LeadingAge Magazine · May/June 2014 • Volume 04 • Number 03
Is your community an "institution," or is it a "neighborhood"? Is the woman attending your day program "Mrs. Smith," or “the diabetic”? Do you "discharge" residents, or "help them to move out"? When people inquire about your services, do you use jargon, or talk about life in your community?

Those working hard to serve the growing senior population may find it frustrating to have to pay attention to “the language of aging,” but there is little doubt, among many LeadingAge members, clinicians, marketing experts and academics that this is an issue that won’t go away.

When it comes to marketing, potential residents are turned off by the terminology of the “nursing home” universe. It seems that words are more than sounds. They reflect a whole culture of care, and changes in words can, then, mean changes in how staff perceive, and care for, residents and clients and their needs.

“The senior living [field] is changing and evolving, in large part in response to a changing senior generation,” says Matt Wilson, president of Murdock in Oklahoma City, a consulting firm specializing in strategies for senior living. “These generations have new expectations. They have rapid access to significantly more information.” Wilson says the result is a shift that we are just beginning to experience. The language we use to accommodate this shift “is critical to any senior living and care provider’s success.”

It’s more than the changing population that is driving this new awareness of language, according to Karen Schoeneman, a former senior policy analyst in the Division of Nursing Homes for the Centers for Medicare and Medicaid Services who is now a consultant on culture change. She says that as early as the 1980s there was a growing interest in changing a culture that represented patients as objects through its institutionalized terminology.

“You can’t just use words, you have to change your outlook as well,” says Schoeneman. “You have to change your culture to more of a community, you have to wake up to how you are treating each other. It’s gradual, a journey. Change in culture and words are almost simultaneous.”

Judah Ronch, dean and professor at The Erickson School, University of Maryland Baltimore County, also makes the case for a shift in perception: “What ‘old’ means as an identity is really changing. Our job is not just to be the language police but to ask how terms commonly used in our field form the attitudes of people who work there, and their assumptions about what should be provided.” Ronch is co-author of a paper, “The Power of Language to Create Culture,” that explores the issues of language and serving elders.

LeadingAge is well aware of the challenges faced by its members in understanding the “language of aging” issues and ways to take action. A “Lingo Squad” of LeadingAge staff gathers resources, and LeadingAge is hosting, in conjunction with Mather LifeWays, a “CCRC NameStorm” project to try developing a new name for continuing care retirement communities. For more on LeadingAge activities and resources, see the sidebar.

Mindful that language can influence behavior and perceptions, a group of LeadingAge staff came together last year to form the Lingo Squad. The Squad’s charge is to facilitate dialogue and enhance awareness among LeadingAge staff, members, business associates and state partners about the importance of language in our field.

Together, the squad gathered input from members and staff, compiled this library of resources and articles, and created the game LeadingAge WordUp.

As we’ve grappled with how language influences the way we think and act, we’ve come across some articles that informed our work. In Karen Schoeneman’s article "Mayday," she explores the language of person-centered care:

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.

The language of person-centered care has become foundational to the Lingo Squad’s thinking around the importance of language in our field.

In an effort to increase dialogue on the topic, we made language a common thread throughout the week at the 2013 Annual Meeting. During one general session, we posed a social media question to attendees. From the general session stage, we asked attendees “What one word would you eliminate from our field’s vocabulary?” We received responses like: “facility,” “replace the word feeder with needing dining assistance,” and “ban caring for the infirm.”

In the exhibit hall, attendees had the opportunity to be contestants in LeadingAge WordUp. The family-feud-style game was designed to help individuals and organizations question the vocabulary we currently use in our field. Contestants were given a word and asked to come up with new alternatives. For example, if a contestant received the word “facility,” they might say “community,” “home,” or “organization.” Game show winners received a WordUp t-shirt and everyone can download the game from the LeadingAge website.

As our work on language evolves, we encourage members to use the tools and resources on the LeadingAge web site, play the WordUp game in your community and continue considering how words influence thoughts and behavior. Any questions, comments or suggestions can be sent to wordup@LeadingAge.org.

- Written by Kirsten Jacobs and Kevin Bradley, education development managers for LeadingAge.

