Staff members are the cornerstone of providing individualized, preference-based care. They play the key role in putting this philosophy of care into action. This tip sheet explores ways to build staff commitment and engagement in learning about resident preferences – and most importantly, in using the information to enhance joy and meaning in residents’ lives.
Step 1: How to Start the Conversation with Staff Members
Engage the staff in a learning circle or team meeting to talk about why it is, or why it may be important, to ask residents about their preferences. Seek examples from staff first. Possible questions to prompt discussion include:
- How do we honor residents’ rights?
- How do we provide better care?
- How do we promote or support choice or control?
- How do we ensure resident satisfaction with care?
Step 2: How Staff can Learn About Preferences
In the learning circle or team meeting, ask: “How do we know the way a resident likes to live his or her daily life?” “How are we currently assessing resident preferences”? “How do you think we can do it better”? Staff members learn about resident preferences through a variety of complementary processes, including:
- Through daily interactions and conversations with residents
- Through others: family, friends, and other residents
- Through care planning meetings
- Through formal assessment using the Preferences for Everyday Living Inventory (PELI) or MDS 3.0 Section F. Preferences for Customary Routine
Step 3: Develop a Process to Communicate Information about Preferences
Some ways to integrate preferences into resident care are:
- Involve direct care workers in care planning meetings – to assist with communicating resident preferences and promote discussions of successful strategies. View care planning as a dynamic, ongoing process.
- All About Me Board – in resident rooms (inside the closet), post the person’s preferences and modify as needed.
- Share resident preference information – in rounds, huddles, clinical records, resident profile cards, “I Care” planning process (story), or on a white board. Once you’ve learned what a resident likes and dislikes, inform others, as appropriate, so that all can honor those preferences – include Environmental Services, Maintenance, Nursing, Chaplaincy, Finance, Dining.
Step 4: Encourage Staff to Honor and Fulfill Resident Preferences
“When they started asking how important things were to me, I thought, ‘Are you serious?’ No one had ever done that before. It feels like they are listening to me and we are ‘in this together.’”
Felicia – Nursing Home Resident
- Staff with more developed observational skills may be able to adapt care to resident preferences. Building observational skills can be a focus for hands-on staff training.
- Support staff in brainstorming ways to meet residents’ preferences. (See Ensuring Resident Choice tip sheet.)
- Encourage staff to be flexible and creative in developing new strategies to address preferences.
Step 5: Listen and Respond to Staff Concerns
Preference assessment is a new concept for many nursing home staff members. Naturally, they may have concerns and questions about how the process will work. Engage in honest, ongoing dialogue about anticipated problems and possible solutions to support culture change and build buy-in. Typical concerns are discussed below. Explore further questions that arise with all nursing home staff members (social workers, recreation staff, dieticians, food workers and nursing). Check in routinely to address issues that surface day-to-day in honoring resident preferences.
Will asking residents about their preferences increase the workload?
When you start asking residents about their preferences, they often report feeling happier, which makes life easier for staff. Residents who feel they are not being heard can become more demanding. Anticipating this dynamic, and asking residents upfront about their preferences, can lighten the load for staff over time.
Are we raising expectations for care that cannot be met?
It’s natural to worry that residents will make impractical, “over-the-top” requests. Yet most resident preferences are realistic. Residents are less likely to be anxious, fearful or unreasonable when they know staff members listen to them, pay attention to their choices and respond thoughtfully and creatively. This works best when you know the personalities involved. Talk with residents to work out issues and come up with compromises.
How do you prioritize resident preferences?
At times, it can be challenging to figure out how to meet individual preferences – for instance, when six residents in a household indicate that it is very important to go to bed at 10 pm. If only two staff members are assigned to the group, this preference seems unlikely to be met. However, empowering staff to connect on the issue and think creatively along with residents can lead to a successful outcome. Hold a neighborhood meeting and discuss the bedtime dilemma with residents. Perhaps some will say that their important preference is to be asleep by 10 p.m. but they are willing to get into bed at 9:30. An alternating schedule also might meet the needs of the majority. When staff and residents collaborate, they can devise inventive ways to fulfill preferences.
What about family members? Don’t they add more work?
Residents who are awake, alert and oriented have a right to make their own decisions. Family members often advocate for their loved ones’ interests, but they aren’t always realistic about the person’s needs and preferences. Usually, talking with families can resolve differences and lead to an effective, caring partnership. However, routinely documenting preferences can protect residents’ autonomy in situations where family members try to overrule a resident’s wishes.
For more information, use the link below to view this tip sheet’s webinar.
We gratefully acknowledge support from
The Patrick and Catherine Weldon Donaghue Medical Research Foundation