Teresian House AM

Teresian House Pledge
Introductions
General Information
Program Objectives- AM
Explain the process of developing
an organizational chart with the
residents on top
Explain the importance of having
multidisciplinary neighborhood
teams
Make a list of Universal Duties
that would work for your facility
Program Objectives - PM
Tailor a Personal Preference
Questionnaire for your facility
Develop a Personal Preference
Care Card
Decide what to implement from
the Dining with Dignity Program
Assess what Artifacts of Culture
Change can be started right away
in your facility
“We want our homes to be NOT
BETTER, but BEST”
Mother Angeline Teresa
Carmelite Sisters for the Aged and Infirmed
PHILOSOPHY OF CARE
Quality of Care
Quality of Life
Wholistic Caring
Hospitality
Pastoral Ministry
Shared Commitment
Social Justice
Christian Witness
Redemptive Suffering
Sanctity of Life
Roman Catholic Doctrine
The Foundress
Mother Angeline
Teresa
“At the time I was called a
revolutionary, but I went ahead
with my plans for creating new,
home-like residences for the elderly,
where they would be encouraged to
retain their independence. It would
provide living quarters for elderly
couples and recreational facilities,
as well as medical care”
Beginning in 1993
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Management study to identify needs
Department heads asked to create their “out of the
box” dream for the next 5 years
Interdisciplinary Committee, called the Dream
Team was formed
Subcommittees formed to target type of dining
service and personal laundry service
Consultant firm selected to assist with zoning, CON,
etc.
Interviewed 7 architects and contractors
Strategic Planning Committee submitted a CON to
state in December of 1995
After CON, financing plan was initiated.
Resident Centered Care
Emphasizes small neighborhoods which create a
feeling of comfort and security for the resident.
Care is focused on individual residents’
preferences and abilities.
Staff are specially trained to respond to
individual residents’ needs.
Traditional job descriptions are less defined, thus
providing an environment of cooperation where
everyone works together to ensure that the
residents’ physical, psychosocial, and spiritual
needs are met.
Department of Health Orientation
Teresian House Resident Centered Care
August 3, 1998
Life Enhancement
PURPOSE
To explain to our Department of Health Surveyors what Resident Centered Care is at
Teresian House and the reasons why we believe in the Neighborhood Concept
“In the past we have always striven to have our home “homelike”, but now with Resident
Centered Care about to be implemented, our goal is to have our home “just like home”.
(quote from one of our nurses, Lynda Neer)
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Welcome
Neighborhood Concept
Architectural Drawings
Residents in Motion
Partners in Care
Tour
Questions and Answers
Physical
Environment
Organizational
Environment
Resident
Centered Care
Psychosocial &
Spiritual Environment
THE PHYSICAL
ENVIRONMENT
Patio In Front of the Main
Entrance
Old hallway
hallway
New
Old semi-private room
Private homelike room
New Building-Howard Hubbard Pavilion
Original Main Dining
Room
Intimate
Dining
Neighborhood Kitchen
CNA/Nurse work areas incorporated into
neighborhood sitting rooms
Added Neighborhood Sitting
Rooms
Multidisciplinary Rehab Gym
Little Flower Day Care
Williamsburg Room
Garden beds and daycare
Little Flower Daycare and Rose Garden
Lobby
The Lobby
Charity
Daisy
Courtyard Views
Howard Hubbard Pavilion Foyer
Resident room in new
addition
Hubbard Pavilion
hallway
Neighborhood Dining Room
Kitchen in Hubbard Pavilion
Garden Rooms
Book Nook
Dutch doors
The Construction Process
New Building opened in November of
1998
All floor renovations were completed by
November of 1999
Maintained 100% occupancy during entire
process
No resident was moved until their
permanent room was ready
THE
ORGANIZATIONAL
ENVIRONMENT
STAFFING BEFORE RCC
Director of Nursing
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RNs
LPNs
Nurse Aides
Nurse Managers
Shift Supervisors
Resident Assistants
Ward Clerks
Director of Social Services
Director of Activities
Director of Housekeeping
Director of Food Services
AFTER RCC FLOOR STAFFING
RCC Coordinator
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RNs
LPNs
Aides
Activities
Housekeeping
Social Workers
Director of Food Services
Director of Nursing
Nursing Administration
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Provides support and consultation
Consists of:
Director of Nursing
Assist. Director of Nursing
In-service instructor/ infection control nurse
MDS Coordinator
Rehab Nursing
Clinic nurse of Ancillary Medical Services
Shift Supervisors
Nursing Secretary
CHANGES IN FTEs
INCREASE IN RCCs
7.0 FTEs
INCREASE IN ACTIVITY WORKERS
2.0 FTEs
INCREASE IN SOCIAL WORKERS
INCREASE IN HOUSEKEEPERS
3.0 FTEs
2.4 FTEs
(2.0 FTEs)
DECREASE IN LAUNDRY
INCREASE IN PLANT OPERATIONS
INCREASE IN TRANSPORTATION
INCREASE IN BEAUTICIANS
DECREASE IN FOOD SERVICE
NET CHANGE IN FTEs
1.0 FTEs
1.0 FTEs
.6 FTEs
(12.2 FTEs)
2.8 FTEs
Resident Centered
Care Coordinator
Training Process
RCCC
Spring ‘98
Prepared the 21 Week Resident
Centered Care Coordinators
Training Course Syllabus
Posted the Position
Interviewed Applications (18)
Picked 10 + 4 Administratorsin-Training
13 Completed the course
Training ran from 3/16/98
through 7/23/98
Training was weekly and began with
information and vision of the concept.
