Getting on Board with Nursing Home Culture Change
Posted: 10/2/2007
Achieving desired change is always a process requiring hard work. Change aimed at transformation requires even more. Perseverance, patience, and guided objectives must be added to the mix. Many of our nursing homes today are engaged in a transformational process coined "Culture Change", named to indicate the movement away from an institutional "medical-care" model to a person-centered or "consumer-directed" model of care. So, what does this actually mean? How do we spot it and why should we consider it important?
Nursing homes, as one of the most highly regulated professions, have always been immersed in quality of care. We are deeply concerned about how to achieve the best possible clinical outcomes and the best quality of life for our residents. We have often achieved great results by sharing best practices among our fellow professionals. Culture change, however, goes way beyond this and involves rethinking both our practices and our values, from top management to caregivers throughout the organization. In 1997, a group of professionals representing organizations from all disciplines of long-term care gathered to form principles and practices intended to guide nursing homes in a journey to improve the quality of life for their residents, as well as the quality of work for their staff. Today this group, called The Pioneer Network, works even harder than ever around the country to advocate and support those who seek transformation of our nursing homes.
Nursing homes pursuing a person-centered environment employ certain key techniques and target specific areas of improvement. Bathing, consistent staffing, promoting interesting and individualized recreation, creating home-like environments, and providing flexibility in sleeping and dining schedules are all common themes for culture change facilities. As a twenty-five year veteran in the nursing home profession, I first became aware of the need for drastic change when my own mother required long term care. For the first time in her life, my mother was awakened at 4:30 a.m. each day so she could take her medication on an empty stomach and meet the 7:30 a.m. scheduled breakfast time of the facility where she lived. Instead of the facility's staff seeking to understand her individual needs, my mother was made to conform to their environment. This of course is standard procedure in traditional nursing homes as they direct their work with efficiency and systems. Prior to my personal experience, I wore lenses developed by years of institutional practice. Now I see things differently and deeply believe that culture change is not something we have to try, but something that must happen.
This radical departure from rigid practices can not happen by management simply creating new policies and ensuring staff compliance. Real change will only take hold in our nursing homes one person at a time at a level of individual, personal transformation. The job of management is to shake up the status quo, provide the education and get the staff on board who will help lead the way. In most facilities, informal leaders already exist - those staff members you can think of immediately as positive influences. Obstacles to overcome, however, often include convincing our staff to rethink old habits and adopt new ways of thinking.
Several years ago, Elmhurst Extended Care adopted the "Eden Home" model, which recognizes that the bulk of suffering in nursing homes is caused by loneliness, helplessness and boredom and can be eradicated through human and animal companionship, variety, spontaneity and purpose-filled lives. A few key staff leaders seemed reluctant to embrace this new way of living and working. When asked why, they responded that nursing homes were no place for animals. We then discussed that Eden was not about animals, but about relationships. When these staffers understood that our goal was to provide companionship, purpose and meaning through our Eden program, they become our best advocates and allies. Elmhurst, through its national designation as an Eden home, was recently featured on ABC Evening News with Charles Gibson as a representative of this new person-centered revolution in nursing homes. We all were very proud.
The central principle of culture change as defined by the Pioneer Network is one of the oldest and best principles: Do unto others as you would have them do unto you - The Golden Rule. This simple but powerful statement rings true throughout all nursing homes embracing culture change and it crosses every relationship, including those with our employees. A key part of culture change is empowering front-line staff, such as nursing assistants, to make decisions and to encourage them to develop relationships with residents. It becomes a win-win situation leading to reduced staff turnover and improved quality of life. In fact at Elmhurst, in our first three years of adopting the Eden philosophy, we have experienced a 38 percent drop in our discharge rate to hospitals and a 40 drop in our death rate. This evidence implies that culture change is not simply a nice idea, but is one that creates dramatic improvements that can be measured and reproduced.
It is important to keep in mind that all stakeholders must be on board in order to ensure nursing home transformation - consumers included. On November 14, 2007, RI-Generations, our state's Culture Change Coalition, will hold the First Annual Culture Change Symposium. The day will include representatives from across long term care and features Nancy Fox, Executive Director for the Eden Alternative, as the keynote speaker. This will be an important forum for invested stakeholders to network and share resources. It will also be a wonderful opportunity for the public to learn more about how long term care can transform to a place we can all call home.
For more information about nursing home culture change, go to www.pioneernetwork.net or www.riqualitypartners.org.
Rick Gamache is administrator of Elmhurst Extended Care and the chair of the Rhode Island Health Care Association (RIHCA). RIHCA is comprised of the majority of Rhode Island's skilled nursing facilities that are dedicated to providing accessible, quality health care to the frail and chronically ill.
