The Federal and State surveyors showed up at our Kahului community this morning, so I thought that today would be as good a day as any to write about some of the changes in the Centers for Medicare and Medicaid Services (CMS) guidelines that support our efforts in creating more homelike environments through both physical environmental changes and resident-centered caregiving. The new guidelines, which went into effect on June 17, 2009, call on nursing homes to begin/continue de-institutionalizing their physical environments. CMS suggestions include:- Eliminating overhead paging and bed/chair alarms
- Refraining from having meal service in dining rooms using trays
- Removing institutional signage
- Eliminating medication carts
- Reducing mass purchased furniture, drapes and bedspreads
- Eliminating large, centrally located nursing stations
It is important to note that the above are only some suggestions provided by CMS, however if a nursing home does not meet these suggestions, they will not be considered non-compliant. According to the CMS guidelines a nursing home "is expected to do all it can within fiscal constraints to provide an environment that enhances quality of life for residents, in accordance with resident preferences" (F252). CMS memo issued on April 10, 2009, which include its new interpretive guidelines for surveyors, states: "A 'homelike' or homey environment is not achieved simply through enhancements to the physical environment. It concerns striving for person-centered care that emphasizes individualization, relationships, and a psychosocial environment that welcomes each resident and makes him/her comfortable."In addition, new CMS guidelines also call for visitors to have 24-hour access to residents, regardless of their familial relationship. I am happy to be able to say that visiting hours and visitor sign in books at both of our nursing communities were eliminated over three years ago as part of our initial Luana efforts.These new CMS guidelines are the result of the symposium hosted by CMS and the Pioneer Network in April 2008, which focused on the impact of innovative environmental design on creating a home and community for nursing home residents. If you are interested reading the background paper from this symposium, please click on the below link:Creating a Home in the Nursing Home: A National Symposium on Culture Change and the Environment Requirements
I was at our on-site yoga class the other day and Ted Tucker, our Chief Human Resources Officer, shared that he was out in the neighborhoods the evening before and was pleased to see that when he stopped at the West Neighborhood, he found two residents eating their dinners while one nurse was charting in the kitchen. This may not sound like something to get excited about, but it's a small step in creating an environment that feels like home.
Back in January 2009 the renovation and transformation of the West Neighborhood nurses' station into a kitchen, dining and living space for residents was completed. Nurses still do their paperwork here, but now it's a mixed use area for both residents and nurses. Residents have a living area where they can watch TV and relax, and there's a dining area adjacent to the kitchen where they can eat their meals with one another. One of the biggest challenges has been the adjustment of using the same space as a living area for residents and and a work area for nurses.
In moving toward creating a more home-like environment for residents, one of the goals for this Neighborhood is to be able to serve meals family-style instead of on individual trays. While residents are currently encouraged to sit together to eat, a family-style meal would mean that residents could choose what they want to eat and if they want to have seconds. One can imagine that the social interactions that occur around a dining room table may be much more dynamic than those in a cafeteria.
In my previous posting, I shared a photo of resident Helen Oliveira's newly decorated room, however there have been several residents whose rooms have been redecorated over the last year. The first room belongs to Marge Champlin, who moved into the Ilima Neighborhood at Hale Makua Kahului back in November 2008. When she saw her room for the first time she thought she was staying in a hotel. There were fresh cut roses by her bedside, a beautiful painting hanging above her bed, and touches of vibrant colors throughout her room.
Upon learning that her mother would be moving to Hale Makua, Marge's daughter, Melissa, wanted to ease the transition of her mother's move by creating a living environment that her mom would be comfortable in, one that felt as much like the home she was leaving as possible. She found inspiration in the things that her mother loved, like painting and flowers. The result was the transformation of a standard bedroom into a personalized room perfectly suited for her mom.
This phrase, "I want to go home", is probably a familiar one. We've all heard it from time to time, however for most people this phrase may come as a surprise when the person saying it wants to return home to their residence at a nursing home. This morning our Activities Director, Teresa Lopes, stopped me in the hallway to share a story that resident Helen Oliveira's family member had shared with her. They had brought Helen to their home to celebrate a family birthday. When dinner was done Helen told her son that she wanted to go home, her friends were waiting for her and would be wondering where she was if she didn't get back to Hale Makua soon.
With Luana our goal is to really transform Hale Makua into a place that feels like home to the residents so that residents are happy to call Hale Makua their home. Or as our CEO, Tony Krieg, says "we want to put the 'home' back into 'nursing home'". Part of this effort includes encouraging residents and their families to personalize the decor in resident rooms, which can include hanging photos and artwork on the walls, bringing in bedding linens, lamps and plants, hanging window coverings, etc.
Helen's daughter-in-law recently redecorated Helen's room for her birthday. Pictured here is Helen in here newly decorated room.
