In the late 1990s, a new type of reform, culture change, entered into nursing home language, calling for improved quality of life and a shift away from institutional, medically-focused care. Early reform centrally focused on improving clinical quality in nursing homes, overshadowing quality of life. Since OBRA ‘87, nursing home reform has been a prominent national issue largely due to egregious cases of abuse, neglect and exploitation. Since perceptions or assumptions can serve as a source of resistance to change, redefinition or “unlearning” to make way for more accurate definitions of PCC could aid in reducing organizational resistance to implementation of PCC and thus improve the rate of adoption. Pre-adopters’ lower score following a year of education and exposure to PCC may reflect a shift in perceptions of PCC as a concept or a deeper conceptualization of PCC. In contrast, adopters rated their PCC achievement as higher on post-test (2015) than on pre-test (2014). ResultsĪcross all seven domains of PCC, pre-adopters rated their PCC implementation as significantly higher on pre-test (2014) than on post-test (2015).
Paired t-tests and mixed repeated-measures linear models, controlling for potential confounders, were employed to test the study hypotheses. Outcomes were self-ratings of perceived PCC implementation across seven domains of PCC at the beginning and end of the 2014–15 program year, after pre-adopters had received PCC education and adopters had implemented a year of PCC. MethodsĪ multi-arm, pre/post intervention study was conducted during the 20 years of the PEAK 2.0 program comparing pre-PCC adopters to adopters.
Given perception is an important feature of the change process, it was hypothesized that pre-adopters engaging in PEAK 2.0’s initial Foundation year (level 0) would have lower perceived PCC adoption following a year of education and exposure to PCC, whereas adopters (PEAK 2.0 level 1–5 homes) would have higher perceived PCC adoption following a year of participation in their respective level in the program. This study examined how nursing homes perceive their adoption of PCC practices across seven domains and how these perceptions change in response to an educational intervention embedded in a statewide program, Promoting Excellent Alternatives in Kansas nursing homes (PEAK 2.0). Change such as this, requires transformation of organizational culture, frequently generating resistance and slow moving change. Comprehensive adoption of culture change via person-centered care (PCC) practices in nursing homes has been slow.
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