Person - centered care in a long-term care facility - Assignment Example

? Person- centered care in a long-term care facility al affiliation Person- centered care in a long-term care facility 0Introduction Long-term-care facilities are institutions, in which, feeble individuals, aged people or persons suffering from chronic conditions are taken to, in order for them to be given proper long-term care. Such facilities include; nursing homes, assisted living institutions, and care homes. Residents in these facilities are people who are unable to care for themselves properly, as a result of the prior mentioned conditions. Majority of residents are aged 85 years and above, and are in constant need of someone to assist them in performing their habitual practices. This essay seeks to evaluate how a worker in a long-term care facility can improve the conditions in the facility using the person-centered approach as opposed medical-centered care. In order to assess the problem successfully, the worker needs to follow the following steps: first of all, the worker needs to identify the problem, then a review of the worker’s macro reality. The third step involves the worker establishing their own macro reality, then identifying any relevant people who might help the attain success. Step five entails an estimation of probable fiscal fee and benefits, followed by an evaluation of the worker’s professional and private risk. The last step of appraisal is an evaluation of intervention’s probable success. 2.0 Nature of the problem In prior years, residents in long-term care facilities were made to feel as if they were in a hospital, where the most used approach in this field was the staff-centric approach. Under this approach, medical practitioners have always treated such people as disabled weaklings, waiting to die. Therefore, care providers need to monitor residents constantly, as well as keep updated reports on the progress of such patients (Sullivan, 2002). On the other hand, person-centered care approach seeks to have such people treated in a manner that most likely to make them live comfortably and feel at home. The issue of concern here is that person-centered care seeks to cater adequately for the needs of these people on a personal level. According to Assisted Living Workgroup Report to U.S. Senate Special Committee on Aging (2003) these people ought to have their communal, emotional and religious needs catered for while still being allowed to enjoy privacy and personal choice. The chief complaints were; inadequate care in as far as quality of life is concerned and disregard for residents’ rights. These residents complained that care providers, often failed to answer to their calls for assistance, that members of staff did not respect the residents, and poor feeding in terms of quantity, quality and variety. In addition, residents complained that some of the staff members did not handle them properly, and sometimes residents suffered minor and serious accidents. Lastly, residents complained that they were not being given adequate notice concerning discharge and eviction from nursing homes (Colello, 2011). In the traditional model, occupants in long-term care facilities had little privacy or none at all. They shared bedrooms, bathrooms, and only a curtain was used to separate these spaces, so as to generate a feeling of confidentiality. In addition, staff could routinely enter residential rooms without even knocking or waiting for a response if did indeed knock. All this meant that an individual could not find time to spend by themselves or with relatives who would come to visit. The right of an individual to enjoy privacy is highly emphasized in person-centered care. Under the new rules, privacy should be enhanced as residents are provided with private bedrooms and areas where they can spend personal time with family and friends. Personal belongings are also a crucial part in handling occupants of nursing homes. When a person leaves home and registers in a long-term care facility, they feel a certain loss at leaving behind all their possessions, which they have attained through hard work. Residents, therefore, feel disrespected when employees at nursing homes perceive the few items that residents are allowed to carry, as just that, items. The worker, therefore, proposes that residents be allowed to bring any items they consider valuable and that employees handle such objects with care. In the traditional model, nursing units were designed in such a way that 40-60 beds were arranged on either sides of a long corridor, a sole multi-use room for meals and group activities, and a nursing station was located at the centre, for easy monitoring. In accordance with the new guiding principles, the worker proposes that residents within the facility be grouped into groups of 7-24, and then assigned a household, which should look like a real house. Residents should be provided with spaces that feel like, and reflect spaces residents have in their real homes. This includes structures such as kitchens adorned with tables, living rooms with fire places, private bathrooms and bedrooms, and outside spaces for communal gatherings (Calkins & Brush, 2009). The worker also considers the issue of lighting in the long-term care facility. According to the worker, lighting in a majority of these facilities was designed to suit the needs of staff members as opposed to residents, in the traditional medical-centered model. The worker recognizes that vision in human beings tends to deteriorate with age, therefore, advocating for the need to provide ambient lighting in the facility. 