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The Culture Change Movement


Culture Change is a movement to transform long term care homes from institutions to communities where the human spirit can thrive and everyone can have a meaningful voice and choice in the decisions that impact them.

The Culture Change movement was launched in 1977 at a meeting of a diverse group of visionary long term care stakeholders including elders, direct caregivers, nurses, activity professionals, social workers, administrators and operators, advocates, ombudsmen and state and federal regulators. In a real sense, the fact that all these people, many of whom were suspicious and antagonistic of one another’s roles, sat together as equals to create a new vision for eldercare was the first step in the national culture change journey.

The Pioneer Network, the nation’s leading organization in the field of aging and long term care concerned with culture change, evolved from this initial meeting. The first steps in organizing the network focused on developing a consensus on the values that would anchor culture change. (The Pioneer Values and Principles can be found at http://pioneernetwork.net/AboutUs/Values.) The quintessential value, Do unto others as you would have them do unto you, is the basis of virtually all of the world’s cultural traditions and provides the litmus test for all aspects of life within the long term care home.

Embraced by CMS, AHCA and LeadingAge (formerly AAHSA)

The concept of culture change has been embraced by the Centers for Medicare Services (CMS) and is embodied in such CMS directives as the recent Interpretive Guidelines for F-248 and F-249. The nation’s leading provider organizations, including the American Health Care Association (AHCA) and LeadingAge (formerly the American Association of Homes and Service for the Aged) have actively supported the culture change movement and its potential to improve both the substance and image of long term care.

While the ultimate goal of the movement is “deep systems change” within long term care, culture change is seen as a journey on which organizations and individuals need only place one foot in front of the other and follow the path. It is by no means a rigidly prescribed set of activities or even a destination.

The Pleasure of Your Company® and Culture Change

The Live Oak Institute team that created The Pleasure of Your Company was led by Debora and Barry Barkan who were among the founders of the Pioneer Network. (Taun Cosentino Relihan, MA, MSN, PhD was a co-creator of The Pleasure of Your Company.) Their commitment to culture change began in 1977 with the Live Oak Project, which is widely acknowledged as the first successful effort to transform a long term care home by changing the culture from institution to elder-centered community.

From the start it has been a fundamental assumption at Live Oak that any initiative or new program within nursing homes will be most effective if it is embedded in the culture and continually expands and deepens a community in which learning is ongoing and person-centered values and practices are constantly championed.

These are some of the ways in which implementation of The Pleasure of Your Company supports the culture change process:

  • By building a Visit Corps for all staff, volunteers and family members, everyone in the home comes out of departmental silos and becomes involved in advancing quality of life and deepening relationships with residents.

  • The Pleasure of Your Company helps everyone on the home’s team to see each resident, even those who are cognitively frail, as a whole person with history, interests, likes and dislikes.

  • It tailors all one-to-one activities to each person so that their needs, desires and aspirations drive their individualized activity program.

  • It provides a sophisticated yet simple communications system that delivers crucial information where it is needed and enables each Visit Corps member to feel responded to, valued, and heard.

  • Constant learning is the circulatory system that brings the lifeblood of the new culture to every person in the environment. Formal and informal education is embedded in every aspect of The Pleasure of Your Company.

  • By involving the most isolated residents in meaningful programming in which they develop relationships that bridge isolation, the whole home becomes a lighter and more joyful environment.

The beauty of The Pleasure of Your Company is that it shifts the culture by focusing on the accomplishment of federally mandated objectives rather than on the goal of introducing change into the environment. Without explicitly saying so, it is a roadmap for advancing the culture change journey. If you follow the detailed and highly specific program, the culture begins to shift.

Dr. Bill Thomas on Activities4Change.Com’s Founders

“Barry and Debora Barkan have done more to restore and expand the concept of the Elder in American society.  Among the original pioneers of culture change, they continue to create new insights into aging and elderhood. I am excited about the Activities4Change.com  because it will offer all of us who value relationships and quality of life a new source of information and education.”

Dr. William Thomas
author of What are Old People For? How Elders Will Save the World
Co-founder, with wife Jude, Eden Alternative

Founder, The Greenhouse Project