Culture Change and Quality of Care Among High Medicaid Nursing Homes: Does Earlier Adoption Matter?

Abstract

High Medicaid nursing homes are associated with lower resident quality of care due to fewer nurses, lower occupancy rates, and lower proportion of Medicare and private pay residents. Culture change is a movement to transition nursing homes to more home-like environments to improve quality of life and care of residents. The literature on culture change initiatives indicates a positive relationship on outcomes, however little to no literature on the use of culture change initiatives in high Medicaid nursing homes and quality. The purpose of this study was to examine how the involvement of culture change initiatives among high Medicaid facilities was associated with nursing home quality. The study relied on both survey and secondary nursing home data for the years 2017-2018. The sample included high Medicaid (85% or higher) nursing homes. The outcome of interest was the overall nursing home star rating obtained from the Nursing Home Compare Five-Star Quality Rating System. The primary independent variable of interest was the years of involvement in culture change initiatives among nursing homes, which was obtained from the nursing home administrator survey. The final model consisted of an ordinal logistic regression with state-level fixed effects. High-Medicaid nursing homes with six or more years in culture change initiatives had an increased log-odds of having a higher star rating, while facilities with one year or less had significantly lower log-odds of having a higher star rating. Culture change initiatives may require some time to effectively implement, but these initiatives are potential mechanisms to improve quality in high Medicaid nursing homes.