I personally think it is wonderful plan, but understand the fear and concerns direct care staff face while implementing these changes? Is anyone implementing this in there facility?If so what are some of the changes you have made? & How is it working so far? Any tips?:rotfl:

Could you explain what this is in more detail?

Culture Change is an initiative that promotes changing the culture of the traditional nursing home setting which is more institutional environment to that of a more family-homelike environment. Examples of Culture change in long term care are:

- No nurses stations

- No specific meal times, residents eat when they want

- No expectation of rise times or sleep times, residents awake and sleep when they want

- No shower schedule- residents shower & bathe when they want

The goal is to develop an environment that is as close to the one in which we all live everyday, an environment which is focused on the needs of the resident.

This sounds more like an assisted living than a nursing home to me!

Well than ALF have home-like culture...and I believe residents would able to celebrate life in a nursing home more if the routine was more customary.

nice CONCEPT.......

WOW, this is interesting...I can not wait to see if more nurses are familiar with culture change in LTC.

I had an administrator that was pro culture change.

It sounds nice, and maybe if impemented the problems would be worked on, but looking at it, I would not want to be in on the change. Getting everyone up to eat is challenge enough, but what if 6 people want up at the same time. I think there needs to be structured environment. To me, it would be a nightmare for the MDS nurse, not to mention ancilary departments like dietary. Dietary would have to evolve into a restaraunt type setting. (that might actually be good- who wants to eat those soggy noodles that have been sitting in a pan for a long time. eeewww)

While it would be more like home for them, enabling more choices, etc, I don't have the staff to make that happen.

Good Point, so lets validate:

Currently, most LTC have set eating times of which entire units eat at the same time and individuals whom need assistance receive that assistance with minimal difficulty. So imagine if lunch time where served from 11 am - 2pm than those same 6 individuals whom need assistance to eat could be spread out over the course of the meal time according to when they prefer to eat. Dietary would definitly change but as you stated this change may only improve the department. As I am sure anyone who works in LTC knows resident counsel meetings often always reveal complaints about dietary...because choice of food is often all the control many elderly have...why not give them this. If the residents could eat what they want when they want, this may increase satisfaction.

Please elaborate on the problems you feel the MDS Coordinator would experience... Culture change is a little challenging...kinds of reminds me of a period about 10-11 ears ago when we had to put all the siderails down:lol2:

That sounds very nice for ALFs, but LTC needs more routine than that. If you left it up to some residents, they'd NEVER bathe. Either because they don't want to or are unable to make the decision to do so--and eating may be the same way. Some residents are unable and staff would have to be increased by quite a bit to meet the many different demands of people who need assistance with their ADL.

I'm not getting the part about eliminating nurses stations--but I do realize they take away from the home-like atmosphere. But with nothing put aside, LTC is STILL a healthcare environment. Nurses need a place to do their work and what better place than somewhere that all the residents can find help if they need it?

I agree there will be those residents that have poor decision making skills and for these residents we need to provide guidance and structure...then there are those residents who are able to create there own routine but that right has been taken away from them. Who says health care has to be so institutional...We have been made to believe that this is the only way nursing can be provided. I disagree 100%. In home health care or in a group home setting an individual goes into the residents home and provides care that is as close to the way it would have been done if the resident were doing it independently. LTC should be the same way.

I agree that nurses need a place to chart and review documentation, call physicians, etc...but why does it have to be at a nurses station which sits in the middle of the residents living room...could an office service the same function? Or even a documentation room?

If I ever have to go into a LTC facility to live, I know my quality of life will be better if the staff conforms to my customary and routine instead of making me conform to theirs.

I think it is amazing that LTC is finally catching up with industry that provides care for people with developmentally disabled who long ago learned that warehousing people in big buildings leads to poor care and poor outcomes. Now most people with DD get care in small group homes, sometimes with as few as three people in a real home in the community. I would love to see small group homes for the elderly, with real skilled nursing care. I bet you would see much better outcomes. Plus, as the DD industry discovered, it is actually cheaper to have 10 little homes than to maintain one huge building.

Wonderful concept, but doomed to fail unless staffing ratios improve DRASTICALLY. Why even bother with these concepts when the concept of nurse patient ratios have not been seriously addressed in LTC? Seems like putting the cart before the horse.