for Change Artifacts of Culture Change Benchmark Reports 04/01/2010-3/31/2011

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1 TOOLS for Change VOL. 1 NO. 1 APRIL 211 Artifacts of Culture Change Benchmark Reports 4/1/21-3/31/211 ( EXECUTIVE SUMMARY SURVEY DETAILS Number of Surveys 319 Geographic Range Chain Affiliation 47 States and Canada 67% of Respondents Respondent Org Type For-Profit: 32%; Non-Profit: 23%; Government: 45% Average Size Average Number of Employees Beds *Only organizations with confirmed provider numbers are included in benchmark reports. For homes that completed multiple surveys, the most recent survey scores were utilized in compiling statistics TOTALS Homes completing the Artifacts of Culture Change average 241 total points (42% implementation rate) - TABLE A. Care Practice and Family & Community measures represent the highest implementation rate at 5% - TABLE A. Note: Outcome measures are not included in implementation and discussed below. The Environment section averages the lowest implementation rate (32%) due in large part to low completion rates of measures worth more points in this section including Measure #15 (Households), with an average score of 7 out of 1 points. This is further illustrated by the left hand distribution of scores in GRAPH C. OUTCOMES Homes completing the Artifacts of Culture Change report relatively stable outcome measures (74% in TABLE A). This is further illustrated by the right hand distribution of scores in GRAPH G. It is unclear whether stability is a predecessor to change or as a result of change. Scoring seems to indicate that homes completing the Artifacts have high scores prior to transformations. 83% of homes report no (zero) use of agency staff for Nurses or CNA positions 8% have had only 1 Administrator (zero turnover) in the past 12 months and 4% report that the Administrator has been with the home for 5+ years. 75% have had only 1 DON (zero turnover) in the past 12 months and 35% report that the DON has been with the home for 5+ years.

2 MEASURES What measures are homes FULLY implementing? Homes report 1% implementation of more minor environmental transformations such as an extra lighting source, policy supports (residents can decorate their own rooms), and some process changes such as activities led by other departments. - TABLE B What measures are homes PARTIALLY implementing? Core culture change elements included in The Centers for Medicare & Medicaid Services Interpretive Guidelines such as choice of waking time, and choice of bath/shower times are reported as occurring for SOME as opposed to all residents by the many homes. - TABLE C Visit to read more about Interpretive Guidelines. What measures are homes NOT implementing? Most homes completing the Artifacts do not have Households and still utilize traditional nurses stations. Residents are not able to bring pets into the homes. Staff still wear uniforms and do not have career ladder opportunities. - TABLE D TABLE A Artifacts Average Totals by Section SECTION AVERAGE SCORE MAXIMUM SCORE PERCENT COMPLETE Care Practice Artifacts % Environment Artifacts % Family & Community Artifacts % Leadership Artifacts % Workplace Practice Artifacts % Staffing Outcomes & Occupancy % Total Scores % TABLE B Top 15 Measures by Number of Surveys Reporting 1% Implementation (Maximum Points Awarded) MEASURE NUMBER (DESCRIPTION) SECTION TOTAL SURVEYS 21 - Accessible Bathroom Sinks Environment Decorate Rooms Environment Snacks Care Practice Outside Conferences Workplace Walking/Wheeling Path Environment Extra Lighting Source Environment Special Dining Room Family & Community Job Development Workplace Community Groups Meet in Home Family & Community Sinks Paddle Handles Environment Activities led by other departments Workplace Temp Controls in Room Environment Birthdays Care Practice Room Refrigerators Environment Accessible Bathroom Mirrors Environment 187 TOOLS for Change 2

