Culture Change in Long Term Care for the Elderly

Culture care is a public policy term that looks at the cultural capital of individual and community behavior. The term stresses the social and cultural capital in decision-making, alongside financial incentive as a driving force behind behavior of an organization or individual and promotes healthy living via a health plan and personal responsibility into community and organizational infrastructures. Incorporating culture care into long term care facilities for the elderly is a concept that has been around for the past decade and is a growing idea. There are a multitude of benefits culture care can provide to these facilities, and to the people whose lives revolve around these organizations. 

Nursing homes were primarily established to care for the medical needs of elderly “patients”. This “medical mode” of care contrasts with the more modern “social model” of care that is reflected in the culture change trend seen in long-term care facilities over the past decade. The medical model worked well for alleviating suffering and handling medical problems, however the focus of this model is on biology rather than the entire person. A social model of culture care acknowledges the elderly living environment as a home, not a hospital. Culture care better addresses the needs of the whole person and enhancing the work environment for elder care staff. The physical structures of long-term care facilities are being looked at in the cultural change movement, to maximize feelings of a homelike or neighborhood environment, not an institution. The trend is to utilize a consistent rather than a rotating staff, to improve staff retention and resident centered care and look at aging as a continued stage of development. Culture change works at eliminating the three plagues of nursing homes: loneliness, helplessness and boredom. (Weiner & Ronch, 2003) The culture change movement in elder care doesn’t just help the residents of these facilities; there are financial and practical reasons to incorporate culture change in elder care. 

The Commonwealth Fund 2007 National Survey of nursing Homes looks at the culture change movement and measures the extent which nursing homes are adopting culture change principles and practicing resident-centered care. The Commonwealth Fund took a representative sample of 1,435 nursing homes between February and June 2007. The questions were administered to directors of nursing and focused on three domains of culture change: resident care, working and physical environment of facility and staff culture. The survey looked at practices that would make care more resident-directed and that fostered staff autonomy in decision-making, both of the primary elements of culture change long-term care facilities. The questionnaire also focused on the physical environment looking and functioning more like a home than hospital. 

The survey “highlights important lessons, including the finding that the more a nursing home has adopted culture change principles, the greater the benefits that accrue to it, in terms of staff retention, higher occupancy rates, better competitive position, and improved operational costs.” (Doty, Koran, & Sturla, 2008) These benefits add up to big financial and practical gains for institutions implementing culture change, in addition to the obvious moral values fundamentally incorporated into this new paradigm shift. 

A paradigm shift is a change in thinking from one way, to another. It is revolutionary, transforming and driven by agents of change. We are entering a new era in America, with the largest baby-boom population born between 1946-1964 numbering over 77 million in the United States. (Baby Boom Population, n.d.) This population is starting to hit 60 years of age, and will become the primary consumers of long-term care facilities over the next few decades, both for their parents and later for themselves. Their influence will be enormous on a rapidly changing long-term care environment. The underfunding of Medicare and Medicaid relative to demand, along with increasing liability, insurance costs and an increasing gap between those most able to and those least able to pay, has created a financial crisis for long-term providers and those shopping for elder care. (Thomas, 1996) Workforce crises such as high turnover and absenteeism, low morale and difficulty recruiting skilled professionals, plagues long-term care facilities. Rising expectations of family members and the baby boomers over what should be provided by long term care facilities, and the shortcomings of these facilities, increases liability. 

There is a call to change involving values and culture in long-term care facilities culture. Organizations are changing from a large institutional medical model where geriatric patients are “placed” in clinical feeling needs-based homes, towards newer “person-centered” homes characterized by increasing elder choice, staff autonomy and personalized service in a more neighborly home environment. Increasingly facilities are stressing the social and cultural capital of their business’s in decision making, knowing that there is an additional financial incentive benefiting the organization, along with the healthy living and personal responsibility characteristics of these community infrastructures. The cultural change model addresses the needs of the whole person with physical structures redesigned to maximize a homelike environment. The core belief of the cultural change model is that aging is a continued stage of development and growth, rather than a period of decline. The goal of such facilities is to de-institutionalize long-term care facilities to create “human habitats” instead of medical facilities. Cultural change in these settings strives to eliminate loneliness, helplessness and boredom through enhanced companionship, variety and spontaneity within the environment. The benefits to the elderly, their caregivers, families and the business of eldercare are enormous. 

References

Baby Boom population - U.S. Census Bureau - USA and by state. (n.d.). Boomers Life: Music, People, Health and Issues of Interest to Boomers. Retrieved from http://www.boomerslife.org/baby_boom_population_us_census_bureau_by_state.htm

Doty PhD, M. M., Koren MD MPH, M. J., & MPH, E. S. (2008). The Commonwealth Fund -- Health Policy, Health Reform, and Performance Improvement. The Commonwealth Fund -- Health Policy, Health Reform, and Performance Improvement. Retrieved from http://mobile.commonwealthfund.org/Publications/Fund-Reports/2008/May/Culture-Change-in-Nursing-Homes--How-Far-Have-We-Come--Findings-From-The-Commonwealth-Fund-2007-Nati.aspx

Thomas, W. H. (1996). Life worth living: how someone you love can still enjoy life in a nursing home: The Eden alternative in action. Acton, MA: VanderWyk & Burnham.

Weiner, A. S., & Ronch, J. L. (2003). Culture change in long-term care. New York: Haworth Social Work Practice Press.