Culture Change began with the Nursing Home Reform Act

Culture Change - Started in 1987

Back in 1987 the Nursing Home Reform Act was passed. It established quality standards for nursing homes nationwide. It was also to emphasized the importance of quality of life, and preserved residents' rights. However, despite enactment of this law, serious concerns remain about the quality of care provided to residents in the nation's 16,000 nursing homes. To improve the quality of care and the quality of life for nursing home residents, a growing movement, known as "culture change," is working to deinstitutionalize long-term care and radically transform the nursing home environment.

In the culture change model, which has gained momentum over the past decade, seniors enjoy much of the privacy and choice they would experience if they were still living in their own homes. Residents' needs and preferences come first; facilities operations' are shaped by this awareness. To this end, nursing home residents are given greater control over their daily lives—for instance, in terms of meal times or bed times, and frontline workers—the nursing aides responsible for day-to-day care—are given greater autonomy to care for residents. In addition, the physical and organizational structure of facilities is made less institutional. Large, hospital-like units with long, wide corridors are transformed into smaller facilities where small groups of residents are cared for by a consistent team.

The Commonwealth Fund 2007 National Survey of Nursing Homes 
In the past decade, there has been growing awareness of culture change among professionals and providers in the field, but the extent to which nursing homes across the country have adopted a resident-centered culture is still unknown. In 2007, The Commonwealth Fund conducted a nationally representative survey of nursing homes to learn more about the penetration of the culture change movement at the national level and measure the extent to which nursing homes are adopting culture change principles and practicing resident-centered care. A representative sample of 1,435 nursing homes was surveyed between February and June 2007.

The questionnaire was administered to directors of nursing who were asked about three domains of culture change: resident care, staff culture and working environment, and physical environment. Specifically, the survey examines whether nursing homes have adopted practices that make care more resident-directed, that engender a work environment that fosters staff autonomy and decentralized decision-making, and that alter the physical environment to make their facilities look and function like a home, rather than a hospital.

Although survey results are mixed regarding the degree to which nursing homes report they have adopted resident-centered practices, findings indicate a hopeful picture about the potential for deep, systemic change within the industry. Four or five years ago, few nursing homes were familiar with the term "culture change." Today it is recognized by and familiar to almost all providers. If the first step to change is awareness of a problem and the availability of an alternative, then the field of nursing home care is indeed poised for transformation.

Furthermore, the survey shows that in facilities that incorporate some aspects of culture change, the more culture change initiatives that are under way, the greater the benefits in terms of staff retention, higher occupancy rates, better competitive position, and improved operational costs. As the awareness of these and other competitive and operational advantages becomes more widely known, it is likely that many more nursing homes will begin to shift toward making the changes in human resource management, the physical environment, and care delivery that are the hallmarks of resident-centered care.

Architectural Changes in Culture Change Nursing Homes

A number of changes are being enacted within the design of new Nursing Homes in regard to Culture Change. Being able to create homes that provide for comforts & privacy as well as eliminating the Institutional feeling within the New Homes is important to the design. We are providing for this in a number of ways.

Private bedrooms & baths are just one but very important to the individual resident. We are also giving them unique Households where no more than 20 residents will be living in the Home. This eliminates the Long Corridors too. The extent of corridors will serve no more than the length of 10 bedrooms. The Individual Households also have their individual front doors and possibly unique elevations as well. The central part of the Household will be a place for a Living Room space along with a Dining & Kitchen area. There will no longer be a need to cart all the residents to a central dining area. Each household can be handle specific needs of residents.

Of course there is also a need for Central Spaces that include the Administration Area, a Rehab Therapy area, a primary Meeting Hall, a Chapel or Quiet Room along with a central Spa & Salon. These spaces are all interconnected by what we like to refer to as our Main Street.

The Households & Main Streets form the Courtyard areas where the residents can enjoy the outdoors in quiet and peaceful areas to enjoy water features, gazebos and even outdoor grilling areas. Another consideration is perhaps a play area for the youth who come to visit their families or if some daycare were to be provided for the staff. We know how much the residents enjoy watching children play.