Culture Change and Person Centered Care: The Challenges of Implementation

By Pamela D Wilson CSA, CG, MS, BS/BA

Despite significant national efforts since the 1980’s, to improve quality of care, quality of life remains sub-standard for many nursing home and assisted living residents. The culture change and person-centered care movements seek to improve resident quality of life and care by focusing on deinstitutionalization and individualized care.  Research lists six domains around which culture change efforts are focused: a) resident direction, b) home environment, c) close relationships, d) staff empowerment, e) collaborative decision making, and f) measurement based quality improvement.1

Several models of culture change exist. These include the Wellspring Model, the Eden Alternative and the Green House Model.  Many communities tout progress in changing physical environments to appear more home-like, supporting the idea of culture change, by including common areas, plants and animals in order to attract potential residents and caregiving families. Other communities focus on deficiency free surveys and Minimum Data Set (MDS) quality indicators to support person-centered care.

While a visually pleasing environment and quality measures support culture change and person-centered care, focus and dedication to the individual care of the person is missing from this recipe for communities focusing mainly on environment and quality indicators. Many communities fail to address the root cause of the failure of person-centered care which includes high staff turnover, a lack of consistent and well-trained workers and poor coordination across care teams.

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