Culture Change in Long Term Care Services: Eden-Greenhouse-Aging in the Community

Abstract

To discuss the relationship between residents and the management team, we must first review the transition from a medical model to a social model of care that is sweeping across America. Long-term care (LTC) management models were developed for a very autocratic and hierarchical style of management based in the 1960s. Those facilities were built on the model of hospitals (after the Hill-Burton Act of 1946), where the major focus was on healing, or palliation of, physical ailments and mental impairment. Residents were—and, for the most part still are—isolated from family, friends, and community, often without any consistent interaction from the outside world. However, Baby Boomers today will not tolerate such an environment for their parents or themselves. A cultural revolution started to occur in skilled care facilities that changes the resident and management relationship called Resident-Centered Care. Culture change is the common name given to the national movement for the transformation of older adult services. It is based on person-directed values and practices where the voices of elders and those working with them are considered and respected. In the management process, decision-making is pushed down to the lowest level of front line staff. Administrators have become facilitators of process improvement and community advocates for senior consumerism exploring new ways to enhance wellness, fitness, and other creative outreach programs.