Culture Change in Nursing Homes: What Is the Role of Nursing Home Resources?

Abstract

Quality of care has been a long-standing issue in US nursing homes. The culture change movement attempts to transition nursing homes from health care institutions to person-centered homes. While the adoption of culture change has been spreading across nursing homes, barriers to adoption persist. Nursing homes that disproportionately serve minority residents may have additional challenges implementing culture change compared with other facilities due to limited financial and staffing resources. The objective of this study was to examine how nursing home characteristics are associated with culture change adoption in Central Florida nursing homes. This cross-sectional study included 81 directors of nursing (DONs) who completed the Artifacts of Culture Change survey. In addition, nursing home organizational data were obtained from the Certification and Survey Provider Enhanced Reports (CASPER). A logistic regression was conducted to examine the relationship between high culture change adoption and nursing home characteristics. The overall adoption of culture change scores in Central Florida nursing homes was low. Nevertheless, there was variability across nursing homes in the adoption of culture change. High culture change adoption was associated with nursing homes having lower proportions of Medicaid residents.

An Empirical Typology of Nursing Home Culture Change Implementation

“…The finding that culture change implementation was associated with payer mix was in line with previous studies (Chisholm et al, 2018;Miller et al, 2018). The findings from previous studies using the national data or the data of other states may reflect the fact that culture change requires considerable financial resources (Chisholm et al, 2018;Miller et al, 2018), and higher pay from Medicare and private payers versus Medicaid may facilitate culture change implementation (Chisholm et al, 2018;Lepore et al, 2015;Shield et al, 2014). However, in Minnesota, NHs cannot charge private-pay residents more than the Medicaid rate, with the exception of private rooms and special services (Minnesota House Research Department, 2016).…”

A framework for delivering nursing care to older adults with COVID‐19 in nursing homes

“…More recently, the NH industry is described as a “2‐tier system, with the lower‐tier consisting of Medicaid‐reliant NHs” (Chisholm et al., 2018). Experts have noted that Medicaid‐reliant NH disproportionately serves Black residents and that they are associated with lower quality of care (Chisholm et al., 2013). Evidence has shown NHs with fewer proportions of Medicaid residents were high culture change adopters (Miller et al., 2014).…”

“…Early investigations have found an estimated 9% of all White NH residents reside in lower-tier NHs, compared to 40% of all Black residents, who are three times more likely to reside in one of the poorer, lower-tiered NHs than Whites (Smith et al, 2007; refer to Table 1). More recently, the NH industry is described as a "2-tier system, with the lower-tier consisting of Medicaid-reliant NHs" (Chisholm et al, 2018). Experts have noted that Medicaidreliant NH disproportionately serves Black residents and that they are associated with lower quality of care (Chisholm et al, 2013).…”

Assessing Quality for People Living With Dementia in Residential Long-Term Care: Trends and Challenges

“…However, in Western countries, where 50% to 70% of long-term care (LTC) residents have dementia (Alzheimer’s Society, 2018; Bjork et al, 2016; Lithgow, Jackson, & Browne, 2012), addressing personally meaningful outcomes in care is challenged by performance indicators that emphasize service standards over personally meaningful outcomes (Kane & Cutler, 2015; Miller & Barrie, 2016). Although attempts to redesign care and systems to foster person-centered and relationship-centered care have emerged (Chisholm et al, 2018; Nolan, Davies, Brown, Keady, & Nolan, 2004; Owen, 2006), the alignment of performance indicators with personally relevant goals has been uneven (Shier, Khodyakov, Cohen, Zimmerman, & Saliba, 2014).…”