Culture Change in Long term Care
Is it time to rethink how we care for seniors in nursing homes? Many facilities still use outdated models that don’t put residents first, leading to loneliness and poor quality of life. Culture change in long-term care aims to shift this by focusing on dignity, choice, and person-centered care. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guest Kiran Sahota to talk about what culture change means, why it matters, and how it can transform life for nursing home residents.
Sahota:
I called them little shift huddles where I would go in with the nurses together. So there was always that shift report going on, it’s me going to have to implement the change as a leader and be the example. So that procedure was so well implemented that we could catch things sooner and we were reducing readmissions because we were very proactive about things like that.
Schenk:
Hello out there. Welcome back to the Nursing Home Abuse Podcast. My name is Rob. I’ll be your host for this episode. Today we are talking about culture change in nursing homes. What is the culture? What needs to change? We had, we’d actually have an episode about this. It’s a we. It came out, what are we looking at t in February of 2021.
Wow. It’s been a long time where we talked about culture change, I guess from the perspective of the public maybe use this particular vocabulary versus this one. But in today’s episode, the culture change is essentially from the. From the industry side, what are some things that the nursing home does that could be seen as a culture that should change for the benefit of the residents?
We have a, we had a great conversation today. We weren’t alone. We had the fantastic Kiran Sahota with us. So stick around to learn more about culture change and her perspective on that subject.
We have the fantastic Kiran Sahota. Kiran is DE is a dedicated registered nurse with extensive experience in skilled nursing. Since 2014, she has served as a director of nursing leading teams and ensuring high quality patient care. Recently, Kiran pursued certification in legal nurse consulting, expanding her expertise with a deep passion for patient advocacy.
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She’s committed to improving healthcare outcomes and supporting individuals in need of compassionate, knowledgeable care, and we’re so happy to have her on the show this week. Kiran, welcome to the show. Thank you.
What does culture change mean in long-term care?
Schenk:
What, this will be the softball question of the century. What does culture change mean in long-term care in nursing homes?
Sahota:
Culture change to me in a long-term care facility technically means something that is going to shift culture, not only for. The employees, but also how it’s going to affect the patients. I think it has to be twofold. It can’t just be one fold because everything follows each other. How the employees are affected versus how the patients are affected ’cause everything affects the entire facility as a whole.
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Schenk:
But said. But I guess what would be a a, an example of the culture that is changing.
Sahota:
An example of the culture that is changing is the staffing shortages in our facilities. And the biggest thing is, nurses not.
Particularly wanting to come and work in skilled nursing facilities or using this as a stepping stone to go into bigger hospitals. That’s a big culture change. Because then constantly the shifts in employment or in employees can cause a big problem for our residents because they get so used and.
Used to and comfortable to employees, and then all of a sudden, then they have a whole set of new employees. And that alone can cause a lot of I think, trauma to them because they get attached and they get very comfortable with employees, and then all of a sudden you have to change. And that also from a training perspective, is a lot of burden for the skilled nursing facilities constantly to keep having that turnover.
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How does person-centered care improve nursing homes?
Schenk:
Interesting. One I guess a current culture that. I guess we’re saying it needs to change is the concept of nurses maybe settling for nursing homes until they get something else. I guess I’d never heard of that. It’s, you say it’s a stepping stone to some, to, to hospital work.
Sahota:
Yes. In California here I’ve been a director of nursing for 10 years at a skilled nursing facility.
And that is the constant thing that, that, that’s a constant pattern that they graduate out of RN school and they’re using it as a pattern. So LVNs typically yes nursing, skilled nursing is where they will stay for longevity, but then. When they’re RNs, then we are a stepping stone for them.
So they use us for about six months as experience. Some places will allow a year, some will allow six months depending on the experience that they can gain and then have, get into entry level positions at the hospitals. And that constant shift is hard because. From an employment perspective, how much are you going to give?
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How committed are you to your rn? So that always causes a problem for me, especially for me as a director of nursing. But. Is also affecting the residents because they get so used to a certain staff member and then the consistency, then all of a sudden that staff member is gone and now they have somebody else to work with.
So I think that the continuation, the assessment, and I would say the. Bigger structure that RNs will bring to skilled nursing is very few and far between. I’m an RN and I knew from the get go that I wanted to be in skilled nursing. I started in skilled nursing as a CNA and I continued.
But there is very few and far between RNs that will want to commit to nursing homes or skilled nursing by far.
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What are the biggest challenges in shifting LTC culture?
Schenk:
So I. I guess from what I hear you say is that reducing the current culture of turnover is something that needs to happen. So what are some ways that we can do that? What are the ways the industry can do it or residents or lay people?
Like how do you change that?
Sahota:
One thing which we’ve, I’ve tried to use as a concept of changing it is. Having the orientation and the, I would say the empowerment that you’re going to provide the RNs to be a little different and a little higher level than you would provide to other employees, such as opportunities for leadership.
Right from the get go. Because they want to expand. Your pay scales make it competitive. Yes. We cannot pay the acute care facilities, but then maybe have them have add-on positions that they can, you can incorporate with their regular work. So you can pay them a little more. Because they’re looking for, ways to improve themselves, way to grow. And as an RN they want to do more because they’re able to do more with their scope of practice. So I think having that incorporated within the hiring process and making this a leadership opportunity for them right from the get go will empower them to stay because they’re looking at the next steps of what they can do.
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For me doing that I have been successfully as a DO and I was able to at least hire a few RNs that have now been in the facility for quite a. Quite a while by giving them like roles like MDS nurse and things like that right from the get go saying, once you get this experience I can move you on to something else.
And I think that really boosted their morale of oh, I can do more things and incorporating it right from the get go rather than waiting, because then you are going to keep ’em for longevity. So I think more directors of nursing in the industry. More administrators need to look at an RN application.
