Pella Chronicle


April 5, 2013

Changing the culture is part of transforming the aging experience

Pella — Changing the culture is part of transforming the aging experience.

Much progress has been made over the last 20 years in the national movement to transform services for older adults in ways that improve their quality of life.

This movement, known as culture change, gives older adults choices and empowers them to practice self-determination in meaningful ways throughout their daily lives. Culture change is based on person-directed values of choice, dignity, respect, self-determination and purposeful living.

One of the early projects in culture change was the development of Green Houses, where residents enjoy privacy yet are part of a tight-knit community. The Green House also provides an environment designed to look and feel like a real home, including private rooms with private bathrooms, a residential-style kitchen, a communal dining area and accessible outdoor space. Institutional elements, such as medication carts and nurses’ stations, are avoided.

Significant benefits of this approach were identified in a study that compared health outcomes and quality of life for initial Green House residents in Tupelo, Miss., with those of residents at two nearby traditional nursing homes.

The study, led by Rosalie A. Kane, Ph.D., of the University of the Minnesota School of Public Health, found Green House residents experienced better quality of life, with the same or better quality of care than those in the comparison homes. Green House residents reported higher scores on elements of emotional well-being, such as happiness and looking forward to the future. They also experienced lower rates of depression, reduced activity, bed rest and decline in functional abilities than residents of the traditional homes.

Here in Marion County, organizations serving older adults are in various stages of moving from a clinical model to a social, transformative model. Some have embraced culture change and the person-centered approach by altering the physical environment by building smaller households, while others are providing choice and honoring residents’ choices in their current setting.

When it comes time to select a community with skilled nursing for a beloved family member, you’ll most likely want to identify and choose one dedicated to transforming aging into a positive experience through culture change. Asking the right questions is the best way to do this.

Fortunately, the Pioneer Network, which is working to promote culture change and person-directed care in all long-term care settings for older adults, has developed a set of questions to help families in this situation.

Listed below are some of the Pioneer Network’s recommendations for questions to ask and responses for which to listen. These are not the only correct answers, but they do provide a good idea of what indicates that a community is working toward creating home for residents.

-How is your community involved in culture change?

Listen for: "We have a committee that works on making our place a home for residents who live here. Residents and families serve on the committee. Staff members attend the state coalition meetings and go to conferences to learn more. Several staff members (including direct care workers) have visited other places involved in culture change. We have consistent assignment so that our staff can get to know the residents they are caring for, including their individual needs and wishes."

-How will you get to know my family member?

Listen for: "It is very important for us to really get to know each person who lives here. We have a questionnaire for your family member to fill out that helps us get started. If they are not able to do this (because of dementia, for example), we want you to help us get to know them. Then we will talk with them and spend time together. We will learn about their preferences, their past, what they enjoy doing now, and their goals and wishes for the future. Everyone on the team will get to know your family member."

-Will my loved one be awakened at a set time in the morning or will she have a choice?

Listen for: "Residents may choose to sleep as long as they want without being awakened.”

-What is your policy regarding food choices and alternatives?

Listen for: "Let me show you a list of the alternatives we always have on hand if someone does not like the main entree being offered. Do you think your loved one would be satisfied with these? If not, we can accommodate her (or his) wishes."

For additional questions and advice on what to listen for when evaluating answers, visit Pioneer Network’s website at Guide/ and click on Key Questions.

Culture change is something that I’m really passionate about because I’ve seen firsthand the positive impact it makes on residents’ quality of life.

Nancy Hamilton is Executive Director of Hearthstone, a Ministry of WesleyLife.


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