On March 21, 2012, Courtney Bouker from Arden Courts of Northbrook presented Culture Change: The Person-Centered Dementia Care Approach. This Chicago Bridge event was hosted by Northwestern University Cognitve Neurology and Alzheimer’s Disease Center (CNADC) and food was provided by Warren Barr Pavillion.
For many seniors examining their long-term care options, the decision to “age in place” remains the most desirable. Unfortunately, for those individuals with dementia who require a higher level of care, often nursing homes are the only option. For many, the traditional model of institutionalized care represents a detention center they will try desperately to avoid. The culture change model represents a more person-centered approach in which the comforts of aging in place can be replicated in an institutional setting.
Also referred to as person-centered care, culture change values the needs and desires of the individual, thereby empowering seniors to exercise choice and preserve a sense of autonomy in a nursing home setting.
Applications for Culture Change in Dementia Care
As an advocate for culture change and the model of person-centered care, Bouker shared her career journey through various Continuing Care Retirement Communities (CCRCs), providing examples of how this approach could be applied. As an experienced care provider for individuals living with dementia, Bouker helped attendees explore the approaches to activities of daily living that could mean the difference between an environment of institutional care and one reminiscent of home. Attendees shared their personal preferences for daily activities such as meal times, sleeping schedules and hobbies to demonstrate that the “one size fits all” approach to institutional care does not address individual needs and can lead to difficult behaviors. Culture change considerations for nursing home residents may include:
Daily Activity Culture Change Model
Meals Provide residents with choice, and honor meal habits and preferences
Bathing Make residents comfortable, respect their privacy. Give residents choice of bath times, provide warm towels.
Sleep Residents choose when to wake/sleep
Approach to Difficult Behaviors
According to Bouker, triggers for behaviors could include physical, emotional, environmental or task-related changes. In the culture change model, residents’ needs, habits and routines are taken into account to limit the number of behavioral triggers and foster a safe and comfortable environment. When implementing person-centered care, it is important to get to know the individual, honor what makes the person human and apply the golden rule. For example, if you were woken up every morning at 6:00am only to wait in the dining room for two hours before the start of breakfast, you would likely become agitated!
Benefits for Aging Network
Under traditional institutional care models, nursing home staff are bound by the structure, order and designated outputs of the living community. The culture change model encourages staff to engage with residents one-on-one, thereby fostering closer relationships and increasing employee satisfaction. Higher employee satisfaction may ultimately lead to less workplace turnover.
The Language of Culture Change
The most basic component of culture change is a transformation of the words and phrases used in a nursing home atmosphere. Below is a sample of traditional vocabulary used and the same phrase modified for a more person-centered emphasis.
Common Phrase Culture Change Model
Bib Napkin, apron
“I am going to take Fred for a walk” Fred and I are going for a walk
*Examples provided by Courtney Bouker
Want to Learn More or Get Involved?
Please visit the Pioneer Network site to learn more about educational events, the Regional Pioneer Coalition, and the Pioneer Annual Conference. Related websites include:
Thanks to Elsye Baylis for editing this post.