Culture Change FAQ




1. What is Culture Change?
2. What is the history of the Culture Change Movement?
3. What are some of the benefits from Culture Change?
4. What are some examples of Culture Change approaches?
5. How does Culture Change affect nursing home staff?
6. Are Culture Change approaches in violation of CMS or state regulations?
7. What if a nursing home is unwilling to implement Culture Change?
8. If Culture Change is so good, why is there resistance to it?
9. My facility has some Culture Change activities, but why hasn’t overall care improved?
10. Is Culture Change expensive to implement?
11. Will Culture Change work in a diverse, urban setting?
12. How widespread is Culture Change?
13. How can I learn more about Culture Change?

1. What is Culture Change?
Culture Change (also known as person-centered care or resident-directed care) transforms the long-term care medical model to one that nurtures the human spirit, as well as meeting medical needs. Culture Change is not a finite destination – it is a work in progress, always evolving to meet the needs of the residents.

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.

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2. What is the history of the Culture Change Movement?
For more than a decade, a small group of early pioneers in the long-term care field have worked to fundamentally change the values, practices and culture of their organizations to create places for living and growing, rather than for declining and dying.

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.


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3. What are some of the benefits from Culture Change?
  • 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.



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4. What are some examples of Culture Change approaches?
Care practices built around resident preferences, personalized care plans, consistent team assignments, actively engaging families and a collaborative leadership style.
  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.



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    5. How does Culture Change affect nursing home staff?
    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.
  7. Culture Change approaches that honor those relationships.
  8. Consistent assignments - teams of staff work together with groups of residents on an on-going basis, rather than rotating assignments.
  9. Certified Nursing Assistant (CNA) empowerment – include CNA in care plan meetings and seek staff opinions.


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    6. Are Culture Change approaches in violation of CMS or state regulations?
    The Centers for Medicare and Medicaid Services (“CMS”) and the MA Department of Public Health (“DPH”) are committed to working with facilities to find innovative ways to allow the implementation of Culture Change.

    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.youtube.com/watch?v=El35aaByvY0.
    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.



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    7. What if a nursing home is unwilling to implement Culture Change?
    It is important to acknowledge that it will take some time to achieve widespread Culture Change. It is expected that facilities ignoring the movement toward person-centered care will be at a financial disadvantage with lower occupancy rates, higher CNA turnover costs, etc. It is therefore anticipated that market forces will eventually force those facilities to move toward Culture Change. Promoting education about Culture Change is essential to spreading Culture Change throughout the nursing home industry, and you can play an important role by educating yourself and others on the benefits of Culture Change.


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    8. If Culture Change is so good, why is there resistance to it?
    Changes to any existing system can be difficult and carry with them a certain level of resistance. Professionals schooled in a long-accepted medical model are being asked to look at their duties and care practices from a different perspective. Even though Culture Change approaches are beneficial, the evolution of change creates additional questions and concerns on the part of professionals which can impede the process.


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    9. My facility has some Culture Change activities, but why hasn’t overall care improved?
    Some facilities fall into the trap of implementing Culture Change activities on a superficial level. What can be missed is the meaning behind those activities, even though the activities are positive - such as community involvement, memorial quilts, etc. True Culture Change involves a change in the attitude and philosophy of management and staff to be focused on the needs and well-being of the resident.


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    10. Is Culture Change expensive to implement?
    Some facilities may decide to make expensive renovations to install “neighborhoods" as one of their Culture Change goals. However, such sweeping changes to the physical plant are not required to implement Culture Change approaches which are rooted in management styles and staff attitudes. In general, there may be some consulting costs and other minor costs related to changes in services. These costs have been viewed as minimal and are offset by savings from a decrease in staff turnover rates and improvements in the well-being of the residents.

    Furthermore, results from a study conducted by Marilyn Rantz, University of Missouri, reported that good-quality care in nursing homes actually costs less than poor quality care (March/April, 2003 Nursing Outlook). Rantz says the important point practitioners can take from this study is that well-run, quality health care can be achieved without high costs.

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    11. Will Culture Change work in a diverse, urban setting?
    Culture Change has been successfully implemented in nursing homes in large cities with diverse demographics, as well as in small facilities in rural settings. Size and location are not the driving forces for implementing Culture Change but the committment of staff to the well being of residents is.

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

    1. The Maine General Rehabilitation and Nursing Center in Glenridge is in a rural, close-knit community and is portrayed in the American Health Quality Association Culture Change documentary entitled "Culture Change in Long-Term Care: A Case Study".
    2. Providence Mount St. Vincent, located Seattle, WA, has more than 170 skilled nursing beds and is one of the original Culture Change facilities in the country. (http://washington.providence.org/senior-care/mount-st-vincent/.)

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    12. How widespread is Culture Change?
    The MA Culture Change Coalition has implemented regional forums to educate MA nursing homes on various aspects of Culture Change and to support facilities already on the Culture Change path. Approximately one-third of Massachusetts nursing homes are involved in these forums, with the number and interest growing in the state. Also, on a national level, there are more than 30 statewide culture change coalitions in various stages of development around the country.


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    13. How can I learn more about Culture Change?

     

    See 'Helpful Links – Culture Change' for additional information.



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