Roadmap for Cultural Change

The Culture Change Roadmap: An Explorer’s Guide

The culture of nursing homes has historically been based upon a medical/institutional model of care.  This model, while well intended, did not focus on the whole individual.  Rather, care was focused on the disease process and systems required to manage the institutional setting.

Today, the culture of nursing homes is transforming….known as “person-directed/centered care” this culture change movement is redefining the model of care in our nation’s nursing homes.  Although culture change can take on many forms, it is always a movement towards “home” and honoring the individuals we care for.

The Wisconsin Coalition for Person Directed Care understands that there are many roads a facility may take on its culture change journey, but each road will have some common paths  and may be shared with others traveling to the same destination.  The information and resources in this section are designed to help your organization find your own way.  Good luck!

Why Should We Embark on this Journey?

Culture change isn’t simply about trying to make choices in food, social programs and building style that please the most people and generate the fewest complaints.  It’s truly about listening, looking and responding in a way that tells residents that we, as staff, visitors or volunteers, have heard them and respect their choices.  It’s not about having a more modern look to your nursing home so that it’s easier to market it in your community.  Rather, it’s about showing the way residents, families, staff and external customers are valued, so that your nursing home truly comes to be seen and felt as “home” to those who live, work and visit there.

Culture change recognizes that, as in every family’s home, there will be conflicts and challenging choices to make.  But the difference comes in how those conflicts and challenges are worked through using a family-like focus vs. a textbook-like process.

Most nursing homes that are well along the journey to culture change will tell you they would never go back to the old way.  Staff are proud to work in a “community” that values personhood, choice and voice, and this is reflected in the respectful and caring way in which they do their work, whatever their job may be.  Visitors often say that the change has been so dramatic as to help change the way they see aging.  Most importantly, residents feel like the nursing home is truly “home,” and they belong there.  Like in any family, they are included, they have roles and responsibilities, they are involved in conflict as much as in celebration, and they have, most importantly, dignity and control.

Clinical outcomes do not suffer – most facilities really working diligently at the continuous journey of culture change are performing extremely well in areas such as pressure ulcer prevention, restraint elimination, overall health and well-being, and, most importantly, resident and family satisfaction.  Census is high and staff turnover is low!

Besides the business case behind creating “home” for those who need support in their daily lives there is a bigger and more important reason to do so.  It is the right thing to do…everyone has the right to be acknowledged and valued for who they are and what they want to become.  Whether you are someone who needs assistance or the person who provides that assistance each has an innate right to develop quality relationships and the opportunity to lead a meaningful life.

Convinced that culture change is a journey worth taking???  Read on…

Casual Tourist or Seasoned Explorer (Adventurer?)

Culture change is more than making “brick and mortar” changes to your nursing home. Rather, culture change builds on and emphasizes the power of the relationships between all of the journey’s navigators: residents, families and friends, staff, and even external customers such as vendors and volunteers.

If you’re a “casual tourist” you may be in the discussion and planning phase of what culture change might look like in your facility, or you have perhaps been up and running for a bit but feel unsure of the next turn.  You’ve had conversations in your resident and family councils about how residents envision “home,” you’ve held education and information sessions with all of your staff about the benefits of adopting a culture change philosophy, and have maybe even already made some assignments to staff and to residents to investigate aspects of potential change in their areas.

Hopefully you have also been listening to those persons that come into your facility from other places who may also have perceptions about what your “home” looks, sounds and feels like to them.  Pay attention to your clergy and social volunteers, your vendors, your physicians.  Ask them what they hear from your residents about their “home,” what they see and hear in other facilities, and what expectations for “home” they might have if they lived in your building.

It’s important to remember that most nursing homes will go through similar stages on their culture change journey.  Some of the first “stops” on your route may be to implement consistent assignment, make some low cost environmental changes, offer more dining choices, and encourage personalization of resident rooms.

Click here to read an informative article on getting started.

If you’re a more seasoned explorer you’ve already successfully navigated some of the speed bumps, and hopefully have found that by really embracing culture change, not just the physical plant changes, but also the relationship changes, the road for residents, families and staff leading to “home” has become much smoother.  By now you’re experiencing fewer resident and family complaints about things like schedules, menus and how to fit in essentials such as therapies and religious offerings.  You’re getting good and useful suggestions for how decisions are planned for and made, and residents and families share your concern and efforts toward positive clinical care outcomes as much as they share your care and concern for the emotional well being of all who live and work there.  The end of the road isn’t quite in sight yet, but you’re ready to see what’s over the next hill to further making your nursing home truly “home” for your residents, with a big extended family.

Regardless of where you are in the culture change process, the road can be bumpy, but there are many other adventurers out there, not only in our state but also in our nation, who have been down that road and who found ways around the obstacles.  Check on our Resource link for information and advice for both the casual tourist at the beginning of their culture change journey and the seasoned explorer.  To help you get started, we have designated a few resources that may be particularly helpful.  All of the links our Resource section are designed to help you, inspire you, and to affirm that you’re headed in the right direction.