Understanding Nursing Home Culture Change: The High and Low

Abstract

Culture Change is the transformation of a nursing home (NH) from an institutional establishment with a top down approach to decision making to a resident‐centered program that creates an environment that focuses on what is most important to residents and staff. Twenty‐five care practices from the Colorado Foundation for Medical Care served as the theoretical framework for seven dimensions of Culture Change—home‐like environment, resident‐directed care, staff/resident relationships, NH staff empowerment, NH leadership, quality improvement, and shared values. Using a secondary data analysis, the overall aim of the study was to examine differences in staff and leadership reports of Culture Change among Kansas nursing homes with high (n = 7) and low turnover rates (n = 5). Facility turnover rates were obtained from the 2006 Kansas Medicaid Cost Report. Leadership (n=75) and staff (n=437) participants from Kansas nursing homes (6 rural and 6 urban) completed data collection with response rates ranging from 26 to 85%. We hypothesized that staff in nursing homes with low turnover rates would report higher levels of Culture Change than staff in high turnover homes. Data analysis was conducted using two sample t‐tests. Although both leaders and staff in low turnover nursing homes reported higher levels of Culture Change across all dimensions than those in high turnover homes, we only found significance (p <.05) differences in the staff/resident relationships dimension by leaders and staff, and in the leadership dimension by leaders. The results of this study revealed that turnover rates have potential to serve as a proxy measure for some aspects of Culture Change. However, further testing in a larger sample is needed.