scholarly journals The Benefits of Culture Change in Nursing Homes—Obtaining Nationally Representative Evidence

2021 ◽  
Author(s):  
Julie C. Lima ◽  
Pedro Gozalo ◽  
Melissa A. Clark ◽  
Margot L. Schwartz ◽  
Susan C. Miller
Keyword(s):  
Nursing Homes ◽  
Culture Change ◽  
Nationally Representative

scholarly journals The Changing Adoption of Culture Change Practices in U.S. Nursing Homes

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Julie C Lima ◽  
Margot L Schwartz ◽  
Melissa A Clark ◽  
Susan C Miller
Keyword(s):  
Nursing Homes ◽  
Physical Environment ◽  
Culture Change ◽  
Panel Study ◽  
Factors Associated ◽  
Centered Care ◽  
Nationally Representative ◽  
Practice Implementation ◽  
Over Time ◽  
Domain Scores

Abstract Background and Objectives The study aimed to: (i) describe whether culture change (CC) practice implementation related to physical environment, resident-centered care, and staff empowerment increased within the same nursing homes (NHs) over time; and (ii) identify factors associated with observed increases. Research Design and Methods This was a nationally representative panel study of 1,584 U.S. NHs surveyed in 2009/2010 and 2016/2017. Survey data were merged with administrative, NH, and market-level data. Physical environment, staff empowerment, and resident-centered care domain scores were calculated at both time points. Multivariate logistic regression models examined factors associated with domain score increases. Results Overall, 22% of NHs increased their physical environment scores over time, 32% their staff empowerment scores, and 44% their resident-centered care scores. However, 32%–68% of NHs with below median baseline scores improved their domain scores over time compared with only 11%–21% of NHs with baseline scores at or above the median. Overall, NHs in states with Medicaid pay-for-performance (with CC components), in community care retirement communities, with special care units and higher occupancy had significantly higher odds of increases in physical environment scores. Only baseline domain scores were associated with increases in staff empowerment and resident-centered care scores. Discussion and Implications This is the first nationally representative panel study to assess NH CC adoption. Many NHs increased their CC practices, though numerous others did not. While financial incentives and indicators of financial resources were associated with increase in physical environment scores, factors associated with staff empowerment and resident-centered care improvements remain unclear. Studies are needed to assess whether the observed increases in CC adoption are associated with greater quality of life and care gains for residents and whether there is a threshold effect beyond which the efficacy of additional practice implementation may be less impactful.

scholarly journals Culture Change Initiatives in High Medicaid Nursing Homes: Does Time of Adoption Make a Difference?

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 22-23
Author(s):  
Latarsha Chisholm ◽  
Akbar Ghiasi ◽  
Justin Lord ◽  
Robert Weech-Maldonado
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Culture Change ◽  
Fixed Effects ◽  
Ethnic Disparities ◽  
State Level ◽  
Change Initiatives ◽  
Term Care ◽  
Star Rating ◽  
Racial Ethnic

Abstract Racial/ethnic disparities have been well documented in long-term care literature. As the population ages and becomes more diverse over time, it is essential to identify mechanisms that may eliminate or mitigate racial/ethnic disparities. Culture change is a movement to transition nursing homes to more home-like environments. The literature on culture change initiatives and quality has been mixed, with little to no literature on the use of culture change initiatives in high Medicaid nursing homes and quality. The purpose of this study was to examine how the involvement of culture change initiatives among high Medicaid facilities was associated with nursing home quality. The study relied on both survey and secondary nursing home data for the years 2017-2018. The sample included high Medicaid (85% or higher) nursing homes. The outcome of interest was the overall nursing home star rating obtained from the Nursing Home Compare Five-Star Quality Rating System. The primary independent variable of interest was the years of involvement in culture change initiatives among nursing homes, which was obtained from the nursing home administrator survey. The final model consisted of an ordinal logistic regression with state-level fixed effects. High-Medicaid nursing homes with six or more years in culture change initiatives had higher odds of having a higher star rating, while facilities with one year or less had significantly lower odds of having a higher star rating. Culture change initiatives may require some time to effectively implement, but these initiatives are potential mechanisms to improve quality in high Medicaid nursing homes.

Culture Change and Quality of Care Among High Medicaid Nursing Homes: Does Earlier Adoption Matter?

2021 ◽  
Vol 2021 (1) ◽  
pp. 15579
Author(s):  
Latarsha Chisholm ◽  
Akbar Ghiasi ◽  
Justin Lord ◽  
Ganisher K. Davlyatov ◽  
Robert J Weech-Maldonado
Keyword(s):  
Quality Of Care ◽  
Nursing Homes ◽  
Culture Change

scholarly journals USE OF PALLIATIVE CARE CONSULTS AND END-OF-LIFE CULTURE CHANGE PRACTICES IN NURSING HOMES

2018 ◽  
Vol 2 (suppl_1) ◽  
pp. 392-392
Author(s):  
M L Schwartz ◽  
M A Clark ◽  
J C Lima ◽  
S C Miller
Keyword(s):  
Palliative Care ◽  
Nursing Homes ◽  
End Of Life ◽  
Culture Change

scholarly journals KNOWLEDGE MANAGEMENT AND THE ADOPTION OF CULTURE CHANGE INITIATIVES BY HIGH-MEDICAID-CENSUS NURSING HOMES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S697-S698
Author(s):  
Larry Hearld ◽  
Akbar Ghiasi ◽  
Jeffery Szychowski ◽  
Robert Weech-Maldonado
Keyword(s):  
Knowledge Management ◽  
Nursing Homes ◽  
Culture Change ◽  
Interaction Analysis ◽  
Binary Logistic Regression ◽  
Change Initiative ◽  
Patient Centered ◽  
Change Initiatives ◽  
Logistic Regression Models ◽  
Facility Survey

