The old way
(institution-directed culture)
The culture change way
(person-directed culture)
Staf members provide standardized
treatments based on medical diagnosis.
Staf members enter into a caregiving
relationship based on the individual
needs and desires of the resident.
Schedules and routines are set by the
staf.
Residents and staf members design
schedules that refect their personal
needs and desires.
Work is task-oriented, and staf members
rotate assignments.
Work is relationship-centered, and staf
members have consistent assignments.
Decision making is centralized.
Decision making is as close to the
resident as possible.
The environment is hospital-like.
The environment refects the comforts of
home.
Structured activities are available only
when the activity director is on duty.
Spontaneous activities are available
around-the-clock.
There is a sense of isolation and
loneliness.
There is a sense of community and
belonging.
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a reduction in unanticipated weight
loss
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increased involvement with the
outside community, including
children, students, clubs and associa-
tions, religious organizations, and
town government.
Just like home
MeadowView Terrace, HRHS’s
long-term care community located
in Clarksville, recently completed
a 30-bed expansion, the design of
which fts the culture change phi-
losophy. Placing smaller groups of
residents into a household setting
provides greater opportunities for
growing relationships among staf
members, residents and their fami-
lies while promoting independence,
resident socialization and active
participation in daily life.
“We want our residents to lead the
long-term care
kind of daily life they are interested
in,” says Betty DeOrnellas, Meadow-
View Terrace administrator. “Tat’s
why our households have kitch-
ens and laundries. Some residents
actually do like to help wash their
clothes. And how can anyone get a
snack from the refrigerator if the re-
frigerator is located far away behind
a locked door?
“Tis is home. And homes have
kitchens and laundry rooms. And
our residents really appreciate the
opportunity to do the things they
want to do simply because they
enjoy doing them.”
In their book In Pursuit of
the Sunbeam: A Practical Guide
to Transformation From Institu-
tion to Household, Steve Shields
and LaVrene Norton describe the
long-term care household model
as “small groups of people sharing
house and home while directing
their own daily lives.” Tis difers
greatly from the traditional nurs-
ing home model, in which residents
have to ft into the daily routine of
the institution.
According to Shields and Norton,
certain essential elements serve as the
foundation of the household model:
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Te household is each resident’s
home and sanctuary.
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Te people who live there direct
their own lives, individually and
collectively.
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Te boundaries of the person
and his or her home are clear and
respected as a matter of course.
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Grace, a shared sense of what is sa-
cred about the house and its people,
is deeply valued, consciously created
and preserved. Ritual, spontaneity,
friendship, celebration, recreation,
choice, interdependence, art and
humor are all manifestations of a
culture of grace.
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Te people who live there are
loved and served by a responsive,
highly valued, decentralized, self-led
service team that has responsibility
and authority.
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Leadership is a characteristic not
a position. Leaders support, and
are supported by, values-driven,
resource-bearing principles and
practices as a way for each person to
actualize his or her full potential.
“Tese elements may sound
impossible to achieve, but they really
are not,” Zamora says. “When we
focus on each person living at Te
Woodview, or MeadowView Terrace,
or Seasons at Te Woodview as an
individual with specifc needs and
desires, and when we allow our staf
to build close relationships with
these individuals and empower them
to make day-to-day decisions based
on those relationships, then we are
moving forward with our person-
centered and resident-directed care
philosophy. And isn’t this what we all
want for our loved ones and, when
the day arrives, for ourselves?”
Then and now: Changes in long-term care
lifeand health
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