Culture Change and Person-Centered Care


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This presentation was developed by the Texas Culture Change Coalition to serve as a tool to inform others about the background and principles of culture change in long term care.

Please feel free to use it as a whole or in part to inform others about the benefits of culture change.

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  • Provider Directed:Dining Meals are served at fixed times. Residents who are independent eat in a dining room and others who require assistance eat in their rooms. Meals are brought on trays from central kitchen. Residents who do not prefer meal may choose alternate meal. Staff Centered:Meals are served during fixed periods of the day (i.e., breakfast 7 to 9:30 am). Meals are prepared from a main kitchen and each meal offers residents two choices for a main meal, except for breakfast which is buffet style. Residents who are independent eat in a dining room and the others who require assistance eat in their rooms. Patient Centered:Residents have input on meal times and the menu. Residents are served freshly-prepared food from a rolling steam table. The food is not prepared in large industrial kitchen, but a smaller residential one. Aides serve the food to residents on dishes and not trays. The steam table is taken to residents who cannot come to the dining room. Resident Directed: Residents decide on the menu and where they want to eat and at what times. Meals are prepared in a residential kitchen near where the residents’ rooms are located. Meals are served family style, where serving bowls and platters are placed on the table and residents, who are able, can help themselves. Those who require assistance receive it from staff.
  • Audience Interaction: Ask the audience what simple pleasures they enjoy every day. Exercising? Having their coffee a certain way? What time do they get up? Do they shower in the evening or in the morning, etc.? What if these daily pleasures were taken away from you? Providing person-centered care means allowing individuals to enjoy the same daily pleasures that they would enjoy at home.
  • Culture Change and Person-Centered Care

    1. Culture Change andPerson-Centered Care
    2. Culture ChangeBackground Examples Benefits
    3. Culture Change: What is It?National movement aimed at improving long term care services for elders and individuals with disabilities.
    4. The Three Components of Culture Change StaffOrganization Residents
    5. Core Principles of Culture Change Self Determination Sense of Community Dignity Choice Belonging Support Purposeful Living Contributing
    6. Where Did We Begin?The Institutionalized Model Medical System- Model Centered Custodial Conformity Care Task- Oriented
    7. What Comes to Mind When YouThink of a Nursing Home? Sterile Medicine Carts Fluorescent Lights Hospital Beds Intercom System Nurses’ Station
    8. Where Are We Headed?In 2011, the first Baby Boomers reached age 65.By 2030, 72 million people will be aged 65 or over.
    9. A Need For ChangeLeading Organizations inCulture Change:
    10. The Eden AlternativeFounded byDr. Bill ThomasEnd the Three PlaguesFound in Nursing Homes:HelplessnessLonelinessBoredom
    11. Eden LifeLong LivingApplies the Eden Principles to individuals with disabilities.
    12. Same Principles, Different Needs Eden Eden LifeLong Living Alternative Nursing Home Residential Home Elders Non-Elders CNAs DSPs Shorter Term Longer Term Full Life Life Interrupted Person-Directed Person-Centered
    13. Person-Centeredness ContinuumListen to these dining examples.Where would they fit on the continuum? Provider Staff Person Person Directed Centered Centered Directed Low HighPioneer Network
    14. What is the Goal? Institutionalized Individualized Care Care
    15. Person-Centered Care Know the Person Individuality and Uniqueness of Every Person EmpowermentResponsive,Permeable EnvironmentPerson Has Input About Wants
    16. Daily Pleasures
    17. Artifacts of Change Staff and residents are at the center of the change process!New Paint Staff recognition Children Elimination of call systems Animals Resident Plants Recognition
    18. How Do We Get There? Empower Have Residents Knowledge and Staff Incorporate Create Artifacts of Urgency Change Improve Feedback Care Improve Quality of Life
    19. Does Culture Change Work? YES! Research shows that Culture Change implementation increases quality of life and decreases staff turnover.
    20. The High Cost of TurnoverThe direct cost of losing one direct care employee is $2,500.
    21. One Study Proves…. Nursing homes engaging in culture change can not only improve their residents quality of life, but can also achieve better financial returns.E. Elliot, "Occupancy and Revenue Gains from Culture Change in Nursing Homes: A Win-WinInnovation for a New Age of Long-Term Care," Seniors Housing & Care Journal, 2010 18(1):61–76.
    22. Occupancy Rates90%89%89%88%88%87% Control87% Culture Change86%86%85%85% 2004 2008
    23. Culture Change adopters could expect to see an additional$584,073 in revenue per year.
    24. The Bottom Line Better Trained Less Increased Resident Better More and Turnover and Care ReferralsEmpowered Staff Family Satisfaction Doing What’s Right is Good Business.
    25. A Better Place to Work…
    26. A Better Place to Live.
    27. Culture Changeis NOT a quick fixor a marketingploy.It is the systematic change of an organization in order toprovide a better place to live and work.
    28. What is the Key?Complete Support From Leadership!
    29. Take Culture Change With You!Small Steps Can Have a HUGE Impact!
    30. Great Culture Change LiteratureOld Age in a New Age: The Promise of Transformative Nursing Homes by Beth BakerWhat are Old People For? How Elders Will Save the World by William H. Thomas, M.D.The Journey of a Lifetime: Leadership Pathways to Culture Change in Long Term Care by Nancy FoxLife Worth Living: How Someone You Love Can Still Enjoy Life in a Nursing Home by William H. Thomas, M.D.The Silverado Story: A Memory-Care Culture Where Love is Greater than Fear by Loren Shook & Stephen Winner
    31. Changing Aging Blogstream:Keep Up with Culture http://www.changingaging.orgChange Happenings! Pioneer Network:Visit these websites for more http://www.pioneernetwork.netinformation on culture change inlong term care, where it isheaded, and how you can be an Eden Alternative:agent of change! Eden LifeLong Living: Texas Culture Change Coalition: The Picker Institute, Long-Term Care Improvement Guide: LTC_Improvement_Guide.pdf