Choosing a Nursing Home: Culture Change Questionnaire

For more than a decade, pioneers in the long-term care field have worked to fundamentally change the values, practices and culture of their organizations to create places for living and growing, rather than for declining and dying.  This Culture Change(1) movement is gaining momentum - while many facilities maintain the old medical model, more and more facilities are embarking on the Culture Change transformation.  This questionnaire has been developed to help you determine if a nursing home is committed to implementing Culture Change, and how far along the Culture Change path the facility has journeyed.  If a facility has not yet initiated Culture Change, use these questions to determine if the nursing home is moving in that direction.  If at all possible, select a nursing home with a commitment to advance Culture Change approaches.
  

  

Developed by the Massachusetts Culture Change Coalition.

November, 2008

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Choosing a Nursing Home: Culture Change Questionnaire

Definitions(1)

Care Plan Meetings: The care plan is developed as a team effort - nurse, CNA, activities and dietary staff, and social worker, with critical input from the resident and/or family members. The ombudsman can also be invited to the meeting by the resident, family or facility staff. All participants discuss the resident’s care at a care plan meeting to ensure that all medical and non-medical issues (including meals, activities, therapies, personal schedule, medical and nursing care, and emotional needs) are agreed upon and addressed. The care plan details how the staff will help a resident every day and includes the methods for achieving defined goals. After an initial meeting when the resident is admitted to a nursing home, care plan meetings are primarily done on a quarterly basis. Including the CNA in the care plan meeting is a Culture Change approach, indicating that a facility is respectful of a CNA’s relationship with the resident, and the knowledge and training of a CNA.

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 CNA: The Certified Nursing Assistant (“CNA”) performs direct care and is the primary caregiver for the resident. If a facility has consistent CNA assignments, the resident and CNA have the opportunity to build a close relationship, allowing the CNA to gain a deep understanding of the resident and allowing the resident to develop a true level of comfort and trust with the CNA.  Substitute CNAs covering vacations and other absences are also consistently assigned to the same residents.

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Culture Change: Culture Change is the transformation of the medical model of nursing home care to a more social-based, home-like care model, focusing on resident choice and relationships -  not only between residents and staff, but also between all levels of staff and families/friends of residents.  Residents, families, and staff work in a cooperative and respectful way.  The resident’s daily life does not adhere to a rigid schedule, but is based on the resident’s life-long habits.

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Family Council: Federal and MA legislation support the creation and operation of Family Councils to help improve the quality of resident care and life.  These regulations give families, friends and representatives of nursing home residents the right to discuss concerns in a confidential venue, and require that a facility respond to the group’s grievances.  Also, Family Councils provide educational opportunities and a support system for its members, and often enhance activities programs.  Sometimes, nursing homes organize Family Councils chaired by facility staff.  Although such facility-run family councils can be helpful, they frequently do not provide members with a venue for sharing serious concerns in private or advocating for change.

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Neighborhood: Future nursing home models will build smaller units for approximately 10-20 residents to foster community-style living – for example, each unit will have its own dining area, nurses stations will not be prominent, d├ęcor will be more residential, etc.  Older facilities are making adjustments where possible, such as creating a sense of identity within smaller groups of residents - residents have more input into everyday activities; smaller dining areas; increased social involvement of staff, family and residents; eliminating public address systems, etc.

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 Resident Council: Resident Councils are run by and for the residents of the facility, and have the same rights under federal law as Family Councils. A Resident Council routinely meets to answer resident questions, organize events and discuss concerns. Facility staff may assist with the operations of the Resident Council, with the same issues mentioned under Family Council above.

 

Developed by the Massachusetts Culture Change Coalition.

November, 2008

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