Replacing the Institutional Word Homelike with Home and Normal Life

We have been reviewing CMS Tag 741 and its long list of examples of individualized, non-pharmacological approaches to help meet behavioral health needs. In the last article we reviewed Adjusting the environment to be more individually preferred and homelike.

The CMS definition of homelike is incredible from CMS Tag F584 Safe, Clean, Comfortable Homelike Environment:

A “homelike environment” is one that de-emphasizes the institutional character of the setting, to the extent possible, and allows the resident to use those personal belongings that support a homelike environment. A determination of “homelike” should include the resident’s opinion of the living environment.

All the examples given by CMS in its guidance were explained and expounded upon last time.

Now we analyze the word and how the culture change movement has moved on from it. The word itself is actually institutional although CMS’ intention was good in 1987. In fact, look at the definitions.

Google first says homelike “a place or setting as comfortable, familiar, cozy, and inviting”. Now, of course, we want all these things for the people who live and stay in the homes you represent. On that note, talk to them about this. Ask if their home is cozy, comfortable, familiar and warmly inviting. Asking people these exact questions is a great place to start.

Secondly, Google says “It is often used to describe spaces outside of a traditional residence – such as hotel rooms, cafes, or assisted living facilities – that make people feel warmly relaxed.” Kind of proves it.

Break down the word. Home … like. If you think about and focus on the like part, it really means that this is not your home when it is only like home. Therefore, this word does not work when we talk about the place where people live.

What do you call the place where you live? We all refer to our home and our house, and we never use the word homelike. To me that also proves the point.

Why don’t we call it the home or house it is? The terms care center or facility also have nothing to do with the home and house it actually is to those who live there. The word homelike ends up actually being institutional.

Now think about the culture that words like facility, care center and homelike create. Not home. Not house. Not normal. In other words, fake, abnormal, and institutional.

Homelike means like home, like a home but not really a home. Maybe inadvertently, but the word itself gives it away that this is not home and not a home.

In contrast, look at the words home, house, community. What culture do words like these create? Normal. Home. Real life. Normal life.

Look through the lens of home; not institution or facility or homelike or a healthcare setting.

In the 30 years of the culture change movement, you will also hear leaders speak about real home, true home, and being at home or feeling at home. When someone refers to the nursing home or assisted living as their home, we know we’re getting there. Remember housewarming parties? What if people were so proud to live in a nursing home or assisted living, they insisted on hosting one? It has happened actually. If were to happen more, we will know we have arrived.

Using the term homelike was well intended, however, like home really gives it away that it is not home. We advocate for creating true home for those who live there. Leaders in the culture change movement teach that we don’t say food-like or pregnant-like. The language works against us. When you find yourself wanting to use the word homelike, try to think about what you really mean. I wonder if we are searching for the word and/or concept of simply normal life. I think we all yearn for normal life, certainly not institutional life.

It is one thing to use more dignified language – please do it – and it costs no money to change culture by changing language.

The next step is to actually change the culture to be home, true home. In a home, those who live there make their own decisions about their daily life. In culture changed homes those who live there decide on the décor, they decide which juice to purchase and some homes give authority to choose who gets to work there!

Language has power to create culture.

Do your words continue to perpetuate institutional culture or do your words create a normal, home culture?

And back to the best part of the CMS regulations, talk a lot about how the home is institutional and how that institutional character could be de-emphasized. This is in the regulations! In other words, discuss what would make their home normal. Using CMS regs to your advantage is smart.

Create home, not homelike.

Join me in becoming a Guardian of Normal Life. Don’t let the institutional culture pull you in. Be intentional to call it out. No one wants institutional or homelike. Everyone wants normal and regulations support!

De-emphasize the institutional character of the setting by at least starting with your words.

Carmen Bowman, MHS, Regulator turned Educator of Edu-Catering: Catering Education for Compliance and Changing Institutional Culture is an activities/engagement/community life, regulatory compliance and culture change consultant.  She offers new or not-yet-qualified activity director consultation and personalized continuing education for professionals/teams/associations. At www.edu-catering.com join The Be Encouraged Blog, Become a Leader of Normal Life with the eResource GUARDIANS OF NORMAL LIFE: How Activity/ Recreation/ Engagement/Community Life Professionals can Save the World of LTC and share with your team the eBook Individualizing Medication Administration using Regulations. At the Edu-Catering YouTube channel, see documentaries that highlight changed cultures.