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Letter to the Editor

August 18, 2008
by FB73C3C989C141FAAC1A8E7F7C27D180
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Richard, please accept my congratulations on the redesign and renaming of your excellent magazine. However, I want to challenge you as an industry leader to make an even more significant contribution to changing our future and those of our residents for the better through the extraordinary power of words.

No person wants to live or make their home in a “facility.” Let us together banish that term from our speech forever starting with the next issue. Likewise, no one wants to be “admitted” into or be a “patient” in their home.

I recognize that short-term nursing centers rely on clinical healthcare expertise, but no person will ever object to being a “client” of such a professional organization. I further recognize that we have many different types of places one can live (or be served), and, when we refer to them in general, let me suggest we use “communities.”

If we truly want to change, we must raise the bar for everyone, and this can not happen without attacking the root cause: The lexicon we use and its very negative impact (some would argue damaging) on our residents and clients.

Will you accept the challenge?


Anthony J. Mullen, Partner, Royal Star Partners

Cofounder, NIC

Poll Question





Tony Mullen is right on all counts.

We have to change our language to compliment and express changes in our thinking, beliefs and reinforce behaviors. The application of words on the status quo is the most economical means of sharing evolutionary thinking, and leads to broader based understanding and the re-solving of conventional problems.

When we want to effect change in the world, we have to focus our thinking toward the desired result, creating the vision in our mind. In communicating and executing the vision we have the medium of words and architecture.

I can tell you that at Wattenbarger Architects, where our practice is exclusively seniors environments, the word "facility" is discourage if not forbidden. The simple reason is that nobody chooses to live in a facility. The attachment to the word "facility" can be attributed to the need for operational efficiencies from the perspective of both building systems and personnel. However, the word conveys nothing of value to the social settings. A facility cannot overcome loneliness, but a community can.

Furthermore, if we can agree that the expression "home-like" is an inadequate expression of our collective vision, I submit that "Community" has greater power to lead us down the best path.... for now.

I agree that words are very powerful. I was a member of the disability movement in the 80s when we changed the language to "people first" as in people with disabilities. Though it didn't go trippingly over the tongue... it did make a difference. People are first and their disability is second.

I don't have much problem with the term resident. However after living in a nursing home for 12 years I think patient is a little stupid. The short-term care folks are referred to as patients. I know that staff try to be very careful of their terminology. And I am sure that those involved with admissions have their jargon that they use on a day-to-day basis. I don't think it would offend me too much. Anyone who has worked anywhere has used jargon before.

Client is definitely a more dignified term. However I don't know if that will come into use any time soon. As a resident in a nursing home, I have no idea how much administrators and department heads read about new trends. In the disability movement, I read constantly. I wanted to know what was going on... everywhere. I feel that your magazine should be read by all management teams in nursing homes.

As far as the term facility is concerned, home is probably a better designation. No one has ever mentioned...that I have read... Long-Term-Care Home as a possible name. I use nursing home still just because people then know exactly what I'm talking about. Long -Term-Care Home could refer to assisted-living as well as custodial care. That's another lovely term that we have never changed either. But I guess it exactly states that the resident needs that type of care and needs to be where it is provided on a 24-hour basis.

I think beyond terminology in long-term-care presenting a good attitude towards those folks who live in nursing homes is much more important. A friendly, communicative, warm and caring environment says a lot more than mere words could ever say.

Words have power. They paint pictures, lend emotional overtones and influence our thoughts, feelings and actions. Based on direct feedback from families, for example, most dementia care communities no longer use that word. They call themselves "Memory Care" - a term that just feels warmer, especially to families already suffering the effects of this disease process. Likewise, it's way past time to stop referring to a vacancy as a "female bed" ("Do you have space for my mother?" "Yes, we have a female bed available."). Sort of sets the stage for expectations about the type of personalized care you can expect to receive, doesn't it. It should be a "community" of people, living in the same residence, receiving care and services in a way that honors them as individuals. Each of us making an effort to carefully more appropriate words is one way to help.

People living in LTC environments are generally referred to as residents. However, sometimes "patient" is used for short-stay people undergoing things like rehab. These days moving to long-term care is like signing an apartment lease. Being "admitted" sends a negative message of fraility and the inability to care for oneself. Although facility is used in our articles, words like "home," and "organization" have more impact. A facility is thought of as just a building, which is kind of cold, when you think about it. Anyhow, that's my weigh in.