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!

Q. How did you get involved in the culture change movement?

I remember the moment I realized this place was dying and nobody knew it. The average age of our independent residents was 91. I remember thinking, oh my God, we have all these people getting ready to go into the last stage of their life and all we have is a 60-bed health care unit run in a very clinically solid, yet very old-fashioned way, and there are no support systems.

I felt an urgency to do something to make sure we maintained not only our market position, but also that we put the programming in place to responsibly deal with all of these folks who were going to [need additional care].

It got very personal for me... my father lived in one of our [independent resident] apartments, and I thought, what's ahead for Dad?

We had to do a pretty radical financial turn-around because we had very little cash and were losing money. All the cards were stacked against us. I share that because there are all sorts of reasons we can find to not change.

We clinically were viewed as the best in the state. We went the entire decade without any citations or survey deficiencies. But I would go down [to the health care center] and become physically uncomfortable... It began to dawn on me piece by piece that this whole way we "care" for elders should make all of us feel sick.

The call lights and buzzers offended me... what a strange way to transmit you have a need... and all the while those flashers or beepers are going off because they're required by regulation. Then comes the cart with all the big plastic trays, bouncing, clattering. It offended me that these trays would sit in front of people and the bibs would go on - the titanic nurses station, the regimentation of bathing.

And that's just the beginning. What time people [got] up in the morning, the kind of food they [had] for breakfast, the whole process of getting them up... was a blatant disregard for the person.

These processes and ideas had been in place so long, people didn't even think about them, didn't question them.

So we began to have conversations as a leadership team... once it became permissible to start saying we want to change, then everybody began to ask questions.

Q. How did you get everybody involved and committed?

I began posing the problem to everyone, starting with the leadership team. Momentum began gathering. There was consensus we had to do something... the board was fully behind doing something, so we gave it our vision of culture change... [the vision] began to emerge through the bringing in of stakeholders.

Q. So, it was everyone's vision?

We talked with independent residents about their needs and what they thought their needs would be in the future... we talked with people in the community.

As we began to move into the design phase... we began to bring in all the different staff and resident groups and talk about specifics.

For example, we gathered a group of aides together when we talked about designing the bathroom... the kitchen employees designed the kitchen. We brought residents into the process of deciding what their living spaces would be like... that generated a lot of involvement.

[LaVrene Norton] knew of other places [that had implemented culture change] and encouraged us to visit some of them. We went to Minnesota and Saskatoon... and we took away something valuable from each... then we visited this place way up in northern Minnesota... this tiny town of Bigfork. We pulled up to this... small hospital building that looked like it was built in 1962.

They opened the door and I cant describe to you the emotion I felt. They had achieved most of the architectural things that had been floating around in my head... that really revved me up.

Q. So you found what you were looking for?

Well, not that we were going to go back and do exactly what they did. But it crystallized all these things in my mind... now I knew we had "gotten it".

We went back to Bigfork, and we took the architect with us. I think Bigfork was getting so sick of us by that time, because I was sending folks, especially the nay-sayers, up there on buses... and they came back, some pretty enthused and some begrudgingly admitting that there was potential... they were impressed to have talked to the [Bigfork] staff... and were powerfully moved by that.

Q. So now you've got your ideal design, your staff believes in this idea, and all your residents are behind you, are you done?

We thought we were done, but we weren't... we knew we were missing something... we brought LaVrene back, and she helped us realize some things.

LaVrene told me, "Steve, you have to give them the skills, this isn't going to come automatically."

And that's what the last two years have been, just intense, continuous infusion of skills through learning circles, written word and whatever methods we can use to convey them. Conflict resolution skills, critical thinking, judgment, hospitality and person centered care - it's endless. It's got to become a part of who you are if you go on a culture change journey.

You can never say, "Okay, we're finally done with culture change, good job everyone." But there are milestones that can be finished and celebrated.

Q. Take us through the reconstruction of your nursing home.

When we started construction and began ravaging the T-shape, everything went out the door.

I'm so excited about the T-shaped conversion because it's duplicable. There are T-shapes all over the country, so others can look at ours and do this.

When you walk in, there's no nurses' station. There are three outside front doors that have architectural features. One is Georgian, one Farmstead - they're distinct front doors. They have potted plants next to them, and there are doorbells with a completely different signal.

Now, when you go into one of our houses, it's not like walking into a traditional nursing home. You don't feel like you're in an institution. There's a living room, a dining room, a kitchen, bedrooms, and bathrooms just like at home. The environment sends a message of home, but what really makes you feel at home is how you're received. When you go in there's music playing, cookies baking, popcorn popping and people socializing.

My father has been a resident here for six years... he's in one of our households now.

When Mother died last year he withdrew even further in his grief. But now he's moved into Lyle House, and he's flowered. He's reaching out to people, greeting them and referring to this as his house.

I'm seeing a man in his last years, even as he's losing the ability to walk, self-actualizing in ways that he didn't as a young man.