Page 7 - The Deep Seated Issue of Choice

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THE DEEP SEATED ISSUE OF CHOICE
WHERE DO WE START?
The Commonwealth survey reported that while almost all nursing homes are familiar with culture change, “progress has been slow in transforming long-term care facilities from institutions to homes. Of the 1,435 nursing homes sampled, 5% reported that the definition of culture change or resident-centered care ‘completely’ described their home, another 25% reported that the description fit ‘for the most part’, to total 31% (adopters). Another 25% indicated the term describes their home ‘in a few respects’ (strivers), while 45% responded ‘not at all’ (traditional).”
Study results indicated, in part, that:
• Fifty-eight percent of culture change adopters allow residents to determine their
own schedules, compared with only 22 percent of traditional nursing homes.
• Seven of 10 culture change adopters report that residents are involved in decisions about their facility, but only one-quarter of traditional nursing homes
(27%) involve residents in such decisions.
• ...only 14 percent currently cross-train staff to play several functional roles (for
example, housekeeping, nursing, food service and activities ) to serve a variety of
resident needs.
• On average, nursing homes report that only 8 percent of residents currently reside
in neighborhoods and only 1 percent live in households.
• While more nursing homes are making the dining experience resident
centered...About three of ten nursing homes (29%) in the U.S. indicate they have implemented initiatives to make dining less institutional, such as offering restaurant, family and buffet styles and providing more dining times.
• Nearly half (46%) of culture change adopters report they have changed how meals are served. In contrast, only 22% of traditional homes report they are making such changes.
The authors also state, “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 nursing homes become more engaged in culture change and adopt more of the associated practices, staff retention, market competitiveness, occupancy rates, and operational costs also improve...With the examples and best practices gleaned from the culture change movement, nursing homes can begin to make the necessary changes to improve the quality of life for their residents and staff.” (Doty, Koren and Sturla, 2008)
Has culture change improved quality of life and quality of care for residents? Evidenced based practices confirming positive outcomes in quality of care and quality of life are beginning to emerge as researchers evaluate culture change. Residents and staff living and working together in transformed homes continue to benefit from resident-centered care.
We are fortunate that there are growing numbers of providers who have adopted transformational culture change which embodies resident-centered care. Growing numbers of residents, family members, community advocates, ombudsmen, regulators and professional care groups are beginning to appreciate culture change as a positive force that will achieve quality of care and life for elders. Most importantly, deep-seated culture change is an important avenue for implementing the national nursing home reform law (The Nursing Home Reform Law, Title III,
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