1. State Investment in Culture Change in Long Term Care Natasha Bryant, MA Academy Health Annual Research Meeting June 8, 2008

2. Overview  Introduction  Methodology  Findings and Themes  Summary and Significance

3. Introduction

4. Project Purpose and Importance  Grant: Commonwealth Fund  Purpose – State role in promotion of culture change  State can be a major player and catalyst of change

5. Three Inter-Related Areas of Activity Workforce Improvement Continuous Quality Improvement Person- Centered Care

6. Research Questions  What motivated each state to invest in culture change?  Who were the major drivers?  What were the financial and non- financial investments?  What were the specific activities supported by the state?  What were some of the major crosscutting themes?

7. Methodology

8. Selection of Case Study States  Sample: selection of states  Case study states  Georgia  Kansas  Massachusetts  Michigan  North Carolina  Oregon  Vermont

9. Data Collection Activities  Telephone interviews  Review of secondary documents  Site visits  Stakeholder meeting

10. Findings and Themes

11. State Motivation  States reactive rather than proactive  Long-term care workforce crisis  Awareness and knowledge of culture change models  Reaction to negative press

12. Types of Magnitude of State Investments  CMP dollars  Legislative funding  Medicaid  Discretionary grants  In-kind time

13. Approaches to Culture Change and Initiatives  Workforce improvement  Person-centered care  Continuous quality improvement

14. Themes  Degree of coordination/integration across initiatives  Regulatory barriers  Importance of relationship building across stakeholders  Uncertainty about funding  Relative lack of legislative champions

15. Summary and Significance

16. Summary  State can have a major role in influence to adopt and expand culture change in nursing homes  Three strategic objectives of culture change:  Person-centered care  Workforce improvement  Continuous quality improvement

17. Significance  Enhance awareness of state policy and program staff  Guidance  Providers, consumers and workers better understand initiatives that have been successful and how they can advocate