In previous posts, I have described Continuous Care Retirement Communities (CCRCs). Recently I began exploring two CCRCs which are owned by the same non-profit organization. My parents began living in one of them in 1992 and the second one is located nearer my home.
I had a tour of the Assisted Living facilities of the second CCRC--my Mom lives in the Assisted Living facilities of the first CCRC. Both CCRCs have some best practices that are worth sharing as well as some areas for improvement.
As an organizational change consultant for more than 30 years, I would like to offer my services to these CCRCs as a facilitator for Best Practice Exchange. Because my mother lives in one of the facilities, I would be happy to provide these services in exchange for credit for Mom's expenses at the facility.
I have not yet made a proposal to the CCRCs or their parent organization and I can see the value such a program could have on the two CCRCs I am familiar with and the potential value the program could have for the other CCRCs owned by the same parent organization.
Perhaps I can get someone to view my digital portfolio and to check-out my profile and services so that they can see that I am serious about these ideas.
Showing posts with label CCRCs. Show all posts
Showing posts with label CCRCs. Show all posts
Tuesday, April 27, 2010
Wednesday, October 21, 2009
The Human Connection--Compassion--A Missing Component
In the continuous care retirement community (CCRC) where my 94-year-old mother lives, care givers associated with the nursing home and assisted living units have recently decided to go to 12-hour shifts. There are two teams--a white team and a blue team-- of care givers (nurses, certified nursing assistants, and resident staff assistants). The shifts are from 7:00AM to 7:00PM and from 7:00PM to 7:00AM. Each team has both a day sub-team and a night sub-team. The white team will be on for two days, and then has two days off while the blue team works. Each team works Saturday, Sunday, and Monday every other week.
In order to accommodate staff requests during this turn-over period (which began October 18th, 2009), some teams moved to different coverage areas. This CCRC has two assisted living units for people who have reached an age where they need more help than they get in their independent living apartments--help with medicine delivery, food preparation and delivery, and cleaning their apartments. Residents in these units live in one of 44 studio apartments with private bathrooms. One of these two assisted living units is for people with dementia--who have more problems with memory than the people on the other unit.
Care givers used to working with the dementia patients have developed routines in their service that they try to implement throughout the week. Because of their dementia, their patients are more docile and responsive to relatively aggressive leadership from their care givers. Some of these care givers have switched to be care givers in the other assisted living unit where the residents have more of their usual faculties for decision-making.
Some of these care givers, with the best of intentions, have tried to impose the structure of their dementia-unit routines on the residents of the other assisted living unit. The reaction of the residents of the non-dementia assisted living unit is strongly negative. These care givers, rather than making their own routines the important factor in their care, need to learn the needs and personalities of the residents of this unit and to adapt what they do to meet the needs of the residents rather than forcing the residents to conform to a routine that the care givers value.
What causes the biggest conflict is what is perceived by the residents as a lack of compassion and connection on the part of these care givers. This creates a big disconnect between the care givers and the residents they serve.
The 12-hour schedule with accompanying rotations are also contributing to the disconnect due to the stress on the body caused by disrupting normal rhythms of sleep for the night shift workers. (See the previous post on this issue.)
In order to accommodate staff requests during this turn-over period (which began October 18th, 2009), some teams moved to different coverage areas. This CCRC has two assisted living units for people who have reached an age where they need more help than they get in their independent living apartments--help with medicine delivery, food preparation and delivery, and cleaning their apartments. Residents in these units live in one of 44 studio apartments with private bathrooms. One of these two assisted living units is for people with dementia--who have more problems with memory than the people on the other unit.
Care givers used to working with the dementia patients have developed routines in their service that they try to implement throughout the week. Because of their dementia, their patients are more docile and responsive to relatively aggressive leadership from their care givers. Some of these care givers have switched to be care givers in the other assisted living unit where the residents have more of their usual faculties for decision-making.
Some of these care givers, with the best of intentions, have tried to impose the structure of their dementia-unit routines on the residents of the other assisted living unit. The reaction of the residents of the non-dementia assisted living unit is strongly negative. These care givers, rather than making their own routines the important factor in their care, need to learn the needs and personalities of the residents of this unit and to adapt what they do to meet the needs of the residents rather than forcing the residents to conform to a routine that the care givers value.
What causes the biggest conflict is what is perceived by the residents as a lack of compassion and connection on the part of these care givers. This creates a big disconnect between the care givers and the residents they serve.
The 12-hour schedule with accompanying rotations are also contributing to the disconnect due to the stress on the body caused by disrupting normal rhythms of sleep for the night shift workers. (See the previous post on this issue.)
