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Culture clash in nursing homes'

by Carol Bradley Bursack, Editor-in-Chief

As our medical system helps people live longer, we are facing new challenges. One unique challenge is that the "very old," people in their 80s and 90s, and the "young old," people in their 60s and 70s often live in the same care centers. However, they come armed with different histories and different demands. This creates a type of culture clash. Assisted living centers and nursing homes are trying to adjust.

Person-Centered Care: Dealing with Culture Clash in Nursing Homes

If you think about what Grandpa George's life was like as he grew up during the Great Depression, you may be able to understand him a little better. The dust bowl of the 1930s still clogs his brain--memories of being crammed into a bed with his siblings to stay warm and the fright of seeing people begging on the street continue to linger.

Generational Gaps Do Exist

Today, Grandpa George now belongs to one of those groups scientists term the "very old." Although he's pretty sharp for his age, he still needs nursing home care for his fading body. What he enjoys most is chatting with others his age about the old times, good and bad.

Grandpa George and your dad often see each other, as your dad, who is only 68, has severe Multiple Sclerosis, and had to move into the same nursing home as his father. Normally, they get along okay, though their relationship was never close.

Grandpa George seems to derive pleasure in complaining loudly when he sees your dad, who never has had a great appetite, leave the food on his plate unfinished. This was always an issue when your dad was growing up as Grandpa George was a stern father who never forgot the scarcity of his own youth. Waste, to him, is a sin. Your dad couldn't always comply, and there was friction.

This badgering still makes your dad angry. But it isn't only Grandpa George and your dad who grate on each other. And the issues aren't only about food. There are now at least two generations living in many assisted living centers and nursing homes.

And these generations grew up under very different circumstances.

A More Privileged Generation

Your dad was born just before World War II. Rather than remembering the Great Depression, his memories are mostly of the post-war years when the soldiers came home, got jobs, and bought their first homes. Times were relatively good. During his teens, your dad saw television become commonplace in homes and he learned to love rock and roll. He grew up with hope for the future and an assurance that his life would be better than his parents' lives had been.

In most aspects, his life was better. But now, tough old Grandpa George still kicks up dust while your dad is just trying to make a life worth living while coping with his miserable disease.

They both want to listen to the music that the nursing home provides each afternoon. But Grandpa George wants polkas and "old time" music. He loves the city "kitchen band," and he enjoys big band music like Benny Goodman played.

Dad finds big band music okay, but the rest of the stuff a horror. He wants what many now would call "the oldies." Duane Eddy, The Ventures, the young Elvis--that is the music that gets his blood moving. To Grandpa George, that is just noise.

Combining Cultures, Effectively

The generation that was fine with the old perked coffee is being encroached on by a generation that wants gourmet coffee from freshly ground beans. The generation that thinks that Lawrence Welk still looks great on TV, even though it's re-runs they are watching and Welk is long dead, is sitting side by side with the generation that waits for the next nursing home computer class to open up.

A few leading edge boomers with ill health are joining your Dad, who is just a bit too old to be a boomer, and your stern old grandpa, who is two generations removed. These folks want video games and are glued to their personal laptop computers.

What's a good nursing home to do?

It Begins with Person-Centered Care

Adjust. This is not a circumstance that is going to go away.

Today's person-centered nursing homes are scrambling to please everyone. They are installing Wii game systems which allow elders of many ages to virtually bowl, when they wouldn't be strong enough to lift a real bowling ball. They give the very old, the young old and even boomers a way to connect on common ground.

These homes may have to install two types of restaurants--one, an old style country store with a common coffee pot and checkered table cloths and one with computers and three types of java, but hey, if it works, why not?

People treated as individuals are nearly always easier to care for. They also get along better with their peers. So, even if Grandpa George scolds your dad about leaving food on his plate, your dad may still be a happy camper, since he knows he can soon escape and listen to Bob Dylan sing about rebellion.

And Grandpa can say, "good riddance" as he wheels in to view one more re-run of Lawrence Welk while he has fond thoughts of dancing with Grandma Bessie. When that is done, the two may meet on common ground for some Wii bowling.

Person-Centered Care: Providing New Options in Care

It's all part of the evolution turned revolution in assisted living and nursing homes. When person-centered care is given, when people's pasts are recognized and made part of their present, everyone wins. With careful thought and planning, this culture clash may actually improve the lives of all elders in assisted living and nursing homes.

Who can argue with that?