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Why is it so hard to change the culture of long-term care?

by Sue Lanza

Changing the way we care for seniors or modifying the "culture" in long-term care settings has sparked many new approaches that have been in the recent news. Progressive advisory groups such as the Pioneer Network or the Eden Alternative have offered up logical methods for adjusting the way that we help seniors age gracefully. So why can't we just do it?

You've heard the expression "you can't teach old dogs new tricks". Boy does that ring true when I think of my days trying to implement a much needed revolution in dementia care in one facility where I worked. But it doesn't matter what aspect of senior health care your group wishes to change. I have reluctantly discovered that trying to make even the tiniest alterations in the way things are done brings screams of terror and/or a general feeling of discomfort. Intellectually, we know that encouraging more of a social model of care that allows clients features like community and support is the better way, yet emotionally we have trouble letting go of our old methods of doing things. Here are a few reasons why we cling to our ancient habits and resist change.

"We've Always or We've Never" Thinking

I can't tell you the number of occasions in our dementia culture change project that we would be having a discussion about a subject such as modifying the environment and someone would interrupt and start to tell me why this could not be done. Almost without fail, it would be either one of these two wonderful reasons:

  • "We've never done it this way"
  • We've always done it this way"

How could we possibly think of changing anything when this has been our security blanket. We know it works and we are fearful of any new routine. Crumbling these brick walls of thinking and beginning to look at new ways of getting the same things done is not for those with sensitive stomachs. You will need to listen to this talk quite a bit and stonewall the group until they begin thinking outside the box. There is no other solution except to maintain the vision of change and keep at it. If you think this is easy, reflect back on when you first learned to use a computer. You never thought you couldn't do it but after much pushing, here you are on the web doing things so differently.

The People

The folks that are responsible for the transformation in long-term care may also be lacking in motivation as well as stuck in same-old thinking. We don't like to admit it, but some workers in long-term care are there strictly for a paycheck. There, I said it. I know that this could be true for all types of industries but many entry level jobs can be found in the booming health care field. Some workers are not up to doing anything beyond their eight hours a day plus breaks. That being said, our dementia project of opening a new dementia special care unit had its fair share of unmotivated team members but slowly, sometimes painfully, a line-up of like-minded people came together.

The Money

You knew that eventually money had to play a part in this. For some programs to get off the ground and stay afloat, cash must be spent upfront to get it moving for things like training, consultants, environmental changes, etc. For example, we looked at getting the Eden Alternative training and couldn't swing it because of the cost factors.

The other end of the expenditure spectrum might be the owners and managers looking at "what will I get out of this"? If a culture change occurs and the overall social environment is improved with residents that are thriving and happy, there is still is this nagging price tag question. Will we get reimbursed more? Usually the answer is no; and for our dementia remodel, it was definitely no. Will it help our marketing efforts? Probably. However, any change of this type is not done for cash flow or awards but rather because it is the right thing to do! Could you put a value on your relative's quality of life? No, I thought not.

The Daily Grind

I found out the hard way about what was the last and most notable factor in making culture change in long-term care so hard to do. It turns out that you can eventually make change slowly with the kicking and screaming I mentioned earlier, but maintaining that change? That is another story entirely! I thought that once we opened our newly configured dementia unit after 18+ months of struggle that we had our worries behind us. Instead, we weathered through years of the unit being open while key staff members moved, budgets were cut and new administration didn't see the vision. It was excruciatingly difficult at times to keep going successfully but there was also a force behind it of those who were there from the start. Maintaining the culture change was more challenging than starting it up from scratch. What a lesson!

So you're thinking to yourself,"Wow, she is so negative. I thought this was going to be an uplifting piece". It isn't negativity; it is just being realistic about what it takes to make these changes occur. These are some of the reasons why every facility in America hasn't embraced culture change as we had hoped.

Despite all the obstacles that I mentioned, there are groups just like mine in long-term care feverishly tackling culture change every day. And if you asked us to put a value on our efforts in raising consciousness in quality of life for our seniors in long-term care, we would all say that is was "priceless."