Preparing future long-term care leaders: Perspectives change after becoming residents
The past 24 hours have been surreal for the 21-year old nursing home resident. She has signed reams of forms during her admissions process. She has become overwhelmed with questions and left trying to understand and remember everything she has been told. Once admitted, she is wheeled to her new home, a room, where she meets her roommate and, coincidentally, becomes more nervous and anxious as staff introduce themselves ask questions and even examine her. Later in the day, she eats a pureed dinner in the dining room with other residents and then is transferred to bed for an evening's sleep.
Is this young woman rehabbing from a car accident or entering a hospice program because of a terminal illness? No, she is a student in an evidence-based healthcare administration program preparing to become a future administrator.
Future long-term care leaders undoubtedly have challenges ahead. Managing reimbursement, public policy, quality care and funding, while demonstrating the value of care to both the consumer and taxpayer will prove demanding. While each facet of care is fundamentally critical, at the end of the day, what about the resident? How can we prepare our next-generation leaders to not only be strategic administrators but also caregivers inspired to provide high-quality, resident-centered care?
Leaders within the University of Wisconsin-Eau Claire's Health Care Administration (HCAD) program saw an opportunity to prepare future administrators to think and educate themselves with a more-resident centered focus. The university implemented a resident-for-a day component to their curriculum to provide an avenue for students to literally walk a day in the shoes of nursing home residents. Researchers and leaders at the university uncovered compelling trends that suggest this type of experience is perspective changing. Through analysis of student data post-experience, researchers concluded that the activity not only provided students with realistic resident experiences but also changed perspectives of each of the participants.
During the fall 2010 semester, students preparing to become administrators were required to participate in the resident-for-a-day experience. Enrolling as residents within nursing homes throughout the Midwest, 36 students left their homes and admitted themselves into nursing homes.
Students diagnosed themselves with a limitation that would require dependency upon someone else for care. Students simulating a stroke were mobile only through the use of a wheelchair while arm and leg weights were used to impair movement. Some students wore eye patches to simulate a ﬁeld of vision cut while others smeared their glasses with Vaseline to imitate cataracts.
University of Wisconsin-Eau Claire Students began the 24-hour experience in social services, going through the admission process and interacting with all members of their care team. They ate meals, one of which was pureed, in dining rooms with other residents. They received help from CNAs with bedtime routines. Additional self care assistance, along with other dependency activities such as using the call light, wearing an alarm to restrict movement and being transferred were all included in the student's care plan.
“Throughout my stay, I was observing other residents' choices, behaviors, interactions and experiences,” said one participant. “Being in that situation, as a resident, was eye-opening.”
After sleeping overnight and going through the discharge process the next afternoon, students documented their experiences, observations and reﬂections.
“Staff have such an incredible opportunity to impact the lives of residents,” wrote one of the students. “This experience helped me appreciate the importance of hiring and retaining the best possible staff. Turnover is not only costly in a monetary sense, but also to the well-being of residents.”
Analysis by researchers at the university revealed perspective changes in participants, both in terms of a more empathetic view of the resident experience as well as organizational practices necessary to support resident-centered care. Students developed empathy towards residents by gaining an understanding of the signiﬁcant life transition that occurs when living in a nursing home. They also identiﬁed several strategies and practices necessary to develop cultures to support resident-centered care. The analysis showed most students indicated a desire to lead future organizations with a resident-centered care philosophy.
“As providers of long term care, we must remember our nursing home is not just a place of employment but our residents' home, and everything we do, the way we provide care, has an impact on the quality of life of each and every one of our residents,” reﬂected one participant.
The data in this study validate the fact that simulation activity of this kind provides participants with a chance to have a paradigm shifting, perspective changing experience that will engender individuals to lead organizations from a person-centered care approach. Current leaders, advocacy groups and providers looking to advance the profession can help promote evidence-based educational opportunities to further the profession-wide change already in play. Advancing the profession and improving the way resident services are delivered is paramount. Leaders today can continue to educate and evaluate the ability of studies such as this one to maximize competencies of employees today as well as create strong leaders for the future.
Jennifer Johs-Artisensi, Ph.D., MPH is an Associate Professor and the Program Director for the NAB-Accredited Health Care Administration Program at the University of Wisconsin-Eau Claire. This research project was supported in part by a grant from the Office of Research and Sponsored Programs at UW-Eau Claire.