Aging Well

Arts and Aging
Resource Guide – Enhancing
Health through the Arts

Confidence in “Comfortable”
Retirement is Declining,
Survey Says

Nutrition for Longevity:
Dietary Changes
for Healthy Aging

Workforce Strategies

Culture Change in
Long-Term Care Communities:
How Far Have We Come?

Building the Health Care
Workforce within
an Aging Society

Eliminating Barriers for
Older Workers to
Stay in the Workforce

Brain Health

University of California
Offering Free Internet Videos on Neurodegenerative Disorders

Potential for a Vaccine against Alzheimer’s Disease?

Celery and Green Pepper
Provide Hope for
Alzheimer's Disease

Focus Topic: Osteoporosis

Anti-Inflammatory Therapy
May Help Prevent Osteoporosis

Guidelines Issued for
Screening Men for Osteoporosis

Osteoporosis Medication
Use in Long-Term Care
Residents with Fractures

Newsworthy Resources

Benefits of Resistance Training
in Older Cancer Survivors

Quick Health Facts 2008

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Table of Contents

Culture Change in Long-Term Care Communities:
How Far Have We Come?

By Paula Fenza, Staff Writer

The Nursing Home Reform Act of 1987 established quality standards for long-term care (LTC) communities nationwide by emphasizing the importance of quality of life and preserving residents’ rights. However, despite enactment of this law, serious concerns remain about the quality of care provided to residents in the nation's 16,000 LTC communities. To improve the quality of care and the quality of life for LTC residents, a growing movement known as "culture change" is working to transform the LTC environment.  In the culture change model, seniors enjoy much of the privacy and choice they would experience if they were still living in their own homes. Because residents' needs and preferences come first, facility operations are shaped by this awareness.  LTC residents are given greater control over their daily lives—for instance, meal times or bedtimes—and frontline workers are given greater autonomy to care for residents.

Although there has been growing awareness of culture change among professionals and providers in the field, the extent to which LTC communities have adopted a resident-centered culture is still unknown. In 2007, The Commonwealth Fund conducted a national survey of LTC communities to learn more about the culture change movement and to measure the extent to which LTC communities are adopting culture change principles.

Although survey results are mixed regarding the degree to which LTC communities report having adopted resident-centered practices, findings indicate a hopeful picture about the potential for deep, systemic change within the industry. Four or five years ago, few LTC communities were familiar with the term "culture change." Today, it is recognized by, and familiar to, almost all providers.

Furthermore, the survey shows that the more culture change initiatives are under way in a LTC residence, the greater the benefits in terms of staff retention, higher occupancy rates, better competitive positioning, and improved operational costs. As the awareness of these and other competitive and operational advantages becomes more widely known, it is likely that many more LTC communities will begin to shift toward making the changes that are the hallmarks of resident-centered care.

A summary of the Commonwealth Fund Survey findings:

• In general, LTC communities have been most successful at increasing residents’ involvement in decision making, and there is some evidence that management is accommodating collaborative and decentralized decision making to empower direct-care workers.
  
  
• About 30 to 40% of all LTC communities report they are currently implementing some principle of culture change that fosters resident-directed care—including allowing residents to determine their own daily schedules, practicing resident-centered bathing techniques, or by actively involving residents in LTC decisions.
  
  
• Culture change adopters have initiated a range of staff empowerment initiatives. Although only a minority of LTC communities have undergone organizational changes, making the organization less hierarchical and empowering direct care LTC staff, direct care workers are more likely to have leadership opportunities and be authorized to make decisions about delivering resident care.
  
  
• Very few LTC communities have renovated their traditional nursing units into "neighborhoods"—smaller functional areas that can include common community and dining areas—or "households," which are small home settings with a full kitchen, dining room and living areas for 25 or fewer residents and their dedicated staff.
  
  
• The more culture change principles are embraced, the greater the increase in staff retention and occupancy rates, and the greater the decrease in operational costs. As LTC communities become more engaged in culture change and adopt more of its associated practices, staff retention, market competitiveness, occupancy rates, and operational costs also improve.
  
  
• LTC communities that have not yet adopted culture change but have leaders who are committed to culture change and resident-directed care also demonstrate that they are moving toward being the type of facility that empowers workers, provides direct care workers with leadership opportunities, encourages decentralized decision making, and allows staff to make decisions about resident care.
  

Source:  Doty, M., Koren, M. and Sturla, E., Culture Change in Nursing Homes: How Far Have We Come? Findings From The Commonwealth Fund National Survey of Nursing Homes, The Commonwealth Fund, May 2008. http://www.commonwealthfund.org.