To accommodate and attract the growing number of people who are living longer, healthcare institutions must find a way to increase value. One way to add value is found in the Planetree model of resident-centered care.
This approach makes residents and families active partners in care alongside the clinical staff. Loch Lomond Villa, working with Planetree and Herman Miller Healthcare, chose this model to transform its facilities, its processes, and its culture.
What We Know
The growing cost of long-term care is rapidly outpacing most people’s ability to pay for it. Nursing home care runs about $60,000/year in Canada*1 and almost $84,000 in the U.S., where it has jumped 24 percent in the last five years.*2
Demand for long-term care services is also increasing as the baby boom generation continues to age and as life expectancy (which is currently 82 years in Canada and 79 in the U.S.) continues to increase.*3 By 2050, the segment of Americans 85 or older will be 10 times what it was in 1950*4 and the proportion of Canadians 80 and older in 2056 is projected to be one in ten—triple what it was in 2005.*5 In the U.S., about 20 percent of those over 65 years of age live in institutional settings.*6
In order to accommodate and attract the increasing number of people who are living longer, healthcare institutions must find a way to increase value.
One way of delivering value is resident-centered care, “a healthcare setting in which residents are encouraged to be actively involved in their care, with a physical environment that promotes resident comfort and staff who are dedicated to meeting the physical, emotional, and spiritual needs of the residents.”*7
It’s an approach in which everything revolves around what’s best for the resident, rather than the convenience of the caregiver or the limitations of the facility. It’s also an approach that directly addresses a big determinant of resident satisfaction, i.e., how staff interact and care for residents. Research shows that residents’ top priorities all relate to staff communication and empathy. Staff responsiveness and sensitivity are important to residents, as are being kept informed, being included in treatment decisions, and having their emotional needs met.*8
Meanwhile, staff satisfaction depends on how positively they perceive their own effectiveness in treating patients. At Stamford Hospital in Stamford, Connecticut, “as employee satisfaction improved, satisfaction scores for emergency department patients increased from the 44th to the 89th percentile, and scores for inpatients increased from the 18th to the 75th percentile.”*9 It’s a reinforcing loop: The more satisfied the staff, the more well served the patient; the more well served the patient, the more satisfied the staff.
(Left) Resident-centered care facilities encourage relationship building among staff and residents.
There are other advantages. In one five-year study that compared a hospital that used patient-centered practices and one that didn’t, the patient-centered hospital had a shorter average length of stay, lower cost per case, and higher overall patient satisfaction scores.*10 Another hospital experienced a 20 percent decline in malpractice claims in the nine years after it adopted a patient-centered approach.*11 While all this research was conducted in hospitals, it’s logical that long-term care facilities can also realize significant benefits.
In addition, for many organizations, the resident-centered care model provides a strategy for staff attraction and retention because of staff pride and the satisfaction they get from working in a resident-centered facility.
Those organizations following the resident-centered model fall along the entire continuum of long-term care—skilled nursing, independent and assisted living, and sub-acute and short-term rehabilitation. In the day-to-day ways that each is building community, cultivating relationships, engaging all stakeholders in decision-making, and personalizing support and services for those who live there, they are modeling what is possible.
(Left) At Loch Lomond Villa, residents and staff have easy access to nature in the courtyard and on walking paths.
When the Province of New Brunswick, Canada, decided to fund a $52 million multi-phase expansion and renovation of Loch Lomond Villa, a home specializing in dementia and psychogeriatric care, the administration saw it as an opportunity to go beyond structural changes. “Our goal was to transform our 40-year-old culture into one that is truly resident-centered, making our home as comfortable and as homelike as possible,” says CEO Cindy Donovan.
While Loch Lomond Villa has won awards and is used as a benchmark by other organizations, the administration was willing to look hard at their practices. “We asked ourselves the questions again. Are we truly resident-centered? Is what we thought was quality care for our residents truly what the residents and their families thought was quality care? Times are changing, levels of care are changing, the needs of the residents are changing, and we need to change with them,” says Donovan.
After much research, Loch Lomond Villa chose to follow the Planetree model of resident-centered care, which aims to personalize, humanize, and demystify the healthcare system. The Planetree Network is a global group of acute care hospitals, continuing care facilities, and outpatient clinics all working to, as Planetree says, “transform their healthcare by considering every aspect of the healthcare experience from the perspective of their patients and residents, and reconnecting staff to their passion for caring for others.”
It’s a model that advocates changing the organization’s culture and the performance criteria. It differs from other patient/resident care models in that it emphasizes educating residents and families and making them active partners in care alongside the clinical staff. Planetree has demonstrated that resident-centered care is not only an empowering philosophy, but also a viable and cost-effective model.
As part of Loch Lomond Villa’s project kick-off, a Planetree consultant spent three days onsite conducting information sessions for residents, families, tenants, staff, volunteers, community partners, and board members. Donovan says Planetree helped Loch Lomond Villa understand “you don’t know what you don’t know.” It also showed Loch Lomond Villa how to create ownership among employees and hold them accountable in a safe way.
Elements of their culture change included:
- Resident-direction in care and daily activities supported by the design of the environment;
- A home-like atmosphere;
- Close relationships between residents, family members and staff;
- Staff empowerment, whereby they played a key role in what was purchased;
- Collaborative decision-making; and,
- Quality improvement processes.
(Right) Natural light and a view to nature are critical elements of resident-centered facilities.
