A Resource for Culture Change at Nursing Homes

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The informal meetings of a small group of providers and researchers, brought together by their interest in changing the culture of nursing home care, led to the creation of a national movement within less than 10 years. Pioneer Network, the organization that resulted, represents a coalition of nursing homes committed to 13 principles for improving the quality of their institutions and practices. Its aim is to support elders and those who care for them in their homes, assisted living facilities, nursing homes, and other settings. The organization also acts as a liaison between long-term care researchers and nursing homes, both to encourage nursing home participation in studies and to translate research findings into practice. Pioneer's Web site, which was recently expanded, serves as a resource for nursing homes throughout the United States that are interesting in improving their quality or participating in a peer-support network. As such, it offers Pioneer publications, selected articles, case studies, research summaries, and online networks.

Organization: The Pioneer Network, an organization that provides information on and resources for resident-centered care.

The issue: The informal meetings of a small group of providers and researchers, brought together by their interest in changing the culture of nursing home care, led to the creation of a national movement within less than 10 years. Pioneer Network, the organization that resulted, represents a coalition of nursing homes committed to 13 principles for improving the quality of their institutions and practices. Its aim is to support elders and those who care for them in their homes, assisted living facilities, nursing homes, and other settings. The organization also acts as a liaison between long-term care researchers and nursing homes, both to encourage nursing home participation in studies and to translate research findings into practice. Pioneer's Web site, which was recently expanded, serves as a resource for nursing homes throughout the United States that are interesting in improving their quality or participating in a peer-support network. As such, it offers Pioneer publications, selected articles, case studies, research summaries, and online networks.

The intervention: Concerned by the devaluation of aged people and those who care for them, a small group of nursing home providers and researchers came together in 1997. Collectively, they had developed four approaches to transforming these traditional institutions and their practices—the Regenerative Community, Resident-Directed Care, Individualized Care, and The Eden Alternative. The group's interest in making elder care facilities places for living and growing rather than for declining and dying led them to create the Pioneer Network in 2000.

 

The Pioneer Network coalition is dedicated to supporting elders and the people who work with them in their homes, assisted living facilities, nursing homes, and other settings. Its collaborating institutions agree to 13 core values. They are: know each person; each person can and does make a difference; relationship is the fundamental building block of a transformed culture; respond to spirit, as well as mind and body; risk-taking is a normal part of life; put person before task; all people are entitled to self-determination wherever they live; community is the antidote to institutionalization; do unto others as you would have them do unto you; promote the growth and development of all; shape and use the potential of the environment in all its aspects: physical, organizational, and psycho-social/spiritual; practice self-examination, searching for new creativity and opportunities for doing better; and recognize that culture change and transformation are not destinations but a journey, always a work in progress.

Pioneer's principal mission is to serve as a resource for nursing homes throughout the United States—helping them to improve, creating a peer support network, and linking providers with long-term care researchers for a two-way exchange of information. In its liaison role, the organization aims to encourage nursing home participation in studies establishing evidence for best practices and models and to translate these research findings into practice. With these goals in mind, the Pioneer Network expanded its Web site in 2004. The site now serves as a centralized place from which people can access specific publications, learn about state and community initiatives, and contact relevant discussion groups. Its online "Resource Center" features publications that have been developed as a resource for institutions that are interested culture change.

Pioneer Networking, published biannually, is the official newsletter of the Pioneer Network. It includes articles on successful culture change efforts nationwide and provides updates on Pioneer Network activities. Several of Pioneer's other publications are available either as a set or individually. The set includes: Meeting of Pioneers in Nursing Home Culture Change, referred to as the "Yellow Book" due to the color of its cover, offers a look at Pioneer Network's formation; Relationships: The Heart of Life and Long Term Care, or the "Red Book," explains the importance of relationships to those who live and work in nursing homes; The Pioneer Challenge: A Radical Change in the Culture of Nursing Homes, or the "Green Book," summarizes key elements of culture change; and the Bibliography lists dozens of articles and books.

A final book, A Personal Journey by Barry Barkan, was initially released at the Pioneer Network's national conference in 2002 to promote the education and development of those on the cultural transformation path. A video, Innovations in the Quality of Life, is available as well. It highlights the mission of the Pioneer Network and culture change process it established. Pioneer's leaders describe the organization's journey, and "I" format care plans and new techniques in bathing are discussed and demonstrated. The "Champions of Change" section features individuals, coalitions, and homes that have begun to put Pioneer Network's philosophy into practice.

Additional resources on the Web site include selected articles and research summaries. There also is a new blog, a speaker's bureau, listserv, message board, employment postings, and other networking opportunities. The Pioneer Network published Getting Started: A Pioneering Approach to Culture Change in Long-Term Care Organizations in July 2004. This 300-page handbook was designed to provide nursing homes with a compendium of lessons learned from those already several years into the transition from a medical model to resident centered care.

For more information, go to www.pioneernetwork.net.

Updated January 2006

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