AGING AND DISABILITY SERVICES ADMINISTRATION

2005 NH "Dear Administrator" Letters

October 31, 2005

ADSA: NH #2005-033
CULTURE CHANGE

Dear Nursing Facility/Home Administrator:

For a number of years there have been several movements designed to move the “culture” of nursing homes from an institutional model to a more home-like model.
Some examples are the “Eden Alternative” and the work of the “Pioneer Network”.

The Centers for Medicare and Medicaid Services (CMS) has been working with Quality Improvement Organization (QIO) on the issue of culture change in nursing homes.  CMS recently provided guidance on how the federal regulations fit in with culture change efforts occurring in nursing homes. 

There are innovative ways to provide care and services to nursing home residents and to implement culture change while still complying with the regulations.  According to CMS, the federal regulations are not barriers to culture change.  There is no federal or state law that prohibits culture change efforts in nursing homes. 

There are federal regulations that may support culture change efforts.  Nursing homes are mandated by F- tag 250 to provide medically-related social services to attain or maintain the highest practicable physical, mental and psycho-social well being of each resident.  F-tag 240 also requires a facility to care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident’s quality of life.  Similarly, the regulations direct nursing homes to help residents reach his or her highest level of functioning.

We look forward to working with any nursing home wishing to participate in culture change.  If you have any questions, please feel free to contact your RCS Field Manager. 

Sincerely,

Joyce Pashley Stockwell, Director
Residential Care Services