If your profession involves senior care, you have undoubtedly heard the term “culture change” for the past few years at conferences and in numerous publications. Generally speaking, everyone agrees that culture change is a necessary and desired shift in the delivery of services and care to seniors. Developers advocate culture change. Design professionals support it. Retirement communities have incorporated the term and its concepts into their brands and mission statements.
So now that the various industries serving the senior care market have embraced the culture change initiative, there must be a prescriptive process for making the shift at your existing facility. It should be as easy as ordering a Happy Meal. “Yes, Mr. Architect, we would like one open living and dining room, one decentralized work station, a residential interior finish palette, a large Coke and a side of fries.” Congratulations, you have now officially changed the culture of your facility; or have you?
This drive-through scenario may be an appealing concept, but it’s not a very realistic one. In reality, the experience of changing your culture may be more like a buffet. The meat and potatoes of the planning process are fairly consistent from facility to facility. Dining, living and activity spaces will expand and be more open and accessible to residents. The institutional hospital aesthetic, commonplace in the medical model facilities serving the previous generation, will need to be repackaged and services discreetly relocated. And yes, the finish palette will ultimately receive a face lift. Elements that grace the covers of home magazines and catalogs will be incorporated into the newly improved spaces within your facility. Experienced designers will find ways to seamlessly incorporate these elements in a creative fashion that makes everything feel new.
However, a “buffet” approach to culture change also allows a care provider to choose and modify common elements to fit individual mission guidelines, staffing patterns, programming goals and facility constraints. A perfect example is the provision of food service. Many facilities have a central commissary that provides bulk food to multiple dining venues. Culture change typically envisions uncooked ingredients being delivered to a satellite kitchen to be prepared, cooked and served to residents in individual households. For some facilities this presents a challenge from both a staffing and logistics standpoint. Satellite kitchens require a chef and servers, as well as adequate space and equipment to prepare, serve and store food. The food service components of some facilities are not structured to accommodate additional staff and skilled labor. Additionally, the satellite concept of decentralized food provision leads to underutilization of what may be a state-of-the-art central commissary.
There’s no need to abandon culture change, even if your food service infrastructure cannot support a complete operational overhaul. You can still reap the benefits associated with a serving kitchen and dining venue where menus are flexible and delicious aromas fill the air. A smaller preparation kitchen, in which bulk foods are delivered and finished, can accomplish many of the same goals envisioned in culture change.
According to Beth Bossert, NHA, Administrator for Health Care Services at Masonic Village at Elizabethtown, Pennsylvania, “The creation of our new, country style kitchens has been a catalyst for implementing culture change in our residents’ daily lives.”
Renovations at Masonic Village helped to create resident-centered households where living spaces are the focus and service areas are tucked away behind the scenes. Each household has its own serving kitchen and dining space, but Masonic Village has also maintained the central service kitchen for the bulk of the food preparations.
“By having a central production kitchen support the individual neighborhood country kitchens, we are able to offer flexible dining, accommodate resident preferences and provide improved quality of meals without increased staffing or necessitating significant storage space and equipment,” Bossert reports.
Some facilities may be prepared to totally revamp existing infrastructure, while others are unable or unready to abandon the efficiencies of a central kitchen facility. The point is, culture change is not now, nor will it ever be, a “one size fits all” initiative. Every solution should be as unique as the community and residents it will ultimately serve. Communities should continue embracing culture change with the knowledge that the solution can be as flexible as an all-you-can-eat buffet.
Daniel R. Godfrey, Jr., AIA, LEED AP is a senior project manager at RLPS. He has served as project architect for a number of community renovations designed to support culture change initiatives.