Because of Planetree’s emphasis on making residents active participants in their own care, Loch Lomond Villa started by asking residents and their families what they valued. That served as the basis for practical approaches to creating a resident-centered culture, including:
- Systems for getting to know residents;
- Resident-centered staffing approaches;
- Choosing the right furniture to maximize independence;
- The move-in experience;
- Supporting the community through grief and loss;
- Supporting spirituality;
- Managing risk;
- Culinary engagement;
- An environment of living and comfort;
- Experiences that promote well-being; and,
- Community connections and transitions of care
Changing the culture and the processes is hard work for everyone, and Donovan wanted to do everything possible to make sure the changes “stuck”—including using building design to reinforce and support the changes in operations and culture as the staff refined its approach to resident-centered care. The design problem came in the form of the question “What is the best way to accomplish that?”
(Left) Loch Lomond Villa's Celebration Lounges are inviting spaces for a variety of functions and gatherings.
For help with that particular question, Loch Lomond Villa turned to Herman Miller Healthcare, the first manufacturer named a member of the Planetree Visionary Design Network, because of its dedication to resident-centered care. The same qualities that made it worthy of membership made it a good fit for the project—its commitment to the design of healing environments, incorporation of evidence-based design elements into design solutions, sustainability, and knowledge sharing.
(Right) A comfortable and aesthetically pleasing environment contributes to the emotional well-being of residents.
After visiting the site and listening to Donovan talk about her goals, Herman Miller recommended several product solutions, which the residents used and evaluated for comfort, ease of use, safety, and durability. Those evaluations helped Donovan make final design decisions with confidence.
The new Loch Lomond Villa (four "neighborhoods" with 25 residents in each) has other design elements, as well, that help create the type of resident-centered environment Donovan envisioned, such as:
- Common spaces that encourage relationship building and interaction among staff and residents, including Celebration Lounges where a variety of activities and gatherings take place.
- Amenities such as a movie theatre, a baby grand piano, Internet café, computer stations, and a library provide a huge spectrum of activities and choices for how residents spend their time.
- Glass-covered atriums, outside courtyard and walking areas, water fountains, a fishpond, and waterfalls encourage outdoor activities.
- Color-coded wayfinding and other visual cues in different neighborhoods help residents and visitors orient themselves.
- Windows provide plenty of natural light and views to the outside.
- Designated respite areas for staff, as well as showers and locker rooms.
- New tools and processes (such as tablet-type pads with touch screens for recording data) save staff time and eliminate redundant paperwork.
- State-of-the art technology, including a motorized ceiling lift, helps staff move residents more easily and safely in and out of bed.
- Decentralized and well-placed storage rooms and supply cabinets save steps and improve staff efficiency.
- Cameras let staff monitor residents from various places, improving safety, and LED screens keep visitors informed about various activities.
Donovan, who is quick to point out that design can support cultural change but never replace it, is nonetheless pleased with the final result. The materials and finishes are appropriate to the environment, but instead of looking and feeling “institutional,” the environment is comfortable and aesthetically pleasing. Details like this contribute to the emotional well-being of residents, Donovan says. “It helps alleviate fear and anxiety that seniors sometimes have living in a place that’s unfamiliar; soothing colors and comfortable well-designed environments help residents feel more at home.”
In addition to making changes to the design, Loch Lomond has instituted a quality improvement program that measures several clinical outcomes, including falls, trips to emergency rooms, medication errors, and wounds, as well as measuring resident, family, and staff satisfaction. Loch Lomond Villa feels strongly that staff and family involvement and empowerment are all keys to their success.
The success of the project can be attributed in part to the collaborative effort of the Loch Lomond Villa team, Planetree, and Herman Miller and the expertise each brought to the table. Donovan says something else is a bigger factor, however: “The most powerful resources available for those on a journey of organizational resident-centered transformation are not manuals, web sites, or education sessions; they are the individuals who make up the heart and soul of your community.”
Photo credit: David Ellison
1. Michael Grignon and Nicole F. Bernier, “The Real Costs of Long-Term Care for Canada,” Troy Media, December 6, 2012, http://www.troymedia.com/2012/12/06/the-real-costs-of-long-term-care-for-canada/ (accessed August 19, 2013).
2. Blake Ellis, “Nursing Home Costs Top $80,000 Year,” CNN Money, April 9, 2013, http://money.cnn.com/2013/04/09/retirement/nursing-home-costs/index.html (accessed August 19, 2013).
3. World Health Organization, 2011 http://gamapserver.who.int/gho/interactive_charts/mbd/life_expectancy/atlas.html (accessed September 10, 2013).
4. Congressional Budget Office, “Rising Demand for Long-Term Services and Supports for Elderly People,” June 26, 2013, http://www.cbo.gov/publication/44363 (accessed August 19, 2013).
5. Canadian Union of Public Employees, “Residential Long-Term Care in Canada,” October 2009, p. 22, http://cupe.ca/updir/CUPE-long-term-care-seniors-care-vision.pdf, (accessed August 19, 2013).
6. Congressional Budget Office, “Rising Demand for Long-Term Services and Supports for Elderly People,” June 26, 2013, http://www.cbo.gov/publication/44363 (accessed August 19, 2013).
7. Patrick A. Charmel and Susan B. Frampton, “Building the Business Case for Patient-Centered Care,” Healthcare Financial Management, March 2008, p. 2.
9. Ibid, p. 6.
10. Ibid., p. 2.
11. Ibid., p. 4.