Family and community and leadership culture change practices in U.S. nursing homes

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%.