Culture Change

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Culture change is the term used to describe the transformation of older adult services from systems focused primarily on meeting medical needs to a team-based approach based upon person-directed values and practices, an approach in which the voices of elders and those working with them are all considered and respected.


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 example, 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 front-line staff given the authority to make decisions regarding elders’ care needs.
  • QUALITY IMPROVEMENT PROCESSES. Culture change should be understood as an ongoing process of overall performance improvement, not just as a superficial change or provision of amenities.”

Below are a few examples of the many Web sites to help one explore more about culture change in long-term care:

Pioneer Network:
National Consumer Voice:
Next Avenue:
Caring for the Ages:
Changing Aging:
The Eden Alternative:
Action Pact:
The Green House Project:

Florida Ombudsmen Training in the Artifacts of Culture Change (ACC) Tools

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Part II of FPN’s Project with the Florida Department of Elder Affairs Long-Term Care Ombudsmen Program, “Florida Ombudsmen Training in the Artifacts of Culture Change (ACC) Tools,” took place on May 23 and 24, 2023. After FPN conducted eight (8) focus groups across the state in Part I with nursing home and assisted living administrators and their teams on their experiences with culture change practices, FPN provided in-depth training on what we learned and how ombudsmen can apply the ACC tools to their work. Additional efforts to partner with ombudsmen as culture change advocates is under discussion, and several ombudsmen have joined the FPN Steering Committee and coalition-at-large as a result of this partnering. For further information about how you could become involved, please contact any member of the FPN Steering Committee.

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