How Nursing Home Regulation Can Support Culture Change

eAlert eeb92ff9-d44f-45a8-9696-cd2119c30358

The traditional nursing home regulatory approach, which uses survey and enforcement to ensure compliance with performance requirements, has created tensions between providers and surveyors and is not a method best geared to achieving lasting improvement. Moreover, some nursing home providers say that certain federal and state regulations and procedures are barriers to culture change efforts, which aim to transform nursing homes from institutions to "homelike" environments. <br /><br />In a new <a href="/publications/issue-briefs/2009/oct/supporting-culture-change-working-toward-smarter-state-nursing">Commonwealth Fund issue brief</a>, Robyn I. Stone, Dr.P.H., and colleagues at the Future of Aging Services call for a new model of nursing home regulation that strikes a balance between the current regulatory process—which will still be needed to weed out substandard facilities—and a partnership model aimed at promoting high performance. The authors outline such a model and highlight federal and state initiatives that are educating surveyors and providers about culture change innovations. <br /><br />"The success of the partnership approach will depend, in large part, on the extent to which stakeholders buy into the process and assume responsibility for successful implementation," the authors say. <br /><br />For an accompanying episode of <a href="~/link.aspx?_id=B40B041419414FF884C419B37F266AD5&_z=z">New Directions in Health Care: The Commonwealth Fund Podcast</a>, producer Sandy Hausman talked with regulatory staff at the Centers for Medicare and Medicaid Services (CMS) and the Kansas Department on Aging about the partnerships they have established. At CMS, meetings between regulators and providers have led to changes in the Federal Interpretive Guidance for Surveyors that consider residents' rights, the physical environment, and other quality-of-life issues in a new light. In Kansas, a new division has created grants for education and awards for home that deliver "person-centered" care.