Monday, June 29, 2009

Culture Change in Nursing Homes

This year the federal Centers for Medicare & Medicaid Services are finally upholding the Olmstead Act. Below are resources and information.

The Olmstead Decision of the Supreme Court (1999) states that: ... under the Americans with Disabilities Act, it is a form of discrimination to isolate and segregate persons in institutions when they can live like other people in the community and enjoy the benefits of society.

State surveys of nursing homes will now include a “self-determination” component that will be embedded throughout the survey, addressing all levels of nursing home operations. Below are some links to key culture change websites. Check out The Pioneer Network's 40 page document about the changes to the nursing home survey.
But first, here are some of the radical inspiring results of a typical culture change program:

Results of The Tupelo Project (Tupelo, Miss.)
The Tupelo operation has been cost neutral in a 99% Medicaid funded facility
  • Elders moved to the Green Houses without transfer trauma.
  • Elders report very high levels of satisfaction with their quality of life
  • Families report high levels of satisfaction with care.
  • Dementia related behavior problems have been markedly reduced.
  • A decrease in wheelchair use related to the short navigable distances.
  • A decrease in urinary incontinence.
  • An increase in appetite, food consumption with accompanying weigh gains.
  • A decrease in the use of nutritional supplements.
  • An increase in elder engagement in personal and household activities.
  • A consistent care staff with a 10% turnover rate in 2 years (nat'l average 90% annually.)
  • Two deficiency free state surveys.


Pioneer Network -
The Pioneer Network is a clearinghouse of information and resources about culture change in nursing homes. The Pioneer Network facilitates deep system change and transformation in our culture of aging.
"We: Create communication, networking and learning opportunities; Build and support relationships and community; Identify and promote transformations in practice, services, public policy and research; Develop and provide access to resources and leadership."

Eden Alternative -
Information and tools for making life better for our Elders and those who care for them.

Greenhouse Project -
A revolutionary new model of care developed by Dr. Bill Thomas. The ideas and Principles of the Eden Alternative with small houses for 6-10 Elders who require skilled nursing care.

Action Pact -

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