Culture Change: Let's Not Make it a Cliché

Wednesday, November 7, 2007

Reissued September 5, 2018

There is a wonderful revolution taking place in (albeit all too few) nursing homes across the country. As long as there are parents who say to their children, ‘Promise me you’ll never put me in a nursing home,” or any of us groan to think that we may spend our last days in a medical institution that is foreign to any feel or sense of “home” with all its deep and deeply personal implications, then there is need for this revolution – this transformation to spread.

It goes by several names: Culture Change; Transformative Nursing Homes: Resident-Centered Care; Person-Centered Care; Green House Model; Household  Model, Wellspring

What all these terms have in common is a philosophy that holds to the following values and attitudes:

• The resident is put back into the driver’s seat, making as many choices about his/her daily life as possible. One implication is that activities and care revolve around the resident as much as           possible, as contrasted with an institutional schedule and staff convenience.

• It is an environment that honors the culture of aging as life-affirming, satisfying, humane and meaningful.

• The place has the feel and look of HOME. Just two evidences of change in the environment:
            No medical carts rumbling down the hallways.
            No nurses' station.

Although the culture is not transformed by merely instituting programs, studies have shown that in communities where the culture has transformed to a resident-first culture, certain  practices/programs are present. That information can be used as somewhat of an evaluation of how far along on the journey of culture change a community has come.  It is accessible at this link:  http://www.artifactsofculturechange.org/ACCTool/  . Once on that site,scroll down to the,"Artifacts of Culture Change Downloadable Version".

Culture change is not about rearranging the furniture. Far from it. It is a deep, challenging transformation of attitudes and values which is dependent on strong, knowledgeable leadership. The leader must have a deep belief in these transformative values and the leadership ability to shape staff so that these values permeate every cell of their being. Anything short of this is not transformative change and the result will not be ‘culture change.’

The win-win part of culture change is that this transformative mode of operation costs no more than traditional, institutional care. In fact, there are many reasons why the cost is probably lower. That’s a topic for another day.

Steve Shields, CEO of a transformative community in Manhattan, KS speaks of what made it possible for him and his staff to move forward in their journey of transformative change. He is quoted in Beth Baker's book, Old Age in a New Age:  When Action Pact consultants first introduced the concepts of culture change, "The vision was painted so strongly and in front of everybody that it became holy. Truly."

I spoke with Steve about that quote and asked him what he meant by  saying that culture change is ‘holy.’ He said simply and straightforwardly, “It is holy because it liberates our elders and returns hope to them.”

CIRCLES

© April 5, 2005 by Imelda Maurer, cdp

It’s a wonderfully thrilling time to work in the field of aging. Each day brings exciting news of approaches to care and life in nursing homes and retirement centers that put HOME back into “nursing home.” This cultural transformation from the institutional, medical model of “living-every-day-by-a-schedule-that-someone-else-decides-for-me” to a model where the nursing home resident is truly the CENTER of all decisions, programs and activities goes by several names: Culture Change; Cultural Transformation; Person-Directed Care; Green House Project and similar terms. The common theme is that the resident is at the center of the program.

The graphic above is taken from the Internet at

http://www.pioneernetwork.net/news-and-events/Accord2.php The article from the newsletter of the Pioneer Network summarized focal points of its June 8 - 9 meeting in St. Louis.

"Marguerite McLaughlin of Quality Partners in Rhode Island (the QIO that supports all QIOs nationally) presented a framework for person-directed care to illustrate the need for elders to be at the center of

● transformative care practices (e.g., bathing frequency, time and method),
● transformative workplace practices (e.g., a culture of valuing and respecting caregivers and their needs), and
● transformative environmental practices (e.g., the creation of sanctuary, shelter and peace that provides a sense of community and safety, free of unwanted intrusions)."

Recently I was fortunate enough to visit a nursing home that pioneered this cultural transformation: Teresian House, a 300-bed nursing home in Albany, NY, owned and administered by the Carmelite Sisters for the Aged and Infirm. Sister Pauline Brecanier has been the administrator there since the late ‘80s. Sister Pauline believed even then that the nursing home “should look and function as any family home would" (from CULTURE CHANGE, Haworth Press).

