Nursing Home Organizational Change: The “Culture Change” Movement as Viewed by Long-Term Care Specialists

Abstract

A decade-long grassroots movement aims to deinstitutionalize nursing home (NH) environments and individualize care. Coined “NH Culture Change” the movement is often described by its resident-centered/directed care focus. While empirical data of “culture change’s” costs and benefits are limited, it is broadly viewed as beneficial and widely promoted. Still, debate abounds regarding barriers to its adoption. We used data from a Web-based survey of 1,147 long-term care specialists (including NH and other providers, consumers/advocates, state and federal government officials, university/academic, researchers/consultants, and others) to better understand factors associated with perceived barriers. Long-term care specialists view the number-one barrier to adoption differently depending on their employment, familiarity with culture change, and their underlying policy views. To promote adoption, research and broad-based educational efforts are needed to influence views and perceptions. Fundamental changes in the regulatory process together with targeted regulatory changes and payment incentives may also be needed.

Caring for Dying Patients in the Nursing Home: Voices From Frontline Nursing Home Staff

“…In this regard, some promising efforts to improve supportive EOL care in long-term care are already underway (e.g., establishing guidelines for best practice for EOL care in NHs that include strategies for involving families in resident care and decision making) in many states including Colorado, California, and Missouri. 29–31 Additionally, models of care like the Green House approach 32 and the culture change movement in NHs 33 with their emphasis on person-centered care, promoting family involvement, and enhancing quality of life have demonstrated successful ways of delivering supportive care, including needed social support, to residents nearing death.…”

Overcoming Resistance to Culture Change: Nursing Home Administrators’ Use of Education, Training, and Communication

“…It is possible that an inability to tailor education, training and communication to a facility’s specific needs could be the cause of an important impediment to the diffusion of culture change and explain resistance to culture change found among nursing home administrators themselves. This resistance has been previously identified as a barrier to culture change in the industry (Miller, Miller, Jung, Sterns, Clark & Mor, 2010). The authors are uncertain about the role that leadership training and management skills development for nursing home administrators plays in implementing successful culture change initiatives.…”

Physicians in Nursing Homes: Effectiveness of Physician Accountability and Communication

“…For example, a potential use of the measure is to test its association with the culture change movement that has become an important part of NH quality improvement in recent years. 40 We hypothesize that NHs that undergo culture change will also improve their medical care processes and this would be measurable through the EPAC measure. EPAC may also be useful in testing whether the recently developed Interventions to Reduce Acute Care Transfers (INTERACT) developed by Ouslander and colleagues improves physicians’ attentiveness and communication within the NH.…”