Culture change in nursing homes (NHs) is a broad-based effort to transform NHs from impersonal institutions to genuine person-centered homes. Culture change practices have been implemented increasingly with varying levels of success. This study (a) generated an empirical typology of culture change implementation across Minnesota NHs using latent profile analysis based on the survey data from administrators in 102 NHs and (b) examined variations in NH characteristics and quality outcomes associated with the typology. Three types of culture change implementation were identified: high performers, average performers, and low performers. The distributions of culture change scores were distinct across the three types, with low performers lagging far behind others in family and community engagement, and end-of-life care. High performers were distinguished through demonstrating better resident quality of life and higher family satisfaction. The findings provide empirical support for policymakers, providers, and advocates to direct culture change expansion and resource allocation.
BurackO. R.ReinhardtJ. P.WeinerA. S. (2012). Person-centered care and elder choice: A look at implementation and sustainability. Clinical Gerontologist, 35, 390–403. https://doi.org/10.1080/07317115.2012.702649
2.
CastleN. G.FergusonJ. C. (2010). What is nursing home quality and how is it measured?The Gerontologist, 50(4), 426–442. https://doi.org/10.1093/geront/gnq052
ChisholmL.ZhangN. J.HyerK.PradhanR.UnruhL.LinF.-C. (2018). Culture change in nursing homes: What is the role of nursing home resources?Inquiry: A Journal of Medical Care Organization, Provision and Financing, 55, 46958018787043. https://dx.doi.org/10.1177/0046958018787043
5.
CohenL. W.ZimmermanS.ReedD.BrownP.BowersB. J.NoletK.. . . CollaborativeT. R. (2016). The Green House model of nursing home care in design and implementation. Health Services Research, 51(Suppl. 1), 352–377. https://doi.org/10.1111/1475-6773.12418
6.
ColemanM. T.LooneyS.O’BrienJ.ZieglerC.PastorinoC. A.TurnerC. (2002). The Eden alternative: Findings after 1 year of implementation. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 57(7), M422–M427. https://doi.org/10.1093/gerona/57.7.M422
7.
DuanY.MuellerC. A.YuF.TalleyK. M. (2020). The effects of nursing home culture change on resident quality of life in U.S. nursing homes: An integrative review. Research in Gerontological Nursing. Advance Online Publication. https://doi.org/10.3928/19404921-20200115-02
8.
GastmansC.MilisenK. (2006). Use of physical restraint in nursing homes: Clinical-ethical considerations. Journal of Medical Ethics, 32(3), 148–152. https://doi.org/10.1136/jme.2005.012708
9.
GauglerJ. E. (2005). Family involvement in residential long-term care: A synthesis and critical review. Aging & Mental Health, 9(2), 105–118. https://doi.org/10.1080/13607860412331310245
10.
GrabowskiD. C.ElliotA.LeitzellB.CohenL. W.ZimmermanS. (2014). Who are the innovators? Nursing homes implementing culture change. The Gerontologist, 54(Suppl. 1), S65–S75. https://dx.doi.org/10.1093/geront/gnt144
11.
GrabowskiD. C.O’MalleyA. J.AfendulisC. C.CaudryD. J.ElliotA.ZimmermanS. (2014). Culture change and nursing home quality of care. The Gerontologist, 54(Suppl. 1), S35–S45. https://doi.org/10.1093/geront/gnt143
HansonL. C.ReynoldsK. S.HendersonM.PickardC. G. (2005). A quality improvement intervention to increase palliative care in nursing homes. Journal of Palliative Medicine, 8(3), 576–584. https://doi.org/10.1089/jpm.2005.8.576
14.
HillN. L.KolanowskiA. M.Milone-NuzzoP.YevchakA. (2011). Culture change models and resident health outcomes in long-term care. Journal of Nursing Scholarship, 43, 30–40. https://doi.org/10.1111/j.1547-5069.2010.01379.x
15.
