This document outlines best practices for implementing person-centered care and culture change in an adult day setting. It begins with four presentation objectives: 1) Increased understanding of person-centered care and culture change in adult day settings, 2) Introduction to best practices for integrating person-centered care, 3) Best practices for team-building and staff support, and 4) Best practices for community engagement. The document then provides information on concepts of person-centered care like autonomy vs risk, key terms, and benefits. It also discusses the differences between institution-directed vs person-directed care and reviews philosophies that influence person-centered care like the Eden Alternative and inclusion.

1. Person-Centered Caring
and Culture Change
in an Adult Day Setting:
Best Practices

2. PRESENTATION OBJECTIVES:
1. Increased Understanding of Person Centered
Care and Culture Change in an Adult Day setting.
2. An Introduction to Best Practices for Healthcare
Professionals for Integrating Person-centered
Care into An Adult Day Center
3. Best Practices for Team-Building and Support of
Care Professionals
4. Best Practices for Community Engagement in an
Adult Day Setting
2

3. INTRODUCE OUR
WORLD
REVIEW CONCEPTS
REVIEW PHILOSOPHIES
SHOW TRANSLATION OF CONCEPTS AND
INTEGRATION OF PHILOSOPHIES AT AGP
3

4. INTRODUCE OUR
WORLD
REVIEW CONCEPTS
REVIEW PHILOSOPHIES
SHOW TRANSLATION OF CONCEPTS AND
INTEGRATION OF PHILOSOPHIES AT AGP
4

5. SOCIALIZATION,
PLANNED ACTIVITIES, and
SUPPORTIVE HEALTH SERVICES
in a safe and well supervised
environment.
COORDINATED PROGRAM
of professional and
compassionate services for
adults in a community-based
group setting.
EMERGING PROVIDER OF
TRANSITIONAL CARE AND SHORT
TERM REHABILITATION
following hospital discharge.
ESSENTIAL SOCIAL and HEALTH
SERVICES NEEDED TO ALLOW ADULTS
TO REMAIN LIVING AT HOME
while providing support and respite to
caregivers.
ADULT
DAY
CENTERS
(ADC)
MAINTAIN HIGHEST LEVEL
OF HEALTH and/or
INDEPENDENCE for the
individual while providing
respite and support to
caregivers
as PREFERRED PLATFORM FOR
CHRONIC DISEASE MANAGEMENT,
adult day centers are an interactive,
safe, and secure environment for
individuals requiring supervised daily
care.
5

6. A Grace Place Care Adult Center
www.agraceplaceacc.org/
6

7. A Grace Place Adult Care Center celebrates each individual, each
caregiver and each employee through Person Centered Thinking and
Person Centered Care.
ESTABLISHED
NON-PROFIT
• Since 1976,
providing
essential health
and social
services to
support adults
with disabilities
and/or agerelated
conditions, while
providing respite
and support for
their caregivers.
• with a strong
mission focus to
strengthen adult
caregiving and to
maintain or
increase the
health,
independence
and quality of life
of both the adult
in care and the
caregiver.
SERVING
• Over 210
individuals per
day.
SEVEN
• separate
programs
designed to
meet the unique
needs of each
individual.
• AD, brain injury,
stroke, PD,
intellectual
disabilities,
autism, cerebral
palsy, etc.
• Ages: 18 -100+.
INDIVIDUALLYCENTERED
PROGRAMS
• Provide a
community–
based alternative
to institutional
care.

8. INTRODUCE OUR
WORLD
REVIEW CONCEPTS
REVIEW PHILOSOPHIES
SHOW TRANSLATION OF CONCEPTS AND
INTEGRATION OF PHILOSOPHIES AT AGP
8

9. Institution-Directed vs.
Person-Directed Care
Culture Change
Person-Centered
Culture
Person-Centered Care
9

10. PERSON-CENTERED CARE is an approach to
care that respects and values the uniqueness of the
individual, and seeks to maintain, even restore, the
personhood of individuals.
We do this by creating an environment that promotes:
Personal Worth and
Uniqueness
Social Confidence
Respect
Truthfulness
Independence
Engagement
Hope
10

