Home puts residents first

Nobody really wants to go to a nursing home.

The people who live in nursing homes are there because they need too much care to live alone or even with loved ones anymore.

If they had a choice, they wouldn’t go to a place that forces them to adjust their schedules to suit the people they pay to take care of them.

So when the staff at Pinewood Terrace in Colville, Wash., decided to change the facility to fit its residents, rather than the other way around, what they were initiating was a fundamental change in the way nursing homes are run.

“The way we did things before was institutional,” said Gail McDowell, administrator at the 91-bed Pinewood Terrace. “We thought we were doing what’s best for residents, but we were doing it for us.”

What the staff members discovered, much to their surprise, was that residents are much easier to take care of when they have a say in their care. Management found it less expensive to care for happier residents, and residents found a place more like home.

“I like it better,” said Vic Lawson Jr., a 45-year-old resident with cerebral palsy. The former Wal-Mart employee lived in his own apartment, assisted by a caregiver, until his degenerative condition required him to move to Pinewood Terrace about two years ago. “They take good care of me,” he said, but “I get up when I want to.”

No longer does the nursing home staff require Lawson to rise with every other resident for breakfast by 7:30 a.m. This was one of the more significant cultural changes in the way the nursing home is operated.

Today, about 30 of the state’s 247 nursing homes are involved in varying stages of cultural change, according to Steve McLean, corporate communications manager for Qualis Health, a nonprofit organization that contracts with the state to provide consultants to health care facilities.

It all started a few years ago, McDowell said, when Pinewood Terrace, owned by Eagle Health Care of Bothell, Wash., decided to make improvements in three areas: pressure ulcers, pain management and use of restraints. Pinewood Terrace had bedsores under control, but its staff realized they could use help with pain management.

About 15 percent of residents complained of moderate to severe pain on a regular basis, and that didn’t count patients with dementia who couldn’t complain. The staff began to realize that many behavioral problems with residents were associated with pain.

The staff, working with doctors, reconsidered its position on routine pain management, instead providing medication to residents before they had to ask for it. The residents’ pain went away, and the facility improved its score on pain management – which now ranks better than state and national averages.

“There is a misconception about tolerance, especially among the elderly,” said Qualis nurse-consultant Jeff West, who advised Pinewood Terrace. Routine medication, he said, is now considered the best way to treat chronic pain. “Having to ask for medication is not a good way.”

Restraints are another area in which Pinewood Terrace has made improvements.

The facility did not use a lot of seat belts or other types of restraints, but it did use side rails on beds. Such rails, intended as a safety measure, put elderly residents at risk of injury when they try to climb over them.

With a $40,000 investment by Eagle Health Care, Pinewood Terrace bought new beds that adjust to become high enough to let staff care for residents, and low enough to prevent injury in a fall.

As a result of Pinewood Terrace’s success in pressure ulcers, pain management and restraints, the facility was invited by Qualis to participate in a pilot program to advance cultural change in nursing homes. The first order of business was to view life in the nursing home through the eyes of its residents.

“We gave them cameras and asked them to take pictures of things that looked like home and things that looked like homeless,” McDowell said, explaining that people have control over their lives at home, but the homeless are at the mercy of others.

“One picture of a resident’s room, with all three beds turned back the same way, looked institutional,” McDowell said, and made the resident feel homeless.

“We told them where to sit, what time to go to bed and what time to get up,” she said. “We changed their whole life without asking. We decided we didn’t want to do that anymore.”

Employees were asked whether they would like to spend the night at the facility. They didn’t. It was too noisy with workers coming and going at all hours of the night, checking patients, changing them and putting away laundry.

“How could anyone ever get to sleep there?” McDowell said they asked themselves. And then they realized how residents must feel.

“We thought we were doing what was best,” McDowell said. “It was what we had always done.”

In many cases, the staff found changes easy and inexpensive. An eight-hour incontinence product that draws moisture away from the body allowed patients to sleep through the night. Laundry carts could be made quieter. A steam table allowed breakfast to be served throughout the morning, and patients could rise at will.

The benefits are now being realized.

The amount of laundry has decreased, resulting in savings on utilities and labor. Well-rested patients are happier and easier to care for, resulting in less routine care and more personalized care, or as McDowell put it, “Good quality care costs less than poor quality care.”

The staff, too, realized it had been institutionalized, and the changes improved employee morale.

Employees now have more of a say in how the facility is run. A team of employees set behavior standards for the staff based on interviews with co-workers. Another team of employees participates in interviewing and hiring.

Cultural change has resulted in better patient care, less employee turnover and greater job satisfaction at Pinewood Terrace.

“We came to realize we were not doing them any favors, and we weren’t doing us any favors either,” McDowell said of the way things had been.