Establishing a Person-Centered Culture in a VA Nursing Home

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by JOHN DAVY

The Veterans Administration has taken up the model of person-centered care, asking administrators throughout its health care system to modify their facilities and train their staff accordingly. Staff from the VA’s newly-renamed Haley’s Cove Community Living Center (HCCLC) in Tampa, Florida recently published a case study on their own shift to the patient-centered model.

HCCLC assigned an ethics committee responsible for providing oversight and education on patient autonomy, and which reviews ethical issues that arise in providing care. The case study provides examples, including a resident asking to stay outside on the patio on sleepless nights. The case study presents how the committee and staff established a plan to encourage the resident’s autonomy without putting him or other residents at risk. Other examples include allowing residents more choice in diet and dining, and providing support for residents who want to dine out.
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Measuring Person-Centered Caregiving

by John Davy on February 15, 2011 in Aging in Action

Person-centered care has become the dominant model for dementia care in the US and UK. This model emphasizes that older adults who are receiving care should be viewed as social beings in a relationship. More concretely, this involves recognizing the personality, values and individual needs of the care recipient, and understanding their behavior through this lens. Within this framework, so-called resistive behaviors, such as withdrawal or aggressive behaviors toward caregivers, are framed as a sign of individual needs.

Despite the growing emphasis on person-centeredness, there has been relatively little done to formally measure the person-centeredness of caregivers. Researchers at Wichita State University and the University of Kansas recently published a study (Lann-Wolcott et al 2011) to validate two measures of person-centered caregiving, and to determine whether person-centeredness would reduce resistive behaviors on the part of individuals with dementia. One of these, the Person-Centered Behavior Inventory (PCBI) measures the extent to which the caregiver performed a set of targeted person-centered behaviors. The other measure, the Global Behavior Scale (GBS), does not count specific behaviors but is a more general assessment of the manner in which care is delivered. Further, the study explored a few other questions about the instruments– for example, whether different kinds of patients responded differently to person-centered care, and whether there was an effect of caregiver age.
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RealCareNowTV: Person-centered Alzheimer's care

The Pinnacle of Culture Change | ChangingAging.org

by Peg LaPort
UPDATE: Please continue this conversation on the newly-created LinkedIn Changing Aging Network.
Now that the snail mail has delivered hard copies of this month’s outstanding issue of Provider Magazine, I’d like to revisit highlights of the cover story: “Culture Change Goes Main Stream.”

• In 2005, nearly three-quarters of health care opinion leaders surveyed by the Commonwealth Fund were unfamiliar with the concept of “culture change,” despite nearly 20 years of advocacy within the movement.
• Three years later in 2008, 66 percent of respondents reported they were familiar with the culture change movement — a dramatic turnaround.
• A 2007 National Survey of Nursing Homes reported one-third of nursing homes had adopted some culture change practices and another one-third were planning to follow suit.

What’s driving the change in attitudes? Certainly, decades of work by advocates in the culture change movement pushing for more person-centered approaches to long term care, such as Dr. Bill’s Eden Alternative philosophy and Green House Project, labeled by Provider as the “peak” of the culture change movement. As of this year, 79 Green House homes have opened in 14 states, and another 132 homes are either in development or under construction in another 12 states.
But the biggest indicator of a sea-change in attitudes towards culture is the conversion of big for-profit facilities:
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Measurement Framework: Evaluating Efficiency Across Patient-Focused Episodes of Care

Although health care spending per capita in the United States is more than double that of other industrialized nations, the United States ranks comparatively low on key indicators of the quality of care and population health status. Inefficiencies such as duplicate tests and widespread regional practice variations plague the system. Performance measurement is essential to system transformation. To provide guidance to key stakeholder groups in accelerating toward a high-performing, high-value healthcare system, the National Quality Forum (NQF) convened a Steering Committee to develop a framework for evaluating the efficiency of care over time, including clear definitions and a shared vision of what can be achieved around quality, cost, and value, serving as a foundation for the work of larger performance improvement efforts. This report presents the NQF-endorsed® measurement framework for assessing efficiency, and ultimately value, associated with the care over the course of an episode of illness and sets forth a vision to guide ongoing and future efforts.

 Access the Report