Page 2 - Life Happens in the Kitchen

The author acknowledges the Stages of Culture Change as the framework for this study of the many ways to infuse choice into dining in skilled nursing and assisted living facilities. “A Stage Model of Culture Change in Nursing Facilities” by Leslie A. Grant, Ph.D. And LaVrene Norton, MSW identifies the stages as Traditional (institutional), Transformational, Neighborhood and Household. Below is a quick overview of each:
Porch Swing SeriesTM Culture Change Workbooks ©2004-2005 Action Pact, Inc
“A Stage Model of Culture Change in Nursing Facilities”
by Leslie A. Grant, Ph.D. And LaVrene Norton, MSW
Stage I – The Institutional Model is traditional, medical in orientation, and organized around a nursing unit without permanent staff assignment. Neither residents nor staff are ‘empowered’ in this model, because the organizational power structure is ‘top-down’ or hierarchical, going from administrator to department heads to supervisors to frontline staff. Dining is usually in a large central dining room, and often utilizes trays.
Stage II – The Transformational Model is the point at which there is a stated awareness of the need for resident-centered care. The key initiatives of this stage are efforts at reducing staff rotation, engaging elders and staff together in teams to do planning, and looking at a variety of ways to increase choice at mealtime.
Stage III – The Neighborhood Model shows a growth in self-led, interde- partmental teams, decentralized dining, and breakfast options which make it possible for elders to get up when they want and eat what they want.
Stage IV - The Household Model is home. Elders live in households (either within the walls of a larger environment or stand-alone) with functioning kitchens. Cross-trained staff report into a self-led household team instead of up through departments. Elders truly run their lives, get up when they want, eat what they want when they want it, choose their snacks and order their pantry items, have friends over and plan their own social lives.
It is not known at this time what Stage V or VI might bring. This is a process that elder care environments, both nursing and assisted living facilities, are embracing. Each organization must plot its own path based on mission, energy, resources and culture. We hope that you find this workbook helpful to you wherever you find yourself on the journey to home.