The Atlantic: Nursing Homes Still Operated Like Asylums, But They’re Changing

American nursing homes have been, and for the most part still are, very institutional settings that can even be compared to asylums, according to The Atlantic, but the tides are turning as a culture shift toward person-centered care begins to sweep through the industry.

More than half of the nation’s nursing homes are committed to a culture change, according to nursing home trade groups the American Health Care Association (AHCA) and The Alliance for Quality Nursing Home Care, where nursing home residents’ values and wishes are “seriously considered and honored,” rather than having daily operations running in a uniform, regimented manner. 

Most agree that implementing culture change could have a powerfully positive impact on improving the quality of residents’ lives, but there are some barriers that exist in the form of incompatibility with current regulations and even liability on behalf of nursing homes.


The nursing home industry is the second-most regulated sector in the U.S., topped only by the nuclear power industry. That means there are a lot of rules governing how nursing homes are run, and that can get in the way of person-centered care. For example, beds can only be located in certain spaces in units, making it difficult for residents to rearrange their furniture to suit their personal tastes, says The Atlantic.

There are also regulatory prohibitions on open kitchens, meaning residents aren’t able to just go fix a snack whenever they want to. “If we are serious about making nursing homes more comfortable and homelike, a review of existing regulations and amendment or removal of those regulations that impede culture change must be put into place,” say the article.  

Sometimes, though, the biggest barrier to culture change in nursing homes is not the actual wording of the regulations but rather the often inconsistent, incoherent, and uninformed way that the regulations are interpreted and enforced by government employees who regularly survey facilities and cite them for perceived noncompliance. The new QIS process may help. But it will in no way diminish the imperative for intensive, ongoing education of government surveyors to inculcate them with the principles and goals of culture change and a commitment to performing their quality oversight function in a less punitive and more collaborative mode. Pilot efforts in this regard established by the Rhode Island health department’s nursing home survey agency may serve as a useful model for other states.


Finally, we must address the legitimate anxieties of nursing home owners, governing boards, and hands-on personnel about potential lawsuits if a more homelike environment results in residents’ suffering injuries as a consequence of their own choices. Courts and personal injury attorneys need to be educated so that they will embrace nursing home practices that embodying the new standard of care to which providers should be held legally accountable. Compliance with culture change-driven standards of care should be recognized as a defense to claims of negligence. The best way to ensure this would be legislation codifying the legal weight given to these standards.

Ultimately, the institutional settings of the past are no longer acceptable, and if the industry is serious about improving the lives of its residents, there’s going to need to be a change not just in culture, but also in regulations to accommodate “necessary innovation.” 

Read the full article here

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Written by Alyssa Gerace