KaneR. A.KlingK. C.BershadskyB.KaneR. L.GilesK.DegenholtzH. B.. . . CutlerL. J. (2003). Quality of life measures for nursing home residents. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 58(3), 240–248. https://doi.org/10.1093/gerona/58.3.M240
16.
KaneR. A.LumT. Y.CutlerL. J.DegenholtzH. B.YuT. (2007). Resident outcomes in small-house nursing homes: A longitudinal evaluation of the initial green house program. Journal of the American Geriatrics Society, 55, 832–839. https://doi.org/10.1111/j.1532-5415.2007.01169.x
17.
KehoeM. A.Van HeeschB. (2003). Culture change in long term care: The Wellspring model. Journal of Social Work in Long-term Care, 2(1–2), 159–173. https://doi.org/10.1300/J181v02n01_11
18.
KorenM. J. (2010). Person-centered care for nursing home residents: The culture-change movement. Health Affairs, 29, 312–317. https://doi.org/10.1377/hlthaff.2009.0966
19.
LeporeM. J.ShieldR. R.LoozeJ.TylerD.MorV.MillerS. C. (2015). Medicare and Medicaid reimbursement rates for nursing homes motivate select culture change practices but not comprehensive culture change. Journal of Aging & Social Policy, 27(3), 215–231. https://dx.doi.org/10.1080/08959420.2015.1022102
20.
LoeM.MooreC. D. (2012). From nursing home to green house: Changing contexts of elder care in the United States. Journal of Applied Gerontology, 31(6), 755–763. https://doi.org/10.1177/0733464811401022
MillerS. C.LeporeM.LimaJ. C.ShieldR.TylerD. A. (2014). Does the introduction of nursing home culture change practices improve quality?Journal of the American Geriatrics Society, 62(9), 1675–1682. https://doi.org/10.1111/jgs.12987
23.
MillerS. C.LoozeJ.ShieldR.ClarkM. A.LeporeM.TylerD.. . . MorV. (2014). Culture change practice in U.S. nursing homes: Prevalence and variation by state Medicaid reimbursement policies. The Gerontologist, 54, 434–445. https://doi.org/10.1093/geront/gnt020
24.
MillerS. C.SchwartzM. L.LimaJ. C.ShieldR. R.TylerD. A.BerridgeC. W.. . . ClarkM. A. (2018). The prevalence of culture change practice in US nursing homes. Medical Care, 56(12), 985–993. https://doi.org/10.1097/MLR.0000000000000993
MorV.ZinnJ.AngelelliJ.TenoJ. M.MillerS. C. (2004). Driven to tiers: Socioeconomic and racial disparities in the quality of nursing home care. The Milbank Quarterly, 82(2), 227–256. https://doi.org/10.1111/j.0887-378X.2004.00309.x
OberskiD. (2016). Mixture models: Latent profile and latent class analysis. In RobertsonJ.KapteinM. (Eds.), Modern statistical methods for HCI (pp. 275–287). https://doi.org/10.1007/978-3-319-26633-6_12
30.
PoeyJ. L.HermerL.CornelisonL.KaupM. L.DrakeP.StoneR. I.DollG. (2017). Does person-centered care improve residents’ satisfaction with nursing home quality?Journal of the American Medical Directors Association, 18(11), 974–979. https://doi.org/10.1016/j.jamda.2017.06.007
31.
PuurveenG.BaumbuschJ.GandhiP. (2018). From family involvement to family inclusion in nursing home settings: A critical interpretive synthesis. Journal of Family Nursing, 24(1), 60–85. https://doi.org/10.1177/1074840718754314
32.
RahmanA. N.SchnelleJ. F. (2008). The nursing home culture-change movement: Recent past, present, and future directions for research. The Gerontologist, 48, 142–148. https://doi.org/10.1093/geront/48.2.142
RobinsonS. B.RosherR. B. (2006). Tangling with the barriers to culture change—Creating a resident-centered nursing home environment. Journal of Gerontological Nursing, 32(10), 19–25. https://doi.org/10.3928/00989134-20061001-04
35.
