Life in nursing homes often strips residents of a sense of meaning and of opportunities for using skills honed over a lifetime. Their world now depends on medical and social service professionals, not on their own experiences to shape how they live.
"If someone would ask me, I might have something to say," one local resident admits. "You don't live here 24 hours a day without learning something."
That knowledge gained by residents, staff and family members will be used to work with front-line workers in a project of education based at the University of Rochester. The effort will integrate the views of these "resident experts" into a curriculum for the education of certified nursing assistants and other staff. It will supplement the prevailing medical model with "the voices of the experts who are usually quite mute in the long-term care setting and in education for long-term care work," says Dale Dannefer, project director and professor at the University.
The University's Margaret Warner Graduate School of Education and Human Development is collaborating with ViaHealth HillHaven, a local nursing home, and Lifespan of Greater Rochester, a community-based agency dedicated to serving people in the second half of life. The project is funded by a $230,000 grant from the New York State Department of Health. The goal of the project-co-led by residents and staffers with guidance from Warner School team members-is to use the firsthand knowledge of residents to rethink the development of a new curriculum for nursing home workers.
The plan, devised by Dannefer, doctoral fellow Paul Stein and colleagues from Lifespan, involves the creation of small work groups of residents, staff and family members. Meeting weekly, the work groups will critically review areas of staff practices and nursing home policies.
"We want to establish modes of learning and teaching in which people with dementia and other disabilities can express themselves and contribute to the communities in which they live," says Dannefer, who is a sociologist of aging. "So often, the culture of the training and of the work implicitly carries a view of residents as depersonalized objects rather than as people who can participate in designing the work practices of caregivers and the conditions of their lives."
Dannefer's project, called "Beyond Culture Change: Regenerating Meaning Through the Living-Learning Community," is aimed not only at improving the satisfaction of both staff and residents with the way the work is done, but also with combating problems of staff motivation and morale, which are accompanied by high staff turnover rates and staff shortages. If the collaborative work-group idea yields fruit, the design could serve as a model for integrating education and human services, says Dannefer. Work on the project began in March and will last for two years. It includes an evaluation component.
Dannefer is working with Rosemarie Fagan of Lifespan, who is project coordinator. Carter C. Williams, an internationally known advocate for long-term care reform, serves as project consultant.
In a separate project begun in 1998, Dannefer is collaborating with two other Monroe County nursing homes. Both facilities have started to make systemic changes in the policies and organizational structures of their facilities. His research team is evaluating how the new operations are affecting their residents.