Boyd C
Providence/Mount St. Vincent, Seattle.
Health Prog. 1994 Sep;75(7):34-9, 50.
Four years ago the leaders at Providence/Mount St. Vincent, Seattle, decided to scrap the traditional medical model of long-term care and create an environment directed by the residents. The traditional system in nursing homes is designed to foster dependence. Our new social model, in contrast, is almost entirely directed by resident preference and need, and it places a high value on human interaction. So far we are having the most success with our assisted living program, which is built into apartment living as part of the rent. All services are available to all residents when they need them. The residents are forming warm relationships with resident assistants, and the flexible, nonmedical help they receive allows them to age in place. The nursing center has been divided into "neighborhoods" of about 20 residents, each with its own staff. A cross-trained, highly capable staff is essential to support resident independence and choice. In one experimental neighborhood, nonmedical tasks that nurses have traditionally done are now being reallocated to resident assistants, who are paid half as much as nurses. The physical heart of every remodeled neighborhood will be a kitchen, as we strive to create a homelike environment. Purposeful activity is replacing therapy in a void. And residents with cognitive impairments are gradually being integrated with more cognitively aware residents. We believe that in the long run, resident-directed care will be less expensive than the medical model.
四年前，西雅图普罗维登斯圣文森特医院的领导决定摒弃传统的长期护理医疗模式，打造一个由居民主导的环境。养老院的传统体系旨在助长依赖。相比之下，我们新的社会模式几乎完全由居民的偏好和需求主导，且高度重视人际互动。到目前为止，我们的辅助生活项目取得了巨大成功，该项目作为租金的一部分融入公寓生活。所有居民在需要时都能获得所有服务。居民们与居民助理建立了温馨的关系，他们得到的灵活、非医疗性帮助使他们能够在原地养老。护理中心已被划分成约20名居民一组的“社区”，每个社区都有自己的工作人员。一支经过交叉培训、能力很强的员工队伍对于支持居民的独立性和选择权至关重要。在一个试点社区，护士传统上做的非医疗任务现在被重新分配给居民助理，居民助理的薪酬只有护士的一半。每个改造后的社区的核心区域将是一个厨房，因为我们努力营造一个像家一样的环境。有意义的活动正在取代空洞的治疗。认知受损的居民正逐渐与认知能力更强的居民融合在一起。我们相信，从长远来看，居民主导的护理模式将比医疗模式成本更低。