11. Person-Centered Care Attributes
Core Values of
Choice,
Dignity,
Respect,
Self-Determination and
Purposeful Livingbe replaced
with your own text.
Rooted in the work of Tom
Kitwood*, a British gerontologist.
The text demonstrFosters optimal
aging and living for the individual
t will look when you replace the
placeholder with
your own text.
PersonCentered
Care
Empowers
Care is driven by the
individual
Tom Kitwood (1937-1998 ) was a British social psychologist and psychogerontologist, author of the theory of person-centered
care approach; together with Kathleen Bredin, he developed the method of Dementia Care Mapping.
11

12. Having negative
image of adults with
a disability.
Example: “Over the
Hill” birthday cards and
in terms of people with
Intellectual or
Developmental
Disabilities, “retarded”
jokes or the
assumption that they
are incapable of doing
anything at all.
.
Behavior by one
person that limits
another’s freedom
or autonomy.
Example: Staff
make a participant
stop playing cards and
join in a Trivia game
which the staff is
leading and is a
favorite of the staff.
Independence
or freedom to do
as one wishes.
Example: Care
Professional and
Individual together
selecting a time for
one’s meals or
activities rather
than having it
imposed.
MEDICAL MODEL
AUTONOMY
PATERNALISM
STEREOTYPING
Key Terms
Suggesting a
traditional approach
(contrasted with a
holistic approach) to
the diagnosis and
treatment of illness.
The physician
focuses on the
defect, or
dysfunction, within
the patient, using a
problem-solving
approach.
12

13. Autonomy vs. Risk
RISK =
Individual Safety and
Liability
RISK
AUTONOMY
AUTONOMY =
INDEPENDENCE
Surplus Safety* = Safety trumps ALL
*Rooted in the teachings of Dr. Bill Thomas and the Eden Alternative as well as Dr. Judah Ronch.
13

14. What happens when we create an
environment that is “too” safe,
where individuals have
no autonomy?
Using the Questions tab of the Webinar’s Control Panel,
please type in your own examples.
14

15. What happens when we create
an environment where staff
has NO voice?
Using the Questions tab of the Webinar’s Control Panel,
please type in your own examples.
15

16. Person-Centered Culture
Direct care staff have a say in how work is
carried out and how decisions are made.
Individual preferences are
the basis of care decisions.
For the most part, staff organizes
their routines to accommodate
individuals’ routines.
Developed by Sue Misiorski and Joanne Rader. Retrieved from www.pioneernetwork.net
16

17. Some of our
language is
“institutional”
Person with…
The language we
use is important
in providing
person-centered
care.
The Language of
Person-Centered
Care
Some of our
language may
unintentionally
demean people.
17

18. POLL
How do you refer to the
people to whom you provide
service?
A. Participant
B. Individual
C. Client
D. Patient
18

19. Heightened job satisfaction
Heightened self-esteem
Employees
Heightened life skills
Career opportunities
Less staff turnover
INTRINSIC
Agency
Less client turnover
Increased quality care
BENEFITS
OF PERSONCENTERED
CARE
Increased satisfaction
Individuals
Increased connections to others
Increased security, peace of mind
Caregivers
Increased financial support
Marketing
EXTRINSIC
Donors
Word-of-mouth value; propelling agencies into
new partnerships
Attractive model to support emotionally and
financially
19

20. CULTURE CHANGE:
National movement for transformation of adult services across the healthcare continuum
Based on personcentered and
directed values and
practices
Consideration:
for the individual,
caregivers and staff
Deep system
transformation that
may require
changes in
organizational
practices, physical
environments,
relationships at ALL
levels and workforce
models.
20

21. Institution-Directed vs. Person-Directed Care:
What is the difference?
21

22. Institution-Directed Culture
Staff provides standardized
"treatments" based upon
medical diagnosis.
Work is task-oriented and
staff rotates assignments.
Schedules and routines are
designed by the facility and
staff, and individuals must
comply.
Institution
-Directed
Culture
Decision-making is
centralized.
Structured activities are
available when the activity
director or other activity staff
are on duty.
As long as staff know how to
perform a task, they can
perform it "on any patient"
in the facility.
There is a hospital
environment.
Staff is disengaged
There is a
sense of
isolation and
loneliness.
From the Pioneer Network website http://www.pioneernetwork.net/Providers/Comparisons/
22

