Project Background and Objectives: VA Community Living Centers (CLCs, formerly VA nursing home care units) serve significant numbers of veterans and require substantial expenditures. To improve the quality of life for CLC residents, culture change was initiated in 2005, aimed at making CLCs more resident-centered and homelike. A systematic evaluation could gauge progress of this effort, identify facilitators and barriers to transformation, and explore the impacts of culture change on residents and staff. This pilot project is a step toward development of an evaluation of CLC culture change.
The aims are (1) to access existing databases and to assess the quality and utility of their data for an evaluation of CLC culture change, and (2) to identify measurement gaps in undertaking such an evaluation and to explore measures and procedures to address these gaps. Project Methods: Several existing databases could provide measures of key concepts in an evaluation of CLC culture change. These include the All Employee Survey (AES; organizational functioning and climate); the Phibbs Long-Term Care Staffing database, developed for another funded research project (staffing levels; attributes of staff, residents, programs); the Minimum Data Set (MDS; aggregate resident characteristics and outcomes); and the Artifacts of Culture Change survey (ACC; adoption of resident-centered care). The utility of these databases will rest on their coverage of key issues and their capacity to detect true differences among CLCs and in a given CLC over time. We will undertake analyses to address these issues. For example, where possible, we will analyze interrater agreement (e.g., AES responses for staff with different levels of training or the ACC completed by independent raters), the scale structure (e.g., How are AES scales related and can some scales be combined without loss of information?), and agreement of data from different sources (e.g., staff characteristics of AES respondents vs. staff characteristics as compiled in the Phibbs Long-Term Care Staffing database). We will determine whether the units of analysis in other databases can be aligned with the CLC units used for the ACC survey and for other databases that might provide outcome measures, such as the MDS, and how the time frames in different databases can be aligned. We will integrate data derived from different databases and assess evidence for scale validity in terms of the relations among related measures of facility and unit characteristics. Based on these analyses and systematic review of the literature, we will identify measurement gaps in planning an evaluation of culture change. We will explore measures and methods that could be used to fill these gaps by working directly with leaders of the culture change effort and by engaging in informal discussions with staff in local CLCs concerning their experience with the transformation process. Significance: Systematic evaluation of the culture change occurring in VA CLCs could enhance efforts to improve veterans' care and quality of life and could provide guidance on effective models of long-term care for the wider community. This pilot project will prepare the way for development of a full proposal to conduct such a systematic evaluation.
To improve the quality of life for residents of VA Community Living Centers (CLCs), culture change was initiated in 2005, aimed at making CLCs more resident-centered and homelike. This pilot project is designed to lay the groundwork for a systematic evaluation of the CLC culture change effort. The aims are (1) to access existing databases and to assess the quality and utility of their data for an evaluation of CLC culture change, and (2) to identify measurement gaps in undertaking such an evaluation and to explore measures and procedures to address these gaps. Systematic evaluation of the culture change occurring in VA CLCs could enhance efforts to improve veterans'care and quality of life and could provide guidance on effective models of long-term care for the wider community.