Nursing home culture change has been around since the emergence of the Eden Alternative in the early 1990’s, yet few long term care communities use its practices. Culture change practices radically change nursing home operations and organizational structures in ways that flatten the organizational hierarchy and share decision making power with elders and direct care workers. Implementation studies have shown that organizational change is challenging and requires sustained engagement from leadership. The aim of this translational research study was to identify what keeps nursing home leaders from adopting culture change so that barriers could be addressed, resulting in more living communities adopting person-centered culture change practices.The Maryland Culture Change Coalition conducted a culture change training series across the state in the Summer of 2015 aimed at nursing home administrators and assisted living managers. Exit surveys were given to all participants. Ninety eight participants completed the survey. The most common barriers identified were about regulations and their enforcement, and about the effectiveness of culture change practices.Together these indicate ongoing concerns with regulations and the application thereof. If administrators are not convinced that culture change practices improve outcomes for older adults then they are less likely to consider making changes that they perceive as threatening to the health of the organization. This suggests a need for more outcomes research, clearer policies, and education for administrators and surveyors.
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