Though ‘culture change’ is a concept evolved in US, long before we practiced it ever since we were in the elder care. One of the newest drivers of change in nursing homes is changing the culture of the organization. In our study with the seniors, few years back we came to a Conclusion that ‘old age homes’ were considered as destitute homes and a dreaded place to stay. The mindset of the people is difficult to change as they have pre conceived notions about the physical appearance, hygiene, the treatment, the attitude of the staff and in short the overall inferior care. We understand thoroughly why people fear nursing homes and the history of the industry, here is how we fix it.
‘Culture change’ is the common name given to a 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 is a word we hear a lot and goes hand in hand with the concept of culture change. In this article We’d like to touch on how to facilitate culture change and why it is beneficial to your long term care setting. Let’s face it, aged residential care in India is changing rapidly and this impacts the experience of residents, staff and visitors to long term care settings. It impacts their desire to be in your care facility or to move somewhere else. This applies to be both residents and staff. Families often choose the care provider for their elderly relatives. What do they perceive when they visit you?
Culture is the predominating attitudes and beliefs that characterize an organization. The culture or attitude of ‘old age 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 organisations, 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.
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.
There are also barriers and challenges to creating and sustaining a definable and deliberate culture. The experience of the residents and staff is a result of the culture (behaviours) which should be aligned to your organisation values, mission and goals. There are well publicised workforce shortages and high turnover of staff. Long term care is also in the middle of change from paper-based systems to electronic storage and management of information. The environment in which care is being provided is also changing through new construction of buildings from a institution to non-institutional. The atmosphere being created by those within the long term aged care residential setting is changing to a more relaxed feel.
Culture is the predominate beliefs, values, and assumptions that characterise an organization.
Culture change is the wave of the future in the field of senior care and nursing homes. Traditional nursing homes are considered sterile, cold, and smelly; a place where not only do you give up your material possessions, but your autonomy, privacy, dignity, and respect. Traditional nursing homes focus on the treatment, the money, and the time. Mission communities are on a quest to change the way we care for people in nursing homes. There are three levels of culture change:
Physical Change
First, we change the building to feel more like home. We remove anything institutional, or that you would not have in your own home. We take away the institutional feel by warming the walls, hanging art, putting in modern flooring and removing the nurses station. Dining rooms provide a social atmosphere and residents may bring furniture from home to create a space that is special to them. Lush gardens and beautiful patios create a place to gather outdoors.
Organisational Change
Next, the organization has to change the way we approach care for the residents and how we treat our staff, or ‘care partners’. Decision making is placed into the hands of the residents or those closest to them. Why? Because they have become well-known with each resident. They understand their ‘rhythm’ of daily life. Residents keep the right to choose; when to go to bed, when to get up, what and when to eat, they even help create their own activity calendar to be meaningful to them. Residents, families, and care partners are encouraged and invited to attend training, activities, and sit on our committees. Each committee is dedicated to creating a home for our residents that bring back autonomy, privacy, dignity and respect.
Personal Change
Our care partners attend regular training, designed to help them change the way they view the elderly and the way we care for each other. We train them in the art of culture change, ageism, interpersonal skills and memory care. By changing the nursing home to a care community, we pave the way for the future of care for the ageing and disabled population.
What should you look for in a nursing home of the modern world?
- Do the clients 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, and timed med pass?
- Are their a variety of activities, designed for all levels of cognition and abilities?
- Does the environment seem calm and quiet ?
- If you are looking for memory care, are the residents appropriately engaged, or are they kept in front of the TV napping?
Always look for the home that makes you and our loved one feel happy, never settle for second. Our Organisation is a proud supporter of culture change in nursing homes and home health agencies.