Nursing Home Culture Change and its Effect on Quality of Life for Residents

University of Minnesota Ph.D. dissertation. 2020. Major: Nursing. Advisor: Christine Mueller. 1 computer file (PDF); 203 pages.For over two decades, a movement to transform nursing homes (NHs) into person-centered homes, referred to as NH culture change, has been occurring globally and in the United States. This culture change movement strives to improve quality of life (QOL) for people living and working in NHs through a range of innovations that emphasize resident autonomy, home-like environments, staff empowerment, and family and community engagement. However, sound evidence is lacking for the benefits of culture change practices on resident QOL. This study pursued the following aims: (1) describe the implementation of culture change practices in NHs in Minnesota; (2) generate an empirical typology of culture change implementation, and examine NH characteristics and quality outcomes (including resident QOL, family satisfaction, and clinical quality indicators) that are associated with the types of culture change implementation; (3) test the domain-specific relationships of culture change practices with resident QOL and family satisfaction, and examine the moderating effect of small homes or households on these relationships. This cross-sectional study surveyed NH administrators about culture change implementation in all Medicare and/or Medicaid certified NHs (n=363) in Minnesota. Administrative data on NH characteristics and quality outcomes was used. This study generated an empirical typology of culture change implementation based on a latent profile analysis (comprising high performers, average performers, and low performers). High performers were distinguished through demonstrating better resident QOL and higher family satisfaction. The culture change domains for the physical environment, staff empowerment and leadership, and end-of-life care were positively associated with at least one specific domain of resident QOL and family satisfaction. Staff empowerment and leadership had positive effects on a wider range of resident QOL outcomes. Implementing small home and household models had a buffering effect on the relationships between staff empowerment and resident QOL or family satisfaction. The findings of this study provide practical implications for NH providers to develop a tailored culture change intervention that best meets the needs of residents, family members, and staff in their facility. The findings also inform policy with regard to resource allocation to support NHs at different levels of implementation to achieve comprehensive culture change