Does Comprehensive Culture Change Adoption via the Household Model Enhance Nursing Home Residents’ Psychosocial Well-being?

BACKGROUND AND OBJECTIVES: Several studies suggest that to substantially improve residents’ psychosocial well-being, traditional-model nursing homes should redesign themselves as small, homelike “households” along with comprehensively adopting other aspects of “culture change,” a set of reforms meant to improve residents’ quality of life. But this evidence mainly comes from qualitative studies. This comparative, observational study tested quantitatively whether residents in a household-model nursing home that had comprehensively adopted culture change reforms displayed greater positive affect, increased cognitive engagement, more extensive social interactions with staff and greater use of the environment than did residents at partial culture-change-adopting facilities with traditional, institutional environments. RESEARCH DESIGN AND METHODS: Household-model residents were matched on clinical and demographic factors with residents at two institutional control facilities that had partially adopted culture change and were observed for 8 hours each. To provide potentially converging evidence, aides and nurses were also observed. Finally, a culture change implementation assessment was conducted. RESULTS: The implementation assessment showed that the household-model home had implemented culture change beyond national norms, whereas the control facilities were U.S.-typical partial adopters. It also revealed that household-model staff cared for residents in a more person-centered manner. Observation analyses revealed that household-model residents spent less time idle and less time stationary at wheelchair hubs. Moreover, although household-model residents did not spend the most time in the dining area overall, they spent the greatest percentage of time there talking with staff, displaying positive affect, and displaying active engagement. Finally, household-model residents and staff spent the most time in task-oriented interactions, including personal care. DISCUSSION AND IMPLICATIONS: These results suggest that the intended psychosocial benefits materialize in household-model facilities, particularly in the dining area and in resident–staff relationships. The findings raise the possibility that facilities may be able to achieve these outcomes without entirely redesigning their environment.