Changing the Culture of Nursing Homes

As a hospice volunteer in Detroit nursing homes for nine years, I have become very familiar with the kind of culture that is predominant in many nursing home facilities. When I speak of culture in this manner, this is what I mean: Whenever we enter a building, a certain climate or culture greets us. Depending on what that culture is, we sense the possibility of the kind of experience we will have. If unpleasant sights, odors and sounds greet us after we enter, we will certainly draw negative conclusions about what to expect. And we will probably be correct. On the other hand, a culture that nourishes and stimulates appropriately makes us feel welcome, happier and encouraged to return.

Too many nursing homes have structured, unexciting and tense cultures that impact staff, patients, caregivers and other visitors poorly. Among other practices, patients are expected to eat and sleep at the same times on a daily basis, although most people would readily agree that people's natural schedules are not that aligned. The ongoing boredom and loneliness, along with excessive focus on rules and medical procedures, have lost sight of peoples' overall human needs. In addition, there is a layer of anxiety regarding compliance, or lack of compliance, with all the various rules that must be followed, regardless of how they impact people. In urban areas, particularly those that serve low income and racial-ethnic minorities, these factors are especially noticeable.

Fortunately, growing groups of reform-minded individuals are making their voices heard regarding the need for change in nursing home culture. They are not pushing cosmetic changes, but real changes in how people live and work together with a common goal. The focus is primarily patient-centered and encourages their independence. The following are a few of the alternative practices they are promoting to improve nursing homes:

1) Personalized schedules
2) Independent "houses" composing a nursing home
3) Family atmosphere with plants and small pets indoors
4) Regular contact with children through on-site daycare centers and after-school programs
5) More activities and decreased medication

As millions of baby boomers become senior citizens, we will be hearing more about these reforms. Our support will be needed to make these changes real and available to all patients, regardless of where their nursing homes are located. What do you think about changing the culture of nursing homes?

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes
Hospice and Nursing Homes Blog