Leadership from the bottom up: reinventing dementia care in residential and nursing home settings

A number of recent policy initiatives have sought to improve the quality of dementia care in residential and nursing homes. Drawing on current literature and themes identified from in-depth interviews with four managers working in these settings, this paper discusses the potential for different styles of leadership in developing a suitable organisational culture in which quality dementia care might develop and thrive. It argues that alongside valuable strategic imperatives coming from the UK National Dementia Strategy (DH, 2009), there is a corresponding need for more 'bottom-up' approaches within dementia care settings themselves through the empowerment of staff. It argues that this would enable more participatory approaches to organisational development. The paper specifically discusses the concepts of both 'climate' and 'culture' in institutional care for older people and how these features can be enhanced to support a more person-centered approach. Particular emphasis is given to the significance of leading a culture of learning, which we view as crucial to any transformation process.