AGING IN OREGON
Understanding Long Term Care Services for the Older Adult
Module 4 –Culture Change & The Emerging Role of the Nurse in LTC
The Important and Emerging Role of the
Nurse in Long Term Care
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Nurses have had a presence in long term care for
some time, particularly in the nursing facility.
As the population ages and nursing’s focus shifts
toward care of the older adult, nurses have an
opportunity to significantly influence care in the long
term care setting.
The nurse’s role in long term community care is also
emerging, especially in the assisted living and
residential care environments.
Long Term Care Culture Change
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What is culture change?
 A national effort to make long-term care less ‘institutional’ and
more ‘home-like’ for residents. This movement acknowledges that
nursing homes are places where people live—often for many
years.
What are some key components of culture change?
 Resident directed (or resident centered) care—care that is
provided in ways that the resident desires
 Empowered ancillary staff—staff can modify care routines based
on the desires of the resident, not what is most efficient for the
institution
 Home-like environment—physical environment is deinstitutionalized (no more long hallways)
VIEW the MOVE website for more information!
Person-Directed Care
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A philosophy of Person Directed Care (PD) strives to
implement and support the choices that the person
being assisted makes and to keep all decisionmaking as close to them as possible.
The literature references person-centered and
person-directed care. What are different nuances in
these terms? Which term best reflects the type of
care you observe in clinical settings?
Continuum of Change for Person-directed Care
Applying Person-Directed Care to the
Care Planning Process
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Click on this link to open a document from the
Department of Human Services in Wisconsin that
provides a good overview of how to apply persondirected care to the care planning process for an older
adult with dementia (it will open in a separate window).
Pay particular attention to:
The Five Basic Needs of People with Dementia
 The Well-Being Profile
 Descriptive Language and Old & New Language
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Culture Change in Oregon: Making
Oregon Vital for Elders (M.O.V.E.)
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M.O.V.E. is the Oregon culture change organization
representing key stakeholders in LTC. The group
offers approximately 4 seminars/workshops on a
variety of culture change topics each year.
Building on principles of the Pioneer Network,
Oregonians from a variety of organizations and
experiences founded M.O.V.E., a coalition in which
ideas and actions come together to create culture
change for the benefit of elders and those who
support them.
http://orculturechange.org/
Culture Change in Oregon
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In many ways, the LTC culture change began,
particularly in Oregon, with the development of
community-based care settings such as assisted
living and adult foster care. The need to address
issues such as privacy, respect, choice, and
promoting independence are written into the
Oregon laws governing these services.
Nurse Competencies for Nursing Home* Culture
Change
HOW WOULD YOU RATE YOUR COMPETENCY IN EACH OF THESE AREAS?
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Models, teaches and utilizes effective communication
skills such as active listening, giving meaningful
feedback, communicating ideas clearly, addressing
emotional behaviors, resolving conflict and
understanding the role of diversity in communication.
Creates systems and adapts daily routines and “persondirected” care practices to accommodate resident
preferences
Views self as part of team, not always as the leader.
Evaluates the degree to which person-directed care
practices exist in the care team and identify and
addresses barriers to person directed care.
Nurse Competencies for Nursing Home*
Culture Change (cont.)
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Views the care setting as the residents’ home and works to
create attributes of home.
Creates a system to maintain consistency of caregivers for
residents.
Exhibits leadership characteristics/ abilities to promote
person-directed care.
Role models person-directed care.
Problem solves complex medical/psychosocial situations
related to resident choice and risk.
Facilitates team members including residents and families, in
shared problem-solving, decision-making, and planning.
Note: although developed specifically for nursing homes, these competencies are
relevant to nurses in other LTC settings such as ALF, RCF, AFC, Home care.
Developed through a collaboration of Pioneer Network and Hartford Institute for
Geriatric Nursing, 2010, www.pioneernetwork.net
Nursing Expertise in Assisted Living and
Residential Care
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Oregon was the first state to provide housing/care in
assisted living facilities (ALF), often as a substitute for
nursing home placement.
There is no “ceiling” on the level of care that can be
provided in ALF in Oregon. Older adults living in ALFs
have chronic conditions such as dementia, diabetes, and
cardiovascular concerns that require complex clinical
management and demand expert nursing oversight,
observation, and intervention (Singer, McDaniel, &
Hornby, 2002; McDaniel, 2003).
Nursing Expertise in Assisted Living and
Residential Care (cont.)
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Recent changes in Oregon ALF and RCF regulations
require an increased level of nursing services and a
nurse who is able to respond to complex resident care
needs, including frequent change of condition
assessments; medication, wound, and pain management,
nursing delegation; end-of-life care; and directing
unlicensed staff.
The knowledge and effectiveness of the nurse can make
the difference for an older adult to age successfully in
place.
Nursing Competencies
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Four competency domains for nursing practice in the
assisted living/residential care setting have been
identified.
 Care
of Older Adults (care/clinical management)
 Systems (policies, procedures, quality improvement,
regulatory compliance)
 People (interpersonal communication/supervision with
staff, residents, families, and outside agencies)
 Time Management (organization, planning,
prioritization)
McDaniel, 2009
In Their Own Words
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Click on the youtube links below to hear nurses who
are working in assisted living and long term care
share their thoughts about this emerging and
exciting nursing work and role.
 Brad
Resources
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Check out these great resources to enhance your
learning and support your nursing practice with
older adults.
 Hartford
Center for Geriatric Nursing
 ConsultGeriRN.org
 Oregon State Board of Nursing, Division 47, RN
Delegation of Nursing Tasks to Unlicensed Persons
 Nursing Delegation Self-Directed Course