Culture change in eldercare.
I first heard the term a few years ago, and it wasn't until having the words come up in several conversations, lectures and workshops that I realised I didn't have a good understanding of what it meant. I understood change (although definitely not all the implications) but culture? It took reading and thinking and listening to be begin to get a handle on it.
Our society has had a certain accepted way of looking after our elders. We have government regulations to make sure they are safe, well-fed, clean and cared for. In fact, we have government regulations up the wazoo. The problem is the government regulations take on a life of their own, requiring documenting, regulating, inspecting and follow up. The people who are paid to do the caring spent huge amounts of their times managing the regulations. Also, I can be "safe, well-fed, clean and cared for" and be bored, feel useless, and as if my life is over.
Culture change says it doesn't have to be that way.
Here is one definition:"Culture change" is the common name given to the national movement for the transformation of older adult services, based on person-directed values and practices where the voices of elders and those working with them are considered and respected. Core person-directed values are choice, dignity, respect, self-determination and purposeful living." 1
How does this look, especially with people with dementia? Can they really direct their care? Have purposeful lives?
Yes. The answer is yes.
It look like this:
* George doesn't want to shower. He can't do it by himself, and he isn't about to let a woman, or even a man shower him. Showers cause him a huge amount of stress. So the caregiver begins to talk to George about his grandmother, and while they are having a great conversation in the bathroom, she hands George the cloth and he cleans his front while she quickly does the back. He brushes his own teeth and shaves--tasks he's still able to do. They keep talking the whole time, and at the end, he gives her a hug.
* Mabel likes a slow start to the day. Breakfast is long over by the time she is ready to eat and get dressed. Mabel is allowed to sleep until she wakes up on her own. Her breakfast is brought to her on a tray, which she enjoys in her room. She is ready to face the day about 11:00. Some days, she will skip lunch, but have a sandwich around 2:00. By dinner time, she happily joins her table mates in the dining room.
* Doreen is in a wheelchair, and can't walk on her own any more. In her youth, she used to be a ballroom dancer, and when the right music is playing, her feet start to twitch. One of the staff helps her up and holds her to maintain balance, and she moves in time to the music. Doreen is smiling.
Culture change is about finding who the person is and what matters to them, and giving the needed care based on this. It asks. It listens. It respects.
At the end of the day, the elder, no matter what their physical, mental or emotional state, has purpose.
They matter. They always did, and they always will, until the end.
Culture change is difficult, expensive and incredibly worth every effort and every cent.