The culture change study is one of just a few large-scale analyses of the potential benefits associated with culture change adoption.
The LeadingAge Center for Applied Research (CFAR) has received a $149,776 grant from the Retirement Research Foundation to evaluate a Medicaid pay-for-performance incentive program designed to facilitate the adoption of culture change in 340 Kansas nursing homes.
The main goal of the nursing home culture change movement is to transform hospital-like, institutional settings into homes in which residents’ preferences govern everyday life, and residents and staff members live together in close-knit units akin to families.
The movement also aims to empower employees to make care decisions on their own, thereby helping to increase job satisfaction and reduce turnover.
CFAR researchers will examine whether the “Promoting Excellent Alternatives in Kansas” (PEAK 2.0) incentive program improves:
- Resident health.
- Resident quality of life.
- Residents’ satisfaction with their nursing homes.
- Employee job satisfaction.
Researchers will also assess the educational and evaluation components of the PEAK 2.0 program.
Culture Change: An Important Study
The culture change study is being carried out in collaboration with researchers at the Kansas State University Center on Aging. The 18-month research project, which began July 15, is one of just a few large-scale analyses of the potential benefits associated with culture change adoption.
Two previous large-scale studies found relatively few beneficial effects of culture change on resident health. But those studies had design limitations that could have led to their inconclusive results, says Dr. Linda Hermer, senior research scientist at LeadingAge.
“Several features of the Kansas program and our analyses will allow us to examine with greater precision whether the PEAK program is beneficial,” says Hermer, who is leading the research team.
Features of the Kansas PEAK Program
The Kansas State Legislature adopted the PEAK program in 2011 to:
- Help make Kansas nursing homes less institutional.
- Ensure that person-centered care and resident choice govern daily life.
- Improve resident health and well-being.
- Empower employees, increase their job satisfaction, and reduce their turnover rates.
None of these outcomes have been comprehensively and quantitatively examined since the program was initiated, says Hermer.
Kansas State University’s Center on Aging has been working with the PEAK program since 2012, when it developed training programs to educate nursing home staff about culture change.
The center also conducts structured, in-person interviews with residents and staff at each home to evaluate how well nursing homes are implementing culture change.
This reliance on 3rd-party evaluators, rather than on nursing homes’ self-reported progress, is an important distinction of the PEAK program, and will make it easier to evaluate culture change outcomes, says Hermer.
The fact that all of the Kansas nursing homes have been trained and are evaluated in the same way will help researchers, she says.
“This should reduce some of the heterogeneity among the homes in how they implement culture change and are evaluated, and it should make it easier to find improvements and harms that result from culture change,” says Hermer.
Goals of the Culture Change Study
The CFAR research team will evaluate the PEAK program by assessing:
- Residents’ health outcomes: Researchers will track the Centers for Medicare and Medicaid Services’ Minimum Data Set for each program year.
- Residents’ satisfaction with their nursing homes: The team will use a satisfaction instrument administered by the Kansas Department of Aging and Disability Services to track satisfaction levels on an annual basis.
- Resident quality of life: Quality-of-life survey deficiencies will be tracked annually.
- Nursing home employee turnover rates.
Researchers will produce articles and issue briefs that are expected to benefit aging services providers, states, and other stakeholders considering the adoption of culture change incentive programs.
“The CFAR team is looking forward to evaluating the effectiveness of the Kansas program,” says CFAR Executive Director Robyn Stone. “At LeadingAge, we believe culture change is an important aspect of expanding the world of possibilities for aging, and we hope our research on this project will further reinforce that belief.”