Anthropology & Aging Anthropology & Aging, Vol 35, No 1 (2014), pp. 71-73 ISSN 2374-2267 (online) DOI 10.5195/aa.2014.38 This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License. This journal is published by the University Library System of the University of Pittsburgh as part of its D-Scribe Digital Publishing Program, and is cosponsored by the University of Pittsburgh Press. Book Review Jurkowski, Elaine T. Implementing Culture Change in Long-Term Care: Benchmarks and Strategies for Management and Practice. New York: Springer Publishing Company. 2013 ISBN: 9780826109088. 298 pp. Price $55.00 (paper) Renée Rose Shield, PhD Health Services, Policy & Practice (Clinical), Brown University http://creativecommons.org/licenses/by-nc-nd/3.0/us/ http://www.library.pitt.edu/ http://www.pitt.edu/ http://www.library.pitt.edu/articles/digpubtype/index.html http://www.upress.pitt.edu/upressIndex.aspx Anthropology & Aging Vol 35, No 1 (2014) ISSN 2374-2267 (online) DOI 10.5195/aa.2014.38 http://anthro-age.pitt.edu Book Review Jurkowski, Elaine T. Implementing Culture Change in Long-Term Care: Benchmarks and Strategies for Management and Practice. New York: Springer Publishing Company. 2013 ISBN: 9780826109088. 298 pp. Price $55.00 (paper) Renée Rose Shield, PhD This volume is written by professor and Graduate Program Director at Southern Illinois University Carbondale’s School of Social Work, Elaine Jurkowski, MSW, PhD. More than a ‘how- to guide,’ Implementing Culture Change in Long-Term Care: Benchmarks and Strategies for Management and Practice reflects the author’s extensive and practical experience in promoting culture change practices emblematic of nursing home reform. Particularly informed by the culture change initiatives within the Pioneer Network umbrella (and with a Foreword by a recognized culture change champion and founder of The Eden Alternative, Bill Thomas), the book is organized as a useful handbook to assist administrators, care staff and other stakeholders in long-term care. The chapters progress logically with suggestions of how to implement practices and policies within culture change domains to reduce the institutional feel of these facilities and create a more person-centered, humane and homelike experience for the frail, older adults housed in them. The culture change movement has great face validity but has just the beginning of a sturdy evidence base to support its feel-good intentions. Nonetheless, numerous culture change practices are being incorporated in increasing numbers of nursing homes to challenge the typical look and feel of institutional hospital-like routines, practices and décor. Such changes include expanded resident choices for dining, bathing and activities, and environmental improvements such as the elimination of overhead paging systems and nurses’ stations and more comfortable living areas, to name a few such commonly implemented practices. The book’s organization reflects its purpose to provide benchmarks and strategies to further institutional reform. In a succinct, clear and easy to follow writing style, Jurkowski in Part I describes the context of the system of American long term care and includes historical and demographic information to situate nursing home populations and how nursing homes have developed over the decades. Various “paradigms” of care that have guided how institutional care is financed, organized and carried out in this country are described against which the culture change paradigm is held up as significantly different and positive; in culture change model, individuals and their preferences are honored and not delegitimized. Jurkowski summarizes the origins and principles embedded in the culture change movement. She clarifies the purpose and content of the Artifacts of Culture Change Tool (ACCT) developed by the Centers for Medicare and Medicaid (CMS) and used as a summary of benchmarks to identify and measure culture change implementation in long term care settings. In Part II, Jurkowski describes strategies and benchmarks of culture change practices in detail, itemizing the different domains that are typically targeted: care practices, environmental improvements, family/community practices, leadership practices, workplace practices and outcome practices. Part II is replete with examples and strategies that have been used in facilities to demonstrate practical ways to implement useful improvements. Numerous photographs graphically depict these suggestions. For example, in a Shield| Book Review Anthropology & Aging Vol 35, No 1 (2015) ISSN 2374-2267 (online) DOI 10.5195/aa.2014.38 http://anthro-age.pitt.edu 72 section describing how meal time can be enhanced to be more person-centered and less institutional, photos of dining layouts are included for table or buffet arrangements; and in a chapter about environmental practices, photos of alternative bathrooms, bedrooms, reworked nurses’ stations, showers and bathrooms, and outside areas with raised gardens help the reader understand the attraction of these improvements. In Part III, Jurkowski lays out strategies and resources for implementing change broadly. Using strategies from other