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Culture Change
Several years ago, FRIA led a coalition of consumers, providers,
unions and civic groups that brought some of the Culture Change
Pioneers to New York City. Their reform ideas create a vision
and a movement, created by providers and supported by consumers
and unions. It recognizes that to give truly individualized care
to residents, we have to “change the whole culture” of today’s
nursing homes.
Culture change reformers have made nursing homes better places
to live and work and visit. They look to social service group
residences for models and to team management rather than traditional
professional hierarchies. They put decisions close to the resident,
empowering direct care staff who know the residents best. They
schedule care activities like meals and baths according to resident
preferences rather than specialized department routines. They
create inclusive communities to reduce isolation and loneliness.
Committing to culture change is a big step for a nursing home.
It takes commitment at the top, agreement by staff at all levels
and several years to find out how to do it effectively at a particular
home. The culture change movement is a rich source of best practices
with an end result that is profound, long-term and on going.
More information about Culture Change is found in FRIA’s publication,
Culture Change, A Gentle Revolution.
Best
Practices
During a recent Project, FRIA researched nursing home best practices.
The following are just some of the practices that we found providers
using to improve the
lives of nursing home residents.
These
practices address the main problem areas that concern families
and suggest a new attitude toward caring for nursing home residents.
Adopting practices like these can be the first steps toward a
new approach in your relative's home.
This list is a selection only. We have gathered many more provider-initiated,
recognized "best practices; in books, libraries, videos and accounts
of other families' experiences. This library and this knowledge
is available to you
Avoid Weight Loss & Dehydration
- Mobile snack carts,
- Finger food snacks,
- Appetizing smells and sights
of family style meals
- Self-serve juice dispensers,
- Clear pitchers to remind
residents to drink
- Warm tea and broth as alternatives
to ice water
Calm Agitation in Alzheimer’s Patients
- Staggered staff shifts
for easier transitions
- Rocking chairs
- Touch therapy and massage
with aromatherapy
- Evening activity and exercise
for "night owls"
- Bathing techniques that
allay fear
Make Surroundings More Homelike
- Convert long hall units
into smaller households or neighborhoods
- Carpet floors (this can
also serve to reduce injury from falls,)
- Substitute cell phones
and pagers for PA systems and call bells
- Add plants and pets
- Put out candles, linen,
and champagne when residents invite guests on special occasions
- Extend breakfast times
for early and late risers
Avoid Isolation / Increase Engagement
- Hold "community meetings"
with song and ritual
- Assign staff to socialize
with residents at family style meals
- Invite civic meetings,
school performances, day care programs into the nursing home
- Expand volunteer programs
Meet Needs of Special Populations
- Outings for ventilator
dependent residents
- Day programming for Alzheimer's
residents
- Regular menu and activity
alternatives reflecting different cultural backgrounds
Use the Best Established Clinical Standards
- Hospice/end of life care
program
- Multi-disciplined pressure
sore prevention program (including nutrition, skin care repositioning
reminders, family/volunteer monitoring)
The above examples are practices that have been tried in other facilities
that have been shown to be successful in improving care for residents.
As families and friends of residents, FRIA believes that you can be
a driving force in bringing these kinds of innovative and proven ideas
to your relative’s nursing home. This effort can be successful if
you bring to it commitment and a willingness to work collaboratively
with other consumers, nursing home staff and administrators. |
