Culture Change in Nursing Homes Can't Come Soon Enough

The idea of 'culture change' has been around for awhile now, at least fifteen years. Many of us who work in nursing homes are familiar with the concept that nursing homes should become less institutional and more homelike. As a nurse who has worked in the field of geriatrics for most of my nursing career, it's a change I embrace. Why, then, is progress toward culture change so glacially slow?

'Culture Change' means different things to different people. Some embrace the term as a total transformation to resident directed care. Others envision incorporating bits and pieces, gradually working choice into their institutional settings.

My vision of culture change is simple. If people can do something in their own homes, without impinging on someone else, they should be able to continue their lifestyle should they need nursing home care. This usually isn't the case. Nursing homes walk a tightrope between what individual residents want, and how their choices impact the other residents. In addition to regulatory requirements, there are the preferences of families and doctors to be considered. There is also the philosophy of the nursing home itself, or the corporation to which it belongs. Is the emphasis on individuality or community? Is efficiency valued above everything else? What really matters, the residents or the bottom line?

Many agree with the idea of culture change but come to a dead stop when it comes to implementing changes. Why is this logical, humanizing effort so difficult to begin? Changing nursing homes from institutions modeled on hospitals to warm, nurturing environments isn't easy. Most facilities don't have the option to start over with small households, each with their own dedicated caregivers.

Nursing homes are congregate living. What one person does affects others. Staffing levels are often such that one nursing assistant attempts to meet the needs of ten to fifteen residents or more. With those staffing ratios, care is seen by the staff as a series of tasks they must accomplish as efficiently as possible.

What happens in one department also affects other departments. this is especially true of the nursing and dietary departments. If residents are late getting to meals or meals are late coming out from the kitchen, sparks fly!

What will a changed nursing home look like? Residents will get up and go to bed when they choose. They will eat meals when they want. They will have choice in what they eat. Meals are often one of the only things residents look forward to. Meal service is an excellent place to start implementing culture change.

Staff members will have more time to spend with the residents. They will need more time, because a home-like environment isn't as efficient as an institution, but who wants to live in an institution? Staffing levels will need to increase, as least in the short-term, as changes are made. Change itself is inefficient, and makes everyone uncomfortable until they get used to the new routines.

Is all this effort and upheaval worth it? Residents who live in humanized environments would shout a resounding yes! Studies have shown depression, feelings of worthlessness, and use of pain medications are lower in nursing homes that have undergone culture change. Staff turnover is reduced, because caregivers are doing what they want to do - spend time with and make a difference for the residents.