Nothing is Traditional about Nothing is Traditional about Environments in a Traditional Environments in a Traditional Nursing Home Nursing Home Lois J. Cutler, PhD Lois J. Cutler, PhD Creating Home in the Nursing Home Creating Home in the Nursing Home Symposium by CMS & Pioneer Network Symposium by CMS & Pioneer Network April, 3, 2008 April, 3, 2008
Session Plan Session Plan � Focus: Physical environments in typical Focus: Physical environments in typical � nursing homes based on 10 years of research nursing homes based on 10 years of research � Findings from research Findings from research � – Quality of Life Study & other studies Quality of Life Study & other studies – � Introduction to NHRegsPlus Website Introduction to NHRegsPlus Website � � Recommendations at 4 levels: Recommendations at 4 levels: � – Federal regulators & policymakers – Federal regulators & policymakers – State regulators & policymakers State regulators & policymakers – – Builders & owners Builders & owners – – Administrators & staff leaders Administrators & staff leaders –
QOL in Nursing Homes QOL in Nursing Homes Funded by CMS, 1998-2003 Funded by CMS, 1998-2003 � 5 states 5 states – – 8 NH/ state 8 NH/ state – – 131 units 131 units – – � 21 SCU – – 1988 resident rooms & baths 1988 resident rooms & baths 21 SCU � Environmental checklists focus on QOL Environmental checklists focus on QOL � domains (not dementia specific) domains (not dementia specific) � 3 levels of assessments 3 levels of assessments � – Resident room & bath (112 items) Resident room & bath (112 items) – – Nursing unit (140 items) – Nursing unit (140 items) – Facility wide (134 items) – Facility wide (134 items) Captured specific objective environment of each Captured specific objective environment of each � � individual & linked environment to QOL & functional individual & linked environment to QOL & functional data data
Definition of Physical Environment Definition of Physical Environment Fixed, semi-fixed, & unfixed Fixed, semi-fixed, & unfixed components of physical structure & components of physical structure & furnishings, fixtures, decor, and furnishings, fixtures, decor, and equipment (excluding backstage). equipment (excluding backstage).
Quality of Life Domains Quality of Life Domains � Autonomy Autonomy � Comfort Comfort � � � Dignity Dignity � Security Security � � � Privacy Privacy � Functional Functional � � competence competence � Meaningful Meaningful � activity � Spiritual well- Spiritual well- activity � being being � Enjoyment Enjoyment � � Individuality Individuality � � Relationships Relationships �
Sharing Space Sharing Space Bedroom Bathroom Bedroom Bathroom � 580 (29%) private 580 (29%) private � 25% private 25% private � � � 1152 (58%) 2 bed 1152 (58%) 2 bed � 42% 2 people 42% 2 people � � � 178 (9%) 3 bed 178 (9%) 3 bed � 5% 3 people 5% 3 people � � � 78 (4%) 4-6 bed 78 (4%) 4-6 bed � 18% 4 people 18% 4 people � � � 10% 5-20 people 10% 5-20 people � � 13% outside room 13% outside room � traveled up to 82ft traveled up to 82ft
Storage Storage (Regulations require: accessible, (Regulations require: accessible, individual, private closet space) individual, private closet space) � 7% clothes rods accessible (36 7% clothes rods accessible (36” ”-48 -48” ”) ) � yet 65% used wheelchairs yet 65% used wheelchairs � 37% lockable storage 37% lockable storage � � 41% counter space around bathroom 41% counter space around bathroom � sink sink � 9 bathrooms had space 2 9 bathrooms had space 2’ ’X2 X2’ ’X2 X2’ ’ � � 14% of rooms incontinence products 14% of rooms incontinence products � visible visible
Sharing Space: Sharing Space: One Counter and One Chair One Counter and One Chair
Barriers to Autonomy Barriers to Autonomy (65 % wheelchair usage) (65 % wheelchair usage) � Long undistinguishable Long undistinguishable � corridors corridors � State req. distance to State req. distance to � nursing station seldom nursing station seldom achieved achieved � Limited automatic door Limited automatic door � openers openers – Main door: 19 yes, 21 no Main door: 19 yes, 21 no – – Unit: 2 yes, 129 no Unit: 2 yes, 129 no – � Bathroom key needed Bathroom key needed � or for visitors only or for visitors only
