Making resident-centered care a priority
Jana Scavona, Wellness Director for Inverness Village
When Asbury Communities Inc., began its journey with Planetree it was not without a few questions. In our healthcare centers, where this culture-change journey would have its greatest presence, we wondered how we would make time to truly live the Planetree philosophy.
In the four years since that journey began, our questions have been put to rest and inspiration has blossomed. Embracing Planetree has changed our work lives and personal lives in ways we could never have predicted. And we were thrilled when our communities, Springhill, in Erie, PA, and Inverness Village, in Tulsa, OK, were recognized for the work we have done by becoming the first healthcare organization in our respective state to be awarded Bronze Recognition for Meaningful Progress in Resident-Centered Care.
Planetree is a philosophy of service that puts building relationships with residents at the heart of an associate's job. It encourages us to take time to listen and share. It encourages us to create a system where residents' voices and preferences are sought out and honored. Most importantly, it encourages us to always be seeking opportunities to make residents' new homes in the community as home-like and as personalized as possible. Each day, our goal is to find ways to get to “yes” as often as possible and to encourage our associates to go the extra step without considering it extra work.
Culture change is a topic receiving a lot of attention in our industry these days. Our experience with it has led us to a better present and future for all members of our communities. It also equipped us with key insights to share with other senior living communities in order to achieve similar success.
Independence and comfort
Leaving a house you've lived in for decades is a difficult and emotional process, and your new home should feel that way – like home. One Planetree criterion for healthcare residents is that they be provided with the choice of both where they live and with whom they live, with staff input as appropriate. At Springhill, incoming residents are shown available living options on the continuing care spectrum and are then able to choose their preferred home. Residents in our skilled nursing center, ForestView, are able to place applications for roommates, so they can share a room with a friendly face.
In addition, Planetree asks that processes be in place for integrating patients' and residents' preferred routines and rhythms of daily life into care plans. In OakView at Springhill, which provides personal care, family and residents determine what they would like to do on any given day, and what time they would like to get up, eat, nap, and go to sleep each night. Staff at Heather Hall in Inverness Village also creates and follows support plans that incorporate resident preferences. Those plans are re-evaluated and updated on an ongoing basis with residents' and family members' input.
For instance, if a resident prefers to sleep until 9 a.m. and just have coffee and toast in their room before beginning therapy, our assisted living and healthcare centers honor that. Residents do not live by a one-size-fits-all schedule. If you prefer a bath over a shower, and to do that in the afternoon, we work with associates to find a way to make it work.
Forging a bond
Both Springhill and Inverness Village use Planetree as a catalyst for resident and associate engagement.
Planetree Committees meet on a regular basis at all Asbury communities. Staff retreats, which began when Planetree was first introduced, informed and energized associates to make culture change a priority. At Inverness Village, healthcare associates hold Planetree Chats, which are informal meetings where staff members share stories about “Planetree moments” they have had with residents or lift up suggestions for meeting specific residents' needs. This monthly associate recognition program at Inverness Village, called Planetree Champion, recognizes the work of associates from all departments who are embracing the philosophy. Springhill similarly recognizes associates putting Planetree to work, with recognition occurring quarterly.
At both communities, several examples stand out.
An Inverness Village associate recently changed her own wedding plans in response to a resident's sadness over being unable to attend her granddaughter's wedding. She threw out her plan for a 450-guest bash and instead is holding it at Inverness Village with the resident as an honored guest. Her fellow neighbors at assisted living are also invited guests and are choosing flowers, along with a new dress or suit, for the day.
At Springhill, an associate taking flying lessons promised a community resident, whose husband was a distinguished World War II pilot, that when she received her pilot's license she would take the resident on a flight to honor her husband. That promise was fulfilled in September 2013 on a day that was memorable not only for the associate and the resident, but for our entire Springhill community as well.
And our communities are enhancing and changing our policies around grief and loss, too. Each month, Inverness holds a memorial for associates where we release a balloon for each resident who has passed away. Staff members share thoughts and memories and the chaplain offers a short prayer. This idea came to us from a certified nursing assistant in a Planetree Chat. For family members, we have changed the way we handle a resident's room after they pass. We place a beautiful quilt on the bed with a single rose and do not move any of the resident's belongings until family members have returned to the room. In addition, a large card is placed on the resident's door for associates and residents to share condolences or memories. This is then mailed to family members.
