|
|
The Language of Culture Change
"Mayday"by Karen Schoeneman I've always been a fan of words. When I was young, I'd spend hours browsing through a 20-pound unabridged dictionary that gave the histories of words as well as their meanings. I've just recently found out why people shout "Mayday" when their ship or plane is in trouble. It's a misspelling of the French, "m'aidez" which means "help me," and is pronounced "mayday." Well, today, I'd like to shout "Mayday" for help with my words. I've worked 30 years in long-term care. Over that time, I've come to realize that much of the language we use is in need of replacement because it unintentionally demeans people, contributing to a hierarchical sense of "us and them" or a dehumanizing institutional culture instead of a nurturing community with respect for its members. When I started working in long-term care in 1972, I worked in a "State School and Hospital" with "inmates" who were called "retarded" and categorized as "moron," "idiot," "imbecile," "mongoloid." Those words were not intended as insults, just diagnoses. We've already come a long way from there, but we still have far to go. And those of us who came from a past that accepted words like these need help—your help—to upgrade our institutionalized brains. Part of transforming long-term care practice is finding new words to describe staff, programs, parts of the building, and the "industry" itself. As I've attended Pioneer and Eden conferences, I've been immersed in a new type of language called "person-centered." The idea behind person-centered language is to acknowledge and respect long-term care residents as individuals. Using person-centered language, I've learned, is often as simple as reversing common phrases to put the person first and the characteristic second. "A wheelchair-bound resident," for instance, becomes "a person who uses a wheelchair for mobility," and "a feeder" becomes "someone who needs assistance with dining." A few years ago I wrote an article about this subject for Provider magazine and invited readers to e-mail me words and phrases they thought were outdated, along with their suggestions for what to use instead. Look at the word "therapy," for instance. Why does everything have to be therapy once you live in a nursing home? If I liked to paint before I moved into the nursing home and I paint now that I'm there, why is my hobby now "art therapy?" I mean no insult to the wonderful folks who call themselves therapists and their work, their special training, or their skills. In fact, I'm a massage therapist myself. But in this context, "therapy" is another of those separating words. This list below is a collection of suggestions culled from the many responses I received from readers of Provider, along with some additions from friends and colleagues and a few thoughts of my own. The list is not definitive, and I am not its keeper. It's not up to me to say whether these words are our best or only choices, but I do know they're a start, so I'm sharing them in hopes that they'll spur more thinking and discussion.
The language of long-term care belongs to all of us—not only the "us" who work in this field but, at least as importantly, the elders and others with disabilities who require long-term care services, their families, and the public at large. The most urgent task we face may be agreeing which "bad" old words to throw away. Finding new ones should be easier. After all, that's just a matter of choosing words that are both accurate and respectful, and that unabridged dictionary is full of good words. | Old Word | Suggestion | "victim of . . ." or "suffering from . . ."
| "has . . ." or "with . . ." | wing, unit
| household, street, neighborhood, avenue | | allow | encourage, welcome | | diaper | pad, brief, disposable brief, brand names, incontinence garment | the elderly
| elders; older adults, people, or individuals | patient
| resident (some think this is passé), individual, elder | a feeder/the feeders, feeder table
| person who needs/ people who need assistance with dining, dining table | a diabetic, a quad, a CVA
| a person who has (whatever condition)
| nurse aide, CNA, nursing assistant, front line staff (sounds like war)
| resident assistant, certified resident assistant
| admit, place
| move in
| discharge
| move out
| | lobby, common area | living room, parlor, foyer
| nurses' station
| work area, desk
| facility, institution, nursing home
| home, life center, living center
| 100-bed facility
| 100 people live in this home/center | | housekeeping, housekeepers | environmental services, homemakers
| | long-term care industry | long-term care profession or field | | eloped, escaped,elopement | left the building, unescorted exiting | | dietary services, food service | dining services | | problem residents, behavior problems | person with behavioral symptoms | | agitated | active, communicating distress | | ambulation, wandering | walking |
Karen Schoeneman is a senior policy analyst in the Division of Nursing Homes in the Centers for Medicare and Medicaid Services. The opinions expressed in this article are those of the author and not necessarily shared by CMS. More words...
| People | Old Words | New Words | | | Grandma, Mommy, Kid, Sweetie, Honey, Girls, Old Timer | Resident's name/ Mr./Mrs./Ms. | | | Wheelchairs/Walkers | People who use a wheelchair/walker | | | The Elderly | Elders |
| Bed (i.e. - A 100-bed facility) | Resident |
| Residents Identified by Diagnosis | Their name -- Learn it!
|
| Wanderers | People who like to walk |
| Disabled | Person needing support/ What their abilities are |
| Toilet Resident | needs help in the bathroom | | | Activity Director
| Community Life Coordinator
|
| Non-nursing/Ancillary staff | (name) from (department) |
| New Admit | Someone offered a home here, New Neighbor |
| Feeder/Feedy | Person who needs help eating |
| Patient | Resident, Participant, Client, Neighbor |
| Resident | My Friend |
| Dementia/Demented | Person with cognitive losses |
| Girl, Guy (CNA) | Their name, My Friend |
| I
| We/ The Team |
| Food Service Worker, Hey You | Their Name |
|
|
| | Places | Old Words
| New Words
|
| Facility, Nursing Home | Community, Home, Care Community, Life Center |
| Agency | Supplemental Staffing |
| Bath | Spa |
| Ward | Village |
| Nurses' Station | Work Station, Den, Support Room |
| Storeroom | Pantry |
| Solarium | Living room |
| Unit | Neighborhood |
| Tray Line | Fine Dining |
|
|
| | Things | Old Words
| New Words
|
| Activities | Meaningful things to do |
| Mechanical Soft Food | Chopped Food |
| Nourishment | Snack |
| Bibs | Napkin, Clothing Protector |
| Diaper, Pampers, Pull-ups | Briefs, Panties, Attends |
| Hospital Gown | Pajamas, Nightgown |
|
|
| | Actions | Old Words | New Words |
| Transport
| Assist to…
|
| Admit/Place | Move in |
| Ambulate | Walk |
| MIA, Elopement | Taking a walk |
| Toileting | Using the bathroom |
| Baby-sit | Resident interaction |
| Allow | Help/Facilitate |
| Claims | States, Says |
|
|
| | Attitudes | Old Words | New Words |
| You are fat | You are thick or curvy |
| Care Plan Problem | Resident Strength |
| "I didn't know my resident could do that." | "I love it when my resident does that!" |
| Problem | Challenge/Opportunity |
| "You need to…" | "Would you like to...?" |
| "Sit down, you'll fall." | "Let's walk!" |
| "Trays are here." | "Dinner is served."/ "It's dinnertime!" |
| "He's on the pot." | "He's not available right now." |
| Long-Term Care Industry | Long-Term Care Community |
| A two-assist | Requires two helpers |
| "We're already doing that." | "We need to REALLY do that." |
| "We tried that." | "Let's try again." |
| "That's not my job." | "I'll take care of that." |
| Industry | Mission |
| 14-hour rule | Freedom of Choice |
| Old ways | Change in order |
| Can't escape | Would like to go outside |
|
|
| | Conditions | Old Words | New Words |
| Short-staffed | Adequate staffing |
| Confined to wheelchair | Uses a wheelchair |
|