Making culture change efforts while staying in compliance can be seen as finding
the balance in quality of life and quality of care. And while fear of deficiencies
may keep some from making changes in the way things are done, regulators themselves
are open to culture change and what it means for elders. It seems that not only
must the gap between quality of care and quality of life be bridged, but so must
the gap between regulators and nursing homes.
According to Patricia Maben, MN, RN, LNHA, the former director of the long-term
care program for the Kansas Department on Aging and Glenna Massey, a regulator for
the state of Colorado, the regulations' basis in the medical model of long-term
care makes regulating the social model more tricky.
"We fall back on the medical model that we want to protect residents from
themselves," Massey said.
Trying to apply regulations to a new way of doing things takes some getting used
to, Maben said. "Staff need to spend time thinking about, 'This is the way we did
it before, this is how we do it now and how is this safe for the resident?'"
Of course, resident safety is of the highest concern for staff and regulators,
but residents can have more freedoms and still be safe. "People think, 'We can't
have residents in the kitchen,' so they put up barriers," Maben said. Dangers in
the kitchen can be avoided. "Even if you have dementia," she continued, "you know
what a kitchen is. Just remove hazards, turn off appliances, lock up the knives -
common sense things."
There continues to be struggle with regulations about things like rising, going
to bed and medications pass schedules and issues around resident falls as
facilities try to find new ways for residents to have more say in how they live
their lives.
"Things like clutter in the hallways are hard to get around," Massey said. "In
the big wide hallway it would be lovely to have a park bench for the residents to
sit on but, if there is an emergency, it's going to get in the way of getting
people out through the corridor."
However, while there are safety struggles, individualized planning and quality
of life tags very much support and encourage culture change. Both Maben and Massey
agree that education and communication between regulators and nursing homes are the
ways of getting both sides working together to make quality of life improvements
for elders.
"Education is how we bridge the gap between surveys and culture change. We've
got to have good dialogue between the people who are trying to do this well and
the state survey agencies," Maben said.
While education is the answer, it is something that must be actively sought on
the part of both parties. "Organizations like Eden and the Pioneers and reading
books galore can educate the State on the movement," Massey said. The other side of
the coin, facilities are looking for information too. "Facilities look to
regulators, but it is not our place to educate [on culture change]. We aren't
supposed to, but I wish we could," she said.
Not only must facilities and regulators work individually to bridge the gap, but
they also must collaborate. Culture change facilities can explain how they do
things to surveyors, Maben said. "They'll say, 'You will not see everyone at
breakfast. We give meds morning and evening instead of a specific hour. You'll see
staff sitting down and visiting more and we expect them to do that. Activities are
what the resident wants to do. In general, staff respond to what residents want to
do.' It may not be perceived as being the traditional way, but it meets standards
of practice."
The new way of doing things will require a new way of thinking. Maben said, "It
can't just be data that makes the decisions. We need to put in the human element."
