Culture of a Nursing Home in Order Essay

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Culture of a Nursing Home

In order to qualify as a culture, a group or subgroup of people needs to have sufficient characteristics to differentiate it from the surrounding society. This paper examines a nursing home in the community in order to determine whether the people at the nursing home constitute their own culture. The paper examines whether their rituals, physical space, artifacts, social habits, music, and arts are sufficient to establish the nursing home as a culture separate and distinct from the overriding culture in the area. Furthermore, it examines the role that the various members of the nursing home community play in forming and continuing the culture.

Of all the aspects of the nursing home environment that differentiate it from the prevailing culture outside of the nursing home, the element of control is probably the most defining of it as a culture. The residents of a nursing home are all adults, as are the staff members. As adults, the residents are entitled to a certain level of self-direction and respect for their personal autonomy. However, the fact that they are living in a nursing home environment suggests that, for whatever reason, they are unable to manage at least some of the aspects of self-care. In addition, some of them have conditions, such as dementia, that make it impossible for them to fully participate in all of their own decision-making. As a result, the facility must exercise a level of care and observation over them that is fundamentally incompatible with the type of freedom one normally associates with adult people in the United States. For example, residents who are leaving the facility need to check in and out of the facility. There are also curfews at the facility, so that residents who leave must be back by a certain time and visitors to the facility are not permitted to arrive prior to a certain time (8am) and must leave by a certain time (9pm). Furthermore, the resident rooms are gender-segregated. While married couples are permitted to cohabitate in the same room, residents are not permitted to have other opposite-sex residents as guests in their room if a door is closed. The reason for this rule is linked to age-related dementia impacting sexual impulsivity control in many elderly males, but is applied to all residents regardless of gender and whether or not the individual resident is experiencing dementia. As a result, the environment curtails a significant number of the residents' personal freedoms.

Moreover, the staff at the nursing home is almost entirely composed of people who are younger than the residents. While the prevailing U.S. culture may not extend as much respect to the elderly as the culture in other nations, there is a general rule that the older someone is, the more authority and autonomy the person deserves. Therefore, to have younger people in charge of the older people is a role reversal, which distinguishes the nursing home culture from the prevailing outside culture.

Socioeconomic status and race also play into this cultural transformation. The residents of the nursing home that was observed would be considered middle-class and upper middle-class, and, therefore, of higher status than the workers, who would be considered lower-middle class and lower-class. Furthermore, the residents of the nursing home were composed of a racial and ethnic mix that roughly mirrored that of the outside population; majority white with a representative proportion of minority residents. However, the staff is composed primarily of African-Americans. In American society, as a whole, African-Americans are considered a lower-status group, but, in the nursing home environment, they have power over many non-minority residents. Furthermore, because many of the residents are old enough to have retained a significant degree of racial prejudice, this role-reversal can be complicated. It was not unusual to hear some of the residents using overtly and subtly racist descriptions to describe staff members in a manner what would be completely unacceptable outside of the nursing home environment, yet staff members largely acted as if this did not impact them. Furthermore, when focusing on race it is impossible to ignore that Asians seemed underrepresented in the resident population of the nursing home, further differentiating it from the surrounding neighborhood's cultural environment.

The nursing home has a rigid schedule that helps inform the ritual elements of its cultural environment. One element of this rigidity becomes apparent when one examines meals in the nursing home. Residents are given breakfast at 8am in a dining hall or provided with the option of eating in their rooms with delivery between 8am and 9am. They eat lunch at noon. There is an afternoon snack provided at 3:30pm, and dinner service begins at 5:30pm.

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The residents are given a choice from a limited number of options at each meal time. These options do not reflect any particular ethnic background, but is more broadly composed of what one might identify as generic "American" food. The food choices observed during the nursing home visits included: mashed potatoes, meatloaf, steamed vegetables, salads, jello, baked chicken, baked fish, rolls, fruit cups, yogurt, eggs, sausage, club sandwiches, egg salad, tuna salad, and crackers. The foods were bland, without a significant amount of spice. Moreover, while there was pepper available on the table, none of the tables had salt available on them. One resident explained that this was due to the fact that many residents had salt-sensitive high blood pressure. Some residents did bring their own salt shakers with them to meals.

Not only are meals strictly served at particular times, but other daily activities are also regimented. The mornings seem devoted to self-care and leisure time. The nursing home has personal service providers come in to an in-house salon, and the mornings were times for hair appointments and nail appointments. Doctors come to make their rounds in the morning. The nursing home provides a shuttle bus to various doctor and dentist appointments in the morning. In addition, twice a week the nursing home provides shuttles for shopping services at a mall and at a strip center that included a grocery store. Generally, these errands are concluded prior to lunch being served at noon.

The afternoon provides an opportunity for more tightly structured recreational activities. Art plays a crucial role in these recreational activities. For example, many of the recreational activities are focused on crafts. The residents are given opportunities to participate in crafts in a large group setting, and, upon further investigation it became clear that many of them have formed smaller groups to focus concentration on a specific type of artwork. For example, there is a quilting guild that met with regularity, as well as a painting group. Another group of seniors engages in Christmas crafts. Arts and crafts formed a cornerstone of the community, so much so that the nursing home even sponsors a "Christmas in July" craft fair, where residents can sell their crafts for spending money or to donate to various charities.

Music also plays an important role in the culture. The nursing home has music playing constantly, although it was not audible throughout the facility. The front lobby and seating area feature the type of music traditionally referred to as Muzak, and it ranges in origin from classical to contemporary music. However, the great room of the facility, which features a large living space for the residents to enjoy, features exclusively music that would have been popular during the young adult years of the residents: primarily big band and swing music. This music is sometimes a low background music, although at least once a week a performer from the community comes into the nursing home to perform live music for the residents. For example, the author witnessed a Frank Sinatra tribute singer covering Frank Sinatra and Tony Bennett songs during one visit. The music plays an important part in the culture of the nursing home. Many of the residents actually get up and dance to the music, and even those that cannot dance to the music can be observed snapping fingers, clapping, tapping their feet, or swaying in their chairs. Moreover, the music seems to prompt significant discussions about the decline in popular music over the course of several generations, though there seems to be significant disagreement over whether rock and roll had invigorated or destroyed traditional American music.

In fact, debate seems to play a large role in the culture of the nursing home, and not in a destructive way. It is not unusual to hear the residents debating political policies, and, oftentimes those debates focus on foreign policy, rather than domestic policy. Many of the residents were personally impacted by World War II and have very strongly held opinions about the merits of isolationism as opposed to intervention. They also seem to disagree strongly about the role that Israel plays in global policy. However, there appear to be rules surrounding the propriety of these debates. One woman in her early 90s appears to have been appointed the de facto mediator for these debates,….....

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