Culture Change Now! is Action Pact's periodical for long term care professionals interested in Culture Change. It is filled with how-to information and articles of inspiration. All levels of staff and families will will enjoy the only publication solely dedicated to culture change!

A constant theme in all successful culture change journeys is high involvement of residents, staff and other stakeholders during every phase of the process. The "learning circle" pioneered by Action Pact's LaVrene Norton is an effective technique for gleaning input even from those who normally don't express themselves during meetings.

But how do we involve elders living with dementia who have extremely limited communication skills?

One method that shows promise is the Dementia Community Learning Circle, a variation on Norton's learning circle that integrates an approach to elder care advanced by the late dementia researcher, Dr. Tom Kitwood.

In his book, Dementia Reconsidered: The Person Comes First, Kitwood outlines a set of interactive skills caregivers can use to meet the basic human needs for elders living with dementia that may lead them to function at a higher level, experience joy, connect with others and find meaning in their daily lives.

The Dementia Community Learning Circle puts those skills to work in an environment that meets the elders' need for comfort, identity, inclusion, attachment and occupation. It works like this:

Elders, staff and other participants sit in a circle without tables or other obstructions blocking their view of one another. A facilitator poses a topic and the first person in the circle is introduced and given an opportunity to address the topic.

The facilitator introduces elders who are unable to introduce themselves in a way that reinforces the elder's individuality. Family members and caregivers who know the elders best should be included in the circle. They can help tell the elder's story.

The facilitator continues around the circle, engaging each person and encouraging him/her to participate. Topics and activities are geared toward the cognitive strengths of those with dementia. For example, singing is an effective way of enabling elders with dementia to reconnect, as they often remember words to songs they grew up with.

Unlike in Norton's learning circle, participants in circles geared for elders with dementia are allowed to speak out of turn. In fact, the more interactive conversation there is, the better. Sharing elders' personal stories in the circle - often with help of family members - strengthen bonds within the nursing home community. Caregivers are more likely to treat the resident with love and respect if they know what the person was like before they were ravaged by dementia, and they are better able to create opportunities for the elder to celebrate who they are.

Dementia Community Learning Circles have produced astonishing results among even those who are usually highly disruptive and besieged by paranoia, enabling them to recall certain events in their lives, connect with others and participate in shared decision-making.