By Jennifer Crane, MS, CDP
There are many elements in nursing/care home administration that are vital for the support of older adults in order to ensure that they attain the highest state of physical, mental, and psychosocial well-being. Nursing/Care homes have become a place where the fundamental aspects of these elements are combined in a holistic approach to resident care. While all of the factors in the aforementioned categories are necessary, the three most critical elements to promoting positive outcomes include adequate staffing, appropriate environmental features, and addressing individual resident preferences.
Staffing
In order to meet the needs of residents, administrators must plan and allocate an appropriate amount of staffing for the facility. However, proper staffing levels can be notoriously difficult to control, while administrators must consider key factors such as the ratio of staff to resident and staff turnover rate. A proper ratio is dependent upon what works for the facility, considering the type of facility, residents’ needs and facility funding. For example, the nursing-home portion of a well-funded facility may have one skilled nurse per 27 residents (site visit, April 2016), which staffing level adequately meets the residents’ needs. Zimmerman and Cohen (2010) discuss the benefits of consistent staffing, asserting that staff are able to get to know residents on a more personal level, which can help to avoid the upset and confusion of residents that can result from a high turnover rate. Staff that has received the proper training, as well as and the support of team members, are better able to do their jobs and to meet the needs of seniors. The turnover rate in many nursing homes is between 30 and 120%, which does not allow for training, for familiarity, or for a sense of safety to develop on the part of residents (site visit, April 2016). This turnover rate causes remaining staff to operate at lower levels of confidence and experience, which, in turn, can slow the response times and effectiveness for the needs of seniors.
It is imperative to support older adults in ways that will maintain physical, mental, and psychosocial well-being.
Environment
Environment is especially important for residents, especially for those with cognitive or other physical issues that impair their ability to function normally. Day, Carreon, and Stump (2000) state that design is an important therapeutic resource that supports the health and functionality of residents. Elements such as facility design and layout assist with orientation and resident safety, while modifications such as quiet rooms with soft colors and the removal of noisy paging systems help to prevent overstimulation (Day et al., 2000). The modifications that provide orientation “cues” for residents reduce stress levels, lessen confusion and incontinence and prevent people from wandering, adding to the safety and emotional well-being of the resident (Sloane et al., 2002). An environment that is less “institutional” in nature is conducive to reducing negative behaviors such as agitation, isolation, exit-seeking and improving positive experiences like socialization and improved mental function (Day et al., 2000). While nothing is exactly like being at home, a homelike environmental design is key to residents being comfortable and able to relax (site visit, April 2016).
Resident Preferences
Providing care that centers on the personal preference of the residents is an integral part of giving respect and ensuring healthier outcomes. A recent visit to a nursing home facility illustrated the relevance of seniors having a voice in their own lives and care. For example, residents at this facility take part in a program that allows choice in the recipes used for meal preparation, effectively giving a voice to residents about the food served at their facility (site visit, April 2016). Heid, Van Haitsma, Kleban, Rovine, and Abbott (2015) state that individual preferences shape how care should be delivered, allowing for higher levels of physical and emotional well-being. Person-centered care states that preferences actually communicate psychological needs, and that individualized plans can be created and implemented that support these needs (Heid et al., 2015). The more staff and residents are able to connect and get to know each other, the better the staff is able to meet resident’ needs (site visit, April 2016). Details from food choices to favorite activities to resting options are integral to making a resident feel more at home and cared for.
Conclusion
It is imperative to support older adults in ways that will maintain physical, mental, and psychosocial well-being. Some of the key elements necessary to provide good care are adequate staffing, appropriate environmental features, and the personal preferences of the senior. Staffing needs to be provided at appropriate and consistent levels to provide well-trained, personable, and timely aid to residents. Turnover rates have an effect on the care and comfort levels of both staff and residents. It is important to provide environments that are homelike and provide features that help to reduce stress and confusion. Finally, it is imperative that the personal preferences of residents help to shape care. Person-centered care is instrumental in helping to connect to seniors as individuals and to tailor care to what is really needed. Together, these elements support the effort to provide quality, practical care to older adults.
References
Day, K., Carreon, D., & Stump, C. (2000). The therapeutic design of environments for people with dementia: A review of the empirical research. The Gerontologist, 40(4), 397-416.
Heid, A. R., Van Haitsma, K., Kleban, M., Rovine, M. J., & Abbott, K. M. (2015). Examining clinical predictors of change in recreational preference congruence among nursing home residents over time. Journal of Applied Gerontology, 1-19. doi:10.1177/0733464815617288
Sloane, P. D., Mitchell, C. M., Weisman, G., Zimmerman, S., Long Foley, K. M., Lynn, M., … Calkins, M. (2002). The therapeutic environment screening survey for nursing homes (TESS-NH): An observational instrument for assessing the physical environment of institutional settings for persons with dementia. Journal of Gerontology: Social Sciences, 57(2), S69-S78.
Zimmerman, S., & Cohen, L. W. (2010). Evidence behind the green house and similar models of nursing home care. Aging Health, 6(6), 717-737. doi:10.2217/AHE.10.66