By Robyn Stone
Relationship-based care is more important—and harder to achieve—than you think, writes Robyn Stone, co-director of the LeadingAge LTSS Center @UMass Boston.
Two items on my winter reading list reminded me of an essential truth that has the power to improve quality of life for residents, their families, and team members in nursing homes around the country. I can sum up that truth in two simple words:
Relationships matter.
This truth may seem obvious, rather than earth-shaking. But my winter reading illustrated clearly that relationships in nursing home settings matter a lot more than most people think they do—and that building and sustaining those relationships is a lot harder than it looks.
In January, a team of nurse researchers wrote an article in Research in Gerontological Nursing suggesting that workforce challenges in nursing homes call for implementing a “relationship-centered team nursing” model. This new model has four distinct components, which, taken together, have the potential to improve quality of care, resident quality of life, and staff quality of work life. Those components include:
- Open, clear, and timely communication among staff, residents, and their families, and the structures to support it.
- Empowerment of staff so they feel appreciated and respected in their ability to deliver the kind of care residents and families expect.
- A coaching style of supervision, which creates collaborative working relationships among staff.
- Family/care partner involvement, which contributes to optimal care.
The importance of relationships was also highlighted in a research brief prepared by the LTSS Center team and released in February. The brief underscored the need for consistent, transparent, and supportive two-way communication between family caregivers and direct care professionals in nursing homes and assisted living communities. Researchers found that the availability of this type of communication was associated with improved resident quality of care and quality of life—and, more specifically, improvements in residents’ mental health.
While the focus of these two resources is slightly different, both point us in the same direction. As we strive to fulfill our mission to care for a growing older population, we must focus squarely on the people who live in, work in, and have relatives in nursing homes—including nurses, direct care professionals, residents, clients, and family caregivers. Their relationships with one another are critical to our success.
Every care setting operates better when those living and working in that care setting enjoy authentic relationships with one another. But these relationships are particularly important in nursing homes, where older adults receive essential services and supports in the same place where they live. Because of their unique dual role as care settings and homes, nursing homes have a special obligation to encourage and support relationship building.
Don’t we already encourage and support authentic relationships? Yes, to a certain extent, we do. But, as we all know, building and sustaining any relationship can be complicated and fraught with pitfalls. In nursing homes, relationship-building requires special skills, hard work, and constant attention. Even the most caring nurse or direct care professional needs targeted education, training, and support as they build and participate in relationships with residents and fellow team members.
Fostering meaningful workplace relationships in nursing homes also requires changes in the structure and culture of our organizations; an accountability system that ensures organizational leaders, clinicians, and caregivers remain focused on relationship-building; and policy initiatives that encourage and reward the operational changes needed to build relationship-centered nursing homes.
The authors of the Research in Gerontological Nursing article call for scientific leadership in redesigning, testing, and implementing a nursing care delivery model that operationalizes relationship-centered team nursing. While we wait for these research findings, providers of aging services can get a jumpstart on the relationship-building process.
My winter reading list might be a good place for you to start. Both documents, available online at no charge, provide valuable information you can use to strengthen your nursing home by strengthening the relationships that take shape within its walls.
Next, consider beginning a process to assess how well your organization supports relationship-centered nursing home care. Ask your nurses, professional caregivers, residents, and family members how they perceive relationships in your organization and what improvements they’d suggest.
Finally, keep your eyes on the research. Hopefully, we’ll soon have a more precise definition of relationship-based care, more information about its essential components, and recommendations for applying that knowledge to nursing home operations.
Adopting relationship-centered care models will help your nursing home differentiate itself in the marketplace among prospective residents, strengthen its recruitment and retention efforts, and improve its quality outcomes. For all these reasons, this evolving concept is well worth your attention.
Robyn I. Stone, DrPH, is senior vice president of research at LeadingAge, and co-director of the LeadingAge LTSS Center @UMass Boston. Her widely published work addresses long-term care policy and quality, chronic care for people with disabilities, the aging services workforce, affordable senior housing, and family caregiving.