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Comparisons of Nursing Home Cultures

Institution-Directed vs. Person-Directed

Institution-Directed Culture
  • Staff provide standardized "treatments" based upon medical diagnosis.
  • Schedules and routines are designed by the institution and staff, and elders must comply.
  • Work is task-oriented and staff rotates assignments.
  • As long as staff know how to perform a task, they can perform it "on any patient" in the home. 
  • Decision making is centralized. 
  • There is a hospital environment. 
  • Structured activities are available when the activity director is on duty.
  • There is a sense of isolation and loneliness.

Person-Directed Culture

  • Staff enters into a caregiving relationship based upon individualized care needs and personal desires.
  • Elders and staff design schedules that reflect their personal needs and desires.
  • Work is relationship-centered, and staff have consistent assignments.
  • Staff bring their personal knowledge of elders into the caregiving process. 
  • Decision making is as close to the elder as possible.
  • The environment reflects the comforts of home. 
  • Spontaneous activities are available around the clock.
  • There is a sense of community and belonging.