Resident Care in Nursing Homes
Nursing Home Culture Change
There's a culture change transpiring in nursing homes from the traditional institutionalized care to in person-directed care. The traditional culture in nursing homes revolves around the tasks within constricted schedules: residents wake up and go to bed, eat, bathe, and even go to scheduled bathroom visits.
The change refocuses individual routines, giving control to the elders and the staff who work closest to them. The goal is normal living, and nursing homes adjust care and routines to the resident not the institution. The typical routine for a resident in traditional care; a person is given the waking time, bathing slot, and dining room seating.
With the culture changing to resident-focused care, the person makes decisions as they would in normal life and it promotes choice, purpose and meaning in daily life. It means to encourage and support residents to achieve the highest level of physical, mental and psychosocial well-being that is possible.
Residents remain at the center of the decision-making and care planning process. The staff participates in active listening and observing and adapts to each person's changing needs.
Examples of Resident-Directed Care
- Dining - Meals give options and with resident input. Food's available 24 hours/day and staff give food to residents when they want it. Dining rooms have table settings, table cloths, lighting, music, servers and restaurant-style service.
- Bathing - Flexible schedules to meet the residents' desires and choices. Bathing encourages dignity.
- Resident daily schedules - Residents participate in making the daily agendas and developing the care plans.
- End of Life Choices - Programs that support residents' participation in their own end-of-life care and wishes.
- Rooms - Designed for privacy and individual needs.
- Outdoors - Public spaces designed for stimulation and activity.
- Neighborhoods - Social environment designed to create households.
- Staff - regularly assigned to same residents.
- A Sense of Community - Meetings to promote community and unplanned activities.
- Living Environment - Connects with the larger community that embraces nature, gardens, animals, children, crafts, music, art and technology.
- Volunteer Programs - Allows for resident-specific activities and visits.
- Resident-directed care - programs to give formal training on person-directed care to staff.
Resident Care in Nursing Homes
Nursing home care changes from task-centered to resident-centered and they restructure their systems to support staff in obliging residents' needs and preferences.
In the old culture of traditional nursing home care, when residents transfer to hospitals because of an acute change in their clinical condition, the patient becomes prone to trauma and more health risks due to hospitalization. But in the newer, patient-centered care, the changes in condition are better managed safely without transfer.
- Staff gives standard treatments based on diagnosis.
- Routines prioritize nursing home and staff needs, not the residents'.
- Work is task-oriented and assignments rotated.
- Tasks performed on the patient.
- Centralized decision-making, not resident-centric.
- Hospital environment, yet home-like setting.
- Structured activities lead by activity director only, not resident-led.
- Sense of isolation and loneliness.
Risk Prevention to Health Promotion
Resident-Centric is Better Care
In the resident-centered goal, nursing home staff are more prepared with enhanced resources and skills. The nursing home staff can safely care for residents on-site.
How patient-centered care benefits a resident living in a nursing home?
- Have autonomy and able to direct their own care and services.
- Have choices that foster personal interaction and involvement.
- Have access to an environment that supports trust and respect.
- Have closer relationships with staff who are in tune with health changes.
How does resident-centered care benefit nursing homes?
- Have better outcomes due to quickly identifying and responding to changes in a resident's condition.
- Have increased referrals from people having better experiences.
- Have increased staff retention because of the strong relationships with residents.
What to Look for When Evaluating Nursing Homes
- Homelike dining
- Homelike bathing environment
- Resident-driven schedules
- Opportunities for self-care and mobility using adaptations in personal and public settings
- Rooms designed for privacy and individual needs
- Involvement with children, pets, plants
- Outdoor spaces yielding resident stimulation and activity
- Resident involvement with care planning
- Consistent staffing
- Staff training
- Family involvement in decisions
- Intergenerational living
- Volunteer programs for residents
- Promote staff satisfaction
- Open communications with all involved
What to watch out for in Medications
Medications promote well-being and when used inappropriately, they compromise a resident's well-being and even cause death.
- Inappropriate use of antipsychotics causing adverse effects: death, heart attack, stroke, falls, and hospitalizations.
- Non-pharmacologic interventions that promote quality of life and well-being.
- Non-pharmacologic interventions that promote communication and relationships for residents with family and friends.
- Appropriate medications reduce risk of medication errors.
What to watch out for in Mobility
Mobility helps a person's range of motion, bed mobility, transferring, walking, eliminating physical restraints, wheelchair mobility, and reducing fall risk. It improves freedom of movement and increased activity.
- Stronger muscles and bones, which makes fractures less likely in a fall.
- Improved heart and lung function.
- Enhanced sleep.
- Improved appetites.
- Less complications like muscle wasting.
- Increased attention and alertness.
- Better moods.
- Move better and more often, lessening risk of pressure ulcers.
- Better self-transfer and walk more safely.
- Steadier when standing or walking.
- Promote independence with during activities like dressing, eating, and using the toilet.
- More social.
What to watch out for in Managing Pain
Managing pain prevents and minimize episodes of moderate to severe pain. More pain causes depression, sleeplessness, restlessness, or decline in appetite and unintentional weight loss.
- Residents better control pain management.
- Residents do not experience a decline in functional status.
- Residents are not at risk for depression due to uncontrolled pain.
What to watch out for in Pressure Sores
Pressure sores are dangerous and painful for a resident because broken skin introduces infection into the body. If untreated, pressure ulcers can deepen, exposing the bone. They are hard to heal. Sometimes, pressure ulcers lead to serious medical complications and even death. Even if pressure ulcers heal, the skin never returns to normal and will be at higher risk for future pressure ulcers.
Pressure sore prevention:
- Residents experience less pain.
- Residents experience fewer infections.
- Residents experience better quality of life by avoiding the negative effects of pressure ulcers.
Nursing home who practice resident-centric care knows this transition is a collaborative process and it requires the understanding of clinical and the life quality indicators for individuals, resulting in a modified approach to care.
When searching for a nursing home to care for your loved one, don't assume all nursing homes practice this new patient-centered care approach. It requires a big system change in practices, physical environments, workplace practices, and relationships with staff and family members.
After seven years of helping her aging parents, Carol Marak has become a dedicated senior care writer. Since 2007, she has been doing the research to find answers to common concerns: housing, aging and health, staying safe and independent, and planning long-term.
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