Artifacts of Culture Change Self-Assessment for Assisted Living Communities

Welcoming is intentional by the community utilizing such methods as a welcoming committee/welcome wagon, resident buddies/mentors, first meals with specific individuals who either work or live there, an event held for others to meet the new person, assigned team members meeting with the new person, etc.

A national task force of clinical standard setting organizations, culture change leaders, and CMS developed evidence-based standards to enhance both nutrition and satisfaction with food and the dining experience. Research has shown that restrictive diets for older individuals in long term care are of little benefit, and in fact can be detrimental. These diets often cause residents to reject their meals, leading to weight loss. Restricting sugar, salt, or fat make little difference in blood sugar, blood pressure, or cholesterol in the older person. Research evidence shows that a liberalized, regular diet for most residents can enhance quality of life as well as contribute to maintenance of physical health. Pioneer Network developed the Dining Practice Standards Toolkit to assist providers in implementing the Standards. (Both available on Pioneer Network website under the Dining category in the Resource Library.)

The Dining Practice Standards include a section on using real foods instead of and before the addition of artificial dietary supplements. Research has shown frequent resident rejection of supplements, with consequent weight loss. Real foods are individualized according to a resident’s abilities to chew and swallow. Examples of real foods are smoothies, shakes, malts and/or protein and fiber powders when extra protein is needed.

Service/care plan refers to the service/care plan document as well as other documents and/or processes used by the community to support sharing of the resident driven comprehensive plan of care. This can include the medication administration record, treatment administration record, a kardex system, getting to know you documents, and should be supported in community policies and procedures.

The Bathing without a Battle book and DVD provide research-based information on proven methods to enhance the bathing experience for those who resist traditional techniques. It contains valuable information on bathing, showering, bed baths, and hair washing methods to accommodate residents’ fears and pain to produce a pleasurable outcome for both residents and team members. (Available on Pioneer Network website.)

A life story goes beyond the typical social history, to provide detailed information about what makes this person unique. It goes beyond demographics such as marital status to cover what makes the person special.

The term “approach” is used as a culture change term instead of “intervention.” An intervention in society at large refers to a dire situation for which there must be an intervention. Individualized approaches are what has always been meant since the approaches used for one person are different/individualized from the next.

Privacy-enhanced, shared rooms have a partial wall between two sides of a shared room, typically floor to ceiling. Sometimes the wall is removable for choice purposes. This gives better privacy than a curtain and two people still typically share one bathroom.

Locked living areas (secured memory care units or neighborhoods) are now viewed as “the hidden restraint” and homes that have unlocked them find that people who are no longer locked in do not have the negative reactions that come when any person is locked up.

Instead of referring to admission, being admitted or a “new admit,” culture change/non-institution speak refers to the more natural process, of moving in. Combined with welcoming, the process is intentional about ensuring each person is made to feel comfortable and at home. The move in process takes place over a period of time and is not limited to the day of move-in.

According to The Eden Alternative®, “Care partnership implies a balance of care—that opportunities to give as well as receive are abundant and experienced by everyone in the care relationship. Whether two people are friends, neighbors, family members, or client and provider, the relationship is mutual and therefore both people are giving and receiving. Instead of giving care, someone partners in care.” (Refer to The Eden Alternative website “Worlds Make Worlds” document.)

A troubleshooter is a team member from any department/team whose role is to ensure things get done for their assigned resident(s). There are often many things going on with one resident across various departments/teams. For example, a team member from Maintenance, who is the troubleshooter for Mr. P, notes that his request for change in breakfast items has not been fulfilled, his wheelchair wheels squeak, he is missing his winter coat, and has asked for a dentist appointment. The troubleshooter converses with people in the relevant departments/teams to determine status and keep Mr. P informed.

Learning Circles are group meetings in which a topic is posed, and each person speaks in turn with no crosstalk or discussion until the whole group has spoken. This process honors those who are reluctant to speak up and reins in those who can dominate a conversation. Learning Circles were brought to the culture change movement by LaVrene Norton of Action Pact, and more information is available at the Action Pact website and in the Resource Library on the Pioneer Network website.

Community Meetings were developed by the residents and Debbie and Barry Barkan of Live Oak Living Center. These meetings were, and are ideally, intentionally held every day for residents, team members, and any families able, to gather as a community to build connection by: discussing issues of mutual interest and concern; celebrating life events and birthdays, having new residents and employees introduce themselves; remember/mourn; share goodbyes before someone leaves, acknowledge gains/progress, life passages, losses, illness/recovery from illness, return from absences, the role they take on in the community (someone gives a news/sports/weather report or tells a joke each time), review of policies and procedures in layman’s terms, planning future events, and anything the community decides to do. Select "Partially Implemented" if community meetings are held less often than weekly.

This can occur through participating in events such as state and national culture change conferences and webinars, as well as a review of resources. The expectation is that apply knowledge and share information with team members, residents, and families.

Cross training refers to staff team members intentionally becoming trained in other areas. This can be any area although it commonly refers to professionals becoming cross trained as CNAs in order to help with ADLs which represents the bulk of resident need.

This could mean that the home is flexible with accommodating the need for a team member to be able to attend classes during their normal work hours, scholarships, etc.

Non-institutional language considers the person first, enhances dignity, and is not pejorative or paternalistic. For example, facility becomes home, unit becomes neighborhood, wheelchair-bound becomes person who uses a wheelchair. Pejorative language “we allow our residents to sleep as long as they want” becomes “we support residents to sleep until they wake up.” Pejorative is also terms such as “the girls on 2nd floor,” “the feeders,” “our” residents, and referring to people as room numbers – “112B has her call light on again.” Paternalistic language like, “Are we ready for our shower?,” becomes, “What time would you like your shower?” This also includes such terms as “he’s a complainer” and sing-song language used for babies. (Refer to language resources in the Resource Library on the Pioneer Network website under the Culture Change Fundamentals category.)