this model to fulfill resident preferences and assure quality of life.
Over time, many providers, consumers and government representatives became concerned that long-term care was not always the highest quality achievable, and thus in 1987 the Omnibus Budget Reconciliation Act was born. Nursing-home reform legislation known as OBRA mandated that residents come first and must be afforded the potential to live each day as though they are in a true home.
Stemming from OBRA, a new focus emerged: better-quality care, resident rights advocacy and promoting the human spirit. Driven by a philosophy of putting residents first, creating communities and taking a holistic approach to caregiving, many providers have adopted new social models of care.
Staff focus on promoting physical, mental and spiritual well-being and care settings that provide a sense of home. One of these models is “resident-directed care” which is best implemented in an environment of “culture change.”
The primary goal of the resident-directed model is to provide care that is more directed by residents’ preferences and needs and places high value on human interaction in order to improve resident satisfaction and quality of life.
Secondary goals are to improve resident function and health status as well as staff efficiency and productivity. Under this model, staff honor residents’ deep, healthy desire to retain control over their lives. Residents are primary participants in developing their individual care. As much as possible, residents choose their own daily routines and services they wish to receive.
This model offers personalized care in a physical structure that resembles houses or neighborhoods rather than traditional wings or units. Hallways and resident rooms can be filled with plants and pets, “neighborhoods” (or units) are decorated based on resident preferences and care always revolves around the needs, preferences, and wishes of residents and not around the schedules of caregivers.
Intergenerational activities involving children visitors or on-site day-care enrollees, residents and others of all ages are scheduled daily. All of these stimuli add layers of connection and normalcy for residents and help them continue to experience meaning in their lives.
The notion of culture change suggests that by changing the focus of control from a hierarchical system of staff management to one based on residents making choices, dramatic changes can occur in the way residents and staff live and work together.
The development of meaningful relationships can extend into a nursing home community where people are recognized, appreciated, cared about and understood. Thanks to the hard work of hundreds of providers, consumers and government representatives, these and other social models of care are being implemented at facilities around the country. Providence Mount St. Vincent in West Seattle is one. Through perseverance, the new Vashon Community Care Center will be one of the next.
Charlene Boyd has served as administrator of Providence Mount St. Vincent in West Seattle since 1996. She is also a founding board member for the Pioneer Network — a national organization leading the culture change movement for the long-term care industry. She also is a VCCC board member.
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