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Getting Started with Person-Directed Care

Understanding the Culture Change Process

Understanding the basic principles of person-directed care is the first step in making an informed decision, asking the right questions and moving forward with implementation. The overview below addresses culture change in nursing homes. In the near future, this section will include similar examples for assisted living, home and community based services.

What Is "Culture Change"?

To transform the culture of traditional long-term care institutions, it is important to first understand what this means. "Culture" is generally defined as an aggregate of customs and common ways of living by a group of  individuals, passed down from one generation to the next.

The nursing home "way of living" that was transmitted from prior generations to the present is completely foreign to ways of living in the community today. Somehow, despite good intentions, systems were created that deny residents even the smallest amount of control over their lives. For example, a resident admitted to room 2 in the west wing of ABC Nursing Home will likely inherit the same bath schedule as the person occupying the bed before her. If Mrs. Jones had a whirlpool bath on Monday and Thursday at 10 a.m., then so will Mrs. Smith when she moves into that room. This pattern evolves because assignments are designed to be efficient for the staff, not to meet residents' individual needs. Residents get out of bed, go to the bathroom, eat, attend activities, and go to sleep on a schedule dictated by the facility. These systems negatively undermine quality of life to the point where American society tends to consider nursing home services only as a "last resort."

The culture change movement is working to transform this institutional approach to care delivery into one that is person-directed. The culture envisioned is one of community, where each person's capabilities and individuality are affirmed and developed. The tools Comparisons of Cultures and the Continuum of Direction identify some of these core differences between an institution-directed culture and a person-directed culture. Understanding these differences is a fundamental step in "getting ready" for organizational change.

The Process of "Getting Ready"

The getting-ready phase is a time for Learning, Self-Reflection, Adopting New Beliefs, Organizational Assessment, and Planning. There is much to be accomplished during this time, all of which is critical to the success of the change process.

Excerpts of Getting Started are from the Nursing Home Magazine article, "Pioneering Culture Change" authored by Sue Misiorski, PHI's Director of Organizational Culture Change. Access the full article here.

The Building Blocks of Culture Change

For information about additional tools and resources for getting started and continuing your culture change journey click here.