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“Culture Change” is long overdue

Published on May 17th, 2009

The Charlotte News & Observer had a great article on how the culture of nursing homes are changing.  Hopefully, for the better. This culture change is long over due and is desperately needed in most nursing homes.  Instead of a hospital-style nurses’ station, staff members talk with residents in an area that looks like a comfortable office, den and kitchen in someone’s home.  The physical and organizational structure of facilities is made less institutional. Large, hospital-like units with long, wide corridors are transformed into smaller facilities where small groups of residents are cared for by a consistent team.   All this means that the center has adopted the long-term care approach known as culture change.

What does culture change mean?  In the culture change model, seniors enjoy much of the privacy and choice they would experience if they were still living in their own homes.  Residents’ needs and preferences come first; facilities operations’ are shaped by this awareness.  To this end, nursing home residents are given greater control over their daily lives — for instance, in terms of meal times or bed times, and frontline workers — the nursing aides responsible for day-to-day care — are given greater autonomy to care for residents.

A symposium in Raleigh on Tuesday will examine facets of the movement’s main tenet: that residents’ preferences should guide the way nursing homes are run, not what’s most expedient for owners and staff.   The label "culture change," or "resident-centered care," may give the approach a touchy-feely sound, but it’s serious business to the several facilities in central North Carolina already adopting the changes. Some are even spending millions in building renovations to make it all work.

Changes at Hillcrest include:

Allowing residents more choice in schedules and dining choices, a move away from the structured regimes of many facilities.

Creating "neighborhood" halls with an approachable nurse’s work station, small kitchen and den to service 16 or so residents. Carpeting, wall sconces and light wells that bring in sunshine create a homier appearance.

Having frontline workers such as certified nursing assistants take on some housekeeping and food-preparation duties so that residents get consistent care from fewer staff members.

Taking soiled laundry outside — out of living areas — as soon as it’s gathered, avoiding waste smells not usually evident in homes.

Getting medicine and housecleaning carts off the halls when not in use, making for easier walking and less of a hospital-corridor feel.

Advocates for older people have pressed for better conditions in nursing homes for decades, but the specific improvements grouped as culture change have gained momentum during the past 10 years. A survey in 2007 by the Commonwealth Group, a national nonprofit, showed that about 30 percent of homes have adopted the approach, with an additional 25 percent striving toward it.  Hopefully, this kind of change will become madatory throughout the country.

 

Joe Pioletti
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