10 Ways to Change the Culture of Long-Term Care in the U.S

By Bell, Virginia; Troxel, David | Aging Today, May/June 2003 | Go to article overview

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.

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