The "culture" in culture change
Some folks are not fond of the “culture change” title for this movement of person-centered care and home for elders. I’ve heard that people have a problem with it because it seems everyone will have to change their personal “culture” which indeed is a big part of our individualism. More nursing home centered language is sometimes favored to point out where the focus really is. However, the behaviors and practices we’d like to change are born in the greater climate of American culture. In our daily lives, these things may not seem to be a problem or at worst, an annoyance or something that can be quickly dismissed with a “Oh, that’s too bad.” But in the microcosm of a nursing home, their effects are amplified.
Take, for instance, one practice that is on the rise in our broader culture that is symbolic of the one-size-fits-all mentality that we are trying to abolish in nursing homes: the forwarded friendship email. Now, of course the people who send them mean well – the way we’ve always “meant well” in caring for our elders in nursing homes. But, there are some people who are so “busy” they maintain their relationships with these generic emails that at the end demand that if you are a true friend you will send it to 10 people or you’ll have bad luck. I understand that these are somewhat like the “old fashioned” greeting card, a way to say “I’m thinking of you” to someone. (Stick with me, this is not just a rant, I have a point.) But, when this sort of email (that is also sent to several other people at the same time) replaces a phone call or a lunch date to actually build and maintain a relationship, well the relationship dwindles to consist only of the “sent” and “delete” buttons – completion of task. You know it is in trouble when a file of cute cat photos gets sent to someone who doesn’t even like cats. This is just one example of efficiency trumping relationships. Substitute “care” for “email” and you’ll see what I mean.
When the world outside the nursing home walls reinforces bad habits, they are more difficult to break. So, call the movement whatever you’d like, but try out this activity to help people be more aware of how our culture effects what goes on in a nursing home.
Ask the group to brainstorm some examples of how culture at large influences the culture in nursing homes. You may mention the example above to get things rolling. Other examples may be multitasking, always being busy, liking things to move quickly (how many places and times do you think, “c’mon, C’MON!”), fast food, no use for elders, not respecting or honoring our elders, the ever striving to be “young and hip” and “fight signs of aging.” Let the group come up with what they can before you add any of these. List them on a board as you go. Now, have a discussion about each one, addressing these questions:
What does fast food (for example) look like in our culture and why do we do it and/or like it?
What are the disadvantages?
How do those things about fast food carry over into the nursing home?
How can we alter these practices to better honor people (staff, residents and families)?
This is obviously an exercise to get people thinking, but it can also be a great first step in making an action plan for creating person-centered culture in your nursing home and perhaps even in other areas of life.
Of course, this stuff could make for some very interesting learning circles with elders. (see learning circle directions) Since theirs is a generation that certainly honored their elders, ask them about it. What do they think of fast food? Why is everybody always in a hurry? What’s a good way to make someone feel special?
For more discussion-generating material related to this topic, try Dr Bill Thomas' book What Are Old People For? and the related article Maturing With Soul from our free resources page.
