Culture Change News

Culture Change News

(Articles below appear in reverse chronological order from most recent back to earlier news. NORC Gazette cited as the source of many articles is a secondary source.  The primary sources can be found in the original article as cited in the NORC Gazettes posted on this site.)

Green House project is subject of AR legislation

Two bills regarding the Green House project have been passed unanimously by the Arkansas House.  The first bill, HB 1363, gives the State Office of Long-Term Care the authority to establish staffing standards for nursing homes certified as Green House projects or as Eden Alternative.  No Green House project homes currently operate in the state, but an assisted living facility with many Green House concepts is being built.  A companion bill, HB 1364, was also passed by the House.  This bill would allow the Office of Long-Term Care to use money from the Long-Term Care Trust Fund to finance pilot Green House projects in the state.  Under the plan, nursing home operators who want to redesign their facilities using Green House ideas can seek grants from the state office.  This fund consists of fines levied on nursing homes that are out of compliance with state laws and regulations.  Both bills now go to the Arkansas Senate.

Source: Southwest Times Record, February 8, 2007

AR ombudsmen active in culture change
The Arkansas Ombudsman Program has joined with other major organizations in the state to form the “Arkansas Accord.”  The Accord is a partnership between the Arkansas Health Care Association, The Arkansas Health Care Foundation, the Arkansas Foundation for Medical Care, the Office of Long Term Care and the Ombudsman Program with a goal of working together to promote culture change in nursing homes through person directed care.  The goals of the Arkansas Accord are aligned with those of the St. Louis Accord held in June 2005.  Kathie Gately, Arkansas State Ombudsman, has been very active in the formation of the Arkansas Accord.  On the Accord’s website, Gately is quoted as saying, “If we did not open ourselves to growth and learning, we would still be rubbing two rocks together to provide a spark for our fire.”  The website contains a wealth of information about culture change, including tip sheets about person directed care and resources on nursing home workforce retention.  Users can also submit regulatory questions and share success stories.  The website is: http://www.afmc.org/HTML/programs/quality_improve/nursing_home/arkansasaccord/arkansasaccord.aspx.

MN Culture Change Coalition holds summit

On March 23, 2007, the Minnesota Culture Change Coalition, of which the Office of Ombudsman for Older Minnesotans is a member, held a full-day education summit, Partnering for Person-Centered Care.  The Summit was designed to introduce consumers and policy makers to the concept of person-directed care. Last October, the Coalition held a similar summit targeting providers and surveyors.  This year’s program was provided at no charge to about 200 participants through funding from Civil Monetary Penalty monies.  Facilitators Barbara Frank and Cathie Brady of B & F Consulting discussed the roots of the culture change movement and provided information on concepts which are key to creating a sense of “home,” such as individualized care plans and developing consistent staff assignments.  Several vignettes were shown depicting culture change, including a piece from a film about a collaborative project done by Bethesda Heritage Center in Willmar, Minnesota and ombudsman staff and volunteers utilizing the tool, “Residents Have the Answers.”  A highlight of the film was a segment that featured residents explaining to new staff how they wanted to be recognized and treated as individuals in their home.  For more information, contact Maria Michlin, Minnesota Acting State Ombudsman.

Source: Email from Maria Michlin, March 27, 2007

New laws advance culture change in Arkansas

Arkansas Governor Mike Beebe has signed into law two bills that are designed to promote culture change in the state.  The first bill, HB 1364, would allow money from civil monetary penalties to be used to “enhance the quality of life for long-term care facility residents through the adoption of principles and building designs established by the Eden Alternative or Green House programs or other means.”  The second bill, HB 1363, mandates that the state promulgate staffing standards for nursing homes that are designated or certified as Eden Alternative or Green House Project nursing facilities.  Minimum staffing standards are already required for non-Eden Alternative/Green House Project homes in Arkansas.  To read the bills, go to http://www.arkleg.state.ar.us/ and enter the bill numbers.

Source: www.myfoxmemphis.com, March 5, 2007; http://www.arkleg.state.ar.us/

Green Houses keep growing

At the recent joint conference of the American Society on Aging and the National Council on Aging in Chicago, Robert Jenkens, a top consultant and developer involved with new senior care models, reported that applications to start new Green House long-term care facilities are rolling in at the rate of two per week.  Jenkens said that those applications are in addition to the 33 Green Houses currently open and the more than 20 others already in development.  He also noted that one major chain is investigating the possibility of becoming the first for-profit entity to pursue the Green House concept.  If it does, it would mark a watershed moment in the Green House movement, according to Jenkens.  Both Jenkens and academic researcher Rosalie Kane of the University of Minnesota discussed current and future plans for the Green House at the conference.  Kane has studied care processes and outcomes since the first Green Houses opened in Mississippi in 2003.  “I don’t think I could have made up better results,” she said.

Source: McKnight’s Long-Term Care News & Assisted Living, March 9, 2007

CMS to broadcast second of 4-part series on culture change

On May 4, the Centers for Medicare and Medicaid Services (CMS) will broadcast part two of a four part series, “From Institutional to Individualized Care.”  This second broadcast, entitled, “Transforming Systems to Achieve Better Clinical Outcomes,” will: focus on the benefits of a holistic, individualized approach to night care, bowel and bladder function, activities, and food services; show how individualized care gives nursing homes more ways to respond to people’s clinical needs; and identify benefits of consistent assignment and participatory management practices.  The session will air from 1:00 - 3:30 pm Eastern time and will feature a number of prominent experts, including Barbara Frank, Cathie Brady and Dr. Susan Wehry.  For registration, viewing instructions, satellite coordinates and handouts, go to the CMS Survey and Certification Online Course Delivery System at: http://cms.internetstreaming.com.  The third broadcast in the series will be aired on May 18.

