Culture Creation: A Concept Based on Person-Centered Care

  • Recently, I came across an article that made me smile - really smile. I've written copiously about "culture change" in nursing homes. Part of culture change, pushed with great skill by the Pioneer Network's great work, is that nursing homes are becoming person-centered, rather than set up for staff efficiency. The irony of all of this is that once person-centered care is in place, the residents of the nursing home are generally much easier to care for.


    In person-centered care, the care is based on the needs of the individual. The person's who goes to live in a nursing home is no longer just a number. Most homes want to know a great deal about how the person made a living, how large a family they have and spouses and children's names, as well as food preferences, normal sleep patterns (for that person) and other personal details.

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    Now, according to an article on, the residents are being heard, and they want some rock and roll!


    Of course, this story is really more about coping with "sundowning," which is a common problem people with Alzheimer's experience. Toward the end of the day, they seem to have to go somewhere, or do something. They are anxious, agitated and their caregivers have a hard time settling them down. But it's also about culture change and boomers.


    Greenwich nursing home has an approach to care that is working. They provide activities for people at the time of day sundowning occurs to divert the people experiencing the stress. In an article titled Greenwich nursing home takes new approach to Alzheimer's care, the author explains other changes at Greenwich as well:


    "While there used to be music two or three times a week up on Redwood, there's now something for the residents to do every day between 2 and 4:30 p.m., whether it's music and dancing, or a tea social...The changes are among many that make up a new approach Greenwich Woods is taking in caring for people with dementia...'It's culture creation.'"


    I love that term - "culture creation." It implies, to me, that an effort is being made to make these last months or years of life for people in a nursing home culture rich with living, instead of time to wait for death.


    The article states: "If something looks better, you're going to eat it {talking about making pureed food look like the real thing}... noting that residents with pureed diets often feel isolated when they're served something that looks much different from what everyone else is eating. The physical environment is also important. Showering can be traumatic for people with dementia, so the shower room on the Redwood unit was painted and decorated with soothing blues and tans, and rechristened the ‘Spa Room.'"


    Considering what an issue bathing is for those who care for people with Alzheimer's, if the "spa" idea helps, the technique should spread rapidly. Advice on how to bathe people who are terrified of a shower or bath abounds, and most suggested approaches - quiet mood, warm temperature, soft music, no stress  - help. Yet people with Alzheimer's are unpredictable. What works one time may not the next. Most caregivers know that forcing the issue only makes matters worse. Sponge baths are often an alternative, until the next try. So, a spa environment? Why not?


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    The culture creation at Greenwich came with training from Alzheimer's specialists. I'm always excited to find, that one nursing home or chain of nursing homes at a time, progress is being made. Culture change, in the sense that person-centered care is far more successful - not to mention loving and humane - works.


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Published On: January 06, 2011