Person Centered Culture
Change In
Adult Day Services
National Adult Day Services Association
Annual Conference 2008
Presented by:
LaDonna Jensen, RN
Marilyn Hartle, MSW, LCSW
What is organizational culture?
 Belief
systems
 Rules - both formal and informal
 Norms
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What is culture change?
Understand culture change is a
“persistent, subtle ingenious
substitution of one way of being
by another.”
Thomas Kitwood
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What is culture change?
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Widespread movement within the field of aging
and care for persons with dementia
Movement to profoundly change systems and to
transform care organizations to be driven by the
choices and needs of the people they serve
Person Centered Care is driving the change in
facilities that care for people with Alzheimer’s
disease
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What is Person Centered Care?
“Person Centered Care is a combination of
theories based on ethics and values - as well
as care techniques - that guide care
practices. It is based on the belief in the
inherent value of an individual. PCC takes the
perspective of the person with dementia and
creates a social psychology of care that
supports well-being.”
“Jentle Harts Consulting”
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Person Centered Care
Person Centered Care is an ongoing process of
compassion, education, modeling, evaluation and
monitoring engaged in for the purpose of
improving the health and well-being of all persons
involved in the giving and receiving of care.
Luther Manor Adult Day Services
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Elements of Old Culture:
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Environment
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Organization
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Ring of recliners around a television
Bathrooms partially used as storage rooms
Staff specific badges that emphasize position/job title
Hierarchal staff structure
Decision making occurs from top down
Outcome measurements
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Focus on physical outcomes of care, i.e. falls, weight , skin
breakdowns, nutritional intake
Emphasis on medical monitoring
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Elements of Old Culture, cont.

Program
 Herd
mentality-everyone must do the
same thing at the same time in the same place
 Unchanging, repetitive calendar
 Staff lead all activities
 Limited access to outdoors
 Little or no participant input into program choices
 Therapeutic fibbing as an unquestioned approach for
people with dementia
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Why Change?
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Consumer demand
Third party reimbursement expectations
Upgraded expectations of services by the baby boomers
Accrediting bodies have changed expectations
What once was standard of practice is now considered
deficient practice
It is the moral and ethical thing to do
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Change in Language
Old Language
Person Centered Language
Admit
Discharge
Allow
Join
ADS no longer meets their needs
Facilitate
Adult Day Care
Adult Day Services
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Change in Language, cont.
Old Language
Person Centered Language
Clients
Participants, guests
Activities
Meaningful occupation, engaged
Caregiver
Care partner, carer
Traditional Care Plan
Language
Alteration in thought
process
“I” Care Plan
“I have problems with my
memory.”
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Assessments for Care Planning
Traditional Assessments
Person Centered
Assessments
Medically based
Person based
Emphasis on symptoms,
impairments, deficits
Acknowledge losses but
emphasis on strengths
Minimal psychosocial history Life story emphasized
Family structure
What does family mean for
this person?
Does the person “fit” in the
program
How can our program
support the well-being of this
person?
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Care Plans
Traditional
“I” Care Plans
Based on medical/nursing
care plan
Used solely to direct
medical care
Uses first person narrative
Intended for nursing or
medical staff use only
Intended for use by all staff
who are involved in the
person’s care
Based on strengths
Based on problems
Used to support quality of life
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Why “I statement” Care Plans?
Strives to put the person back in charge of
their own life
 Supports & documents our efforts to
advance person centered
care/individualized care planning
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How do we facilitate “I” Care Plans
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Is the participant consulted?
Is their involvement facilitated regardless of their level of
impairment (physical, cognitive or mental)?
Are we too busy filling out forms to learn the essence of
this person?
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What are their hopes?
What brings them joy?
What are their dreams?
What do they worry about?
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Examples of things to ask:
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Name of choice. Is this name appropriate for all staff to
use?
