The culture change movement brought a much-needed emphasis on the dignity and humanity of those receiving long-term care. Research has identified many outcomes of culture change—reduction in over-medication, more home-like environments in long-term care (LTC), improved social life for residents, and many other targeted benefits. As an article in the most recent Gerontologist notes, however, “little evidence suggests that elders themselves have participated in the identification of areas in need of improvement within their LTC communities and in the development of culture change initiatives.” This article presents a study that involved older adult residents as experts and participants in implementing culture change in LTC.
The authors present a review of culture change research and programs and argue that while culture change initiatives have been very successful at addressing two of the three “plagues” of nursing home life (as identified by Bill Thomas), loneliness and boredom, the third “plague” of helplessness is less frequently addressed. Initiatives to improve quality of life in LTC have focused rarely on or made use of older adults’ senses of competence and self-efficacy. By using a participatory action research (PAR) model, the researchers doubly addressed the self-efficacy of residents: residents served as experts and researchers in a study the very aim of which was to identify possibilities for resident-directed culture change.
Residents grouped themselves into seven resident groups (RGs), which identified several areas of potential reform. Rather than just providing a list of suggestions, these RGs debated the merits and impact of suggested reforms, and developed several specific, workable solutions to problems they had identified, particularly in the area of resident-staff relationships and opportunities for civic engagement. The article provides examples of several of the RGs’ interventions, including a set of general policies for resident interaction. The study provided a case example of PAR as a solution to two sets of problems: PAR functioned as a means to improve and implement culture change within a care facility but also served in itself as a means for residents to demonstrate their own competence and to build social relations with one another.
Shura R, Siders RA and Dannefer D (2011). Culture Change in Long-term Care: Participatory Action Research and the Role of the Resident. The Gerontologist 51(2):212-225.