New eyes

“Trompe l’oeil” is French for “trick of the eye.” The term is often applied to art that tricks the viewer into seeing something that either isn’t actually there or can be perceived as different things depending on how you look at it.

For example: young girl or old woman?


(Yes, this is the culture change blog. I’m getting there...stick with me.)


AND...here’s my point. There are lots of silly things going on in long-term care that add up to a serious lack of home. They’re there, we just don’t see them because we’re not really looking. But, if these things were going on in our own home I bet we’d notice. Check out this excerpt from In Pursuit of the Sunbeam (get your copy here.) by LaVrene Norton and Steve Shields:

Try on a pair of catalyst glasses that allow you to see the dust, the problems. Let yourself see the degree to which your facility honors home, normalcy, relationships, privacy and choice. Walk through your facility with new eyes and play a game – “Things That Are Stupid” or “Things That Are Not Home” or “Things That Would Make Me Crazy If I Lived Here.” Do it not because you can change these things immediately, but because you need to see. We need to experience the irritant as the first step to changing it.

Do you see these things?
• No salt and pepper shakers or sugar packets on the tables.
• Lists that dictate when people take baths; elders pushed in wheelchairs down the public hallway to the bathing room, naked under their robes, feeling vulnerable and cold; the dreaded shower chair experience.
• Schedules for awakening residents, starting at 5:30 a.m. when you dress them and set them in front of the nurses’ station to snooze for two hours until breakfast.
• Residents put to bed at 6:30 p.m.
• Waking residents up every two hours to turn them.
• The facility turned into a prison for fear of elopement.
• Alarms placed on the bodies of confused residents that go off every time they get up. What must that feel like for the elder? Does she become increasingly anxious about the alarms yet unable to escape them to somewhere that feels safe?
• No real “alone time” for residents, especially for those paired with a stranger for a roommate after having lived for decades alone or with a spouse. Nowhere for the resident to go for quiet and solitude.

Ask everyone to make a list of his or her discoveries throughout a couple of work days. Even ask elders to make lists. Then get together and discuss your findings. Once you’ve seen these things for what they really are, it will be hard not to move forward with change.

Just a reminder: all blogs and hand outs are available in a downloadable, pretty format here. Print them out and make copies for participants in your training sessions or meetings. This blog is for YOU to keep up a learning environment in your organization.

Spread the word

It is common to think culture change is a movement in long-term care, but, to truly be effective, it needs to be a movement in our whole society. It is not only the folks who work in nursing homes who need to value choice and home and the elders themselves, but everybody. A) because we need to stop isolating frail elders from society in general. B) because it is really everybody’s issue because we all grow old. C) because the more folks that get on board, the more it will become the norm and what is expected of long-term care. Family members will demand their loved ones have choice and home. It is easier for the traditional, institutional model to exist if there is no demand otherwise.

When people ask me, “So, what do you write about?” and I say “nursing homes,” I can almost see behind their eyes thoughts of linoleum floors, institutional clutter, people staring and slumping all bathed in a blue/grey florescent glow. And then I go on to tell them about culture change, about the way it is and the way it could be. I see them begin to shut down as I describe a life without home and choice because nobody wants to think about it. But when I go on to talk about the bright possibilities and the quiet but strong efforts being made for deep change, I see hope in their eyes and I know they will think about it if and when the times comes for a loved one to move into long-term care. I know they will think about the aspects of “home” in a nursing home.

So, here’s the activity: Next time you are somewhere and somebody asks you what you do for a living, or how work is going, tell him or her about your culture change efforts. You don’t have to drag out your organization’s Values Statement, but make a statement of value by telling them about how you’ve changed breakfast, instituted permanent staffing, gotten rid of departmental silos or, bless you, put elders back in the driving seat of their own lives with resident-directed care. And tell them why. Get them excited. Help create the demand. I bet you’ll even feel some pride about your work too.

You can also do a learning circle with your team on: "What can I tell my neighbors and friends about our culture change efforts here?" or "What am I proud of regarding our culture change efforts?"