SchwartzM. L.LimaJ. C.ClarkM. A.MillerS. C. (2019). End-of-life culture change practices in U.S. nursing homes in 2016/2017. Journal of Pain and Symptom Management, 57(3), 525–534. https://doi.org/10.1016/j.jpainsymman.2018.12.330
36.
ShieldR.LoozeJ.TylerD.LeporeM.MillerS. C. (2014). Why and how do nursing homes implement culture change practices? Insights from qualitative interviews in a mixed methods study. Journal of Applied Gerontology, 33(6), 737–763. https://dx.doi.org/10.1177/0733464813491141
37.
ShieldR.TylerD.BerridgeC.ClarkM.MillerS. C. (2018). Innovative use of cognitive interviewing for nursing home research. Journal of the American Medical Directors Association, 19(12), 1133–1135. https://doi.org/10.1016/j.jamda.2018.05.004
38.
ShierV.KhodyakovD.CohenL. W.ZimmermanS.SalibaD. (2014). What does the evidence really say about culture change in nursing homes?The Gerontologist, 54, S6–S16. https://doi.org/10.1093/geront/gnt147
39.
ShippeeT. P.Henning-SmithC.GauglerJ. E.HeldR.KaneR. L. (2017). Family satisfaction with nursing home care: The role of facility characteristics and resident quality-of-life scores. Research on Aging, 39(3), 418–442. https://doi.org/10.1177/0164027515615182
40.
ShippeeT. P.Henning-SmithC.KaneR. L.LewisT. (2015). Resident- and facility-level predictors of quality of life in long-term care. The Gerontologist, 55, 643–655. https://doi.org/10.1093/geront/gnt148
41.
StataCorp LLC. (2017). Stata statistical software: Release 15 (Version 15.0).
42.
SternsS.MillerS. C.AllenS. (2010). The complexity of implementing culture change practices in nursing homes. Journal of the American Medical Directors Association, 11(7), 511–518. https://dx.doi.org/10.1016/j.jamda.2009.11.002
43.
SturdevantD. L.MuellerC. A.BuckwalterK. C. (2018). Measurement of nursing home culture change: Systematic review. Research in Gerontological Nursing, 11(2), 103–112. https://doi.org/10.3928/19404921-20171205-01
44.
SullivanJ. L.ShwartzM.BurgessJ. F.Jr.PeközE. A.ChristiansenC. L.Gerena-MeliaM.BerlowitzD. (2013). Person-centered care practices and quality in Department of Veterans Affairs nursing homes: Is there a relationship?Medical Care, 51, 165–171. https://doi.org/10.1097/MLR.0b013e3182763230
45.
TylerD. A.ShieldR. R.RosenthalM.MillerS. C.WetleT.ClarkM. A. (2011). How valid are the responses to nursing home survey questions? Some issues and concerns. The Gerontologist, 51, 201–211. https://doi.org/10.1093/geront/gnq095
46.
White-ChuE. F.GravesW. J.GodfreyS. M.BonnerA.SloaneP. (2009). Beyond the medical model: The culture change revolution in long-term care. Journal of the American Medical Directors Association, 10(6), 370–378. https://doi.org/10.1016/j.jamda.2009.04.004
47.
WinchR. F. (1947). Heuristic and empirical typologies: A job for factor analysis. American Sociological Review, 12(1), 68–75. https://doi.org/10.2307/2086492
48.
XuD.KaneR. L.ShamliyanT. A. (2013). Effect of nursing home characteristics on residents’ quality of life: A systematic review. Archives of Gerontology and Geriatrics, 57, 127–142. https://doi.org/10.1016/j.archger.2013.03.015
49.
ZimmermanS.CohenL. W.ReedD.GwytherL. P.WashingtonT.CagleJ. G.. . . PreisserJ. S. (2013). Families matter in long-term care: Results of a group-randomized trial. Seniors Housing & Care Journal, 21(1), 3–20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4167776/
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