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Posted: May 18, 2005

Professional Caregiving

Culture Change

Culture change is in the air. The Pioneer movement, the culture change process, is taking hold in each state in different ways. I can tell you that in Missouri, thanks to some of the progressive leaders in the field, we now have a statewide coalition, the MC5, whose goal it is to bring providers together to share successful models, inspire action and create a healthy competition in which we all strive just a bit harder to mold our services to the needs and wants of our customers.

Most of you will think of the clients we serve in their homes, in our centers, in our facilities. Some still live in their neighborhoods with a varied array of support sources. Others live in new environments, maybe brand new structures that cater to the needs of seniors who have greater care needs and service coordination than their families alone can maintain.

The culture change movement is about redesigning our services to match our customers. Who said everyone must get up at 7 a.m. and be dressed and in the dining room by 8:30 a.m.? Who?? Really, for too many years now, we have allowed structure and schedule to run our facilities, as if each person in them had the same wake up preferences, activity interest and ability and taste in cuisine. We are finding that it couldn't be further from the truth, and many changes are easily doable. Easier than raising $6 million for a new building, for sure!

The culture change movement is about examining and implementing changes that can be made at little or no cost that accommodate the personal preferences of our clients, residents, and program participants. Choices at meals, extended dining room hours for the early birds and also for the night owls. Activities that reflect true interests and desires of the people who actually live there. Revolutionary!

Seriously, those of us who have been in this field for decades have to unlearn the model that says "Today is Thursday and there will be a music program in the morning and bingo in the afternoon." Now, if there are two residents who live in your facility and these activities are what they have told you is how they want to spend their time, then ok --.but not, if you are simply deciding for the group who will be doing what and when.

Can't a group of quilters sit at a table with the materials for a quilt along with a volunteer? This could even be someone in the facility whose job is in the accounting office, but for two hours each month they join the quilting group, matching the resident's passion with their own.

Can't the sports fanatics get some popcorn and hotdogs and watch the greatest World Series tapes, together as fans, as retired ball players? Why not? Even folks with dementia, or should I say -- especially folks with dementia -- need the stimulation of activities that had meaning for them in their lives.

Can't the Donna Reed's in the group have a game of cards and iced tea in another part of the room? Why not?

OK, you get the point. Summarizing the residents' particular interests and then grouping them with others who share the same passion is a great first step in developing programs that are person-centered.

Families who love to play a role in their loved one's lives, but simply cannot provide full-time care at home, might play a significant role in leading a session once a week or month: a cooking group, a reading group, a music group. This will not only make visiting easier for them, it will give new programs to the residents, staff and facility from which to build. This is how to create a volunteer program. Ask your families what they are skilled at, passionate about, and knowledgeable in, and offer them a chance to be a STAR!

Other staff are also customers in this model of culture change. Why? Because we have evidence that when the care environment is client-focused, strength-oriented and responsive to the interests and needs of the residents or clients, the client is happier -- and that result improves the general atmosphere.

When we as professionals feel we have succeeded, we have engaged a client or 10, we have given someone an opportunity to shine or get sorely needed recognition, we go home more satisfied and wake up ready to go back to this environment. It is one that promotes and encourages healthier social, psychological and functional living. Managers will see absenteeism drop when the environment is a positive one. When care partners take part in the design and plan of activities, processes and special events, they are more invested in seeing them succeed.

So whether we are talking about our clients, the seniors with whom we work, or their family members or our colleagues, supervisors and supervisees, the Culture Change movement has promise for us all. (See a longer article on Implementing Person Centered Care-Nissenboim, S., in the Activities Director's Quarterly for Alzheimer's and Other Dementia Patients, Winter, 2005.)


Sylvia Nissenboim is a licensed clinical social worker and who has been working in the field of adult day services in the St. Louis area. She is the director of four adult care and enrichment centers for the American Red Cross and also operates a personal and professional coaching firm, LifeWork Transitions, specializing in caregiving concerns, adult day care management and other aging services, such as virtual coaching and family care giving support groups. She co-authored The Positive Interactions Program, is a national speaker, and has served as president of the Missouri Adult Day Care Association and as a member of the Missouri Governor's Advisory Council on Aging..

© 2005 Pederson Publishing, Inc. All Rights Reserved.
Commercial use, redistribution or other forms of reuse of this information is strictly prohibited without the prior written permission of Pederson Publishing.

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