Who Cares About Person Centered Care?

imagesGYDO2NELHave you ever been at one of those institutions where the number one priority is following the schedule that has been appointed for the staff? Typically an organization feels forced to maximize employee efficiency because of financial constraints. For example, Nursing Homes often receive Medicaid funding. Medicaid pays such a low daily rate that the administration is pressed to minimize staffing in comparison to the number of residents served. While trying to make a profit is completely understandable, the end result is one lonely CNA being responsible for all of the care needs of 9-12 people. When you have been told that you must have 10 people up, showered, dressed and ready for breakfast by 8:00 a.m. you can bet that grandma’s needs as a person aren’t really being considered. How could they be? However, it’s not the CNA’s fault, it’s the organization’s fault. Administrator’s must make tough financial decisions to ensure that every resident receives “person-centered” care.

In addition to working within financial constraints, there are is another hindrance to person centered care. That hindrance can be referred to as, “the medical model.” The medical model assumes that the medical professional knows what is best for the patient and therefore needs little to no input from that person about the type of care they will receive. Doctor knows best, you know! While no one doubts the superior medical knowledge of the medical provider, we still have to make distinctions for the differences in people.  Person centered care therefore focuses on the individual.

In order for caregivers to be successful with the residents they serve, they must become expert at person centered care. In person centered care, the individual and their unique needs come first. Human interaction is the key. Interacting on a personal level allows caregivers to discover what their residents really need and become empowered to help the person get those needs met. In order to make this a reality, administrators must figure out a way to provide staffing ratios that facilitate having the necessary time for human interaction. A good guideline might be staff members having time to not only provide for direct care needs, but also time to interact with the resident on a personal level. Interaction not only makes the resident feel better but also allows for questioning and probing to determine other previously undisclosed needs. How many residents are receiving care day by day based upon medical documentation and clinical plans which are wholly unknown by the resident, yet continue on day after day?

At Intellegis we provide a 3:1 staffing ratio. Although this ratio is less profitable, it allows our staff the much needed time to care for the person, as a person. Important conversations can occur which serve as a guide to providing future care. We feel like we owe that to the person. I’m sure you would expect the same for your loved ones in whatever setting they may find themselves. A good question to ask providers before agreeing to residential support is, “what is your staffing ratio?” The answer to that question will give you an indicator as to whether your family member will have an opportunity to receive person centered care or will simply receive care dictated by staffing ratio constraints and busy clinician input. Who cares about person centered care? We do, that’s who!

We at Intellegis hope you choose wisely…

Common Sense Approaches to Behavior – Meeting Needs…

Cart_Anger-2Working in a residential facility for people with acquired brain injuries means we encounter many behaviors during the course of a day. Sometimes people scream and curse at the staff, sometimes they threaten with violence and at times may even become physically aggressive! And while this is often nerve-wracking for all involved, there is often a simple common-sense solution that we fail to employ.  But, before I get to the simple solution, let’s first think of behavior in terms of something people use to “get to” or “get away” from something.  And adding to that, let’s consider an example of how almost all of us respond in certain situations.

Imagine that you are peacefully living in your own home and suddenly become a little hungry.  How would you handle it?  My guess is that you would walk into the kitchen, open the fridge and grab a snack.  Then you would return to your favorite chair, munch on your snack while you finished watching “Parenthood.” Simple…easy..no worries, right?  Now imagine a similar scenario but you are living in a group home for people with certain disabilities. You feel a little hungry and walk into the kitchen to grab a snack. But this time you are met by a staff member with an agitated look on his face who promptly informs you, “Sorry the kitchen is closed bud!”  Imagine!  The kitchen is closed?  All eating possibilities are suspended until tomorrow?  Imagine!  What would you do in that scenario?  My guess is that even absent an acquired brain injury you would start to escalate and yell and even demand, by God, that someone better get you a snack or there is going to be hell to pay!  And chances are, if you made enough of a scene, someone would reward your behavior with the food you requested, complete with requesting assurances from you that next time you would obey the kitchen “rules” etc., etc!

So, doesn’t it make complete sense to you that given such constraints a person would exhibit certain negative behaviors?  Yet for some reason we falsely conclude that a person with certain deficits should  somehow feel differently!  I think if we as Managers and Administrators fall into the trap of putting our residents into any category different than the general group “human” we will end up dreaming up ideas and rules that fail to take into consideration basic human needs. And the most common reason for a person to escalate and demonstrate negative behaviors is not getting their needs or perceived needs met.  So the first question we need to ask ourselves, when challenged with negative behaviors, is what need does this person have (or perceive they have) that we aren’t helping them to meet.

Here is another common scenario.  A resident approaches the staff and says I need to go to the store.  The staff typically respond with some answer that states in one form or another – no!  The responses could be “it isn’t your shopping day” or “we don’t have the staff available to take you to the store right now” or “we are just about to eat dinner” or even “you just went to the store yesterday!” Yet what do all of these responses have in common?  They all represent the answer – no!  And worse, they communicate that we aren’t really concerned with what your need is as much as we are concerned with following our schedule or plans.  Screaming follows, we write reports and the day ends like yesterday ended.

In order to stop or greatly reduce the cycle of negative behaviors; behaviors people are using to get something they want or get away from something they don’t want, our number one job is to find out what the need is and then work creatively if necessary to get that need met!  Oh sure, I get the dollars and cents of business.  I understand the limitations of staffing and staff costs.  I even appreciate the necessity for rules or guidelines to help things run more smoothly and efficiently.  You bet!  But even more than that, I understand people and how they respond when their important needs aren’t being met (even if it just their perceptions).

So the simple solution to escalating behaviors is to work with your staff to become expert at finding out what the need is and then assuring your customers that it will be met. Our motto here at Intellegis is that we never say “no” to a request.  We may say, okay let me go talk to the supervisor and figure out how we can help you, but we never give answers that can be interpreted as “no.”  Why?  Because a no answer to a perceived need will almost always end in escalated behaviors which in most cases we end up meeting anyway as a response to the madness that just ensued after we said no!

So do yourselves and those people you serve a favor.  Instead of getting caught up in the yelling and the cursing and the threats, respond calmly in a way that communicates your sincere desire to help the person get their needs met. And you know what you will discover?  Old such and such really isn’t such a bad person after all!

Hispanic Man, Woman and Child having fun in the park.

Message from the Marketing Director

A message from the Marketing Director, Gina Lee…

Hello Intellegis visitor! We are so excited for 2012! We can’t wait to welcome new residents into our facility, and be a strength to you- a member of the brain injury community! As we get started this year we ask for a bit of patience with our office hours- we are here 5 days a week, but have limited hours until we get the facility up and running. You can always leave a message- we check them Monday thru Friday!

Please join us on the first Thursday of every month for a Brain Injury Support Group activity! We’ll be meeting at 6:30 for social activities. Future events include making cookies, bowling, a game night, dancing, exercise basics, a drawing class, and more. We look forward to seeing you there! As always, bring ideas of activities you’d like to participate in- we would love for you to share your talents! And remember- our activities are free! Soon we will also be adding a caregiver aspect to our support group activities.

We can’t wait to see you again, or to meet you! Call me with any questions, and happy 2012!
-Gina Lee