There is a growing movement within the field of long-term health care that has come to be known as the "Culture Change" movement.  The term refers to the culture of the organization and entails a variety of factors, one of which is the belief that each individual has the right to experience the highest level of well-being possible, an idea that extends to both staff and clients.  The impetus is focused on the individual client and that individual's right to direct his or her own care to the greatest extent achievable.  The movement began in the late twentieth century as visionary leaders recognized the need to transform the institutional model of nursing home care into a social model that addressed emotional and relational issues, in addition to physical and medical needs.  The work of those early pioneers has gained the attention of professionals in other special care arenas, such as brain injury and MH/MR care providers.

This person-directed care model challenges care providers and professionals to examine traditional beliefs and practices by defining new ways to measure quality of outcomes.  A task force convened in 2004 and sponsored by the Jefferson Area Board of Aging and the Eden Alternative® defined the ultimate outcome of the person-directed care as Well-Being. 

The concept of well-being reaches beyond the current quest for quality-of-care and quality-of-life outcomes.  Well-being encompasses clients, staff, families, leaders, organizations, and the community as a whole.  The greater task, then, is to articulate a clear definition of the term and its components.   The task force identified seven primary domains of well-being along with a comprehensive survey that explores each of the domains in depth.

An encapsulation of the seven domains is:

• Identity - One's own identity, history, and feelings of self are essential to well-being.  The concept of being well known by significant others is fundamental.
• Growth - Regardless of a person's physical or mental status, that individual remains capable of further development, learning, enrichment, unfolding, and evolving.
• Security - Based on Maslow's hierarchy of needs, a sense of security (freedom from doubt, anxiety, or fear) is a basic need that must be met before we can grow toward self-actualization.  In the field of health care, this basic need includes privacy, dignity, and respect.
• Autonomy - To be one's own person and to make one's own decisions is integral to well-being.  In order to honor this need, top-down management styles must be transformed so that hands-on caregivers and clients can attain the highest degree of autonomy possible.
• Connectedness - All living beings require connections to others, to place, and to nature as well as to past, present and future, in order to thrive.
• Meaning - The search for meaning in life is primary.  Everyone needs a sense of value and purpose, the opportunity for reflection, and the chance to pursue that which is personally sacred.
• Joy - Joy is a condition of spirit that fills the soul.

In short, constant attention to the well-being of staff and clients offers a climate in which a true community forms, offering a life worth living marked by honesty and deep caring for each other.