Abstract:

Nursing homes all over the country are casting off their institutional nature and working towards creating home. This emerging change is due to a new phase of cultural, organizational, and physical evolution in long-term care, the Culture Change Movement. Spear-headed by The Pioneer Network, the Culture Change Movement recognizes the need to create a place where elders can live comfortably and receive needed care, rather than simply creating a building where medical services are provided. This dissertation explores how culture change in long-term care occurs. Culture change in long-term care is the process of transforming a facility from operating in an institutional medical model manner to operating under a holistic resident-centered care manner focused upon fulfilling individual resident's needs, wants, and wishes.

While much has been written on the psychosocial/spiritual environment of culture change within long-term care (Fagan, 2002; McNamara, 1999; Gold, 2002), very little has been developed on the process of creating culture change (The Pioneer Network, 2004; Shields and Norton, 2006) or the role of the physical or architectural environment in this transformation. Although making changes solely in the physical environment does not bring about culture change within long-term care (McNamara, 1999), this research reveals that placemaking, the in-depth processes of creating new physical environments or re-creating existing environments, may have a more important role in creating culture change than previously acknowledged.

Using a systemic approach, this dissertation research examines culture change in three arenas of a long-term care facility-the psychosocial/spiritual environment, the organizational environment, and the physical or architectural environment. These case studies of exemplary culture change facilities revealed several insights in regards to culture change in long-term care: (A) The hidden program and our mental models of long-term care contribute greatly to the difficulty experienced in creating culture change in long-term care. (B) Despite most literature on culture change in long-term care describing it as a systemic process, generally little emphasis is given within the literature to the role of transformation within the physical environment in creating culture change. (C) Culture change in long-term care is an organic, creative, complex and holistic process, which is not accurately described by the majority of the current process models of culture change in long-term care. (D) There are several goals, objectives, actions, tools, and processes are used to facilitate culture change transformation in long-term care organizations. (E) Although many advocates of culture change in long-term care describe culture change as a never-ending journey, case study facilities demonstrate that creating a learning organization is the result of culture change transformation.