Promising Models for Transforming Long-Term Care

Journal of Pain and Symptom Management

Shield

Miller

2015

Context Studies have found that nursing homes (NHs) that rely heavily on Medicaid funding are less likely to implement innovative approaches to care, such as palliative care (PC) or resident-centered approaches commonly referred to as “culture change” (CC). However, a nationally representative survey we previously conducted found some high Medicaid facilities have implemented these innovative approaches. Objectives The purpose of this study was to identify the factors that enable some high Medicaid NHs to implement innovative approaches to care. Methods We conducted telephone interviews with 16 NH administrators in four categories of facilities: 1) low PC and low CC, 2) low PC and high CC, 3) high PC and low CC and 4) high PC and high CC. Interviews explored strategies used to overcome barriers to implementation and the resources needed for implementation. Results We had expected to find differences between low and high NHs, but instead found differences in NHs’ experiences with CC and PC. Since the time of our national survey in 2009–2010, most previously low CC NHs had implemented at least some CC practices; however, we did not find similar changes around PC. Administrators reported numerous ways in which they had received information and assistance from outside entities for implementing CC. This was not the case for PC where administrators reported relying exclusively and heavily on hospices for both their residents’ PC needs and for information related to PC. Conclusion PC advocates could learn much from the CC model in which advocates have used multipronged efforts to institute reform.

Section: Introductionmentioning

confidence: 99%

Diffusion of Palliative Care in Nursing Homes: Lessons From the Culture Change Movement

Journal of Pain and Symptom Management

Shield

Miller

2015

“…The term resident-centred care implies that the facility has become more focused on the preferences of individual residents. Care of this kind is intended to be less routine and, as such, must rely on strong relationships between staff and residents (Angelelli, 2006).…”

Section: Introductionmentioning

confidence: 99%

“…Providing residents with more autonomy and choice implies that direct-care workers must be more flexible and have more autonomy themselves, in order to be able to follow-through on resident needs or requests (Yeatts and Cready, 2007). Direct-care workers must also have stronger relationships with residents, to become familiar with their personal preferences (Angelelli, 2006). Due to this, many facilities engaged in culture change have created permanent assignments for direct-care workers.…”

Section: Introductionmentioning

confidence: 99%

Nursing home culture, teamwork, and culture change

Journal of Research in Nursing

2010

Aims: Most developed countries are taking steps to move away from institutional models of care for the aged, in an attempt to both improve quality of life for those receiving care and improve the work of those providing care. In the USA, the concept of 'culture change' (CC) encompasses a variety of philosophical and practice models being employed to de-institutionalise skilled nursing facilities, also known as long-term care (LTC) facilities. Teamwork among direct-care workers is often promoted as an important aspect of culture change. However, a recent study found that, among facilities attempting CC, teamwork was the least commonly implemented CC component. This suggests that facilities may be having difficulty implementing teamwork and also raises questions about the link between teamwork and facility organisational culture. This study examined the relationship between teamwork and organisational culture in the LTC setting. Methods: Observations in 20 LTC facilities were used to identify facilities with high and low amounts of teamwork. Interviews with nursing staff from four high-teamwork and five low-teamwork facilities were compared to determine the aspects of organisational culture associated with teamwork, and explore how teamwork might be sustained in LTC facilities. Findings: Aspects of culture, including positive staff attitudes toward co-workers, were associated with high-teamwork facilities. Managerial modelling of these attitudes may be one factor that helps sustain teamwork. Conclusions: LTC facility managers may need to adjust their own attitudes and behaviour to support teamwork in their facilities. This has implications for facilities attempting to de-institutionalise.

“…Such changes include removing nursing stations or creating small self-contained households or neighborhoods including kitchens and communal space. Organizational changes are aimed at altering how care is delivered, such as increasing the autonomy of direct-care workers in ways that allow them to organize their work around the needs and preferences of facility residents (Angelelli, 2006). …”

mentioning

confidence: 99%

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

Gerontology & Geriatrics Education

Lepore

Shield

et al. 2013

Nursing home culture change is becoming more prevalent and research has demonstrated its benefits for nursing home residents and staff, but little is known about the role of nursing home administrators in culture change implementation. The purpose of this study was to determine what barriers nursing home administrators faced in implementing culture change practices and to identify the strategies used to overcome these. We conducted in-depth individual interviews with 64 administrators identified through a nationally representative survey. Results showed that a key barrier to culture change implementation reported by administrators was staff, resident and family member resistance to change. Most nursing home administrators stressed the importance of using communication, education and training to overcome this resistance. Themes emerging around the concepts of communication and education indicate that these efforts should be ongoing, communication should be reciprocal, and that all stakeholders should be included.