State Investment in Culture Change in Long Term Care Natasha Bryant, MA Academy Health Annual Research Meeting June 8, 2008

Overview  Introduction  Methodology  Findings and Themes  Summary and Significance

Introduction

Project Purpose and Importance  Grant: Commonwealth Fund  Purpose – State role in promotion of culture change  State can be a major player and catalyst of change

Three Inter-Related Areas of Activity Workforce Improvement Continuous Quality Improvement Person- Centered Care

Research Questions  What motivated each state to invest in culture change?  Who were the major drivers?  What were the financial and non- financial investments?  What were the specific activities supported by the state?  What were some of the major crosscutting themes?

Methodology

Selection of Case Study States  Sample: selection of states  Case study states  Georgia  Kansas  Massachusetts  Michigan  North Carolina  Oregon  Vermont

Data Collection Activities  Telephone interviews  Review of secondary documents  Site visits  Stakeholder meeting

Findings and Themes

State Motivation  States reactive rather than proactive  Long-term care workforce crisis  Awareness and knowledge of culture change models  Reaction to negative press

Types of Magnitude of State Investments  CMP dollars  Legislative funding  Medicaid  Discretionary grants  In-kind time

Approaches to Culture Change and Initiatives  Workforce improvement  Person-centered care  Continuous quality improvement

Themes  Degree of coordination/integration across initiatives  Regulatory barriers  Importance of relationship building across stakeholders  Uncertainty about funding  Relative lack of legislative champions

Summary and Significance

Summary  State can have a major role in influence to adopt and expand culture change in nursing homes  Three strategic objectives of culture change:  Person-centered care  Workforce improvement  Continuous quality improvement

Significance  Enhance awareness of state policy and program staff  Guidance  Providers, consumers and workers better understand initiatives that have been successful and how they can advocate