The Goals of Culture Change are:

1. restore control over daily living to residents of long-term care facilities, respecting the right of residents to make their own decisions;
2. involve all levels of staff in the care process, honoring those who work most closely with residents;
3. include families and friends in a comprehensive team building approach to care;
4. provide a familiar and hospitable environment, a supportive workplace and responsive, individualized care practices that focus on the needs and preferences of people, rather than those of the facility.

In 2000, these reform leaders from around the United States established the Pioneer Network (http://www.pioneernetwork.net/ as the umbrella organization for the Culture Change movement. In recent years, this movement has expanded to include home and community-based services.

• Resident benefits: reduces loneliness, helplessness and boredom; improves physical and mental health (e.g. reduces depression and behavioral problems); reduces unanticipated weight loss, reduces mortality, etc.;
• Staffing benefits: reduces employee turnover, eliminates temporary agency staffing and mandatory overtime, reduces workers’ compensation claims/costs, etc.;
• Additional benefits: significantly improves employee, resident, and family satisfaction; increases involvement with the outside community including children, students, clubs, and religious organizations, etc.

1. Care practices built around the preferences of the resident, including waking/sleeping, meals, bathing, etc.
2. Personalized care plans written in “I” format, encouraging residents to make decisions on all aspects of their care.
   e.g. Instead of “ambulation 2X/day”, a care plan would say, “I like to walk. My favorite times for walking are after lunch and dinner.”
3. Consistent team assignments to care for residents (see How does Culture Change affect nursing home staff?);
4. Actively engage families who are sought out for visits, family councils, care input, etc.
5. Collaborative leadership style which opens lines of communication and nurtures human connections.

1. Relationships between staff and residents are at the heart of care. Systems and structures are developed to support these relationships by focusing on person-centered care, rather than task completion.
2. Culture Change approaches that honor those relationships:
    
3. Consistent assignments - teams of staff work together with groups of residents on an on-going basis, rather than rotating assignments.
4. Certified Nursing Assistant (CNA) empowerment – include CNA in care plan meetings and seek staff opinions.

The essence of Culture Change fulfills the mandate of the Nursing Home Reform Law (OBRA’87) by allowing nursing homes to be responsive to individual resident’s needs and creating an environment in which residents thrive.

1. The following CMS Video Link discusses how Culture Change is consistent with existing federal regulations: http://www.pioneernetwork.net/research/cmsmov.wmv (media player is required to view this file).
2. The MA Culture Change Coalition was initiated in mid-2005 to foster Culture Change in MA facilities. Participants in the Coalition include a wide-range of long-term care related organizations. The Massachusetts Advocates for Nursing Home Reform represents residents, their families/friends, Family-Run Councils, and other advocates in the Coalition.

Examples of successful Culture Change in two diverse nursing home settings:

1. The Maine General Rehabilitation and Nursing Center in Glenridge, portrayed in the American Health Quality Association Culture Change documentary, is in a rural, close-knit community. The documentary, “Culture Change in Long-Term Care:  A Case Study", can be obtained through the production company: ImageWorks 619-239-6161.
2. Providence Mount St. Vincent, located Seattle, WA, has 215 skilled nursing beds and is one of the original Culture Change facilities in the country. (http://www.providence.org/Long_Term_Care/Mount_St_Vincent.)