As something of like how I’m not only I’m in need of an RN and I need an RN because I need to meet my PPD hours. A lot of us think that way, but how do we shift that to, I need this person, I want them to work for me, not only because I need them for the hours, but because I want my facility to have that level of competency at all times and, avoid that constant shift that is happening.
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Schenk:
Other than staffing, turnover for the reasons that you’ve described, what are some other, cultures or things that, that you’ve identified in long-term care that needs to change?
Sahota:
The culture is quality of care for the residents. Big, it’s always a big thing. The quality of care.
Of course a lot of facilities have quality measures that they follow, right? We want to follow those and we want to make sure, but how do we think above that, right? How do we think above the quality measures and not do it as a compliance piece, but also to make sure that our facilities. Are there to provide for our residents with, absolute good quality of care.
Why do we look at quality measures of I want my quality measures to look good. That is why I’m going to provide the care. It shouldn’t be that way. It should be, I want to provide quality care and then let the quality measures follow, and I think that’s going to be. A big culture change that doesn’t come naturally, but eventually if you start in small baby steps, it’ll eventually get there.
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How can staff be trained to support culture change?
Schenk:
So in that particular instance what can a nursing home do to bring the focus back to what you described, which is we want to do it for quality’s sake.
Sahota:
Teamwork, work as a team. And I think what happens is whenever there is something new or a change that needs to happen in the facility, you often will see that the director of nursing, the administrator, the IDT team will sit together in an in a conference room and try to discuss what change needs to happen.
And then the frontline staff always get. The back end of it, right? But how about we culture shift and start with the frontline staff. Why don’t we gather information, make them the chairperson of that particular committee, or whatever change you’re trying to make. So then the change that is implemented starts with them because they’re the ones going to be able to do it, and they’re the ones who know how to make it happen. And then. Then spend time on the backend work. I think what often happens is we spend so much time trying to formulate this plan and we get so overwhelmed with trying to get the details ironed out that by the time it’s time to get it to the staff frontline, we’ve already lost concept, but how about we go the opposite way, and some of the things that I. I always focused on as a director of nursing that I did was shift huddles, right? I called them little shift huddles where I would go in different times. Collect all the CNAs, get all the CNAs on board with the nurses together.
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So there was always that shift report going on. So the nurses and CNAs constantly knew what was going on. ’cause there was always this issue of my nurse didn’t tell me about this change of condition, or my CNA doesn’t know. What is going on with my patients, right? So in order to create that culture change, I can tell the nurses till I’m blue in the face, right?
You need to do this, you need to do this. But that’s not what’s going to help. It’s me going to have to implement the change as a leader and be the example. So I started doing huddles with them, where I empowered the CNAs ask the question. Ask the question to your nurse, let the nurse answer that question.
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That way you guys build that relationship where the nurse knows that, yes, my CNA is going to ask that question, and the CNA knows that this is expected from my nurse to make sure that they give me report at the beginning of the shift. So I think just that culture made a huge difference. And the quality of care of the patients, the information was.
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Very well circulated throughout the shift, so nobody was left without, and that alone is a very good quality of care perspective because just with that particular I would say intervention, I was able to reduce, I. Readmissions because the nurses, everybody was communicating, this patient is on antibiotics, they’re taking this because they have a urinary tract infection.
Please make sure you hydrate them. If they don’t look well, please let me know. So then that procedure was so well implemented that we could catch. We were reducing readmissions because we were very proactive about things like that.
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What role do residents and families play in this shift?
Schenk:
So that is amazing because I, at least in my experience, when you empower the people, like when you ask them their opinion and they get involved, they’re invested.
- And it’s not just, they’re not, when you’re doing the huddle, they’re not just thinking about what they’re gonna get for lunch which are they gonna get, the Taco Bell Mill deal number three, they’re actually invested and they’re like, oh, okay. They want my opinion, so I’m gonna be, I’m gonna be present. I think that’s amazing.
Sahota:
We can try little things. That’s all we can do, is put the pieces together and sometimes it works, sometimes it doesn’t. But it’s always nice when it works out for the quality of care of the residents.
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How does culture change impact resident quality of life?
Schenk:
How did you, I’m not like I, at least in my experience, and I could be wrong, but I, that sounds like you might be in the minority.
So like how did you come into this? Like how did you decide that you want to try to make the culture better?
Sahota:
Being invested in it, I moved here from India in 2004, and I always knew I wanted to do something in the nursing field, and I started as a CNA. I stayed in the same facility. I did my clinicals there as a CNA, and I continued there.
I got my RN, I became a director of nursing there. I got my master’s and now I’m working on my PhD. So I just continued there because I’m invested, and. For lack of better explanation, I feel like the elder population and working with them is just so rewarding. No matter what it is just so rewarding being with them in that stage of life.
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So I think it just came naturally. It’s very hard to explain, but naturally I’m inclined. I got so many offers from other places given my background, but never, it never was enticing to me that this was. Just the perfect fit. Long-term care or anything to do with long-term care is always my, my, my best.
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Schenk:
Kiran, hats off to you. I think that’s fantastic. Keep up the great work and we’re really glad that you were able to come on the show today to share your perspective with us.
Sahota:
Thank you so much. I really appreciate it.
Schenk:
Folks, I hope that you found this episode educational. If you have any ideas for topics you would like for me to talk about, please let me know.
If you have any ideas for people that you want me to talk to, please lemme know that as well. New episodes of the Nursing Home Abuse Podcast come out every week. Please get a mug, get a nursing home abuse podcast mug, and if you do, I promise I’ll stop talking about it. And with that folks. We’ll see you next week.
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