Does Comprehensive Culture Change Adoption via the Household Model Enhance Nursing Home Residents’ Psychosocial Well-being?

Abstract

Background and ObjectivesSeveral studies suggest that to substantially improve residents’ psychosocial well-being, traditional-model nursing homes should redesign themselves as small, homelike “households” along with comprehensively adopting other aspects of “culture change,” a set of reforms meant to improve residents’ quality of life. But this evidence mainly comes from qualitative studies. This comparative, observational study tested quantitatively whether residents in a household-model nursing home that had comprehensively adopted culture change reforms displayed greater positive affect, increased cognitive engagement, more extensive social interactions with staff and greater use of the environment than did residents at partial culture-change-adopting facilities with traditional, institutional environments.Research Design and MethodsHousehold-model residents were matched on clinical and demographic factors with residents at two institutional control facilities that had partially adopted culture change and were observed for 8 hours each. To provide potentially converging evidence, aides and nurses were also observed. Finally, a culture change implementation assessment was conducted.ResultsThe implementation assessment showed that the household-model home had implemented culture change beyond national norms, whereas the control facilities were U.S.-typical partial adopters. It also revealed that household-model staff cared for residents in a more person-centered manner. Observation analyses revealed that household-model residents spent less time idle and less time stationary at wheelchair hubs. Moreover, although household-model residents did not spend the most time in the dining area overall, they spent the greatest percentage of time there talking with staff, displaying positive affect, and displaying active engagement. Finally, household-model residents and staff spent the most time in task-oriented interactions, including personal care.Discussion and ImplicationsThese results suggest that the intended psychosocial benefits materialize in household-model facilities, particularly in the dining area and in resident–staff relationships. The findings raise the possibility that facilities may be able to achieve these outcomes without entirely redesigning their environment.

The Benefits of Culture Change in Nursing Homes—Obtaining Nationally Representative Evidence

“…For NH administrators considering culture change implementation, it is important to maximize resource allocation by understanding what domains of culture change have the most impact. 14 Despite these strengths, there are a number of study limitations that may have contributed to the null findings. Although leveraging the pre-existing MDS data was a strength overall, we were limited in our choice of relevant patient outcomes.…”

The Small House Model to Support Older Adults in Long-Term Care

“…25 For example, residents of small house models have the freedom to choose their own waking, bathing, eating, and sleeping schedules. 4,21,26 They are afforded the opportunity to make their own dietary choices and participate in meal planning. 21,25 Spontaneity is also encouraged with respect to the types and timings of social activities available to residents.…”

“…4 The model fosters the development of strong personal relationships between residents and caregivers, which in turn, re-enforces the ideal of person-centred care. 5,23,26,27 The overarching goal of this approach is to care for older adults with compassion and dignity, empowering them to be meaningfully engaged and take ownership of their care. [11][12][13]24,28 Organizational Structure…”

“…These residents were usually privately funded; however, Medicaid programs provided at least partial funding for some residents. 4,26 One study reported daily rates of US$246 to US$495 for accommodations in a small house facility. 33 Objective 2: Key Differences Compared With the Traditional Model…”

Resident Preferences and CNA Empowerment: Testing Validity and Reliability of a Culture Change Survey Tool

“…Items are loaded into a factor based on its shared variance for an underlying factor (Yong & Pearce, 2013). Although it was often included in previous studies (Grabowski et al, 2014;Hermer et al, 2017;Miller et al, 2013), the physical environment items did not share enough variance to generate a factor, implying that these items did not measure an underlying latent factor.…”