Culture Changes in Nursing Homes Can Improve Quality of Care Background: Culture Change in Nursing Homes
Tuesday, December 9, 2014
Culture change practices in nursing homes aim to make facilities homelike and care resident-centered. Residents who live in culture change nursing homes have more choices. For example, instead of having a set time every day to eat or sleep, residents in culture change facilities can choose different times when they have their meals or go to bed. This gives residents greater control and independence, which can improve their quality of life.
While definitive evidence is not available, studies have found that residents who live in nursing homes that are adopting culture change practices appear to benefit in many ways. For example, residents in culture change facilities experience fewer incidences of losing activities of daily living, lower feelings of boredom and helplessness, and higher overall satisfaction than residents of non-culture change facilities.
Staff empowerment is also a component of culture change practice. Culture change nursing facilities encourage their staff to share their thoughts, including suggestions regarding changes and innovations in nursing home care. “Such staff empowerment practices have been shown to be associated with lower staff turnover and higher staff satisfaction,” notes Susan Miller, PhD. Miller, and colleagues of the Center for Gerontology and Health Care Research at Brown University School of Public Health, have been studying culture change in nursing homes. Their latest research appears in the September 2014 issue of the Journal of the American of the Geriatrics Society (JAGS).
Newest Research: A Look at 800 Nursing Homes and their Approach to Resident Care
To learn more about how culture change can improve care quality in nursing homes, Dr. Miller and colleagues compared the records of more than 800 nursing homes that were undergoing culture change. They assessed whether nursing homes that introduced culture change had improved outcomes for residents.
Among other things, the researchers looked at the extent to which the nursing homes were adopting culture change practices. They also examined quality outcomes such as providing specific types of care—for example, training for residents with difficulty controlling their bladders or bowels. The researchers also examined what percent of residents in the nursing homes were fed with feeding tubes. This is important because tube feeding can cause more harm than help in adults with advanced dementia, who are usually better fed by hand.
The researchers also checked to see how many residents had “advance directives.” These are legal documents that let others know what kind of care a person does and does not want toward the end of their lives, when they may not be able to speak for themselves.
In addition, the researchers examined how frequently residents of the nursing homes had fallen, developed bed sores, or been hospitalized, since these things can indicate that improvements in care are needed.
Overall, the nursing homes that adopted culture change practice more completely had improved performance in important indicators of care and quality. This was not the case for nursing homes that introduced less-complete culture change practice. These findings highlight the value of the numerous efforts underway to further expand nursing home culture change practices. The authors noted that continued research in this area is needed.
This summary is from the full report titled, “Does the Introduction of Nursing Home Culture Change Practices Improve Quality?" It appears in the September 2014 issue of the Journal of the American Geriatrics Society, and is authored by Susan C. Miller, PhD, Michael Lepore, PhD, Julie C. Lima, PhD, Renee Shield, PhD, and Denise A. Tyler, PhD.