Section Three

Proposal:

Higher Educated Caregivers: Cutting Cost and

Increasing Care in Assisted Living Facilities

Introduction:

For the past two summers I have spent my time working at an Assisted Living Facility near my hometown. Throughout this time I have had a first hand experience of what it is like to work in an assisted living facility. Using this experience I will write an Autoethnography documenting my experience as a direct care giver/mobile caregiver and the situations I observed. I will also compare my personal experiences with situations described in current research. This comparison of my experience to current research ideas will give an insight to what Assited Living Facilities are really like.

Aims of the Study:

To show a correlation between higher educated caregivers and patient care/cost efficiency by answering the following questions:

1. How does the hiring of higher educated individuals increase care and decrease cost?
2. What type of nursing atmosphere would higher educated caregivers give to an Assisted Living facility?
3. In what ways would hiring higher educated individuals create more efficient patient care?
4. Would Communication and Understanding between higher educated care givers create a system of checks for patient care?
5. How would the staffing of non-educated individuals in positions the same as higher educated caregivers create high turnover of the higher educated caregiver?
6. How does the higher educated caregiver create feelings of independence among their residents?
7. In a facility with higher educated caregivers, will the caregivers be more likely to participate and encourage furthering education?
8. By having higher educated staffers, how would this effect resident education about their care?

Source:

Williams, K, & Warren, C. (2009). Communication in assisted living. Journal of Aging Studies, 23. Retrieved from http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6W51-4TKXD75-1-1&_cdi=6557&_user=3569841&_pii=S0890406508000844&_orig=search&_coverDate=01%2F31%2F2009&_sk=999769998&view=c&wchp=dGLbVlz-zSkzk&_valck=1&md5=4b74c957c61527358aa8d60f81ee54e3&ie=/sdarticle.pdf

Weech-Maldonado, R, Shea, D, & Elmendorf, K. (2007). Long-term care providers and their perceptions of the external environment: rural versus urban differences. Journal of Applied Gerontology, 26(78), Retrieved from http://jag.sagepub.com/cgi/reprint/26/1/78 doi: 10.1177/0733464806296145

Castle, N.G., & Engberg, J. (2007). The Influence of staffing characteristics on quality of care in nursing homes. Health Services Research, Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2254574/ doi: 10.1111/j.1475-6773.2007.00704.x.

Ball, M.M., Lepore, M.L., Perkins, M.M., Hollingsworth, C., & Sweatman, M. (2009). “They are the reason i come to work”: the meaning of resident- staff relationships in assisted living. Journal of Aging Studies, 23(1), Retrieved from http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6W51-4TKXD75-2&_user=3569841&_coverDate=01%2F31%2F2009&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1210903812&_rerunOrigin=scholar.google&_acct=C000060884&_version=1&_urlVersion=0&_userid=3569841&md5=87736721aa814edae02baeb346698fd8 doi: 10.1016/j.jaging.2007.09.006

Spellbring, AM, & Ryan, JW. (2003). Medication administration by unlicensed caregivers: a model program. Journal of Gereontological Nursing, 29(6), Retrieved from http://web.ebscohost.com/ehost/detail?vid=5&hid=11&sid=73e293b6-662d-40bd-9644-a9cf3e63eaa3%40sessionmgr13&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=c8h&AN=2003104511#db=c8h&AN=2003104511

Stefanacci, RG, & Podrazik, PM. (2005). Assisted living facilities: optimizing outcomes.. Journal of the American Geriatrics Society, 53(3), Retrieved from http://web.ebscohost.com/ehost/detail?vid=5&hid=11&sid=73e293b6-662d-40bd-9644-a9cf3e63eaa3%40sessionmgr13&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=c8h&AN=2005076192#db=c8h&AN=2005076192

Lima , JC, Miller, SC, & Shield, RR. (2009). Palliative and hospice care in assisted living: reality or wishful thinking?. Journal of Housing for the Elderly, 23(1-2), Retrieved from http://web.ebscohost.com/ehost/detail?vid=7&hid=11&sid=73e293b6-662d-40bd-9644-a9cf3e63eaa3%40sessionmgr13&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=c8h&AN=2010264224

To demonstrate how autoethnography is used by researchers and how they can influence the nursing field.