3.0 Who is affected by this problem? The most affected people in as far as person-centered approach is concerned are residents in long-term care facilities. Almost every resident in a nursing home has problems to do with traditional, staff-centered approaches. From a report conducted by an ombudsman in 2007, statistics show that there have been numerous complaints by residents concerning the quality of life long-term care facilities. For instance, in 2007, there were approximately 300, 000 cases of residents complaining about how they were being treated in nursing homes and other support institutions. The worker also identifies staff members as being affected by the person-centered approach especially in terms of workload. The worker determines that the traditional approach is characterized by insufficient nursing aides to gratify the desires of individual residents. This often leads to negative attitudes of overworked nursing aides, towards residents. The worker, therefore, under the proposed approach looks at crucial areas in which, staff members are affected by the person-centered approach. First, if a member of staff is expected to devote their time and energy on an individual resident, then their wages need to be increased. Secondly, the staff needs to be trained on how to go about implementing the new procedures. The worker proposes a new type of education for existing staff members so that they can be proficient in dealing with the changes. According to the worker, staff education should also be enhanced to reflect on the personal, emotional, and psychosomatic needs of residents. Members of staff should also be trained to appreciate the strengths of residents, rather than focusing solely on their weaknesses and perceiving them as frail individuals in constant need of help (Colello, 2009). Staff should be flexible enough to meet the desires of every resident (National Center for Health Workforce, Analyses Bureau of Health Professions &Health Resources and Services Administration, 2004). Relatives of residents and the local community are also directly affected by the proposed change. The worker explains that this is for the reason that; the community is expected to foot the bills that are going to arise from the implementation of these changes. Everyone would want to see their relative or neighbor treated well. Therefore, the worker needs to convince the relatives and the local community that the intended change is for the good of the residents, and society as a whole. That way, this group of people is going to be very willing to provide the much needed resources and funds. It is, therefore, imperative that macro change be implemented in nursing homes, considering the number of files being opened as a result of complaints from residents and relatives. This will result in residents’ peace of mind, as well as decreased levels of depression among residents (Sullivan, 2002). 4.0 Macro change and personal reality In an effort to improve the living conditions in long-term care services, the worker has seen it necessary to evaluate macro and personal reality in the facility. Macro change refers to the major issues in the change process that need to be addressed. These include; financial implications, environmental factors, legal, political, social, and technological conditions. In assessing macro reality in the facility, one needs to assess the barriers to the intervention, as well as forces perpetuating the intended change. The macro change might include the overhauling the entire facility’s program, as well as a change in its policies. For example, changing the entire design or structure of the nursing home may be the only option to achieving the desired goals. After the worker is through assessing the macro issues, they turn their attention to their personal reality. The worker needs to consider personal weaknesses and strengths before embarking on the proposed change in the long-term care facility. In order to achieve this, self–centered care should be the mission in nursing homes (Sullivan, 2002). All staff should be actively involved in designing a favorable environment for the implementation of person-centered care. This may include changing staff education, policies governing the facility, the procedures to be followed when dealing with residents, and job descriptions of different staff members (Kirst-Ashman & Hull, 2011). 4.1 Barriers to person-centered care 4.1.1 Funding and resources One of the major factors that might present a challenge to the implementation of self-centered care is funding and resources. The worker might have all these ideas on how to change the settings in the long-term care facility, but the funds and resources may not be forthcoming. For example, if the facility is to include the number of rooms in the facility to ensure privacy of residents, then more funds for building are needed (Calkins & Brush, 2009). If the funds are to come from within the facility, this might have a ripple effect on other operations in the long-term care facility. For example, this might merit the laying off of some members of staff, in order to save money that is used to put into practice the proposed transformation. This might not go down well with the employees being laid off. 4.1.2 Internal political climate This brings us to the second barrier, which is the relationship between the administrators and other staff members. How the administration treats employees, as well as the political climate within the facility determines how the process of change will be implemented. A rigid administration which does not consider the views of other staff members is most likely to meet resistance from the latter. If staff members are not for the idea, then implementation of the same will be very challenging. 4.1.3 Clear understanding of the problem Another issue that may work against the proposed change would be a lack of an apparent understanding of the problem and how to solve the mentioned problem. For example, the worker may be aware that the facility needs to encompass person-centered care, but may not know how to execute the change. For example, the worker may not have an adequate understanding of residents’ needs. Change in the entire setting of the facility might not necessarily mean catering for the needs of each and every resident. 4.1.4 Personal reality The worker in this context also needs to assess their personal weaknesses, for example, the level of confidence they have in the project’s success. If the worker has very low confidence in the potential success of person-centric care, then other employees will also be demoralized. Consequently, the change process might not even start, leave alone progress. 4.1.5 Personal risk In an effort, to champion for the rights of residents and bring change to the facility, some people within or outside the facility may perceive the worker’s intentions negatively. For example, administrators may tend to think that the worker is trying take over their leadership roles, thus bringing about resentment towards the worker. Others might think that the involvement of external people in the assessment process might lead to the tarnishing of the facility’s reputation. This is because most organizations prefer to keep their weaknesses to themselves, and find solutions on their own. Either way, the worker’s career is at stake if influential people feel that the facility is being threatened by the worker’s actions. The worker could lose their job, strain work relationships, or minimize their chances of upward mobility within the facility (Calkins & Brush, 2009). 