Assisted Living and Culture Change

November 2006

The growth in assisted living communities over the last decade and a half has been part of an impressive and hopeful widening of the long-term care and service-rich housing spectrum. Different options for non-institutional care have emerged just as a new grassroots movement has begun to transform existing institutional settings so that care is individualized and resident preferences and choices are honored. Known commonly as “culture change,” this movement is now evolving beyond a small number of early adopter nursing home organizations and its principles and practices are beginning to spread outside the walls of traditional nursing homes.

Which brings us to the question: does “culture change” have any real meaning in the context of assisted living? After all, the core concepts and philosophy of assisted living – autonomy, privacy, dignity, flexibility, and individualized services – are clearly aligned with what culture change is supposed to be all about. In other words, perhaps there is no need for culture change in assisted living because the culture of assisted living communities already possess that which advocates for culture change in institutional settings seek.

But do they?

Clearly not all places calling themselves “assisted living” are fully implementing the core principles of assisted living. Culture change has much to offer these organizations as they work to live up to the foundational elements of the assisted living philosophy.

Words like autonomy, privacy, dignity, flexibility and individualized services sound good in marketing materials, but how does an organization go about actually making them a reality in the day-to-day lived experience of assisted living residents? Simple having private rooms and non-institutional décor is not enough.

Leading assisted living organizations bring those principles to life by implementing management practices that make it possible for direct care workers to truly understand and act on the personal care needs and lifestyle preferences of residents. Such management practices include having direct care staff work as equal members of self-led work teams, training direct care workers in person-directed care practices related to bathing and other personal care routines, and establishing consistent assignment of direct care workers so they can form meaningful relationships with the residents whom they serve. Forward thinking management practices also involve making sure the relationship between the direct care worker and her immediate supervisor is a healthy one, where the direct care worker feels appreciated and part of an organization that honors her contribution.

All of the above practices are being promulgated as part of the culture change movement, and they apply as equally in assisted living communities as they do in nursing home environments.

A second area where the notion of culture change applies to assisted living is in building a sense of community that ties the organization to a broader civic life. Emphasizing the individual elements of autonomy, privacy, dignity, flexibility and individualized services obviously makes good sense, but if assisted living residences are to be true assisted living communities then a healthy sense of community-life must be nurtured and respected.

Simply by nature of their newness, many assisted living residences do not have natural connections to the philanthropic and civic engagement history of their surrounding neighborhoods. The residents themselves are the connection when they move in. An active community life and a sense of a broader connection require constant nurturing on the part of visionary leadership. Culture change practices like a regular community meeting and the creation of a shared organizational story can have great utility when working to cultivate a vibrant assisted living community.

So what does “culture change” mean in the context of assisted living? The good news is that excellent assisted living communities are living out the basic tenets of a changed culture every day. They have much to teach others who seek to remain true to the foundational principles of the assisted living philosophy.

Further reading to learn more about culture change and person-directed care:

Commonwealth Fund - Transforming Long-Term Care: Giving Residents a Place to Call "Home"

Pioneer Network – “Continuum of Direction” care practice examples

--
Joe Angelelli, Ph.D