December 9, 2015, by Centre for Applied Social Research
Transforming cultures of care?
Author: Professor Justine Schneider
‘Transforming the culture of care’ is an expression used by well-intentioned people but sadly it seems to be a cliché in danger of losing its power to persuade. I heard it recently here: Alive! – lighting up older people’s lives.
This clip illustrates how a delightful programme of music and dance can make an impact on institutional care settings. Great stuff, as far as it goes, and forgive me for being cynical, but I know – anecdotally, from insiders – that mealtimes, staff preferences and medical interventions easily take precedence over arts activities in care homes. The spaces where music, dance or other creative activities can be held are often dining rooms, and mealtimes therefore limit the availability of the room for such activities.
Care staff sometimes disregard professional artists on their premises by inconsiderate ‘noises off’ or by using the artist’s space as a short cut through the home. Clinical interventions have the power to interrupt everything going on in a care home, perhaps because nurses and doctors have high status, or because they only come in from time to time. In some ways these three examples reflect givens in the culture of residential care: regimented meals, powerful care staff and even more powerful medical attendants.
Transforming the culture of care will require more than an afternoon of music and movement each week, because residents are disempowered in so many ways; a radical rethink of care culture has yet to be undertaken.
Some progress has been made, for instance, in terms of the acceptance that individualisation in important. However, person-centred care can be seen as a relatively minor adjustment in relation to the dominance of routines, staff attitudes and the medicalisation of old age. Structures and routines, as well as those people who are paid to care, define a culture that limits residents’ potential, but older people are also handicapped by their own expectations of those of society.
Ideas for truly transforming the culture of residential care are welcome!
Justine Schneider, December 2015.
Justine has extensive experience in many aspects of applied health research using a wide range of methodologies and approaches. She has particular expertise in mental health service evaluation, carers, care homes, costs and supported employment for people with any kind of disability or disadvantage. Her current work focuses primarily on dementia and staff development, and she is exploring innovative approaches to knowledge exchange in dementia care through the arts.