Long-term Care Culture Research Articles

Insights from recreation and leisure practitioners regarding disparities of advancing long-term care culture change

ABSTRACT Culture change in long-term care (LTC) signals a shift from a medical model of care to a social, relational model of caring to support the creation of strong compassionate communities and promote quality of life. Since leisure is a strong contributor to quality of life in LTC, researchers have argued that recreation and leisure practitioners have an important role to play in the culture change movement. In this paper, we describe Canadian recreation and leisure practitioners’ perceptions of their role and experiences in the LTC culture change process. Findings highlight how recreation and leisure practitioners see their role as drivers of culture change but question the role of formal education in advancing culture change initiatives. In light of the findings, we discuss the opportunities and challenges that exist for recreation and leisure practitioners as they realize their potential to advance culture change in LTC.

Experiences of Social Distancing During Coronavirus Disease 2019 as a Catalyst for Changing Long-Term Care Culture.

Purpose In this article, we draw a parallel between the experience of social isolation that occurred throughout the world during the Coronavirus Disease 2019 pandemic and similar experiences occurring in everyday life for people with communication disorders living in long-term care (LTC) facilities. We propose that speech-language pathologists can use the widespread experience of social isolation as a learning catalyst in the effort to shift the LTC culture to one that more highly values a communicative environment that is accessible to all, thereby reducing risk of social isolation for those with communication disorders. Conclusions Many training paradigms for promoting an accessible communicative environment are available in the speech-language pathology literature, yet institutional barriers exist for their widespread implementation. Overcoming these barriers is a challenge that requires awareness and learning on the part of staff and administration regarding the impact of an unfriendly communicative environment on social isolation, and the resulting psychosocial consequences. Learning theory indicates that new learning in adults is motivated by connections between personal experiences and the material to be learned. Explicitly infusing established training programs with the experience of social isolation brought on by the Coronavirus Disease 2019 pandemic may be the key needed for changing the communicative environment in LTC.

Changing the Long-Term Care Culture Through Interprofessional Practice: A Speech-Language Pathologist–Led Initiative

Purpose This article describes a speech-language pathologist–led effort to implement a facility-wide dining culture change from institutional-style “feeding” toward home-style “dining” at 1 long-te...

The potential for leisure to be a key contributor to long-term care culture change

ABSTRACT Long-term care (LTC) culture change describes efforts to transform LTC homes into caring communities where quality of life is paramount. Since leisure is recognized as one of the strongest contributors to quality of life for individuals living in LTC homes, it has a vital role to play in the culture change process. In this paper we present findings from a study that examined ways leisure programs and practices in LTC homes align with culture change principles. These findings highlight ways leisure is providing opportunities for residents, team members, and family to be in relationships where there is deeper knowing of individuals and celebrations of their lives, a sharing of power, and opportunities to work together to enhance meaningful experiences. We argue that in order for leisure to fulfill its potential as a key contributor to culture change, there need to be more flexible and freely chosen experiences that bring people together and help to create nurturing communities within LTC homes.

Culture Change: Pioneer Network Forges New Partnerships

Culture Change: Pioneer Network Forges New Partnerships

Changing the culture of long-term care through narrative care: Individual, interpersonal, and institutional dimensions

Interest in the practice of narrative care with older adults is continuing to grow (Kenyon & Randall, 2015). Significant attention has been paid thus far to various formal interventions or programs that enhance the narrative development of individuals in later life by helping them to express and explore their unique life story. Comparatively little, however, has been paid to the many informal opportunities for practicing narrative care in long term settings that occur amidst everyday interpersonal interactions - e.g., staff-resident interactions in nursing homes. Even less attention has been paid to the importance of cultivating an overarching institutional narrative that provides a supportive context for the practice of narrative care in general. This paper will contribute to discussions of “person-centered care” by arguing the need to change the culture of long-term care so that narrative care is practiced on all three levels at once: individual, interpersonal, and institutional.

Join the Revolution: How Montessori for Aging and Dementia can Change Long-Term Care Culture.

