Who are the innovators? Nursing homes implementing culture change.
OBJECTIVE
A key directive of the Affordable Care Act of 2010 is to transform both institutional and community-based long-term care into a more person-centered system. In the nursing home industry, the culture change movement is central to this shift in philosophy. If policymakers are to further encourage implementation of culture change, they need to better understand the factors associated with implementation.


METHODS
Using logistic regression (N = 16,835), we examined the extent to which resident, facility, and state characteristics relate to a nursing home being identified by experts as having implemented culture change over the period 2004 through 2011.


RESULTS
At baseline, the 291 facilities that were later identified by experts to have implemented culture change were more often nonprofit-owned, larger in size, and had fewer Medicaid and Medicare residents. Implementers also had better baseline quality with fewer health-related survey deficiencies and greater licensed practical nurse and nurse aide staffing. States experienced greater culture change implementation when they paid a higher Medicaid per diem.


CONCLUSIONS
To date, nursing home culture change has been implemented differentially by higher resource facilities, and nursing homes have been responsive to state policy factors when implementing culture change.
*Address correspondence to David C. Grabowski, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115-5899. E-mail: grabowski@med.harvard.edu.
David C
DC
Grabowski
Amy
A
Elliot
Brigitt
B
Leitzell
Lauren W
LW
Cohen
Sheryl
S
Zimmerman
D003468:Cultural Evolution; D003953:Diagnosis-Related Groups; D004059:Diffusion of Innovation; D006284:Health Plan Implementation / Q000379:methods*; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration; D009735:Nursing Homes / Q000458:organization & administration*; D009936:Organizational Innovation; D009939:Organizations, Nonprofit; D010067:Ownership; D018802:Patient-Centered Care; D017150:Public Sector; D011787:Quality of Health Care / Q000458:organization & administration*; D012111:Residence Characteristics; D013219:State Government; D014481:United States
Nursing homes; Organizational & Institutional issues; Person-centered care