We used data from 834 U.S. nursing homes (NH) to understand culture change practice for the two domains added to our 2016 survey: family and community, and leadership. Domain scores reflect the average performance on nine and ten questions respectively, scored from 0 (rare) to 3 (almost always). Mean domain scores were 1.6 (sd = 0.46) for family and community and 1.40 (sd=0.32) for leadership. No differences in performance were observed by nursing home characteristics for either domain. Performance on both domains was correlated (p<0.05) with all other survey domains. We also assessed the relationship between leadership practices (by score quartiles) and the outcome of nursing assistant retention above 50% (at 12 months), using multivariate logistic regression. After adjusting for NH characteristics, compared to NHs in the lowest quartile of leadership domain performance, NHs in the highest quartile had 2.04 (95% CI: 1.18–3.53) greater odds of experiencing retention above 50%.