Preference in group dynamics
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Likes to be in the center of things
Reflective—prefers to watch
Prefers small, quiet groups
Likes large groups with lots of noise and activity
Example from
Luther Manor Adult Day
Wauwatosa, WI
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If they were writing their own care plan, what
would it look like?
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People (staff) remember the details of stories
more than statistics or lists of tasks
When staff know something about the people
they interact with, they can move beyond being
task focused
My Personal Care Plan
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Person centered outcome measurements
Quality of life indicators
 Dementia care mapping
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 Attempts
to take the perspective of the person with
dementia
 Evidence based, observational process
 Can be used in several ways for quality improvement
processes as well as individual care planning
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Recruiting Staff Who “Get It”
Flexible
 Kind
 Empathetic
 Comfortable with participants
 Participant choice drives the program
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Typical Program Assistant Job
Descriptions
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Lists skills & competencies needed with corresponding
responsibilities
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Participate in assessment/care planning
Assist in developing the activity plan
Carry out plan of care
Carry out recreation activities
Observe and report observations
National Adult Day Services Association
Training the Program Assistant in Adult Day Services, 2004
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Observe & Report Observations
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Current standards require observation at minimum of:
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Skin tone
Strength
Flexibility
Signs of physical discomfort
Changes in abilities, behaviors, appearance
Program Assistants should be able to conduct calm observation & report
detail in times of crisis, reporting only what is seen, heard & done
National Adult Day Services Association
Training the Program Assistant in Adult Day Services,
2004
Is This Good Enough?
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Potential Additions to Job Description
to Support Person Centered Care
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A primary responsibility is to get acquainted with
the participant and work on establishing a
relationship with him/her & their family
Observe for evidence that a person experiences
particular pleasure in a specific activity & report
that during care plan meeting
Observe & report signs of emotional discomfort
whenever they occur with a participant
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Program Assistant Job
Descriptions
Traditional Job Description Person Centered Job
Description
Assist and supervise
activities of daily living
Facilitate independence and
coach through activities of
daily living. Assist only when
necessary.
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Performance Expectations
When person centered care is embedded in
an organization, the primary performance
expectation is that the goals of person
centered care will be pervasive in all
interactions with participants.
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How Can Staff Deliver Person
Centered Care?
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Must be modeled by supervisors
Must be a core value & underpinning philosophy
of all care
Must be understood-what does this mean for me
in my position?
Must understand what is different-not just doing
“the same old thing” but calling it by a different
name
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How Can Person Centered Care
Support Be Offered to Staff?
Well-being of staff a priority
 Education/training to do job well
 Clear job expectations
 Equipment adequate, appropriate &
available
 Accoutrements/accessories available to
personalize care
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Person Centered Care for Staff
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Basic understanding by managers/administrators of what
staff is experiencing in care
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Sorrow
Sense of loss
Fear of situations that are beyond their control
Fear of aggression from participants
Managers recognize stress, strain and/or burnout of staff
before critical stage (resignation)
Luther Manor’s exercises for Person Centered Care Staff
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Person Centered Care for
Families
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Families respected as care partners
 Seek
family input regularly
 Be sensitive to the family’s perspective on care
 Be sensitive to fears
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Positive relationships are nurtured between staff
and family members
Communicate, communicate, communicate!
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Bibliography
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Kitwood, Tom, Dementia Reconsidered, Philadelphia:
Open University Press, 1998.
Krugh, Christine, MSW and Bowman, Carmen S.,
Changing The Culture of Care Planning: A persondirected approach, Milwaukee: Action Pact, Inc. 2006.
Shields, Steve & Norton, Laverne, In Pursuit of the
Sunbeam: A practical guide to transformation from
institution to household., Milwaukee: Action Pact Press,
2006.
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Contact Information
LaDonna Jensen, RN
Marilyn Hartle, MSW, LCSW
PO Box 551087
Indianapolis, IN 46205
317-255-2248
ladonna@jentleharts.com
marilyn@jentleharts.com
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