Prior to beginning culture change, nursing homes should analyze potential barriers, such as staff turnover, and develop plans to deal with these barriers. Infusion of culture change is dependent on inversion of the organizational structure, placing decision-making in the hands of the older adults. Although data from this study indicated decreased depression in older adults and increased family satisfaction with culture change, there were many confounding variables. Evaluation of culture change can be enhanced by using repeated measures and qualitative techniques.
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