QIOs Hope to Institute Culture Change in LTCFs

AMDA will be meeting with CMS staff this month to discuss the 8th Scope of Work, which includes plans to promote organizational culture change in long term care facilities (LTCFs) and introduce four new performance measures. AMDA will encourage CMS to introduce the concept of culture change on a small scale or pilot level, allowing time for the development of valid, reliable, tested measures of resident and staff satisfaction until there is recognized scientific evidence to support such measures, AMDA believes that QIOs and nursing homes should not be mandated to institute culture change. AMDA also will explain that "culture change" appears to be used by many as a broad generalization to encompass such issues as following basic management principles and practices, holding staff and practitioners accountable, following a proper care process, giving employees adequate support, and so on. It would be beneficial for CMS to identify just what "culture change" means and how specific elements of management and practice will be identified and measured.

AMDA also will address concerns with the introduction of four new performance measures on pressure ulcers, physical restraints, chronic and post-acute pain, and depression. AMDA is concerned that nursing homes will be asked to improve on these four measures in addition to instituting culture change. AMDA will strongly suggest that CMS allow stakeholders to select two or three of the measures on which to focus its efforts over the next three years.

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