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The Language of Culture Change

"Mayday"

by Karen Schoeneman

I've always been a fan of words. When I was young, I'd spend hours browsing through a 20-pound unabridged dictionary that gave the histories of words as well as their meanings. I've just recently found out why people shout "Mayday" when their ship or plane is in trouble. It's a misspelling of the French, "m'aidez" which means "help me," and is pronounced "mayday." Well, today, I'd like to shout "Mayday" for help with my words.

I've worked 30 years in long-term care. Over that time, I've come to realize that much of the language we use is in need of replacement because it unintentionally demeans people, contributing to a hierarchical sense of "us and them" or a dehumanizing institutional culture instead of a nurturing community with respect for its members.

When I started working in long-term care in 1972, I worked in a "State School and Hospital" with "inmates" who were called "retarded" and categorized as "moron," "idiot," "imbecile," "mongoloid." Those words were not intended as insults, just diagnoses. We've already come a long way from there, but we still have far to go. And those of us who came from a past that accepted words like these need help—your help—to upgrade our institutionalized brains.

Part of transforming long-term care practice is finding new words to describe staff, programs, parts of the building, and the "industry" itself. As I've attended Pioneer and Eden conferences, I've been immersed in a new type of language called "person-centered." The idea behind person-centered language is to acknowledge and respect long-term care residents as individuals. Using person-centered language, I've learned, is often as simple as reversing common phrases to put the person first and the characteristic second. "A wheelchair-bound resident," for instance, becomes "a person who uses a wheelchair for mobility," and "a feeder" becomes "someone who needs assistance with dining."

A few years ago I wrote an article about this subject for Provider magazine and invited readers to e-mail me words and phrases they thought were outdated, along with their suggestions for what to use instead. Look at the word "therapy," for instance. Why does everything have to be therapy once you live in a nursing home? If I liked to paint before I moved into the nursing home and I paint now that I'm there, why is my hobby now "art therapy?" I mean no insult to the wonderful folks who call themselves therapists and their work, their special training, or their skills. In fact, I'm a massage therapist myself. But in this context, "therapy" is another of those separating words.

This list below is a collection of suggestions culled from the many responses I received from readers of Provider, along with some additions from friends and colleagues and a few thoughts of my own. The list is not definitive, and I am not its keeper. It's not up to me to say whether these words are our best or only choices, but I do know they're a start, so I'm sharing them in hopes that they'll spur more thinking and discussion.

The language of long-term care belongs to all of us—not only the "us" who work in this field but, at least as importantly, the elders and others with disabilities who require long-term care services, their families, and the public at large. The most urgent task we face may be agreeing which "bad" old words to throw away.

Finding new ones should be easier. After all, that's just a matter of choosing words that are both accurate and respectful, and that unabridged dictionary is full of good words.

Old Word Suggestion
"victim of . . ." or "suffering from . . ."  
"has . . ." or "with . . ."
wing, unit
household, street, neighborhood, avenue
allowencourage, welcome
diaperpad, brief, disposable brief, brand names, incontinence garment
the elderly
elders; older adults, people, or individuals
patient
resident (some think this is passé), individual, elder
a feeder/the feeders, feeder table 
person who needs/ people who need assistance with dining, dining table
a diabetic, a quad, a CVA
a person who has (whatever condition)
nurse aide, CNA, nursing assistant, front line staff (sounds like war)
resident assistant, certified resident assistant
admit, place
move in
discharge
move out
lobby, common area living room, parlor, foyer
nurses' station 
work area, desk
facility, institution, nursing home
home, life center, living center
100-bed facility     
100 people live in this home/center 
housekeeping, housekeepers environmental services, homemakers
long-term care industry  long-term care profession or field 
eloped, escaped,elopement left the building, unescorted exiting 
dietary services, food service  dining services 
problem residents, behavior problems person with behavioral symptoms 
agitated active, communicating distress 
ambulation, wanderingwalking

Karen Schoeneman is a senior policy analyst in the Division of Nursing Homes in the Centers for Medicare and Medicaid Services. The opinions expressed in this article are those of the author and not necessarily shared by CMS.
 
More words...
People Old Words New Words 
 Grandma, Mommy, Kid, Sweetie, Honey, Girls, Old TimerResident's name/ Mr./Mrs./Ms.
 Wheelchairs/WalkersPeople who use a wheelchair/walker
 The ElderlyElders

Bed (i.e.  - A 100-bed facility)Resident

Residents Identified by DiagnosisTheir name -- Learn it!

WanderersPeople who like to walk

DisabledPerson needing support/ What their abilities are

Toilet Residentneeds help in the bathroom
 Activity Director
Community Life Coordinator

Non-nursing/Ancillary staff(name) from (department)

New AdmitSomeone offered a home here, New Neighbor

Feeder/FeedyPerson who needs help eating

PatientResident, Participant, Client, Neighbor

ResidentMy Friend

Dementia/DementedPerson with cognitive losses

Girl, Guy (CNA)Their name, My Friend

I
We/ The Team

Food Service Worker, Hey YouTheir Name



PlacesOld Words
New Words

Facility, Nursing HomeCommunity, Home, Care Community, Life Center

AgencySupplemental Staffing

BathSpa

WardVillage

Nurses' StationWork Station, Den, Support Room

StoreroomPantry

SolariumLiving room

UnitNeighborhood

Tray LineFine Dining



ThingsOld Words
New Words

ActivitiesMeaningful things to do

Mechanical Soft FoodChopped Food

NourishmentSnack

BibsNapkin, Clothing Protector

Diaper, Pampers, Pull-upsBriefs, Panties, Attends

Hospital GownPajamas, Nightgown



ActionsOld WordsNew Words

Transport
Assist to…

Admit/PlaceMove in

AmbulateWalk

MIA, ElopementTaking a walk

ToiletingUsing the bathroom

Baby-sitResident interaction

AllowHelp/Facilitate

ClaimsStates, Says



AttitudesOld WordsNew Words

You are fatYou are thick or curvy

Care Plan ProblemResident Strength

"I didn't know my resident could do that.""I love it when my resident does that!"

ProblemChallenge/Opportunity

"You need to…""Would you like to...?"

"Sit down, you'll fall.""Let's walk!"

"Trays are here.""Dinner is served."/ "It's dinnertime!"

"He's on the pot.""He's not available right now."

Long-Term Care IndustryLong-Term Care Community

A two-assistRequires two helpers

"We're already doing that.""We need to REALLY do that."

"We tried that.""Let's try again."

"That's not my job.""I'll take care of that."

IndustryMission

14-hour ruleFreedom of Choice

Old waysChange in order

Can't escapeWould like to go outside



ConditionsOld WordsNew Words

Short-staffedAdequate staffing

Confined to wheelchairUses a wheelchair