Improving the lives of older people
and their carers by transforming the
communities in which they live and work"

A bridge over troubled waters of culture change

Rayne Stroebel, shares from his experience.

What happens to culture change when budgets are cut? We use it as another excuse to not embark on the culture change journey. Any excuse!

Care Homes in South Africa are faced with an existential crisis. The landscape of post-apartheid is bleak, to say the least. Long term care in our country accommodates 2% of the over 65 year old population, of which 98% is still white. Government funding is aimed at keeping Elders in the community and to provide basic primary healthcare services in rural areas where the basic commodities like running water and sanitation is not available.

Like most institutional thinking, the lack of financial resources (and therefore not enough staff) is always the number one reason why Care Homes protest against culture change efforts. It is literally the door that is slammed in the face of the bright eyed, bushy tailed Eden salesperson. No amount of quoting research can convince the hard-line finance person that culture change can actually improve the bottom line.

And yet – where the brave lead (and in our case it is interestingly enough mostly where women lead) – miracles happen. In 2010, the Free State Care in Action organisation embarked on a culture change journey. A volunteer organisation started in 1902, led by a group of women who cared for soldiers returning from the Anglo Boer War, took on the challenge to change the culture of care in 12 Care Homes in a rural part of South Africa. These homes are all subsidised by the state in a haphazard and unstructured manner, depend on volunteers as board members and mostly house the poorest of the poor.

The deciding factor to embark on the journey was based on a different premise. It was not a financial motivation, but a deep concern for the relevance of the institutional model, which in turn would impact on the financial sustainability. The core leadership group realised that the nursing model was not relevant, that it was all about decline, and that they needed to change the culture.

Presenting The Eden Alternative to a group of people who are all volunteers, who truly believe in their mission, who are not ashamed to roll up their sleeves and who have no fear of challenging the status quo was not easy. It took 18 months of training, education and conferencing before the Board approved our proposal to embark on a two year journey of transformation for their twelve homes.

What we found on our initial visits were often beyond desperate. Local GP’s who decided to put catheters in all “frail” residents, residents tied to their cots with swimming pool nets, locked up behind bars and malnourished. As the organisation did not have the resources to pay for this exercise, the individual homes had to come up with the money to participate in the project. And this is where the steel showed – women who were determined to make a difference started baking, knitting, selling, begging. And the money followed. In homes with no running water and no heating in winter, the hearts of the community started opening when the message spread that a new energy has been released.

Our first meetings were all based on the “Who am I?” approach – a fun way of getting to know people beyond job descriptions. The warmth and openness that followed these sessions truly opened hearts and minds. Along the journey unemployed people from informal settlements came to volunteer their services because they saw and heard about the “good work” that was happening in homes that once were considered the worst places in these villages. Stories of Elders engaging with the children of staff members, relationship developing between “white” and “black” people – who never used to greet one another spread like a wild fire.

Money is a lame excuse. Changing a culture will improve quality of life, it will enhance independence in activities of daily living, improve nutritional status, and subsequently lower the burden on care staff. It will engage Elders to regain continence, reduce fall risks and improve mood. Which in turn will mean less medication and other consumable costs.

Culture change needs guts, not money. It needs commitment and a “yes we can” attitude. It does not require fancy equipment and expensive training programs. It requires sitting under a tree, renewing our covenant with the earth, our Tikkun Olam.

Two years later we visited these Care Homes to see if the changes lasted. I was moved to tears seeing and feeling the genuine transformation. Not just the transformation away from the institutional model of nursing, but the deep commitment towards creating a better life not just for Elders in the Care Home, but also for the greater community. A new spark of engagement from Elders to serve their community provided money for further development programs, upgrading of very old and sad buildings. From baking bread to polishing shoes (night staff in a small village offered a shoe polishing service – drop off on your way home in the afternoon and collect first thing in the morning). These funds served to revamp the entrance hall and offices of their home. For the Elders, by the Elders.

Culture change starts with wise leadership. Wise leadership starts with committing to our purpose to make this world a better place. If you dare open yourself to this journey, the money will follow.


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