Abstract Culture change represents an organizational transformational process to become person-centered, through staff and resident empowerment. Culture change initiatives have been associated with fewer health-related deficiency citations and better psychosocial outcomes. Knowledge management, defined as the process of creating or locating knowledge, and managing the dissemination of knowledge within and between organizations, has been shown to be associated with the adoption of innovations such as culture change initiatives. This study examines the relationship between knowledge management activities of high Medicaid census (70% or higher) nursing homes (NHs) and the adoption of culture change initiatives. This study used facility survey data from approximately 324 nursing home administrators (30% response rate) from 2017- 2018, merged with data from LTCFocus, Area Health Resource File, and Medicare Cost Reports. Binary logistic regression models revealed that the probability of adopting a culture change initiative was 0.12 higher for facilities reporting a one-unit higher level of knowledge management activities. Additional interaction analysis revealed that knowledge management activities were associated with a greater likelihood of adopting a culture change initiative for NHs where the director had been in his/her position fewer years. Similarly, higher levels of overall knowledge management activities were significantly associated with greater adoption of culture change initiatives at intermediate levels of nurse retention. Results suggest that knowledge management activities may help high Medicaid NHs acquire and mobilize informational resources in ways that can support the adoption of patient-centered initiatives. These activities may be particularly effective in nursing homes with leadership and nursing staff instability.

Bureaucratic Rituals in Nursing Homes: The “CARE Model” and Culture Change

2014 ◽  
Vol 3 (3) ◽  
pp. 21-32
Author(s):  
Jason S. Ulsperger ◽  
J. David Knottnerus ◽  
Kristen Ulsperger
Keyword(s):  
Nursing Homes ◽  
Culture Change ◽  
Care Model

Expressions of Caring as Lived by Nursing Home Staff, Residents, and Families

2005 ◽  
Vol 9 (3) ◽  
pp. 31-37 ◽  
Author(s):  
Theris A. Touhy, ◽  
Wendy Strews ◽  
Cynthia Brown
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Qualitative Analysis ◽  
Family Member ◽  
Culture Change ◽  
Healthcare Delivery ◽  
Interview Data ◽  
Nursing Home Staff

Nursing as caring (Boykin & Schoenhofer, 1993, 2001) was utilized as the framework for design of a model of healthcare delivery in a nursing home that is intentionally grounded in caring. The article presents themes emerging from a qualitative analysis of interview data in which participants were asked what was most important when caring for a resident or family member and to share an experience that best represented caring. Suggestions are offered for creating a model of culture change in nursing homes that honors and values expressions of caring as lived by staff, families, and residents.

scholarly journals Implementing Culture Change in Nursing Homes: An Adaptive Leadership Framework

2014 ◽  
Vol 55 (4) ◽  
pp. 616-627 ◽  
Author(s):  
Kirsten Corazzini ◽  
Jack Twersky ◽  
Heidi K. White ◽  
Gwendolen T. Buhr ◽  
Eleanor S. McConnell ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Culture Change ◽  
Adaptive Leadership ◽  
Leadership Framework

scholarly journals Black–White Disparities in Moves to Assisted Living and Nursing Homes Among Older Medicare Beneficiaries

2019 ◽  
Vol 75 (9) ◽  
pp. 1972-1982 ◽  
Author(s):  
Meghan Jenkins Morales ◽  
Stephanie A Robert
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Nursing Homes ◽  
Assisted Living ◽  
Multinomial Logistic Regression ◽  
Living Arrangement ◽  
Community Dwelling ◽  
Housing Tenure ◽  
Medicare Beneficiaries ◽  
Nationally Representative

Abstract Objectives Investigate black-white disparities in older adults’ moves to assisted living and nursing homes and draw from the Andersen Healthcare Utilization Model to test explanations for any disparities. Methods Data are from a nationally representative sample of older community-dwelling Medicare beneficiaries from the 2015 (N = 5,212) National Health and Aging Trends Study (NHATS). We use stepwise multinomial logistic regression to examine black-white disparities in moves out of community housing to assisted living or a nursing home over 2 years, before and after adjusting for predisposing (age, gender), enabling (income, housing tenure, Medicaid, living arrangement) and need (activities of daily living [ADL] limitation, physical capacity, self-rated health, and dementia) factors. Results Black older adults are less likely to move to assisted living and are more likely to move to a nursing home compared to white older adults. Black-white disparities in moves to nursing homes are explained by black-white differences in enabling and need factors, whereas black-white disparities in moves to assisted living remain even after adjusting for enabling and need factors. Discussion Unmeasured factors related to systemic racism (e.g., residential racial segregation, racial discrimination) and/or black-white differences in care preferences might further explain black-white disparities in moves to assisted living and warrant further investigation.

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