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Sue Ducat

The Culture-Change Movement In Nursing Homes:
Is It Delivering On Person-Centered Care?

Bethesda, MD - In the 1980s, the National Citizens' Coalition for Nursing Home Reform began working with policymakers at the Health Care Financing Administration and the Institute of Medicine to ensure that nursing homes provided individualized care to their residents. In the mid-1990s the Pioneer Network launched a movement aimed at improving the quality of care and the quality of life in nursing homes. An article published today by Health Affairs evaluates the accomplishments of the "culture change" movement, as consumer advocacy, combined with legal, legislative, and policy initiatives, has transformed nursing homes from impersonal health care institutions to person-centered homes offering customized long-term care services.

Person-Centered Care For Nursing Home Residents: The Culture-Change Movement
by Mary Jane Koren

Mary Jane Koren is assistant vice president, Frail Elders Program, at The Commonwealth Fund in New York City.

A diverse group of stakeholders, including the Centers for Medicare and Medicaid Services (CMS, which replaced HCFA), helped create a definition of the characteristics expected to be present in the "ideal" facility. They included the need for a homelike rather than institutional environment where residents are enabled to make decisions affecting their day-to-day lives and given choices, and relationships between residents and staff are close. Management hierarchies would be decentralized, with staff empowered to respond to residents' needs. Studies are showing that these changes are having positive effects on staff turnover and performance.

Comparing findings from Commonwealth Fund surveys of health care opinion leaders, Koren finds that widespread awareness of the movement has come about only in the past few years. In 2005, only 27 percent of respondents were familiar with the culture change movement, compared to 66 percent in 2008.

She notes that states have played an important role in recognizing and promoting the movement, using regulatory approaches, recognition programs, and participation in culture-change coalitions. She also observes that "States' efforts to rebalance the mix of long-term care services and supports offered in institutional and community settings...giv[e] consumers alternatives to nursing homes ...thereby forcing traditional nursing homes to reassess what they must offer to stay competitive." Koren concludes that while the difficulties of implementing and maintaining culture changes are still formidable, the current policy environment is conducive to further innovation and adoption of new models, which have the potential of being enacted well before the baby-boom generation arrives at the nursing home doors.


Health Affairs, published by Project HOPE, is the leading journal of health policy. Beginning in January 2010, the peer-reviewed journal appears each month in print, with additional Web First papers published weekly at http://www.healthaffairs.org/. The full text of each Health Affairs Web First paper is available free of charge to all Web-site visitors for a two-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund.


©2010 Project HOPE–The People-to-People Health Foundation, Inc.