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What If There Are No Nursing Homes Doing Culture Change in My Area?

What if you visit several nursing homes in your area and none of them meet the "test" with their answers to the "Key Questions"? Or what if you find a good nursing home, but there is no room available for you or your family member? This is a very difficult situation to be in—to know that things could be better, but not to be able to get it for yourself or a family member. Unfortunately, as this movement is still young and growing, it is not yet the "new normal." In 2007, fewer than one third of nursing homes said they were involved in and/or committed to adopting culture change (see Culture Change in Nursing Homes: How Far Have We Come? Findings From The Commonwealth Fund 2007 National Survey of Nursing Homes at That is the reason we are doing this project and asking for your help.

Long-term care can be changed. It can be different. Many nursing homes are changing and have changed, which proves that it can be done. Remember that culture change and person-directed care are just starting to expand beyond nursing homes into all of the other long-term care settings, including assisted living communities. The culture change movement is still new, and changes take time. We cannot get discouraged about this. This is why we need more advocates to spread the word and help promote change.

Consumers can create the demand for this new type of long-term care. Steve Shields, CEO of Meadowlark Hills in Manhattan, Kansas, a leader in culture change and author of a book, toolkit and business case for the household approach, clearly states that in the future, because of marketplace demand, person-directed care and households will be the only model. All others will not survive. He gives the example, that in his town of about 100,000, the household model is now the only model of nursing home care, a result of multiple factors, but clearly because of consumer awareness and demand.

If you are in the difficult situation of looking for a nursing home that provides person-directed care and there is none available in your area, try some of the education and advocacy suggestions described in the section titled What Can I Do Next?. Keep trying, keep looking, and keep spreading the word. The more that nursing home providers hear consumers asking for it, the faster they will be motivated to make the changes that we all want for our loved ones and for ourselves.

If your loved one is in a nursing home, helping the staff quickly get to know her/him and you is crucial. Here are some ways to do that:  attend care planning meetings; ask questions and share information about who your loved one is, their life history and daily routines. This will allow staff to provide better care for your family member. Putting the information in writing enables it to be shared with the staff who work around the clock. Stay involved and don't be afraid to speak up and be an advocate.  A resource for learning more about nursing homes is the book "Nursing Homes: Getting Good Care There" by Virginia Fraser, Sara Hunt, Barbara Frank, and Sarah Greene Burger. Also, consider joining or starting a family council. For information on family councils visit the Family Council Center on the website of the National Consumer Voice for Quality Long-Term Care.

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