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Supporting Culture Change: Working Toward Smarter State Nursing Home Regulation


The traditional nursing home regulatory approach, which uses survey and enforcement to achieve performance improvement, has created tensions between providers and surveyors. It has had limited success in improving quality overall and not necessarily allowed innovation to flourish. This has been the perception of many homes wanting to undergo transformative "culture change" reforms. To move toward a new model of nursing home regulation, the states and federal government must strike a balance between the traditional regulatory approach to weed out substandard facilities and a partnership model aimed at promoting high performance. This issue brief highlights the importance of how such a model is structured, as well as the need to adequately train and educate regulatory staff and providers about culture change. Regulators, providers, consumer groups, residents, and their families also will need to commit to the principles of person-centered care to ensure the success of the new collaborative approach.

Publication Details

Publication Date: October 9, 2009
Citation: R. I. Stone, N. Bryant, and L. Barbarotta, Supporting Culture Change: Working Toward Smarter State Nursing Home Regulation, The Commonwealth Fund, October 2009.


Executive Director, American Association of Homes and Services for the Aging
Senior Research Associate , Institute for the Future of Aging Services
Senior Communications Associate, Future of Aging Services