One of the most pleasant parts of may daily routine is opening my email inbox and delighting in the profound insights that my correspondents offer on a regular basis. I hear from a wide range of people with widely disparate points of view.
Today I found this note from a very well known leader in the field who wishes (you’ll soon know why) to remain anonymous. I was stunned by the depth and subtlety of the insights offered here.
Read it, then offer your thoughts below…
During the last six months, I have been trying to determine why my state’s nursing homes have not been investing in the management and culture changes that The Eden Alternative (and others) has been presenting to them over the last number of years. There is overwhelming evidence that such changes positively influence the lives of both nursing home employees and residents. Why has such change not taken place?
I have talked with many administrators from both the private and non-profit sectors and have studied their organizational philosophies and structures. I have taken a close look at their current financial situations and have listened carefully to what they have said and not said. The conclusion that I have drawn is that the current approaches will not, by themselves, bring about significant culture changes in the operation of nursing homes in my state.
The for-profit chains see Medicaid nursing home beds as loss leaders. Although they use their volume to spread the costs, their profit centers are their “specialty services”, Medicare and off-site operations. Upper management is primarily focused on these areas. They have a fundamental disagreement with the culture change philosophy and a distrust of “the new way of doing things.” The for-profits have the financial resources to make the necessary changes but they currently have no interest in doing so.
In the non-profit sector there is an opening for cultural changes but they have little financial resources to take the necessary risks and no skilled people who know how to do it nor are there any concrete examples of how it can be done. Non-profit boards are typically reluctant to engage in anything out of the ordinary due to lack of understanding and financial limitations. Although the nursing home administrators might be interested in making certain changes, they are usually afraid to push the envelope. They have not seen how it can be done successfully in my state.
I believe that a solution exists which includes both continuing what Eden has been doing but augmenting this by establishing one or more nursing home pilot projects in my state. These pilot projects would incorporate the Eden principles and culture changes throughout their operations. These facilities would give existing non-profit nursing homes and their boards operating examples of what can be done and give them a tangible path that they can follow. Seeing the positive dynamics of a fully functional “new culture” facility in their own back yard will create a movement and desire for them to transform themselves.
With respect to the for-profit chains, these pilot projects and the movement of the non-profits will put pressure on them. This will increase especially when the State and federal regulators start enforcing the intent as well as the letter of the law for the regulators will now have something to hold as a standard. Somewhere out there is a tipping point, a point where it the for-profits realize it is no longer beneficial to continue in their old ways. Change will then take place on a significant scale.
Note from Dr. Thomas: The question here is: “Should Eden and Green House become more active and aggressive and place a new emphasis on showing providers what change looks and feels like?”