In a previous article, we wrote about the trend toward smaller households in senior care centers, ones which more closely approximate a family environment. This encourages closer relationships and more natural participation in daily activities like food preparation and gardening.
The household model sets a framework for greater community, but there is much more to creating a person-centered culture. Four walls and a roof make a house, but the furnishings make it a home. In the same way, a beautifully designed model for intimate living only works if the people there have the capacity for intimate connection.
The Center for Positive Aging describes person-centered care as "an approach and philosophy that always puts the person first....Person-centered values include choice, dignity, respect, privacy, self-determination and purposeful living. Making choices about your own life, being listened to and “heard,” and being truly 'known' is a basic human right."
This implies both policy and people. Policies are the easy part. People, though - in this case, the front line staff - are the most important.
Just as you can argue over whether leaders are born or made, you can argue over whether the right employees are recruited or trained. Both would be true. Hire well, train well, and the benefits flow from there.
The biggest obstacle to this for most senior care centers is cost. Simply put, quality is seen as a greater burden on payroll. Yet some administrators find creative ways of being truly person-centered without exceeding manpower and other budget constraints. How do they do this?
They take the time to hire carefully. The saying goes that if you want something done, give it to the busiest person you know. So it goes that one high quality employee is worth three "timecard punchers." Despite the urgency of filling the void, and the time HR and partners may need to scour the city for candidates, it's worth the extensive search. Utilize interim staffing, if necessary, and wait for the right person, one who has the capacity for connection. This transcends educational level, age, gender and background. It can appear in any race or creed. It is hard to teach, and when you find it, it is pure gold.
Send the call out far and wide across your community. Reward your employees for referrals who are hired. Ask your residents and their families who they know. This carries some risk when you don't hire the granddaughter of Betty's neighbor down the street, but enough diplomacy gets you through those moments.
For your existing staff who may not be naturals, training may well prove fruitful. Active listening can be learned with sufficient motivation, and there are fun, participative programs that begin by revealing how bad we ALL are at listening. From there, they help build skills through practice. Good for residents, good for friendships, good for marriages.
Whatever it takes, a person-centered culture requires teaching employees that despite the challenges or monotony of daily routines, their number one job is to be truly present for the residents.
A hospital patient's wife jokes that her husband received very attentive care during his stay. In fact, an STNA came by every hour like clockwork to ask him how his pain was on a scale of 1 -10, to which he replied, every time, "10!!!" The STNAs carefully recorded the response, smiled and wished him a great day.
Too often, seniors have this kind of experience with well-meaning employees who think they are doing their jobs if they smile and check in from time to time. Are we expecting saints? Perhaps. But higher bars make for bigger leaps.