State Investment in Culture Change in State Investment in Culture Change in Long Term Care Long Term Care

Natasha Bryant, MA

Academy Health Annual Research Meeting

June 8, 2008

Overview

Introduction Methodology Findings and Themes Summary and Significance

Introduction

Project Purpose and Importance

Grant: Commonwealth Fund Purpose – State role in promotion of

culture change State can be a major player and catalyst

of change

Three Inter-Related Areas of Activity

Workforce Improvement

Continuous Quality

Improvement

Person-Centered

Care

Research Questions

What motivated each state to invest in culture change?

Who were the major drivers? What were the financial and non-

financial investments? What were the specific activities

supported by the state? What were some of the major

crosscutting themes?

Methodology

Selection of Case Study States

Sample: selection of states Case study states

Georgia Kansas Massachusetts Michigan North Carolina Oregon Vermont

Data Collection Activities

Telephone interviews Review of secondary documents Site visits Stakeholder meeting

Findings and Themes

State Motivation

States reactive rather than proactive Long-term care workforce crisis Awareness and knowledge of culture

change models Reaction to negative press

Types of Magnitude of State Investments

CMP dollars Legislative funding Medicaid Discretionary grants In-kind time

Approaches to Culture Change and Initiatives

Workforce improvement Person-centered care Continuous quality improvement

Themes

Degree of coordination/integration across initiatives

Regulatory barriers Importance of relationship building across

stakeholders Uncertainty about funding Relative lack of legislative champions

Summary and Significance

Summary

State can have a major role in influence to adopt and expand culture change in nursing homes

Three strategic objectives of culture change: Person-centered care Workforce improvement Continuous quality improvement

Significance

Enhance awareness of state policy and program staff

Guidance Providers, consumers and workers

better understand initiatives that have been successful and how they can advocate