Among the positive impacts resulting from transforming a “nursing home” into “HOME are these: obviously happier elders, happier, more content, longer retained employees, a full house since word of mouth about good customer care spreads quickly, and a neutral financial impact. In other words, this innovative, humane approach to life in a nursing home doesn’t cost any more than the way ‘traditional’ nursing homes operate.

My hunch is that medical costs, number of hospitalizations and visits to the Emergency Room are much lower than in a traditional nursing home. But I don’t know of any study that has looked at those factors.

My reason for visiting Teresian House was to visit with a Sisters’ Congregation, the Religious of the Sacred Heart, who has recently begun to depend on Teresian House to care for their frail elders who need nursing home care. The Sisters have done an outstanding, remarkable attentive, and thought-full job in planning for and implementing this transition, and are to be highly commended for that. (More on that in a later blog, I hope.)

The living proof that Teresian House is really HOME, and that the elders who live there feel at home, is evidenced by the following which is shared with you with Sister Mary’s permission.

Sister Mary Ranney is a 95-year-old Religious of the Sacred Heart. She moved from the convent retirement center, Kenwood, to Teresian House (located on Washington Ave), some months ago. She wrote the following which was included in the Sisters’ community-wide newsletter. (‘Bunny’ is the name of one of the Sisters who visit there weekly. There are, incidentally, Sisters there every day VISITING, HELPING, ADVOCATING, as a part of their job description.)


Teresian House: a Kenwood on Washington Ave!
“So much has been said of our new home, and so well expressed, that it is difficult to add to the picture. For me, one thing is different! Here, we walk in circles, no straight lines. Surprisingly, we get there! A circle to the chapel, He is in it; a circle to the dining room, friends await us; a circle to the front door, guests on hand; a circle to Bunny’s class and we get lost! I notice too, there is more light in circles, more love in circling hugs, more joy in enlarging our circle, more peace to have come full circle”

It seems to me that the Sisters and all the elders at Teresian House are experiencing ‘the hundredfold’ promised in Mark 10: 29 – 30. It is my hope and prayer that we will all be that lucky!

Blessings on you, Sister Pauline, and on all advocates and practitioners who are working to make nursing homes HOME!

I’m Not a Young Woman

© March 26, 2007 by Imelda Maurer, cdp

Lowe’s had a large selection of vacuum cleaners, and I needed one. I had just moved to begin a new ministry and was shopping that Saturday afternoon for some basics for the small house I was renting. The salesman was helping another woman when I walked up. I was there only a moment or two before he looked at me and said, “I’ll be with you in a minute, young woman.” To which I responded politely, “I’m not a young woman.” The woman he was helping was probably embarrassed at my apparent lack of social sensitivity to this well-meaning salesman. She turned to me and said, “He’s trying to make you feel good.” “I know,” I said, “but I’ve lived 63 years to look like this, and I don’t want any of those years or experiences disregarded.”

How many of us have not had that experience at least once since we passed 55 or 60 years of age? How did we really feel about such a remark? A good feeling because maybe we really don’t look as old as we really are? Maybe ‘they’ really think I am still young. And am I happy that I am seen as still young?

Our western society is so terribly ageist. The state of youthfulness is worshipped and sought after to the tune of billions of dollars raked in by the cosmetic and anti-aging industry here in the United States alone. On the other hand, birthday cards for anyone 30 or older make degrading joke after degrading joke about one’s age. What a shame.

Dr. Andrew Weil, in his recent book, HEALTHY AGING addresses this concept of our society’s abhorrence of aging. He concludes by saying that no matter how much we spend on hormonal supplements, plastic surgery or anti-aging cosmetics, we cannot stop the aging process, and we should “accept” our aging. No, Dr. Weil, we should not “accept” our aging, we should CHERISH and HONOR our aging. It is a sacred part of our life journey.

