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Culture Change

A nursing home is a place residents call "home." A place where someone lives and calls home should nurture the human spirit as well as meet medical needs. Culture change is a movement that seeks to create an environment for residents, which follows the residents' routines rather than those imposed by the facility; encourages appropriate assignments of staff with a team focus to make deep culture change possible; allows residents to make their own decisions; allows spontaneous activity opportunities; and encourages and allows residents to be treated as individuals. Deep culture change is an important component of the right of residents to “care and services to attain or maintain the highest practicable physical, mental and psychosocial well being;” as promised in the 1987 Nursing Home Reform Law. It is the role of the Ombudsman to advocate for residents and their right to make choices to direct their care and life in long-term care facilities. Below are documents and resources that may help ombudsmen in their work to achieve resident-directed care.

Resources


ACL Guidance for Outreach and Providing Services for Holocaust Survivors (January 2017)
ACL created this guidance as a vehicle by which the Aging Services Network can build stronger connections to organizations and stakeholders providing care to Holocaust survivors, to enhance service capacity and quality.  The guidance examines the unique needs and challenges of serving Holocaust survivors, with a particular focus on mental and physical health, nutrition, transportation, caregiver support, outreach, legal and ombudsman services, with a foundation in person-centered, trauma-informed approaches. 

Journey to Culture Change (November 2015)

Presented by the Maryland Culture Change Coalition, these slides serve as a guide on the culture change movement and how culture change can be implemented.

Culture Change Resources (NORC 2012)

LTCOP Innovative Practices: Incorporating Person-Centered Care in Ombudsman Training, Complaint Investigation and Advocacy  (October 2012)
This webinar is designed to help ombudsmen think about applying person centered care principles to the role of the ombudsman in advocacy and program management. The presentations delve into the gray areas around avoiding the perception of being more of a provider advocate than a consumer advocate, resource allocation, and teaching ombudsmen how to apply the principles to their ongoing work.

The Role of the LTC Ombudsman in Culture Change: Promoting Resident Directed Care in Nursing Homes and Assisted Living (NORC 2007)
This resource brief is designed to generate ideas about how long-term care ombudsmen can promote systemic, resident-directed care practices in facilities. Included are examples of state and local ombudsman program involvement in promoting culture change practices, offers tips for ombudsman advocacy, discusses the role of the ombudsman and lists salient resources.

Ombudsman Best Practices: Supporting Culture Change to Promote Individualized Care in Nursing Homes (NORC 2000)
This paper presents long-term care ombudsman practices in supporting culture change in nursing homes, drawing on lessons learned by State Ombudsman Programs that have engaged in such initiatives. It includes an overview of the issues, relevant practice precedents and examples of best practice. The section “Lessons Learned” examines important considerations for state and local ombudsmen who want to begin or continue culture change efforts.

Changing the Nursing Home Culture (March 2008)
Alliance for Health Reform Culture Change Issue Brief

Pioneer Network
A grassroots movement to transform the culture of aging in America. The movement is called culture change, the transformation of traditional institutions and practices into communities in which each person's capacities and individuality are affirmed and developed.

Locate Your State Culture Change Coaltion - search for your state coalition

Training and Outreach


LTCOP Innovative Practices: Incorporating Person-Centered Care in Ombudsman Training, Complaint Investigation and Advocacy Intensive

Culture Change Inservice Training (NORC)
Ohio Department of Aging, Finer with Age, February 2011 Program Regarding Person-Centered Care

Quality Partners of Rhode Island - coordinated a 2004-2005 CMS pilot of QIO work in nursing homes. Individualized Care: The Key to Quality and Retention

Residents: The Heart of the Matter - Best Practices of Northern Michigan 13th Annual Conference

Texas Long-Term Care Ombudsman Initial Certification Training Manual: Module 10- Resident-Directed Care and Module 11- Systems Advocacy

Additional Trainings on Culture Change are available here.

 Ombudsman Best Practices


Guam
The Guam Ombudsman program was instrumental in the installation of the new call lights system for the 59 rooms for the frail elderly residents of St. Dominic's Senior Care Home.  (2011)

Louisiana
The SLTCOP has created, conducts, and leads a regional culture change coalition of PSA. (2011)

Maryland
During the last year, the Ombudsman Program has worked to introduce culture change in a variety of arenas so that the term becomes a part of policy discussions and so the concept would be utilized more frequently in long term care facilities – nursing homes and assisted living facilities. The Department of Aging also worked to develop Maryland’s first GreenHouse and promoted other culture change activities.

Ombudsman steps included: participating in the development of Maryland’s Alzheimer’s Statewide Plan that was legislatively mandated to guide the Governor and other decision makers; encouraging the Alzheimer’s Commission to include in the plan the development of a Culture Change Coalition, language about the importance of person centered/directed care, and training for all facilities in successful practices that are resident focused; identifying an expert in Culture Change to present at the legislatively mandated Nursing Home and Assisted Living Oversight Committee; encouraging statewide conferences to include sessions on Culture Change (GSA, etc.); holding meetings at facilities that incorporate comprehensive culture change so that participants can see firsthand this kind of model; and identifying retired persons who are interested in Culture Change to participate in the development of a Coalition.

The initial meeting to form a Culture Change Coalition will be held April 2013. The Ombudsman Program took the lead on the administrative work including sending out invitations, keeping a list of interested persons, etc. Two local ombudsmen were identified to participate in the forming of a coalition. There is increased excitement and interest in Culture Change including possible inclusion in the Medicaid incentive program. (2013)

Ohio
The Ohio program is using Civil Money Penalty funds to improve person-centered care in nursing homes. Each of twelve regional ombudsman programs applied to the state ombudsman for funds to work with individual homes on person-centered strategies. The program is also using funds to enhance training for ombudsmen to use root cause analysis so that resolution of complaints is person-centered. (2011)

Texas
After hearing about TimeSlips, a creative storytelling process for people with dementia, developed at the University of Wisconsin Milwaukee, a staff ombudsman educated facility staff about the benefits of person-centered activities and encouraged staff to implement these principles on an ongoing basis. (2011)

Information to Share with Consumers


Pioneer Network

A grassroots movement to transform the culture of aging in America. The movement is called culture change, the transformation of traditional institutions and practices into communities in which each person's capacities and individuality are affirmed and developed.

Locate Your State Culture Change Coaltion - search for your state coalition

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