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Improving resident satisfaction: Island Nursing and Rehabilitation Center, a 2009 OPTIMA award finalist, implements culture change to improve facility life for its residents--and staff.

After analyzing the results of its 2006 and 2007 Resident Satisfaction Surveys, management at Island Nursing and Rehabilitation Center in Holtsville, New York, noticed that while residents' perceptions of the quality of care and life provided were good, it wanted to offer opportunities to improve. With this in mind, Island Nursing began its culture change mission. According to David Fridkin, Island Nursing's Administrator/CEO, "We wanted to be considered different than the nursing home norm. Culture change involves rethinking values and practices. It is about change that brings all who are involved--staff, management, residents, and families--to a new way of creating an environment that brings each resident dignity and freedom."

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Island Nursing provides an environment where residents enjoy much of the privacy and choice they would have in their own homes and it is committed to helping residents continue their lives with dignity and meaning. In support of this commitment, the facility serves the needs of all residents--physical, emotional, social, and spiritual to help them enjoy a rich, full life.

Planning for progress

Culture change doesn't just happen--it takes a comprehensive plan and commitment from a variety of stakeholders. Representatives from recreation therapy, the nursing staff, the nutritional services director and dieticians, the social work department, and the engineering/security staff brought a variety of skills, talents, and innovative thinking to the table and passed them along to the entire staff, including the Resident Council. "Our Resident Council is very involved in making the community that meets everyone's needs," says Fridkin. The Resident Council went so far as to take a vote that they wanted to be called "friends" instead of residents.

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Island Nursing and Rehab Center also has an active and involved Family Council. The families are supportive of the facility and provide creative ideas and support for new programs. For example, during a Family Council meeting, the families suggested acknowledging staff members with a Certificate of Appreciation and a $50 gift. The families collect these funds among themselves and choose a staff member who they think deserve this award.

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Culture changes

The "Garden of Hope" was a "project initiated by a resident's family at a Family Council meeting," Fridkin recalls. Through a grant and fundraising activities, the Garden of Hope became a reality. The engineering department was involved in the design and oversaw construction. More than $38,000 was raised. Today, it is an oasis of tranquility; it is a lovely place to reminisce, socialize, watch a sunset, garden, or just listen to the peaceful cascading waters of the fountain. Staff is generous in supplying plants from their own homes to add to the beauty. This garden oasis keeps residents connected to the world around them and its tranquil atmosphere has proven extremely beneficial for residents with Alzheimer's.

Neighborhood living. To reinforce the feeling of home, Island Nursing turned each floor into a neighborhood where residents could forge friendships and bond with their caregivers. To reinforce the feeling of home, each neighborhood was named by the residents who live there: Seashore Drive, Vineyard Way, and Lighthouse Lane.

Together residents and staff work together to plan activities based on individual interests and abilities. This partnership has been a factor in high staff and resident satisfaction surveys. The nursing staff is a vital part of each neighborhood. It allows residents to play a role in decision making, reinforcing their sense of purpose and individuality.

Other changes

Food, always a focal point, was not overlooked. Dietary staff dressed up the dining area with tablecloths and placed condiments on the tables. "Also, if the menu doesn't appeal to someone, staff will call the kitchen and get a meal that's more to the resident's liking," says Fridkin. The Rehabilitation Department has also established a weekly "Cooking Club" where residents cook their favorite dishes from scratch. They have cooked meatball heroes, eggplant parmigiana, lasagna, cookies, and cakes. In addition, up to twice a month the Recreation Therapy Department hosts a "Happy Hour" where residents (who have their physician's permission) can have one ounce of an alcoholic beverage, along with snacks and social interaction.

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Parties and get-togethers are regular affairs at Island Nursing. Recently, recreation staff held Halloween, Super Bowl, and Mardi Gras parties. Residents have been taken on "trips"--via the 106" screen on the home theater system--to Italy and France. These events are enormously popular, along with off-site trips to local attractions such as the racetrack. In addition, each floor has a lovely lounge that can be reserved by families for private gatherings.
Table. Patient Satisfaction Survey

 2006 2007 2009

I am allowed to participate in decision making 78% 78% 93%

I can choose what I want to eat 75% 63% 88%

I feel safe 97% 98% 96%

I am happy here 69% 71% 88%

I enjoy bathing time 76% 67% 85%

Staff members take time to listen to me 72% 74% 88%

I would recommend this facility to my friends 81% 80% 92%


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Funding culture change

Although many culture change activities can be instituted at low or no cost, others do require some financial resources. Along with grants, Island Nursing's premier fundraiser is the annual Comedy Night. "'Comedians for Hire' provides comedy entertainment," explains Fridkin. A stage is put up in the Therapeutic Recreation Room, which accommodates about 125 people. Show tickets are sold to residents' families and friends, but although residents don't attend the show, they still enjoy the performances through the facility's closed-circuit TV system.

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In addition to ticket sales, each department and some vendors create and donate themed baskets to raffle after the show. "There have been wine samplers, lottery baskets, pasta baskets ... the ideas are limitless," remarks Fridkin. "This can generate $18,000-$20,000 that we can direct to enriching our residents' lives," he adds.

With these additional funds Island Nursing has purchased a home theater system and an overhead sound system. Recently, a digital piano was purchased for the third-floor dining room. So all can enjoy the old standards, the piano music is piped into all resident dining areas. The piano is also part of the Therapeutic Music Dementia program.

Summary

Island Nursing continues to reach out to its residents to make them feel right at home. A recent satisfaction survey (see table above) indicates that it is succeeding in providing a happy, engaging environment for its "friends."

"Remarkable things happen when you work with remarkable people," says Fridkin. He credits the entire staff for creative thinking, positive attitudes, and their continuing dedication to the people they serve.

To send your comments to the editor, please e-mail mhrehocik@vendomegrp.com.

At a glance ...

Rethinking values and practices brings everyone together to create a homelike environment at all levels of care.

Island Nursing and Rehabilitation Center Development Team

David Fridkin, Administrator/CEO

Margaret Frost, MSW, Director of Social Work

Lisa Cerami, MSW, Social Worker

Lorrie Prescott, Director of Therapeutic Recreation

Roy Bruno, Director of Food/Nutritional Services

Tim Wintz, Director of Engineering/Security

Kim Polito, Director of Physical Therapy

Kuang Hee Jung, RN, Director of Nursing

Holly Suriano, Occupational Therapist

by Sandra Hoban, Managing Editor
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Title Annotation:CULTURE CHANGE
Author:Hoban, Sandra
Publication:Long-Term Living
Date:Mar 1, 2010
Words:1190
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