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Getting Ready for Person-Directed Implementation

Adopting New Beliefs

Adopting new beliefs is important for a provider considering culture change. It is essential to review and revise facility mission, vision, and values statements. For example, Neville Manor, a not-for-profit nursing home in Cambridge, Massachusetts, revised its mission statement to reflect its culture change initiative. The original mission was: "To provide quality of life and quality of care to residents who come to us for long-term residential or short-term rehabilitative care. We assist residents to achieve their highest possible level of physical, psychosocial and spiritual potential, always working to protect and enhance their dignity. We seek to continually improve the services we provide."

This mission statement is a fairly common example from a traditional nursing home viewpoint. However, after initiating its culture change, Neville Manor's new mission statement, with input from residents, staff, families, ombudsmen, and others, became:"To be a thriving healthcare community in which the individual needs and desires of the residents direct and shape daily life."

This new mission statement makes the shift to person-centeredness evident.

The vision statement answers the questions: Where are we going? What is the goal? Using an inclusive process to shape culture change, vision helps to clarify the difference between the atmosphere existing in the nursing home and the atmosphere everyone is being asked to help create. The team at Fairport Baptist Home in Rochester, New York, for example, designed this vision statement to support its culture change initiative: "We envision for our residents normalcy and individualized, quality care. We will work in partnership to create the best of "home": an environment of friendship, spontaneity, creativity, comfort, and pleasure. We envision a place where each of us is known, where each is comfortable being one's self, where each of us wants to be. And, we envision a thriving and growing community, full of life and vitality, in which all are welcome and all contribute."

This vision statement describes an atmosphere where the residents and staff are known as individuals.

A values statement explains how people in the nursing home want to live and work together, and serves as a yardstick against which practices should be measured. For example, a nursing home that claims person-directed care as a value, but assigns wake-up times according to CNA assignment, is not practicing this value. The Edgewood Centre in Portsmouth, New Hampshire, drafted a statement that defined five values: Home, Empowerment, Appreciation, Relationship, and Teamwork. Together these values define how community members strive to treat one another: with respect, caring, compassion, and cooperation.

The process of establishing mission, vision, and values to support culture change takes time. An inclusive process is critical. If an advisory committee creates a first draft, it can submit the document to others within its nursing home community for their feedback. Several drafts of each statement will probably be generated before everyone is satisfied and feels a connection with the content. Encouraging widespread feedback is a step that cannot be skipped; without it, the statements will be mere pieces of paper hanging on the wall, having little meaning to those who live and work in the home.