Jeff,  In our building, we are working on adjusting some of the titles.     We no longer have department heads, they are called mentors and leaders.   We have even changed some of the front line worker titles.   Our charge nurses are now shift leaders, our medication nurses are called mediciation specialists, and our CNA's are called resident care specialists.   It has been difficult to transition to new titles.   We are all so stuck in the old medical model of care.   Hope this helps.  

Hi Jeff,

Thanks for your entry. In my work providing support and advocacy to adults officially labeled as having "severe dementia(s)," "autism," and as having "problem" or "challenging" behaviors I have been called a "community integration specialist," a "personal assistant" or "behavior specialist." And of course there is a new name or title of "Best Friend" (Bell & Troxel, increasingly adopted by those who support folks with the label of 'dementia.' These are recent titles that do make inroads to revising our old medical model mindset.

Changing much of our language is fundamental to creating a new paradigm of support. Obviously this extends way beyond titles of staff (not to diminish that effort in any way). For example, I feel that the term "dementia" has way outlived any usefulness it may have had, and recent work in this area (Kitwood, 1997; Sabat, 2001) does dramatically illustrate the harm that such "defectological" approaches unwittingly create while simultaneously benefitting (to no small degree) the industry participants, thus maintaining the old medical model.

One goal of the so-called "front line" of empowered direct care workers/nurses should be to convey to both physicians and administrators that we will no longer accept either the old paradigm language OR old-paradigm approaches to support. If widespread, this advocacy could effect change in how both the legal system and the insurance companies interface with physician's and patient's decisions about health care, since those decisions are ultimately dependent upon our compliance and support.

So let's change our language and actively investigate/implement new methods of support, especially for those who have difficulty advocating for themselves or their loved ones. We owe it to current and future generations of elders who richly deserve our honor, respect, and assistance.      

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