What Culture Change Is and Why an Aging Nation Cares

Article excerpt

In the world of aging, culture change has been described as everything from new wallpaper and a bird in the nursing home lobby to a major social shift in U.S. society. Culture change is the process of moving from a traditional nursing hoirie model-characterized as a system unintentionally designed to foster dependence by keeping residents, as one observer put it, "well cared for, safe and powerless"-to a regenerative model. This model, which increases residents' autonomy and sense of control, is also sometimes referred to as resident-centered care. Culture change embodies an emerging, progressive view of aging that seeks to find a common thread in the various approaches to reformulating what it means to grow older in the United States.

Culture change in nursing homes means systemic change throughout a facility from both individual and organizational perspectives, a transformation anchored in values and beliefs that returns control to elders and those who work most closely with them. The goal is creating a culture of aging that is life affirming, satisfying, humane and meaningful. Successfully implemented culture change can transform a facility into a home, a patient into a person and a schedule into a choice.


About 5% of elders in the United States-1 .6 million people-currently live in 16,800 nursing homes. That number will soar, reflecting not only the accelerated growth of those age 85 or older but also the growing number of working women, who will be less available for caregiving (the majority of caregivers for aged loved ones are women). Too often identified by their diseases or conditions rather than their names, elders in nursing homes become the objects of care services, disenfranchised and isolated from the normal rhythms of everyday life. Staff assume responsibility for making daily lifestyle decisions for residents-when to get up, when to eat and what to eat, when to bathe and when to go to bed.

The earliest nursing home pioneers began their work in the 19705 as individuals working to rethink long-term care. Their efforts grew urto a national grassroots movement focused on transforming nursing homes from a medical to a more holistic care model. As their numbers and experience grew, these kindred spirits-a wide range of healthcare professionals, regulators, family members, residents, researchers and design professionals - knew in their hearts that things could be different for elders. They believed that life with meaning is possible in any setting.

The cornerstone of the pioneer approach is striking in its simplicity: Residents first! The goal is to redesign nursing homes as places for living, with good medical and nursing care supporting-rather than dominating-daily life. In recent years, strongly inspired by the residential appeal of assisted living, this new nursing home environment is characterized by a sense of home.

Culture change must start at the top, with complete support and participation from all levels of management. Staff participation in planning and design is essential because without involvement from the entire organization, culture change will never get off the ground. This approach empowers staff, inspires creativity and puts more focus where it belongs: on direct-care staff, who provide for residents' daily needs. Also, establishing a positive psychosocial and spiritual environment is crucial for getting to know, being involved with and often loving the resident elders.


Initiating change with organizational and psychosocial changes not only provides a solid foundation for understanding how the physical environment is expected to function but also makes modification and change much easier. Design changes can foster a social-holistic model of care that accommodates and supports rather than drives residents' behavior. …