23. Person-Directed Culture
Individuals make decisions
every day about their individual
routines.
The staff makes decisions
every day and is empowered.
The staff has relationships
with the individuals so that
they know their lifelong
habits and honor them.
PersonDirected
Culture
The staff organizes their
schedules and assignments to
meet the needs of the
individuals they care for.
23

24. Person-Centered Care: A Review
1
Enhancing
professional
caregiver’s
capacity to be
responsive
2
Enhancing facility
involvement
3
Establishing a
home-like
environment
4
5
Returning control Recognizing and
using employee
to individual
strengths
6
Relationship
means knowing
the individuals.
This starts with
their preferences
for care, their
daily routines,
etc. It also
means getting to
know individuals
on a deeper
level (their
history, their
stories, etc) 24

25. 25

26. INTRODUCE OUR
WORLD
REVIEW CONCEPTS
REVIEW PHILOSOPHIES
SHOW TRANSLATION OF CONCEPTS AND
INTEGRATION OF PHILOSOPHIES AT AGP
26

27. Inclusion
Servant
Leadership
INFLUENCES
ON CARE
PHILOSOPHY
Eden’s
Philosophy
PersonCentered
Care

28. The three plagues of Boredom, Loneliness, and Helplessness account for the bulk of suffering
among our clients. *The words create an acronym B L and H  BLaH
EDEN ALTERNATIVE PRINCIPLES
A Person-centered community commits to creating a Human Habitat where life revolves around
close and continuous contact with plants, animals, and children. It is these relationships that
provide the young and old alike with a pathway towards a life worth living.
A Person-centered community imbues daily life with variety and spontaneity by creating an
environment in which unexpected and unpredictable interactions and happenings can take
place. This is the antidote to boredom.
Clients deserve easy access to human and animal companionship. Loving companionship is
the antidote to loneliness.
A Person-centered community creates opportunity to give as well as receive care. This is the
antidote to helplessness.
Meaningless activity corrodes the human spirit. The opportunity to do things we find
meaningful is essential to human health.
Medical treatment should be the servant of genuine care, never its master.
A Person-centered community honors its individuals by de-emphasizing top down bureaucratic
authority, seeking instead to place the maximum decision making authority into the hands of
the Clients to care professionals.
Creating a Person-Centered community is a never ending process.
28

29. Know each person and employee
Each person can and does make a difference
The Values and Principles of the
Pioneer Network
Relationship is the fundamental building block of a transformed culture
Respond to spirit, as well as mind and body
Risk taking is a normal part of life
Put person before task
All adults are entitled to self-determination wherever they live
Community is the antidote to institutionalization
Do unto others as you would have them do unto you
Promote the growth and development of all
Shape and use the potential of the environment in all its aspects: physical,
organizational, psycho/social/spiritual
Practice self-examination, searching for new creativity and opportunities for doing better
Recognize that culture change and transformation are not destinations but a journey,
always a work in progress
www.pioneernetwork.net
29

30. Social inclusion
A socially inclusive society is defined as one where all people feel valued, their differences are
respected, and their basic needs are met so they can live in dignity. Social exclusion is the process
of being shut out from the social, economic, political and cultural systems which contribute to the
integration of a person into the community (Cappo 2002).
Everyone Is Ready
None of us has to pass a test or meet a set of criteria before we can be
included.
Everyone Can Learn
As human beings we all grow and change and make mistakes: and we are
all capable of learning.
The Values that
Underpin Social
Inclusion
developed by Scottish Human
Services Trust (2005)
Everyone Needs Support
Sometimes some of us need more support than others.
Everyone Can Communicate
Not using words doesn’t mean we don’t have anything to say.
Everyone Can Contribute
We need to recognize, encourage and value each person’s contributions including our own.
Together We Are Better
We are not dreaming of a world where everyone is like us - difference is
our most important renewable resource.
30

31. Servant Leadership
Servant-leader focuses on the growth and wellbeing of people and the communities to which
they belong. While traditional leadership
commonly involves the accumulation and
exercise of power by the person at the “top of the
pyramid,” servant leadership is different.
The servant-leader shares power, places the
needs of others first, and helps people develop
and perform as highly as possible.
-Check your ego at the door
(Rooted in Robert K Greenleaf’s work in the Center for Servant Leadership)
31

