Non‑Discrimination Policy
Resident-Directed Care: The Culture-Change Movement
Posted February 02, 2010
Continuing on with the idea of creating more a homelike environment for residents, I’d like to share an excerpt from an article titled “Person-Centered Care for Nursing Home Residents: The Culture-Change Movement” from Health Affairs Web First, January 7, 2010 issue:
Proponents of culture change do not recommend a specific model or set of practices. Instead, they support principles governing resident care practices; organizational and human resource practices; and the design of the physical facility. According to these principles, an ideal culture change facility would feature:
- Resident direction. Residents should be offered choices and encouraged to make their own decision about personal issues like what to wear or when to go to bed.
- Homelike atmosphere. Practices and structures should be more homelike and less institutional. For instance, larger nursing units with 40 or more residents would be replaced with smaller “households” of 10 to 15 residents, residents would have access to refrigerators for snacks, and overhead public address systems would be eliminated.
- Close relationships. To foster strong bonds, the same nurse aides should always provide care to a resident.
- Staff empowerment. Staff should have the authority, and the necessary training, to respond on their own to residents’ needs. The use of care teams should also be encouraged.
- Collaborative decision-making. The traditional management hierarchy should be flattened, with frontline staff given the authority to make decisions regarding residents’ care.
- Quality improvement processes. Culture change should be treated as an ongoing process of overall performance improvement, not just as a superficial change or provision of amenities.
Author: Mary Jane Koren, M.D., M.P.H., Assistant Vice President, Quality of Care for Frail Elders, The Commonwealth Fund