Cultures, by their very nature, can either embrace or resist
change. Culture change can arise from an improved environment,
due to inventions and other influences like regulations, or
as a result of contact with other cultures. In its attempt to break
away from traditional long-term care models culture change
movement has created its own lingo

Buettner, Linda L.

NC DOCKS at The University of North Carolina at Greensboro

English

The University of North Carolina at Greensboro

Objective Become familiar with culture change language and objectives. Describe methods to make activity calendars more homelike ~ALL FUNCTIONING LEVELS CU Iture change and activities: Learning the lingo and making yourself invaluable Linda L Buettner, PhD, eTRS, LRT Cultures, by their very nature, can either embrace or resist change. Culture change can arise from an improved environ-ment, due to inventions and other influences like regulations, or as a result of contact with other cultures. In its attempt to break away from traditional long-term care models culture change movement has created its own lingo. • Shahbaz: new word for universal worker with CNA and culinary training • Elders: people that live in the home. They should be called by their preferred name. • Environments conducive to eating and socializing: smaller homelike like settings • "Normalized meaningful activities": things a family might do together that are meaningful to elders. • Green house: intentional community for people that need supportive services .. Empowerment: partnering with elders to seamlessly provide for medical needs and quality of life .. Person first language: the elder with "memory impair-ment" instead of "the dementia patient." This has been the norm for many years but now the culture change people have picked up on it. Cultural diffusion in long-term care is a challenge because traditional staff doesn't know the lingo or what might happen Activities Directors' Quarterly for Alzheimer's & Other Dementia Patients Volume 10, Number 1 27 28 to their jobs as facilities "transition" to smaller group homes. In this diffusion, a physical form is transferred to another culture without the meaning being transferred or making sense. For example, when activity calendars were first required in nursing homes, they were considered an advance to move activity plan~ ning and activity offerings to all of those residents that lived in the facility. In culture change the activities that are desired are "normalized" and homelike, not necessarily offered in the same way or in large groups. Thus the meaning of activity calendar has not transferred well because we have grown to use them as a "one size fits all" approach to planning stimulation. The regu-lations and the movement toward smaller homelike settings are not conducive to large group or themed activities from the past. There is a theory called diffusions oj innovations that explains why cultures adopt new practices, ideas, and products. Over the past few years a variety of forces have emerged to transform medically based nursing homes into smaller more homelike places with individualized meaningful things to engage in. It has a lot to do with Baby Boomers watching the care of their parents and wanting something better in the future. While the traditional activity calendar is still required by law, it is chal-lenging in this new environment. The Eden Alternative, The r Greenhouse Movement, and the National Alliance of Small Houses (NASH) have brought in the neighborhood concept, animals, onsite childcare, green spaces, and family style meals. These are not really new ideas. European communities have been using a "service home" model for older adults for many decades, but we are using the same US nursing home regula-tions, and it looks like a square peg in a round hole when it comes to meaningful activities. So where does the Activity Calendar 'fit in to all of this? Although we probably all hang a calendar in our homes, we don't fill the daily hourly blocks with themed activities created to keep ourselves busy. We do things based on our preferred routines, our interests/preferences, our families, our needs, and our limitations. And a bleak example of acculturation to the activity calendar can be seen in the story of the dozens of nurs-ing home residents, who are forced to attend the monthly birth-day party for people they may not know or care about, and end up sleeping or trying to leave throughout the crowded and Activities Directors' Quarterly for Alzheimer's & Other Dementia Patients Volume 10, Number 1 Key ingredients Over the past few years a variety of forces have emerged to transform medically based nursing homes into smaller more homelike places with individualized meaning-ful things to engage in. often noisy lIactivity." Another acculturation recently described by a Shahbaz was the "joyous time she spent coloring with her elder .'1 Obviously the culture change movement needs help in planning and delivering meaningful activities. Discuss this with your administration and the planning team. One of the most vital ways to form meaningful relationships with older adults is through a shared activity that provides dignity and quality. Culture change and stress Culture change, for the individual, a nursing home, or an entire SOciety, is one of the most stressful of all human experiences. This underscores how pivotal culture really is to our personal identities and our psychological foundation. Think about the older person moving from their home into a long-term care setting. How stress-ful and distressing the losses must be for the elder. For those who are very sick, recovering from a hospital stay, or who may have lost a care provider or pet in the processl the stresses are even greater. Adjusting to having strangers around, needing help with personal care, and perhaps leaving a dignified life elsewhere is dif-ficult to imagine. As many long-term care settings transition into small homes or units with neighborhoods the staff often feels the same stresses as those residents. Staff titles are melding, job descriptions blurring, and entire disciplines seem to be disappear-ing into strange sounding descriptors! Benefits of staying active Staying physically and mentally active reduces your chances of getting a host of illnesses, keeps bones strong and healthy, helps you maintain your vitality and independence in later years, and improves your mood and mental functioning. In short, it can help you live a longerl healthier life. This is what life in and out of a nursing home needs to focus on; the wishes of the older adult for an active life worth living. Simply /I color-ing or sitting around the kitchen" does not provide these bene-fits. The activities that we design must help elders move around, make choices, and retain important skills for living. Our jobs with older adults/ no matter what the title or the description, must focus on one thing-the older people that live in that home. It is up to each discipline to discover their new roles and the best ways to use their