Purpose: The purpose of the study was to empirically test items of a new measure designed to assess person-directed care (PDC) practices in long-term care. Design and Methods: After reviewing the literature, we identified five areas related to PDC: personhood, comfort care, autonomy, knowing the person, and support for relationships. We also identified an additional component of environmental support. We developed items to reflect the constructs, and then a series of lay and professional experts in the field reviewed the items for face validity. We distributed the resulting 64-item PDC and Environmental Support for PDC measure to direct care workers and nursing, administrative, and other staff from a range of long-term settings across Oregon, culminating in a sample size of 430 participants from eight sites. We employed exploratory factor analyses to reveal the underlying structure of the measure. Results: After we dropped 14 items from the measure, it attained good simple structure, revealing five PDC constructs as previously theorized and three Environmental Support constructs: Support for Work With Residents; Person-Directed Environment for Residents, and Management/Structural Support. All constructs were conceptually distinct and internally consistent, and, as expected, all were positively correlated. Implications: The PDC measurement tool developed through the Better Jobs Better Care demonstration program funded by the Atlantic Philanthropies and Robert Wood Johnson Foundation is an important step toward operationalizing the philosophies inherent in the concepts of PDC and is expected to be a useful tool in evaluating successes in meeting PDC goals and in prompting further research regarding PDC and its consequences for resident and client outcomes.

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Development and Initial Testing of a Measure of Person-Directed Care

The nursing home culture change movement aims to improve resident quality of life and quality of care by emphasizing the deinstitutionalization of nursing home culture and focusing on person-centered care. This article briefly reviews the history of culture change, discusses some of the challenges related to culture change in nursing homes, and overviews the conceptualization and select models of culture change. Building from this background, it critiques current understanding, identifies critical research questions, and notes key issues arising during a workshop that addressed existing and emerging evidence in the field. This review and analysis provide a context for how 9 accompanying papers in this supplemental issue of The Gerontologist fill identified evidence gaps and provide evidence for future practice and policies that aim to transform nursing home culture.

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Transforming nursing home culture: evidence for practice and policy.

What Matters Most to Nursing Home Elders: Quality of Life in the Nursing Home

Care homes play a vital role in the provision of support for the frailest members of our society, and given the demographic trends their role will continue for the foreseeable future. However, there remain enduring concerns about the quality of care such homes provide. Training and education for staff are often seen as the key to raising standards and as such are widely promoted. This paper presents a conceptual review and synthesis of the literature on the role of education and training in initiating and supporting change in care homes. A systematic method to the identification of sources was adopted, and a rigorous three-stage approach to analysis applied. The review identifies the barriers and facilitators to change and concludes that education is a necessary but not a sufficient condition for success. Rather it is argued that the role and status of care homes needs to be raised, and that a relationship-centred approach to care adopted, which acknowledges the importance of attending to the need...

The role of education and training in achieving change in care homes: a literature review

Advocates of culture-change management suggest that the right sort of managerial philosophy can transform nursing homes from impersonal institutions into safe, caring communities. However, participant observation carried out at Heartland Community, a nonprofit culture-change nursing home, suggests that culture change founders on the structural problem of inadequate staffing. Resource limitations imposed by Medicaid and Medicare reimbursement rates mean that even nonprofit facilities desiring to maximize staffing cannot afford to hire enough staff to live up to basic care standards. Thus, above-average staffing notwithstanding, Heartland's nursing aides could not complete their work on time without compromising the quality of care by breaking important care rules. Resource limitations also forced management to adopt a series of punitive personnel policies that actively undercut the rhetoric and aims of culture change, turning culture change into a rhetorical device for shifting blame for care problems from...

Culture Change Management in Long-Term Care: A Shop-Floor View:

SUMMARY The Pioneer Network is a national grass roots network of individuals in the field of aging, working for deep systemic change through both evolutionary and revolutionary means, using Pioneer values and principles as the foundations for change. Pioneers are individuals who work in residential long-term care settings and community based settings, in government, research, advocacy and education whose goal is to seed and cultivate a new culture of aging. In-depth change in systems requires transformation of individual and societal attitudes toward aging and elders, transformation of elders' attitudes toward themselves and their aging, changes in the attitudes and behavior of caregivers toward those for whom they care and changes in governmental policy and regulation. Pioneers refer to this work as culture change. While maintaining its work to recreate nursing homes, the Pioneer Network has expanded its vision, mission and focus to encourage and facilitate culture change values, principles and person-ce...

Rose Marie Fagan

Papers

Pioneer Network: Changing the Culture of Aging in America