Show the support of autoethnography
Show the disapproval of autoethnography as a research source.

To Explain my experiences as a noneducated caregiver and then student nurse and why education for any caregiver is important.

Source:

Wright, J. (2008). Searching one’s self: the autoethnography of a nurse teacher. Journal of Research in Nursing, 13(4), Retrieved from http://jrn.sagepub.com/cgi/reprint/13/4/338 doi: 10.1177/1744987107088046

Framework:

In the medical field new research is being done constantly. I would feel fairly uncomfortable stating that I was going to research any of the above questions systematically and create new information for the medical field. Almost all of my questions have been answered in nursing/medical journals. However, they have been answered by highly educated medical professionals who see the assisted living facilities from the outside. My insight into this research is my experience working in an Assisted living facility. My autoethnography will give a first hand account of the environment of an Assisted living facility. My experiences are personal to myself. I can then use research to back what I have experienced in the Assisted Living facilities. An Authoethnography describes a person’s culture, ethnic backround or even personal experience. By using this research method I will give an insight into what it is like to be a caregiver in an assisted living facility.

Implications/Applications:

By giving a first hand account of what it is like to work in an Assisted Living Facility, my information presented can help influence future decisions about staffing in such facilities. Also my work will show what works and what doesn’t in the current system. This information can help both owners/employers of assisted living facilities and also individuals considering care from Assisted Living Facilities.

Outline:

I. Introduction

A. How does the staffing of higher educated caregivers in AssistedLiving Facilities cut down on costs and increase patient care?

1. Examples of past research

2. Definition of Autoethnography and Purpose of use

3. Use of Autoethnography’s by Nurse’s/ Contribution to the nursing field

II. Methodology

Support of autoethnography
Citiques of autoethnography
Examples of other Nurse findings through autoethnography

III. Autoethnography

A. An Autoethnography (My Story)

1. Working in Assisted Living

2. Staffing of and Communication between

3. Resident Care

4. Nursing School and Caregiver

5. Relationships with residents

6. Other staff understanding of the mentally ill

IV. Discussion

Reflection of my journey and what I have learned.

III. Conclusion

A. How research compares to personal experience

B. What correlation is there between higher ed. staffers and patient care/ cost effeincy

C. What I have learned through this experience and what I hope others will gain from it.

D. Reflection of my experiences.

Formatted after:

First Draft:

Higher Educated Caregivers: Cutting Cost and

Increasing Care in Assisted Living Facilities (ALF)

Andrea Chandler

Research Writing

Marlen Harrison

March 2, 2010

Introduction

Working in an ALF as a mobile/direct caregiver can both reflect and challenge what is learned throughout a bachelor of science in nursing program. When I turned eighteen I began to work in an ALF. I worked at that facility for two summers, first as a direct caregiver and then as a mobile caregiver. That second summer was between my freshman and sophomore year of nursing school. It was that summer that I began to think critically about the quality of care given in ALF. In a perfect system ALF would be able to have educated caregivers that would be able to assist the resident in all activities of daily living (ADL). But what happens when you have an inexperienced staff in your facility? Does an LPN who just recently graduated from their licensing program have the expertise to differentiate between appropriate and inappropriate care? How does the increase staffing of higher educated caregiver’s, not only affect the quality of the patient care, but also increase knowledgeable patient care and decrease cost for the ALF resident?

