A pilot program to put certified nursing assistants in leadership positions is helping to move Hebrew SeniorLife's nursing-home culture away from an institutional feel to a model where residents get more choice and freedom in their day-to-day activities.
With the support of a $300,000 grant from the Boston Foundation, Hebrew SeniorLife and its educational partner JVS have been training CNAs to become what they call senior resident assistants, leading teams to help transform the medical model — with its strict schedules — into patient-centered care.
The six-month training senior RA program, held for eight hours each Friday, teaches a variety of skills, including how to work with residents and families, documenting care on computer systems, leadership, time- and stress-management skills and orientation of new CNAs.
"You learn how to better manage yourself and your team on the job," said Gerry Guerier, a 20-year CNA who took the program. "It teaches us to listen better in order to understand and resolve problems."
The 32 CNAs chosen for the senior RA program are among the best at Hebrew SeniorLife's Roslindale and Dedham campuses, said Doris Bertram-Morin, dir- ector of professional dev-elopment.
"They are natural leaders who have earned the respect of all the staff," Bertram-Morin said. "In fact, by observing and reporting what they see to nurses, the senior RAs have become extensions to nurses and that is a huge asset."
Tammy Retalic, chief nursing officer at Hebrew SeniorLife in Roslindale, said senior CNAs are a critical component in changing the way nursing homes work.
"We're trying to make a big cultural change away from the medical model, and senior RAs are the ones helping to create more home-like environments for the residents," Retalic said.
Teams of four to five CNAs work with five to six residents, helping with activities of daily living. But instead of requiring set times for meals or bathing, senior RAs have learned to take a flexible approach to scheduling, based on resident preferences.
"We learn their life stories, their likes and dislikes and give residents a choice about creating their own life," said senior RA Nancy Jeanniton, who has been a CNA for eight years and works at Hebrew SeniorLife's NewBridge on the Charles in Dedham. "It's a big change from the old nursing home institutional style. It's their home. And we do whatever we can to be flexible and offer them more freedom."
"With the training, I feel confident speaking up and doing what needs to be done for the residents. And we are the role models for demonstrating best practices."
The biggest new responsibility for senior RAs is that they are now the main liaison between nursing-home residents and their families.
"It used to be that when families asked about residents, you'd direct them to the charge nurse," said Anne Allison, a senior RA who's been a CNA at Hebrew SeniorLife in Dedham for 10 years. "Now, the senior RAs talk to the families about residents and it makes everything feel more personal and home-like. You get to know the entire family."
During the recent blizzard, Allison said a resident begged her to stay in her place at NewBridge on the Charles, which she did for two days.
Senior RA Prince Kuffour, a CNA who has worked with dementia patients for six years on the Roslindale campus, says the program has helped him and his co-workers better manage the stress of the job.
"It's very challenging working with dementia patients," Kuffour said. "The training helped me learn skills such as being able to pull back during stressful situations. It's helped me and others on my team better protect patients."
He said it's better for CNAs to have their own leadership structure in reporting to charge nurses and operations leaders.
"We are the first line of contact with residents," Kuffour said. "But now we feel interwoven with everyone else providing care."
Another benefit for Hebrew SeniorLife is that offering their best CNAs more training — and an increase in wages — helps retain them, which keeps the continuity of care in place. And senior RA training is also a ladder up the career path for CNAs who aspire to eventually become LPNs or RNs.
Once the training is over, senior RAs also have some ongoing support. Through the Boston Foundation's SkillWorks initiative, a career coach is assigned to meet with each senior RA once a week.
"We brainstorm on what to do if things aren't working out with a resident or team co-worker," said the RA program career coach, Mary Jo Kiepper of JVS. "I help bring out their leadership and problem-solving skills."
With the success of the Hebrew SeniorLife pilot RA program, several community colleges, among them Mass Bay, Middlesex Community and Quinsingamond, will start to offer a similar senior CNA certificate training program.
"The RA training has given me an opportunity to develop my career," said Guerier. "And it's helped me build better relationships with residents and provide a better quality of care."
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