3 TABLE C Top 15 Measures by Number of Survey Reporting Partial Implementation (Partial Points Awarded) MEASURE NUMBER (DESCRIPTION) SECTION TOTAL SURVEYS 16 - Private Rooms (Possible 5) Environment Dogs and Cats Care Practice Intergenerational Program Family & Community Direct Window View Environment Waking Time Choice Care Practice Consistent Assignment CNAs Workplace % Cross-Trained Workplace Consistent Assignment LPNs Workplace Consistent Assignment RNs Workplace CNAs Care Conferences Leadership Computer/Internet Adaptations Environment Seat Heights in Public Rooms Environment Bathing without a Battle Care Practice Bath/Shower Frequency Care Practice Someone with Dying Resident Care Practice 12 TABLE D Top 15 Measures by Number of Surveys Reporting NO Implementation (Zero Points Awarded) MEASURE NUMBER (DESCRIPTION) SECTION TOTAL SURVEYS 64 - Day Care Onsite Workplace Households (Possible 1) Environment Residents/Families on Quality Committees Leadership Call System Environment Resident s Pets Care Practice No uniforms Workplace Gliders Environment Career Ladder Workplace No Traditional Nurses Station (Possible 25) Environment Massage Care Practice Warm Towels for Bathing Environment Aromatherapy Care Practice Baked Goods Care Practice Private Guestroom Family & Community Self-scheduling Workplace 21 TOOLS for Change 3

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5 TABLE E Average Per Question Score MEASURE SECTION AVERAGE SCORE 1 - Expanded Dining Care Practice Snacks Care Practice Baked Goods Care Practice Birthdays Care Practice Aromatherapy Care Practice Massage Care Practice Dogs and Cats Care Practice Resident s Pets Care Practice Waking Time Choice Care Practice Bathing without a Battle Care Practice Bath/Shower Frequency Care Practice Someone with Dying Resident Care Practice Memorial for Individual Resident Care Practice I Care Plans Care Practice Households (Possible 1) Environment Private Rooms (Possible 5) Environment Privacy Enhanced Rooms (Possible 25) Environment No Traditional Nurses Station (Possible 25) Environment Direct Window View Environment Accessible Bathroom Mirrors Environment Accessible Bathroom Sinks Environment Sinks Paddle Handles Environment Adaptive Handles Doors Environment Closets Moveable Rods Environment Decorate Rooms Environment Extra Lighting Source Environment Temp Controls in Room Environment Room Refrigerators Environment Seat Heights in Public Rooms Environment Gliders Environment Store/Gift Shop/Cart Environment Computer/Internet Adaptations (Possible 1) Environment Workout Room Environment Bathing Rooms with Radiant Heat Environment Warm Towels for Bathing Environment Protected Outdoor Garden/patio Environment Raised Gardens Environment Walking/Wheeling Path Environment Call System Environment Overhead Paging Turned Off Environment Laundry by Household/Neighborhood Environment Intergenerational Program Family & Community Community Groups Meet in Home Family & Community Private Guestroom Family & Community Café/Restaurant/Tavern/Canteen Family & Community Special Dining Room Family & Community Family & Community 3.5 TOOLS for Change 5

6 TABLE E (continued) Average Per Question Score MEASURE SECTION AVERAGE SCORE 47 - Common Kitchen Area Family & Community CNAs Care Conferences Leadership Residents/Families on Quality Committees Leadership Staff Guardian Angel for Residents Leadership Learning Circles Leadership Community Meetings Leadership Consistent Assignment RNs Workplace Consistent Assignment LPNs Workplace Consistent Assignment CNAs Workplace Self-scheduling Workplace Outside Conferences Workplace No uniforms Workplace % Cross-Trained Workplace Activities led by other departments Workplace Awards to Staff Workplace Career Ladder Workplace Job Development Workplace Day Care Onsite Workplace Paid Volunteer Coordinator Workplace Employee Evaluations Workplace Longevity CNAs Outcomes Longevity LPNs Outcomes Longevity RNs Outcomes Longevity DON Outcomes Longevity Administrator Outcomes Turnover CNAs Outcomes Turnover LPNs Outcomes Turnover RNs Outcomes Turnover DONs Outcomes Turnover Administrator Outcomes % CNAs Agency Outcomes % Nurse Agency Outcomes Occupancy Rate Outcomes 3.1 Made Possible with Support from The Commonwealth Fund Pioneer Network in Culture Change 23 E. Ohio Street Suite 4 Chicago, IL 6611 Phone: Fax: info@pioneernetwork.net TOOLS for Change 6