U.S. nursing home culture change: Then and now
We examined culture change practices within the same U.S. nursing homes (NHs) in 2009/10 and 2016. The proportion of NHs engaged in at least some culture change practices remained steady (87.2% vs. 87.7%). We calculated changes in scores across three domains using items measured at both time points (homelike physical environment, staff empowerment, and resident-centered/directed care). Cronbach alphas ranged from 0.40 to 0.65. For NHs with domain scores at both time points, more than half scored as high or higher at Time 2 on staff empowerment and resident care (58% and 70%, respectively) while only 37% scored as high or higher on physical environment (p values <.01). We recalculated domain scores at Time 2 using the expanded set of survey items. Scores correlated well with the original versions and Cronbach alphas improved (range 0.63 to 0.78). Compared to T1 measures, on average NHs improved across all three domains.