Person-centered care models in integrated care systems: The role of nurse assistants as “keepers of likes and preferences” in skilled nursing home care facilities

Abstract

Introduction: Caring for older people in vulnerable situations requires the coordinated work of different professionals in order to assess and identify their needs, wishes and preferences for care. Among the professionals of the interdisciplinary team, the figure of nurse assistants is particularly important. They are in permanent contact with residents, have significantly more interactions with them and their families and, therefore, they have valuable information regarding their overall situation, daily routines, perceived wellbeing and changes in their condition. Paradoxically, while it is recognized that this professional should play a central role in the interdisciplinary team since they are able to customize the care provided to the needs and preferences of the residents; in practice, for several reasons, this is not always the case. Short description of practice: After a year and a half of research and conceptualization, SARquavitae put in place an applied project to revise its care model: the INTEGRA Project. One of the key areas of the project has to do with the figure of the reference professional (RP) as keeper of users' likes and preferences and a source of relevant daily care information for the family. After a process of care reorganization and training, the function of "reference professionals" was implemented. It meant daily close supervision by the nurse coordinator and leadership by the director or the nursing home. Objective: The RP is responsible for the continued support and attention to the detail of a small and limited number of users (7-8). In addition, RP will get to know perfectly their assigned users, and thus may provide a closer and individualized care in accordance with their life plan. The RP should be proactive: in communicating and dealing with both their assigned users and their relatives. This professional is responsible for communicating the relevant information about users and their relatives to the interdisciplinary team in order to assist in the definition and/or adjustment of the Personalized Care Plan with special attention to the details which can improve the user's wellbeing and quality of life. Implantation procedure: Different assessment tools and records have been developed for the RP and, hey had been included in SARquavitae care information system (GCR). The aim is to provide this professional with instruments of their own that allow them to share information and evaluate results. The allocation of RP is performed according to care and organizational criteria, so that a RP will have the residents in their group of care, allowing them to establish a strong relational link. Once assigned, it is communicated both to the resident and their relatives through a letter and a formal meeting. This meeting is attended by at least one professional of themanagement team to make the official presentation of this professional and clarify their roles and responsibilities. Key findings: Preliminary results after one month of fully implementation show that the change in the nurse assistants is generating high levels of satisfaction to professionals, users and relatives. As expected, professionals recognize the usefulness of the information provided by this figure insofar as it helps to individualize and personalize the therapeutic plan adapted to each user. Residents and their relatives appreciate the RP proactive role and their close and constant contact to solve any situation. They acknowledge, like PR themselves, that the stronger relation facilitates and optimizes the quality of care. This leads to an increased sense of security and confidence, which impacts on subjective wellbeing. Highlights: The launch of this figure requires a revision of SARquavitae care model, the roles of different professionals, care organization and to conduct a training process with potential RP to explain them their functions and develop social and communication skills that facilitate interactions with residents and their relatives. An indicative time frame for consultation and interaction with the RP is recommended in order to assure a quick and adequate response. Conclusion: In light of the results obtained, it is considered appropriate to continue with this figure in SARquavitae centers and deepen its assessment. In total it will be deployed in 74 nursing homes and 22 day care centers where more than 9,500 workers attending 11,000 users across the whole country.