All of these examples show the strength of the bonds being forged, nurtured and celebrated at our communities.
Communication is vital to providing quality care for residents of Asbury communities, including input of residents and family members. Planetree requires that a process be in place to encourage all stakeholders to communicate with staff about any concerns related to care. To that end, Springhill holds an open door policy for family members and residents, and we also hold quarterly meetings with residents' relatives. At the request of family, we publish monthly e-newsletters that provide more frequent, in-depth communication. Both Springhill and Inverness Village also keep community residents up-to-date with Anticipate More magazine and weekly newsletters.
Across both campuses, we strive for consistency in staff assignments so that residents are familiar with the people around them—our associates, dining and housekeeping team. Shift-to-shift communication ensures that all members of a resident's environment are familiar with how his/her day is going, and staff is able to stop in and check on a resident at any point.
Asbury Communities lives by the maxim that wellness has more than one dimension; it's more than improving physical strength. Five other dimensions are critical: spiritual, intellectual, emotional, social and vocational. Planetree recognizes this and desires to ensure that residents' needs across all dimensions are met.
As a non-denominational community, Springhill's interfaith chapel holds services each week. The chaplain makes himself available to residents and their family members, but other counseling services are also offered.
Another Planetree criteria is that residents must have access to nature. Spread on 45 acres, the Springhill campus provides wooded and landscaped areas for residents and families to enjoy. There are outdoor garden areas at ForestView Health Care Center and OakView Personal Care, and a paved walking path nearly a mile long circles the Springhill pond. Group walks are offered to assist residents with more difficult parts of the pathway that would not normally be accessible.
Residents of Inverness Village's health center residents have access to walking paths, a pergola sitting area, as well as raised vegetable gardens where they are able to grow produce. When a gardener was no longer able to garden, the maintenance staff planted a tomato plant right outside his window so he could follow its growth.
Emotional wellness is paramount to overall wellness. At Inverness, we're fortunate to have a lovely, formal dining room that residents can reserve for special occasions. Residents in the healthcare continuum enjoy this same privilege, working with our chef to plan their own menu for events. One couple at Inverness Village went out to dinner each year to celebrate their anniversary. When the wife experienced health issues and could no longer travel, staff members decorated the dining room for the couple and prepared a special meal. The next year, the wife could no longer eat solid foods, and the husband was at a loss for how to forge a new tradition without a meal as the centerpiece. Associates created a feast of memories with photo albums and video collages the husband and other family members provided.
The Planetree recognition process
Overall, Planetree recognition is acquired through a rigorous, but collaborative process. Since Asbury began its partnership with Planetree, we've focused on our strengths and identified our challenges. But most importantly, we've developed a plan to create stronger communities that incorporate resident and family feedback in order to provide the best level of services for those we serve and those who have yet to come.
A first step toward earning qualification, and particularly the Bronze Recognition afforded to Springhill and Inverness Village, involves asking some specific questions of your community:
How do our associates interact with the residents who call our communities home?
How involved are those residents on how the campus operates and the services it provides? How and is their voice heard at the administrative level?
How well does the staff know the people for whom they care, and what systems are in place to encourage that?
How can we better collect input from the people who matter in residents' lives—their families?
What formal and informal policies and systems are in place that encourage all of the above to happen on a consistent basis?
Just answering a few of these questions will get you started down the pathway towards success.
Sharon Belovarac is the administrator of Forestview, which provides skilled nursing care at Springhill in Erie, PA. She has been an RN for 23 years and has worked the last 18 years at Forestview.
Jana Scavona has been the Wellness Director for Inverness Village in Tulsa, OK, since its opening in May of 2003. Her focus is to support and create person-centered prevention wellness and recovery opportunities throughout the Inverness Village community for its more than 450 residents and 200 associates.
Steven Walkingstick is the administrator of health services at Inverness Village in Tulsa, OK. He has been a licensed Nursing Home Administrator since 2005 and got his start in the long-term care profession by working as a dishwasher at a small-town nursing home while attending college.