Birmingham, Ala.—I believe that those of us with determination will survive the current nursing home culture and reinvent the way we experience aging—one person at a time.
Almost two decades ago, pioneering thinking ignited a fire in me, a fire that would never allow me to go back to the broken, traditional nursing home model of care. I stayed the rugged, unchartered journey of changing the way we think about aging, not just when we are old, but throughout our lives.
The way I look at aging now has profoundly changed since I joined the culture change movement. I am 60, and as I look back at my own cultural experience of aging in America, the only recognition of aging was when I received my AARP card. Aging meant diminished value—go golf.
My professional experience was coloring my personal experience; the two were becoming inseparable. Culture change was instilling a sense of pride and purpose in my own aging experience.
I was beginning to look at it like an African friend of mine explained it. When an elder dies, a library is lost. I began to think, in a kind of verse,
As I grow old, I gain the gift of wisdom.
My wisdom has value and allows me to be purposeful.
Professionally, my vision shifted away from the treatment model of care to a human model focused on friendship, purpose, and the unexpected. The more I focused on quality of life, the stronger I became at transforming the culture of aging within the nursing home. Excellent medical treatment in my mind was a given; there had to be excellent medical treatment but it could not be the focus of the elder’s existence. From a human dignity stance, it was time to free the elders and the caregivers from the cultural prison of institutional care.
Nursing home providers are like Vietnam Veterans. But like the Vietnam Veterans, the caregivers are not the problem. The work of caring for old people is sacred and needs a culture of support.
Through culture change, the punitive model of care needs to change–the punitive culture that is perpetuated by the press and thousands of deficiency notices posted in our greeting areas screaming out our failings and inciting fear in our families as they enter our communities. It is a punitive culture of care accelerated by litigation that leads to a “freeze factor,” rendering change or decision making nearly impossible.
As long as the nursing home culture remains punitive, it remains impossible to create a culture of love and kindness.
One might liken the culture we work in to the following scenario. Caregivers are on the beach with their feet planted solidly in the sand facing the ocean. Their arms are raised up to the sky while the tidal wave rises from the ocean. The wave rushes to the shore and drowns them–yet more come and more drown. The national rate for caregiver turnover is staggering, even in a bad economy.
We live the definition of insanity: doing the same thing over and over and expecting different results. And we have been doing this in large part since the 1960s. Culture change, person-centered care, provides an opportunity to transform nursing homes.
When I embraced culture change and vowed never to go back, it was nirvana. It unshackled my vision and rocked my understanding of aging, the culture of aging. It was a transformational surrender–not just a change but a transformation–that broadened the boundaries of the industry I worked in for over 20years and allowed me to be an innovator, a pioneer. It allowed me to envision getting it right.
As I started my own personal transformation in the nursing home, I posted a picture above my desk. It was a picture to inspire me of an elderly woman, bent over watering a plant with dried, crusty desert earth all around her. The sun was beating down, and she had on a large straw hat. You could feel the desert heat. For me the picture exemplified the hard work of culture change and how impossible the mission of changing the culture of aging seems.
I started to believe we could replace nursing homes with thriving integrated communities focused on the human spirit rather than on human frailty.
That we could create communities where families would feel welcome, engaged and want to come and visit.
That we could create a life worth living for someone whose world is now six foot around them.
That we could create communities where elders can enjoy children, gardens, and pets—not just therapy pets, but cats and dogs, like they enjoyed in their homes 365/24/7.
That we could create communities that are supported by organizational models of concentric circles with the elders, families, and direct care workers driving the care, rather than the pyramid model of care with the administrator and director of nursing in control.
Nursing home caregivers are most adept at surviving. They have survived tidal waves, and they have survived in deserts. Driven by passion, mission, and purpose, nursing home caregivers will deliver a new culture of care that gives supports in balance with medical treatment, community that nurtures the human spirit. (Debbie van Straten has worked in long term and post-acute care for more than 30 years. While running her own rehab center from 1993-2003, she grew disillusioned with traditional practice and tried to find a route to authentic person-centered care. She was named one of the Eden Alternative’s first mentors. She now runs her own publishing business.)