10 Ways to Change the Culture of Long-Term Care in the U.S
Bell, Virginia, Troxel, David, Aging Today
A growing movement is underway in the United States to look at the culture of care in long-term residential programs as it affects the staff, residents and care-givers. According to the Pioneer Network, the organization of innovators in long-term care based in Rochester, N.Y., "Cultural change is the transformation of traditional institutions and practices into communities in which each person's capabilities and individuality are affirmed and developed." Cultural change is considered vital since so many long-term care programs in the United States are struggling with regulatory, financial, staffing and programmatic challenges. An individual working in long-term care can become an agent of change by taking the following steps.
1. Innovative Staff Training. Staff members can become proactive in changing training to meet their needs. Some of the old ways of training by just attending lectures or watching videos without feedback are simply not effective learning tools. Staff training is serious business and needs to be taken seriously. It should involve everyone-including administrative staff and others not in direct care-and it should be interactive, with games and role playing, storytelling, discussion and follow-through. To be effective in today's world, training must take into consideration the cultural diversity of staff and be sensitive to their needs. In addition, many staff members can benefit from training in life skills-such as money management, assertiveness, teamwork and anger management-to enhance their lives and help them become more effective in their work.
2. Team Building. Almost all long-term care programs strive for effective teamwork, but it is easier said than done. Particularly when turnovers is high, teams are hard to sustain. Competition and in-fighting between shifts can be particularly pronounced. Teams are built when staff members get a chance to know each other across position boundaries, and role playing can drive home the importance of teamwork. Many effective programs also insist that staff change shifts now and then to help them make new friends and understand the ebb and flow of a residential care community. Team-work is also enhanced many times over by subscribing to universal work concepts and embracing an inclusive activities philosophy (see #7, below).
3. Linking Staff Members to Needed Services. Because many staff members may be recent immigrants or single mothers, they may need help with childcare, transportation and housing. Also, they may have concerns that can interfere with their effectiveness at work. One way to address these difficulties is to offer a formal or informal employee assistance program that can include referrals to appropriate services. A caring community also offers on-site classes in subjects to help staff grow as people. Examples of possible classes include English as a second language, managing a challenging teenager, money management, working with one's doctor, or credit management.
4. Mentoring Programs. If a staff member is particularly good at one activity, such as bathing residents, she can become the mentor for that particular activity. A caring community also matches new employees to more experienced workers. Instead of giving a "sign on" bonus to a new worker just for showing up, giving a bonus to a worker and mentor after three or six months of good service is more of an incentive. In addition, allowing a senior employee to become a mentor builds pride and self-esteem in that worker and demonstrates the management's respect for the worker's accomplishments and experience.
5. Respecting Multiculturalism. Caring communities celebrate the diversity of their staff, residents and family members. When appropriate, celebrate cultural holidays, encourage staff to bring food from their cultural tradition to share with others, and offer courses in the dominant language of the staff. When one program in Southern California offers staff training in Spanish, for example, it gives staff members an opportunity to learn more effectively without negating regulations or management wishes that staff be able to converse in English. Communities also can provide opportunities for staff to teach others words in their native language that may be particularly useful in long-term care and can encourage interaction between staff members, residents and families who share the same cultural or religious background.
6. Embracing Principles of Person-Centered Care. Dementia has helped us understand the magic of person-centered care. People with dementia cannot and will not fit into the structure of an institutional setting where the rules and schedules, most often very unfamiliar to them, are already set. The field of long-term care has learned from people with dementia that by working with them as individuals-not merely doing things to or for them-they can respond in a much better way. The person, not the task, becomes central to care. Each person is understood, respected, supported and encouraged in using their remaining strengths. A staff member can use person-centered care with each resident and benefit from the person-centered relationships.
7. Developing an Inclusive-Activity Philosophy. Activities should no longer be the responsibility of the activity director alone. All staff-even those in administrative positions-can have an important role in providing activities for residents throughout the day. Activities are everywhere and every encounter can be meaningful. Think of all the activities that fall between the boundaries of the structured schedule: acknowledging a resident, calling a person by his or her preferred name, listening, laughing, giving compliments, asking for residents' opinions, letting someone help with a small task, asking someone for a lesson in his or her area of expertise, or taking a walk with a resident outside. In addition, tap the resources of staff for varied activities. For example, a staff member could bring his or her hobbies to share, a staff secretary can bring in her quilt collection or the facility gardener could talk about ornamental roses. This type of interaction benefits the residents and reconnects staff members with their purpose for working in the long-term care setting.
8. Working With Residents' and Staff's Life Stories. Each person has a unique life story, filled with rich experiences. Knowing each resident's life story helps staff appreciate the contribution of individuals to their family, community and perhaps the world beyond. Personal stories help staff understand why a resident says and does things that at times may seem strange. Knowing a person's life story also gives the staff clues for things to do and ways to relate to the person. Stories provide information for reminiscing, kidding and teasing, or just small talk to help build self-esteem. The life stories of staff members are equally important-if staff members feel known in their workplace, they often see the importance of getting to know the residents better.
9. Enhancing Family Interactions. The more families feel they are part of and involved in the care of their loved one, the more pleased they are apt to feel with the caregiving situation. Getting to know the family is key to enhancing family interactions. Keep in mind that families no longer conform to the traditional nuclear family. Today's definition of a family includes single parents; lesbian, gay, bisexual and transgender members; unmarried domestic partners; and three, four or more generations. Families have a very different understanding of what constitutes good care, and they are probably at their most vulnerable when having to entrust care of a loved one to those outside the family fold. Most families want to work with the staff, so getting to know them and listening to them can be an important part of providing a caring environment for residente.
10. Developing a Personal Action Plan. It is so easy to become overwhelmed by the long hours, challenging regulations and conflicts that happen in long-term care that staff frequently don't know where to begin making a positive change. One approach is for staff members to make a personal action plan listing as many ideas for change as come to mind. Once the list is made, each person should begin to work on one idea. Examples of possible actions plans could include getting to know one resident better; starting a mentor program; celebrating something at work from one's own heritage; bringing in a personal collection, perhaps for use in an activity after dinner; revamping staff training; or inviting a nonprofit group in to do a workshop.
Good luck in your work as a pioneer for cultural change in long-term care!
Virginia Bell is a program consultant to the Great Kentucky and Southern Indiana Alzheimer's Association, Lexington, Ky. David Troxel is executive director of the Santa Barbara Alzheimer's Association, in California. This article is based on their presentation at the 2003 Joint Conference of the National Council on the Aging and the American Society on Aging held recently in Chicago. They coauthored The Best Friends Staff: Building a Culture of Care in Alzheimer's Programs (2001) and A Dignified Life: The Best Friends Approach to Alzheimer's Care-A Guide for Family Caregivers (2002), both published by HealthProfessions Press/Health Communications, Deerfield Beach, Fla.…
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Publication information: Article title: 10 Ways to Change the Culture of Long-Term Care in the U.S. Contributors: Bell, Virginia - Author, Troxel, David - Author. Magazine title: Aging Today. Volume: 24. Issue: 3 Publication date: May/June 2003. Page number: 13. © American Society on Aging Jan/Feb 2009. Provided by ProQuest LLC. All Rights Reserved.
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