Monday, August 24, 2009
Aging, Quality of Care, Quality of Life--Healthcare Oversight of Continuous Care Retirement Communities
Healthcare for the aging--a worry for baby boomers with aging parents and for young adults with aging baby boomers for parents--and a huge and growing worry for Medicare.
Hospitals, Rehabilitation Facilities, Nursing Homes, and Continuous Care Retirement Communities (CCRCs) are all part of the health care system for the aging in the USA.
Much of my day today has been invested in reviewing information available on the World Wide Web comparing nursing homes, and hospitals. Medicare has made some additions to its http://www.medicare.gov website where you can choose to compare hospitals and nursing homes. The government data for nursing homes associated with CCRCs appears to be inadequate--sometimes focused on only Medicare-related services rather than including the entire range of service provided by the CCRC to include skilled nursing care.
Continuous care retirement communities (CCRCs) today include independent living units, assisted living units, memory care units, and skilled nursing care units. So far the government surveys do not focus on the overall community. Instead they focus on sub-elements of one unit. For example, they may look at the Medicare wing (19 beds) of a Skilled Nursing Facility (with 70 beds).
CRCC Oversight
CCRCs are accredited today by the Continuing Care Accreditation Commission (CCAC) which is wholly owned by the Commission for Accreditation of Rehabilitation Facilities (CARF). In many states, this is wholly voluntary and there is no mandate for accreditation by any organization. In the accreditation process, the service provider pays the Commission to conduct an in depth survey of the facility and what it offers. The Commission treats service providers in much the same way a university treats its students. Providers pay for the surveys as students pay tuition to the university for a course. Service providers may or not pass the standards to be accredited just as students may not pass the standards set for course or degree completion by the university.
This accreditation is at least a step in the right direction of allowing the public to make more informed decisions about healthcare. CCRCs are not inexpensive and a major concern about any such place is ongoing quality of care and quality of life. That's not easy to measure, especially on surveys where not enough residents may be willing or able to complete the survey. At the same time, even if they had a mandate, governmental oversight agencies may not look at (or even for) a clear picture of the quality of care and quality of life afforded at a CCRC.
We are still in a "buyer beware" situation. The information available over the world wide web (Internet) is at least helpful in making more informed decisions. The information needed may not be readily available, however, and may require some depth of research (and time investment) to uncover information crucial to making the informed decisions.
CCRC Decision-making
One thing that CCRCs seem to be doing--in the footsteps of lots of other organizations--is trying to consider themselves as either unique (one of a kind) or too similar (much like) another organization. The CCRC my mother lives in has decided to move to 12-hour shifts for its employees dealing with residents in assisted living and the skilled nursing facility.
In my personal experience of working 12-hour shifts, it is not a healthy option for anyone involved. While on duty at the Pentagon many years ago, my group decided to go on 12-hour shifts. We would start either at Noon or at Midnight and work that shift for several days (four, I think). This meannt that we would work from Midnight to Noon for four days, have two days off, then work from Noon to Midnight for four days and have three days off. While we had time off, I remember sleeping the first two days after the Midnight to Noon shift and not being able to sleep for awhile when we switched to the Noon to Midnight shift. (There were military reasons for the starting times, by the way.) Nursing homes and hospitals usually like a 7AM to 7PM shift and a 7PM to 7AM shift.
At the end of a twelve-hour shift, and even more so at the end of several days of that shift, we were not at our best. The constant switch of our internal clocks really messed people up--we react to lightness and darkness and it takes time to recover. A 34-year-old major working with me had a stroke and died after we were on the new schedule for a few months. He left a wife and two children. No one functioned at his or her best and decisions made when we were not at our best could (in an emergency situation) not have been the best ones to take. (We didn't have that problem during the time I am referring to.)
Many hospitals and now CCRCs are advocating the 12-hour day shift schedule, talking about how much time-off people will have in the course of 14 days and the continuity of care patients or residents will receive by seeing the same people on the same shifts. The CCRCs say that it has been successful in hospitals so they want to implement it. In my experience, what this shift schedule does is insure continuity of worse care for the people being cared for and continuity of a feeling of jet-lag and frustration on the part of the care-givers. It is good for schedulers and may help in financing plans. In hospitals I have seen diminished quality of care from caregivers toward the end of their 12-hour days. CCRC's usually do not have the same intensity of responsibility seen by nursing staff in hospitals and they have their own concerns at the CCRC.
At the end of my day I am aware that I have touched the "tip of the iceberg" and have lots more to learn about ensuring the quality of care and quality of life offered by CCRCs to my family. It's also something I have to think about in my own future as well.