In the mid-1990’s best practice protocols were established for use in ALF. These protocols encompass four main areas: services, environment, resident rights and risk negotiations, and management responsibilities. These protocols are still used to produce risk protocols. (Peterson 2005) Studies show that quality of care given in ALF is directly influenced by having more than one favorable characteristic. With the increase staffing of registered nurses the quality of care would also increase. For nursing assistants job stability is important. (Castle, Engberg 2007) If ALF are looking to improve the quality of care in their facility it is important that they make staffing changes. Much research has been done to show the link between the increase staffing of ALF and the quality of the care given in the facility

To bring light on the necessity of educated caregivers, I am writing of my personal experience through autoethnography. By writing about personal experience, an author can inform their readers of what they have experienced. By using my personal experience working as a direct/mobile caregiver, I can give a first hand account of what it is like to work in ALF and what problems I have seen. This will contribute to the medical field by giving insight into the problems that continue to need to be revised in the ALF protocols. When ALF hire higher educated caregivers, not only does the quality of care given to residents in the facility increase, but the costs to the facility decrease.

Literature Review

Assisted living facilities are long term care facilities that care for the elderly. Staffing characteristics vary among assisted living facilities. However, research has been done to show what staffing characteristics are necessary to provide optimum care. Studies have shown that staff working at a facility providing 24-hour care should be of sufficient numbers and knowledge level to meet the ever changing care needs of the residents. The staff should be educated about basic changes that occur throughout the aging process and preventative measures to prevent harm to the residents (Stefanacci & Podrazik 2005). The staffing of ALF must be educated and be able to provide basic nursing skills. Research has also been done on communication between staff and the residents in the facility. Williams, and Warren researched communication between the staff and residents, what living in an ALFis like, and also, communication among residents:

“Local culture mirrors that of the larger society, with different patterns of communication attributed to women and men: the sociability of the women, and the dominance of the male ‘board of directors.’ The women are seen by both staff and other residents as more likely to engage in activities and gossip, while the self segregating men talk of sports and politics, and then retreat to solitary activity” (p. 26 2009).

The article also states that assisted living facilities should encourage their residents and help maintain their self control. Debra Dobb states of Assisted Living Facilities, “A better understanding can result in more empathetic staff and positively affect the type of care they provide: Social scientists doing ethnographic work in long term care settings could benefit the field by….educating staff on how to seek social explanations for residents’ behaviors.” (As quoted from Williams &Warren 2009 p. 35).

One way for a researcher to bring new information about ALF into the academic world is by the use of Autoethnography. Autoethnography allows the researcher to explain personal experiences. By examining personal experiences of ALF care givers, researchers can have a better view of what working in an ALF is really like.

Methods:

I will be writing an Autoethnography that describes my personal experiences in an ALF. I will share my experiences of how patient care was handled and the characteristics of the staff I was working with. It is important that I write my experience to share what occurred while I was employed at an ALF.

An Autoethnography examines an author’s personal thoughts and feelings. Foley states:

“The role of the researcher in qualitative inquiry may be viewed as synchronous to that of the psychiatric mental health nurse. Both are attempting to use their selves – their thoughts, feelings, understandings, and experiences, to work in partnership with others so that further understandings and meanings of the lived experience may be understood and the lives of the ‘others’ in particular, enriched.”

All nursing involves the use of these skills that are “synchronous” to the role of the researcher in qualitative inquiry. By sharing a caregiver’s insight into particular situations, this “story telling” can assist in making novice nurses into expert ones.

This methodology allows for the documentation of personal experience and to show the growth and ever changing understanding of the author. Working in an Assisted Living Facility as a mobile caregiver/direct caregiver can both reflect and challenge what is learned in a Bachelor of Science in Nursing Program. By using this methodology one can show their personal experiences and what they view needs to be changed/ revised in a more detailed manner.

Autoethnography:

When I started working at an ALF, I was excited about being able to get a “heads-up” on my nursing clinicals. I started the summer before my freshman year of college. The facility I worked for hired me for a direct caregiver position. They taught me how to give showers, transport residents, and prepare the residents for bed. When I started school in the fall, I began to see that the way the ALF trained me was vastly different from what I was learning at school. The techniques taught at the University where based off of evidence based practices that were proven to reduce injuries and prevent unnecessary wastes. At the ALF my training revolved around what would get the job done the quickest. While at school, I began to wonder about what would cause this discrepancy in the patient care techniques. I then realized that because of how uneducated the staff members at the ALF were patient care techniques were like playing a game of “whisper.” One educated caregiver taught someone who was uneducated patient care, then that individual taught someone else who was uneducated patient care, but without the knowledge of why certain things were included in the patient care techniques. Without that knowledge steps in the care giving routines were excluded to get other things done. If an ALF would hire higher educated, the quality of the patient care would increase because more caregivers would understand the “why” behind the patient care being given.

