Traditionally, nursing home staff have focused on completing tasks. Nursing administration would ask nursing assistants to begin waking, toileting and dressing residents as early as 5 a.m., so everyone was ready for breakfast at 7:30. Residents had little choice or autonomy, and nursing assistants felt pressured to finish their work. Fortunately for both residents and staff, that model of care is changing.

Rhythms and relationships

"In the new model of care, the resident drives the rhythm of their day," explains Kathy Yechout of Presbyterian Homes & Services ( Yechout coordinates Liberty, a person-centered model of care that allows residents to determine how they wish to live within the community setting.

Residents live in "households" of 15 to 20 people. They are encouraged to let the staff know when they wish to sleep and rise, what they prefer to eat and what activities they enjoy. Resident assistants (RAs) help with personal care, light housekeeping, light cooking and daily activities. Because RAs work in the same household every day, they get to know residents as individuals.

"There's less pressure to just complete assigned tasks," says Dan Strittmater, who heads up Presbyterian Homes' strategic initiative. "Staff have time to develop relationships with residents. They enjoy their work more and become more confident in their abilities."

Career ladders

In the traditional task-centered model, career options for nursing assistants were limited. But in the person-centered model, RAs have a real career ladder.

At Presbyterian Homes, all RAs must complete 75 hours of nursing assistant training. The Liberty model provides an additional 150 hours of classroom training followed by a 2,000-hour apprenticeship. Upon completing the apprenticeship, RAs can become "certified household specialists."

This credential can be a first step toward a two-year nursing or business degree. "In long-term care, experience as an RA is the very best preparation for both clinical and housing managers," Strittmater says.