NF Culture Change

What is Culture Change?

Changing the culture of nursing homes begins with viewing the facility as a place where people live — not just places where people go to work.

Culture change is an evolving process whereby a nursing home moves from being an institution driven by tasks and schedules to a place that reflects the residents wishes and their needs. With culture change comes a new way of thinking: focusing on residents' abilities, preferences and routines to provide care that meets their needs.

Facilities undergoing culture change build their care practices around residents' preferences. Daily routines are person-directed and resident-centered and all levels of staff are involved. Implementing consistent assignments helps develop strong relationships between the residents and the staff. In addition, developing relationships between residents, families and caregivers is also important.

At its core, culture change reflects certain values that are important when providing resident-centered and resident-directed care:

  • Choice
  • Dignity
  • Respect
  • Self-determination
  • Purposeful living

When you visit a nursing home that has undergone culture change, you will see:

  • An environment that reflects home and community.
  • Leaders who are committed to cultivating living environments that nurture, inspire and create a home-like setting and ambiance.
  • Direct care workers who are empowered to make decisions and are supported by managers.

When a person-centered and person-directed culture is in place, the voices of residents and caregivers are respected and considered. These facilities have core values that include choice, dignity, respect, self-determination and purposeful living. (Reference: Pioneer Network 2016)

The HHS Culture Change Initiatives promote and support nursing home providers as they transform from a traditional system-directed culture to one that is person-centered and person-directed.

Studies have shown that nursing homes that make these changes have higher occupancy rates, higher revenue, and lower staff absenteeism and turnover. Case studies have indicated higher levels of resident satisfaction when nursing homes have implemented culture change.


HHS Resources

Resources from Other Organizations

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For Culture Change story submission or general questions about culture change, please email

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