Thirty percent of re-hospitalizations in nursing homes occur for residents who have been there for seven days or less. Getting care right from the start makes a big difference in whether a nursing home stay is successful.
Transitions can be traumatic, especially when people are frail. For people coming into a nursing home from the hospital, that transition is smoother when there is good coordination and hand-offs between the nursing home and the hospital and when there is good coordination internally within the nursing home across shifts and departments.
There is a considerable base of evidence about practices that can alleviate transfer trauma. These practices focus on ways of anticipating and meeting people’s psycho-social needs, helping them acclimate to unfamiliar surroundings, and providing immediate comfort and security.
Smooth transitions from the hospital can prevent re-hospitalization, and promote the return to home for short-stay residents. Helping residents maintain their highest practicable well-being right from the start is important. How new residents are welcomed in is even more important.
For most residents and their families, this is their first experience of being in a nursing home. They don’t know how it works and they are afraid and traumatized. It helps to remember that everything is new and unfamiliar for them. This is a big event in their lives and they need a lot of support. They also may be very tired from all the preparations to come to the nursing home, or from having been at the hospital before they came.
We only get one chance to make a good first impression. We can help staff get off to a good start with a new resident by making sure staff have the information about the person so they can be ready to give a good welcome when the person arrives. Focus first on ensuring that staff learn as much as they can about someone coming in, as quickly as possible, so they are immediately able to get people comfortable and off to a good start in their stay.
Get to know each new resident’s personal routines and history. This is key to ensuring that they get off to a good start to their stay. It’s the little things that matter. Ask: what do you need for a good night’s sleep? What’s your morning routine? Would you like a bath or a shower? What and when do you like to eat? What would you like to be called? What can we do to make you comfortable? An emerging bet practice is to have the CNA who will be caring for the new resident get this information right away when someone new comes in. At Park Avenue Extended Care in NY, CNAs ask five simple questions:
- How would you like to be addressed?
- What time do you want to shower?
- What time do you want to go to bed?
- What time would you like to wake up?
- What would make you comfortable?
If residents share information with staff and then find that it is not known by others who take over their care, their worry increases. If you have residents or families asking, “don’t you people talk with each other?” then you need to shore up the way your staff do share this information. So make sure you have a good system for passing information along from shift-to-shift.
At Park Avenue, the CNAs fill out a form with this information and put it in the CNA assignment book so that the answers are available to anyone caring for that resident. CNAs share the answers with their co-workers and their charge nurse so that immediate accommodations can be made to maintain the resident’s preferred routine.
Key organizational practices for ensuring a good welcome include consistent assignments of staff, huddles to share information about residents and their needs, and internal coordination among CNAs, nurses, admissions staff, dining, rehab staff, and others to help make sure each new resident's transition into their nursing homes is comfortable and seamless.
With consistent assignment of caregiving staff, new residents and families can quickly build confidence in the care-giving relationship. They will be reassured when they see how well staff know them and can take care of the little things that make them comfortable. And that will contribute to their satisfaction.
Shift huddles are a great way to pass the information along from the dedicated caregivers to other co-workers and to other shifts. The better staff work together, the more welcomed and assured residents and their families feel.