For me as a Sister of Divine Providence, it is another wonderful and good aspect of God’s Providential love and care. For me, aging is an adventure. I’ve never been this old before! Who will I be as an old(er) person? How will the experiences of my life, both inner and outer experiences, show themselves in my face, in my body?

Aging can hold much pain for some of us. I don’t deny that. Many older adults suffer complex health problems. But that is not a universal experience. Each of us has some control over how our older years will be lived based on our inherited genes and by the way we live each day now: healthy diet, at least a 30-minute walk, positive attitudes, and informed, regular care of body, mind and spirit.

If we each fought ageism every time we encountered it, whether it is public policy or a well-meaning sales clerk, wouldn’t we individually be a lot more psychologically healthier? Wouldn’t our entire society be a lot healthier?

Can you look at yourself in the mirror and smile with gratitude for the life’s journey that has been yours so far, and that reveals itself in that face you see in the mirror?

I Never Saw Your Wrinkles

© March 2 2007 by Imelda Maurer, cdp

Several years ago I fell in love with gardening. It was a kind of surprising transformation following a farm-life childhood, where the work seemed only drudgery. So averse was I to having to go on Saturday mornings to hoe the weeds out of the long rows in the grape vineyard or from around the young corn plants, or to pick the field peas, that I cultivated the habit of praying for rain every weekend.

When I was in my mid-30s, I found myself living in rural southern Louisiana with an ample yard of beautiful, dark, delta soil beneath the lawn. I decided to attempt a small organic vegetable garden and cultivated a patch that was probably 20 feet by 12 feet. I was astounded at the delight I took in seeing the small seedlings take hold and flourish, at the beauty of the different shades of green against the dark, black soil. I looked forward to the time I would be able to spend in my garden, a time that became richly reflective and meditative, as well as emotionally fulfilling.

As that first spring progressed, the tomato plants grew almost shoulder height, producing tomatoes for me and many of my neighbors. After the growing season, I removed the dead plants and added them to the compost pile where, during the still winter season, they turned into rich dirt. That compost, added to the garden, nourished the next season's young plants. I had an experiential awareness of the universal cycle of life, death and subsequent new life, as I had observed my garden plants mature, provide fruit and later yield to death.

There is a distinct beauty in a young, maturing plant. A pepper plant, for example grows so straight with wondrous, dark, shiny, green leaves. Its stems strengthen and become almost woody, enabling it to support the proliferation of beautiful, glossy, waxy peppers. In doing so, the plant loses its youthful appearance and gains the beauty of maturity.

I began to understand not only that the appearance of the pepper plants in each stage of growth and development held its own beauty, but that there was a certain rightness and appropriateness in the beauty of each stage of that pepper plant's life. The reflective time in the garden provided the recognition of a connection between the stages of life in the plants I loved and nurtured and the stages in my own life. I recognized in a new and profound way that there is a beauty, a rightness, an appropriateness in who we are and how we appear at whatever age.

I've believed for many years that as we age our beauty deepens. The face and eyes of older persons reflect the richness of their life experiences and the wisdom that comes from their life's journey of intermingled pain and joy. It is this inner self, wonderfully manifested in some way in our physical being, that is who we really are. Robert Redford alluded to this perspective in an interview in which he spoke of a personal rejection of having plastic surgery because he believes that in that process, "something of your soul in your face goes away."
We all know at some level that, when we look at someone, or when we call a person's image to mind, that we are seeing the person as he or she really is -- something of the inner self. This was exquisitely voiced by a woman in a news story that ran recently on "Good Morning America.” The story cited growing numbers of adults older than 65 who are choosing plastic surgery. Featured was an 80-year-old woman who had recently had a face lift, tummy tuck and breast augmentation. She was shown sitting around a table with women of her own age group, obviously friends and acquaintances. One in the group asked why she underwent plastic surgery. The subject of the interview answered, touching her smooth, wrinkle-free face: "Look how smooth my face is. Don't you remember how wrinkled it was?" To which her friend replied in a soft-spoken voice, "I never saw your wrinkles."