Organizational and resident care principles and practices: consideration of nursing home structural, market, and administrative factors
A movement known as "culture change" was developed in an effort to improve conditions in the nursing home. The goals of culture change include increasing resident autonomy, increasing resident and direct care staff decision-making, creating a home-like environment, flattening the internal organizational hierarchy, and decentralizing roles in the nursing home in an effort to empower all employees. The purpose of this study was to identify features of Alabama nursing homes that are related to adoption of organizational and resident care practices consistent with culture change principles. Three categories of nursing home features were examined: structural factors, market factors, and nursing home administrator (NHA) influence. Additionally, NHAs' perceptions of barriers to implementation of such innovations were explored. All Alabama administrators of Medicare or Medicaid-certified nursing homes were invited to participate. A standardized survey was used to collect administrator self-report information about their facility and their perceptions and attitudes regarding culture change principles and practices. The response rate for the survey was 32.9%. Participants consisted of 75 nursing home administrators. Two administrators were responsible for daily operations of two facilities each; therefore, a total of 77 nursing homes participated. The majority of the NHAs reported that they were very familiar with the principles of culture change, yet that culture change principles and practices only "somewhat" described their nursing homes. Medicaid census was significantly related to reported adoption of culture change practices, as was median household income and market density. Nursing homes with a lower Medicaid census were more likely to implement culture change practices. Nursing homes situated in counties with a higher median income and more older adults were also more likely to implement these practices. Culture change implementation was higher in nursing homes with administrators that felt that culture change implementation was feasible in their nursing home. Barriers to implementation of these practices were residents' ability to engage, staff resistance to change, lack of resources, and regulations/survey process impediments.