Dr. El's subversive guide to culture change

Dr. Eleanor Barbera
Dr. Eleanor Barbera

We often think of culture change as a formal process initiated by company leaders that involves setting organizational goals and moving employees in big and small ways toward those goals.

But culture change also can be a grassroots effort that shifts the dynamics between residents, staff and community, one unit at a time.

Altering expectations

As a psychologist, I've been trained to observe the interactions of groups of people. The current dynamics of many long-term care settings involve residents who are in the passive role of “recipients of care” while the staff members are in the active role of “providers of care.” The residents are frequently isolated from each other and from the community outside the facility. They feel bored and useless, leading to depression.

Leaders in the culture change movement, the Eden Alternative calls loneliness, helplessness and boredom the “three plagues” of long-term care. Its aim is to eliminate these plagues through transforming the culture of the facility. Another culture change resource, the Pioneer Network, refers to the need for elders to have, among other things, “purposeful living.”

These organizations and others offer tried-and-true paths to alter the dynamics of your facility, but not every setting is ready for them yet. If you're working in a culture-change-resistant organization and find yourself yearning for a way to make a difference — today — consider the possibilities here.

Grassroots culture change ideas

Purposeful pursuits such as knitting and crocheting

As part of a therapeutic recreation program, these crafts can dramatically shift the dynamics noted above, especially when the needlework has a point. (Sorry, I couldn't resist!) Residents who are working together to make lap blankets for new residents or hats for premature infants change from being passive recipients of care to active providers of care for others within the facility and in the larger community. Industrious and engaged residents show workers that elders can contribute to the world despite their age and physical or mental limitations. (For more on this, see the Recreation audios on my website. For more on therapeutic knitting, visit stitchlinks.com.)

• An active welcoming committee

Entering long-term care is very stressful for newcomers and an effective welcoming committee is an excellent way for long-time residents to recognize their own value and share their expertise. Research such as a 2014 American Seniors Housing Association study indicate that new residents are vulnerable to bullying by peers and to dissatisfaction with their unfamiliar community. Connecting new arrivals with other residents reduces bullying, increases satisfaction and lowers the likelihood that an individual will leave the community. Welcome visits and gatherings, care packages and mentors can breathe new life into a languishing group.

• The story project

Many people are familiar with programs such as StoryCorps that assist elders and others in telling and recording their stories for generations to come. This idea can be borrowed and incorporated into the life of senior communities by interviewing residents. Stories can be shared in the community newsletter and group activities and in a brief, large-print blurb in the neighborhood or floor where the resident resides. This activity recognizes accomplishments, creates opportunities for connection among peers and gives staff the chance to see the resident in a different light.

• Engaging younger residents

Younger residents often have unrecognized skills —± perhaps they can read well aloud or they're great DJs or they can keep track of funds at a bake sale. Without positive direction, some younger residents engage in diversions that disrupt the community. Instead, make use of their talents to assist their elders.

• Twelve-step meetings

One of the main tenets of Alcoholics Anonymous (AA) is that those who have achieved sobriety maintain it through giving service to others. Residents with years of recovery have a great deal to offer those who are just starting out and many residents begin their sobriety with entrance to your community. Holding AA and other 12-step meetings on campus creates an opportunity for residents to help others and offers a host of benefits outlined here.

• Peer helpers

Taking a page from my successful training as a peer counselor in college, I envision a trained and structured group of residents who help their neighbors in various ways: visiting the newly bereaved, sitting calmly with a nervous resident, checking in on someone who's bedridden, and other valuable tasks.

If an organization isn't ready to embark on a formal culture change program, there's still plenty that can be accomplished at the grassroots level. Hiring or coordinating with willing staff members, particularly those in the recreation and volunteer departments, can change the dynamics of the facility — and culture-change-resistant colleagues need never know these clandestine plans!

Eleanor Feldman Barbera, PhD, author of The Savvy Resident's Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.

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