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How Is It Changing?

There are a number of models of culture change. All share common values of choice, dignity, respect, and relationship, although they may be implemented in different ways. These models are also not the only options for implementing culture change. While some long-term care communities adopt these models, others develop their own.

Here are some examples:

The Eden Alternative
The Eden Alternative was developed in 1991 by Dr. Bill Thomas, a Harvard trained physician and geriatrician, and his wife, Judy. The Eden Alternative is so named because it is an alternative to the traditional institutional model of long-term care. Dr. Thomas believes that human beings do better when they are surrounded by the natural world, including not just plants, animal, and beauty, but genuine relationships with people of all ages. The Eden Alternative model is built on alleviating what Dr. Thomas describes as the three plagues of old age: loneliness, helplessness, and boredom. The Eden Alternative has ten principles, which drive how it is implemented in a long-term care community. Learn More

The GREEN HOUSE® Project
"THE GREEN HOUSE® Project creates small, intentional communities for groups of elders and staff to focus on living full and vibrant lives. Each Green House residence is designed to be a home for six to 10 elders, blending architecturally with neighboring homes. The Green House homes are characterized by their vibrant outdoor spaces and pleasing aesthetics both inside and out. Each elder has a private room or unit with a private bathroom. The elders' rooms allow ample sunlight and are clustered around a shared living room with a hearth, an open kitchen and dining area. The homes are relatively small, allowing many elders to get around without wheelchairs. Safety features are carefully built into each home." Learn More

The Household Model
The Household model consists of self-contained living areas with 25 or fewer residents, each with their own fully functional kitchen, living room, and dining room. Staff work in multi-disciplinary work teams. LaVrene Norton of Action Pact, Inc. and Steve Shields of Meadowlark Hills Retirement Community in Manhattan, Kansas, one of the first organizations to renovate its health care/skilled nursing facility into households,  define households as "Small groups of people sharing house and home while directing their own daily lives through a responsive, highly valued and decentralized self-led service team that is supported by values-driven, resource-bearing, leadership philosophies, practices, policies, and
systems." Learn More

"Planetree's holistic approach encompasses body, mind, and spirit. It supports the involvement of family and friends in providing care and empowers individuals by providing information and education. Planetree recognizes the importance of the nutritional and nurturing aspects of food and the healing benefits of an attractive physical environment. Nature, art, music, and space for meditation and prayer are incorporated into this environment." Learn More

Wellspring Innovative Solutions
"Wellspring primarily focuses on strengthening clinical and managerial skills of staff, empowering residents and frontline staff, and creating a high quality of life for residents. One of the strengths of Wellspring is that it enables nursing homes to affect culture change within their existing physical plant and wherever they are along the continuum of change." Learn More

In addition to these more formalized models, individual long-term care communities implement culture change in their own ways. Resources for providers on their culture change journey can be found at Promising Practices.

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