talents to improve quality of care and quality of life for the older members of the home. The Activities Directors' Quarterly for Alzheimer's & Other Dementia Patients Volume 10, Number 1 29 30 activities professions, along with music and recreation therapy f1 professions have amazing skills to bring to culture change. Without these disciplines there will be little engagement in diversional or therapeutic activities in the home. Below are some concepts and questions to consider with your team as you work through the culture change process. Involve all disciplines Culture change leads to sense of community when the peo-ple involved feel as if they belong and are trusted. This includes the sense that others in the culture change movement /I care" and that the culture change leaders will not ignore the gifts those who provide meaningful engagement can bring to the movement. Dr. Judith Voelkl wrote the activities we offer pro-vide the II core" and "balance" in the elders' life. The core activi-ties are the things done with the older adults in a routine family centered way. The balance includes the special planned activi-ties outside of the home and beyond the routine. The core and balance concept requires activities professionals, music, and recreational therapists to share their knowledge and help guide the process in and out of the home. In the culture change com-munity the staff melnbers are not viewed exclusively in terms of ,. performing a single role or function. Each person in the home, both staff and elders, are seen as unique, complex, and evolving individuals that need to engage in both core and balance activi-ties. Can an untrained former CNA do all this and make it accept-able to a state survey team? Not without you! Make your admin-istrators aware of this issue and clarify your roles. Questions to ask yourself and your team: • Do members of the staff really know each other's tal-ents and dreams? • Do people know the talents and dreams of the older adults (elders)? • Do all staff members and elders feel as if they belong and are welcomed? • Do older members of the household need encourage-ment or cuing to maintain an active life? How will this be accomplished and are relationships important? Actfvities Directors' Quatterfy for Alzheimer's & Other Dementia Patients Volume 10, Number 1 ... Hint The core and balance concept requires activ-ities professionals, music, and recreational therapists to share their knowledge and help guide the process in and out of the home. • How can team members provide just enough men-toring to provide both core and balance activities? Who will plan these activities and maintain evidence of.benefits? • Can you work together to provide a new type of calen-dar filled with both core and balance opportunities? When the culture change team recognizes that they hold similar values, a shared vision for active engagement evolves for the older adults in the home. Members are enthusiastic about the goal to give each older person a meaningful life (not simply setting up activities on a calendar but providing home-like, normalized schedule) that allows for new learning, partici-pation in the home, active movement, and time for relaxation. Leadership commitment There are groups of leaders in the culture change movement that must understand that most frail older people cannot self-initiate activities and that life is about the meaningful things we do beyond self care (eatingl bathing, and dressing). A communi-ty goal must be to utilize the skills of those that have always had a special connection with older adults through activity engagement from the initial planning meeting into the imple-mentation phase of culture change. Ask yourself and your team members: • How will leaders help identify benchmarks of success for meaningful activity in and out of the home? Do the surveyors agree with these benchmarks? Can you edu-cate the surveyors on these concepts? • What is the best way to teach current nursing home leaders about the skills and active living concepts that will make you useful in the culture change process? ie, what specialized skills do you bring to the table? • How will leaders link their personal values, vision, and their own need for meaningful activity to the cul-ture change project? Remember this is about the elders that live in the houses, not the preferences of culture change leaders. Activities Directors' Quarterly for Alzheimer's & Other Dementia Patients Volume 10, Number 1 Linda L. Buettner, PhD, eTRS, LHT; Professor, Department of Recreation, Tourism, and Hospitality Management, University of North Carolina at Greensboro, Greensboro, North Carolina. 32 • How will residents with depression, dementia, and rehabilitation needs stay active without leadership of activity professionals, music, and recreational therapists? A day in a small house Rise (between Prepare for the day Wash, dress, breakfast, lis-5:30 AM and ten to radio or bird feeders 9:30 AM) Mid-morning Choice of physical Walking, small group yoga, offerings (between activity and light snack gardening, visit with neigh-10 AM and 11:30 AM) bors and have a snack Pre-lunch offerings Choice of helping Assist with meal prep, (between 11 :30 AM activity light housekeeping, mak-and 12:15 PM) ing or using Simple Pleasures items Mid-day offerings Choice of l1.mch indoors Buffet style lunch with (between 12:15 PM or on patio: once per opporhmities to sit with and 1:30 PM) week invite a luncheon friends indoors or out-guest or interesting doors, help with clean up educational speaker. After Ilmch Choice of spa time, Relax in the spa tub, get offerings (between soap operas, trip to the nails or hair done; get 2 PM and 4 PM) commtmity library, or a some books or tapes from music lesson the library, learn piano Late afternoon Choice of help with Set table, help with recipes, offerings (between dinner offerings, watch watch educational televi-4 PM and 6 PM) Oprah or The Food sian and discuss with oth-Network to get "tips," ers during ditmer, or spend work in the garden some time in the garden. After dinner Choice of evening walk, Walking with others, visit-offerings (between visit with Pet Partners, ing pet comes to join the 6 PM and bedtime) reading, or family card home for an evening, play games then ready for cards with others, watch bed television or relax and pre-pare for bed This is a sample of one day on the calendar of a small house. You would need to make it your own and carefully individualize the offerings for the elders in the home. Those requiring assistance to take part would require expert adaptation, cuing, and assistance. Remember, small house residents require skilled care and experts on engagement to live well! Activities Directors' Quarterly for Alzheimer's & Other Dementia Patients Volume 10, Number 1 

Culture change and activities: Learning the lingo and making yourself invaluable

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Culture change and activities: Learning the lingo and making yourself invaluable

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