Culture change in long-term care.

TLDR: The American long-term care (LTC) system, based on a medical model, regards residents as sick patients, unable to care for themselves, and several “care-models” have emerged, including the Eden Alternative, Wellspring, and Regenerative community models.

Abstract: The American long-term care (LTC) system, based on a medical model, regards residents as sick patients, unable to care for themselves. Routines are organized for the efficient operation of the facility, rather than the needs of residents. The focus of care is to treat the residents’ weaknesses, not to develop their strengths. Culture change is a movement that departs from the traditional institutionalized care model, towards “person-centered” care. This change places the residents and their direct care workers at the center of the organizational structure. Residents are allowed to determine their own care and daily experiences. Culture change promotes quality of life and quality of care. LTC facilities’ “pioneer practices” have implemented this change, and several “care-models” have emerged. The “individualized care” model helps residents return to familiar routines: residents decide what is important to them, and how they want to live out the rest of their lives. The “regenerative community” model downplays illness and builds upon residents’ strengths, helping residents flourish despite declining health. The “resident-directed care” model separates facilities into small home-like neighborhoods, with resident choice at the heart of the community. Each neighborhood has a permanently assigned, cross-trained staff team. (Table 1) The Wellspring model is based on a charter group of 11 freestanding not-forprofit homes in eastern Wisconsin (The Wellspring Alliance). This model developed in 1994 in response to managed care oversight. This model seeks both to enhance quality of resident care and to enhance the quality of work-life for staff. The Wellspring model has hired geriatric nurse practitioners, and given employees necessary skills and a voice in how their work should be performed. The Wellspring homes share staff training, comparative data on resident outcomes and multidisciplinary resource teams. 5 The Eden Alternative is the most recognized model of successful culture change. Dr. William Thomas created The Eden Alternative in 1991 to alleviate the three “plagues” of LTC: loneliness, helplessness, and boredom. This community-centered approach seeks to “create a human habitat where life revolves around close and continuing contact with plants, animals, and children.” 2 Seeing the animals, children and gardens of an Eden facility, many onlookers erroneously equate “Edenizing” with these elements. However, “Edenizing” includes a change in philosophy. Much like resident-directed care, Eden emphasizes community and neighborhoods, with staff organized into interdisciplinary teams. The major tenets of the Eden philosophy are: 6