Nursing Home Culture Change

Nursing home reform is finally a hot button issue and it doesn’t hurt to dream big about what nursing homes can look like in the future. More nursing homes are moving away from a model where residents’ schedules and care are dictated by the staff. They are also moving away from dark, loud, over stimulating environments.   The transition to a nursing home can be difficult, but there is a movement in the United States that might make this transition a bit easier.

Nursing Home Culture Change

The movement that is sweeping the United States is the concept of a household model of nursing home care, otherwise known as “nursing home culture change”. Culture change is marked by a client-centered model of care, where the person living in the nursing home is given more freedom and choice.  In this model, residents are encouraged to live how they want to. For example: to get up when they want to, and to eat when they want to.  Even the  physical environment is more like the home they used to live in and less like a sterile hospital setting. Culture change is important because it still allows a person who has been placed in a nursing home to be able to continue to grow and develop their minds, bodies, and souls. They are given the opportunity to continue to live their life the way they choose to, to the fullest extent possible. Also, all residents benefit from the culture change model. It does not matter if the resident has dementia or is there for rehabilitation or what insurance they have.

Culture Change: a Reality In Illinois

Two places in Illinois are working to change the way their nursing homes are run. One, The Mather Pavilion, is a facility that has nursing care and rehabilitation, as well as memory care. Residents are allowed to walk the halls if they wish. Family and friends are encouraged to visit the resident and fun activities that challenge the resident’s whole person are always happening. Residents benefit physically, spiritually, mentally, and psychologically from a variety of activities to choose from. Some examples include:
  • a visiting music therapist who plays guitar,
  • a visiting Girl Scout Troop,
  • a celebration of Haitian culture, or
  • time spent outside in the lovely garden doing an activity.
The Mather Pavilion  does things that affirm each residents’ abilities, needs, and personality. Another facility, Three Crowns Park, provides independent living, nursing care and memory support. Their memory care  and skilled nursing support is divided up into “houses”.  The residents and their families are allowed to choose how they wish to decorate their rooms and it can be personalized: painted and carpeted to meet their needs. The call lights are hidden behind wall sconces and if a resident needs something, nurses carry pagers and when a resident has a request, the nurse will see it on her pager.  There are no nursing stations, just tiny cabinets that hide charts and a computer monitor. When the staff is not helping a resident, they sit and spend time with the residents while they are charting. They have private showers and the shower rooms are decorated like spas.

The Benefits of Culture Change

I think that it is important for nursing home administrators and all staff at nursing homes to embrace nursing home culture change. Nursing homes that embrace culture change stress that it is not just the nurses’ job to make culture change happen. It is everyone’s job. When the entire staff responds to residents’ needs as they happen, then residents will feel better, as their needs are being comprehensively addressed. I think culture change should continue to be implemented because it results in better mental health for both the residents and the staff. The residents are in a better mood, which results in less depression, anger, anxiety, or agitation for them. Residents living in a culture change nursing home are also more likely to want to participate in activities because they decide what they want to do and when. Staff show the residents that their thoughts, participation and ideas truly matter by allowing them to make choices and reading the resident’s verbal and nonverbal cues.  If you’ve never visited a nursing home dedicated to culture change, set up an appointment, they will inspire you for what nursing home culture change can be! Thank you to ECRCMasterNaturalist on Picasa Web Albums for the photograph. This article was edited by Mark Schmidt.


  • Bridget Murtha

    Great article Melissa. I plan to share this article with some of the seniors I work with. They will be happy to learn about the culture changes already taking place. We have a long way to go!

  • Steve McMillin

    Thanks for writing, great article. I would love to hear reports of Culture Change in high care environments, which are becoming more common as residents wait longer to enter long term care. When I worked in LTC there were a lot of concerns about visual supervision by the nurse without a nursing station, transitioning to buffet in the dining room when more frail residents had trouble carrying trays, and falls and adverse reactions when frail residents walked halls and gardens and ate what they wanted when they wanted. Some staff felt that Culture Change had been developed for the more able nursing home population of a previous generation and not today’s more frail cohort that require a high level of constant supervision, and as a result Culture Change can be a bit of a “hard sell” for some staff.

  • Melissa

    Thanks for your comments, Bridget! I am glad that you will share this with your seniors!

  • Melissa

    Thanks Dan, for the great links! I am familiar with all of them and thanks for the conference info! I am always looking for conferences to attend to broaden my knowledge base!

Leave a Reply

Your email address will not be published. Required fields are marked *