Today's "traditional" nursing homes were created about 50 years ago as "homes for the aged." Architecturally, many were built like hospitals and organized to be similarly run. As a result, nursing homes became regimented and task- and schedule-driven. With the advent of federal and state reimbursement for nursing home care (through Medicaid and Medicare), many regulations were written by government agencies to create and oversee better care.
Originating from a focus on illness and dependency, daily life in many nursing homes is organized around predetermined schedules and to-do lists for the staff, who may not know the resident well. Because the emphasis is primarily on quality of care and not on quality of life the resident's life often lacks choice, meaning, and purpose. There is little sense of being "at home."
The culture change movement is working to transform this institutional approach to care delivery into one that is person-directed. The culture envisioned is one of community, where each person's capabilities and individuality are affirmed and celebrated. In culture change, quality of care and quality of life are inseparable and equally important.
The physical environment that is created as a result of culture change is an important part of creating home. However, it is important to understand that the values of culture change—choice, dignity, respect, and relationship—are of primary importance. A facility that focuses only on changing the environment without changing the underlying culture, including the attitudes and roles of leadership and staff, gains little. A resident's daily quality of life and ability to make choices will not be likely to improve through environmental changes only. Using bathing as an example, a beautiful spa-like room is of little benefit if the residents are still bathed on a rigid schedule or against their will.