Residents at the Princeton Elim Home are now able to choose what they want for meals. While that may not seem like a big deal for the population of people not in a nursing home, it is for those who are a resident of institutional settings. There is a movement to make nursing home care more homelike, at least judging by the background for the new program Princeton Elim Home is using called Person First Care. Much of the motivation for the change, says Princeton Elim Home Administrator Todd Lundeen, is due to the glut of baby boomers coming of the age of needing long-term nursing care. Many of them are going to want to maintain the freedom of choice they have been used to, as much as possible, he indicated.

A major physical change already took place at the Elim Home in Princeton five years ago when a major wing was added and extensive remodelling was completed. The major expansion and upgrade created a physical structure for the program changes being started now, says Lundeen.  Instead of just having the traditional corridors with rooms on each side, the construction project created seven neighborhoods, or spaces with a more home-like look. The neighborhoods were distinguished by having a living room and kitchen and each was given a name – Turnaround Point (a rehab area), Rum River Place (memory care unit), Skyview, Sunshine Circle, Pine Cone Lane, Moonlight Bay and Prairie Bloom. More spacious rooms with single occupancy were also created.

Person First Care

The new way of caring for the nursing home’s residents allows them more choices and provides more opportunity to build relationships between staff members and the elders, Lundeen adds. The program Elim is using is called  Person First Care, and is based on the so-called, household model of long-term care. As noted, the Elim residents can now choose their menu items, and eventually will be able to alter the times they eat and will also be given more say on the kinds of outings and activities they have. Instead of the staff trying so much to make the Elim Home resident fit into the staff’s schedule, the attempt is to do the reverse, Lundeen added.

More than 50 of the staff members were cross trained to acquire nursing assistant skills, as part of the changes, and another batch is going through the training. Even Lundeen took the 84-hour nursing assistant training. That helped sell the program to other workers, he said. The training course is not as fully intensive as the one that people take to become a nursing assistant, but it does give some of the skills, Lundeen said. The nursing assistant job is very rewarding through helping the elderly with their most basic needs, “but I can see why those staff members are tired at the end of their day,” Lundeen said. Nearly all the workers at Princeton Elim Home received cross training, and so if one of them is walking down a hall and a resident needs some help, quicker assistance may be more likely, Lundeen indicated.

Princeton Elim Home, in the fall of 2006, applied to the state for an alternative payment system to fund the training and other costs to make the program changes. It means a five percent increase in the daily room rate the Elim Home receives. Princeton Elim Home had to show it would use the extra money to increase the quality of life for its residents and meet the satisfaction of the residents’ families, Lundeen noted. As a result, Princeton Elim Home was one of 19 nursing homes in the state total of 385 nursing homes to be awarded the extra funding of $210,000, said Lundeen. It will be for fiscal year July 1, 2007, to June 30 this year.

Nursing homes have traditionally operated according to departments, with each person sticking to the job of that department, says Lundeen and nursing director Greg Wainman. With the cross training increasing the efficiency in nursing home care, more time will be freed up to build relationships with the elders, Lundeen said. Primary care staffing, one of the three priority areas identified to implement in the new programming, means more continuity in who is staffed at each household, said Wainman. The goal is to keep the same staff members within each household, Lundeen said. Princeton Elim Home administrators explain that the Person First Care program follows principals laid out in the book, “In Pursuit of the Sunbeam” by Steve Shields and LaVrene Norton.

Full implementation of Person First Care has not fully happened but staff members are taking some “baby steps” toward it, said Lynell Morris, who’s job is LPN staffing at the nursing home. Instead of automatically giving a resident a card showing a specified menu for a meal, for example, “we ask them what they want,” Morris said. Last Thanksgiving, some of the home’s residents went shopping for groceries, with the help of staff, for their Thanksgiving meal.

Learning Circles to Determine Wants

The Elim Home has also been conducting learning circles to figure out, in Wainman’s words, what the nursing home residents feel would make their place feel most like home. The learning circles are small group discussions, in which participants sit in a circle and each is given a chance to speak. It was from these circles that the three priorities were identified of enhancing the dining experience, having meaningful activities and continuity in primary care staffing.

Regarding primary care staffing, the elderly said they don’t want a “stranger coming to their room,” some calling it “unsettling,” Wainman explained. They like to see the same faces come into their room as much as possible, he explained. Also, allowing the residents to choose from a list of things to eat instead of having a “scripted” menu, gives them “more spontaneity, more variety,” said Wainman. The same is true in giving the residents more chance to decide what they want for activities, he added. The Elim Home won’t be able to grant every kind of field trip wish, but the staff will try to grant requests where possible, said Lundeen.

Princeton Elim Home, is in the approximately one percent of the nearly 17,000 nursing homes nationwide that are involved in Person First Care, Lundeen said. It is also the first of the Elim Homes in the Elim family to have it, he added. The Elim family of nursing and rehab homes includes facilities in Princeton, Milaca, Fargo, Minneapolis, St. Paul, Buffalo, Watertown, and Des Moines. But there could be more interest as the time goes on for other nursing homes to be part of it because of the statistics on the aging population. “Very soon within the next few years, we will have more seniors over age 65 than there will be kids under 18,” Lundeen said. “How do you meet that need and meet the need with the money you have? It’s a huge problem coming down the track.” Lundeen indicated that there is a lot of potential in tapping into the input that the elderly can more freely give. It will also be “therapeutic” for them, he said, to be involved in the decision making.