Efforts to improve the quality of life of persons with dementia in long-term care through the implementation of various approaches to person-centered care have been underway for the past two decades. Studies have yielded conflicting reports evaluating the evidence for these approaches. The purpose of this article is to outline the findings of several systematic reviews of this literature, highlighting the areas of improvement needs, and to describe a new person-centered care model, DementiAbility Methods: The Montessori Way. This model focuses on the abilities, needs, interests, and strengths of the person and creating worthwhile and meaningful roles, routines, and activities for the person within a supportive physical environment. This is accomplished through gaining the commitment of the facility's leaders, training staff, and monitoring program implementation. The potential for a culture change in long-term care environments is dependent on the development and rigorous evaluation of person-centered care approaches.

Changing the Culture of Long-Term Care: Combating Heterosexism

The purpose of this article is to describe how heterosexism impedes the provision of culturally competent care for lesbian, gay, bisexual, transgender, and queer (LGBTQ) residents in long-term care (LTC) facilities. LTC facilities continue to employ staff members who lack an understanding of sexuality and sexual diversity in the elderly. In this article, we identify the heterosexual assumption, namely heterosexism, as the primary issue surrounding the holistic care of the LGBTQ elder in LTC. We first review the literature related to LGBTQ elders in LTC facilities, identifying the themes that emerged from the review, specifically the definitions of homophobia and heterosexism; perceptions of LGBTQ elders as they consider placement in LTC facilities; and staff knowledge of and biases toward sexuality and sexual diversity in LTC settings. Then, we suggest approaches for changing the culture of LTC to one in which LGBTQ elders feel safe and valued, and conclude by considering how facility leaders are in a unique position to enable LGBTQ elders to flourish in what may be their last home.

Introduction

"Introduction." Anthropology Now, 6(1), pp. 1–2 Additional informationNotes on contributorsMaria D. VesperiMaria D. Vesperi is professor of anthropology at New College of Florida. Her research interests include cultural constructions of aging and race in urban North America, early industrial history and the relationship between ethnographic writing and narrative journalism. Her publications include Anthropology off the Shelf: Anthropologists on Writing (2009), co-edited with Alisse Waterston, City of Green Benches: Growing Old in a New Downtown (1998, 1985) and The Culture of Long Term Care: Nursing Home Ethnographies (1995), co-edited with J. Neil Henderson. She was executive program chair of the 2006 AAA Annual Meeting and recipient of the 2009 AAA/Oxford University Press Award for Excellence in the Undergraduate Teaching of Anthropology. She currently serves as chair of the AAA Summer Internship Subcommittee.

Alternative Therapies for a New Era of Health Care

More than 20 years ago, an article about the use of music, art, and pet therapy in nursing facilities appeared in this journal. At the time, these fields were still evolving, and there was limited clinical evidence regarding their value. While there were a few champions of these therapies among practitioners, many more were skeptical about their benefit to long-term care facility residents. This article presents an update on these alternative therapies in light of recent developments in health care, changes in the culture of long-term care, and federal efforts to reduce the use of antipsychotics. Key Words: Alternative therapy, Alzheimer's disease, Animal-assisted therapy, Antipsychotics, Art therapy, Cognitive impairment, Dementia, Music therapy, Nonpharmacological, Pets, Quality of life.

The Physician's Role in Long-Term Care Culture Change

This article describes an approach to nursing home physician care that allows physicians to play a more integral role in the long-term care culture change movement. Through a simple refocusing of the traditional clinical assessment and plan, the physician's role is shaped and redefined, support staff more clearly see how the physician may contribute to the effort, and residents and families are reassured that the entire care team is working together to improve the care provided.

Beyond the Medical Model: The Culture Change Revolution in Long-Term Care

Culture change in long-term care facilities involves a shift in philosophy and practice from an overemphasis on safety, uniformity, and medical issues toward resident-directed, consumer-driven health promotion and quality of life. Fundamental to this shift is a focus on the importance of the relationships between residents and direct care staff. This review presents and discusses the key elements of culture change, including workforce redesign, resident-centered care, leadership, and the implementation process and evaluation. A case report describes how medical staff can participate in this grassroots movement and help foster the social, cultural, programmatic, and physical changes that can alter the culture of long-term care one home at a time.

