The Humanistic Approach to Residential Support (They are humans, right?)

calm-down-i-m-only-human-2I’m often amazed how people are treated when they happen to become residents in various residential support programs or facilities. Once a person assumes the title, “resident” the rules change for him or her. Suddenly they are no longer a person with the same wants and needs that you and I have. In fact, their individual needs as a human being are somehow traded in for the “rules” of that particular facility! For example, “Breakfast is at 7:00 a.m.” Every day breakfast is at 7:00 a.m.? Well, what if the person wants to sleep in one day? I mean you and I can choose to sleep in one day, right? But, oh no, not the “resident.” The resident must be up at 6:00 a.m., showered by 6:30 a.m. and the dining room, by God, for breakfast by 7:00 a.m. Whether or not they like it is inconsequential. What matters is the facility rules…end of story.

Being a Program Administrator, I certainly understand the financial considerations of staffing, scheduling etc. But, what I can’t wrap my mind around is the lack of consideration for people not being treated like human beings. No we don’t have the staffing to man the dining room all day long, but isn’t there a better solution? It seems to me (and you may call me crazy), that the people living in our programs should be able to get up whenever they choose. And can we not figure out some alternative meal for the guy that got up at 9:30 a.m. The same sort of logic applies to bedtime. Again, what time do you go to bed? My guess? Exactly whenever you want to! Can you even imagine some 22 year old staff member telling you it is lights out at 10:00 p.m.? And we wonder why our people tend to escalate. They escalate because they are adults who have probably spent considerable time making their own choices. Just because they were forced to move to your facility does not mean they stopped being adults. People with Alzheimers are still adults. People with brain injuries that are older than 18 are still adults. Elderly people in their sunset years are still adults! Something is wrong with our philosophy, I think.

How about that dreaded adult activity called sex? We have the audacity to get flabbergasted when we find resident A in bed with resident B. Moralistic considerations aside, that is sort of what adults do, isn’t it? Yet in the facility it is reportedly a “no-no!” I remember one of my staff telling me once, “Such and such is in his room with his girlfriend and they have the door shut!” (Lord help us quick!) I responded, “Well good, make sure you don’t go in there (as that is generally what the door closed symbol means!). Sure I know we can’t have some kind of hippy-free love thing going on, but we ought to take into consideration that adults have needs and who are we to stifle them? Really, if we are doing our job with a serious commitment to human needs being met, we should encourage people to get their needs met in ways that are, of course, decent and considerate of the other humans. That’s how we do it in real life, yes?

Now, here is the ultimate shocker! What about alcohol? Oh no – don’t you even go there! Again, we are talking about human beings, right? Can you have a glass of wine when you get home from work? If you are an attorney, you can have one at work (smile). What about a beer? It seems you may do so if you so desire. So, where did we ever get the idea that facilities needed to be “lock-down” centers when it comes to alcohol? We got the idea because the thought of alcohol at work just doesn’t seem right; introduces potential liability and thus we pass along that concept to people who have the misfortune to live with us. I recognize that certain “residents” are on many types of drugs. Alcohol and drug interaction is a serious thing. But, why don’t we run that idea by the treating physician? Maybe 2 beers wouldn’t make a difference? Maybe it would? But the all encompassing “no alcohol” rule, well maybe that is a little much for (here it comes) “adults!” We manage liability successfully in a multitude of realms at work like driving vehicles, safety rules, behavior support training, but when it comes to alcohol we default to – no way! It seems the same care we take in making sure Mr. Jones with the brain injury doesn’t costume too much food because his “I’m full valve” isn’t working, could be taken in making sure we regulate the alcohol intake in light of potential drug interactions. Ya think?

We need to take a fresh look at how we interact with the people in our programs. We need to stop seeing them as “labeled adults” and get back to seeing them as simply, “adults.” Human beings require a humanistic approach and the sooner we can make that happen, the better we become at providing true residential support!

Written by an adult for adults…




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…