By Julie Follo

As America’s baby boomer generation ages into retirement and beyond, the nation’s long-term care system is changing to meet the needs and expectations of this burgeoning population. While nursing homes have traditionally been the cornerstone of our long-term care system, in recent years admissions have declined and emphasis has shifted to the development of community-based programs and services for elders. Nursing homeowners, administrators and advocates realized that major changes were needed in the delivery of institutional care and have initiated a major drive to reinvent the nursing home. This initiative has been labeled the culture change movement.

 We as PGCMs have several responsibilities. We must give our clients the opportunity to demonstrate appreciation and to give back. We must allow ourselves, and the caregivers with whom we work, to experience the recognition and gratitude for work well done. Ultimately, however, our primary focus must be to maintain our ethical standards, values, and a strong sense of empathy for both the paid caregiving staff upon whom our work fundamentally depends, as well as clients we serve.

In this way we will be able to maintain the necessary professional respect and influence necessary to impact the care of current and future generations facing the challenges posed by longevity. What is culture change? Culture change is the term given to the national movement for the transformation of nursing homes – and other long-term care services as well – with a goal of improved quality of life for elders through greater autonomy, self-determination, and daily lifestyle choices.

Culture change transformation involves several different components. In terms of the physical environment, the term refers to the shift from traditional institutional corridors, rooms and nursing stations to the creation of smaller, more homelike housing with living space for a small community of people built around a central living area, a kitchen and separate private bedrooms and bathrooms.

Another aspect of culture change involves the introduction of children, pets and plants into the nursing home to promote positive interactions for residents in a pleasant, vibrant environment. Culture change also involves a major change in workforce models by strengthening the role of the front-line worker (traditionally the certified nursing assistant) through advanced training, continuity of assignments and increased decision-making authority.)

Finally, and perhaps most importantly, culture change involves the adoption of “person directed practices” and “person-centered language.” Person-directed care enables greater choice for the resident in aspects of daily life such as the times for getting up and going to bed, eating, napping, going outdoors, bathing, and the content, method and timing of meals. Person-centered language emphasizes a shift from terms like “wheelchair-bound” to “person who uses a wheelchair for mobility,” or from “feeder” to “person who needs assistance with dining.”

In some facilities, the term “resident” is no longer used, wings or units are called “neighborhoods” or “communities,” and admission and discharge is referred to as “moving in” and “moving out.” All of these practices are designed to create a humane environment that places the individual first by supporting and respecting each person’s dignity, rights, freedoms and individuality.

Examples of culture change in action One of the early culture change initiatives, the Eden Alternative, was started by Dr. William Thomas in 1992 in a nursing home in New York State. The Eden philosophy is dedicated to eliminating the loneliness, helplessness and boredom that too often characterizes institutional care. Eden communities emphasize the inclusion of children, companion animals, indoor plants and gardening in the lives of residents. Caregivers encourage the residents themselves to direct and manage as much of their own care as possible.

 A new initiative, Eden at Home, will soon expand these concepts to the larger community by offering person-centered long-term care services at home. Read more about the Eden Alternative on their website, Green House homes, also developed by Dr. Thomas, began in Tupelo, Mississippi in 2003 and are now being replicated across the nation. These homelike, residential style buildings house six to ten elders, with a central living room and kitchen and private bedrooms and bathrooms for each resident.

Each house has two nursing assistants on site who are responsible for running the home, including cooking meals and doing chores with participation from the residents themselves. Green Houses also embrace the inclusion of sunlight, green plants and access to outdoor spaces as essential components of a health-promoting environment. Information about the replication of Green House homes can be found at Interest in the culture change movement is growing, resulting in the gradual transformation of long-term care in many settings across the country.

Other examples of established culture change models include the Pioneer Network (, the Wellspring model, Planetree (, and the small house movement ( As these models proliferate, we can look forward to a long-term care delivery system that puts each individual’s needs and preferences at the forefront and nurtures not only the body, but also the mind and spirit.

Julie Follo, RN, MSN, CMC, has over thirty years of nursing experience, including inpatient oncology care, discharge planning and case management. She is currently Supervisor of the Educational Services department at Connecticut Community Care, Inc. She was the 2008 recipient of the Nightingale Award for Excellence in Nursing.

Advocare Care Management is your preeminent care manager in Boca Raton. We work with you to get the resources, tools, support, connections, and advice for aging life care for seniors or loved ones. We assist families throughout South Florida including Palm Beach counties. We are available 24 hours a day and will give you the help you need. Contact Advocare Care Management today and let us help you.

Reprinted with permission from Advocare Care Management is the place to go when caring for an aging loved one.