reform movements, including disability rights, she discusses how assessments can be made to track and sustain progress as well as to itemize ways to engage a variety of stakeholders in the process of planning and implementing changes effectively. Each chapter ends with a useful summary paragraph. The discussion/reflection questions following each summary are nicely conceived and can help trigger productive conversations among involved stakeholders about long-term care and how it is delivered. Also useful is chapter 15 which itemizes and deconstructs “interpretive guidelines” from CMS that govern regulations for long-term care. The Appendices feature culture change organizational resources, websites, and a glossary of terms. While this volume is a useful handbook to help implement culture change practices in US long-term care, anthropologists will find certain considerations lacking. In particular, as is typically done, the word “culture” has been used without discussion of what culture means. Jurkowsky certainly cannot shoulder the blame for using this term without definition or exploration since this omission is common in reform movements. Still, I find myself wishing that while “culture” (or its lack) is often blamed or credited for problems or successes generally, some thoughtful exploration of what defines or is meant by culture would be a nice and informative accompaniment. The same goes for the unscrutinized use of the word “community.” In my opinion the book would also be greatly enhanced if there were mention of Erving Goffman’s masterful description of the “total institution” (Goffman 1961) or Thomas Kuhn’s influential idea that “paradigms” are not so easily overthrown and largely determine how scientists and the rest of us think about any given subject (Kuhn 1962). The ideas of these seminal thinkers undergird the premises and the challenges involved in the attempted overthrow of institutional regimes that still rule nursing home care. Another gap is that the ambitious efforts that the US Department of Veterans Affairs has made to restructure their nursing home equivalent, Community Living Centers, have gone unremarked in these pages. I did not find the tips and strategies that were promised for anticipating barriers in existing policies and from regulators, nor do I see strategies for positive collaboration with them that were supposed to end the book. In this regard, some payment policy reforms, such as Pay-for-Performance, may help institute the adoption of beneficial practices and environmental changes. I’ve often wondered why physicians are usually left out of proposed reforms for improving nursing homes. Even if it’s difficult to involve physicians in collaboration with other disciplines in these settings, I’d appreciate ideas about how to overcome barriers in recruiting them and thoughtful exploration about how their involvement would aid the practices and processes in nursing homes and the culture change movement. Finally, anthropologists and others may wish that the book were enlightened with illustrations of nursing home care in the US and how other societies house and care for their frail citizens. Illuminating examples can be found that would enrich and fruitfully enlarge the ideas suggested here. For example, Savishinsky’s wonderful examination of how the inclusion of pets in a facility triggers domestic talk among staff and residents would have improved the section on Shield| Book Review Anthropology & Aging Vol 35, No 1 (2014) ISSN 2374-2267 (online) DOI 10.5195/aa.2014.38 http://anthro-age.pitt.edu 73 “facility pets” (1991). Resident, staff and family discontent as well as suggestions for improvement are vividly described in books such as Gubrium’s Living and Dying at Murray Manor (1975), Diamond’s Making Gray Gold (1992), Foner’s The Caregiving Dilemma (1994), Shield’s Uneasy Endings (1988), Kayser-Jones’ Old, Alone and Neglected (1981), Gass’s Nobody’s Home (2004), as well as other and more recent works. Though this volume is more how-to than ethnography, the cultural critique embedded in the radical notion of culture change might be thought to require the inclusion of anthropological perspectives and the wealth of argument and example they offer. I wish it had. References Cited Diamond, T. 1992. Making Gray Gold: Narratives of Nursing Home Care. University of Chicago Press. Foner, N. 1994. The Caregiving Dilemma: Work in an American Nursing Home. University of California Press. Gass, TE. 2004. Nobody’s Home: Candid Reflections of a Nursing Home Aide. Cornell University Press. Goffman E. 1961. Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. Doubleday. Gubrium, J.F. 1975. Living and Dying at Murray Manor. St. Martin’s Press. Kayser-Jones, J. 1981. Old, Alone, and Neglected: Care of the Aged in Scotland and the University States. University of California Press. Kuhn, T. S. 1962. The Structure of Scientific Revolutions. The University of Chicago Press. Savishinsky, J. 1991.The Ends of Time: Life and Work in a Nursing Home. Bergin and Garvey. Shield, R. 1988. Uneasy Endings: Daily Life in an American Nursing Home. Cornell University Press. Book Review Book Review