4.1.6 Staff longevity The worker identifies long serving employees in the facility as potential challengers of the planned amendment. This is because; this group of people has grown accustomed to the way things are currently run within the organization. This means that they are more likely than not to oppose the changes being proposed by a junior colleague, who has not been in the facility long enough. This group of staff members perceives the worker as someone out to make a name for themselves. They are of the idea that since the traditional medical-centered model has worked over the years, and residents are still registering into the facility, then change is not necessary. 4.2 Forces that perpetuate person-centered care 4.2.1 Government and public support Support from the government and the local community is essential in ensuring that person-centered care is achieved in long-term care facilities (Calkins & Brush, 2009). If the local community is made up of people who have relatives in need of care, then such a community will embrace the idea of self-centric care. The worker also needs to ensure that the laws of the land do not restrict any of the changes they are planning to bring into the facility. With aid from the neighboring area and the government, the worker is at the very least assured that external resistance will not be a challenge. 4.2.2 Good relationships among colleagues Collaboration and cooperation between staff members, ranging form the administration level to the support staff is valuable for the change process. The worker, therefore, needs to ensure that all staff members are for the idea of self-centered care. If the worker is a good person who relates well with other staff, then change will be readily accepted, and employees will even participate in the implementation of the change. This is especially true, if the administration is one that appreciates the opinions of junior staff. Freedom of expression will give junior staff a sense of belonging and motivate them to participate in the change process. 4.2.3 Worker’s positive attributes The worker to be a hardworking, competent, and goal oriented person, who is well aware of their capabilities and is confident in their work. The worker then needs to identify other people within the facility, who possess leadership qualities, and are able to lobby support for the project, within and without the facility. Once the worker has other staff members supporting the idea, then the administration will be quite easily convinced. 4.2.4 Restrictive laws The worker already knows that the government requires that residents be treated using the person-centered approach, yet the facility is still operating under the medical-centered approach. The worker, for that reason, is convinced that administrators would not want to be found breaking government law, and are, therefore, bound to accept the worker’s idea (Calkins & Brush, 2009). This is because the facility would not want to tarnish its reputation to the public. 4.3 Goals For the worker in this case study, the short-term goal is to enhance capacity among residents, staff members, and society at large in the provision of person-based care. The long term goal is to transform completely from a medical-centered model in the long-term care facility, into a self-centered model. The latter, which will ensure that residents are being given the best quality of life, while still enjoying their human rights. In order to achieve this, the worker comes up with a project that will involve the transformation of the facility’s structures to reflect a more privatized setting for residents. A change in the facility’s policy will also be crucial if the project is to succeed. Change in policy means that the worker and other staff members, with the support of the administration, start treating residents as people whose lives are only continuing in a new setting, other than people waiting to die. 5.0 Who is involved in the assessment process? 5.1 Members of staff The process of introducing new concepts in a traditional setting can be very challenging and requires the help of other people in the society to implement fully. Therefore, in assessing the prospects of person-centered care in a given facility, the worker first and foremost needs to ensure that other staff members also see the logic behind the proposed system of running the facility. This might prove a bit challenging since different people often have diverse opinions. However, with clearly stated procedures, guidelines and projected outcomes, staff members will be persuaded of the proposition. Motivated staff members are an integral part of any organization that seeks to grow. 5.2 Residents After ensuring that staff members are convinced of the initiative, the worker then needs to convince residents, to approve of the idea as well. The worker needs to categorically state that the new approach is primarily for the good of the residents and make it clear to them the advantages of the intended transformation. For example, the worker can sell the idea of the creation of personal space to residents, to make them see that person-based care will really help them. Once residents are convinced that the proposed adjustment is for their own good, then they will be instrumental in convincing their relatives, and the entire community of the idea. 5.3 The community The neighboring population has to be concerned in the assessment of the problem, if the worker is to succeed in his plans (Calkins & rush, 2009).For example, relatives of the residents need to give their opinion on how they perceive the present conditions, and how they think the new changes will impact on the lives of residents. With the help of colleagues, the worker convinces the public to participate in the change process. In the assessment of the problem, it is crucial to have staff members, residents, their relatives and the local communities buy the idea of person-centered care. These different groups of people will contribute towards the assessment, either intellectually or in monetary terms. This will ensure in-depth evaluation of the problem and nothing will be left to chance. 6.0 Who are the special people who will bring talent to the assessment? 6.1 The administration In order to ensure desirable results, the worker needs to enlist the help of administrators in the facility, as well as the medical directors. Once the worker has convinced the two groups of people of the idea to implement the change, then the change process will be on its way to success. The rational behind getting the worker getting support from senior members in the facility is that, the organization might be more willing to provide funds for the realization of the projected change. 