person_centered_care_definit

Person Centered Care: Definitions and Perceptions of Various Stakeholders The University of Maryland, Baltimore County (UMBC) is a public research university located in Baltimore County Maryland UMBC offers bachelor’s, master’s, and doctoral degrees University of Maryland Baltimore County BIOGRAPHY Nancy Kusmaul, Ph.D., MSW is an Assistant Professor in the Baccalaureate Social Work program at the University of Maryland Baltimore County She received her MSW from the University of Michigan and received her PhD from the University at Buffalo School of Social Work Dr Kusmaul was medical social worker for more than a decade Her research focuses on organizational culture, trauma informed care, and the impacts of culture on care recipients and the workforce She is particularly interested in the experience of direct care workers in long-term care organizations She is a member of the Baltimore County Elder Abuse Coalition and the Maryland Nursing Home Culture Change Coalition Gretchen Tucker, M.A., is a first year graduate student in the Gerontology Ph.D program at UMBC/UMB She received her M.A in Applied Sociology from UMBC Prior to enrolling in the Gerontology program, she was a research assistant at the Center for Aging Studies at UMBC At the Center she conduced qualitative research funded by NIA in a variety of long term care settings from adult day services, assisted living to interviewing persons living in the community She was also a research assistant on a Robert Wood Johnson Foundation grant and held focus groups with older adults living in their homes in aging neighborhoods of Baltimore, MD Her current research interest is on informal family caregivers for persons with dementia University of Maryland Baltimore County RESEARCH SITE The study site is a nursing home which is part of a Continuing Care Retirement Community located in a suburban neighborhood in the Washington, D.C area The site offers independent living, assisted living, and skilled nursing services (including a dementia specific care unit) which enables older adults to age in place within the same community The CCRC offers several amenities including cultural programs such as art classes, educational sessions and lectures, and writing workshops There are several dining options including a bistro A workout facility and indoor heated pool provide areas for exercise University of Maryland Baltimore County BACKGROUND • Residents’ experience of organizational culture results from interactions with staff at all levels Culture of the Site • The staff experience of the organization’s culture is important to understand in shaping the residents’ experience • Residents in long term care settings, seldom encounter the care environment on their own Family may provide material and emotional support Shared Set of Beliefs University of Maryland Baltimore County Assumptions Behaviors RESEARCH QUESTION How different stakeholders in nursing homes (residents, family members, direct care staff, administrative staff) conceptualize and experience a selection of person centered care concepts (consistent assignment, meal choice, waking/bedtime practices, and bathing)? University of Maryland Baltimore County Direct Care Workers Families Management Residents PERSON CENTERD CARE PRACTICES Consistent Assignment Meal Choices Waking/ Bedtime Practices Bathing Meal Choice These four practice areas have been identified as central to culture change by the Pioneer Network (2017) and by the Centers for Medicare and Medicaid Services (CMS) (Jurkowski, 2013) University of Maryland Baltimore County METHODOLOGY • Descriptive qualitative study ANALYSIS • Phenomenological • Semi-structured interviews with residents, family members, direct care workers and management • Transcripts were coded by both researchers, compared, and codes discussed until consensus reached • Interviews were audiotaped and transcribed • Codes were grouped into themes University of Maryland Baltimore County SAMPLING Residents Family Members • Resident participants were identified by designated facility staff • Family members were invited to participate by designated facility staff using a letter from the P.I • Residents needed to have been in the facility > one month and have minimal cognitive impairment as determined by a BIMS score of ≥ 13 • Family member’s resident must have been in the facility >one month and family member had to be age 18+ • Residents who did not meet BIMS criteria could participate with family member providing informed consent and participants assenting to the interview • Researcher also approached family members directly during visits to the facility • The researcher contacted identified residents in the facility or their family member by phone to confirm interest in participating Management Staff • Contacted directly by PI • Management staff had to be in a position of decision making authority over facility practices University of Maryland Baltimore County Direct Care Workers • Notified by designated facility staff using a letter from the PI • Must have worked at facility more than a month and be age 18+ INTERVIEW PARTICIPANTS Age Gender Race/Ethnicity Residents 88 (average Range 79-95 (missing data for residents) – Female - Male 10 - White Family 66 (average) Range 50 - 92 – Female - Male - White 1 Direct Care Workers 41 (average) Range 20-58 – Female - Male - African - Asian - Central American - Hispanic - White – GNA - Activities – Med Tech Management 48 (average) Range 37 –61 – Female - Male – Asian - White LTC Administrator Volunteer Coordinator Director of Social Work Director of Nursing Director of Dementia Care University of Maryland Baltimore County Position/Relation – – – – – Daughters Husband Niece Sons Wife FINDINGS Resident Choice and Autonomy Institutional Realities 10 I: Are there any particular areas of tailoring that you think that your mom would particularly benefit from? Family Member: I feel like, you know, that you, you, you, build a, you know, a system to take care of a set of the population And you try and get the, the averages of what everybody needs together and you try and satisfy them And there are individuals who are maybe more with it, or maybe need more activities, or something and you can’t quite cover all those bases University of Maryland Baltimore County FINDINGS (continued) Meal Choices Management Staff: “As long as the resident is able to make the choice of what they need and what they want and it’s safe for the resident And they’re welcome to go downstairs with the family With the staff They be able to tell the staff, this is what I want, and the staff is able to make an effort of meeting the safety of the resident’s need.” Waking Direct Care Worker: “There can even be three of them wanting to get up at the same time, so you just have to explain to them You have to make sure they are in a safe position If you know the one who will jump up out the bed, you start with the one that will jump out of the bed.” 11 University of Maryland Baltimore County Choice Safety KEY LESSONS LEARNED According to the federal regulation, § 483.24, “quality of life is a fundamental principle that applies to all care and services provided to facility residents Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, consistent with the resident’s comprehensive assessment and plan of care.” The study facility was better than average on providing a person-centered focus to creating a good quality of life for their residents in congruence with the regulation by: • Facilitating choice and autonomy for residents in the four care practice areas • Providing staff the opportunity to structure their day in order to accommodate resident choice Limitations still exist as to how much and what types of choices and autonomy are available to residents and the amount of flexibility in how staff structure their days 12 University of Maryland Baltimore County