Policy Values and Culture Change in Long-Term Care- The Role of State Government in Catalyzing Change

SUMMARY Despite some improvements that can be attributed to the provisions of OBRA '87, the quality of care in nursing homes remains far from optimal. Excessive reliance on a medical model of care fails to address residents' desire to be treated with kindness, courtesy and consideration. In addition, the issue of improving quality of care is linked to addressing growing concerns about nursing home staffing. One solution is for government to play a role in catalyzing a change in the organizational culture of nursing homes to address the concerns that both residents and staff have with the existing culture. A number of states are providing grants to nursing homes to implement culture change. This has included New York State which has emphasized culture change in its Dementia Grant Program.