Hospitals, Rehabilitation Facilities, Nursing Homes, and Continuous Care Retirement Communities (CCRCs) are all part of the health care system for the aging in the USA.
Much of my day today has been invested in reviewing information available on the World Wide Web comparing nursing homes, and hospitals. Medicare has made some additions to its http://www.medicare.gov website where you can choose to compare hospitals and nursing homes. The government data for nursing homes associated with CCRCs appears to be inadequate--sometimes focused on only Medicare-related services rather than including the entire range of service provided by the CCRC to include skilled nursing care.
Continuous care retirement communities (CCRCs) today include independent living units, assisted living units, memory care units, and skilled nursing care units. So far the government surveys do not focus on the overall community. Instead they focus on sub-elements of one unit. For example, they may look at the Medicare wing (19 beds) of a Skilled Nursing Facility (with 70 beds).
CRCC Oversight
CCRCs are accredited today by the Continuing Care Accreditation Commission (CCAC) which is wholly owned by the Commission for Accreditation of Rehabilitation Facilities (CARF). In many states, this is wholly voluntary and there is no mandate for accreditation by any organization. In the accreditation process, the service provider pays the Commission to conduct an in depth survey of the facility and what it offers. The Commission treats service providers in much the same way a university treats its students. Providers pay for the surveys as students pay tuition to the university for a course. Service providers may or not pass the standards to be accredited just as students may not pass the standards set for course or degree completion by the university.
The CCAC was acquired by the CARF in 2003 and is the nation's only accrediting body for CCRCs and other types of continuums of care referred to by the commissions as "aging services networks." (You can see more detail on the CCAC website listed above.)
This accreditation is at least a step in the right direction of allowing the public to make more informed decisions about healthcare. CCRCs are not inexpensive and a major concern about any such place is ongoing quality of care and quality of life. That's not easy to measure, especially on surveys where not enough residents may be willing or able to complete the survey. At the same time, even if they had a mandate, governmental oversight agencies may not look at (or even for) a clear picture of the quality of care and quality of life afforded at a CCRC.
We are still in a "buyer beware" situation. The information available over the world wide web (Internet) is at least helpful in making more informed decisions. The information needed may not be readily available, however, and may require some depth of research (and time investment) to uncover information crucial to making the informed decisions.
CCRC Decision-making
One thing that CCRCs seem to be doing--in the footsteps of lots of other organizations--is trying to consider themselves as either unique (one of a kind) or too similar (much like) another organization. The CCRC my mother lives in has decided to move to 12-hour shifts for its employees dealing with residents in assisted living and the skilled nursing facility.
In my personal experience of working 12-hour shifts, it is not a healthy option for anyone involved. While on duty at the Pentagon many years ago, my group decided to go on 12-hour shifts. We would start either at Noon or at Midnight and work that shift for several days (four, I think). This meannt that we would work from Midnight to Noon for four days, have two days off, then work from Noon to Midnight for four days and have three days off. While we had time off, I remember sleeping the first two days after the Midnight to Noon shift and not being able to sleep for awhile when we switched to the Noon to Midnight shift. (There were military reasons for the starting times, by the way.) Nursing homes and hospitals usually like a 7AM to 7PM shift and a 7PM to 7AM shift.
At the end of a twelve-hour shift, and even more so at the end of several days of that shift, we were not at our best. The constant switch of our internal clocks really messed people up--we react to lightness and darkness and it takes time to recover. A 34-year-old major working with me had a stroke and died after we were on the new schedule for a few months. He left a wife and two children. No one functioned at his or her best and decisions made when we were not at our best could (in an emergency situation) not have been the best ones to take. (We didn't have that problem during the time I am referring to.)
Many hospitals and now CCRCs are advocating the 12-hour day shift schedule, talking about how much time-off people will have in the course of 14 days and the continuity of care patients or residents will receive by seeing the same people on the same shifts. The CCRCs say that it has been successful in hospitals so they want to implement it. In my experience, what this shift schedule does is insure continuity of worse care for the people being cared for and continuity of a feeling of jet-lag and frustration on the part of the care-givers. It is good for schedulers and may help in financing plans. In hospitals I have seen diminished quality of care from caregivers toward the end of their 12-hour days. CCRC's usually do not have the same intensity of responsibility seen by nursing staff in hospitals and they have their own concerns at the CCRC.
At the end of my day I am aware that I have touched the "tip of the iceberg" and have lots more to learn about ensuring the quality of care and quality of life offered by CCRCs to my family. It's also something I have to think about in my own future as well.
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