Chapter 4 Culture Change

Chapter 4
Culture Change: CAGs and the Culture Change Movement

The culture change movement promotes resident centered care and resident empowerment while working to replace traditional nursing home settings with homelike environments. 

Some culture change strategies have included individualized care through resident directed care plans; allowing residents to awaken, eat, shower and dress on their own schedule; empowering both the residents and the direct care workers to make decisions, creating a homelike environment with community meals; maintaining regular staff assignments; and consistently treating residents with the dignity, respect and kindness they deserve. 

This chapter was designed to provide CAGs with information about the culture change movement and to show examples of CAG involvement in culture change projects nationwide.  It is important to note that while some CAGs actively support culture change, there are some who are skeptical about the implementation and the sustainability of the movement.

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1)  Culture Change: General Information
There are several organizations involved in shaping the culture change movement nationwide.  These include the Pioneer Network,
The Eden Alternative, and Action Pact, Inc.

The Pioneer Network is known for coining the phrase “person-directed care” as well as defining the principles of culture change.  They also developed a Champions of Change component on their website which highlights the various organizations throughout the country using Pioneer principles to promote culture change. 

The Eden Alternative developed the Green House Project which supports changing the physical structure of nursing homes by developing small, individual dwellings similar to private homes.  Rooted in The Eden Alternative philosophy, Green Houses focus on resident-centered care.

The Green House Initiative website describes the grant received by the NCB Development Corporation to pursue the rapid replication of the Green House model nationwide. 

Through its “Quality of Care for Frail Elders Program,” the Commonwealth Fund supports initiatives that focus on resident-centered care and establish nursing homes as excellent places to live and work while providing the highest quality of care.  The Fund has been instrumental in supporting the culture change movement.  Information about the latest Commonwealth funded culture change projects can be found on their website in the What's New in Care of the Elderly section. 

The Institute for Caregiver Education (IFCE) works to improve eldercare primarily by promoting culture change in long-term care facilities.  The Institute is geared towards healthcare providers and promotes culture change best practices on their website with a definition of culture change, a description of five core principals, and samples of best practices.  For example, IFCE suggests writing the care plan in the first-person from the resident’s point of view thereby allowing the resident more control over their daily activities.  IFCE also provides culture change consulting services for health care providers.

2)  CAG Involvement in Culture Change

The Massachusetts Advocates for Nursing Home Reform (MANHR), a Massachusetts –based CAG, represents resident advocates in the Massachusetts Quality of Life Coalition.  The coalition was created to help foster culture change in Massachusetts facilities.  MANHR developed a culture change fact sheet that includes a definition of person-centered care, information about the culture change movement and resources for additional information. 

Voices for Quality Care (LTC), Inc., an all-volunteer, Maryland-based CAG, provides culture change information on their website including a definition of culture change and links to additional resources.  Voices also received a grant to coordinate educational conferences dedicated to long-term care culture change in Maryland, Delaware, and D.C.  The purpose of the conferences is to increase public awareness about the culture change movement, and to further engage family members and family councils in meaningful culture change.  Voices’ website includes details about the conferences.

TLC in LTC of Illinois promotes culture change on its website by dedicating a page to Pioneer Practices.  The page includes a history of the Pioneer movement, its core values, charts illustrating the specific characteristics of the Pioneer philosophy, and links to additional Pioneer resources. 

“An Introduction to Culture Change in Long Term Care Through Pioneer Practices” is an informative paper written by Margaret Niederer, Ph.D., for the Illinois Long Term Care Council.  It provides a brief history of the development of nursing homes, an explanation of the birth of the Pioneer movement, definitions of Pioneer values and practices, and a summary of Pioneer efforts in Illinois.

3)  Raising Nursing Home Standards as Part of Culture Change 

Higher nursing home standards is a fundamental tenet of the culture change movement. Florida’s Gold Seal Award for nursing homes is one example of using public recognition to raise nursing home standards.  The Florida Governor's Panel on Excellence in Long-Term Care awards the Gold Seal to facilities that meet or exceed the Gold Seal standards for a two year period.  A description of the Gold Seal program, the award application,  and a list of Gold Seal recipients can be found on the Florida Agency for Healthcare Administration website.