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Shifting the paradigm in geriatric care management: moving from the medical model to patient-centered care
- Authors:
- ENGUIDANOS Susan M., DAVIS Carol, KATZ Lynne
- Journal article citation:
- Social Work in Health Care, 41(1), 2005, pp.1-16.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Studies of Geriatric Care Management Programs have had mixed results at best. Little evidence exists to attest to the effectiveness of these programs in improving patient outcomes and decreasing avoidable acute care service use. In response to these data, Kaiser Permanente's Geriatric Care Management program initiated a randomized trial to test an integrated, multifaceted depression treatment model within the care management framework and it's ability to detect and treat moderately and severely depressed older adults. This paper presents case studies of the geriatric care managers' practice changes associated with this intervention as well as case studies of two depressed clients, their experiences and outcomes associated with this study. Implications of this model are discussed.
The Lyngblomsten Care Center, St. Paul, MN
- Authors:
- MIKELSON Paul, JOHNSON Jane
- Journal article citation:
- Journal of Social Work in Long-Term Care, 2(3/4), 2003, pp.301-306.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Concluding that the medical model nursing home is going to disappear, at Minnesota organisation has created a new residential setting for dependent elderly while retaining nursing home licensure and certification. Based on the "service house" system currently used in Sweden, this model has a focus on autonomy and self determination by maintaining the aspects of daily life that are important to every individual. Residents have full apartments and have their own food for breakfast and supper, breaking the age-old facility problem, where mealtimes dictate your daily routine. Staff act as generalists, which allows greatly improved service with higher staff to client ratios. (Copies of this article are available from: Haworth Document Delivery Centre Haworth Press Inc., 10 Alice Street Binghamton, NY 13904-1580)
Implementing the Eden alternative in Australia
- Author:
- MACKENZIE Susan
- Journal article citation:
- Journal of Social Work in Long-Term Care, 2(3/4), 2003, pp.325-337.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Many Aged Care facilities in Australia are continuing to operate in a traditional medical model, with elders being dependant, living in large institutions and living a life of mere existence. It is Australia's challenge to change the culture of ageing and the perceptions held by the community that elders are powerless and feeble. Australia needs to turn Aged Care facilities into homes, making them attractive for residents, families, and staff and to create a life worth living. In recent times some Aged Care providers have begun to research and implement new practices and philosophies such as the Eden AlternativeTM and culture change, believing that they can create an environment filled with animals, plants, and children. Australia has seen the positive results and data from the USA, and some homes in Australia are now beginning to gather base data and some comparative data, which in preliminary fashion indicate positive outcomes for staff and residents. Australia has to continue on the culture change journey, educating and spreading the awareness and positive changes nationally. Other Aged Care operators need to be aware of these new concepts in ageing, so that they can begin to practice self-determination; person-centred work and self-directed teams and leadership. Greater knowledge, awareness and Australian proactive data and results will assist and encourage others on the journey to culture change. (Copies of this article are available from: Haworth Document Delivery Centre Haworth Press Inc., 10 Alice Street Binghamton, NY 13904-1580)
The Providence Mount St. Vincent experience
- Author:
- BOYD Charlene K.
- Journal article citation:
- Journal of Social Work in Long-Term Care, 2(3/4), 2003, pp.245-267.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
In 1991, a strategic planning team at a senior-living care facility in Seattle, Washington, began a process of organizational and cultural change. The process transformed both the philosophy and model of care, as well as the physical environment of Providence Mount St. Vincent. In 1998, a New York Times writer described the results she observed within and around the nearly 300,000-square-foot building constructed in 1924: The Mount, as those who live there call it, is widely regarded to be what many Americans consider an impossibility-a good nursing home. That is to say, in an industry freighted with the dread of old age, disability and loneliness, and periodically tainted by scandal and abuse, The Mount has found ways to be a home to people who can no longer care for themselves, to provide a sense of community in a place where no one wants to be, to be a community that is more about living than about dying. Prior to the change process, The Mount maintained a traditional, medical model of operations designed to achieve staff efficiencies and meet residents' medical needs within a mission of compassionate care. Studies to measure residents' daily levels of activity and engagement helped determine quality of life within a medical model setting. In a typical U.S. nursing home, residents spend 25-35 percent of their day engaged in some activity. Based on a series of behavioral studies at The Mount in the early 1990s conducted with approximately 1.400 observations of resident activity, a typical waking day in the life of a nursing home resident included engaging in any type of activity for 32 percent of the time. After The Mount's strategic planning team introduced a "neighborhood" concept for people receiving nursing care, the measure of engagement jumped from 32 to 42 percent and the death curve reversed and improved by 83 percent. For the past five years, The Mount has worked with and through a national group called the Pioneer Network to serve as a culture change resource and learning laboratory for other senior-living care providers around the country. This article describes the journey and outcomes of culture change in this facility. (Copies of this article are available from: Haworth Document Delivery Centre Haworth Press Inc., 10 Alice Street Binghamton, NY 13904-1580)
Policy values and culture change in long-term care- the role of state government in catalyzing change
- Author:
- REYNOLDS William E.
- Journal article citation:
- Journal of Social Work in Long-Term Care, 2(3/4), 2003, pp.397-409.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
The quality of care in nursing homes remains far from optimal. Excessive reliance on a medical model of care fails to address residents' desire to be treated with kindness, courtesy and consideration. In addition, the issue of improving quality of care is linked to addressing growing concerns about nursing home staffing. One solution is for government to play a role in catalyzing a change in the organizational culture of nursing homes to address the concerns that both residents and staff have with the existing culture. A number of states are providing grants to nursing homes to implement culture change. This has included New York State which has emphasized culture change in its Dementia Grant Programme. (Copies of this article are available from: Haworth Document Delivery Centre Haworth Press Inc., 10 Alice Street Binghamton, NY 13904-1580)
Beyond the medical model the Eden Alternative(r) in practice: a Swiss experience
- Author:
- MONKHOUSE Christa
- Journal article citation:
- Journal of Social Work in Long-Term Care, 2(3/4), 2003, pp.339-353.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
The medical or institutional model of care has been the standard in most of the 1300 nursing homes in Switzerland. Consequently, staffing problems, increasing costs, and poor reputation have become the norm. This case study describes two 60-resident homes in Zollikon, Switzerland, which implemented the Eden Alternative(r), beginning in 2000. Based on this model, they are committed to the eradication of resident loneliness, helplessness, and boredom. Their tools are companionship, spontaneity, and the opportunity to give care to each other, staff, children, animals, and plants. The change from a medical model was precipitated by a care and financial crisis. Since then, three steps have been taken. The first, the crisis intervention step, was followed by the implementation of total quality management resulting in significant improvements in clinical outcomes and financial stability. Ultimately, the Eden Alternative was successfully introduced. It was perceived as "the missing link" and appears, at this early stage, to meet the real needs of residents and staff. The change process is described and outcomes are presented and discussed. (Copies of this article are available from: Haworth Document Delivery Centre Haworth Press Inc., 10 Alice Street Binghamton, NY 13904-1580)