Power Belongs with The Elder and Those Working Close to Them

By / Posted on August 4th, 2014

New research from The Journal of Applied Gerontology showed that involving Nursing Assistants in decision making has a positive effect on quality of service. From my experience with person-centered care, I can tell you that the research rings true. The Nursing Assistant is the person who works closest with the Elder, day in and day out, and gets to know them best. These staff members know Elders as individuals, rather than just a diagnosis, and when they are empowered to make decisions based on this intimate knowledge, both Elders and staff benefit.

We do a role play exercise during Green House education where we act out a Care Plan meeting. In the first round, the Care Plan meeting is handled as it would be in a traditional setting, with only the clinical staff involved in the conversation. In the second round, we include the Nursing Assistant, Elder, Family Member and Housekeeper. The reaction to this exercise is always astonishment, as participants realize how much important information is missing when all stakeholders are not represented. As the research states, “When nursing staff had the autonomy to make decisions, there was a higher relationship to service quality. The empowerment of nursing assistants had an even greater effect than empowerment of nurses…”

In The Green House model, the power shifts to the Elder and those working closest to them. Power means having the resources and authority to make and execute a decision. This creates a deep-knowing environment where the Elder’s natural rhythm and preferences are honored. Quality is also impacted because of this familiarity. Staff members notice the small things about the Elder’s well-being, that can lead to early detection of illness and acuity changes. When staff members are empowered to meet the needs of the elder, they feel ownership and valued in their job and Elders feel safe and content, because they are known. Ask yourself, “What is best for the Elder?”, when this question is central, it is clear that those who know them well must be involved with decision making.