Culture Change Now! is the most fitting name we could imagine for our website and our magazine. That's because it is happening and needs to happen right now. Want to eliminate institutionalized care and create home for elders? Action Pact will help you on your way home.

"Nursing homes are changing into personal communities, not of wards or wings."

Organizations and institutions, places and people all over the world are exploring new models of living and providing health and human services in this new century. Led by human compassion and economic foresight, facilities are applying historically successful, common sense approaches to living and caring for elders to create long term care communities where elders chose to live their lives with staff who enjoy assisting them.

Nursing homes are changing into personal communities, not of wards or wings. They are staffed by familiar caregivers who are there to help their community's residents as they live lives of meaning, value and joy. They have private spaces and family places and a chance to continue to live life with some measure of independence and responsibility. These communities provide the best personal, health and medical services any community member, however frail, will need. These homes are filled with greenery and flowers, with birds and fish and various furry and loveable friends, with baking and tasting and eating and sharing, with grandchildren and cousins and friends and neighbors.

"Only in communities can we be citizens, can we find care, and can we hear people singing."

How can we change our nursing homes to become home? How can we create a warm and friendly world where daily life can actually be pleasant and meaningful? We must look to the lessons of our larger societies for our answers. Look at the towns, cities and neighborhoods in which we have lived. Look at the churches, synagogues, schools and work communities to which we have belonged.

We were most happy in those communities that created a healthy climate. Where we were respected, we had the opportunity to grow and learn and we had choices in our pursuit of happiness. We could set goals and achieve them, could achieve pleasure and satisfaction in daily life, and we were genuinely and highly involved in the creation and maintenance of our community.

Sometimes we think that we have achieved this climate because we follow regulations, but we all know better. It is still not a world that we want to live in. Nor do our parents! It continues to be a world where our residents sit and wait, where family is frustrated and guilty, and where staff find it hard to stay for long.

What if we stepped out of these institutional problems and created a smaller environment? Not an institution, but a small community - a handful of residents, a handful of staff, a few family members and volunteers. Within this smaller group, we could all be highly involved and genuinely responsive to the needs of the community. Together we could plan for daily life that includes daily pleasures for our elders, genuine participation and satisfaction of staff, and more enjoyable involvement from family. These satisfying routines would weave together with memorable moments and meaningful social occasions, all indicators of a healthy community.

Nursing homes around the country are undertaking such culture change by creating many such communities within their walls. This is not an easy task, nor is it one that can be accomplished in one fell swoop. We have broken the process down into four components, each of which we feel is essential to long-term success. Below are some insights into each, and stories which illustrate how other homes have achieved them.

"Profound, sustainable cultural change can take place within an organization only when the individuals.. change themselves from the inside out."

In an organization re-orienting itself to focus on communities, it is important to be just as supportive to the caregivers as to the receivers of care. This is best accomplished by moving leadership as close to the elder as possible, following the proven models of self-directed work teams and cross-trained workers. Eliminate departmental barriers, flatten the organizational chart, give workers and teams permanent assignments, and you will find that leaders will emerge. Leaders from the heart, not leaders by title, and these are the leaders that will connect with individuals. These connections will give the elders feelings of security, and the caregivers feelings of personal responsibility and fulfillment.

"Life is made more enjoyable by experiencing those personal daily pleasures.."

Quality of life truly results from a commitment to person centered care where individuals experience autonomy, the dignity of choice, the dignity of risk and respect in their daily lives. Life is made more enjoyable by experiencing those personal daily pleasures, things that are important to each of us, things that we look forward to throughout the day, every day, in homelike surroundings. Empowered to assert their rights and preferences, to expect dignity in their care and relationships with health care professionals, individuals are encouraged to chose their daily care and services from staff who place supreme value on listening to the resident's preferences while offering professional advice and education on the risks and benefits of resident choices.