Nutrition 411: Wound Healing in the Era of Long-term Care Culture Change
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Patients in skilled nursing facilities (SNFs) have seen institutional life change dramatically over the past several years. SNFs, often called long-term care (LTC) communities, operate under vastly different guidelines than traditional acute care hospitals. Although patients average a 3- to 4-day length of stay, LTC patients often reside in the facility for years, frequently until their death. This necessitates a different approach to care and a more homelike environment. A culture change revolution has taking been shape for several years and is gaining speed.
Understanding related changes can help healthcare providers (HCPs) treat patients and their wounds more effectively.
Defining Culture Change
Today’s LTC patients and/or their surrogates are actively involved in making decisions about their living environment, medical care, and lifestyle choices. This is part of a phenomenon known as culture change. The Pioneer Network (www.pioneernetwork.net), one of the country’s largest organizations that advocates for radical changes in the culture of aging, has spearheaded much of this movement. The group defines culture change as, “The transformation of older adult services, 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.”1 The concept of culture change embraces the patient’s right to make decisions, including the right to refuse medications or treatments, which, in the process, increases the patient’s satisfaction with his or her quality of life. In fact, patients are referred to as residents, not patients, referring to the fact that the healthcare facility is their permanent residence. Some SNFs have embraced the concept completely, while others are just embarking on these changes. But it is clear that culture change in LTC is here to stay.
The adoption of person-directed care is a catalyst for modifications in LTC communities. These changes may include modifications to the physical plant to make the facility home-like rather than institutional, procedural changes such as including the patient’s input in development of a plan of care, and alterations in day-to-day life such as changing medication times to better suit a patient’s sleep schedule or encouraging residents to dine when they choose. Not every person likes breakfast precisely at 7:00 am, so why should this be the only schedule available to residents in LTC?
Meal-related choices are important parts of individualized care and self-directed living for several reasons, but primarily because dining is such a significant part of daily life for most LTC residents.2,3 Many facilities offer their residents dining choices based on individual life-long patterns and history, as well as current preferences. This may include, but is not limited to, open dining times, self-selected menus, buffets, family-style dining, and snack bars or 24-hour accessible pantries. The concept of individualizing or liberalizing diets (as opposed to providing restrictive therapeutic diets)2 is common in LTC today and works hand-in-hand with the culture change movement.
Because LTC is highly regulated by the Centers for Medicare and Medicaid Services (CMS), providers must find the delicate balance between meeting each patient’s medical needs and adhering to the regulations that govern LTC. The CMS regulations embrace all aspects of patient-centered care and culture change.