Culture Change in Long Term Care
History
Long Term Care facilities, another term for nursing homes, were modeled after hospitals and therefore referred to as the medical model, with institutional values of systems and staff efficiency. Long term care is one of the most highly regulated industries in this country, and the regulations and regulators have mandated a highly structured institutional medical model. However, there is a growing national movement of change.
What is Culture Change?
It’s a new model of care, which we refer to as “Culture Change,” as it does indeed change the culture of the institution and the way care is provided to residents.
- The focus shifts away from a traditional medical model in which the physical care of the individual predominates, driven by staff determination of what care the elder needs and perceived staff efficiencies.
- It transforms organizations to be truly driven by the choices and desires of elders. This transformation has person-centered, relationship-based care as the heart of its vision.
- Nursing home existence is characterized in terms of helplessness, loneliness and boredom. In contrast, Culture Change is about advocating for “autonomy, risk taking and opportunities for personal growth.”
- The idea is to “so thoroughly infuse the nursing home environment with normal life that the transition between the home and the outside world is seamless.” The goal is to create “rampant normalcy.” This requires a systematic change in the way we think, which drives how we act, in our community.
Why change?
Perhaps an example will help to explain this. In the medical model, some residents are awakened by the night staff, toileted and dressed starting about 5:30 a.m.; the rest of the residents are wakened by the day staff that start work at 6:30 a.m. Breakfast is brought up on trays by dietary at 7:30 a.m. Residents are served and fed according to a predetermined set menu. Breakfast is finished by 8:30-9:00 a.m.
Now imagine yourself living in that environment. We believe that people ought to be able to choose when to wake up and decide what they want to eat and when. That’s what they have done at home all their lives and this should not change just because their physical condition requires nursing care.
Why us?
Three Crowns Park had a reputation of quality and caring so this movement spoke to our hearts. We also believe that consumers, given the choice, will prefer this person centered type of care.
Why now?
With our expansion, we had an opportunity to change the physical environment and to be supportive of a new operational culture.
What does a transformation based on
person-directed values look like?
The type of environment we are striving to create is dramatically different from the living, working, and care-giving environments found in most health care organizations.
Household Design Principles
- Seek normalcy in all things
- Home is our sanctuary
- Home is where we host visitors
- All homes have a front door
- All homes have a kitchen
- All homes have recognizable dimensions of privacy
Person First Values and Person First Care
- Is a collaborative effort to create meaningful life
- Values the person no matter what their abilities or disabilities are
- Considers the person’s habits, routines and practices when providing care- Know the Person
- Places a HIGH value on the relationship between the elder and the caregiver
- Considers all behavior as an attempt to communicate
- Provides for spirit as well as body and mind
- Puts the person before the task
- Begins decision making with the person
- Accepts risk as a normal part of life
- Believes all people are growing and learning
Residents, their families, and the workers are a part of a thriving, interdependent community.
Transformation
This transformation is referred to as a journey, and it truly is. We began our journey in 2004, working with a Culture Change consultant on staff training and reframing our organization. We took staff to Kansas to experience one of the leading culture change homes. We have begun making the changes for the physical environment.
Our households at Three Crowns Park
Each household accommodates 17-18 residents, primarily in private rooms, with the great room and kitchen at the heart of the house, as it is in our own homes. McDaniel and Hartrey Houses are skilled care nursing households. Colfax House is an assisted living household for individuals with memory loss.
We are very excited and pleased with these ongoing changes and ask that you help us spread the word about the importance of Culture Change within Long Term Care.
