| Variations of new models of nursing home care, sometimes called "regenerative" or "person-centered," are becoming more prominent in the United States. The purpose of this research was to explore how this "culture change" movement is specifically adopted and installed within long-term care facilities, how the change necessitated by this culture affects administrative and staff performance and resident satisfaction and care as expressed by opinions and attitudes, and identification of local environmental factors critical to its successful installation.; A one-year field study examined three proto-typically selected nursing homes that differ in commitment to and phase of installation of new models of care based on objectives defined by nursing home culture change advocates calling themselves the Pioneer Network. Observational, interview, and unobtrusive methods were used to gather data (using Schein's model of organizational culture) on artifacts, values, and assumptions reflecting culture change within the facility. Analysis of the data validated purposive sampling as it revealed environmental, social, and organizational policy and procedural differences in the three nursing homes, with one of the three adopting many of the Pioneer Network values and objectives, another attempting but not fully succeeding in installing culture change features, and the third choosing to maintain a "traditional" nursing home environment. Factors attributing to the ability or lack of ability to change the long-term care culture included leadership, the learning style of the organization, and the ability to access resources and to overcome resistance. The study revealed that some attempts at change were averted, stalled, or delayed because of unintended "side effects" associated with the intervention regimen.; In addition, resident response to culture change was examined through observation, organization documents (satisfaction surveys), and staff interviews. Recognition of change was minimal with residents indicating that they would still rather be "home."; The findings offer implications for the nursing home professionals attempting to create culture change within their organizations. Processes that can be implemented to avoid unintended side-effects of change are examined. Suggestions are offered for creating the sense of "home" through the provision of affective care for residents through stronger relationships with family members and increased volunteer support. Staff and leadership curricula changes reflecting a greater sensitivity to the psycho-social needs of the frail elderly are discussed. |