Green House Projects Show New Life for Long-Term Care

Green House Projects Show New Life for Long-Term Care

Unfolding the Culture Change Map and Locating Ourselves Together

Abstract One promising aspect of the culture change movement in long-term care is the collective effort to “junk the jargon” to do away with institutional language and instead speak plainly in a way that makes it possible for the voices of elders to be heard. This article was written with that spirit of listening in mind. It was co-authored by a 35-year-old gerontologist and an 87-year-old retired professor of social work and sociology with direct experience as a “patient” in the old long-term care culture. The introduction was written by the elder, and her wisdom and perspective guided the body of the text.

Changing the Culture of Long-Term Care

Abstract “Culture change” the effort to transform long-term care institutions into communities where elders and workers thrive has become a significant part of the national agenda in long-term care. This article addresses the difference between programmatic change and the deep, organizational transformation known as culture change. There is a growing need to distinguish between these types of change in order to establish a clear definition of what it means to transform organizational culture This article explores how institutions can become true home by examining how their espoused values align with their values in action. Most importantly, it emphasizes the need to flatten the traditional hierarchy and involve residents and direct-care workers in planning and implementing changes that empower them as decision makers in their own lives.

Quality Oversight and Culture Change in Long-Term Care

SUMMARY The culture of long-term care is changing as the Baby Boomer generation ages, needing long-term care but finding that the quality of care is such that many would rather die than enter a long-term care facility. While quality oversight mechanisms are looked to for protection of consumers, in fact regulations have been seen by the industry as restrictive in this changing culture. This article explores the ways in which quality oversight organizations attempt to address quality and proposes a model for conceptualizing quality oversight alternatives that may help mediate the conflict between the quality oversight and changing long-term care cultures. Finally, challenges are summarized regarding what the various stakeholders in long-term care might do to form partnerships in meeting the needs and desires of the long-term care consumer population.

Culture Change in Long Term Care

SUMMARY While embarking on a journey to learn how to survive in the permanently altered health care marketplace, a group of eleven Wisconsin not-for-profit providers learned that the true keys to sustained organizational quality include teaching line staff best clinical practices and, more importantly, in changing the typical long-term care culture of control. Wellspring Innovative Solutions for Integrated Health Care emerged in 1994 as a pro-active response to the trend toward “managed care,” decreased reimbursement, limited human resources, increased resident acuity, and increased consumer demand for quality. Despite increased challenges in these areas, today Wellspring members have continued to be totally committed to providing quality care and quality of life to those served. At its core Wellspring believes that few individuals are working in long-term care today for the pay. Rather, individuals are attracted to the field because they want to make a difference. Wellspring focuses on showing line staff...

Embracing the Eden Alternative in long-term care environments.

As we move toward the new millennium, 76 million Baby Boomers are on the brink of retirement. For some seniors, long-term care will be a necessity. Older adults value independence, physical activity, intellectual curiosity, caring, and spirituality. The long-term care culture is being revolutionized by The Eden Alternative, which strives to decrease loneliness, helplessness, and boredom by developing healthy habitats in a home-like environment. Three key components are children, plants, and companion animals that provide variety and spontaneity in life.

The Culture of long term care: nursing home ethnography

Foreword by Philip B. Stafford Introduction Perspective on Ethnographic Methods, Analysis and Findings Nursing Home Research Comes of Age: Toward an Ethnological Perspective on Long Term Care by Maria D. Vesperi Perspective and Story in Nursing Home Ethnography by Jaber F. Gubrium Qualitative Research as a Tool Revealing Inappropriate Medicalization of Aging in Nursing Home Care by J. Neil Henderson You Say Respondent, I Say Informant: What Stories Told by Informants Can Tell Us by Lisa Groger Ethnography and the Nursing Home Ombudsman by Lynn D. Mason In and Out of Bounds: The Ethics of Respect in Studying Nursing Homes by Joel Savishinsky Ethics in the Nursing Home: Cases, Choices, and Issues by Renee Rose Shields The Head Nurse as Key Informant: How Beliefs and Institutional Pressure Structure Dementia Care by Athena McLean and Margaret Perkinson Staff/Resident Life Assessing Types of Residential Accommodation for the Elderly: Liminality and Communitas by Barbara Hornum Relatives as Trouble: Nursing Home Aides and Patient's Families by Nancy Foner From the Inside Out: The World of the Institutionalized Elderly by Bethel Ann Powers Continuities and Discontinuities in the Life Course: Experience of Demented Persons in a Residential Alzheimer's Facility by Myrna Silverman and Carol McAllister References Index