The culture of Kansas
Everyone in long-term care loves culture change. But there's a secret.
Nobody's quite sure if, how, or why it works from a research standpoint.
Anecdotally, of course, those in the industry hear about how other providers cured loneliness, boredom or unhappiness. Do a shot at a conference for every time you hear about creating a “home like environment,” although be aware of alcohol poisoning. We also can see how much more comfortable families are when they don't feel like they are leaving their loved one in a sterile, boring environment.
In 2002, Kansas created a pay-for-performance Medicaid program designed to improve residents' lives. Starting this month, the Center for Applied Research at LeadingAge and Kansas State University will delve into a statistical evaluation of whether the program has helped resident health, resident quality of life and employee job satisfaction. The $149,776 grant was awarded by the Retirement Research Foundation.
The 18-month CFAR project will be one of a few large-scale analyses of the potential benefits of adopting culture change. Smaller-scale studies have shown, modestly, that resident quality of life improves with culture change, and larger studies have suggested some positive outcomes related to a decrease in physical restraints and feeding tubes, says researcher Linda Hermer, Ph.D.
“I am hoping one of the things we will be able to tell, with finer precision, is to be able to understand whether there are truly benefits from culture change to a resident's health and quality of life,” she told McKnight's.
Kansas State's Center for Aging, led by the indomitable Gayle Doll, Ph.D., reached out to CFAR because they had good data, but wanted to work with people with quantitative analytic experience. Hermer, a statistician and biological scientist by training, will be working with CFAR Executive Director Robyn Stone, Ph.D.
Hermer is quick to point out that even if there are few benefits to culture change, a facility may still have solid reasons to adopt specific practices. One example is related to employee job satisfaction: It's not unusual to see a spike in turnover when a facility does culture change initiatives. A lot of administrators can live with that, as they want people who buy into the vision.
The team will look at metrics of resident health outcomes through quarterly tracking in CMS' Minimum Data Set, resident satisfaction as measured by a yearly tracking instrument administered by the Kansas Department of Aging and Disability Services, resident quality of life as tracked by quality-of-life survey deficiencies and nursing home employee turnover rates.
Those measurements were picked “based on previous research and hypothesis would allow me to predict if they would improve or deteriorate in a certain way,” Hermer explains.
There are multiple prongs of impact through the study. The first is to see whether there are is solid, statistically significant data to say “Yes, culture change makes the lives of residents better.” Second, whether pay-for-performance programs, which exist in several states, are worthwhile.
It's clear the research team and the industry want to see how culture change improvements move the needle, but Hermer notes “it will be a rigorous study and we will let the data speak to us.”
I, for one, am eager to see the results. In an era where we are pressuring long-term care facilities to rely on analytics and data to make their case to hospitals or other partners, it's refreshing to see partnership between academia and LeadingAge in an effort to prove - or not - a great idea.
Elizabeth Newman is the Senior Editor at McKnight's.