Distance as a Barrier Distance as a Barrier Distance measured from Min Max Max Mean Distance measured from Min Mean farthest bedroom to: farthest bedroom to: Unit entrance .05 mile 58’ ’ 288’ ’ 135 135’ ’ Unit entrance 58 288 .05 mile Dining/social area on unit .04 .04 30 30’ ’ 230’ ’ 115 115’ ’ Dining/social area on unit 230 Primary toilet .02 mile (2-20 03’ ’ 82’ ’ 10’ ’ Primary toilet 03 82 10 .02 mile (2-20 residents shared bathroom) residents shared bathroom) 20’ 20 ’ 270’ 270 ’ 107’ 107 ’ Bathing area .05 mile Bathing area .05 mile Facility dining room .07 mile 08’ ’ 348’ ’ 102 102’ ’ Facility dining room 08 348 .07 mile Main front entrance .07 mile 14’ ’ 387’ ’ 110 Main front entrance 14 387 .07 mile 110’ ’
Inadequate Light Levels Inadequate Light Levels ( 3053 Total Light Meter Readings) ( 3053 Total Light Meter Readings) Range Mean Range Mean Nurses’ ’ station station 10 - 410 FC 91 FC Nurses 10 - 410 FC 91 FC Head of bed 4-95 FC 37 FC Head of bed 4-95 FC 37 FC Bathroom sink 1-75 FC 25 FC Bathroom sink 1-75 FC 25 FC Primary toilet 1-48 FC 13 FC Primary toilet 1-48 FC 13 FC Shower/tub 4-152 FC 46 FC Shower/tub 4-152 FC 46 FC room room
Corridor Clutter as a Barrier Corridor Clutter as a Barrier Functional Competence to Functional Competence to (Range 0-10 Items, M= 3.5) (Range 0-10 Items, M= 3.5) 9% no clutter 9% no clutter � � 3 units had all 10 items 3 units had all 10 items � � 58% medical equipment 58% medical equipment � � 48% laundry carts 48% laundry carts � � 48% housekeeping carts 48% housekeeping carts � � 47% other (cages, dishes, 47% other (cages, dishes, � � podiatrist, prosthesis) podiatrist, prosthesis) 41% clean linen 41% clean linen � � 32% medicine carts 32% medicine carts � � 22% incontinence disposal 22% incontinence disposal � � 18% trash containers 18% trash containers � � 15% weight scales 15% weight scales � �
Personalization Personalization (7 item scale) (7 item scale) � 85% personal photos 85% personal photos � � 39% door 39% door � personalization personalization � 30% brought chair 30% brought chair � � 29% individualized 29% individualized � bedspread bedspread � 18% lamps 18% lamps � � 18% own bureau 18% own bureau � � 8% individualized 8% individualized � drapes drapes
Resident’ ’s Space s Space Resident
Mean Scores of Resident Items Mean Scores of Resident Items by Number of Beds by Number of Beds Private (580) .95* Private (580) .95* Chair (s) in sleeping Chair (s) in sleeping 2 Bed (1152) 2 Bed (1152) .78* .78* area area 3+ bed (256) .31* 3+ bed (256) .31* Resident controls TV Private .78* Resident controls TV Private .78* 2 Bed .55* 2 Bed .55* 3+ bed .37* 3+ bed .37* Lockable storage in Private .48* Lockable storage in Private .48* room room 2 Bed .34* 2 Bed .34* 3+ bed .26* 3+ bed .26* Primary toilet Private .46* Primary toilet Private .46* 2 Bed .23* 2 Bed .23* 3+ bed 3+ bed .14* .14* * Sig. 000 * Sig. 000
Checklists on CMS Website Checklists on CMS Website � http://www.cms.hhs.gov/NursingHom http://www.cms.hhs.gov/NursingHom � eQualityInits/05_NHQIHighlights.asp# eQualityInits/05_NHQIHighlights.asp# TopOfPage TopOfPage � Click: Quality of Life Volume 2 Click: Quality of Life Volume 2 � � Appendices Appendices � – Appendix G Appendix G – – Room & Bath Checklist Room & Bath Checklist – – Appendix H Appendix H – – Nursing Unit Checklist Nursing Unit Checklist – – Appendix I Appendix I – – Facility Checklist Facility Checklist – Published papers on MN website: Published papers on MN website: http://www.hpm.umn.edu/ltcresourcecenter/ http://www.hpm.umn.edu/ltcresourcecenter/
Practical Strategies to Improve Nursing Home Practical Strategies to Improve Nursing Home Environments for Better QOL Environments for Better QOL Retirement Research Foundation Funded by Retirement Research Foundation Funded by � NH personnel get used to their environments: NH personnel get used to their environments: � need to assess with fresh eyes need to assess with fresh eyes � Tendency to rely on convenient suppliers Tendency to rely on convenient suppliers � � Practical solutions can help within ordinary Practical solutions can help within ordinary � maintenance budgets maintenance budgets � Materials included self-assessment protocol Materials included self-assessment protocol � and manual for low-cost strategies and manual for low-cost strategies
Recommend
More recommend
