It asks the people living in the extended care residence to make the decisions about how they want to live. It’s referred to as a “person-centered” or “resident-centered” approach—and the residents’ quality of life becomes the extended care organization’s highest priority. “The model is based on the sense of being at home, but we don’t forego the medical care and service,” Russell says. “It has the larger goal of creating an environment so people in extended care can live on their own terms.”
Culture change in the works
A number of extended care organizations in the U.S. are working to line up with culture change. “It’s happening in bits and pieces across the industry. A lot of buildings are transitioning from the medical model to a more residential model,” Russell says.
Erickson Communities, a developer and manager of retirement communities, is proactively pursuing culture change. “We’re calling it a ‘household model.’ The household model involves changing the physical environment, the staff, and the activities element,” says Mark McElwee, vice president of Renaissance Gardens, the extended care neighborhood of communities built and managed by Erickson. The physical design and features of the household model are based on the idea that, “if you have it in your house, we have it here,” McElwee says. For example, “The dining room is set up so people can open the refrigerator and grab a snack at any time—as they would in their own home,” McElwee says.
The responsibilities of the staff nurses—now called “household associates”—have expanded. Household associates not only care for people, but also take care of the cooking, cleaning, and laundry. “As in your private home, if you had a guest, and there was a spill, you wouldn’t call the housekeeper to clean it up. You would take care of it yourself. The new role of nurses is based on family membership— household associates do everything a family member would do,” McElwee says.
Because the ratio of staff to residents is much smaller in the new model, nurses have more time to learn the individual preferences of a resident and get to know them on a personal level. “This way, relationships develop between household associates and residents,” McElwee says.
Erickson is also adjusting how activities take place in the household model. “People should have choices, and we want to honor their wishes and desires,” McElwee says. Residents communicate with the household associates about what they want to do, and the associates help make that happen. Instead of scheduling an exercise class on Mondays and Wednesdays, the associates ask the residents if and when they would like to exercise each day, or if they would rather do something different.
“If we do our jobs right, we will always be involved—not in charge—of supporting and helping each resident do what they enjoy,” says Warren Burke, senior vice president of health services at Erickson communities. “In the traditional model, the caregiver works for the resident. In the new model, the household associate participates in daily life with the resident.”
Here to stay
According to experts, culture change will continue. “There’s no end in sight. It will be a constant process of growth and transformation in the industry,” Russell says.
“It’s a process to find the best way to deliver care.”