The field of elder care is constantly changing. Over the past decade, major increases in the number of elders in need of care has spurred the development of a broad range of community as well as institutional services. Efforts have been made to encourage in-home care for individuals in lieu of nursing home care, including an array of medical and support services that let elders age in place.
Although great strides have been made in the development of in-home services, it is not always possible to meet an individual’s health care needs in the home. Most elders would prefer to stay at home but do not always have available the level of care and support that makes this possible. For some elders a nursing home stay is the best option.
The National Consumer Voice for Long Term Care is a national advocacy group that has declared October to be Residents Rights Month. Across the country advocates are celebrating and working to raise awareness of nursing home residents’ needs and best practices for facilities.
In the past, nursing homes have been seen as institutional facilities with a hospital atmosphere, inadequate staffing, and “one size fits all” care protocols. To address this issue, Congress enacted the Nursing Home Reform Act in 1987. The act lays out requirements for nursing home care and focuses on the rights and desires of residents. These provisions are referred to as the Residents’ Bill of Rights.
The Bill of Rights includes the right to privacy, the right to communicate freely, the right to be treated with dignity, the right to voice grievances, the right to participate in one’s care plan, and the right to self-determination, among others. These rights are important but are not always observed by nursing homes. In an effort to improve implementation of residents’ rights and improve the quality of life for nursing home residents, facilities began to experiment with different models of long-term care. One of those models is known as “culture change.”
Culture change is loosely defined as a process that will transform long-term care and improve the residents’ quality of life. It treats the resident as the center of care planning and works to accommodate the individual needs and preferences of the resident. The implementation of culture change at the individual level includes such things as accommodating the timing of meals and personal care, changing bathing protocols, introducing plants and pets, interacting with children, and maintaining stable connection with aides. The overall intent of culture changes is to recognize the resident as an individual who is entitled to the greatest possible role in his or her care.
Culture change principles have been implemented in varying degrees by nursing homes. Part of the process has been to give more authority to those who work directly with residents: the nurse aides. Other changes generated by some facilities include the creation of “households” where a smaller number of residents with consistent staffing live in a homelike environment.
Culture change in nursing homes is a process that develops over time. The Nursing Home Reform Act requires that facilities “provide services and activities to attain or maintain the highest mental and psychosocial well-being of each resident.”
Hopefully we can honor residents of nursing homes in our community by ensuring that they receive quality care with dignity and respect. After all, it is their right.
Deb Thomson is a member of the Council on Aging board of directors, a former eldercare attorney, and the recipient of numerous elder advocacy awards.