32. Mr. Carter was only ten years old in 1950 when he was committed to a
state training school. He had picked up a brick and threw it at a child, who
was Caucasian, who was teasing him. Mr. Carter, who was African
American was “slow” and had little family support.
In the 1990’s, he was identified as misplaced in a state training school and
was going to return to the community. A social worker contacted me to see
if we could serve him. I immediately said yes and shared the information
with the staff. The staff’s reaction was strong and I was told, “We do not
accept the mentally retarded.”
I was two years into the job and was unaware of any such procedure.
What would you do in my place?
A. Contact the social worker and relate that we are unable to accept him in our
program at this time
B. Reinforce my leadership and authority and express that we are going to do
things differently now that I am in charge.
C. Tell the back story of Mr. Carter and build a connection.
32

33. Leaders must lead*
• Create an atmosphere that celebrates
the vision and mission
• Solicit input from all stakeholders,
caregivers, staff, volunteers,
individuals, donors, regulators
Practical Strategies
• Build a high energy work force
• Ask work force, in small groups, to develop a
set of values that describe the work culture,
ask each person to bring in an object that
best represents their belief system and then
ask them to explain it. Use this to formulate
the values for their agency.
• Model expectations
• Maintain an “open door policy”
• Provide support to Professional
Caregivers
• Roll up your sleeves, help staff do their work,
work with individuals
• Serve as the Cheerleader for all
• Build ownership
• Be a visionary
• Keep staff informed, have lots of meetings
and talk about “Our Business”
• Know everyone’s name
• Develop wellness teams for staff and let
them decide what strategies they want to
work on for their health
*David Pitonyak, Issue Action Planning: Promoting
Responsive Human Services
• Make coming to work fun, something to look
forward to
33

34. Leaders must
empower staff
Practical Strategies
• Create a culture that values every
voice, every opinion
• Frequently ask for suggestions and be sure
to act on some
• Listen, Listen, Listen! especially when
it is hard to hear!
• Encourage “dreams” and wishes
• Form self-directed work teams to carry out
important work i.e. Wellness program,
customer satisfaction team
• Build trust, build teamwork
• Compliment staff on good work
• Drive our fear
• Empower staff to explain program services
to guests
• Focus on the sincere belief that all
employees are capable, honest,
trustworthy and very capable.
• Manage by consensus and build
decision making from the “bottom up”.
The people closest to the individuals
know the situation best and can with
support and confidence from the
manager, make best decisions
• Encourage staff to decide furnishings,
colors, equipment they need
• Ask for input and involvement on
policies/procedures before you issue a
“regulation”
• Reinforce identification with mission
34

35. Leaders must
create celebrations
• Reinforce accomplishments
• Highlight acts of kindness
• Create reflections
• Create fun
Practical Strategies
• Develop contests such as mission moments
where staff are divided into teams to create
a visual depiction of the Mission
Statement/Values (Quilt, sculpture, DVD)
• Give kudos at staff meetings
• Write personal handwritten notes from CEO
• Celebrate everyone’s birthday
• Know your employee’s family, who is
graduating, who has grandchildren
• Have “All Hands on Deck” meetings
quarterly and celebrate staff’s family’s
milestones, “shout out” on graduations,
births, etc.
35

36. Staff needs to be
constantly and
repeatedly grounded
in the agency’s
mission and vision.
Performance
Appraisals and
evaluations reflect
each employee’s
ability to support the
mission, values of
organization.
A successful work
culture starts with
the interview, hiring
process.
Managers must
“walk the walk” – not
just “talk the talk”.
Lessons
Learned
36

37. INTRODUCE OUR
WORLD
REVIEW CONCEPTS
REVIEW PHILOSOPHIES
SHOW TRANSLATION OF CONCEPTS AND
INTEGRATION OF PHILOSOPHIES AT AGP
37

38. A Grace Place’s Values: How were they developed?
TRUST:
Assured reliance on
character, strength,
and truth
TEAMWORK:
Sharing individual
skills and talents to
reach a common goal
PROFESSIONALISM
Be the best you can
be in conduct,
appearance, and
attitude
FLEXIBILITY:
Ability to adapt to
changing needs of the
members and the
organization
EMPATHY:
Care with
understanding hope
DEDICATION:
A steadfast
commitment to an
optimal quality of life
for our members, their
families, & each other
EMPOWERMENT:
Practicing the belief
that each individual
can make their own
decisions and act on
them
INCLUSIVE:
Embracing each
individual as part of
the whole
HUMOR:
Loving and playful
approach to
challenges
IMAGINATION:
Creating new and
spirited approaches
that further
independence
PERSEVERANCE:
Doing what it takes to
realize dreams
RESPECT:
Valuing difference
and allowing for
compromise
PRIDE IN PLACE:
Demonstration of
respect we show to
our members, peers,
and community
38

