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Nursing Home Culture

Traditional Nursing Home Culture

  • Institution-centered
  • Hospital/industrial model of care
  • Facility leadership/staff have control
  • Residents perceived as sick/unable to care for themselves
  • Organized for the efficient operation of the facility
  • Overall design/operating procedures similar to those in hospitals
  • Basic premise (Bill Thomas) – Disease, Disability and Decline
  • Quality measured by the lack of “bad” outcomes
  • Convinced that we are powerless to alter the quality of life

Transformed Nursing Home Culture

“The new culture brings into focus the uniqueness of each person, respectful of what they have accomplished and compassionate to what they have endured. It reinstates the emotions as the well-spring of human life, and enjoys the fact that we are embodied beings. It emphasizes the fact that our existence is essentially social.”

– Tom Kitwood, Dementia Reconsidered

Centers for Medicare & Medicaid Services/Nursing Home Compare

The primary purpose of the Nursing Home Compare tool on the CMS web site is to provide detailed information about the past performance (based on annual inspection surveys) of every Medicare and Medicaid certified nursing home in the country.

A Tale of Two Nursing Homes



  • Staff provided standardized treatments based upon medical diagnosis 
  • Schedules/routines are designed by the institution 
  • Work is task oriented, staff rotate assignments 
  • Decisions-making is centralized 
  • Facility belongs to the staff 
  • Structured activities 
  • Isolation & loneliness common
  • Staff enter into caregiving relationships based upon residents’ individualized care needs and personal desires 
  • Schedules/routines are flexible to match residents’ needs and wishes 
  • Work is relationship-centered, staff have consistent assignments 
  • Decisions are made by the residents and those closest to them 
  • Facility has become the residents home Spontaneous activities 
  • Residents & staff share feeling of community/belonging