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Frequently Asked Questions

The Language of Culture Change

"Mayday"

by Karen Schoeneman

(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.)

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article about this subject for Provider magazine and invited readers to e-mail me words and phrases they thought were outdated, along with their suggestions for what to use instead.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. If you have words to add to the list, please send them to the Culture Change Network of Georgia . Entries will be added below.

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                  

Suggestions

“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

More words.....

 

Old Words

New Words

People

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

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

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

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

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

Short-staffed

Adequate staffing

 

Confined to wheelchair

Uses a wheelchair

 Source:  The Pioneer Network, www.pioneernetwork.net, with permission.
Karen Schoeneman graciously granted her permission for use as well.