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Westminster-Thurber Community

Quality of Care Impact

Early to Mid-Implementation Signs of Quality of Care Impact: In real world implementation, quality of life impact will likely be evident before formal quality of care indicators reveal significant change. However, residents may rate clinical care higher (due to improvements in their overall experience). In addition, as the quality indicator most correlated with person-directed principles and care, use of restraints should decline. Weight loss and time in a bed or chair are subsequent indicators to follow, but these may not be evident until 2+ years implementation. Of course, the level of clinical improvement depends predominantly on the organization's performance pre-implementation as well as the support of clinical leadership (Medical Directors and Directors of Nursing) for person-directed care.

Quality of Care Impact Quantitative Findings

  • As noted in the above graph, survey results for clinical care from residents of short-stay rehab are particularly high (on a 4 point scale). 100% of residents for the survey period rated the statement, "I was treated with dignity" a 4.0.
  • In the Pathway Home, staff observe combative or depressed behaviors of residents to be decreasing and engagement to be increasing.
  • In the Pathway Home, staffing ratios far exceed Ohio's staffing regulations with 1 Nurse to 27 elders and 1 care partner to 5 elders.
  • The percent of long-stay residents who were physically restrained while in skilled care declined from 4% in 2008 to 1% in 2009  (4% below the national average).

Quality of Care Impact - Qualitative Findings

1) Create an inclusive community and "home" for residents, families, and the outside community that is constantly communicating and reinforcing resident-directed choice and focus.

  • At the Pathway Home, the Activities Director created a "The Pleasure of Your Visit" notebook in which each elder has a page which describes activities that they enjoy. The book is intended as a resource for family members and outside visitors to help them be more interactive with elders during their visits.
  • The Pathway Home has "Wii Wednesdays" and invites residents from other areas of the community to come into the home and participate.

 2) Work is organized around maintaining resident's autonomy and preferences with inclusive language supporting residents to be "known" as individuals instead of medical conditions.

  • At Care Partner Team Meetings in the Pathway Home, staff share ideas for assisting residents and maintaining a person-directed focus based on individual resident's preferences and concerns.
  • "They are in their own home, excited for their own choices, they can smell food cooking and do what they want. For us, it is knowing that we are making a big difference in their daily lives." - Pathway Home Care Partner on the benefits of the environment.
  • "I worked in independent living for awhile, and I could see how different it was for those residents. For me, it's about bringing that same respect back here and helping these residents be as independent as possible." - Pathway Home Care Partner.

3) Inter-disciplinary, cross-trained teams operate throughout the organizational structure with an objective of putting residents before task and taking advantage of synergies in the organization.

  • A clinical representative joins each weekly Care Partner Team Meeting at the Pathway Home. Residents' clinical issues are discussed and care partners share any concerns or observations.
  • Weekly team meetings at the Pathway Home also focus on a clinical topic of discussion (e.g. improving nail care) for staff and resident input, innovation and problem-solving.
  • "We can't do it as individuals. We can stir up the pot, but it takes more than one person to keep it rolling." - Pathway Home Care Partner.

4) A relatively flat organizational structure with the resident at the top of the organizational chart is prioritized (allowing for effective communication among and between inter-disciplinary teams and residents).

  • Residents attend weekly Care Partner Team Meetings in the Pathway Home and can give input. For example, a care partner expressed concern over the position of a resident's TV, suggesting that it might be too hard for her to see. The resident was present at the meeting and stated that she was fine with her room arrangement. Thus, the problem was solved at the source. 
  • "Our opinions matter here. They [leadership] want the home to reflect our style. It's more empowering and the decision-making is closer to us and the residents." - Pathway Home Care Partner.
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