Page 41 - Tale of Transformation

Artifacts of Culture Change Categories and Items
Environment Artifacts
The most dramatic change in environment being made by culture change innovators is the physical renovation from staff-centered, long, impersonal and noisy hallways to small, intimate, resident-centered households and the use of household designs in new construction The physical design of a household is a small home setting with a full kitchen, dining room, living room and work area for a small number of residents and their dedicated staff, with the institutional nurses’ station eliminated (Calkins, 2002).
A household model naturally creates a “family life” where staff can support resident choices and decisions about their daily life such as meals and activities. For staff, tools and supplies are decentralized helping them to give more efficient care. Typical of household models, staff are cross-trained, roles are blended and staff consistently work with the same residents. “Residents are walking more and they can sleep in if they want to. We also enjoy group planning of special events and home cooking and snacks” as explained by a certified household resident assistant of Fairport Baptist Home. “Perhaps the most dramatic news has been residents’ discovery that they have a voice. This has always been true – but in a household of no more than 12 residents, it is much easier for one’s voice to be heard!”(Fairport Homes News, 2002.) Because the household design and model affects life and work globally as an advanced stage of culture change, it is given an advanced level of points in this tool.
The neighborhood model to some, and according to the Stages Tool, reflects a step along the way of moving into a household model. Features of this model include dining on the neighborhood, consistent staff, and practices such as Community meetings without structural changes. Neighborhoods are also referred to in the culture change movement as clusters of households and include common community areas reflective of a neighborhood in the community at large such as libraries, beauty/barber shops, community rooms, courtyards, cafes and snack bars, and shared staff spaces (Calkins, 2003). Neighborhoods are not used in the Artifacts tool so as to not cause confusion and because they include no structure change. The other aspects of the neighborhood such as consistent staff assignment and dining in the neighborhood are covered in other sections of the Artifacts tool The physical design aspects of the household model are included in the Environment section and given a significant number of points due to the significant commitment of resources that it takes to move from corridors and units to a household design.
One feature of nursing home living people have expressed they do not want is to share a room with a stranger. As such, private rooms were given a higher score in this tool also reflective of the commitment of the home to make structural changes, give up shared rooms for private or the foresight of original construction into private rooms. Some homes dedicated to culture change have eliminated all or the majority of shared rooms for private ones. The Quality of Life study showed that those facilities deemed to have high quality of life had the most private rooms and that residents who were interviewed greatly preferred private rooms to shared rooms. (Kane et al, 2003).
A-12