Transforming Long-Term Care:
Giving Residents a Place to Call "Home"
(The following are excerpts from the article)
Author Christine Haran
The Common Wealth Fund
April, 2006
Many Americans dread nursing homes. They smell the disinfectant, picture infirm elderly people in wheelchairs in the halls, and shudder. It's no wonder that so many people consider placement of a family member in a nursing home akin to outright abandonment. They don't see Grandpa moving to a new home that will meet his special needs; they simply see him being institutionalized.
However, the picture is changing. While many nursing homes still do function like impersonal and regimented institutions, over the last decade, a grassroots movement in long-term care known as "culture change," or "resident-centered care," has begun to spread throughout the country. Seniors in nursing homes that have undergone culture change enjoy much of the privacy and choice they would experience if they were still living in their own home.
"The idea is a small group of elders living together with their own staff dedicated to them," explains LaVrene Norton, the executive leader of Action Pact, Inc., a Milwaukee-based company that provides consulting and training to facilities interested in adopting resident-centered care practices. "The elders are living in their own house, defining their own day, and building the relationships they want."
In the culture change model, greater control is given to "frontline" workers—the nurse aides who handle so much of the day-to-day care of residents—as well as family members and residents. Additionally, staff are permanently assigned to a particular group of residents as members of self-directed work teams. Rather than working in a single department, such as nursing, housekeeping, or food service, staff functions are blended so that all staff members can help residents with their personal care, lead activities, and do cooking and light housekeeping.
The physical and organizational structure of the facilities also becomes less institutional. Instead of having rooms off long double-loaded corridors, the facility is divided into "neighborhoods" and smaller "households" with their own names and often their own entrances. Each household has its own kitchen and comfortably furnished living room.
Today at Pennybyrn, rather than waking at 7 a.m. to a tray of often-cold food served in bed, residents can wander into the dining hall at 7:30 or even 10:30 and order breakfast cooked-to-order from a menu. And because a number of housekeepers wanted to be involved, they have juggled their own schedules to become part of the breakfast experience.
"Because CNAs are the ones who actually work with residents, if they don't change how they treat the residents, there is no culture change," says Yeatts, who writes that CNAs "know better than any other employees the likes and dislikes of residents, including what they want when they wake up in the morning (e.g., a glass of water or the newspaper), how they would like their hair combed, and what they want to wear when they go to bed at night."
The Stages of Culture Change:
Stage 1—Institutional model is a traditional medical
model organized around a nursing unit without permanent staff
assignment.
Stage 2—Transformational model is the initial phase when
awareness and knowledge of culture change spreads among
direct care workers and the leadership team.
Stage 3—Neighborhood model breaks up traditional nursing
units into smaller functional areas and introduces
resident-centered dining.
Stage 4—Household model consists of self-contained living
areas with 25 or fewer residents who have their own fully
functional kitchen, living room, and dining room. Staff work in
multi-disciplinary self-directed work teams.
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