1. Progress, Pitfalls & Possibilities
Culture Change:
Progress, Pitfalls & Possibilities
Ruta Kadonoff
Executive Director, Pioneer Network
Consumer Voice for Quality Long-Term Care
October 2016

2. Overview What do we mean when we use the term “culture change”?
What has been accomplished; what are the barriers?
Where are we headed and how can we accelerate progress?

3. What do we mean by culture change?

4. Culture Change vs Person-Directed Care
Culture change: Movement to transform our perception of & response to aging to one that honors and empowers the Elder and their care partners – improving the environments in which aging services happen.
Person-directed care: Elders are supported by their care partners to control their own lives and call the shots about their own care.
Concepts are highly interdependent:
Person-directed care/practices = the what, the outcome of all the organization’s structures and processes.
Culture change = the how, an environment where person-directed care happens by ensuring values, priorities, expectations and work organization are aligned with this goal.

5. What’s so new about that?
OBRA 1987
“Each resident must receive & facility must provide necessary care & services to attain or maintain the highest practicable physical, mental & psycho-social well-being.”

6. CMS Has Now Defined & Required Person-Centered Care
Per Nursing Home Requirements of Participation finalized October 4, 2016, person-centered care means:
To focus on the resident as the locus of control and support the resident in making their own choices and having control of their daily lives.

7. What Does Person-Directed Care Look Like?

8. The Culture Change Movement
1995 NCCNHR Conference – where it all began…
1997 – 34 “Nursing Home Pioneers” first gather in Rochester, NY
Vision: A culture of aging that is life-affirming, satisfying, humane and meaningful.
13 core values statements
No one model – “big tent” approach
2001 – Pioneer Network designated as an independent not-for-profit
Annual conferences bringing together hundreds of practitioners and advocates from across the nation
Culture change models grow & thrive, continuing to evolve: Eden Alternative, Household Model, Green House, Individualized Care, Coaching Supervision, …
1995 conf – Barry Barkan, Joanne Rader, Charlene Boyd, Bill Thomas invited by Sarah Greene Burger

9. So, Are We There Yet?

10. Core Elements of Culture Change – AHRQ 2006
Care and daily activity directed by residents
Environment designed as a home, rather than an institution
Close relationships among residents, family members, staff, and community
Work organized to support and empower all staff to respond to residents’ needs and desires
Management fosters collaborative, decentralized decision-making
Systematic processes in place for continuous quality improvement

11. 2015 State of the Art of Person-Centered Care Survey Results
Research Conducted by Maggie Calkins, PhD
Executive Director, The Mayer-Rothschild Foundation
Emily Chmielewski, EDAC
Senior Design Researcher & Associate, Perkins Eastman
Addie Abushousheh, PhD
Gerontologist & Researcher
We respectfully ask that you not take pictures of video of this presentation. This might limit our ability to get it published in a peer reviewed journal. It will be published, and it will be available on

12. Familiarity with the concept of CC/PCC
Commonwealth
% Unfamiliar
27% Familiar
% Unfamiliar
66% Familiar
Rothschild*
% Unfamiliar
6% Slightly Familiar
94% Familiar
Rob Mayer
*Sample included 134 nursing homes in the US, contacted between November 2015 and March 2016.

13. Categories
Traditional: definition does not describe us; minimal to no leadership buy-in
Strivers: definition describes us “in a few respects”; leadership committed to adopting culture change
Moderate: definition describes us “for the most part”
Total/deep: definition completely fits

14. What Does Person-Directed Care Look Like?

15. Level of Adoption is Changing
Category
Commonwealth
2007
Rothschild
2016
Traditional
43% 2%
“Strivers”
25%
28%
“Moderate” Adopters
26%
51%
“Deep/Total” Adopters 5%
19%

16. Impact on Resident Satisfaction Scores
Communities may use a variety of different Satisfaction measures/companies.
75% of PCC Strivers had 80%+
85% of PPC Moderate had 80%+
95% of PCC Deep had 80%+
Over time and with deeper adoption, the bar raises and people also expect more.
Rob Mayer

17. Impact on Family Satisfaction Scores
70% of PCC Strivers had 80%+
85% of PPC Moderate had 80%+
95% of PCC Deep had 80%+
Rob Mayer

18. Resident Choice and Control
To what extent do residents direct their daily routine?
Not at all
In a few respects
For the Most part
Completely
Traditional
66% -
PCC Strivers
62%
PCC Moderate
PCC Deep
65%
Rob Mayer

19. How long has your community been in the process of adopting
Within 1 year
1-3 years
3-9 years
10 or more years
PCC Striver
17%
58%
25% 0%
PCC Moderate
13%
20%
37%
30%
PCC Deep
21%
44%
Rob Mayer

20. The Rest of the Story
Aggregate data show promise, but not yet the progress we might hope for
BUT, the movement continues to grow & evolve, developing best practices & advancing change
Growth in defined models – for example, 212 Green House homes now open in 30+ states

21. What’s getting in the way?

22. The Barriers Good is the enemy of great
Lack of a strong business case – incentives must change!
Industry consolidation; drive to minimize costs, short time horizons & ROI demands
Focus on short-stay post-acute care; belief that culture change does not apply
Challenges to requiring/enforcing PCC
Low expectations & “us” vs “them”

23. The Key: Remembering & Sharing What’s Possible

24. Contact Information
Ruta Kadonoff Executive Director Pioneer Network (202)