One example of this would be the act of assisting a resident from bed to chair or from chair to toilet. When I was taught at the ALF we were told to “bear-hug” the resident and then count to three and lift. It wasn’t until I went to clinical that I was introduced to gait belts, which greatly improved the ease of moving a resident. Not only did the gait belt, when worn on both the nurse ant the resident, reduce the risk of the resident almost strangling you, but both the caregiver and the resident felt safer when moving from place to place. I often wonder why the gait belts weren’t implemented at the ALF that I was employed at. I can only assume that the facility either did not want to provide them because of cost, or there was a misunderstanding of what they were to be used for.

Another example would be the educated caregiver’s ability to ask “why.” While working at the ALF I saw a huge lack of understanding as to why the residents were receiving the care plans they were assigned. The caregivers had no idea why residents were receiving their medication and as a result monitoring the residents for any changes was difficult or even impossible to do. I wandered why this was as a direct caregiver.

The next summer the ALF then made me a mobile caregiver. I was now responsible for administering treatments to the residents at the facility and collecting vitals. Looking back at it now, I am shocked at the lack of training I received on this part of patient care. I was trained at the ALF for an hour on how to do the treatment passes and how to do vitals. I was trained to do vitals at the ALF with all automated vital taking `machines. These machines can often give inaccurate readings. At my clinical, we spent some time learning about the importance of accurately gathering vitals.

If the ALF I worked at, and others, would hire more higher educated caregivers at their facility, the caregivers would be in a continual learning environment. I come from a family of nurses. I have two aunts who both are registered nurses. Every time I communicate with them they always have informative conversations that allow me to make educated decisions. The same informative conversations would occur if ALF would hire RN to assist the caregivers in resident caregiving.

References

Castle, N.G., & Engberg, J. (2007). The influence of staffing characteristics on quality of care in nursing homes. Health Services Research.

Foster, K., McAllister, M., & O’Brien, L. (2006). Extending the boundaries: autoethnography as an emergent method in mental health nursing research. International Journal of Mental Health Nursing, 15(1), 44-53.

Peterson, S. (2005). Developing risk-management protocols in assisted living: assisted living has its own litigation traps for the unwary. Nursing Homes: Long Term Care Management, 54(11).

Stefanacci, RG, & Podrazik, PM. (2005). Assisted living facilities: optimizing outcomes. Journal of the American Geriatrics Society, 53(3).

Williams, K, & Warren, C. (2009). Communication in assisted living. Journal of Aging Studies, 23.

Wright, J. (2008). Searching one’s self: the autoethnography of a nurse teacher. Journal of Research in Nursing, 13(4).

Second Draft:

Increasing Care and Decreasing Cost: An Autoethnography Demonstrating a Nursing Student’s Experience with the Importance of Higher Educated Care Givers in Assisted Living Facilities (ALF)

Andrea Chandler

Indiana University of Pennsylvania

103 Jenks St. Brookville, Pa. 15825

shqp@imail.iup.edu

1-814-715-3030

Abstract

If ALF would hire higher educated caregivers, the facility would have an increase in the quality of care in the facility and also a decrease in unnecessary costs. This article documents a personal experience of working in an ALF thru the use of autoethnography. The article also compares my experience of the contrasting care techniques that were presented to me at the ALF compared to at the clinical setting.