Included workshops and seminars
Presentations from existing department heads
(Social Services, Activities, Human
Resources, Dietary, Environmental Services,
Pastoral Care, Public Relations, Nursing,
Finance, Purchasing, Rehab)
Team Project
Project 1
You are assigned to a 51 bed Alzheimer’s Unit – 50 licensed and 1 respite (all
rooms are private). The residents are in the early or middle stages of the disease.
There are 4 sets of adjoining rooms for siblings. As a group, you are to prepare
this unit for opening by preparing a written project report including but not limited
to:
1. Budget/include rationale (workpapers)
2. Staffing 24 hrs/day & 7 days/week
3. Bi-weekly schedule
4. Order Supplies
*Medical Medicine
*Equipment
*Activity Supplies
*Stationery
*Housekeeping /Laundry
*Food
5. Develop a program for transferring/admitting the
residents to the new neighborhood
6. Give examples of the resident’s schedule and programs
for 7 days/week plus evenings
7. Prepare a monthly Activities Calendar
8. What steps would you take to ensure staff retention
9. Prepare this as a completed project report with the other
2 members of your team
10. At the end of this project, you are to make out an
evaluation on each other using attached model
EVALUATION BY ADMINISTRATIVE TEAM
Leadership
Finances/Budget
Organizational/Planning
Cooperation
Decision Making
Staff Development
Technical Ability
Administrative Responsibilities
Mission Statement
7 RCC Coordinators Named
3 Nurse managers
1 Social Service Director
1 Activity Director
1 Social Workers
1 Diet Technician
Current RCC Coordinators
Background
PTA w/
Administrator
Diet
License
Technician
Social
Worker
Nurse
Manager
Nurse
Social Work Manager
Activities Director
Director
The RCC Coordinators
Selected our “Neighborhoods”
Chose our team members
Began the RCC journey in October 1998
THE RCC JOURNEY
Neighborhood Teams
Leader/RCCC
Primary RN
LPNs
Certified Nursing Assistants
Social Worker
Activity Coordinator
Housekeepers
Blended Job Duties
The resident’s needs are first priority
All staff are trained to assist residents with
daily tasks that don’t require certification
Examples of Universal Duties
Making beds/changing linens
Emptying Trash
Serving meals/cleaning tables/washing dishes
Setting tables
Doing laundry/putting clothes away
Answering call bells and telephones
Distributing newspapers, mail, nourishments
Bringing residents to destinations
Bringing deliveries (flowers, packages) to rooms
Doing resident nail care
Packing deceased residents’ belongings
Doing activities with residents
Training staff to feed
Creating the Neighborhood Culture
Consistent caregivers
Getting to know staff to promote strengths
and talents
Staff empowerment
Team decision making
Everyone has a voice
We mentor to each other
We learn from each other
Early Challenges for Staff
“Buying into” and taking ownership of
the implementation of RCC Concept
Incorporating global duties into their
daily routines
Organizational changes
Role identification and functioning as
part of a team
Maintaining awareness of “The Big
Picture”
Weekly Team Meetings
Resident behaviors and interventions
Care plan changes
Staffing issues
Resident activities
End of Life
Staff recognition
Discussion of family/resident concerns
Falls and interventions
Weight loss and pressure ulcers
Changes Required by NYS
Department of Health
Reinstatement of RN shift supervisors
Reinstatement of some house wide systems
that were overlooked due to intensive focus on
the development of the individual
neighborhood cultures (consistent tracking of
falls, pressure ulcers, restraints, unsafe
wandering)
Changes We Implemented
Reinstatement of Neighborhood
Secretaries and Neighborhood
Assistants
Weekly meetings with Activities and
Social Workers to share and plan
collaboratively
Daily shift huddles in addition to
weekly team meetings
Positive Outcomes
 More
choices and autonomy for residents
 Smaller quieter units- increased resident intimacy
 Flexible mealtimes/positive dining experience
 Teamwork- cohesiveness, pride, loyalty
 Empowerment of staff to help problem solve
 Increased involvement by the families
 Decreased resident/family complaints
 Aging in place
 Improved longevity of staff
TOTAL TURNOVER PERCENTAGE
56.55
60
50
40
30
48.82
45.45
32.9 32.19 31.62
38.01 38.66 36.23
28.84 30.27 28.03
20
10
0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
2009
Job Discipline
Avg. Longevity Avg. Longevity
(Days)
(Years)
Nursing
Administration
9,118
24.98
RNs
3,705
10.15
LPNs
2,224
6.15
Aides
2,234
6.12
EMPLOYEE LONGEVITY
2010
12
11.31
AVG YEARS OF SERVICE
10
8.02
8
7.15
6
4
2
0
CNA ide
LPN
JOB TITLE
RN
Job Discipline
Turnover Rate
Teresian House
2009
Turnover Rate
National Average
2007*
*American Health Care
Association 7/08
Nursing
Administration
0%
37.8%
RNs
3.7%
41.0%
LPNs
25.59%
49.9%
Aides
21.84%
65.6%
Sustaining Resident Centered Care
S.P.R.I.N.G. Team
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This Team was set up to coordinate any
committees that were formed to enhance the
quality of our services..
