Comparisons of Nursing Home Cultures

Institution-Directed Culture

Staff provide standardized "treatments" based upon medical diagnosis.
Schedules and routines are designed by the institution and staff, and elders must comply.
Work is task-oriented and staff rotates assignments.
As long as staff know how to perform a task, they can perform it "on any patient" in the home.
Decision making is centralized.
There is a hospital environment.
Structured activities are available when the activity director is on duty.
There is a sense of isolation and loneliness.

Person-Directed Culture

Staff enters into a caregiving relationship based upon individualized care needs and personal desires.
Elders and staff design schedules that reflect their personal needs and desires.
Work is relationship-centered, and staff have consistent assignments.
Staff bring their personal knowledge of elders into the caregiving process.
Decision making is as close to the elder as possible.
The environment reflects the comforts of home.
Spontaneous activities are available around the clock.
There is a sense of community and belonging.