Culture Change

The culture change movement advances an alternative to a biomedical model of dementia care.  The Pioneer Network, a group of professionals within long-term care committed to a transformation of care for older adults, defines culture change as a “national movement… based on person-directed values and practices where the voices of elders and those working with them are considered and respected.  Core person-directed values are choice, dignity, respect, self-determination, and purposeful living” (Pioneer Network, 2012).

The movement seeks to address multiple components within institutional structures, including physical environment, relationships, attitudes and values, and organizational practices.  Thomas Kitwood (1997), a pioneer in person-centered dementia care, identified the following seven components of the biomedical geriatric care culture that require transformation:

  1. A shift towards viewing dementia as a form of disability rather than as progressive destruction of personality and identity.
  2. A shift to viewing caregivers and people living with the disease as sources of relevant knowledge, rather than doctors and scientists.
  3. The refocusing of research efforts on improving quality of life rather than focusing solely on biomedical treatments and prevention efforts, that often take the form of solely pharmacological interventions.
  4. A focus on caregiving efforts that address preservation of personhood rather than focusing only on physical care.
  5. An emphasis on the unique abilities, interests, values, and strengths of each individual rather than focusing primarily on cognitive decline.
  6.  View of behaviors as attempts at communication of needs, rather than as problems that need to be managed or diminished through pharmacological intervention.
  7. Acknowledgement of the feelings that arise in caring for people with dementia; these feelings are sources of valuable insight, and may lead to the development of more genuine, empathic relationship with people living with dementia.

For more information, check out:

Thomas Kitwood (1997) Dementia reconsidered: the person comes first.  New York, NY: Open University Press.

G. Allen Power (2010) Dementia beyond drugs: Changing the culture of care.     Baltimore, MD: Health Professions Press.

Athena Mclean (2007) The person in dementia: A Study of nursing home care in the US. Toronto, Ontario: University of Toronto Press.

The Making Time Project

The Making Time Project, 2013

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