“We don’t need no stinking Culture Change!” “We didn’t get any deficiencies that were important.” “It’s not something that is mandated by the State!” “Did you hear the one about the Consultant?”
My first visits to a senior living home were met with these comments. The thing I respected most was the fact that I knew right away where I stood. There was no guesswork, no anticipating an open environment, no attempt at detouring by fogging the conversations with pretense of schmoozing the consultant.
By virtue of being “A Consultant” one already has a strike against oneself. Pompous to assume that one knows so much as to be called into a situation to ‘tell’ others how to proceed in any given area. And CULTURE CHANGE! Might as well come bearing a scepter and a scroll and in a booming voice decree what is to be in an alien land. So much for being Queen for a day! That said, I listened to the comments, chuckled at the jokes, observed the body language which was hostile and closed and confrontational from everyone sitting in that room. And thought, yep, this is why I became a Consultant—to be admired for my experience, respected for my knowledge, liked as a passionate proponent of elder care, and to work with like minded individuals to move forward in providing the best of care. Talk about pompous! The wonderful thing I received from this situation was the ability to learn more than you could ever imagine from running into wall after wall.
Culture Change…it isn’t simply “doing.” It is about becoming: Live it and it becomes.
It should be such a simple thing—bring relationships and individualized care to a home. It should just be a natural extension of a life and those relationships that come into being from sharing an environment. But, people are people. Barriers and a false sense of control are difficult to dissolve. The idea that medical care is only one small component of a human being’s life and not the totality of that individual is for some reason threatening to some staff.
For some Administrators there is the fear of crossing regulatory boundaries and being “more open” for lawsuits. False thinking that “more control” is safer. Some nurses think that they “know better” and in wanting to “fix things” take away the individual’s right to live and make those choices that define themselves as persons—not as how they are viewed by others as a group or disease. Your more convoluted issues arise with the staff who need to define THEIR self worth by being overly involved in the decision making process for a resident. These are coming from perhaps a “caring” but misguided outlook.
Allow yourself to see the person first. The environment is an artificial placement, an extension of where the person is and not WHO the person is. They still own their own destiny. We must remind staff that this is the home of the resident and that we are lucky to be invited into their home and to be a part of their community.
To answer the many questions I received from staff relating to Culture Change, I did so over time. Words do little to affect Culture Change. Action and seeing the outcome is what brings programming, education, and Culture Change to life. Simply put, in my opinion, it is about Life—the “Big L,” life for the residents, their families, the teams and the community outside of the home. Those precious 24 hours in a day of communication with others and communing with one’s higher power, and with oneself is what it is really all about.
Take a moment and consider your co-workers, and all of the sub-cultures and all the experiences that you are relating with each day. Place them in the home setting and then each resident and family and their cultural, religious, and life experiences and you can understand where the fear and barriers can grow from. You can see how convoluted the dynamics can become. Culture Change removes the institution and creates a community from this diverse population.
Culture Change provides an environment that is life affirming and accepting of this truth: All individuals are different while sharing some commonalities. It is making it home for and with the people who live there. It builds on the fundamentals of relationships, risks, choices, and creates an atmosphere of being with, not doing TO someone.
Removing the institution and creating home and community is an action. In home and community, staff interacts with, not controls the residents. Administrators listen to their residents and staff and interact. Families are allowed to interact and be a part of what makes up the home. The residents are the home. Community is what is created. To use that maxim referring to a different population, “It takes a village…”
Be a member of that village. Create that home and community.
Obviously, the group I worked with NEEDED Cultural Transformation. Not because I said so as their Consultant, but because their distrust of their own dynamics; the control they exercised vs. relating with the residents; the disallowing of personalities in their residents; forms of punishment for those they didn’t “like” or who “weren’t easy;” the medical sense of superiority vs. letting a resident be their own person and make their own choices; all of these elements were causing residents to be fearful of the staff and of the “nursing home” area. There were unhealthy dynamics with the residents in response to the staff control issues including acting out behaviors, increased falls, weight loss, incontinence, depression, and increased psychotropic use. The sense that a resident went there to die and never “got out” was pervasive. “Death’s Waiting Room” was the healthcare area’s nickname.
Deficiencies are easy to address as well: regulations are guidelines that one cannot go beneath. Just because a community meets the lowest criteria and passes a survey doesn’t mean that the standards are true quality. Raise the bar. Heck—open the bar! It is time to become what the standards shoot for, not to meet the lowest possible criteria. Create the atmosphere of life and your regulations will not only be met and become a natural part of the home, but the improved quality of life as staff focuses on building relationships with each resident will become stronger and make for better care and ultimately fewer problems.
As for mandated by the State? Humanizing programs are becoming mandated. But is that a reason for Culture Change? Doing the right thing shouldn’t have to be mandated. Individualizing the care, allowing choice, and creating a Community brings rise to a happier and more genuine environment, better dynamics and relationships, healthier residents, lower staff turnover, is fiscally sound, and provides each person their own destiny. What is so radical about those qualities?
As for the jokes? Maybe some days my role is that of the Village Idiot, but I learned that not taking myself seriously but bringing humor to my passion for Culture Change was a big part of my personal journey in Culture Change itself!
- Remember it takes time and action to assist in Culture Change
- True change requires total team support and involvement—one person alone can’t effect change
- When met with adversity ask questions, and keep in mind there is no “winning” but a possibility for knowledge and growth
- Those that get on board in a community are your best cultivators for the positive “contagion” of change
- Keep your humor and keep your focus
- Remember that cultural transformation is like eating an elephant…one piece at a time
- It is a process
By the way
, did you hear the one about the Consultant???
Rhea L. Schneiders,
Associate Consultant and Educator