Introduction

Working in an ALF as a mobile/direct caregiver can both reflect and challenge what is learned throughout a bachelor of science in nursing program. When I turned eighteen I began to work in an ALF. I worked at that facility for two summers, first as a direct caregiver and then as a mobile caregiver. That second summer was between my freshman and sophomore year of nursing school. It was that summer that I began to think critically about the quality of care given in ALF. In a perfect system ALF would be able to have educated caregivers that would be able to assist the resident in all activities of daily living (ADL). But what happens when you have an inexperienced staff in your facility? Does a Licensed Practical Nurse (LPN) who just recently graduated from their licensing program have the expertise to differentiate between appropriate and inappropriate care? How does the increase staffing of higher educated caregiver’s, not only affect the quality of the patient care, but also increase knowledgeable patient care and decrease cost for the ALF resident?

Literature Review

Assisted living facilities are long term care facilities that care for the elderly. Staffing characteristics vary among assisted living facilities. However, research has been done to show what staffing characteristics are necessary to provide optimum care. Studies have shown that staff working at a facility providing 24-hour care should be of sufficient numbers and knowledge level to meet the ever changing care needs of the residents. The staff should be educated about basic changes that occur throughout the aging process and preventative measures to prevent harm to the residents (Stefanacci & Podrazik 2005). The staffing of ALF must be educated and be able to provide basic nursing skills. Research has also been done on communication between staff and the residents in the facility. Williams and Warren researched communication between the staff and residents, what living in an ALF is like, and also, communication among residents:

Local culture mirrors that of the larger society, with different patterns of communication attributed to women and men: the sociability of the women, and the dominance of the male ‘board of directors.’ The women are seen by both staff and other residents as more likely to engage in activities and gossip, while the self segregating men talk of sports and politics, and then retreat to solitary activity (p. 26, 2009).

Methods

I will be writing an autoethnography, which can be viewed in appendix A that describes my personal experiences in an ALF. I will share my experiences of how patient care was handled and the characteristics of the staff I was working with. It is important that I write my experience to share what occurred while I was employed at an ALF. An autoethnography examines an author’s personal thoughts and feelings. By sharing a caregiver’s insight into particular situations, this “story telling” can assist in making novice nurses into expert ones.

Discussion/ Results

During the process of writing this article I became very upset that as a nursing student I was noticing so many things wrong with the facility I worked for. In my nursing classes we are taught the importance of evidence based practice. However, these teachings didn’t transfer over to the real world for me. If the ALF I worked at, and others, would hire more higher educated caregivers at their facility, the caregivers would be in a continual learning environment. Critical thinking is necessary throughout the nursing process, and is crucial for quality of care. Undereducated individuals or even novice nurses lack this skill. To provide quality care that would essentially bring down the costs to the ALF by decreasing the amount of unnecessary or preventable care, the ALF MUST hire nurses and caregivers that can provide knowledgeable and patient centered care. Mobile caregivers and unlicensed individuals who administer medications simply do not have these skills and should not be allowed to work in ALF without continual supervision from higher educated caregivers. By sharing my personal experience in an ALF, I hope to influence the nursing environment by bringing more attention to problems with uneducated caregivers.

My autoethnography documents a personal experience with undereducated staff at an ALF. Caregiver’s in ALF need to know why they are giving patient care to their resident and the resident needs to know that they can trust their caregiver. In my opinion and from personal experience it is a necessity for ALF to hire full time, round the clock, registered nurses for their facility.

Conclusion

ALF need to hire higher educated caregivers to decrease costs and increase care. My personal experience with unknowledgeable caregivers is a testament to this fact. However, there were limitations to my autoethnography. One limitation is the fact that I am writing about myself and how I remember them. Being a novice nurse I questioned everything I wrote about in my autoethnography. My article is qualitative research. Throughout writing my autoethnography I thought about how my topic could turn into quantitative research. I would recommend future quantitative research into the number of “expert” nurses working in a facility compared to quality of care of the ALF.

References

Castle, N.G., & Engberg, J. (2007). The influence of staffing characteristics on quality of

care in nursing homes. Health Services Research.

Peterson, S. (2005). Developing risk-management protocols in assisted living: assisted

living has its own litigation traps for the unwary. Nursing Homes: Long Term Care Management, 54(11).

