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 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 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.

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 speak 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 in 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