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Home Away From Home
“Culture Change,” “Person-Centered Care,” and
Picking the Right Nursing Home
by Brian Foster
W hy is it that just when our frail elders become
most in need of care and comfort they must
face the fear and frustration of living in an
institution that focuses on efficiency and effectiveness over
the quality of their lives? Most of us would never choose
to live in a nursing home. Yet, for the sake of their care, we
ask our loved ones to do just that.
There is pressure afoot today in America, led by the
Pioneer Network, to transform the whole way of life in
nursing homes. It means moving away from an acute
hospital model towards a neighborhood or household model
that honors the dignity of elders by giving them charge
of their lives in an environment that is more like home
than institution. This revolution is called “culture change”
and calls for “person-centered care” — a philosophy that
puts elders ahead of efficiency and replaces one-size-fitsall
practices with individualized service. Out of America’s
17,000+ skilled nursing facilities more than 600 have joined
this movement, including more than 40 in the Greater
New York City area. “Culture changed” nursing homes are particularly beneficial for people living with dementia
as person-centered care meets these people where they
are instead of obliging them to conform to institutional
daily life practices that they may not or cannot understand.
But how will you recognize these progressive facilities?
“This revolution is called
‘culture change’ and calls for
‘person-centered care’
—
a philosophy that puts elders
ahead of efficiency and replaces
one-size-fits-all
practices with
individualized service.”
In nursing homes that practice person-centered care,
residents:
- live in smaller self-contained
units called “neighborhoods”
or “households” with a
dedicated staff
team who have
the authority to make, with
the elders, decisions for their
particular neighborhood
or
household.
- have choice in when they get
up, when they go to bed and
when and what to eat — including
favorite snacks
available any time.
- are offered a choice of bathing methods, times and
frequency in a relaxing setting that does
not include
the uncomfortable, and embarrassing wheelchair ride
down a long hallway to the
shower room, naked except
for a hospital robe.
- decide how they will fill their days and are offered
opportunities and resources for activities
that match
their interests (and go beyond BINGO).
- experience individual daily pleasures such as a cup of
tea in the afternoon, a midnight snack,
hosting friends,
taking care of plants, Chinese food take-out — the
possibilities are endless.
“Person-centered care” is in fact the norm for those
four out of five people living with dementia who remain
in their own homes. As the disease progresses, those around
them adjust and adapt, but by and large as long as they live
in their own homes, the setting is familiar and personalized.
But if that tough point arrives when nursing home
care is no longer avoidable, a wrenching change happens
in the person’s life, when he or she is least ready to adapt.
Facilities going through culture change try to minimize
this disruption. They realize that even people with latestage
dementia can still make many choices. In a more
traditional nursing home however, people go suddenly from
the familiarity and comfort of home to utter powerlessness
and isolation.
While culture change homes usually look more like
home than institution, looks can be deceiving. Some places
have cheerful decor but operate like a production line.
Others have placed elders firmly in the driver’s seat while
their physical environment works to catch up with their
person-centered vision. Here are a few things to pay attention
to when looking for a “culture change” nursing home
for your loved one:
- Staff interacting more with residents than each other
and asking them gently what they would like to do
instead of telling them.
- Generally calm and quiet atmosphere free of institutional
clutter, overhead noise and alarms.
- Cozy, comfortable, natural spaces for residents to gather
and interact as well as places for privacy.
- Kitchen/dining arrangements that allow for meal
preparation and serving near the residents.
Ask staff
- ‘What choice/say do residents have in dining, bathing
and sleep schedules?’
- ‘What provision is there for personalized daily pleasures,
such as that first cup of coffee in the morning?’
- ‘Do you have consistent staff or do they float around the whole facility?’
- And, terribly important, ‘What role can families play
here?’
Brian Foster is a culture change organizational development consultant based in New York City, and associated with Action Pact Inc. of Milwaukee,
WI, an education and consulting firm in nursing home “culture change.” He can be reached at Brian@actionpact.com.
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