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Culture Change 101

Definition of Culture Change

“Culture change” is the common name given to the national movement for the transformation of older adult services, based on person-directed values and practices where the voices of elders and those working with them are considered and respected. Core person-directed values are choice, dignity, respect, self-determination and purposeful living.

Culture change transformation supports the creation of both long and short-term living environments as well as community-based settings where both older adults and their caregivers are able to express choice and practice self-determination in meaningful ways at every level of daily life.

Culture change transformation may require changes in organization practices, physical environments, relationships at all levels and workforce models – leading to better outcomes for consumers and direct care workers without inflicting detrimental costs on providers. 

Culture Change 101

Understanding the Core Principles and Values of Culture Change
Know each person.
Developing a relationship with each resident, knowing their needs and wants as well as their daily routines. Assigning consistent staff to each resident in order to cultivate this relationship.
Each person can and does make a difference.
Despite physical or cognitive impairments, every resident can contribute in some way. Finding a sense of “purpose” for every resident and offering choices for care routines, dining, and activities.
Relationship is the fundamental building block of a transformed culture.
Enhancing the relationships amongst staff with residents, staff with each other and with residents’ families can improve the overall quality of life for each resident.  Incorporating a “Best Friends” approach to caring for the resident.
Respond to the spirit, as well as mind and body.
Moving from a task-oriented, medical model of care to one that is holistic, all-encompassing—addressing the entire well-being of each person.
Risk-taking is a normal part of life.
Allowing the resident to make personal choices even if that choice results in the resident taking a risk.
Put person before the task.
An approach to caring for each resident that places the priority on the care of the resident and not on “getting the task done”.
All elders are entitled to self-determination wherever they live.
Once a person moves into a long term care setting, they still have the same rights to make personal decisions (regardless of the outcome) as they did when they resided in their own home.
The community is the antidote to institutionalization.
Changing the environment from one of little or no choices and no relationships to one of self-determination, “family”, and a sincere sense of community.
Do unto others as you would have them do unto you.
The staff treats each as well as the residents as they themselves would like to be treated.
Promote the growth and development of all.
Shape and use the potential of the environment in all aspects: physical, organizational, and psychosocial/spiritual.
Practice self-examination, searching for new creativity and opportunities for doing better.
Recognize that culture change and transformation are not destinations, but a journey – always a work in progress.

Key Areas of Culture Change

Below are some common focus areas that illustrate how to transform a long-term care facility from a medical model to a more home like model. There are numerous ways of incorporating culture change into a home—these are a few examples:

The Environment 

physical changes in the long term care setting to make the environment more “home-like”.
Lobby area is decorated and inviting
Private rooms for residents
No overhead call system
Individualization and personalization of rooms-paint, décor
Elimination of traditional nursing stations
Designing the bathing areas to be more home like — painting, installing towel bars, décor, aromatherapy
Households–common smaller kitchenette areas and common living areas outside the resident’s room
Providing the opportunity to have pets in the home
Providing more lighting in individual rooms and common areas

The Dining Experience

Elimination of dining trays delivered to each room
Buffet style dining-use of steam trays in the dining room
Preparing eggs to order(using pasteurized eggs)
Offering multiple choices on a daily basis
Knowing each resident’s daily pleasures for dining and providing them
Providing a choice of when each resident would like to dine
Offering residents the opportunity to eat in between meals at their own discretion
Giving residents the choice of whom they dine with
All Staff interacting and dining with the residents
Reduction or elimination of traditional special diets

Resident Choices

Bathing when and how each resident chooses — not on a schedule determined by staff
Elimination of traditional “med pass”-having medications in each resident’s room
Embracing the “I-Care Plan”- allowing the resident to create their own plan of care
Including residents in hiring decision
Providing activities that residents decide upon

Staff Empowerment

Working as a team as opposed to a hierarchal model
Flexibility of staff decision, focusing on the resident needs and choices
Giving staff ability to develop their own schedules
Having staff taking the initiative with physicians on reduction or elimination of medications
Creating an opportunity for staff to interact with residents not specifically doing a task
Relationship Building
Consistent assignments of permanent staff to each resident
Changing the way the staff speaks to each other and to residents. Eliminating words like, “feeder, “nursing home”, “new admit”, “that’s not my job”, “toileting”, “CNA” and other acronyms
Incorporating a “Spa Assistant” where consistent staff are providing the bathing care
Providing an opportunity for residents to be a host/hostess to visitors, offering a refreshment or offering a private space for entertaining

Self Assessment

Assessing the current environment and care practices on an ongoing basis in order to identify areas of improvement and to measure outcomes
The “Artifacts of Culture Change” Tool or various other assessment tools can be administered at the beginning of the culture change journey and reevaluated on a regular basis

Potential Outcomes

Improved overall quality of life for residents
Improved staff morale and satisfaction
Decreased staff turnover rates
Increased occupancy
Decreased food costs
Decreased state survey violations
Reduction in behavioral issues with residents
Reduction in psychotropic medications
Improved medical and psychological condition of residents 

Why Should I join the Journey?

If you want to make a difference in the way elders and persons with disabilities are cared for in your community, become a partner in the “pioneering” efforts of this national coalition. Help spread the message and join a regional coalition near you! Regional Coalition Facilitators work with other healthcare professionals in their areas to educate and to spread the mission and the vision of the Illinois Pioneer Coalition. 
Signing up to be a partner includes you and your organization into a group of caring, innovative and culture changing individuals that are working to make a difference in the lives of persons in Illinois long-term care settings.

The time for a change in Long Term Care in Illinois is here. Our elders and families deserve it. 

This is YOUR chance to get involved.