Transcript Medical Model - Council on Social Work Education

Cultural Change in Long-Term
Care Facilities
A comparison of the medical model and the
social model of care with resident-centered
care as an example of the social model.
Dr. Robin P. Bonifas, MSW, PhD
Arizona State University
School of Social Work
Acknowledgements
 The development of this curriculum
module was made possible through a
Gero Innovations Grant from the CSWE
Gero-Ed Center's Master's Advanced
Curriculum (MAC) Project and the John A.
Hartford Foundation.
Learning Objectives
 Upon completing this module on Cultural Change and
Resident-Centered Care are for students to be able to:
 Discuss the strengths and limitations of the
medical model of care.
 Discuss the strengths and limitations of the social
model of care.
 Compare and contrast the medical and social
models of care.
 Describe the goals of cultural change models in
long-term care facilities.
 Articulate the benefits of cultural change models as
identified by research in this area.
 Discuss the characteristics of the Eden Alternative
as an example of a cultural change model and
specifically a resident-centered model of care.
Medical Model
 Alleviation of human
 Presumption of
Professional
 All people aspiring to
Expertise
 View of patient as
suffering
responsibility
Objectivity
 Illness as a distinct
category
perfectibility
the same ideal
object
 Search for efficient
and rapid therapies
 Focus on biology
Medical Model
 Has definite strengths in some areas:
 Situations where there is substantial
consensus as to what constitutes a
"problem.”
 When such problems reflect situations
involving fairly simple cause-effect
relationships.
 For example, intervention to treat a
broken arm or laceration.
Medical Model
 In other areas, has significant limitations:
chronic illness, disability, mental health.
 An over-reliance on "categories", "ideals",
and "objectivity."
 Does not appreciate the significance of
internal experiences.
 Lack of appreciation for diversity and for
the role of individuals in their own healing
and well-being.
 Lack of consideration of the role of
culture.
Social Model of Disability
 Shifts the focus from impairment as
residing within the individual or family to
residing within the environment.
 Challenges traditional beliefs that physical
and cognitive differences are inherently
bad and lead to life-long suffering.
 Views disability as a socially-constructed
concept.
Social Model of Disability
 Limitations
 Ignores real and distressing aspects of living
life with limitations and illness.
 May be difficult for some individuals to view
their disability as a “neutral” characteristic or
based solely in society:
 Persons struggling with chronic pain
 Persons with heavy caregiving responsibilities
 Persons coping with rogressive loss of physical
and/or cognitive abilities
 Limited utility for people who are newly
diagnosed and are just beginning to learn
about the changes disability will bring to their
lives.
Comparison
Medical model
Social model
Painful hands, unable
Better designed lids,
Difficulties in standing
More seats in public
Unable to climb steps
Ramps and lifts in all
Employers won’t hire
Educate people to look
to open jars, doors
for long periods
into buildings
you because they think
you couldn’t do the job.
automatic doors
places
buildings
at the abilities of
persons with disabilities
rather than looking for
problems.
How Would Medical Model View This
Situation? How Would Social Model
View It?
Student
Entrance to her
school
An Example of the Social Model of Care
Cultural change and resident-
centered care in skilled nursing
facilities…
The Cultural Change Movement
 Nursing homes were originally established to
care exclusively for medical conditions.
 Given that these settings are also individual’s
homes, greater emphasis is now being placed on
addressing a broader spectrum of care.
 Cultural change models are transforming facility
practices to:
 Better address the needs of the whole person.
 Enhance the work environment for direct care staff.
The Cultural Change Movement
 Aims to create levels of privacy and choice that
persons residing in skilled nursing facilities would
experience if they were living in their own
homes.
 Facility operations are designed to reflect that
residents’ needs and preferences come first.
 Residents given more control over their daily lives.
 Frontline workers given more autonomy to care for
residents.
Source: M. M. Doty, M. J. Koren, and E. L. Sturla, Culture Change in Nursing Homes: How Far Have We
Come? Findings From The Commonwealth Fund 2007 National Survey of Nursing Homes, The
Commonwealth Fund, May 2008
The Cultural Change Movement
 Physical structure of facilities redesigned to
maximize the feeling of a homelike environment.
 For example, small “neighborhoods” rather than
large “nursing units.”
 Emphasis is on consistent care providers rather
than rotating care providers.
Source: M. M. Doty, M. J. Koren, and E. L. Sturla, Culture Change in Nursing Homes: How Far Have We
Come? Findings From The Commonwealth Fund 2007 National Survey of Nursing Homes, The
Commonwealth Fund, May 2008
The Cultural Change Movement
 A study conducted in 2007 by the
Commonwealth Fund examined the extent to
which nursing homes (n = 1,435) are adopting
culture change principles and practicing residentcentered care.
 Results indicate that the more culture change
initiatives that are under way, the greater the
benefits in terms of staff retention, facility
occupancy rates, market competitive position,
and operational costs.
Source: M. M. Doty, M. J. Koren, & E. L. Sturla. (May 2008). Culture Change in Nursing Homes: How
Far Have We Come? Findings From The Commonwealth Fund 2007 National Survey of Nursing
Homes. New York, NY: The Commonwealth Fund.
An Example Cultural Change
Model: The Eden Alternative
 Core belief: Aging is a continued stage of
development and growth, rather than a
period of decline.
 Goal: De-institutionalize long-term care
facilities to create “human habitats”
instead of medical institutions.
 Strive to eliminate the “three plagues” of
aging in a nursing home: Loneliness,
helplessness, and boredom.
Source: http://www.edenalt.org/
The Eden Alternative
 Views the best methods to defeat the three
plagues are:
 Enhancing sources for companionship.
 Offering opportunity to engage in the
meaningful care of other living things.
 Adding variety and spontaneity to life.
 The above can be accomplished via the
addition of pets, plants, and children into
facilities.
Source: http://www.edenalt.org/
The Eden Alternative
 Cultural change efforts also address
nursing homes as places of work.
 Move away from top-down administrative
approaches to move decision making
closer to facility residents.
 Frontline workers more involved in setting
their own priorities and organizing the
flow of work.
Source: http://www.edenalt.org/
The Eden Alternative
 In nursing homes that have adopted
the Eden Alternative:
 Employee satisfaction has improved.
 Employee retention has improved.
 Use of psychotropic medication has
declined.
 Use of physical restraints have declined.
 Residents have greater participation in
directing their daily lives.
Source: http://www.edenalt.org/
Video: The Eden Alternative1
1Available
at http://www.edenalt.org/
Discussion: Reactions to The Eden
Alternative?
Other Sources of Information re:
Cultural Change
 Bibliography of journal articles on culture change
 http://www.ahqa.org/pub/quality/161_1058_4913.cfm
 The Commonwealth Fund
 http://www.commonwealthfund.org/index.htm
 National Coalition for Nursing Home Reform
 http://www.nccnhr.org/public/50_156_455.cfm
 The Pioneer Network
 http://www.pioneernetwork.net/
 Paraprofessional Health Care Institute
 http://phinational.org/
 Wellspring
 http://www.wellspringis.org/