Featured Research

from universities, journals, and other organizations

Nursing home care improves with culture change

Date:
August 25, 2014
Source:
Brown University
Summary:
Nursing homes that invest in 'culture change' can develop a more residential and less hospital-like feel. Culture change also allows residents and front-line care workers more of a say in how homes operate. A new study finds that the practice produces important benefits in quality of care, but only when the changes are implemented extensively.

If a nursing home makes an extensive investment in "culture change" it will see improvements in quality of care, according to a new study led by Brown University gerontology researchers.

Culture change is a rethinking of nursing home operations and structure to allow a more residential lifestyle for residents, more resident choice in schedules and activities, and more front-line staff input into care management. Residents, for example, may become able to decide when to go to lunch and nurse's aides may get a seat at the table in designing care processes. Across the country nursing homes are at various stages of implementing such changes, ranging from not at all to extensively.

In the new study, a research team led by Susan Miller, professor of health services policy and practice at the Brown University School of Public Health, focused on homes that had recently accomplished some degree of implementation. Miller's goal was not only to measure whether culture change introduction produced improvements in care quality but to do so for nursing homes that had implemented a similar extent of culture change practice by 2009-10.

"What's unique about this paper is that we stratified by the amount of implementation," said Miller, senior author of the research published online in the Journal of the American Geriatrics Society.

The study's results come from surveys of directors of nursing at 824 homes in which Miller and her team assessed the degree of culture change implementation as of 2009-10. The researchers considered nursing homes that introduced culture change between 2005 and 2010, excluding homes that either had not adopted change or were especially early adopters.

In their analysis Miller and her colleagues separated out the top quartile of implementers from the bottom three quartiles. For each group they looked at whether the list of 13 quality measures improved or worsened in the year after culture change introduction, compared to similar nursing homes that had not yet introduced it. They controlled for factors such as the homes' occupancy rates, their mix of medical cases, and the degree of county-level competition.

Degrees of quality improvement

Upon introduction of culture change, the homes that implemented culture change most extensively produced statistically significant improvements in the percent of residents on bladder training programs, the percent of residents who required restraints, the proportion of residents with feeding tubes, and the percent with pressure ulcers. They also showed a nearly significant reduction in resident hospitalizations. No quality indicator became significantly worse.

Among homes that implemented less culture change, the only significant improvement occurred in the number of Medicare/Medicaid health-related and quality of life survey deficiencies. (Miller said some nursing home administrators stated in interviews that they implemented those practices targeted by state surveyors.) Urinary tract infections and hospitalizations got slightly worse.

No degree of culture change significantly improved other quality indicators such as the percent of residents with advanced directives or the proportion on antipscychotic medications. Falls did not get better, but they also did not get worse as some elder care observers had feared they would under culture change, Miller noted.

The results help affirm that culture change can be effective in homes where the staff has embraced its patient-centered, flatter-management philosophy, Miller said.

"It seems to be a valid notion to improve quality with adoption when you really adopt the philosophy and are doing a lot," she said.


Story Source:

The above story is based on materials provided by Brown University. Note: Materials may be edited for content and length.


Journal Reference:

  1. Susan C. Miller, Michael Lepore, Julie C. Lima, Renee Shield, Denise A. Tyler. Does the Introduction of Nursing Home Culture Change Practices Improve Quality? Journal of the American Geriatrics Society, 2014; DOI: 10.1111/jgs.12987

Cite This Page:

Brown University. "Nursing home care improves with culture change." ScienceDaily. ScienceDaily, 25 August 2014. <www.sciencedaily.com/releases/2014/08/140825100041.htm>.
Brown University. (2014, August 25). Nursing home care improves with culture change. ScienceDaily. Retrieved October 22, 2014 from www.sciencedaily.com/releases/2014/08/140825100041.htm
Brown University. "Nursing home care improves with culture change." ScienceDaily. www.sciencedaily.com/releases/2014/08/140825100041.htm (accessed October 22, 2014).

Share This



More Health & Medicine News

Wednesday, October 22, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Orthodontist Mom Jennifer Salzer on the Best Time for Braces

Orthodontist Mom Jennifer Salzer on the Best Time for Braces

Working Mother (Oct. 22, 2014) Is your child ready? Video provided by Working Mother
Powered by NewsLook.com
U.S. Issues Ebola Travel Restrictions, Are Visa Bans Next?

U.S. Issues Ebola Travel Restrictions, Are Visa Bans Next?

Newsy (Oct. 22, 2014) Now that the U.S. is restricting travel from West Africa, some are dropping questions about a travel ban and instead asking about visa bans. Video provided by Newsy
Powered by NewsLook.com
US to Track Everyone Coming from Ebola Nations

US to Track Everyone Coming from Ebola Nations

AP (Oct. 22, 2014) Stepping up their vigilance against Ebola, federal authorities said Wednesday that everyone traveling into the US from Ebola-stricken nations will be monitored for symptoms for 21 days. (Oct. 22) Video provided by AP
Powered by NewsLook.com
Doctors Help Paralysed Man Walk Again, Patient in Disbelief

Doctors Help Paralysed Man Walk Again, Patient in Disbelief

AFP (Oct. 22, 2014) Polish doctors describe how they helped a paralysed man walk again, with the patient in disbelief at the return of sensation to his legs. Duration: 1:04 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins