The Prevalence of Culture Change Practice in US Nursing Homes: Findings From a 2016/2017 Nationwide Survey
Authors
Miller, Susan C.Schwartz, Margot L.
Lima, Julie C.
Shield, Renee R.
Tyler, Denise A.
Berridge, Clara W.
Gozalo, Pedro L.
Lepore, Michael J.
Clark, Melissa A.
UMass Chan Affiliations
Department of Quantitative Health SciencesDocument Type
Journal ArticlePublication Date
2018-12-01Keywords
nursing home staffingMedicaid reimbursement
person-centered care
nursing home leadership
nursing home turnover
culture change
Geriatrics
Health Services Administration
Health Services Research
Metadata
Show full item recordAbstract
BACKGROUND AND OBJECTIVES: Given the dynamic nursing home (NH) industry and evolving regulatory environment, depiction of contemporary NH culture-change (person/resident-centered) care practice is of interest. Thus, we aimed to portray the 2016/2017 prevalence of NH culture change-related processes and structures and to identify factors associated with greater practice prevalence. RESEARCH DESIGN AND METHODS: We administered a nationwide survey to 2142 NH Administrators at NHs previously responding to a 2009/2010 survey. Seventy-four percent of administrators (1583) responded (with no detectable nonresponse bias) enabling us to generalize (weighted) findings to US NHs. From responses, we created index scores for practice domains of resident-centered care, staff empowerment, physical environment, leadership, and family and community engagement. Facility-level covariate data came from the survey and the Certification and Survey Provider Enhanced Reporting system. Ordered logistic regression identified the factors associated with higher index scores. RESULTS: Eighty-eight percent of administrators reported some facility-level involvement in NH culture change, with higher reported involvement consistently associated with higher domain index scores. NHs performed the best (82.6/100 weighted points) on the standardized resident-centered care practices index, and had the lowest scores (54.8) on the family and community engagement index. Multivariable results indicate higher index scores in NHs with higher leadership scores and in states having Medicaid pay-for-performance with culture change-related quality measures. CONCLUSIONS: The relatively higher resident-centered care scores (compared with other domain scores) suggest an emphasis on person-centered care in many US NHs. Findings also support pay-for-performance as a potential mechanism to incentivize preferred NH practice.Source
Med Care. 2018 Dec;56(12):985-993. doi: 10.1097/MLR.0000000000000993. Link to article on publisher's site
DOI
10.1097/MLR.0000000000000993Permanent Link to this Item
http://hdl.handle.net/20.500.14038/46767PubMed ID
30234764Related Resources
ae974a485f413a2113503eed53cd6c53
10.1097/MLR.0000000000000993