A Closer Look at Pioneer Practices

The passage of the Nursing Home Reform Act (OBRA) in 1987 brought with it standards and regulations meant to ensure residents the right to "care and services to 'attain or maintain the highest practicable physical, mental, and psychosocial well-being.'" Though OBRA was a major step to improving care, it was not consistently and effectively applied. Many people envisioned much more. A few facilities across the country achieved systems that differed from any seen before. These "Pioneers" went above and beyond OBRA by implementing total culture change in nursing homes.

The original Pioneers were a group of long-term care providers and advocates who recognized the need to reexamine long-term care and implement practices to rediscover the human side of care. This group of Pioneers came together in 1997 at a meeting sponsored by the National Citizens' Coalition for Nursing Home Reform (NCCNHR) to discuss the culture change they had achieved and strategies for communicating culture change to facilities across the country.

Though each Pioneer facility had developed its own model of culture change, the models had certain principles in common. The Pioneers identified culture change as an ongoing journey of growth that begins by understanding the experience of the person who lives in the nursing home. Pioneer culture change requires creativity, patience and a team commitment to achieve.

Instead of the medical model approach with sterile and impersonal environments, task-oriented routines, and residents known only by their diagnosis, the Pioneer Practices provide opportunities for individualized care to the maximum extent possible in a homelike environment. The Pioneers all strive for similar goals including changes in environment, staff schedules, resident care, and a facility's system of authority.

The foundation of culture change is a changed mindset. Change must begin with facility administrators, staff, and families challenging their existing assumptions, practicing self-examination of procedures, probing and asking questions, and always searching for how care can be delivered better!

• 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 elders 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.
• Recognize that culture change and transformation are not destinations but a journey, always a work in progress.

EDEN ALTERNATIVE
'Human Habitat' with a diversity of plants, animals, children and personal items neighborhoods with a middle meeting ground Staff in interdisciplinary teams with the power to make decisions.

REGENERATIVE COMMUNITY
An interconnected community incorporating all residents, staff, families, and volunteers. Downplay the illness and build upon the wellness and strengths of each resident. Resident focused, not task focused.

RESIDENT-DIRECTED CARE
Homelike community with neighborhoods. Each community incorporates residents with varying degrees of ability and cognitive function. Cross-trained, permanently assigned staff follow residents' schedules.

INDIVIDUALIZED CARE
Applies resident autonomy and risk-taking to dementia patients specifically. Permanently assigned interdisciplinary staff teams. Creative and compassionate solutions to dementia behavior symptoms.

Pioneer Practices Links

Pioneernetwork--Changing the culture of aging for the 21st century

Eden Online--The Official Eden Alternative™ Website

The Wealshire--Moving Alzheimer's Care Forward