I need your help. Let’s build something together! (Seriously, I need your help.)
The Artifacts of Culture Change is a tool that was developed to help nursing homes (and other types of care communities) rate themselves on where they are on their culture change journey, and where they want to go.
Note: There is a possibility my parents might be reading this, and I am not sure they really know what I do (I love you, Mom and Dad, for keeping me humble), so I will briefly explain culture change. Culture change refers to changing the culture of aging, and how we support each other as we grow older. There are lots of ways we need to change the culture of aging, but culture change is usually thought of the change in a nursing home (or another type of care community like assisted living) from an institutional culture to a true community in which people live with choice, dignity, respect, self-determination, and meaning. If you want to learn more about the culture change movement, go to http://www.pioneernetwork.org. Or, Mom and Dad, ask me when I drop off the dog next week- thank you for pet-sitting!
The Artifacts of Culture Change is a great achievement in making culture change in care communities a little more concrete. It helps to identify what are the elements of a culture we want to see, and whether changes to become this culture are actually happening. The term artifact is especially important because artifacts, at a basic level, are those things that tell us about what a culture is like. This is for any culture. I think the idea of cultural artifacts are fascinating – it really makes you think about what we mean by a culture.
We might say something like, “the culture of my workplace is very casual and fun”. But what does this mean? If an alien came into your workplace, what evidence might they see that this is true? Maybe artifacts of this casual, fun culture are people wearing jeans, or Friday happy hour (if so, I want to work there).
In the nursing home world, an artifact of an institutional culture might be rigid mealtimes (breakfast is only served at 7), or an institutional-looking environment (long hallways, sterile, low natural light, etc.). Artifacts of a nursing home culture that is a true community (one that is going through a culture change) might be the people who live there having choices in when and what they eat, what they do throughout the day, and nice and accessible outside spaces. The Artifacts of Culture Change helps to evaluate whether a care community is a home or an institution. And many more things. Important things.
But I can’t help thinking – even if these things are in place, what do we know about how people are living in this nursing home? What is their life like? Maybe we also need to focus on the individuals living in care communities. Are they living well? If we think about a good culture, one in which people are living well, what would this look like?
I have an idea about another type of Artifacts tool. I want an Artifacts of Living Well tool.
What would be the artifacts of a good life? For anybody. If we think about this question just for people living in nursing homes, we tend to lower the bar a little. So, we have to think about it broadly. Let’s imagine a place called “The Republic of Living Well”. We are visiting the Republic of Living Well. As we tour around this place, how do we know that people are living well in this culture? What are the artifacts of its “living well” culture?
So, what would an Artifacts of Living Well tool look like? Of course, each person’s definition of living well might be unique. But, I assume there are some things that are universal. I’ll start.
Some artifacts of living well might be:
- Smiling.
- A person making yum sounds when they take a bite of cake.
- A sigh when a person gets into a comfortable bed.
- Helping someone.
- Laughter.
- Tan lines (evidence that a person spends some time outside).
- The light in a person’s eyes when they see someone they love.
What else is evidence of a good life? Tell me what you think. Help me build the Artifacts of Living Well. We can do this together.
Being Heard 
Artifacts of Living could be observable evidence of Residents’ participation in each category of the CMS Artifacts of Culture Change, such as:
1. Care Practices: A one page, large printed version of each Resident’s basic preferences for care (such as times for wake up, time for each meal, shower, bedtime, etc.) is constructed with Resident, documented in Care Plan, and taped inside his/her bedside table in a designated location. Both staff and Resident refer to the one page often and update with team if necessary.
2. Environment: There is visible evidence that Residents decorate their space as they prefer. Residents are observed as they use outdoor spaces, both with staff and without staff.
3. Family/Community: Residents are observed in the Cafe, as well as family and others. When questioned, Residents talk about their most recent observation of children or contact with children.
4a. Leadership: CNAs not only attend Care Conferences, but they have direct care items of understanding of each individual Resident to report, which they are taught and coached supportively by leaders to contribute in each meeting and between meetings as needed.
4b. Leadership: When questioned, Resident leaders are able to describe some mechanism(s) that the community uses to ensure that Residents are heard by management. Resident leaders give examples of success of the mechanism. (This could include Resident Committee, Residents on the Board, Regular meetings with management team, etc.)
5. Staffing Outcomes: In addition to longevity of staff, there is evidence that staff members of every level, including management and CNAs, actively participate in ongoing development in the area of Culture Change. This includes participation in Culture Change Conferences, touring and partnering with communities that are advanced in their Culture Change journey, etc.
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Wow, thanks, Ginny, for your thoughtfulness in taking this to the next level!
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Fun for me!
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Thank you, thank you! I’m so honored to get to work with you and benefit from your person-centered approaches in all that you do.
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Likewise, my friend. We have some great work to do together and I am glad we are in it together!
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So when I read this article, the image that conjured in my mind was an actual water well versus Sonya’s intended meaning of what makes one satisfied or complete. I like the water well representation. Wells tap into water sources, and dependence on water is necessary for life. And a living well could be both…a tapping of sources which are obligatory for what matters most.
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I love this, Sue Ellen!
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