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Homeward bound

January 20, 2011
by Lora Gomboc and Becky Weber
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Transitioning to a household model of skilled care
For many people, one of the joys of retiring from work is not having to wake up on someone else’s schedule. That benefit shouldn’t end just because someone needs nursing care. About four years ago, Garden Spot Village, a non-profit continuing care retirement community in New Holland, Pennsylvania, successfully moved to a person-centered, household model of skilled care. It was only natural that we would transition to that model at Maple Farm, a skilled nursing community in Akron, Pennsylvania, that we acquired in September 2009. We are in the process of replicating the culture change.
We started working toward person-centered care at Maple Farm as soon as we took responsibility for the community. We started by giving team members greater freedom to resolve issues for themselves. Most often, they know what’s best because they work directly with the residents. We adopted the concept of learning circles to solicit staff comments and feedback, particularly in relation to decision making and problem solving. This technique allows us to get input from anyone with a stake in the topic at hand. The learning circles, which meet as needed, and the equivalent community circles with residents, ultimately give each household a unique character, shaped by the individuality of its members.
Operationally, our initial changes were simple, yet profound. For example, in the main dining room, cafeteria-style trays and clothing protectors stopped being standard operating procedure. Instead, we put place settings on the tables, started taking residents’ meal orders, and began offering linen napkins—or clothing protectors, if residents prefer. More recently we moved to an open breakfast, served from about 7 a.m. until about 10:30 a.m. We set up a steam table with waffles, eggs made to order, or a breakfast entrée of the day. Eventually, the open kitchen will be staffed 12 hours a day, with some menu items always available. At Garden Spot Village, household residents can always get a sandwich or a fruit plate, and residents and their families have “rights to the refrigerator” 24/7.