Stefanacci, RG, & Podrazik, PM. (2005). Assisted living facilities: optimizing

outcomes. Journal of the American Geriatrics Society, 53(3).

Williams, K, & Warren, C. (2009). Communication in assisted living. Journal of Aging Studies, 23 pg. 35.

Wright, J. (2008). Searching one’s self: the autoethnography of a nurse teacher. Journal of Research in Nursing, 13(4).

Appendix A:

Autoethnography

When I started working at an ALF, I was excited about being able to get a “heads-up” on my nursing clinical. I started the summer before my freshman year of college. The facility I worked for hired me for a direct caregiver position. They taught me how to give showers, transport residents, and prepare the residents for bed. When I started school in the fall, I began to see that the way the ALF trained me was vastly different from what I was learning at school. The techniques taught at the University where based off of evidence based practices that were proven to reduce injuries and prevent unnecessary wastes. At the ALF my training revolved around what would get the job done the quickest. While at school, I began to wonder about what would cause this discrepancy in the patient care techniques. I then realized that because of how uneducated the staff members at the ALF were patient care techniques were like playing a game of “whisper.” One educated caregiver taught someone who was uneducated patient care, then that individual taught someone else who was uneducated patient care, but without the knowledge of why certain things were included in the patient care techniques. Without that knowledge steps in the care giving routines were excluded to get other things done. If an ALF would hire higher educated caregivers, the quality of the patient care would increase because more caregivers would understand the “why” behind the patient care being given. This ability to ask why is very important if we as caregivers are going to give our residents quality care. This ability is critical thinking and essential to nursing. While working at the ALF I saw a huge lack of understanding as to why the residents were receiving the care plans they were assigned. The caregivers had no idea why residents were receiving their medication and as a result monitoring the residents for any changes was difficult or even impossible to do.

The next summer the ALF then made me a mobile caregiver. I was now responsible for administering treatments to the residents at the facility and collecting vitals. Looking back at it now, I am shocked at the lack of training I received on this part of patient care. I was trained at the ALF for an hour on how to do the treatment passes and how to do vitals. I was trained to do vitals at the ALF with all automated vital taking `machines. These machines can often give inaccurate readings. At the ALF we were often very rushed to collect vitals on our residents which often increased the risk of inaccurate readings. The staff however, just wanted it to be done; they didn’t care as long as they had a reading.

In the ALF I was the youngest mobile caregiver at the facility. I often noticed problems in the treatments that were given to residents at the ALF. Other mobile caregivers would not do the necessary med checks before and after administering medications and this led to medication errors. I would often have residents that were prescribed inhalers. I would work three days in a row and have two days off. The inhaler would have three treatments left. The resident was to get the treatment three times a day. After the two days off, I would come back to same resident and see the same inhaler without any medication left being used for the last day when it was empty. After checking the MAR (Medication Administration Record) it would always be signed off on. Being one of the youngest on staff, it was difficult for me to confront caregivers who had been at the facility a lot longer than I had. Communication and understanding of the residents is another problem. Caregiver’s would often get upset at a client who had dementia and wasn’t complacent. They didn’t understand the complications that were involved with the disease and the lack of understanding of their resident led to mistreatment of their resident. The ALF gave the bare minimum of care and was very task-oriented.

Appendix B

Acknowledgements

I would like to acknowledge Dr. Marlen Harrison for his incredible research writing course. Also, I would like to thank Mrs. Kuzneski for teaching her students about the nursing process and the importance of critical thinking.

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Section Three

Proposal:

Higher Educated Caregivers: Cutting Cost and

Increasing Care in Assisted Living Facilities

Higher Educated Caregivers: Cutting Cost and

Increasing Care in Assisted Living Facilities (ALF)

Andrea Chandler

Research Writing

Marlen Harrison

March 2, 2010

Literature Review

Increasing Care and Decreasing Cost: An Autoethnography Demonstrating a Nursing Student’s Experience with the Importance of Higher Educated Care Givers in Assisted Living Facilities (ALF)

Andrea Chandler

Indiana University of Pennsylvania

Literature Review

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