Page 15 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHAT IS POSSIBLE
One of the outcomes we have experienced, and I know many others have also, is a significant decline in depression. I know there is no way to make the link to what specific part of the household experience contributes to what degree to quality of life, happiness, and reduced likelihood of depression. There are obviously many contributing factors to that, but I definitely believe the dining experience is a major part of that new reality for many of our residents. (Newman, 2010)
GUIDES TO PROGRESS ON THE CULTURE CHANGE JOURNEY
The Artifacts of Culture Change, a tool co-developed by Carmen Bowman and Karen Schoeneman, measures actual policy and building changes that many culture change innovators are making on their journey. “These concrete changes are the markers and artifacts of the change of mind that occurs in a journey toward home,” Schoeneman notes. The HATCh (Holistic Approach to Transformational Change) model used by the Person-Centered Care
pilot (Quality Partners, 2005) domains categorize the artifacts of culture change. This tool collects concrete artifacts of the culture change process that a home has, and serves as a guide to progress in moving care and workplace practices, policies and schedules, increased resident autonomy and improved environment on the culture change continuum. (Bowman and Schoeneman, 2006)
In A Stage Model of Culture Change in Nursing Facilities, Leslie Grant and LaVrene Norton introduce a conceptual model of the culture change process in which they use an expertise elicitation method. They note, “Just as people progress through distinct stages of human development, going from infancy to childhood to adolescence to adulthood to old age, nursing facilities undergoing culture change progress through distinct stages of organization change and development.” They define four stages of culture change – institutional model, transformational model (awareness and knowledge begins to spread, consistent staffing may be initiated and minimalist changes to the physical environment occur), neighborhood model (traditional nursing units are broken into smaller functional areas and resident centered dining is introduced without full kitchens), and household model (self-contained living areas with 25 or fewer residents who have their own full kitchen, living and dining room; staff work in cross-functional self-led teams and traditional departments are eliminated). (Grant and Norton, 2003)
Focusing on dining, outcomes in each stage are described in an Action Pact training manual, Through New Eyes – Studying Changes in Processes and Systems:
Traditional facilities can begin by offering residents more dining choices on special event days and making small accommodations to resident choice. Community meals, facility cookouts, fine-dining with family, celebratory birthday meals begin to happen regularly, for all residents.
Millie is encouraged to get up by 6:30 in order to be in the dining room for breakfast at 7:30. She is often dressed and lined up in her wheelchair in the hall waiting for the dining room doors to open. Perhaps, because she’ s cooperative, she’ s actually gotten up at 5:30 by the night shift and falls asleep waiting in the hall. In a progressive facility, staff has learned
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