Individualized Morning Routine

New Quality of Life Surveyor Guidelines

OBRA ’87 states that each facility must provide care and services to:

“attain or maintain the highest practicable physical, mental and psycho-social well-being of each resident.”

When we go by the normal rhythms of a resident, individualizing care, we support their experience of being at home.

When we don’t, we induce agitation and despair, without ever intending to. We wake people out of a sound sleep in the morning so that we can get them to breakfast at a set time. We shower people on the facility’s schedule, not according to their own routines.  We even have people go to the bathroom based on when we’ve determined it’s time for them to go. A woman on her second day living in a nursing home told Carter Williams, “You haven’t lived til you’ve gone to the bathroom on someone else’s schedule.”

While institutional care may seem efficient, it really isn’t. Homes that have individualized their care have found that they actually have more time, and better quality time, with residents. Instead of a rush hour getting everyone up, washed, dressed, and transported to the dining room where they fall back to sleep waiting for their food trays to come, staff at homes that have gone to having people awaken of their own accord, find that they actually have more time to help each resident start their day.

Here about the experiences at two of these homes:

1. MaineGeneral Rehab and Nursing Care at Glenridge in Augusta, ME. Their journey was chronicled in Culture Change in Long-Term Care: A Case Study, created by the American Health Quality Foundation to guide Quality Improvement Organizations and nursing homes interested in using a quality improvement approach to individualizing care and initiating culture change. Funding for this film was provided by The Commonwealth Foundation and Quality Partners of Rhode Island. B&F Consulting guided the production of this film as a model for an effective change process that starts with nursing and relies on inclusive and empowering leadership.
   

1. St. Camillus Health Center, Whitinsville, MA, has been on its culture change journey for about 5 years. In From Institutional to Individualized Care Part One, Sandy Godfrey, Director of Nursing, describes their process of working through issues with staff and residents. Staff initiated the decision to begin consistent assignments as a way to know residents’ individual routines. Nurses monitored issues such as weight loss to ensure no negative outcomes. Administration talked through changes with families. The process was successful, and a building block to further efforts to individualize care.
   

Both nursing homes used very systematic, interdisciplinary, and inclusive processes to make their changes. See: The How of Change.