Holistic Models of Care

Frameworks to assess quality of care

Existing frameworks to assess quality of care focus mostly on the clinical aspect (Donabedian, 1988; Glass, 1991; Gustafson, Sainfort, Van Konigsveld, & Zimmerman, 1990).

A more holistic model by Rantz et al. (1999) with three layers: first layer highlights that residents, families, staff, and the community are the central focus of the framework, second layer emphasises care, staff, and environment, third layer pertains to communication, family involvement, and the sense of home (within the nursing home)

Care Delivery Models

Mirrored by a cultural change in nursing homes, provided overarching goals to address the problems of endemic boredom and learned helplessness for residents, developed a set of principles that govern care practices, organisational and human resource practices, and the design of the physical environment

Wellspring Model (Stone et al., 2002)

Aims: to equip staff with the skills they need to do their jobs, giving them the autonomy to decide how their work should be performed, and empowering them to work as a team towards shared goals

Proposed intervention: multidisciplinary care resource team, development of a programme for the centralised training of the staff

Eden Alternative (Brownie, 2011)

Aims: to promote human growth in care environments and strives to empower older people to pursue meaningful lives

Proposed intervention: include children, animals, plants in the living environment

Green House Project (Zimmerman & Cohen, 2010)

Aims: to provide excellent care, where the residents, their families, and staff are involved in meaningful relationships that were founded on ideals of equality, empowerment, and mutual respect

Proposed intervention: caregivers who attend to the residents’ ADLs and housekeeping roles of cooking and laundry, comprehensive clinical teams, and administration support staff. There is usually at least one nurse serving two to three homes around the clock. The residents and staff in the home are expected to collaborate to create a flexible daily routine that meets individual needs and preferences. The absence of a predetermined schedule encourages residents to be independent in deciding how they want to conduct their lives

Person-centred care model

Originally used for care for PWDs (Koren, 2010)

Aims: desire to shift the balance of power between the PWDs and the services on which they rely, as well as a commitment to diversity and intentional community building