The Administrator and the Director of Nursing
are the only permanent members. The rest of the
committee is made up of employees from every
department. Everyone including the chairperson
serves a 1 year term and before leaving must find
a replacement.
Employee Recognition Programs
Code of Conduct
Our residents, staff, volunteers, visitors, affiliates, vendors, representatives and all who come in contact
with Teresian House, be it for social or business purposes, will be treated fairly with kindness, respect
and dignity.
As staff:
We pledge to put in an honest days work and have a positive attitude that will reflect in our appearance,
communications and commitment to our customers.
We will make ethical decisions that enhance our resident’s quality of life in a homelike atmosphere.
We will all be responsible to work together and mentor each other.
We will strive to work with the community as a partner in education and long term care culture change.
We will avoid conflicts of interest, theft or misuse of equipment, misuse of time, and personal gain at the
expense of the facility.
We will treat business records, resident documents and medical information with the utmost
confidentiality.
We will report a suspicion of misconduct to the appropriate person(s) immediately.
We will abide by all Teresian House Policies and Procedures as well as all State and Federal
regulations governing long term care environments.
The One
Great Teams!
Sensitivity Trainings
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Sister Pauline developed curriculum
for CNAs and LPNs
Dining with Dignity curriculum for
Department Heads and Housekeepers
“Yes, Mrs. Jones, I’m here to
answer your call bell, bathe
you, dress you, undress you
and assist you in brushing
your teeth. I take you to your
meals, ambulate you and see
to it that you make all your
appointments. I’m here to
care for you.
But wait, there is more…”
Carol Tallman
3-11 2nd Floor CNA
“If you need to talk, I’ll lend an ear.
If you cry, I’ll do my best to comfort you.
If you need a hug, I’ll embrace you.
If you need a hand, I’ll reach out.
If you need a shoulder to lean on, I have two.
I’m not just here to care for you,
I’m here to care. Really care”.
Key Result Areas (KRA)
Mission
Leadership
Teamwork
Communication
Operational Effectiveness
Values
Integrity
Respect
Dependability
Reliability
Dignity
Commitment
Support of Residents and Staff
Quality of Life
Self respect
Team player
Ethical/Moral
Loyal
Positive
Support of the RCC Concept
Financial Stewardship
Evaluation Rating Tool
Key result areas were the basis of evaluation
process
Developed tool to illustrate the qualities of lowmid-high performance
Developed for both supervisory and nonsupervisor staff
Excellent
High
Good
Average
Middle
Needs Improvement
Unsatisfactory
Low
360 Evaluations
Also based on KRAs
30 item questionnaire
Completed anonymously using Survey
Monkey
Input from 11 staff including peers, supervisors
and direct reports
Department Heads complete self-evaluations
and set goals based on 360 feedback
Developed non-supervisory 360 questionnaire
for implementation in 2011
360 Evaluation
101
100
100 100 100 100
100
100
100
100
99.07
99
98.21
98
97.67
97.44
97.3
97
96.77
96.55
96.04
96
95
94
Mission
Leadership
Teamwork/Communication
Operational Effectiveness
2007
2008
2009
2010
Leadership Seminars
Team building
DISC Analysis
Hiring/Firing
Incident Reports
Investigations
Corporate Compliance
Non-conflict Resolution
Coaching/Mentoring
Mission Effectiveness
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Director of Mission Effectiveness
Monthly Mission Effectiveness meeting with
Department Heads
Artifacts of Culture Change
Development of Code of Conduct
Development of Teresian House Pledge
Quality First Initiative
Integration of Carmelite Mission/Teresian House
DH Quarterly Reports
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Quarterly summary of progress from each
department
Keeps us focused on the “big picture”
Keeps Sister Pauline informed
Information is relayed to the Board of
Directors
Employee Assistance Programs
Employee Service Program Consultant
available for employees who need assistance
On-site counseling at no cost to employees
Employee Emergency Fund
1 free meal a day for staff
Paid leave buy out
Christmas cash out
Pension plan
Co-pay reimbursement
Prospective Employee Video
“Perseverance is therefore to
always begin again and
never to be discouraged.”