Establishing a Person-Centered Culture in a VA Nursing Home

The Veterans Administration has taken up the model of person-centered care, asking administrators throughout its health care system to modify their facilities and train their staff accordingly. Staff from the VA’s newly-renamed Haley’s Cove Community Living Center (HCCLC) in Tampa, Florida recently published a case study on their own shift to the patient-centered model.

HCCLC assigned an ethics committee responsible for providing oversight and education on patient autonomy, and which reviews ethical issues that arise in providing care. The case study provides examples, including a resident asking to stay outside on the patio on sleepless nights. The case study presents how the committee and staff established a plan to encourage the resident’s autonomy without putting him or other residents at risk. Other examples include allowing residents more choice in diet and dining, and providing support for residents who want to dine out.

When it makes recommendations, the committee draws on scholarly research on social and physical wellbeing, as well as survey research on resident preferences. HCCLC also added new options for social interaction, liberalized their diet restrictions, and increased the involvement of residents’ families and friends in programming and planning. The facility also assigned staff exclusively to “quality of life” work, such as providing companionship for medical procedures and resident patient advocacy. The authors argue that providing staff who are devoted exclusively to such issues frees up the nursing staff to provide increasingly patient-centered care.

After instituting these and other changes that are included in the article, HCCLC saw strong improvements in how the facility was assessed for patient-centered best practices. The authors argue that the ethics committee works as a check and balance component to balance autonomy and the ethical imperative to provide patients and residents with medical care. This article is a useful case study in how care facilities can work to implement culture change and person-centered practices.

 

Article cited:

Dunbar B, Sink P, Alsobrook D, Bailey B, Lonczak T, and Starnes R, (2011) “Ethical Perspectives of Sustaining Residents’ Autonomy: A Cultural Transformation Best Practice.” Nursing Administration Quarterly, 35(2):126-133

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