Culture Change - Started in 1987
Back in 1987 the Nursing Home Reform Act was passed. It established quality standards for nursing homes nationwide. It was also to emphasized the
importance of quality of life, and preserved residents' rights. However,
despite enactment of this law, serious concerns remain about the quality of
care provided to residents in the nation's 16,000 nursing homes. To improve the
quality of care and the quality of life for nursing home residents, a growing
movement, known as "culture change," is working to deinstitutionalize
long-term care and radically transform the nursing home environment.
In the culture change model, which has gained
momentum over the past decade, seniors enjoy much of the privacy and choice
they would experience if they were still living in their own homes. Residents'
needs and preferences come first; facilities operations' are shaped by this
awareness. To this end, nursing home residents are given greater control over
their daily lives—for instance, in terms of meal times or bed times, and
frontline workers—the nursing aides responsible for day-to-day care—are given
greater autonomy to care for residents. In addition, the physical and
organizational structure of facilities is made less institutional. Large,
hospital-like units with long, wide corridors are transformed into smaller facilities
where small groups of residents are cared for by a consistent team.
In the past decade, there has been growing awareness of culture change among professionals and providers in the field, but the extent to which nursing homes across the country have adopted a resident-centered culture is still unknown. In 2007, The Commonwealth Fund conducted a nationally representative survey of nursing homes to learn more about the penetration of the culture change movement at the national level and measure the extent to which nursing homes are adopting culture change principles and practicing resident-centered care. A representative sample of 1,435 nursing homes was surveyed between February and June 2007.
The questionnaire was administered to
directors of nursing who were asked about three domains of culture change:
resident care, staff culture and working environment, and physical environment.
Specifically, the survey examines whether nursing homes have adopted practices
that make care more resident-directed, that engender a work environment that
fosters staff autonomy and decentralized decision-making, and that alter the
physical environment to make their facilities look and function like a home,
rather than a hospital.
Although survey results are mixed regarding
the degree to which nursing homes report they have adopted resident-centered
practices, findings indicate a hopeful picture about the potential for deep,
systemic change within the industry. Four or five years ago, few nursing homes
were familiar with the term "culture change." Today it is recognized
by and familiar to almost all providers. If the first step to change is
awareness of a problem and the availability of an alternative, then the field
of nursing home care is indeed poised for transformation.
Furthermore, the survey shows that in
facilities that incorporate some aspects of culture change, the more culture
change initiatives that are under way, the greater the benefits in terms of
staff retention, higher occupancy rates, better competitive position, and
improved operational costs. As the awareness of these and other competitive and
operational advantages becomes more widely known, it is likely that many more
nursing homes will begin to shift toward making the changes in human resource
management, the physical environment, and care delivery that are the hallmarks
of resident-centered care.
Architectural Changes in
Culture Change Nursing Homes
A number of changes are being enacted within the
design of new Nursing Homes in regard to Culture Change. Being able to create
homes that provide for comforts & privacy as well as eliminating the
Institutional feeling within the New Homes is important to the design. We are
providing for this in a number of ways.
Private bedrooms & baths are just one but
very important to the individual resident. We are also giving them unique
Households where no more than 20 residents will be living in the Home. This eliminates the
Long Corridors too. The extent of corridors will serve no more than the length
of 10 bedrooms. The Individual Households also have their individual front
doors and possibly unique elevations as well. The central part of the Household
will be a place for a Living Room space along with a Dining & Kitchen area.
There will no longer be a need to cart all the residents to a central dining
area. Each household can be handle specific needs of residents.
Of course there is also a need for Central
Spaces that include the Administration Area, a Rehab Therapy area, a primary
Meeting Hall, a Chapel or Quiet Room along with a central Spa & Salon.
These spaces are all interconnected by what we like to refer to as our Main
Street.
The Households & Main Streets form the
Courtyard areas where the residents can enjoy the outdoors in quiet and
peaceful areas to enjoy water features, gazebos and even outdoor grilling
areas. Another consideration is perhaps a play area for the youth who come to
visit their families or if some daycare were to be provided for the staff. We
know how much the residents enjoy watching children play.
