Culture Change

a happy old coupleCulture change is the term used to describe the transformation of older adult services based on person-directed values and practices, in which the voices of elders and those working with them are considered and respected.

Core values are choice, dignity, respect, self-determination and purposeful living.

In “Person-Directed Care for Nursing Home Elders: The Culture-Change Movement” (Jan. 7, 2010 issue of Health Affairs Web-first) author Mary Jane Koren, M.D., M.P.H., elaborated: “Proponents of culture change do not recommend a specific model or set of practices. Instead, they support principles governing elder care practices; organizational and human resource practices; and the design of the physical facility. According to these principles, an ideal culture change facility would feature:

  • Elder direction. Elders should be offered choices and encouraged to make their own decision about personal issues like what to wear or when to go to bed.
  • Homelike atmosphere. Practices and structures should be more homelike and less institutional. For instance, larger nursing units with 40 or more elders would be replaced with smaller “households” of 10 to 15 elders, elders would have access to refrigerators for snacks, and overhead public address systems would be eliminated.
  • Close relationships. To foster strong bonds, the same nurse aides should always provide care to an elder.
  • Staff empowerment. Staff should have the authority, and the necessary training, to respond on their own to elders’ needs. The use of care teams should also be encouraged.
  • Collaborative decision-making. The traditional management hierarchy should be flattened, with frontline staff given the authority to make decisions regarding elder’ care.
  • Quality improvement processes. Culture change should be treated as an ongoing process of overall performance improvement, not just as a superficial change or provision of amenities.”

To view additional research and articles on culture-change in long-term care, visit The Commonwealth Fund at:

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  • Diane Hall, RD, LD, NHA FPN Executive Committee Chair President Balanced Senior Nutrition

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