39. Does your agency’s mission
statement and its values
reflect what you feel your
agency provides?
39

40. It takes a village to support an
individual.
From the professional caregivers at A Grace
Place to family caregivers at home to the drivers
that drop our individuals off, everyone is entitled
to a person-centered response..
Villages are constantly changing.
40

41. The Person-Centered Team
A PERSON-CENTERED
PHYSICAL ENVIRONMENT
OTHER ADULT DAYS
(Advocacy + Civic)
BOARD OF
DIRECTORS
(Breakfast)
CARE
PROFESSIONAL
(Happy Employees)
CARE
PARTNER
(Supporting them
where they are)
INDIVIDUAL
(Inclusive, we
rarely turn
anyone
away)
41

42. Best Practices based on
Person-Centered Care
Pet Therapy
Music Therapy
Validation Therapy
Best Practices
for
PersonCentered Care
Reminiscence Therapy
Team-Work
One-on-One Care
Inclusion
Wellness Program
Expressive Arts Program
(Both within organization &
throughout community)
42

43. What does Community Inclusion mean?
How can we promote it?
How do we build a world where
no one’s left out?
43

44. Best Practices for Community
Inclusion:
44

45. Best Practices for Inclusion found
at A Grace Place:
Inclusive Attitude  Everybody Matters
Everyone Is Ready
Everyone Can Learn
Everyone Needs Support
Everyone Can Communicate
Everyone Can Contribute
Together We Are Better
Community-normalized:
–
–
–
–
Transportation Assistance
Eating Style
Dress Code
Business Cards
45

46. How do we create a
Person-Centered
Response to
Each Individual?
46

47. AN EXAMPLE OF INCLUSION:
By 2030,
between 3.6 and
7.2 million LGBT
Americans
45,000 Lesbian
and Gay
Households in
Virginia by 2030
Richmond ranks #16
nationwide in the number
of Lesbian and Gay
identified households
AGP first agency to provide
Person-Centered Care Training
for Direct Care Support
Professionals providing Care in
Adult Care Services Facilities
47

48. KryssAnne
A transgender female
who battles a terminal
illness, isolation and fear
of healthcare
professionals who
"don't want to touch my
body.”
48

49. Hannah Green is forty five and has been working at A Grace Place for over
ten years. She works in the program that supports adults with intellectual
disabilities and has a very good work record. She is a valued employee
and is well liked by her peers, and the individuals she supports.
When Hannah heard at a staff meeting that the agency was going to offer
training in LGBT in long term care and that attendance was compulsory,
she became very concerned. Her supervisor overheard her say to her
peers that she “was not going to attend even if it cost her, her job.”
How would you handle this?
A. Talk with the employee and allow her to be absent based on the strong
religious objections she expressed.
B. Require her to be present.
C. Take no action and see what she does
D. Open up a dialogue with the employee and see where “the middle” is
49

50. People accept
individuals when
they have an
opportunity to know
them, identify with
them.
People connect with
real stories of real
people and this
connection is vital to
overcoming
prejudices and
discrimination.
Assumptions can be
broken down
individual by
individual.
Lessons
Learned
50

51. KNOW THE INDIVIDUAL
Client:
“I’m sorry. Sometimes it
takes a while for me to
get my words out…”
Caregiver:
“That’s okay,
sometimes it takes
me a while to get my
words out, too!”
Get to know their
back-stories: who
they were, who they
are, and who they
would like to be.
They are more than
diagnoses.
51

52. EMPOWER
A hallmark of PCC is
empowering the
individual. It may take
more effort initially, but will
reap rewards in the long
run.
Honor their individual
experiences. Listen to
who they are.
Understand who they
were, who they are and
who they want to be.
Learn to listen.
52

53. SUPPORT ROLE TRANSITIONS
Honor who they were, their
rituals, their occupations, their
roles. Role transition is one
of the most difficult parts of
aging or change in cognitive
status. Our roles are
engrained into our essence.
Into our being. Supporting
the maintenance of these
roles supports PCC and
positive health outcomes.
53

