The Culture Change Movement in Nursing Homes
What exactly is culture change?
One of the newest drivers of change in nursing homes is changing the culture of the organization. In our last post we talked about why people fear nursing homes and the history of the industry, here is how we fix it.
Culture is the predominating attitudes and beliefs that characterize an organization. The culture or attitude of nursing homes of the past involved only caring for the clinical aspects of care. The disease or disability are at the forefront of everything we do. Care plans are designed to be basic and focuses on what residents can no longer do. Everyday is rigidly scheduled and designed for efficiency of the caregivers in the home.
When a person moves into a nursing home, they give up the entire life they built, reducing their most valuable possessions to a single box. Only what will fit in a small closet and in the small space of one room is allowed. The loss of one’s personal possessions is not all they lose; the most devastating is the loss of identity, privacy, autonomy, dignity, and respect.
The culture of nursing homes dictates that we are the licensed caregivers and we know what is best for you. After all, why else would you be here. In the matter of hours, the nursing home begins designing a safety bubble, the goal is for the resident’s safety. Really it’s more of a reduction of risk for the facilities themselves. We do a complete skin assessment, fall assessment, cognitive assessment, enter diet orders, medications, and so on. Now I am not saying that these assessments are not important. It’s how these assessments are used that makes the difference. If they are used as a means to control and take away choice in the name of safety, this is wrong. If they are used as a tool to identify new goals to achieve physical and personal growth, then you are doing it correctly.
In either of these cases, residents have the right to direct their own care, refuse care, and make any decisions regarding their lives. You may not have control over life’s circumstances, but you have control over your own life.
Culture change seeks to change the attitudes and beliefs of nursing home organizations, creating a place where people make their own decisions about their care. Some as simple as when to go to bed, when to rise, when and what to eat, what activities to do, when to shower or bath, etc.
Seems simple enough…..but for most nursing homes, giving up control is almost impossible. Every aspect of life is scheduled to create ease for the caregivers. When caregivers take away choices, the residents rebel and are labeled non-compliant. Caregivers forget that they are caring for human beings, instead they become tasks to be completed before they clock out for the day.
What should you look for in a nursing home of the modern world?
- Do the residents have choices? Can they sleep in or stay up late?
- Does the home take a complete history, including past history, life skills, growing up, and trauma? The more we know the better the care.
- Has the home eliminated institutional barriers, like, nursing stations, overhead paging, and timed med pass?
- Are their a variety of activities, designed for all levels of cognition and abilities? Their should be more than BINGO, sing-a-longs, and movies.
- Does the environment seem calm and quiet? Are their residents crying out?
- If you are looking for memory care, are the residents appropriately engaged, or are they parked in front of the TV napping?
Always look for the home that makes you and our loved one feel happy, never settle for second.
All Mission Homes are Eden Alternative Registered Homes. www.edenalt.org
Mission Health Services is affiliated with CNS, Community Nursing Services, a non-profit, home health and hospice agency. CNS is a proud supporter of culture change in nursing homes and home health agencies.
Heather Reynolds is a certified Alzheimer’s Dementia Practitioner Trainer and a Certified Eden Educator.