Individual members provide their own stories of working with ‘the language of aging’ to strengthen their marketing and their resident experience. Bill Warne is marketing advisor at Westminster Canterbury Lynchburg, and he’s been in the field for 34 years. He watches the facial expressions of visitors considering life in a retirement community. “You can see how disconcerted they sometimes are by our words. The activities room may mean, ‘Oh, you want to keep me busy,’ and the van or the bus can mean, ‘how the old folks ride around.’”

Ten years ago Warne put in place a 30-word "Before & After" vocabulary chart at Westminster to contrast old and new terms. Everyone is invited to contribute.

“Sometimes it can take a year to put these changes into place, especially when staff is concentrating on performance efficiency and delivery of services,” says Warne. That’s why he works with the CEO, the marketing director and department heads. He looks for emphatic statements of reinforcement by upper-level management.

“We are working against a built-in resistance to leaving home. We’ve got to sound really appealing, using words that provide a crisp contrast to the image of ‘the old folks’ home.’” Warne thinks Westminster visitors are now saying to themselves, “this really sounds like my kind of place.”

Warne says Westminster works with more than simple word conversion lists. “It’s important to use this new language in conversations, presentations, interviews, collaterals, the website, the resident member handbook, newsletters, and even the labeling on our forms. Maybe the only things we can’t change are the residency agreements because these are legal documents.”

(For a copy of Westminster Canterbury Lynchburg’s vocabulary conversion list, contact Warne at Bill@SalesVitality.com or by phone or text at 904-755-5005.)

Like Westminster Canterbury Lynchburg, Mather LifeWays has made language an important part of its work to “change the way people view older adults, seeing not their limitations but their potential and their possibilities,” according to Betsie Sassen, vice president of community initiatives. Headquartered in Evanston, Illinois, Mather LifeWays in 2013 served some 40,000 older adults through its residences, its Institute on Aging and its programs for older adults in their own communities. In trainings, Mather LifeWays employees learn about the new language of possibility, how to be a good listener, how to ask residents high quality questions, and how to be mindful of body language.

“When you work together on language you build a team,” says Sassen. “As people go about their work, or talk in staff meetings, they begin to recognize words that it would help to change. We have a three-page list of words to avoid and what to use instead. In teaching, we have flash cards. And we do a lot of reinforcing, including respectfully correcting each other.”

Carleton-Willard Village, Bedford, MA, is working to respond to the new demands and changing demographics of the older population. Carleton-Willard considers the use of language an essential part of its marketing and behavior toward residents, according to Director of Marketing Peggy Whiteley.

In every case, it’s the intention to have respect and engaging relationships with residents which then leads to attention to language, and not the other way around, according to Stephanie Smith, director of public relations. “We refer to residents as the people who live here. We ask staff to get to know them by name, building relationships as individuals, to have a lot of respect for who they are, their uniqueness, their own stories. When focused on these, the language follows.”

A year ago, reworking their marketing materials became an opportunity to think about language, says Smith, to make it more person-centered. Now they have a "learning in retirement director," rather than an "activities director," and a "bathing spa," not a "tub room." Whiteley says, though, “sometimes it’s difficult or confusing to focus just on the word—in our effort to update our language, we sometimes muddy the meaning. Your words should reflect your intentions, and whether you say independent living or residential living can be less important than your behavior.”

For example, in the Carleton-Willard library is a collection of biographical sketches of residents. A local author has captured interviews about the meaningful events that frame their lives. Residents have shared their oral histories with video, and these are presented monthly.

“It’s not so much changing or dropping terms as what to choose to bring to the forefront,” says Smith. “We use words to focus on the fact that we are a community, a place for friendship. Of course there are services, but the next generation increasingly wants to know ‘What’s the life I’m going to live here?’”

“The language currently used across the spectrum of senior care reflects old assumptions about what aging is and what older people need to thrive as they age,” says Ronch. This language reflects a view of aging as a process of decline. The result is that care and treatment seek to reduce the negative impact of decline. But, argues Ronch, it is also possible to view aging as a stage in human development. With this view, we ask “what is the best quality of life that we can achieve as a person continues to develop? How can we help them to cope well with their life as it is, rather than trying to ‘fix’ it?”

“These are not innocent language problems,” says Ronch. “It’s not just about changing words.” He argues that successful providers will be those who have committed leaders, who understand the importance of language and aging. “People aren’t going to choose to leave their homes otherwise.”

As Sassen says, “it’s not enough just to use different words. We must live up to the attitudes that these new words imply. We want the words to come true.”