Regulating “Culture Change” in Long-term Care

As an institutional type, nursing homes can be most closely linked to the hospitals created during the Industrial era of our nation’s history, and have adopted similar approaches to providing clinical care. While often physically and cognitively frail the needs of nursing home residents are more complex than simply needing medical treatment. These individuals often become permanent residents of these facilities and require a setting that recognizes them as individuals. As America ages, projections point to an increasing use of nursing homes in the next ten to twenty years. Therefore, nursing homes will become an increasingly important place-type in our country. Since 1997, groups increasingly called for more patient-centered approaches. In the field of long-term care, this is often referred to as “culture change.” The goal of culture change is to create a system of “interdependency” that enhances the quality of life for residents as well as the quality of the work environment for staff. This approach focuses on the capacity of residents and their abilities to participate fully in the lives and the decision about their daily routines and care. This type of care requires rethinking the way that residents interact with care professionals as well as the built environment. Finding a fit between these new approaches and existing regulatory requirements is daunting. Nursing homes derive a majority of their resources from federal dollars, and eligibility is contingent upon meeting federal regulatory policies. The existing regulatory statutes may be too clinically focused to provide for the necessary flexibility that is required in a person-centered care approach. Some argue that “negative attributes of nursing home culture are reinforced by governmental regulation and payment mechanisms, as part of a mutually-reinforcing and mutually-symbiotic relationship between government and the nursing home industry (Vladeck, 2003, p. 3).” This paper will focus on understanding of the existing regulatory framework and the implications and contradictions of the new interpretive guidelines that are intended to advance the quality of life in long-term care settings. It will conclude with recommended actions to increase the efforts to ensure that long-term care regulations make quality of life a top priority