Monday, April 12, 2010

Culture Change in Care Today

Have you ever heard of the Pioneer Network? It’s a website and a movement devoted to changing the culture in nursing homes today.

I’d heard about this movement, and certainly heard the words “culture change” associated with nursing homes for the past two decades. I thought that real culture change was happening everywhere, in every nursing home in the U.S.

And then I was faced with a personal crisis. My mother needed nursing home care following a severe car accident.

Three years later, my mother-in-law needed nursing home care following surgery for an intestinal blockage.

Both experiences left me convinced that even though Oregon is one of the leaders in culture change in the U.S., for families like mine, in the nursing homes we carefully selected, it was DOA – dead on arrival.

I was appalled to discover the look, feel and function of the two nursing homes seemed as if they were time warped – no different from my experiences in nursing homes in the mid-1980s, when I first began my career in senior care.

Today, the volunteer advocacy group I participate in talked about culture change. We had a speaker from the local coalition for culture change talk about what they’re doing, and what she sees changing. The bottom line: nowhere near enough.

What will it take to truly effect culture change in today’s nursing homes? What will it take to create an environment where caregivers are empowered to care for people in a warm, genuine way?

I have a feeling it will take a lot more than just talk. It will take more than revising schedules so that medications (or meals) can be delivered when the resident wants them, rather than on a fixed schedule.

Families who have a choice will do exactly what my family did in both situations: as soon as we possibly could, we picked up our loved one and we ran – not walked – to the nearest assisted living community.

In both cases, we ended up with our mothers in an assisted living community that provided gentle, loving, compassionate care, in apartments that felt like apartments not hospital rooms, for less than half the cost. The bottom line in both cases was significantly better care for significantly less money.

Which brings me to my own personal conclusion: families who have a choice in the matter will respond to the lack of change with action. Nursing homes that still feel dark, crowded, cold and clinical will be places where only those who have no choice end up. That will be a sad, sad day, for those individuals who have no ability to choose where they receive care.

Across the country, the number of nursing home beds is declining. The number of assisted living units is increasing. That should give us a clue about what the market wants.

In my own work as the owner of an online training company, we created a new Nursing Assistant training program online that doesn’t just have a lesson in person-centered care, but emphasizes the PERSON behind the care needs in every single lesson. We believe that maybe, just maybe, we can contribute a little to genuine culture change by training people right, from the very start.

Imagine if those people trained the right way from day one stick it out to become the leaders in care. Imagine if companies looked – with their eyes fully open – and saw how the trend to move out of nursing homes into residential models of care will ultimately affect their bottom line.

Imagine if they then decide to do it differently – to give the consumer, and their baby-boomer family, what they want today: a place to receive the care our mothers and fathers need, when they need it, in a compassionate, caring way.

Perhaps then we’ll truly see culture change in nursing home – because we demand it and won’t accept anything less.