Participation of Long-term Care Residents in Culture Change: Still a Challenge and Opportunity

• In Event: 3422 - Section on Aging and Life Course Refereed Roundtable Session
  In Refereed Roundtable 100min: Table 01. Caregiving

Abstract

For older people needing LTC or other forms of assistance, attention to the intertwined meanings and definitions of quality of life, resident-centered care and culture change represents a domain of unresolved challenges. An essential foundation for responding to such challenges is a solid theoretical foundation. We have proposed that NH reformer Bill Thomas’s identification of three pervasive plagues of nursing home life – boredom, loneliness, and helplessness – provide a foundation for such an approach. These plagues provide a lived, experiential basis for institutional critique, and they also correspond to what motivational psychologists have identified as three universal human needs – autonomy, relatedness and competence. The present paper reviews literature on culture change in various forms of elder care since our introduction of this framework in 2011. We observe a bifurcation of conceptual interests and objectives – a dominant set that are institution-focused, organized and driven entirely by professional and “expert” knowledge, and an alternative set that – often utilizing PAR -- recognizes the knowledge, authority and expertise of the residents themselves and of others close to their situations (frontline staff, family.) Evidence from both sets of studies are consistent with our earlier claims and findings that - whatever overtures have generally been made in the direction of culture change - the plague of helplessness and the corresponding need of competence remain unaddressed, relative to the other two plagues. The findings of research from these two paradigms and the implications of this paradigmatic bifurcation for research and practice going forward are considered.

Authors

• Robin Shura, Hiram College

• Dale Dannefer, Case Western Reserve University