6.2 Government agencies The worker also seeks the assistance of government agencies in the assessment of the problem. A government ombudsman comes in handy in assessing the prospects of a person-centered care approach. The ombudsman gives a report to the worker concerning the state of the facility, based on complaints from residents, their relatives, and the society, as well as from personal observation (Colello, 2009). This will ensure that as the worker progresses with the planned change, the government is well aware of the process, and that it is not in any breach of government regulations. 6.3 Other experts The expertise of other players in the medical field who do not necessarily work for the government will be imperative in the assessment of the problem. The worker, therefore, enlists the proficiency of certified psychologists, psychiatrists, and therapists among other specialists. Their role is to give their expert opinion on how the change should be executed to cater for the specific needs of individual residents. Expert opinion brings to the light, issues that other people may not have noticed or may have overlooked. For example, an eye specialist may propose the installation of a different kind of lighting in residents’ dressing rooms. This is because; some forms of light may hinder an old person’s vision, making them rely on nursing assistants to dress them (Colello, 2009). Conversely, good lighting may enhance an elderly person’s vision, and they can comfortably dress themselves. 6.4 The media The media plays a vital role in the assessment of the problem. The worker requests for help from the media, so that the latter can send agents to come and review the problem. If the issue is really as bad as the worker sees it, then the media will publicize the issue and the administration will have no other choice than to upgrade the facility (Sullivan, 2002). The publication of the issue, therefore, serves as an impetus to the change process. 6.5 Insurance companies Lastly, the worker approaches one or more insurance companies for a financial analysis of the proposed project. Such a company will give estimates on how much a resident is supposed to pay in order to be fully covered in the new setting. New buildings and other facilities are assessed, and then the insurer gives an honest opinion on whether a majority of residents will be able to pay for their upkeep. If the estimates are too high, then the worker might have to scale down on the costs of some facilities and equipment. Nevertheless, the worker finds the estimates affordable and decides to pursue the project. 7.0 The prospective success of the macro change The worker then needs to evaluate the probable success of the macro modification, after completing all the discussed stages. The worker evaluates the cost of the project in terms of the cost of building materials, staff time, and the cost of staff education and training. The worker then looks at what other alternatives are there, for providing the same person-based care at a cheaper price, and finds out that there is none. The worker is quite confident that since the change is going to benefit the residents, facility, and the whole community, the administration as well as the society will be eager to grant the needed finances (Sullivan, 2002). Benefits include protection of residents’ human rights, and enhanced relationship between nursing aides and residents. Better quality of life for residents, collaboration and partnerships between different stakeholders, and the projected prestige will be associated with the facility. The only cons are expenditure, and potential resistance from a minority within and without the facility. All things considered, the advantages of the project far outweigh the drawbacks, and the worker decides to go ahead and implement the proposed change with the help of all stakeholders. 8.0 Conclusion It is evident from the discussion above; that person-centered care is the best kind of care for those inhabitants of long-term care amenities. The worker in this particular case takes it upon themselves to initiate the much needed change that will see the quality and quantity of life in the facility improve. According to Sullivan (2002) the worker goes about this by coming up with the modern idea of basing long-term care on the needs of the resident, rather than on those of the staff. The worker then goes ahead to popularize their idea among colleagues, the administration, and the community, so that they can all support the idea. Once the worker has the much needed support, they devise a plan on how the assessment of the problem will be done, and what the guiding principles are going to be. So as to achieve this, the worker evaluates the assets that they have to help them forge forward. After the critical evaluation of available and probable assets, the worker then weighs the pros and cons of the intended project. If the pros prevail over limitations, then the worker starts putting the plan into action, and in the process, all opposition is convinced of the necessity and workability of person-centered care in the long-term care facility. The worker in this case acts in the best interests of the residents, administration, staff, and the entire community, not forgetting the government. References Assisted Living Workgroup Report to U.S. Senate Special Committee on Aging. (2003). Topic group recommendations: Definition and core principles (pp. 11-22). Washington, DC: Assisted Living Workgroup. Calkins, M. & Brush, J. (2009).Improving Quality of Life in Long-Term Care. Retrieved February 10, 2012, from perspectives.asha.org Colello, K. (2009).Older Americans Act: Long-Term Care Ombudsman Program. Congressional Research Service. Retrieved February 10, 2012, form www.crs.gov Kirst-Ashman, K., Hull, G. (2011).Generalist Practice with Organizations and Communities. New York: Cengage Learning. National Center for Health Workforce, Analyses Bureau of Health Professions, &Health Resources and Services Administration. (2004). Nursing Aides, Home Health Aides, and Related Health Care Occupations --National and Local Workforce Shortages and Associated Data Needs. Retrieved February 10, 2012, from bhpr.hrsa.gov/healthworkforce/ Sullivan, K. (2002). Community Organizing Strategies to Reduce Risk and Increase Capacity. The 9th Annual Governor’s Conference on Child Abuse & Neglect. Baltimore. Read More