Source: Centers for Medicare and Medicaid Services

Green House project is subject of AR legislation

Two bills regarding the Green House project have been passed unanimously by the Arkansas House.  The first bill, HB 1363, gives the State Office of Long-Term Care the authority to establish staffing standards for nursing homes certified as Green House projects or as Eden Alternative.  No Green House project homes currently operate in the state, but an assisted living facility with many Green House concepts is being built.  A companion bill, HB 1364, was also passed by the House.  This bill would allow the Office of Long-Term Care to use money from the Long-Term Care Trust Fund to finance pilot Green House projects in the state.  Under the plan, nursing home operators who want to redesign their facilities using Green House ideas can seek grants from the state office.  This fund consists of fines levied on nursing homes that are out of compliance with state laws and regulations.  Both bills now go to the Arkansas Senate.

Source: Southwest Times Record, February 8, 2007

Texas to get first Green Houses
Buckner Westminster Place, a retirement community in Longview, Texas, has announced its plans to build two Green Houses.  Currently, residents at Buckner have an option of assisted living or independent living, but must relocate to a nursing home if they need 24-hour nursing care.  In considering how to provide this higher level of care, Buckner officials said that the Green House model “grabbed our heart” and that when you go to a Green House, “you see life.”  The Green House model was created by Dr. William Thomas, with the first home established in Tupelo, Mississippi in 2003.  Each Green House is a self-contained dwelling for seven to 10 people.  Residents have private bedrooms and bathrooms, and the house has a central hearth, open kitchen and common living area and eating area where residents share meals around a table.  Ground breaking for the estimated $3 million project will be June 3, with construction scheduled to wrap up about nine or ten months later.  Last November the Robert Wood Johnson Foundation donated $10 million to the nonprofit NCB Development Corporation to help spread the Green House model nationwide. Westminster will be the first site in Texas to feature Green Houses. Source: NORC Gazette May 5, 2006

Culture Change Materials Available
A number of practical, innovative tools to create more resident-centered facilities are available on the website of The Commonwealth Fund, which helped fund their development.  Tools include: “Champions for Care: A Workbook for Long-Term Care Providers,” which helps staff members build teams and take on leadership roles; “Modeling and Measuring Nursing Home Reform: The Culture Change Staging Tool,” a free, web-based tool that enables nursing homes to assess their progress in becoming resident centered; and  “Guidance for Bathing Patients with Dementia: Bathing Without a Battle,” a CD and video that offers practical techniques caregivers can use to make bathing a pleasurable experience for people with dementia.  To access the materials, go to: http://www.cmwf.org/tools/tools_list.htm?attrib_id=11991. Source: NORC Gazette April 18, 2006

MN Nursing Home Embarks upon Culture Change
An article in the Sauk Centre Herald in Minnesota highlights the transformation that is occurring at St. Michael’s Nursing Home in Sauk Centre as the facility embarks upon culture change. Staff from all nursing home departments are involved in the change, which the Director of Nursing said was “all about what the residents want.” Changes will be incorporated gradually, and personal information will be included in each resident’s care plan. For instance, the clinical manager noted that morning medication is administered at 8 a.m., but “if they (residents) want to sleep in until 10 a.m., then they will get their meds after 10 a.m.” She added, “We need to adapt to their routines.”  Source: NORC Gazette March 29, 2006

SD Ombudsman Program Promotes Culture Change
As a stakeholder in the South Dakota Culture Change Coalition, the South Dakota State Ombudsman Program has joined with others to transform the state’s nursing homes and assisted living facilities. In addition to the Ombudsman Program, members of the Coalition include: AARP, the Alzheimer’s Association, Avera Health System, Good Samaritan Society, Rapid City Regional Health Network, Sioux Valley Health System, the South Dakota Association of Healthcare Organizations, the South Dakota Health Care Association, the Department of Health, and the South Dakota Foundation for Medical Care (the state’s Quality Improvement Organization). The Coalition successfully asked the Governor to proclaim 2006 as the “Year of Culture Change in South Dakota Nursing Homes.” In the proclamation, the Governor urges “the leadership of all nursing homes to join in a statewide effort to raise awareness and promote person-centered care for every elder residing in a nursing home.” The coalition believes that the proclamation will bring tremendous momentum to culture change work in the state. Jeff Askew, South Dakota State Ombudsman, is also conducting presentations on culture change to nursing facilities using the Pioneer Network’s resource, “Getting Started.” Source: NORC Gazette January 30, 2006

IL Nursing Homes Implement Culture Change
Hitz Memorial Home in Alhambra, Illinois is experiencing first-hand the positive effects of culture change.  About a year ago, Hitz employees began attending seminars on culture change sponsored by the Illinois Department of Aging.  Marcia Haslett, Executive Director of Hitz said, “It was like a light bulb went off in our heads.”  Since that time, the facility has made many changes, including implementing a cafeteria that operates like a restaurant.  Employees serve meals during blocks of time instead of all at once.  As a result, residents can sleep late in the morning if they want to and have more food choices.  Hitz has also established several committees to get residents more involved in decision- making at the home.  Another change is that the number of complaints at the facility has increased ten-fold in the past year – a fact that Haslett reports with pride because residents now feel they can make a difference, and those who are competent speak up for those with physical and mental impairments.  Staff are supportive of the changes, and as one employee stated, “It used to be so regimented.  Everything had to be done at a certain time.  Now (employees) can get to know residents better and talk to them.  We’re more like friends.  It’s like a neighborhood.”  Four other area nursing homes are also involved in culture change.  Source: NORC Gazette December 21, 2005