PPS Alert for Long-Term Care
The evolving role of culture change in long-term care
Editor’s note: This article was written by Randy L. Kozeal, owner and manager of LTC Midwest, LLC, in Wilbe , NE.
CMS published revisions to a number of F-tags in Ap- pendix PP of the State Operations Manual in June. Many of these changes incorporate culture change language into the guidelines, which highlights the importance of recog- nizing the voice of the resident in the overall delivery of care. Long-term care providers have heard about, talk- ed about, strived to implement, and in some cases been chastised for culture change efforts for many years. CMS has now incorporated this initiative into its guidance,
which is a big step forward in the movement to improve the quality of care and life for nursing home residents.
Culture change is rooted in a mind-set. It is a specific thought process whereby the caregiver respectfully serves the voiced needs, wants, and concerns of the resident. Culture change begins at the grassroots level and is a col- laborative venture between the resident, who is at the center of the process, and the caregivers.
Culture change is also deeply rooted in the essence of hospitality. It is a social model that respects the clini- cal aspect of healthcare while striving to enhance the cul- ture and lifestyle of the residents. Culture change respects the identity of the individual. The resident’s voice is para- mount; he or she is in the driver’s seat, not the caregiver.
As you go through the recent regulations, you will find
to culture change. Both direct facilities to address the resi- dent’s preferences and seek his or her guidance in offering activities that will enhance the resident’s overall lifestyle. Resident-centered and resident-chosen activities, often provided in a one-on-one style, are becoming more com-
mon in nursing homes, and the caregiver serves as the coordinator rather than the director of the situation. In addition to the revised regulations and guidance, the
MDS 3.0 will help facilities implement culture change. The resident interview processes of the MDS 3.0 will require that SNFs use the resident’s voice as the main source of in- formation and respond in a timely manner to a resident’s wishes and needs.
So in light of the new guidance and upcoming changes, how should your facility begin to implement culture change? First, facilities should seek out the most current information regarding culture change and read the recent- ly revised guidance. Facilities should also explore the area of hospitality and realize how important it is in the deliv- ery of care and quality of life of nursing home residents. Involving all staff members and helping them recognize that they are part of a team is very important to imple- menting culture change in a facility.
SNF staff members should begin to shift their mind- set to fit a resident-centered model of care while finding the balance between the social and the clinical models in the overall delivery of care.
subtle references, as well as very specific directives, re- lated to culture change. The recently revised F309 guid- ance for pain management is a perfect example. SNF staff members are directed to regularly monitor, observe, and ask the resident about his or her pain. When pain is iden- tified, the guidance requires staff members to respond ap- propriately, not just with pain medications, but with other interventions acceptable to the resident for the mitigation of pain, such as complementary and alternative medicine.
SNFs should move toward culture change because, in addition to the revised guidance and MDS 3.0, there will most likely be more efforts to implement culture change in the future. ■
Questions? Comments? Ideas?
Contact Associate Editor MacKenzie Kimball
The revised guidance for F248, Activities, released in 2006 and the revisions released in June to F242, Self-De- termination and Participation, are filled with references
Telephone 781/639-1872, Ext. 3265 E-mail email@example.com
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