54. ONE ON ONE CARE
A little more time and
effort on the front end
can have greater
positive health
outcomes in the long
run.
54

55. Team Approach
To Care
Calling After
Hours
“The Book”
Best
Practices
for Staff
Communication
Communication
Log
Informal
Professional
Caregiver
Meetings each
morning
55

56. A Person-Centered Response to
Each Professional Caregiver
Keep the engines
running!
• Within a work team model, staff
can take a break when they need
it and the collective team steps in
until the professional caregiver
returns
Respite!
• A Grace Place offers 3 weeks of
annual vacation, holidays and 3
hours of sick leave accrued biweekly
• Everyone is willing to do 2 on 1,
supervisors are always willing to
switch sides if support is needed
56

57. A Person-Centered Response to
Each Family’s Needs
Caregiver Support
• is essential to PCC. They spend as much time
with their loved one as we do and can often
provide information that is vital to their well-being.
Caregiver Education Program
Telephone Support for Caregivers
57

58. How Does Such a Village Lead to A
Caring Response?
A family of
friends
Sharing and
delighting in
the
accomplishm
ents of each
individual
Home away
from home
Encouraging
that one-onone
relationship
“The individuals- you get
attached, it’s hard not to.
To us, we’re family to
them. A lot of them don’t
have any other family.
This is all they know- it is
their home away from
home.” -AGP staff member
“I love helping them
discover something they
didn’t realize they could
do. Like handing money
to a cashier. Or ordering
their own meal when they
are out. You’d think it was
Christmas.” -AGP staff
member
58

59. How to Build a Village of Support:
Team-Building and Servant Leadership Practices
Know your care team
of care professionals
like you know the
clients
Have strong
executive and
management support
and leadership
• “We know each other’s
hardships and help work
around them.” –AGP staff
member
• If a care professional
comes to management with
a problem, listen, take
notes, rearticulate out loud
what is being said to you, to
ensure that you understand.
Be flexible
Have team meetings
and consistent
communication
59

60. The Physical Environment of
AGP’s Village
Note the centralized intake area and the needs-based compartmentalization combined
with a good amount of outdoor space.
60

61. Community Partnerships
•
•
•
•
•
•
Youth Programs
United Way
Faith-Based Organizations
The Business Community
Other Adult Day Centers
Volunteerism
61

62. Person-Centered Volunteers
62

63. Employee
Retention
Greater
understanding
from healthcare
teams about
personcentered care
Purposeful
Living for
Individuals
and Care
Professionals
PCC
Results
Greater
understanding
of inclusion of
all populations
Employee
Creativity
Marketing
63

64. Opportunities and Challenges of Change
Change requires extra
time and commitment of
an already overwhelmed work force and
can be exhausting and
cause stress.
Communication between
departments can be
daunting.
Governmental
regulations and policies
may require additional
effort and demand
creativity.
On-going training and
support of staff are vital
to success.
Staff may lack selfconfidence and
emotional support
needed to
change/embrace new
ideas.
Reflection and
Evaluation among
individuals and work
teams may be
inconsistent
Will we lose clients? Will
we lose staff?
Positive health outcome
for individuals
Higher work satisfaction
for employees
Purposeful living for
individuals
Higher census through
word of mouth
marketing, plus reduced
advertising expenses
More effective work
teams
64

65. REFLECTION
• What have you taken away from our
time together today?
• Can you share your valuable practices
to advance person centered care?
• How can we support you?
65

66. Resources
• David Pitonyak article:
– http://www.dimagine.com/Toolbox.pdf
• Eden Alternatives
– www.edenalt.com
• Person-Centered Care and Dementia Care
– http://www.alzheimers.org.uk/site/scripts/documents_info.php?doc
umentID=1191&pageNumber=3
• Patient Centered Care Improvement Guide
– http://planetree.org/wp-content/uploads/2012/01/Patient-CenteredCare-Improvement-Guide-10-28-09-Final.pdf
• The Pioneer Network
– https://www.pioneernetwork.net/
• Servant Leadership
– https://www.greenleaf.org/
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www.sahp.vcu.edu/gerontology/
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• Debbie Scott: debbiescott@agraceplacecc.org
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